scout

ONCOLOGY Vol 12 No 12

The FDA recently licensed a biological approach for the treatment of metastatic breast cancer. The intravenous monoclonal antibody, trastuzumab (Herceptin), is approved for use alone in certain patients who have tried chemotherapy with little

Although overall death rates from the acquired immune deficiency syndrome (AIDS) are declining rapidly, the incidence of human immunodeficiency virus (HIV) in women continues to climb, and HIV-associated gynecologic disease is also likely toincrease over the next decade. In this paper on lower genital tract neoplasia in women with HIV infection, Abercrombie and Korn review some of the many studies documenting the increased incidence of cervical human papillomavirus (HPV) and HPV-asso-ciated disease in this population. The clinical importance of these studies is underscored by recent data from New York City, where the incidence of invasive cervical cancer increased significantly from 1990 to 1995 in HIV-positive women, compared to the general popu-lation of 25- to 49-year-old women.[1]

The article by Dr. McLaughlin and coauthors provides both a useful summary of the clinical trials involving rituximab (IDEC C2B8 [Rituxan]) and a practical guide for its administration. Their review summarizes the most recent clinical results with this monoclonal antibody, which have just been published in the Journal of Clinical Oncology.[1] The review also includes a section on the potential mechanism of action of rituximab. Several areas merit comment.

Superficial transitional cell carcinoma of the bladder comprises an extremely heterogeneous group of tumors, both in terms of morphology and, even more importantly, in terms of tumor biology and clinical behavior. Drs. deVere White and Stapp provide a succinct overview of the challenges encountered clinically because of tumor heterogeneity and the availability of different treatment options. The authors also outline the use of traditional prognostic factors (clinicopathologic characteristics) and the current state of development of biological markers that hold promise in providing significant clinically useful prognostic information.

Of the many novel new cancer therapeutic concepts under development, chemoprevention recognizes that malignancies derive from a long, complex interaction of environmental stress modulated by individual genetic phenotypic expression. As described in depth by Drs. Singh and Lippman in this two-part article, published in last and this month’s issues of oncology, substances with potential chemopreventive activity have been identified from multiple sources. These include: (1) human cancer epidemiology, with an emphasis on dietary assessment, geographic dietary and environmental variation, and differences in cancer incidence among similar regional populations; (2) from mechanistic hypotheses; and (3) clinical observations after treatment of cancer (eg, tamoxifen [Nolvadex] for breast cancer). Drs. Singh and Lippman ably demon-strate the wide variety of sources of potential chemopreventive agents and describe current research studies and outcomes.

Rituximab (IDEC-C2B8 [Rituxan]) is a chimeric anti-CD20 monoclonal antibody (MoAb) that was recently approved by the FDA for the treatment of patients with low-grade or follicular B-cell non-Hodgkin’s lymphoma. Its potential efficacy in other B-cell malignancies is currently being explored. This article reviews the mechanisms of action of rituximab, as well as preclinical data and results of the clinical trials that led to its approval. Also discussed are the mechanics of administering rituximab on the recommended weekly ´ 4 outpatient schedule. Finally, the article describes ongoing and planned trials of rituximab in other dosage schedules, in other B-cell neoplasms, and in conjunction with chemotherapy. As the first MoAb to gain FDA approval for the treatment of a malignancy, rituximab signals the beginning of a promising new era in cancer therapy. [ONCOLOGY 12(12):1763-1770, 1998]

Drs. Abercrombie and Korn raise critical concerns regarding the need for vigilant monitoring and early intervention to prevent cervical intraepithelial neoplasia in human immunodeficiency virus (HIV)-infected women who have concomitant human papillomavirus (HPV) infection. The evidence is clear that women with HIV are at risk of both more virulent HPV infections and more rapid progression from infection to neoplasia. The authors underscore another critical finding: Women with HIV are at increased risk of developing noncervical condylomas, which are more difficult to detect by standard screening mechanisms and more difficult to treat with standard therapies.