ONCOLOGY Vol 13 No 3 | Oncology

WHO Declares Lymphatic Mapping to Be the Standard of Care for Melanoma

March 01, 1999

Dr. Natale Cascinelli, president of the World Health Organization (WHO) Melanoma Program, declared intraoperative lymphatic mapping to be the standard of care for melanoma. He made this statement during his presentation of the abstract, “An Overview on Sentinel Lymph Node Dissection” at the 9th International Congress on Anti-Cancer Treatments in Paris.

Rituximab: Phase II Retreatment Study in Patients With Low-Grade or Follicular Non-Hodgkin’s Lymphoma

March 01, 1999

A 60-patient phase II study was conducted to determine the safety and efficacy of retreatment with the anti-CD20 monoclonal antibody (MoAb) rituximab (Rituxan) in patients with low-grade or follicular non-Hodgkin’s lymphoma (NHL). Patients were relapsed or refractory to prior chemotherapy but had previously responded to rituximab. Upon progression of disease, patients received IV infusions of rituximab at 375 mg/m² weekly × 4. Patient characteristics were 55% males with medians of: age, 56 years; three prior therapies; 14.2 months since last treatment; and 4.7 years since diagnosis.

Chemotherapy Plus Radiation Improves Survival in Patients With Cervical Cancer

March 01, 1999

The National Cancer Institute (NCI) recently sent a clinical announcement to thousands of physicians stating that strong consideration should be given to adding chemotherapy to radiation therapy in the treatment of invasive cervical cancer.

Navelbine Increased Elderly Lung Cancer Patients’ Survival

March 01, 1999

Elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with vinorelbine tartrate (Navelbine) injection enjoy improved survival over those receiving best supportive care, according to a study published in the February issue of the Journal of the National Cancer Institute.

T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma

March 01, 1999

The role of allogeneic bone marrow transplant (BMT) as a treatment for advanced non-Hodgkin’s lymphoma (NHL) has not been established. Historical limitations tothis approach have included the relatively advanced age of these patients, as well as their extensive treatment prior to BMT. Accordingly, only limited data have been reported about overall and/or disease-free survival in these patients. Depletion of T-cells offers the potential for older patients to undergo allogeneic BMT by reducing complications related to graft-vs-host disease (GVHD), but whether the graft-vs-lymphoma effect would be correspondingly reduced is unknown.

In Vivo Purging and Adjuvant Immunotherapy With Rituximab During PBSC Transplant For NHL

March 01, 1999

Contamination of the peripheral blood stem-cell (PBSC) graft with lymphoma and residual disease remaining in the patient after high-dose therapy are two potential causes of relapse after autologous transplantation. Using a tumor-specific monoclonal antibody may be one way to purge the stem-cell graft in vivo and increase the efficacy of the preparative regimen. Rituximab (Rituxan) is an IgG1 kappa chimeric mouse/human antibody containing murine light- and heavy-chain variable regions and human gamma 1 heavy-chain and light-chain constant regions. The antibody reacts specifically with the CD20 antigen found on the surface of malignant and normal B-cells.

Campath-1H Monoclonal Antibody in Therapy for Advanced Low-Grade Non-Hodgkin’s Lymphomas: A Phase II Study

March 01, 1999

Campath-1H is a humanized anti-CD52 monoclonal antibody (MoAb) that binds to nearly all B-cell and T-cell lymphomas. We report here the results of a multicenter phase II trial of Campath-1H in patients with low-grade NHL. Fifty patients with advanced, heavily pretreated, low-grade NHL were treated with Campath-1H (30 mg administered as a 2-hour intravenous (IV) infusion 3 times weekly for up to 12 weeks).

AIDS Drugs Effective Against Most Common HIV Strain

March 01, 1999

Protease inhibitors, routinely used to treat the human immunodeficiency virus (HIV) in the United States, are highly effective against the subtype C viral strain thought to be most prevalent worldwide, report Stanford researchers.

