ONCOLOGY Vol 14 No 9

Politics may have a little something to do with nearing congressional passage of a bill (S. 662/H.R. 1070) that would allow states to provide medical treatment via Medicaid for low-income women who have been diagnosed with breast or cervical cancer through the CDC’s National Breast and Cervical Cancer Early Detection Program. In the decade that the program has existed, about 1 to 1.5 million women have been screened, with 6,000 cases of breast cancer and 500 of cervical cancer being found. But once diagnosed, these women, whose incomes are too high for Medicaid and who do not have personal health insurance, have to search for “donated” medical care. The Senate bill, originally sponsored by now-deceased Sen. John Chafee, passed the Senate Finance Committee at the end of June. It now goes to the floor, where passage seems assured. The House bill, which passed in May, is sponsored by Rep. Rick Lazio (R-NY), now knee-deep in a high-profile New York Senate race with Hillary Clinton. House Republicans are eager to give Lazio something to talk about. The cost of the measure will be about $50 million a year to the federal government, which contributes about $3 for each $1 that states contribute to the Medicaid pot. Nonetheless, the Senate Finance Committee was concerned enough about a potential precedent to include in its report a sentence saying that this benefit “shall not be viewed as a precedent for extending Medicaid eligibility body-part by body-part.”

The prevention and treatment of invasive fungal infections is being improved by the relatively recent introduction of new antifungal agents. While some of these agents offer better efficacy, others are proving their value more in improved tolerability, said John R.

Surviving cancer is a joyous thing in itself. A new awards program will spotlight that joy and share the stories of 12 survivors who are “everyday heroes,” in an effort to help others who are struggling with the disease.

Hematopoietic Cell Transplantation, edited by Drs. Thomas, Blume, and Forman, is an excellent updated second edition of their comprehensive textbook designed for both practitioners involved in transplantation and those interested in the science of stem-cell transplantation.

Initial data from a phase II study of exemestane (Aromasin) as first-line treatment of advanced breast cancer in postmenopausal women suggest that the new agent may extend the time that patients remain free of tumor growth compared to tamoxifen (Nolvadex).

A potential new treatment under development for prostate cancer may offer clinical advantages, researchers reported at the annual meeting of the American Urological Association in Atlanta.

The Health Care Financing Administration (HCFA) proposed increased reimbursement for two heavily used chemotherapy administration codes (90408 and 90410), but not nearly as much as ASCO had been pushing for. AMA’s relative value update committee (RUC) voted to accept ASCO’s data justifying an increase in the clinical staff time related to an oncologist’s expenses associated with both codes.This recommendation was forwarded to HCFA. Clinical staff time-the time a nurse or staff spends giving chemotherapy or educating a patient-is figured into the “practice expense,” which, with “physician work” (time spent face-to-face with the patient) and “malpractice expense,” is part of the formula for determining a CPT code’s relative value, which dictates reimbursement. However, HCFA slightly lowered the clinical staff times recommended by the RUC. Julie Taylor, deputy director of public policy for ASCO, says the group will be submitting comments to HCFA to accept the RUC recommendation. HCFA’s final decision will go into effect on January 1, 2001.

AstraZeneca announced recently that the US Food and Drug Administration (FDA) has approved use of its breast cancer drug tamoxifen (Nolvadex) to reduce the risk of invasive breast cancer in women with ductal carcinoma in situ (DCIS) following breast surgery and radiation.

Individual physicians and those in small group practices are urged to begin implementing internal audit procedures for “high risk” billing operations.

Irinotecan (Camptosar) in combination with cisplatin (Platinol) increased survival, compared with the current standard treatment for patients with extensive small-cell lung cancer, according to data from a phase III study presented at the annual meeting of the American Society of Clinical Oncology (ASCO).

In treating cancer, discovering new ways to use or modify old drugs can sometimes be as valuable as the identification of new drugs. This point is elegantly illustrated in Dr. Schilsky’s article about capecitabine (Xeloda), a prodrug that leads to high intratumoral levels of fluorouracil (5-FU).

Recently, there has been much controversy over whether patients with prostate cancer should be treated with bisphosphonates not only to decrease pain, but to prevent metastasis.

Commonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven

Commonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven

Patients with locally advanced cervical cancer comprise a significant proportion of the total population with cervical cancer, particularly in developing countries. The inability to control pelvic tumors is still a significant

Adjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including

Commonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven

Adjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including

Adjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including

In this issue of Oncology, Dr. Schilsky has provided a comprehensive yet concise review of the pharmacology of the fluoropyrimidines and, in particular, capecitabine (Xeloda).

Thrombocytopenia occurs at various grades of severity in patients with nonmyeloid malignancies undergoing chemotherapy with myelosuppressive agents. Frequently, it is the major dose-limiting hematologic toxicity, especially in the treatment of potentially curable malignancies such as leukemia, lymphomas, and pediatric cancers.

In order to derive maximum benefit from treatment with chemotherapeutic agents, adherence to the established chemotherapy dose and schedule is imperative.

Recently, there has been much controversy over whether patients with prostate cancer should be treated with bisphosphonates not only to decrease pain, but to prevent metastasis.

Preclinical studies have shown that rhIL-11, also known as oprelvekin (Neumega), stimulates early and later stages of megakaryocytopoiesis (including proliferation and differentiation of megakaryocyte precursors and maturation of megakaryocytes), to

Adjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including

Patients with locally advanced cervical cancer comprise a significant proportion of the total population with cervical cancer, particularly in developing countries. The inability to control pelvic tumors is still a significant

Placebo-controlled clinical trials of recombinant human interleukin-11 (rhIL-11, also known as oprelvekin [Neumega]) in patients with nonmyeloid malignancies have demonstrated significant efficacy in preventing postchemotherapy

Capecitabine (Xeloda) is a new, orally administered, enzyme-activated fluoropyrimidine carbamate designed to generate high levels of fluorouracil (5-FU) in tumor cells. Selective tumor activation of 5´-deoxy-5-fluorouridine,

Capecitabine (Xeloda) is a new, orally administered, enzyme-activated fluoropyrimidine carbamate designed to generate high levels of fluorouracil (5-FU) in tumor cells. Selective tumor activation of 5´-deoxy-5-fluorouridine,

Safety data from two randomized phase II and one abbreviated phase III placebo-controlled, double-blind clinical studies in adult patients with nonmyeloid malignancies indicate that recombinant human interleukin-11 (rhIL-11, also known as oprelvekin [Neumega]) has an acceptable toxicity profile as therapy for the mitigation of chemotherapy-induced thrombocytopenia.