ONCOLOGY Vol 12 No 1 | Oncology

Chemotherapy Plus Tamoxifen May Be Better Than Tamoxifen Alone—NSABP Study

January 01, 1998

Researchers from the National Surgical Adjuvant Breast and Bowel Project (NSABP) announced the results of a large-scale trial designed to determine a more effective treatment for women with breast cancer. Results from this study, published

Self-Reported Use of Mammography Among Women ³ 40 Years Old

January 01, 1998

In 1997, breast cancer will be diagnosed in an estimated 180,200 women, and 43,900 women will die from the disease. Early detection combined with timely and appropriate treatment can alter the progress of and reduce mortality from this

Drug That Increases Platelet Production Wins FDA Approval

January 01, 1998

Genetics Institute, Inc., a subsidiary of American Home Products Corporation, has received FDA approval to market oprelvekin (recombinant interleukin-11 [Neumega]), a platelet growth factor that stimulates the production of blood platelets

Reduced Breast Cancer Risk Among Women With Implants?

January 01, 1998

The widespread impression that breast implants increase the risk of developing breast cancer has little supportive evidence, according to a recent report in the Journal of the National Cancer Institute. Authors Louise A. Brinton and S. Lori Brown

New MoAb Receives FDA Clearance for Non-Hodgkin’s Lymphoma

January 01, 1998

Rituximab (Rituxan) has been cleared for marketing by the FDA. Previously known as the C2B8 antibody, rituximab, is a single-agent monoclonal antibody therapy for relapsed or refractory, low-grade or follicular, CD20-positive, B-cell non-

SGO Clinical Practice Guidelines: Introductory Remarks

January 01, 1998

Cinical practice guidelines for gynecologic oncology were developed under the direction of the Medical Practice and Ethics Committee of the Society of Gynecologic Oncologists (SGO) in concert with national trends in medical care in the United

Cancer Fatigue Awareness Campaign Launched

January 01, 1998

The Oncology Nursing Society (ONS) has begun a public education campaign, entitled “Wake Up to Cancer Fatigue,” which will feature the first Cancer Fatigue Awareness Day on April 2, 1998. The purpose of the campaign is to educate

APC Gene Mutation May Not Lead To Increased Colon Cancer Risk in Ashkenazi Jews

January 01, 1998

A genetic mutation in the adenomatous polyposis (APC) gene found in 7% of Ashkenazi Jewish families in the United States does not necessarily lead to colon cancer, according to a study in the December 15, 1997, issue of Cancer Research.

Simpler, Less Expensive Test for Ulcer Bug

January 01, 1998

Researchers from the University of Wurzburg in Germany have determined that a simple antibody test may be as effective in detecting Helicobacter pylori infection as the more invasive procedures that are currently used. They reported their findings

Integration of New Therapies into the Management of Breast Cancer

January 01, 1998

Speakers at this international workshop, which was held in Lisbon, Portugal, on June 28, 1997, addressed the integration of new treatment strategies, including paclitaxel (Taxol), into the management of women with breast cancer.

Radiosurgery Offers Alternative to Open Surgery for Patients With Brain Tumors

January 01, 1998

There is certainly no good place to get a brain tumor, but one of the worst is in the lower portion of the brain along the base of the skull. Skull-base tumors are often intimately entwined with critical arteries and cranial nerves that emerge from the base of the brain, making surgical removal challenging and risky.

Cocaine Use May Double the Risk of Developing NHL

January 01, 1998

Researchers found that men who use cocaine are twice as likely as abstainers to develop intermediate- or high-grade non-Hodgkin’s lymphoma (NHL). For those who use cocaine more frequently, ie, on at least nine occasions, the risk is more than triple what nonusers face, says Rebecca Nelson, a doctoral student in the preventive medicine department at the University of Southern California (USC) School of Medicine, in an article published recently in the British Journal of Cancer.

New Long-Term Results of Pentostatin Presented

January 01, 1998

Long-term follow-up data on patients treated with pentostatin (Nipent) were presented at the 39th Annual Meeting of the American Society of Hematology in San Diego, California. Pentostatin is currently indicated in the United States for first-line treatment of hairy cell leukemia.