Rituximab Therapy in Previously Treated Waldenström’s Macroglobulinemia: Preliminary Evidence of Activity

March 01, 1999

Waldenström’s macroglobulinemia is a rare, low-grade lymphoproliferative disorder for which few therapies are effective. Although patients with Waldenström’s macroglobulinemia often are reported with cases of small lymphocytic lymphoma, this disease has characteristic lymphoplasmacytic histology, bright CD20 expression, and IgM paraproteinemia. Rituximab (Rituxan) is a chimeric anti-CD20 monoclonal antibody that produces a 50% response rate in previously treated low-grade lymphoma, but has no previously described efficacy in the Waldenström’s macroglobulinemia subtype. We report 7 patients with Waldenström’s macroglobulinemia treated on clinical trials performed by IDEC Pharmaceuticals (N = 6) or at our institution (N = 1). Characteristics of these patients included a median age of 60 years (range, 50-75 years) with 5 being female. All patients were symptomatic, with a median performance status of 1 (range, 1-3), with all having measurable disease independent of paraproteinemia.

Chimeric Anti-CD20 (C2B8)-Mediated Sensitization of B-Cell Lymphoma to Cytotoxic Agents: Role of C2B8 in Regulating Endogenous IL-10 and Oncogenes

March 01, 1999

Our studies have shown that unconjugated antibody therapy targeted to the B-cell marker CD20 by the anti-CD20 antibody, C2B8, inhibits the growth of B-cell lymphomas in vitro. We have also demonstrated that B-lymphoma tumor cells can be sensitized to subtoxic doses of therapeutic drugs by the same antibody.

Superiority of Allogeneic to Autologous Marrow or Blood Stem Cell Transplantation for Low-Grade Lymphoma

March 01, 1999

Several published reports have suggested that although there is a lesser relapse rate for allogeneic bone marrow transplantation (BMT) compared to autologous BMT in patients with low-grade lymphoma, no survival advantage was evident because of higher toxicity associated with allogeneic BMT. To address this issue, we compared outcome in 38 patients with low-grade lymphoma who received allogeneic BMT to 72 patients who underwent autologous BMT at our institution.

Use of Brachytherapy to Preserve Function in Children With Soft-Tissue Sarcomas

March 01, 1999

Dr. Nag and colleagues present an excellent review of several of the techniques of brachytherapy used in both the pediatric and adult populations. The authors are to be commended for their comprehensive summary of the results of the major trials of pediatric brachytherapy in the management of soft-tissue sarcomas.

Comparative Economic Analysis of the Treatment of Relapsed Low-Grade B-Cell Non-Hodgkin’s Lymphoma Using CHOP, Fludarabine, or Rituximab

March 01, 1999

Combination chemotherapy, such as CHOP (cyclophosphamide, doxorubicin HCl, Oncovin, and prednisone), or purine analogs, such as fludarabine (Fludara), are commonly used in the treatment of alkylating agent–resistant, relapsed, low-grade B-cell non-Hodgkin’s lymphoma (NHL). Response rates of around 50% are seen, with median remission duration of 6 to 9 months.

Results of High-Dose Therapy and Autologous Stem Cell Transplant in Patients With Stage IV Hodgkin’s Disease: The Impact of Disease Status and Prior Radiotherapy

March 01, 1999

About 20%-50% of patients with stage IV Hodgkin’s disease may suffer a relapse after initial chemotherapy-induced remission. Consolidative radiotherapy has been used in combination with chemotherapy to reduce relapse at areas of initial bulky disease; however, no survival benefit has been shown in the few randomized studies.

IOM Panel Criticizes NCI Spending on Ethnic Group Research

March 01, 1999

Apanel that included top oncologists at some of the nation’s premier cancer centers criticized the National Cancer Institute(NCI) for not looking behind statistics showing that poor people and ethnic minorities have higher cancer rates in some instances. The Institute of Medicine (IOM), which is part of the National Academy of Sciences, chartered the Committee on Cancer Research Among Minorities and the Medically Underserved. Representatives from the Robert Lurie Cancer Center, Fox Chase Cancer Center, Memorial Sloan-Kettering Cancer Center, and the Stanley S. Scott Cancer Center sat on the committee, which was chaired by M. Alfred Haynes, the former president and dean of the Drew Postgraduate Medical School.

Genes Linked to Early Onset, Distal Location of Hereditary Colon Cancer

March 01, 1999

Researchers have identified a mechanism that may explain where colorectal tumors arise and at what age the tumors develop in people with hereditary nonpolyposis colorectal cancer (HNPCC). The results of the study, conducted at Ohio State’s Comprehensive Cancer Center, help clarify why some people with the same HNPCC-related genetic mutation develop colorectal tumors at 30 years of age while others develop tumors at age 60. They also help explain why tumors in some patients develop in the distal area of the large intestine rather than in regions closer to the large intestine’s junction with the small intestine, which is more typical.

