ONCOLOGY Vol 12 No 3 | Oncology

SGO Clinical Practice Guidelines: Introductory Remarks

March 01, 1998

Clinical 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 States. The members of this committee are listed in Table 1, along with other individuals who contributed to the development of the guidelines. The guidelines, which were distributed in booklet form to the SGO membership in 1996, are being reprinted in this and successive issues of ONCOLOGY for distribution to the oncology community at large.

Scientists Define New Role for Cell Signaling Pathway

March 01, 1998

Scientists at Norris Comprehensive Cancer Center of the University of Southern California (USC) have found a new fork in a much-studied genetic pathway, and their work may lead to new cancer therapies, according to the center’s director.

Coalition Formed to Further Clinical Cancer Research

March 01, 1998

The chairpersons of six National Cancer Institute (NCI)-sponsored cooperative groups have announced the formation of a new entity called the Coalition of National Cancer Cooperative Groups, Inc. The coalition was formed to establish a common platform upon which the cooperative groups can operate, while remaining complementary to the work already being performed within the existing NCI structure.

New Genetic Defect Signals Need for Aggressive Leukemia Treatment

March 01, 1998

Researchers looking at a group of leukemia patients have found that a genetic defect that they discovered 2 years ago serves as an early warning signal, calling for a more aggressive approach to treatment in these patients.

Investigators Involved in Toremifene Studies Call It a Potentially Safer Antiestrogen

March 01, 1998

Toremifene (Fareston), the first new antiestrogen agent for treating advanced breast cancer available in the United States in more than 19 years, is as effective as tamoxifen (Nolvadex) in clinical trials and potentially safer, Richard Gams, md, professor of internal medicine and director of hematology/oncology, Ohio State University, said at a teleconference sponsored by Schering-Plough to introduce the recently approved agent.

New Kind of Vaccine Aimed at Disseminated Melanoma

March 01, 1998

In the next 5 to 10 years, we may have the answer to the question of whether vaccines can fulfill their promise to become an effective treatment for melanoma, predict Brian J. Czerniecki, md, PhD, and Isabelle Bedrosian, md, in the latest issue of The Melanoma Letter, a publication of The Skin Cancer Foundation. These researchers are experimenting with a new kind of vaccine to combat disseminated melanoma.

Steroid Improves Cancer-Fighting Ability of Vitamin D Analog

March 01, 1998

A steroid drug enhances the ability of a vitamin D analog to kill cancer while reducing a potentially serious side effect of vitamin D therapy, according to investigators at the University of Pittsburgh Cancer Institute (UPCI). Their findings on dexamethasone and the vitamin D derivative, 1,25-dihydroxyvitamin-D³ (1,25-D³), in an animal model were reported in the January 21, 1998, issue of the Journal of the National Cancer Institute.

Study Links Smoking in College to Other Risky Student Behaviors

March 01, 1998

College students who smoke not only are endangering their health but also are likely to have adopted other risky behaviors. A new study by researchers at Dana-Farber Cancer Institute and the Harvard School of Public Health has found that college students who smoke are more likely to use marijuana and other illegal drugs, to be sexually promiscuous, and to be uninvolved in sports and athletic activities.

Gene for Inherited Syndrome May Be a New Tumor Suppressor

March 01, 1998

New research has found the gene responsible for Peutz-Jeghers syndrome, a rare inherited disorder that can lead to cancer in many different organs. Unexpectedly, the work may also have uncovered a new category of tumor-suppressor genes.

Letrozole Effective, Well Tolerated in Postmenopausal Women With Advanced Breast Cancer

March 01, 1998

The aromatase inhibitor letrozole (Femara), at a dosage of 2.5 mg once daily, is an effective therapy for advanced breast cancer in postmenopausal women whose disease progresses following antiestrogen therapy, according to data published in the February 1998 Journal of Clinical Oncology. The study was conducted by the Letrozole International Trial Group and was sponsored by Novartis Pharmaceuticals Corporation.

