ONCOLOGY Vol 11 No 10 | Oncology

The Economics of Prostate Cancer Screening

October 01, 1997

As health-care costs escalate, health-care planners must determine how the allocation of health-care dollars should be prioritized. One approach is to assess the cost of achieving a quality-adjusted year of life and then allocating the dollars in descending order, from least to most expensive, until all available money has been expended. Of course, calculating the cost per life-year is the real challenge because it is usually determined from mathematical decision models, which include many assumptions that may be subject to criticism.

Vinorelbine in Non-Small-Cell Lung Cancer

October 02, 1997

During the past 5 years, real strides have been made in the management of advanced non-small-cell lung cancer (NSCLC). The introduction of newer chemotherapeutic agents and novel treatment regimens is paving the way for marked improvements in both clinical outcomes and quality of life.

Management of Progressive Metastatic Prostate Cancer

October 01, 1997

Waselenko and Dawson provide a summary of the extensive experience in the management of metastatic prostate cancer. Their article follows a traditional descriptive format and is quite informative. The part that is missing is a general discussion of the various biological aspects involved in the complex process of prostate cancer progression, which has been the focus of major research over the past few years.[1] Undoubtedly, this emerging body of knowledge will provide the background for the design and development of new treatments. There are a few issues, however, that deserve more emphasis.

Is Axillary Dissection Always Indicated in Invasive Breast Cancer?

October 01, 1997

It is not often that a reviewer agrees entirely with material presented in an article. I find myself in the happy situation of largely agreeing with the basic thrust of this interesting report by Chadha and Axelrod. They begin by describing the increased incidence of breast cancer over the recent decade, but do not mention that since 1990 there has actually been a decreased incidence of breast cancer.[1] In retrospect, it has become clear that the statistical increase in breast cancer during the 1980s was an artifact of extensive mammographic screening, which caught the initial appearance of disease earlier and artificially created a temporary surge of cases that has since abated.[2]

The Timing of Breast Cancer Surgery During the Menstrual Cycle

October 01, 1997

Although the article by Senie and Tenser reviewing some of the data relevant to whether operative timing within the menstrual cycle affects breast cancer outcome is reminiscent of a recent paper that appeared in the December 1996 issue of the Journal of Women’s Health,[1] the question it considers is potentially important enough that this issue should also be raised in Oncology. The article points out the experimental basis for believing that an important interaction may occur between the host-cancer-surgery and the mammalian reproductive cycle.[2,3] This is an important supposition because clinicians have routinely assumed that no experimental foundation underlaid the first and 31 subsequent analyses of relevant clinical data[4,5]-an assumption that is false.

Is Axillary Dissection Always Indicated in Invasive Breast Cancer?

October 01, 1997

The authors provide a comprehensive overview of the role of axillary lymphadenectomy in the treatment of early-stage breast cancer. They do not argue against lymphadenectomy for patients with clinical T2 and 3 tumors and clinical N1 and 2 nodes. However, for clinical N0 cancers and for postmenopausal patients with hormone-receptor-positive tumors, the authors propose radiotherapy to the axilla as a modality less expensive than surgery and with fewer complications. They suggest observation only for lesions associated with a less than 10% to 15% chance of axillary metastasis (T1a cancers, tubular carcinomas, ductal carcinoma in situ [DCIS] with microinvasion). However, for patients with lesionsless than 1 cm with “high-risk features (presence of tumor emboli in vessels, poor nuclear grade, etc),” axillary lymphadenectomy “should continue to serve as a refined prognostic indicator for selection of patients for adjuvant therapy.”

Estrogen Replacement Therapy for Breast Cancer Patients

October 01, 1997

The discussions and debates about the use of estrogen replacement therapy (ERT) in women with breast cancer often seem to ignore or at least leave unnoted the extensive data supporting the general premise that increased, but physiologic levels of estrogens are associated with poorer survival in postmenopausal women with breast cancer. Dr. Colditz summarizes various lines of evidence bolstering this general premise, providing us with some needed lessons about the complexities of interpreting epidemiologic studies and about human cancer biology. Particularly illuminating are his discussion of the biases in ERT-breast cancer causation studies and his exploration of the reasons for the apparently better survival in ERT users who develop breast cancer.