Spotlight Again on Alternative Therapies

March 01, 1999

Actress Jane Seymour, a strong advocate of alternative cancer therapies, was the headlining witness at hearings of the Government Reform Committee held on February 24. Rep. Dan Burton (R-Ind.), chairman of the committee, held the hearings to find out whether federal agencies-be they health care providers, such as Medicare, or research-based, such as the NCI-are aggressive enough in promoting alternative therapies. Those like Burton, who feel that federal agencies have to be more aggressive, support the “Access to Medical Treatment Act,” a bill promoted in the last two Congresses, and again in this one, by Rep. Peter DeFazio (D-OR). DeFazio’s bill had a hearing in 1998 in Burton’s committee, which has no legislative jurisdiction.

Efficacy Controls and Long-Term Follow-Up of Patients Treated With Rituximab for Relapsed or Refractory, Low-Grade or Follicular Non-Hodgkin’s Lymphoma

March 01, 1999

Rituximab (Rituxan), a chimeric monoclonal antibody (MoAb), binds with high affinity to the CD20 antigen found on malignant and normal B-cells, but not on other normal tissues. CD20 is an attractive target because of the accessibility and sensitivity of malignant B-cells to lysis via immune effector mechanisms. This MoAb mediates complement-dependent cell lysis and antibody-dependent cellular cytotoxicity. Also, it has been shown to sensitize chemoresistant human lymphoma cell lines and to induce apoptosis in vitro.

Rituximab Therapy in Hematologic Malignancy Patients With Circulating Blood Tumor Cells: Association With Increased Infusion-Related Side Effects and Rapid Tumor Lysis

March 01, 1999

Rituximab (Rituxan) was recently approved for use in relapsed and previously treated low-grade non-Hodgkin’s lymphoma (NHL); however, little data exist regarding the safety of this agent in patients with hematologic malignancies who have a high number of tumor cells in the blood. We describe our preliminary experience with two such patients in whom we noted a rapid reduction of blood tumor cells, which was associated with severe pulmonary infusion-related toxicity and thrombocytopenia. Two additional patients were collected from physician-submitted reports of adverse events related to rituximab treatment.

In Vivo Purging of Circulating CD34+ Progenitor Cells in Low-Grade Lymphoma With Rituximab and High-Dose Chemotherapy

March 01, 1999

With the aim to overcome the limitations of ex vivo bone marrow purging, we have assessed the ability of the anti-CD20 monoclonal antibody rituximab (Rituxan), given in combination with chemotherapy, to eradicate polymerase chain reaction (PCR)–detectable disease, and to enable the harvesting of large amounts of uncontaminated peripheral blood progenitor cells in patients with low-grade lymphoma (in vivo purging). From April 1997 to July 1998, 20 consecutive patients entered the study. Eligibility included age £ 60 years, a diagnosis of untreated mantle cell lymphoma or of refractory/early relapsed follicular lymphoma, CD20 expression by tumor cells, histologic bone marrow infiltration, and availability of a molecular marker for minimal residual disease detection.

Progressive Intermediate Grade Non-Hodgkin’s LymphomaAfter High-Dose Therapy and Autologous Peripheral Stem-Cell Transplantation Has a High Response Rate to Rituximab

March 01, 1999

Rituximab (Rituxan) is active in low-grade non-Hodgkin’s lymphoma (NHL), but its efficacy in poor-prognosis intermediate-grade NHL is unknown. To address this issue, we administered rituximab to seven patients with CD20-positive diffuse large cell NHL who had progressive disease despite high-dose therapy and peripheral stem-cell transplantation (PSCT). The median age was 59 years (range, 45-62 years) with ECOG performance status 0-1. Prior to rituximab therapy, all patients had undergone PSCT, with responses of two complete responses (CRs), two partial responses (PRs), one patient with stable disease (SD), and two patients with progressive disease (PD). The CRs lasted 9 and 11 months. Upon relapse or progression of disease, the patients received 4 weekly infusions of rituximab (375 mg/m²).

