ONCOLOGY Vol 11 No 7

LITTLE ROCK-Deletion of chromosome 13 and hypodiploidy are major independent predictors of poor prognosis in multiple myeloma, according to a study involving close to 1,500 multiple myeloma patients (ASCO abstract 1054). "Chromosomal studies are the most important prognostic factor in the treatment of myeloma," said lead investigator Guido J. Tricot, MD, PhD, head of the Academic Division of Myeloma Transplant, Myeloma Institute for Research and Therapy, at the University of Arkansas for Medical Sciences in Little Rock. "Chromosome 13 deletion and hypodiploidy are associated with poor prognosis, but too many institutes are failing to do these studies which can predict outcome and help customize treatment."

Karen T. Pitman, MD: We will be discussing the case of a 64-year-old woman who was referred to the Department of Otolaryngology, University of Pittsburgh Medical Center, with the chief complaint of a nonhealing ulcer in the oral cavity that

Although it is clear that diet plays a role in the etiology of many cancers, making dietary recommendations to reduce risk is highly complicated, if possible at all, according to an international cancer prevention expert.

Newer radiation treatments--brachytherapy and conformal radiotherapy--were discussed at a symposium at the 1996 meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in Los Angeles.

Infant screening for neuroblastoma, one of the most common forms of solid tumors in young children, fails to detect the most severe form of the disease, according to a group of international researchers led by University of Minnesota faculty. After

An estimated one-third of HIV-positive women who smoke during pregnancy and do not take zidovudine (AZT [Retrovir]) may pass HIV on to their babies.

Albert H. Owens, Jr, MD, President of the National Coalition for Cancer Research (NCCR), urged the National Cancer Policy Board to "focus on the policies and practices affecting cancer research because, without doubt, research is the

A new study strengthens the evidence that ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the risk of breast cancer in some women.

It is unusual to find an entire book dedicated to one therapeutic agent because a balanced, comprehensive analysis generally requires a somewhat broader perspective, particularly if it is targeted not only to the physicians treating a particular disease

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and the role of the surgeon in

Thousands of practice guidelines/practice parameters have been published by various professional organizations. The American Medical Association,[1] American College of Physicians,[2,3] and others[4-6] have written extensively about

In the United States, an estimated 178,000 new cases of lung cancer will occur in 1997, accounting for 13% of cancer diagnoses and 29% of all cancer deaths.[1] The majority of these deaths will be due to metastatic non-small-cell lung cancer. Cisplatin (Platinol), vindesine (Eldisine), vinblastine, ifosfamide (Ifex), and mitomycin (Mutamycin) demonstrate response rates of 15% or higher in previously untreated patients (Table 1)

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative extent of disease evaluation, and role of the surgeon in

The article by Dr. Burt provides an excellent summary of the rationale for using high-dose therapy with autologous or allogeneic bone marrow transplantation (BMT) in patients with severe autoimmune diseases (SADS). The article also describes the approach to BMT adopted by Dr. Burt and colleagues at Northwestern University. Enthusiasm for this form of therapy has been contagious, and numerous US investigators have initiated similar trials, which are outlined in Table 1 of the article.

The article by Meredith and LoBuglio represents a thorough description of the clinical strategies that have been attempted with radioimmunoconjugates. The authors appropriately point to the extraordinary promise of these agents in the treatment of hematologic malignancies. They also acknowledge the disappointments that have been encountered in the systemic therapy of solid tumors, while noting that there may be some reason for optimism regarding locoregional administration of radioimmunoconjugates.

Colorectal carcinoma is a common problem in the United States, and the liver is the most frequent site of metastatic disease. Because there is a good pharmacologic rationale for the use of hepatic intra-arterial (HIA) therapy, and because of the disappointing survival observed with systemic chemotherapy, studies of hepatic arterial infusion have been conducted.

Studies of hematopoietic stem-cell transplantation as a treatment for severe autoimmune diseases (SADS) are currently in progress. Dr. Burt thoroughly reviews the rationale for these studies. It includes: (1) preclinical studies showing that marrow transplantation is an effective therapy in animal models of autoimmune disease; (2) observations of the effect of stem-cell grafts on SADS in patients transplanted for other indications; and (3) improvements in the safety of the transplant procedure.