Topotecan May Offer New Treatment Option for Patients With SCLC

January 01, 1998

Topotecan hydrochloride (Hycamtin), as a single agent or in combination with other agents, may offer a new treatment option for people suffering from small-cell lung cancer, according to results from five clinical trials reviewed at the 15th

Bernard Fisher Speaks at Fox Chase Cancer Center

January 01, 1998

In a lecture at Fox Chase Cancer Center, noted breast cancer researcher Bernard Fisher proclaimed his triumph against agencies that had accused him of scientific misconduct in his directorship of the National Surgical Adjuvant Breast and Bowel

New Strategies to Protect Cancer Patients From Serious Treatment-Related Infection

January 01, 1998

Researchers presented new strategies to protect patients from life-threatening infections caused by dose-intensive anticancer therapy at a symposium held in conjunction with the 39th Annual Meeting of the American Society of Hematology (ASH).

Recently Cloned Gene Produces Telomerase Activity in Normal Human Cells

January 01, 1998

Geron Corporation announced in Nature Genetics that it has, for the first time, produced telomerase activity in normal, mortal human cells using the recently cloned gene for the human telomerase catalytic protein.

High Frequency of Ovarian Cancer Markers Found in Ashkenazi Jewish Women

January 01, 1998

The finding of a high frequency of genetic markers for both breast and ovarian cancers among Ashkenazi Jewish women has prompted a call for genetic testing for all breast and ovarian cancer victims in this population, regardless of family history.

Studying Natural Bacterial Resistance May Lead to Better Antibiotics

January 01, 1998

Some bacteria in the environment may already have a natural resistance to certain antibiotics, due only to genetic variation and not to antibiotic exposure. These bacteria could provide a key to the rational design of new antibiotics, say researchers in

Use of Saline-Filled Tissue Expanders to Protect the Small Bowel from Radiation

January 01, 1998

Dr. Hoffman and colleagues have persisted in their efforts to provide a safe, reliable pelvic prosthesis to protect the small bowel during high-dose radiation therapy. I started using this type of plastic device in the early 1980s as part of the management of advanced primary and recurrent rectal cancer.[1,2] Similar to data reported by Drs. Hoffman, Sigurdson, and Eisenberg in this issue, my colleagues and I at the National Cancer Institute also noted a learning curve that accompanied our experience. We reported our experience with two iliac artery fistulas that occurred after extensive radiation therapy, possibly due to the prosthesis.[3] Sepsis within the irradiated field and surrounding the prosthesis led to a prosthesis-related death in one patient. A second patient who had multiple postoperative complications died of a pulmonary embolus.

Rehabilitation for the Head and Neck Cancer Patient

January 01, 1998

Ms. Clarke provides an excellent overview of the rehabilitation process for the head and neck cancer patient. She highlights pretreatment and posttreatment rehabilitation issues and details the nature of each multidisciplinary intervention. I concur with the rehabilitation process that she describes and second the importance of multidisciplinary interventions beginning prior to treatment.

Differentiated Thyroid Carcinoma: Risk Group Assignment and Management Controversies

January 01, 1998

Dr. Hicks and his associates have written an excellent article that summarizes current knowledge about the biologic behavior of differentiated carcinoma of the thyroid gland and explores current controversies related to its management. Their review is reasonably complete, citing most of the important recent references on the subject. Regarding treatment con- troversies, the authors discuss the differing philosophies of various investigators and place into perspective the data supporting these opposing viewpoints.

Rehabilitation for the Head and Neck Cancer Patient

January 01, 1998

Although head and neck cancer accounts for only about 5% of all malignancies, the functional and cosmetic changes that result from the tumor or its treatment pose a challenge to the health-care community. In today’s health-care environment, we are being forced or at least encouraged to decrease the length of hospital stay for patients following all types of surgical procedures. As a result, the inpatient census for most units has decreased substantially, causing many specialized patient care units to close.