Autologous Bone Marrow Transplantation for Patients With Advanced Hodgkin’s Disease: Long-Term Follow-Up and Late Events

March 01, 1999

We have previously shown that disease status at the time of autologous bone marrow transplant (BMT) and relapse in a prior radiation field are the most important predictors of outcome for patients with relapsed or primary refractory Hodgkin’s disease (J Clin Oncol 11:704,1993). We have extended this analysis to include 194 patients treated at our center, with a median follow-up of 5 years (range, 1 month to 10 years). All patients were treated with salvage chemotherapy (usually DHAP [dexamethasone, ara-C, and Platinol] or mini-BEAM [BCNU, etoposide, ara-C, and melphalan]) to maximum response, and received the same high-dose chemotherapy regimen, consisting of etoposide (60 mg/kg) and melphalan (160 mg/m²).

Innovative Breast Cancer Education Programs for African-Americans

March 01, 1999

African-Americans are leading the fight against breast cancer in communities across the country. The Witness Project, the East-West Breast Express, and the Navigator Program are just a few examples of innovative programs funded by the Susan G. Komen Breast Cancer Foundation and their local affiliates that are improving the future for many African-American women.

New Cancer Vaccine Appears to Improve Colon Cancer Survival

March 01, 1999

Aphase III clinical trial conducted by researchers at Lehigh Valley Hospital, Allentown, Pennsylvania, found that the OncoVAX colon cancer vaccine reduced the 5-year recurrence rate of patients with stage II colon cancer patients by 61% and improved their cancer-free survival rate by 50%. The study, published in a recent issue of the Lancet, compared patients who underwent surgery alone to patients who had surgery plus the vaccine.

First Major Advance in Treatment of Lung Cancer in Years

March 01, 1999

A cooperative national clinical trial has produced the first major treatment advance in years for small-cell lung cancer. The study, which was published in the February 1999 issue of the New England Journal of Medicine, used two treatments of radiation daily, combined with chemotherapy, compared to the usual practice of delivering one radiation dose per day. Specifically, the protocol covered small-cell lung cancer limited to one-half of the chest area.

Autologous Bone Marrow Transplantation Following Histologic Transformation of Indolent B-Cell Non-Hodgkin’s Lymphoma

March 01, 1999

Transformation from indolent B-cell non-Hodgkin's lymphoma (NHL) to a more aggressive histology occurs frequently in the natural history of these diseases, and is generally associated with a poor prognosis. Histologic conversion occurs in 25%-80% of patients with follicular NHL, but is less frequently seen in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL), reported in 3%-10% of patients. Between December 1982 and August 1997, 27 patients (14 male, 13 female) with a history of indolent B-cell NHL/CLL that had transformed to diffuse large B-cell lymphoma (DLCL) underwent autologous bone marrow transplantation (BMT). All patients were previously treated for indolent NHL/CLL with a median of threeprior therapies, and were similar with respect to whether transformation occurred early (< 18 months from diagnosis) or late.

Rituximab: Correlation Between Effector Cells and Clinical Activity in NHL

March 01, 1999

Unlabeled monoclonal antibodies (MoAbs) are attractive for the treatment of non-Hodgkin’s lymphoma (NHL) as they may: (1) mediate cytotoxicity with complement (complement-dependent cytotoxicity [CDC]) or effector cells (antibody-dependent cellular cytotoxicity [ADCC]); (2) effect apoptosis; (3) be less toxic, less immunogenic, and more effective than toxin- or drug-conjugated MoAbs; (4) not require the complex procedures needed for radiolabeled MoAb therapy (RIT); and (5) not produce the myelosuppression typical of high-dose RIT.

Rituximab: First Report of a Phase II Trial in NHL Patients With Bulky Disease

March 01, 1999

Rituximab (Rituxan) is the first monoclonal antibody (MoAb) approved for the treatment of non-Hodgkin’s lymphoma (NHL). This anti-CD20 MoAb is effective in inducing apoptosis, complement-dependent cytotoxicity (CDC), and antibody-dependent cellular cytotoxicity (ADCC). In single-agent studies in relapsed or refractory low-grade or follicular NHL (International Working Formula [IWF] types A-D), an overall response rate (ORR) of 48% has been reported.