Most patients with autoimmune diseases are thought to have a a normal life expectancy, and thus are treated conservatively. However, these diseases have a diverse clinical course. A small subset of patients have "severe autoimmune diseases," or SADS, which are rapidly progressive and are associated with early mortality. If patients with SADS can be identified before they develop irreversible organ damage, aggressive intervention would be indicated. Consequently, patients with SADS are now being enrolled in experimental protocols of immune ablation and hematopoietic stem-cell rescue (ie, bone marrow transplantation [BMT]) at several US institutions. For various reasons, including the high cost of BMT, it will probably be years before the benefits, if any, of this procedure are known. [ONCOLOGY 11(7):1001-1017, 1997]

There are few options availablefor the patient with advanced non-small-cell lung cancer in whom first-linechemotherapy has failed. Docetaxel (Taxotere), a semisynthetic taxoid,is one of the few drugs that has been systematically investigated as asecond-line option for patients with advanced non-small-cell lung cancer.

Radioimmunotherapy allows for the delivery of systemically targeted radiation to areas of disease while relatively sparing normal tissues. Despite numerous challenges, considerable progress has been made in the application of radioimmunotherapy to a wide variety of human malignancies. The greatest successes have occurred in the treatment of hematologic malignancies. Radioimmunotherapy, with or without stem-cell transplant support, has produced substantial complete remission rates in chemotherapy-resistant B-cell lymphomas. Nonmyeloablative regimens have shown so much promise that they are now being tested as initial therapy for low-grade B-cell lymphomas. Although solid tumor malignancies have been less responsive to radioimmunotherapy, encouraging results have been obtained with locoregional routes of administration, especially when the tumor burden is small. Greater tumor-to-normal tissue ratios are achievable with regional administration. Even with intraperitoneal and intrathecal administration, bone marrow suppression remains the dose-limiting toxicity. Ongoing research into new targeting molecules, improved chelation chemistry, and novel isotope utilization is likely to extend the applications of this strategy to other tumor types. The potential for radioimmunotherapy will be enhanced if this modality can be optimally adapted for integration with other agents and if the administration method can be tailored to the type and distribution of malignancy. [ONCOLOGY 11(7):979-987, 1997]

Docetaxel (Taxotere) andcarboplatin (Paraplatin) have each demonstrated significant activity in

Four phase II trials have beenconducted to evaluate the efficacy and tolerability of single-agent docetaxel

The use of hepatic intra-arterial (HIA) chemotherapy is based on the pharmacologic principle that the regional administration of certain drugs can lead to higher drug concentrations at the site of a tumor. This has been studied most extensively in patients with liver-only colorectal metastases. Four large randomized studies have failed to demonstrate a survival advantage of regional treatment over systemic chemotherapy, although two meta-analyses confirmed an improvement in response rate and suggest a trend toward improvement in survival. Two randomized studies have shown improved survival in patients treated with HIA chemotherapy, as compared with those given supportive care, and quality of life also appears to be superior in HIA chemotherapy recipients. The treatment employed in all of the randomized studies was hindered by substantial hepatobiliary toxicity and many surgical complications. Improved surgical techniques and newer chemotherapy combinations appear to have improved phase II results with HIA therapy, leading to a randomized trial now being conducted by the Cancer and Leukemia Group B (CALGB). The role of HIA chemotherapy in adjuvant settings and in other diseases has not been as well-studied, and such uses remain appropriate only for very selected patients. Ultimately, the regional advantage gained by the HIA route may prove to be most advantageous for the delivery of newer biologic agents. [ONCOLOGY 11(7):947-957, 1997]

Data from the Radiation Therapy Oncology Groupand Eastern Cooperative Oncology Group indicate that increased survival

Docetaxel (Taxotere) isa semisynthetic taxoid that possesses significant activity as a single

Theoretically, effective regional cancer chemotherapy should afford the opportunity to deliver a significantly higher concentration of a cytotoxic agent than is possible with systemic administration of the same agent. Furthermore, regional chemotherapy should cause its greatest stress on the site of administration, producing a lesser burden of toxicity on the whole body.

Docetaxel (Taxotere) hasdemonstrated significant activity as a single agent in the treatment of