The Economics of Prostate Cancer Screening

October 01, 1997

Drs. Benoit and Naslund venture into the complex arena of medical economics and cost-effectiveness analysis of prostate cancer screening-a task that is made all the more difficult because of the dual paucity of data on costs and effectiveness. Their underlying premises are that cost control is a dominant concern in the prostate cancer screening debate and that cost-effectiveness analyses have been used to “justify denial of prostate cancer screening.” Both of these assumptions bear scrutiny.

The Timing of Breast Cancer Surgery During the Menstrual Cycle

October 01, 1997

A number of recent studies have suggested that survival among premenopausal women after primary treatment of breast cancer may be affected by the estimated hormonal milieu at the time of surgery, especially in those with

Estrogen Replacement Therapy for Breast Cancer Patients

October 01, 1997

Dr. Colditz has reviewed the potential hazards of hormone replacement therapy in breast cancer survivors. Let us presume, for the sake of brevity, that his assumptions are correct. With so many risks, why would a breast cancer survivor consider taking hormone replacement, and why would an oncologist prescribe it?

Paclitaxel and Vinorelbine in Non-Small-Cell Lung Cancer

October 02, 1997

Paclitaxel (Taxol) and vinorelbine (Navelbine) are both microtubule toxins but with opposite mechanisms of action. Paclitaxel promotes the assembly of microtubules, whereas vinorelbine prevents microtuble assembly.

Safety Data From North American Trials of Vinorelbine

October 02, 1997

Data from North American clinical trials have shown that vinorelbine (Navelbine) is well tolerated when used as a single agent for the treatment of non-small-cell lung cancer, advanced breast cancer, or ovarian cancer. Myelosuppression is the primary dose-limiting toxicity.

Cisplatin Alone vs Cisplatin Plus Vinorelbine in Stage IV NSCLC

October 02, 1997

Cisplatin (Platinol) has played a major role in the treatment of non-small-cell lung cancer (NSCLC). As a single agent, cisplatin has produced a response rate of approximately 21% in a large number of trials.

Estrogen Replacement Therapy for Breast Cancer Patients

October 01, 1997

Female reproductive hormones cause breast cancer. Long-term use of postmenopausal hormones increases the risk of breast cancer. The apparent survival advantage seen in women diagnosed with breast cancer while taking

Management of Progressive Metastatic Prostate Cancer

October 01, 1997

Metastatic prostate cancer is a growing health problem and is the second leading cause of cancer death in men. While the response of patients with metastatic prostate cancer to initial hormonal manipulation is excellent, the

Future Prospects for Stealth Liposomes in Cancer Therapy

October 01, 1997

While doxorubicin (Adriamycin) is among the most active single agents in the treatment of breast cancer and other solid tumors, its concomitant toxicity limits its use. Quality-of-life issues have driven the search for gentler,

A Safety Review of Pegylated Liposomal Doxorubicin in the Treatment of Various Malignancies

October 01, 1997

Many of the more commonly observed adverse effects of standard doxorubicin (Adriamycin) are lessened by pegylated liposomal delivery (Doxil). The slow release of doxorubicin into normal tissue cells via this form of liposomal delivery ameliorates its potential for severe alopecia, nausea and vomiting, cardiotoxicity, and myelosuppressive toxicity. Infusion-related acute reactions are managed by slowing infusion rates and thorough dilution and mixing of the infused drug. Vesicant properties normally seen with doxorubicin are absent. Palmar-plantar erythrodysesthesia can be reduced by decreasing the dose or increasing the dosing interval. Many of these side effects are developing a predictable profile and are manageable. Because of its overall reduced toxicity profile, pegylated liposomal doxorubicin may be well-suited for use in combination chemotherapeutic regimens. [ONCOLOGY 11(Suppl 11):54-62, 1997]

Current Management of Unresectable Non-Small-Cell Lung Cancer

October 02, 1997

The past 5 years have witnessed an evolution in the management of unresectable non-small-cell lung cancer (NSCLC) in the United States. Combined-modality treatment with chemotherapy plus irradiation has become the standard of care for stage III (locally advanced) disease. Most patients with stage IIIB disease and cytology-positive pleural effusion are now considered candidates for chemotherapy, as are those with stage IV disease.