Therapy for Early-Stage Colorectal Cancer

March 01, 1999

Drs. Peeters and Haller provide a thorough review of the recent historical development, current state of knowledge, and future of adjuvant therapy for early-stage colon and rectal cancers. They provide reasonable recommendations for the

Use of Brachytherapy to Preserve Function in Children With Soft-Tissue Sarcomas

March 01, 1999

This review of the use of brachytherapy (also known as interstitial or intracavitary radiation therapy) in children with soft-tissue sarcomas is well-written and timely. The authors have done an excellent job of summarizing the characteristics of the

Therapy for Early-Stage Colorectal Cancer

March 01, 1999

The article by Drs. Peeters and Haller provides the details of 20 years of investigation into the adjuvant therapy of colorectal cancer. The authors describe pivotal trials through which an international cast of investigators have identified adjuvant

Use of Brachytherapy to Preserve Function in Children With Soft-Tissue Sarcomas

March 01, 1999

Dr. Nag and colleagues provide an overview of brachytherapy, describe its application in pediatric oncology, and review the clinical experience in childhood solid tumors. The limited number of publications includes Dr. Nag’s own important, innovative clinical research using remote afterloading high-dose-rate (HDR) brachytherapy with twice-daily fractions in children with sarcoma.[1]

Commentary on Abstract #2567

March 01, 1999

The CHOP (cyclophosphamide, doxorubicin, Oncovin, and prednisone) regimen has been the standard approach to patients with advanced-stage intermediate-grade non-Hodgkin’s lymphoma (NHL) for more than 20 years.A randomized comparison between CHOP, m-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamide, Oncovin, and dexamethasone).

Commentary on Abstract #418

March 01, 1999

The currently available nucleoside analogs, such as fludarabine, have revolutionized the approach to the treatment of indolent lymphoid malignancies. Fludarabine is the most effective agent for the treatment of chronic lymphocytic leukemia (CLL) and also exhibits major activity in low-grade NHL. Despite the impressive rates of complete remissions, patients with these malignancies remain incurable, and new agents are needed.

Commentary on Abstracts #974 and #1297

March 01, 1999

Overexpression of the bcl-2 gene can be detected in approximately 80% to 90% of patients with advanced-stage follicular NHL, as well as in 20% to 30% of those with diffuse large B-cell NHL. A number of studies have attempted to correlate outcome with residual disease using PCR in patients who have achieved a clinical complete response with chemotherapy, antibody treatment, or high-dose therapy with stem-cell support. However, the studies have been inconsistent, and, therefore, the clinical value of such measurements has been limited.

Commentary on Abstracts #2984 and #2983

March 01, 1999

High-dose chemotherapy with autologous stem-cell support has clearly demonstrated efficacy in patients with relapsed or refractory Hodgkin’s disease (Horning et al: Blood 89:801-813, 1997) and is probably superior to salvage chemotherapy in this setting (Yuen et al: Blood 89:814-822, 1997). Disease burden and chemosensitivity have been shown to be predictive of long-term outcome following the transplant. However, a clear advantage may be difficult to demonstrate because of late complications, including secondary malignancies, particularly acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) (Roberts et al, abstract #2984).

Commentary on Abstract #1177

March 01, 1999

The relative clinical efficacy of autologous or allogeneic bone marrow transplantation (BMT) remains a controversial issue. In most series, outcomes with the two types of transplants have been comparable; relapse is more common with autologous BMT due to contamination of stem cells, whereas allogeneic BMT is associated with greater treatment-related mortality.

Commentary on Abstract #1992

March 01, 1999

The use of all-trans-retinoic acid (ATRA [Vesanoid]) has revolutionized the treatment of patients with acute promyelocytic leukemia (APL)(Tallman et al: N Engl J Med 337:1021-1028, 1997). However, a significant proportion of patients still relapse and die from their disease. Studies from China have indicated that arsenic trioxide is effective even in patients who did not respond to ATRA, and subsequent research has suggested that it works by a different mechanism of action (Shen et al: Blood 89:3354-3360, 1997).

Commentary on Abstract #1701

March 01, 1999

As more new therapeutic agents enter clinical trials, it becomes increasingly more important to have standardized response criteria. Uniform guidelines facilitate acquisition of comparable data, interpretation of data, comparisons of the results among various clinical trials, and identification of new agents with promising activity.

Commentary on Abstracts #2001 and #2000

March 01, 1999

The role of combined-modality therapy for Hodgkin’s disease was the subject of several abstracts presented at the ASH meeting. Radiation therapy has traditionally been the standard approach for patients with early-stage disease. However, several recent studies have suggested an important role for chemotherapy, either alone or in combination with radiation.

