ONCOLOGY Vol 11 No 11

Results of a phase II trial presented at this year’s meeting of the American Society of Clinical Oncology (ASCO) suggest that

The treatment of childhood cancer is a major success story. Twenty-five years ago, only 10% of children with leukemia

In 1995, tobacco use contributed to the deaths of 6,274 persons in Oregon (1995 population, 3,132,000) as reported by

Provisional surveillance data about acquired immunodeficiency syndrome (AIDS) for the first 6 months of 1996 indicated a

Doxil, a pegylated liposomal formulation of doxorubicin HCl, has been shown to be an effective single agent therapy with a

Professor Michel Bolla of the Department of Radiotherapy, Centre Hospitalier de Grenoble, France, commented on new

Current and former smokers may not be not so different after all. Although the appearance of lung tissue in smokers returns to

With a few clicks of a computer mouse, scientists now can access a free on-line index that will soon show tens of thousands of

Over the past few years, several promising new therapeutic agents have been approved by the FDA for the treatment of

Olive Garden Italian Restaurants recently reached their goal of raising $2 million through its “Pasta for Pennies” program to

Cancer outcome is improving by 1% each year, which adds up to very substantial progress over 5 years, says Professor

Physicians at the University of Chicago Medical Center are looking for patients with either mantle-cell lymphoma or multiple

Presenting the nursing perspective on cancer, Ms. Nora Jodrell, Macmillan Lecturer in Cancer Nursing and President Elect of

Despite the development of chemotherapeutic agents, radiation techniques, and improved surgical procedures, many women with gynecologic malignancies will die from recurrent disease. In this broad review, Gurski and Steller examine potential vaccine strategies to improve disease control. The use of vaccines in both prophylactic and therapeutic settings is discussed, and a general overview of vaccines directed against both viral and nonviral tumor-associated antigens is presented.

Dr. Blum has written a comprehensive summary of the natural history, pathology, prevention, and management of anthracycline-induced cardiotoxicity. His excellent state-of-the-art review updates readers on most of the recent advances in this field.

There are many challenges facing those involved in chemotherapy drug development. In addition to identification of new agents, clinical investigators must address questions regarding the optimal methods of administration of established agents so as to maximize efficacy and minimize toxicity. Treatment toxicity affects not only morbidity and mortality but also issues of dose intensity, quality of life, and health-care costs. Therefore, there is great interest in preventing the side effects associated with chemotherapy.

For decades, pancreatic cancer has been one of the most difficult and frustrating cancers to treat. Despite the promising response rates achieved with a number of chemotherapeutic regimens evaluated in phase II trials in the 1970s and ’80s, no regimen proved superior to single-agent fluorouracil (5-FU) in terms of overall survival. As a result, some oncologists adopted a position of therapeutic nihilism and criticized what appeared to be futile attempts to identify effective therapy for patients with advanced-stage disease. Instead, they argued that clinical research efforts should focus on the development of adjuvant therapy for patients with earlier-stage disease.[1]

The development of topotecan (Hycamtin) and the encouraging preliminary results of its use in clinical trials are comprehensively reviewed by Takimoto and Arbuck. The successful development of topotecan demonstrates that focused research and developmental efforts by the pharmaceutical industry in anticancer therapeutics can actually “pay off.” Approximately 15 years ago, the prototypic topoisomerase I inhibitor camptothecin was “placed back on the shelf” because it induced severe, unpredictable toxicity when administered as a sodium salt (sodium camptothecin). After recognition that camptothecin was active by virtue of a novel mechanism of action (topoisomerase I inhibition), developmental research efforts at SmithKline Beecham led to the synthesis of a myriad of camptothecin analogs, significant structure-function information, and the ultimate selection of topotecan as a lead camptothecin analog for clinical development.[1-3]

Michael and Moore provide an excellent review of the frustrating history of drug development for pancreatic cancer. These frustrations have been accompanied by the knowledge that pancreatic adenocarcinoma has almost always metastasized systemically, most often to the liver, by the time the patient comes to a physician.[1] Thus, local treatment, while important, will ultimately cure only a few patients in the absence of effective concomitant or sequential systemic therapy.

Immune responses are generated in a complex network of cellular and humoral factors. The complexity of this system makes it difficult to generate subsets of cells in vivo that are most effective against cancer cells. The goal of vaccine strategies is to redirect the immune system against cancer cells primarily by generating specific T-cell responses which would be the most effective anti-tumor effector cells.

The article by Drs. Takimoto and Arbuck reviews the chemistry, mechanism of action, pharmacology and clinical trials of topotecan (Hycamtin), one of two topoisomerase I inhibitors approved recently by the FDA. Topotecan was approved for refractory ovarian cancer and irinotecan (Camptosar) for advanced colorectal cancer. These drugs represent a new drug class designed to inhibit topoisomerase I, an enzyme involved in relaxation of torsional strain in supercoiled DNA allowing replication and translation. The authors’ overview is informative and unbiased.

Endocrine therapy has long been a mainstay in the therapy of metastatic breast cancer and in the adjuvant setting. The introduction of anastrozole (Arimidex) to the market in 1996 has provided another option for such treatment. Drs. Goss and Tye provide a thorough review of anastrozole and outline its advantages over other aromatase inhibitors as adjuvant therapy for breast cancer and its potential use in the treatment of early breast cancer. The authors delineate many important issues regarding the use of anastrozole; an understanding of these issues is imperative for the optimal utilization of this therapy. The paper has two shortcomings: (1) It focuses almost solely on aromatase inhibitors, to the neglect of other endocrine therapies. (2) Many references are unconventional and represent data on file with various drug manufacturers, which are not easily accessible to readers.

Topotecan (Hycamtin) is a promising new topoisomerase I-targeting anticancer agent that first entered clinical trials in 1989 under National Cancer Institute sponsorship in collaboration with SmithKline Beecham. In 1996, it

Anthracycline antibiotic use is limited by cardiac toxicity. The risk factors are cumulative dose, radiation to the chest and mediastinum, age, and preexisting myocardial impairment. Dexrazoxane (Zinecard) can prevent

Therapeutic and prophylactic vaccines that harness the potential of the immune system against a number of gynecologic cancers are now being developed. The therapeutic vaccines coerce the cellular components of the

The treatment of advanced pancreatic carcinoma has been viewed with pessimism. Because of the lack of activity of commonly used agents, there is no consensus regarding a standard chemotherapy regimen. Assessment of

Aromatase (estrogen synthetase) is the enzyme complex responsible for the final step in estrogen synthesis-the conversion of androstenedione and testosterone to estrone and estradiol, respectively. Inhibitors of this enzyme