Pegylated Liposomal Doxorubicin: Antitumor Activity in Epithelial Ovarian Cancer or Cancers of Peritoneal Origin

October 01, 1997

After pegylated liposomal doxorubicin (PEG-LD) (Doxil) was shown to be active in ovarian tumors, several trials were developed at the University of Southern California to determine its safety and efficacy in a variety of gynecologic and peritoneal malignancies. Completed phase I and phase II trials have found PEG-LD to be safe and effective in the treatment of platinum- and paclitaxel-refractory epithelial ovarian carcinoma. A new phase II trial is currently underway in similarly refractory patients with ovarian and other related cancers and various degrees of pretreatment. In addition, the efficacy of PEG-LD is being explored in combination with paclitaxel (Taxol), with cisplatin, and with hyperthermia. [ONCOLOGY 11(Suppl 11):38-44, 1997]

Concomitant Cisplatin, Vinorelbine, and Radiation in Advanced Chest Malignancies

October 02, 1997

Newer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.

Is Axillary Dissection Always Indicated in Invasive Breast Cancer?

October 01, 1997

In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as

The Economics of Prostate Cancer Screening

October 01, 1997

The introduction of prostate-specific antigen (PSA) testing for use in the early detection of prostate cancer has led to controversy regarding the appropriateness of prostate cancer screening and any subsequent treatment. Much

Management of Progressive Metastatic Prostate Cancer

October 01, 1997

This review succinctly summarizes a relatively large body of literature surrounding the treatment of advanced, stage D2 (M+) prostate cancer. However, the patient with classic stage D2 prostate cancer, presenting de novo with multiple sites of bony metastasis, pain, and other systemic symptoms, is becoming less common in clinical practice. In 1997, prostate cancer is most commonly diagnosed in a locally advanced form, either clinically or pathologically stage C (T3), and accounts for approximately 60% of all newly diagnosed cases in the United States.[1] The reasons for this “stage migration” undoubtedly lie in the widespread use of prostate-specific antigen (PSA) for the detection of prostate cancer while still organ-confined, and in the use of PSA to monitor patients who have undergone definitive local treatment.

The Timing of Breast Cancer Surgery During the Menstrual Cycle

October 01, 1997

Contemporary breast cancer treatment research has focused on systemic postoperative adjuvant treatment and the elimination of established micrometastases. An alternative approach addresses the potential for seeding at the time of primary surgery. Several retrospective reports have suggested that the hormonal milieu during lumpectomy or mastectomy impacts on the likelihood of tumor cell shedding and implantation at distant sites.

Is Axillary Dissection Always Indicated in Invasive Breast Cancer?

October 01, 1997

The article written by Chadha and Axelrod provides a timely discussion of several critical issues in the current debate over the use of axillary lymph node dissection in early-stage breast cancer. As new information and techniques become available, they and others have reassessed the value of axillary lymph node dissection in four key areas:

Historical Review of Trials With Vinorelbine in Non-Small-Cell Lung Cancer

October 02, 1997

Two large-scale, randomized, phase III trials have offered new information on the response rates, survival benefits, and safety profile of vinorelbine (Navelbine) in non-small-cell lung cancer (NSCLC). In a multicenter, European trial, the response rate was significantly higher with vinorelbine/cisplatin (Platinol) than with vindesine (Eldisine)/cisplatin (P < .02) or vinorelbine alone (P < .001).

Rationale for Trials Studying Pegylated Liposomal Doxorubicin in Metastatic Breast Cancer

October 01, 1997

Breast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a