Commentary on Abstracts #1712, #1710, and #1715

March 01, 1999

Rituximab is a chimeric human-mouse anti-CD20 monoclonal antibody that has been studied most widely in patients with follicular non-Hodgkin’s lymphomas (NHLs). This antibody has induced responses in about half of these cases, including a 6% complete remission rate, with responses lasting a median of 11.6 months (McLaughlin et al: J Clin Oncol 16:2825-2833, 1998). Rituximab has only entered widespread clinical use over the past year. As a result, data are just beginning to emerge on the long-term results with this agent.

Commentary on Abstracts #1293 and #2002

March 01, 1999

Gerhartz and coworkers (abstract #1293) and the German Hodgkin’s Group (Diehl et al, abstract #2002) presented their results with interoup (Diehl et al, abstract #2002) presented their results with intensified regimens. The former investigators used a time-intensified COPP (cyclophosphamide, Oncovin, procarbazine, and prednisone)/ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) regimen with granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine, Prokine]) support. Complete remission rates were 62% with COPP/ABVD, as compared with 79% for the intensified regimen. This was taken as evidence of benefit from the higher-dose program. However, these findings are consistent with results that have been reportedfor ABVD and other anthracycline-containing regimens (Canellos et al:N Engl J Med 327:1478-84, 1992; Duggan et al: Proc Am Soc Clin Oncol 16:12a [abstract 43], 1997).

Commentary

March 01, 1999

Although thousands of patients have been treated with rituximab to date, researchers are just beginning to understand the basis on which this agent works. Rituximab is believed to induce tumor regression by several mechanisms of action, including antibody-dependent cellular cytotoxicity (ADCC), complement-mediated cytotoxicity (CDC), and induction of apoptosis. The mechanism by which apoptosis occurs also has not been clearly elucidated.

Commentary on Abstract #432

March 01, 1999

In general, rituximab has an acceptable toxicity profile. However, as the drug has been used more widely, new side effects have been identified that warranted a modification of the package insert. Approximately 70 serious infusion-related events have been reported, with 8 fatalities out of an estimated14,000 patients treated. Death was associated with bronchospasm, hypotension, and severe respiratory distress, with no clear predisposing factors.

Commentary on Abstracts #1173 and #2982

March 01, 1999

Allogeneic BMT has generally been limited to patients younger than age 50 to 55 years, and to those with good performance status and renal function. Several approaches are being evaluated to allow these poorer-risk patients to safely undergo transplantation. The successful use of submyeloablative (“mini”) transplants has previously been reported by groups from Israel (Slavin et al: Blood 91:756-73, 1998) and M. D. Anderson (Khouri et al: J Clin Oncol 16:2817-2824, 1998). A moderately myelosuppressive agent, such as cyclophosphamide (Cytoxan, Neosar), and an immunosuppressive drug, such as fludarabine (Fludara), are used as the preparative regimen. Following BMT, allogeneic donor leukocytes may be used to eliminate residual disease or mixed chimerism. Further study of this interesting approach is ongoing.

Commentary on Abstract #433

March 01, 1999

Although rituximab was approved for the treatment of follicular, low-grade NHL, it is also being evaluated in other CD20+ tumors. Responses have previously been reported in large cell NHL and mantle cell NHL (Coiffier et al: Blood 92:1927-1932, 1998). These authors used 8 weekly infusions of rituximab at two different doses in 54 patients with intermediate- or high-grade NHL or mantle cell NHL. The complete remission rate was 9% with an overall response rate of 31%. Median time to progression as of publication was 246+ days.

Commentary on Abstract #2479

March 01, 1999

The bcl-2 gene is overexpressed in 80% to 90% of patients with follicular NHL. The product of this gene, the bcl-2 protein, not only protects cells from apoptosis but also induces a form of acquired resistance to a wide array of chemotherapy agents (Kitada et al: Blood 91:3379-3389, 1998).

Commentary on Abstract #1711

March 01, 1999

Early reports suggested that therapy with rituximab might be less effective in patients with bulky nodal disease. At the ASH meeting, Davis et al (abstract #1711) reported on 31 patients with indolent NHL and masses measuring ³ 10 cm who received rituximab in four weekly infusions. Of the 31 patients, 1 patient (4%) had a complete remission, and 11 patients responded partially, for an overall response rate of 43%. However, the duration of response was only 8.1 months.