Use of Saline-Filled Tissue Expanders to Protect the Small Bowel from Radiation

January 01, 1998

The article by Hoffman, Sigurdson, and Eisenberg updates their experience in the use of temporary saline-filled tissue expanders (TEs) for small bowel exclusion. In their initial prospective study of 34 patients with a median time of patient surveillance after TE placement of 18 months, the authors demonstrated that small bowel was displaced from more than 95% of the radiation therapy treatment volume in 70% of 27 evaluable patients and from more than 75% of the treatment volume in 89% of patients.[1]

Practice Guidelines: Uterine Corpus—Endometrial Cancer

January 01, 1998

Endometrial cancer is the most common type of female genital cancer in the United States, with an estimated 32,000 new cases and 5,600 deaths per year. During the first half of the 20th century, the incidence of cervical cancer was greater than

Practice Guidelines: Ovarian Cancer

January 01, 1998

After the patient has been evaluated preoperatively, exploratory laparotomy is essential for definitive diagnosis and staging. The patient should be advised of the potential for malignancy based on the physical as well as imaging studies, and an

Practice Guidelines: Cervical Cancer

January 01, 1998

Invasive cancer of the uterine cervix is either the leading or second leading cause of death from cancer among women worldwide and is the leading cause of death from cancer among women in developing countries. In some developing

Small-Cell Lung Cancer: Is There a Standard Therapy?

January 02, 1998

For more than 25 years, chemotherapy has been the cornerstone of treatment for small-cell lung cancer. Many studies have tested a wide variety of drugs in different combinations, resulting in a number of standard

Recent Advances With Chemotherapy for NSCLC: The ECOG Experience

January 02, 1998

Management of disseminated non-small-cell lung cancer has changed over the past 10 years. Newer agents, such as vinorelbine (Navelbine) and paclitaxel (Taxol), have been shown to modestly improve survival in patients with

Metastatic Breast Cancer: Experience with the Combination Paclitaxel Plus Epirubicin

January 01, 1998

This study evaluated the safety and feasibility of the combination of paclitaxel (Taxol) and epirubicin, the 4¢-epimer of doxorubicin, in women with metastatic breast cancer. A total of 85 patients with histologically proven

Overcoming Drug Resistance in Lung Cancer

January 02, 1998

Anticancer drugs have been explored by means of random screening and demonstrated to be active against not only hematologic malignancies but also some solid tumors. Recent progress in the field of molecular biology has

Paclitaxel, Carboplatin, and Radiation Therapy for Non-Small-Cell Lung Cancer

January 02, 1998

Preclinically, the taxanes appear to potentiate radiation more effectively than do the platinum compounds. In our phase I trial (LUN-17) in patients with advanced non-small-cell lung cancer, we defined the maximum tolerated

Paclitaxel, Carboplatin, and Extended-Schedule Oral Etoposide for Small-Cell Lung Cancer

January 02, 1998

We evaluated the feasibility and efficacy of combination paclitaxel (Taxol) (via 1-hour infusion), carboplatin (Paraplatin), and oral etoposide (VePesid) in the first-line treatment of patients with small-cell lung cancer.

Dose-Dense Paclitaxel-Containing Adjuvant Therapy for Breast Cancer

January 01, 1998

The use of dose-dense therapy is one approach to overcoming the “resistance” of malignant cells to adjuvant therapy caused by inadequate drug exposure. In this approach, active drugs are delivered sequentially at their “ideal” dose level separated by short intertreatment intervals. Thus, dose intensification is achieved by means of rapidly recycled treatments rather than by dramatic dose escalation. To overcome absolute cellular resistance, the addition of new, active, non-cross-resistant drugs holds great promise and has specifically motivated the testing of the taxanes. This article describes the results of clinical trials of dose-dense therapy, with particular emphasis on attempts to incorporate one taxane, paclitaxel (Taxol), into the dose-dense regimen of sequential doxorubicin and cyclophosphamide-the so-called A ® T ® C regimen, and into more conventional regimens.[ONCOLOGY 12(Suppl 1)16-18, 1998]

Paclitaxel/Carboplatin in the Treatment of Non-Small-Cell Lung Cancer

January 02, 1998

Chemotherapeutic intervention in advanced and metastatic non-small-cell lung cancer (NSCLC) has changed over the past 2 decades. The improvements offered by cisplatin (Platinol)-based regimens, though significant in

