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ONCOLOGY Vol 10 No 9

Responding to the need for more efficacious and less toxic treatments for chronic myelogenous leukemia (CML), researchers at the University of Pennsylvania are exploring a novel form of gene therapy. By interfering with the transmission of a crucial message, they hope to prevent malignant cell growth without affecting normal hematopoietic cells.

This text, originally published as Dameshek and Gunz's textbook Leukemia (1958), is now edited by an international team consisting of Dr. Henderson, Dr. Lister, and Dr. Greaves. This continues to be an outstanding text in its field, covering virtually all aspects of the acute and chronic leukemias.

Both physicians and public health specialists can learn valuable lessons about communicating cancer risks from the experiences of those engaged in environmental risk communications, said Frank Baker, phd, a senior official of the American Cancer Society (ACS).

Gemcitabine (Gemzar), recently approved by the FDA as a treatment IND for patients with advanced or metastatic pancreatic cancer, has shown promise in the treatment of non-small-cell lung cancer (NSCLC), both as a single agent and in combination with other chemotherapy drugs, Alan Sandler, md, reported at a symposium held at the Chemotherapy Foundation meeting last year.

Following unmodified allogeneic bone marrow transplantation (BMT), up to 60% of patients with chronic myelogenous leukemia (CML) will relapse. The management of relapsed CML has proven especially difficult, because cytotoxic drugs and interferon-alfa (Intron A, Roferon-A) seldom cure the disease, and a second bone marrow transplant is associated with high mortality.

A month of postoperative radiotherapy preceded by radiosensitizing boluses of fluorouracil (5-FU) slashed the recurrence rate and markedly improved survival in patients with Dukes B and C rectal cancer in a study from the Norwegian Adjuvant Rectal Cancer Project Group, presented at the European Cancer Conference (ECCO-8).

Thomas Jefferson University in Philadelphia has received a patent for a molecular-based blood test that provides a novel approach to diagnosing prostate cancer. Jefferson has given exclusive licensing rights to the test to UroCor, Inc., for the United States and Canada, and to the Italian-based biotechnology firm Raggio-Italgene, for Europe and Japan.

Drs. Ilson and Kelsen present an excellent review of the current investigations and treatment recommendations for patients with esophageal cancer. In a comprehensive and concise fashion, they detail controversies in surgical and nonsurgical management, neoadjuvant therapies, and regimens for treating metastatic disease. Their review provides an opportunity to further highlight several research questions.

The paper by Drs. Moul and Heidenreich provides a very nice review of prognostic factors for metastasis in patients with clinical stage I nonseminoma. Risk-adapted management--ie, the management of patients at low risk for metastasis by surveillance and patients at high risk for metastasis by retroperitoneal lymph node dissection (RPLND)--is very reasonable, and we are now at a point where a paradigm can be developed to accurately classify clinical stage I patients as either low or high risk and manage them accordingly.

The treatment of advanced prostate cancer continues to be an enigma. Every few years, it seems, a new variation in treatment is espoused and offered to the public. To date, two trends seem to have emerged: For men under 70 years of age, there seems to be a consensus that definitive treatment should be pursued for low-grade, low-stage, localized tumors. Prostatectomy or radiation therapy may cure or at least increase survival; for men over age 70, less vigorous treatment is often the preferred choice [1,2]. Nevertheless, outside of these two points of agreement, many other controversial questions remain and will persist for some time.

Over the last 10 years, we have learned more about not only the natural history of untreated locally advanced prostate cancer but also the ways in which we can effectively modify radiation therapy to treat this disease. There are now sufficient data to suggest that patients with prostate cancer that is considered locally advanced (stages T2b to T4) have a propensity for the development of lymph node metastasis and occult distant spread. In these patients, there also is a recognized difficulty in controlling the disease locally with radiation, due to the bulk of tumor present and the surrounding dose-limiting, late-reacting normal tissues.

Although therapy for esophageal cancer has generated a profusion of research programs and clinical trials, difficult issues and important questions remain to be addressed and answered. The scholarly, balanced review of esophageal cancer by Drs. Ilson and Kelsen explores these issues and questions in a state-of-the art summary of treatments for this disease. The authors hold impressive credentials in this field: almost all clinical research in esophageal cancer for the past two decades owes some debt to Dr. Kelsen and his colleagues at Memorial Sloan-Kettering Cancer Center. In this commentary, we will utilize a few of the key points raised by the authors to suggest a slightly different perspective on approaches to esophageal cancer treatment and directions for future research endeavors.

A diagnosis of cancer evokes a patient's ultimate existential and spiritual concerns. These concerns can be quite pronounced in the patient with pancreatic cancer due to the generally advanced stage of the disease at diagnosis