Commentary on Abstracts #1296, #1722, and #1721

March 01, 1999

The results published to date with Bexxar and IDEC-Y2B8 have been very promising. Bexxar is an iodine-131 anti-CD20 conjugate which, in a single-institution study including previously treated patients, achieved a response rate of 79%, including a 50% complete remission rate (Kaminski et al: J Clin Oncol 14:1974-1981, 1996), with complete remissions lasting a median of more than 16.5 months. Among previously treated patients, 71% achieved a complete remission and 39% attained a partial remission, for an overall response rate of 100%. The complete remissions lasted 3 to 17+ months (Kaminski et al : Proc Am Soc Clin Oncol 17:2a [abstract 6], 1998).

Commentary on Abstracts #1294, #1295, #1705, and #1706

March 01, 1999

The low-grade NHLs remain incurable with conventional therapies. A variety of new, unique agents are being evaluated, which, hopefully, will improve these results. The purine analogs, particularly fludarabine (Fludara), have shown impressive activity in these patients and have become part of the standard treatment armamentarium. In patients who have not responded to an alkylating agent, fludarabine achieves a 12% to 15% complete remission rate with an overall response rate of about 50%. When used as initial therapy, fludarabine produces a complete remission in almost 40% of patients and an overall response rate of 60% to 70% (Solal-Céligny: J Clin Oncol 14:514-519, 1996).

Commentary on Abstracts #481, #2672, #2673, and #1713

March 01, 1999

Rituximab is highly effective in eradicating detectable lymphoma cells from the peripheral blood and bone marrow of patients with follicular NHL and can render most patientsPCR-negative. Several studies at ASH evaluated the ability of this antibody to provide effective in vivo purging, permitting the harvesting of large numbers of PCR-negative stem cells for autologous BMT (Gianni et al, abstract #481; Buckstein et al, abstract #2672). Engraftment has been successful in the few patients transplanted to date (Flinn et al, abstract #2673). Obviously, longer follow-up of larger numbers of patients is needed to better evaluate the long-term impact of this approach.

Treatment of Estrogen Deficiency Symptoms in Women Surviving Breast Cancer, Part 3

March 01, 1999

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of a suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 47 breast cancer experts and 13 patient advocates participated. The proceedings of the conference are being published in six installments in successive issues of oncology. This third part focuses on the prevention of osteoporosis and the cardiovascular effects of estrogens and antiestrogens. [ONCOLOGY 13(3):397-432, 1999]

Therapy for Early-Stage Colorectal Cancer

March 01, 1999

Surgery is the only curative option for patients with colorectal cancer. The goal of other modalities, such as chemotherapy, immunotherapy, and radiotherapy, is to prolong survival and reduce the risk of recurrence.

Prostate Cancer Risk Assessment Program

March 01, 1999

Prostate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and

Commentary (Moul): Prostate Cancer Risk Assessment Program

March 01, 1999

Ms. Bruner and colleagues from Fox Chase Cancer Center are to be congratulated for their comprehensive, well-designed program to maximize our understanding of prostate cancer in young men who are at high risk for developing the disease. I

Commentary on Abstract #1718

March 01, 1999

Campath-1H is an anti-CD52 monoclonal antibody that has demonstrated impressive activity in patients with relapsed chronic lymphocytic leukemia (CLL) and in those with T-cell prolymphocytic leukemia (T-PLL). Initial clinical trials with this agent were terminated early because of excessive toxicity, ie, myelosuppression and infections. Nevertheless, the investigators were impressed by the activity of the antibody in patients with advanced CLL.

Commentary (Stanford/Ostrander): Prostate Cancer Risk Assessment Program

March 01, 1999

Bruner et al describe a model for risk assessment and genetic counseling of individuals and families at increased risk for prostate cancer. This model includes the establishment of a prostate cancer risk registry and screening clinic for unaffected

Commentary (Burke): Prostate Cancer Risk Assessment Program

March 01, 1999

Bruner and colleagues describe a comprehensive, long-term research program designed to understand, model, and modify prostate cancer risk. According to the investigators, the main problem with early prostate cancer risk screening is the