Molecular Genetics of Hereditary Ovarian Cancer

March 01, 1998

Approximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations

Economics and Quality of Life in Oncology Clinical Practice

March 01, 1998

Pharmacoeconomics and outcomes research are two new sciences that are beginning to affect the practice of oncology. As cost awareness in cancer care becomes acute, practicing oncologists must understand how to apply these sciences to their practices. This publication represents the proceedings of the symposium, Economics and Quality of Life in Oncology Clinical Practice, which was held on November 19, 1997, on the occasion of the EORTC meeting during The First European Conference on the Economics of Cancer. The presentations at the symposium provided an overview of some studies that have begun to explore the variety of activities comprising outcomes assessment, and how such data can be used to help deliver high quality patient care in a cost-conscious environment.

Expert Calls for New Concept of Race in Cancer Studies

March 01, 1998

Cancer researchers and clinicians need to adopt a new attitude toward race classifications as interracial parentage in the United States continues to increase. “I want to uncouple race and genetics,” stated Edison Liu, MD, at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer held in Washington, DC.

Minority Women Successfully Recruited for Dietary Fat Study

March 01, 1998

Postmenopausal minority women can be successfully recruited for a program to reduce dietary fat and can achieve significant changes in their eating habits, stated Carolyn K. Clifford, phd, at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer in Washington, DC.

Dignified Death not Common, Doctors and Nurses Say

March 01, 1998

Of acute-care doctors and nurses responding to a national survey, 62% said that clinically hopeless patients have a “dignified death” in the hospital only “sometimes.” Another 33% said that this scenario occurs “frequently,” and just 5% said “always.”

Political Action Needed to Counter Growing Lung Cancer Threat to Women

March 01, 1998

Women must make lung cancer as hot and as female a public issue as they have made breast cancer, urged a cancer expert speaking at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer in Washington, DC. Five years from now, twice as many women will die of lung cancer than of breast cancer, warned Paul Bunn, Jr., md, Grohne/Stapp Chair in Cancer Research and director of the University of Colorado Cancer Center.

Autologous Ovarian Cancer Vaccine Effective in Initial Trial

March 01, 1998

Jefferson Medical College researchers have created what they believe may prove to be an effective ovarian cancer vaccine made from a patient’s own cancer cells. After testing the vaccine on 11 patients, each with advanced disease, the scientists are encouraged after seeing an initial immune reaction. That tells them that the vaccine is effectively stimulating the immune system into action.

Cultural Factors as Important as Cost in Diet Choices Among Poor

March 01, 1998

Diet is a well-established factor in cancer prevention. According to two Baylor College of Medicine researchers, cultural factors play a more powerful role than cost in determining the food choices of people with low incomes. Speaking at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer, the researchers said that blacks and Hispanics typically eat a less healthy diet than whites, but not because of cost.

Tissue “Expanders” Improve Results of Breast Reconstruction

March 01, 1998

Women who undergo breast reconstruction following mastectomy for breast cancer express strong satisfaction with a novel surgical approach, reported a surgeon at Georgetown University Medical Center in the January 1998 issue of Plastic and Reconstructive Surgery.

Stress of Breast Cancer Can Weaken Immune System

March 01, 1998

In the largest study of its kind to date, Ohio State University researchers have shown that the stress women experience after breast cancer diagnosis and surgery can weaken their immune response, based on at least three different biochemical indicators.

Health-Care Challenges Similar for Rural Poor of Different Ethnic Groups

March 01, 1998

Regardless of their race, poor rural Americans face similar problems that make it extremely difficult for them to receive adequate health care, reported two experts at the 1997 Biennial Symposium on Minorities, the Medically Underserved, and Cancer in Washington, DC. Many rural Americans are white working poor, noted Linda Linville, phd, assistant director for cancer control at the University of Kentucky Markey Cancer Center in Lexington. Although they technically do not belong to a racial minority, white working poor individuals generally are among the medically underserved.