The Role of Carboplatin in the Treatment of Small-Cell Lung Cancer

January 02, 1998

Lung cancer is the leading cause of death due to cancer in the United States, and approximately 178,100 new cases were estimated to occur last year. Small-cell lung cancer (SCLC) accounts for approximately 17% to 25% of all lung cancers. Due to its aggressive nature and rapid proliferation rate, small-cell lung cancer is usually widespread at diagnosis. Therefore, chemotherapy is the cornerstone of therapy for this disease. Cisplatin (Platinol) is an active chemotherapeutic agent used to treat small-cell lung cancer, but its toxicity, including nausea and vomiting, nephrotoxicity, neurotoxicity, and ototoxicity, has led to the investigation of combination regimens with different toxicity profiles. Carboplatin (Paraplatin), a derivative of cisplatin, has far less nonhematologic toxicity, although myelosuppression may be slightly greater than that observed with cisplatin. The reduced toxicity and equivalent efficacy of carboplatin have resulted in the increased use of carboplatin-based regimens to treat small-cell lung cancer. Phase I and II trials of carboplatin as single-agent treatment for small-cell lung cancer resulted in overall response rates of approximately 60% for previously untreated patients and 17% for those who had received prior therapy. New combination chemotherapy regimens that include carboplatin may improve survival in patients with small-cell lung cancer and potentially cure those patients with limited disease. Further investigation of carboplatin and other new agents is warranted.[ONCOLOGY 12(Suppl 2):36-43, 1998]

Paclitaxel and Carboplatin as First-Line Chemotherapy for Advanced Breast Cancer

January 01, 1998

In a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an

Taxanes in Adjuvant and Neoadjuvant Therapies for Breast Cancer

January 01, 1998

Paclitaxel (Taxol) is a diterpene originally obtained from the bark of the Pacific Yew Tree, Taxus Brevifolia. Its mechanism of action is unique. it stabilizes microtubule polymerization, thus blocking cells in the G2/M phase of

Issues in Nonoperative Management of Locally Advanced Non-Small-Cell Lung Cancer

January 02, 1998

The challenge for oncologists treating patients with stage III non-small-cell lung cancer (NSCLC) is to optimize a treatment strategy using nonsurgical therapies. The recognition that chemotherapy response rates for patients

Future Directions in Non-Small-Cell Lung Cancer: A Continuing Perspective

January 02, 1998

Non-small-cell lung cancer (NSCLC) will increasingly come under better control as the current approaches to therapy are more broadly employed and as new therapies are deployed against recently elucidated molecular

Paclitaxel Plus Epirubicin in Advanced Breast Cancer

January 01, 1998

This phase I-II study aimed to determine the maximum tolerated dose (MTD) of paclitaxel (Taxol), infused over 3 hours, when combined with a fixed dose (90 mg/m²) of epirubicin. Other aims were to investigate the combination’s

Prophylactic Cranial Irradiation in Small-Cell Lung Cancer: Is It Ever Indicated?

January 02, 1998

Prophylactic cranial irradiation (PCI) is being reintroduced into multimodality treatment protocols of patients with small-cell lung cancer (SCLC). The history of its use brings interesting insights into clinical evaluations of treatment strategies and design of relevant and informative trials. The critical issues of effectiveness and overall health gains of prophylactic cranial irradiation have been addressed in a series of recently completed clinical trials. These trials tested prophylactic cranial irradiation in small-cell lung cancer patients achieving good response to induction therapy and confirmed the ability of standard prophylactic cranial irradiation schedules to significantly reduce the lifetime risk of brain metastases. A subset of these trials evaluated neurotoxicity in a formal and prospective manner. No sustained or significant detriment in neuropsychometric function could be linked to the use of prophylactic cranial irradiation. In addition, all the large trials have shown a consistent survival advantage in favor of the prophylactic cranial irradiation arm. None of the individual sample sizes were large enough to statistically confirm this survival benefit, but a meta-analysis is in progress and will report on this aspect of evidence shortly. Issues that remain to be answered are the optimal dose and schedule of prophylactic cranial irradiation as well as the timing of this administration. These questions form the nucleus of the next generation of collaborative trials that are being designed.[ONCOLOGY 12(Suppl 2):19-24, 1998]

Paclitaxel Plus Doxorubicin in Metastatic Breast Ca: The Milan Experience

January 01, 1998

A pilot study conducted at the National Cancer Institute in Milan, Italy assessed the efficacy of six or eight cycles of paclitaxel (Taxol) 200 mg/m² q3wks plus doxorubicin (Adriamycin) (60 mg/m² q3wks) in 49 women with

Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA Level

January 01, 1998

The review article by Forman and Velasco represents a concise, up-to-date summary of current knowledge on the use of therapeutic radiation in patients with a rising post-prostatectomy prostate-specific antigen (PSA). The conclusions reached by the authors are reasonable but conservative. In my opinion, a bit too conservative.

Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA Level

January 01, 1998

Drs. Forman and Velasco provide a timely and thorough review of the maturing concept of applying radiation therapy to the prostatic fossa after radical prostatectomy. The guidelines for therapy continue to evolve because of the increasing reliance on blood prostate-specific antigen (PSA) level for both detecting a recurrence of disease and evaluating response to radiotherapy.

Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA Level

January 01, 1998

I agree with Drs. Forman and Velasco that the optimal management of patients with an elevated prostate-specific antigen (PSA) level after prostatectomy remains to be determined. The broader issue, however, is optimizing the management of post-prostatectomy patients who are at risk for recurrence. Hence, the dilemma: Should we wait for a chemically apparent recurrence before instituting treatment? Or, should we, on the basis of available information, quantify the risk of recurrence and the possible side effects of therapy and determine whether or not adjuvant radiotherapy is warranted based on the risk/benefit ratio?

Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA Level

January 01, 1998

The optimal management of patients with an elevated post-prostatectomy prostate-specific antigen (PSA) level remains to be determined. In the pre-PSA era, many patients received immediate adjuvant radiation therapy on

Differentiated Thyroid Carcinoma: Risk Group Assignment and Management Controversies

January 01, 1998

In this review, we provide a framework for clinical decision-making in the treatment of differentiated thyroid cancer. The clinical discussion and treatment recommendations are relevant to an adult population (more than 16

Integrating Thoracic Radiotherapy in the Treatment of Limited Small-Cell Lung Cancer

January 02, 1998

Although the need to combine thoracic radiotherapy with systemic chemotherapy in the curative treatment of limited small-cell lung cancer is now widely acknowledged, there is substantial disagreement on how best to do this. This paper reviews radiotherapeutic factors but also highlights the important interactions that occur with some classes of chemotherapeutics. Studies examining variables like dose and volume are clearly in order. Concurrent therapy given early has been adopted throughout most of the world, except Europe. The reasons for this are explored. Multiple studies are now showing excellent results with fewer total cycles of chemotherapy. Integrationof newer drugs is another challenge for clinical investigators at the close of this century. [ONCOLOGY 12(Suppl 2):15-18, 1998]

One-Hour Paclitaxel Plus Carboplatin for Advanced Non-Small-Cell Lung Cancer

January 02, 1998

We report here the preliminary results of a large phase II multicenter study done in the community setting, using paclitaxel (Taxol) (given by 1-hour infusion) plus carboplatin (Paraplatin) to treat patients with advanced non-small-cell lung cancer (NSCLC). In this study, 155 chemotherapy-naive patients with stage IIIB, stage IV, or recurrent metastatic non-small-cell lung cancer received the two drugs in 21-day cycles. Paclitaxel 225 mg/m² was given by 1-hour intravenous infusion followed immediately by carboplatin at a targeted area under the concentration-time curve of 6.0 (calculated according to the Calvert formula). Colony-stimulating factors were not used routinely. Objective responses occurred in 53 of 155 patients (34%) (53 of 144 [36%] evaluable patients) including three complete responses and 50 partial responses. Fifty-two other patients had stable disease at initial reevaluation. The median survival among all 155 patients was 8 months; the 1-year survival rate was 42%, and the 2-year survival rate was 20%. Leukopenia and cumulative peripheral neuropathy occurred consistently but rarely were severe or affected the course of therapy. One patient died due to sepsis. Other grade 3 and grade 4 toxicities were uncommon. This paclitaxel-carboplatin combination chemotherapy appears to be a relatively convenient, safe, and active regimen in advanced non-small-cell lung cancer.[ONCOLOGY 12(Suppl 2):71-73, 1998]

Rehabilitation for the Head and Neck Cancer Patient

January 01, 1998

As the economics of health care increasingly dictate the parameters of patient care delivery, the role of rehabilitation has taken on new meaning with regard to positive patient outcomes. This is particularly true for the head and neck cancer patient coping with devastating physical and functional changes. With treatment advances leading to increased survival, health-care providers must therefore focus on restoring function and assisting the patient to achieve an acceptable quality of life. For the head and neck cancer patient with multiple rehabilitation needs, this can best be accomplished through a comprehensive, coordinated approach, utilizing interdisciplinary clinical and community resources aimed at facilitating the rehabilitation process and ultimately achieving individualized rehabilitation goals.