Drug Currently in Phase III Trials for Arthritis Shows Tumor-Inhibiting Potential in Colon Cancer Model

March 01, 1998

Scientists at the American Health Foundation’s Nutritional Carcinogenesis Division, under the direction of Dr. Bandaru S. Reddy, division chief and associate director of the Foundation’s Naylor Dana Institute, Valhalla, New York, and Dr. Karen Seibert of Searle Research & Development, St. Louis, Missouri, described an exceptionally strong inhibitor of colon cancer development in an animal model assay in the February 1, 1998, issue of Cancer Research.

Radiologic Diagnosis of Extrathoracic Metastases to the Lung

March 01, 1998

Because many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that

Combined Radiation and Chemotherapy for Carcinoma of the Anal Canal

March 01, 1998

Sphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown

Molecular Genetics of Hereditary Ovarian Cancer

March 01, 1998

Approximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations

Fatigue in Cancer and HIV/AIDS

March 01, 1998

Fatigue is a common and troubling symptom in patients with cancer or HIV/AIDS, resulting in significant disability and adverse effects on quality of life. Its etiology remains complex and is most likely multifactorial. Despite its

Combined Radiation and Chemotherapy for Carcinoma of the Anal Canal

March 01, 1998

Sphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown

Practice Guidelines: Vaginal Cancer

March 01, 1998

Malignant diseases of the vagina account for about 1% of gynecologic cancers. Approximately 95% of vaginal malignancies are squamous cell carcinomas. A variety of neoplasms have, however, been noted as arising in the vagina, and these are listed in Table 1. Like squamous cancer of the vulva, this disease occurs predominately in a geriatric population but occasionally is seen in premenopausal women.

Radiologic Diagnosis of Extrathoracic Metastases to the Lung

March 01, 1998

Because many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that

Would Oncologists Want Chemotherapy If They Had Non-Small-Cell Lung Cancer?

March 01, 1998

In 1985, a survey found that only about one-third of physicians and oncology nurses would have consented to chemotherapy for non-small-cell lung cancer. In response to statements made at a recent American Society of Oncology (ASCO) Board of Directors meeting questioning whether these data are still valid, Dr. Smith and colleagues conducted a new survey of oncologists attending a 1997 National Comprehensive Cancer Network (NCCN) annual meeting. The results of that survey are summarized and analyzed.

Fatigue in Cancer and HIV/AIDS

March 01, 1998

Fatigue is a common and troubling symptom in patients with cancer or HIV/AIDS, resulting in significant disability and adverse effects on quality of life. Its etiology remains complex and is most likely multifactorial. Despite its

Practice Guidelines: Gestational Trophoblastic Disease

March 01, 1998

Gestational trophoblastic disease is a term applied to a rare group of tumors that have several common characteristics: the tumor cells arise in the fetal chorion during pregnancy; the vast majority of the tumors make human chorionic gonadotropin (hCG); the amount of hCG produced is proportional to the amount of viable tumor; and they are sensitive to a variety of cytotoxic chemotherapeutic agents. Histopathologic diagnoses included in this group of tumors are:

Radiologic Diagnosis of Extrathoracic Metastases to the Lung

March 01, 1998

Because many types of cancers metastasize to the lungs, early detection may affect both tumor staging and treatment planning. On the other hand, it is also important to refrain from subjecting patients to procedures that

Cost-Effective Use of Antiemetics

March 01, 1998

Direct comparison of intravenous and oral 5-HT3 antagonists has shown equivalent efficacy if appropriate doses are given, thus allowing widespread use of the more convenient and economical oral route. Effective antiemesis generates additional cost savings by decreasing the resources necessary for salvage antiemetic preparation and administration, additional physician and nursing evaluation, clean-up and maintenance of the patient area, and possible additional hospitalization necessitated by uncontrolled emesis.

Preclinical Studies Using the Intratumoral Aromatase Model for Postmenopausal Breast Cancer

March 02, 1998

To determine the most effective strategies for the treatment of postmenopausal hormone dependent breast cancer, we recently developed a model system in nude mice. In this model, estrogen receptor-positive human breast cancer cells (MCF-7) stably transfected with the aromatase gene are inoculated into ovariectomized, immunosuppressed (nude) mice.

Combined Radiation and Chemotherapy for Carcinoma of the Anal Canal

March 01, 1998

Sphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown

Phase II and III Clinical Trials of Toremifene for Metastatic Breast Cancer

March 02, 1998

Toremifene (Fareston) received FDA approval in 1997 for the first-line treatment of postmenopausal women with estrogen receptor (ER)-positive or -unknown metastatic breast cancer. Phase II and III trials have demonstrated that first-line therapy with toremifene, 60 mg/d, is as effective and as well tolerated as tamoxifen (Nolvadex), 20 or 40 mg/d, in such patients.

Molecular Genetics of Hereditary Ovarian Cancer

March 01, 1998

Approximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations

Improving 5-FU With A Novel Dihydropyrimidine Dehydrogenase Inactivator

March 01, 1998

GW776C85 is a new drug that has been shown to be an effective inactivator of dihydropyrimidine dehydrogenase (DPD). Preclinical studies demonstrated that administration of GW776C85 with 5-fluorouracil (5-FU) resulted in several desirable pharmacologic effects. Initial clinical data on 5-FU combined with GW776C85 suggest potentially increased antitumor activity in at least some malignancies with tolerable toxicity, as well as several distinct economic and quality-of-life advantages including the following: (1) The possibility of administering 5-FU as an oral drug due to excellent bioavailability of 5-FU following inactivation of DPD; (2) a cost-effective alternative to continuous or protracted infusion of 5-FU without the need for hospitalization or surgical placement of an intravenous access and availability of an ambulatory pump; and (3) potential for less interpatient variation of 5-FU toxicity (eg, in host tissues, such as bone marrow and gastrointestinal mucosa cells) due to inactivation of DPD in essentially all patients treated, permitting better 5-FU dosing guidelines. Finally, because tumors may theoretically become resistant to 5-FU by increased levels of DPD, the use of GW776C85 to inactivate DPD may provide a potential means by which tumor resistance can be reversed. [ONCOLOGY(Suppl 4):51-56, 1998]

Overview of Economic Analysis of Le Chevalier Vinorelbine Study

March 01, 1998

The costs and relative cost-effectiveness of different treatments for common illnesses are an increasing concern. New treatments for advanced non-small-cell lung cancer are having an impact. However, these treatments vary markedly in their direct financial costs, toxicity, and quality-of-life profiles. Direct comparisons between most combination regimens are not yet completed. Vinorelbine (Navelbine) is the first new agent approved in the United States for the treatment of metastatic non-small-cell lung cancer in more than a decade. We previously reported results of a post-hoc economic analysis that compared the anticipated cost-effectiveness of three regimens used to treat non-small-cell lung cancer (vinorelbine alone versus vinorelbine plus cisplatin [Platinol] versus vindesine plus cisplatin, the assumed standard treatment in Europe). Results showed that vinorelbine plus cisplatin was the most effective regimen. Using vinorelbine alone as a baseline, vinorelbine plus cisplatin added 56 days of life at an additional cost of $2,700, resulting in a cost-effectiveness ratio of $17,700 per year of life gained. Similarly, vindesine plus cisplatin added 19 days of life at a cost of $1,150, or $22,100 per year of life gained. Compared to vindesine plus cisplatin, vinorelbine plus cisplatin added 37 days of life at a cost of $1,570, or $15,500 per year of life gained. We conclude that the incremental cost-effectiveness of the vinorelbine plus cisplatin regimen was less than most commonly accepted medical interventions. If vinorelbine is preferred because of its favorable toxicity profile, the additional effectiveness of cisplatin added substantial efficacy at an acceptable cost.[ONCOLOGY(Suppl 4):14-17, 1998]

Status of Antiestrogen Breast Cancer Prevention Trials

March 02, 1998

Various ongoing double-blind clinical trials are evaluating the use of tamoxifen (Nolvadex) as chemoprevention for breast cancer. A total of over 24,000 healthy women have been randomized to these trials, and it should be possible, by the year 2000, to detect any preventive effect of tamoxifen in healthy women. Furthermore, with the large numbers of women involved, it should be possible to evaluate prevention in subgroups of participants according to risk of the disease, particularly those women carrying high-risk genes, such as BRCA1 and BRCA2.

Fatigue in Cancer and HIV/AIDS

March 01, 1998

Fatigue is a common and troubling symptom in patients with cancer or HIV/AIDS, resulting in significant disability and adverse effects on quality of life. Its etiology remains complex and is most likely multifactorial. Despite its

Antiestrogen Therapy: Uncertainties and Risk Assessment

March 02, 1998

Tamoxifen is by far the most clinically tested antiestrogenic drug currently used as adjuvant therapy for breast cancer and it continues to provide considerable benefit in this setting. The balance from clinical trials indicates a strong association between the use of tamoxifen and an increase in uterine tumors (three to sixfold). In rats, tamoxifen is a mutagenic, genotoxic hepatocarcinogen.

Overview of Outcomes Research and Management and Its Role in Oncology Practice

March 01, 1998

Outcomes assessment describes a variety of activities, including classic clinical trials with quality of life and cost end points, observational studies examining the outcomes of treatment in the course of routine clinical care, and the process of managing patterns of care in clinical practice. These activities share important common features, including an emphasis on quality of life and economic outcomes, an explicit consideration of the importance of patient characteristics in determining outcomes, and a broad definition of what constitutes cancer care.

Cost-Effectiveness of Vinorelbine Alone or Vinorelbine Plus Cisplatin for Stage IV NSCLC

March 01, 1998

Le Chevalier and colleagues have reported results of a randomized controlled clinical trial comparing vinorelbine alone, versus vinorelbine combined with cisplatin, versus standard treatment consisting of vindesine and cisplatin in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Data on survival in the three study arms and estimates of the resources used to treat these patients were extracted from the publication and inserted into Statistics Canada’s POpulation HEalth Model (POHEM).

Quality of Life Issues in the Treatment of Metastatic Breast Cancer

March 01, 1998

The treatment of metastatic breast cancer involves the sequential selection and delivery of hormonal therapies and cytotoxic chemotherapies. The available therapies for metastatic breast cancer are rarely curative, although high rates of response and modest prolongation of survival may be achieved in association with varying degrees of treatment-related toxicity.

Adjuvant Trials of Toremifene vs Tamoxifen: The European Experience

March 02, 1998

When results from the phase II trials of toremifene (Fareston) and tamoxifen (Nolvadex) in metastatic breast cancer were published, the Finnish Breast Cancer Group began to plan the first trial of toremifene in an adjuvant setting. This multicenter, randomized trial is comparing toremifene (40 mg/d) to tamoxifen (20 mg/d) in postmenopausal lymph node-positive breast cancer patients.

Pivotal Trials of Letrozole: A New Aromatase Inhibitor

March 02, 1998

Letrozole (Femara) is a nonsteroidal aromatase inhibitor that is approximately 10,000 times as potent as aminoglutethimide in vivo. Two pivotal multinational phase III trials have compared letrozole (0.5 and 2.5 mg/d) against megestrol acetate and aminoglutethimide, respectively, in patients with locally advanced or metastatic breast cancer.

Evolving Role of Oral Chemotherapy for the Treatment of Patients With Neoplasms

March 01, 1998

The past 20 years has seen an increasing trend toward the use of oral chemotherapy for the treatment of patients with a variety of malignancies. The advantages of oral chemotherapy include lower treatment cost, compared with that of intravenous (IV) administration, and more convenient treatment for patients.

Emerging Role of Aromatase Inhibitors in the Treatment of Breast Cancer

March 02, 1998

The new generation of potent steroidal and nonsteroidal inhibitors of the enzyme aromatase act by decreasing estrogen production throughout the body in postmenopausal women. The most potent of these agents may also inhibit estrogen synthesis within metastatic breast cancer tissue.

Initial Control of Chemotherapy-Induced Nausea and Vomiting in Patient Quality of Life

March 01, 1998

The side effects commonly experienced by patients receiving chemotherapy for the treatment of cancer can challenge many aspects of daily life. Nausea and vomiting, the most common side effects reported by patients, affect the ability to continue with usual life activities and, thus have a pronounced impact on quality of life.