ONCOLOGY Vol 16 No 6 | Oncology

Cutting-Edge PET/CT Scanner Is Clinically Operational

June 01, 2002

The world’s first clinically operational molecular imager with lutetium oxyorthosilicate (LSO) technology-the biograph LSO, manufactured by Siemens Medical Solutions-has produced a precisely registered, combined positron-emission tomography (PET)/computed tomography (CT) image in 7 minutes at the Hong Kong Baptist Hospital. The biograph LSO imager uses the high-speed properties of LSO as the PET scintillator to provide shorter scan times and unmatched patient throughput.

NCI Expands Clinical Trial Access to Patients and Oncologists Nationwide

June 01, 2002

The National Cancer Institute (NCI) announced recently that it is expanding access to its clinical trials to more oncologists around the country. This new policy will allow cancer patients anywhere in the United States to participate more easily in advanced (phase III) treatment trials.

Specialists Publish Guide on Ductal Lavage for Breast Cancer Risk Assessment

June 01, 2002

In a recent issue of the Journal of the American College of Surgeons (194:648-656, 2002), a collective review led by Monica Morrow, MD, director of the Lynn Sage Comprehensive Breast Center at Northwestern Memorial Hospital in Chicago, presented recommendations on the use of ductal lavage in women at high risk for breast cancer. The article offers guidance on which women are most appropriate for ductal lavage and on how abnormal ductal lavage results should be managed.

Textbook of Lung Cancer

June 01, 2002

Lung cancer is a global problem fueled by the continuous use of tobacco in most countries, despite efforts at expanding smoking cessation programs. Several advances in the diagnosis and treatment of lung cancer were achieved in the past decade. This progress notwithstanding, most lung cancer patients succumb to their illness, and few enjoy long-term survival.

Screening Agent Helps Detect Prostate Cancer Recurrence Earlier

June 01, 2002

A study conducted by researchers at Duke University and Johns Hopkins Medical Centers and published in the journal Cancer (94:987-996) found that the use of indium-111-capromab pendetide (ProstaScint), a radiolabeled monoclonal antibody imaging agent, allowed identification of recurrent prostate cancer earlier than conventional imaging methods, such as the computed tomography (CT) scan. Prostate cancer recurs in nearly 40% of patients, and about 11% are at high risk for metastatic spread of the disease. Conventional imaging methods are often only able to detect a more advanced stage of prostate cancer.

Oncology Care Included in Medicare Disease Management Demonstrations

June 01, 2002

Oncology care will be the focus of one of the new Medicare disease management demonstration programs soon to be initiated. Medicare remains convinced that disease management services can provide substantial savings. There is, however, a problem: Fee-for-service Medicare, which includes most recipients, does not allow for disease management, except in one or two instances, such as diabetes self-education. The Medicare+Choice program-comprised mostly of health maintenance organizations-offers disease management, but seniors have, for the most part, avoided this plan. Therefore, Medicare has selected 15 sites for case management and disease management services, which will be offered to Medicare fee-for-service beneficiaries with complex chronic conditions. Quality Oncology, Inc, of McLean, Va, will implement an urban disease management program targeting beneficiaries in Broward County, Fla.

Liquid Pamidronate Disodium Injection Approved

June 01, 2002

Bedford Laboratories announced that it has received approval from the Food and Drug Administration to market pamidronate disodium for injection. The product will be the only liquid version available on the market, and is equivalent to the Novartis pamidronate disodium product (Aredia), a bone resorption inhibitor indicated for the treatment of hypercalcemia associated with malignancy, for Paget’s disease, and for osteolytic bone metastases of breast cancer and osteolytic lesions of multiple myeloma.

Consensus Guidelines Recommend HPV Testing After Borderline Pap Test Results

June 01, 2002

New clinical practice guidelines, published in a recent issue of the Journal of the American Medical Association (287:2120-2129, 2002), recommend that women who receive borderline Papanicolaou (Pap) test results designated as atypical squamous cells of undetermined significance (ASCUS)-a finding in more than 2 million American women each year-undergo testing for human papillomavirus (HPV). In clinical studies, HPV has been shown to be the primary causal factor in the development of cervical cancer.

Medical Liability Reform Resurrected

June 01, 2002

A bipartisan group of House of Representatives members is trying to pass a medical malpractice reform bill. Medical liability reform disappeared along with the Patients’ Bill of Rights, in which it was included, when the House and Senate failed to agree on a compromise version of the bill at the end of 1999.

InTouch Indexed in Medline and Index Medicus

June 01, 2002

InTouch magazine, a sister publication of ONCOLOGY and Oncology News International, has been selected by the National Library of Medicine to be indexed and included in Index Medicus and Medline. InTouch is published by PRR for cancer patients and their families.

FDA Approves New Treatment for Tamoxifen-Resistant Breast Cancer

June 01, 2002

The US Food and Drug Administration (FDA) has granted approval to AstraZeneca’s new breast cancer drug fulvestrant (Faslodex) for treatment of hormone-receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy, with, for example, tamoxifen. Fulvestrant is an estrogen-receptor antagonist without known agonist effects. It is the only estrogen-receptor antagonist to be proven effective after tamoxifen failure.

The Health Economics of Palliative Care

June 01, 2002

Payne, Coyne, and Smith present a concise review of the surprisingly meager literature regarding costs of end-of-life cancer care, an issue with substantial ethical and financial implications. They present evidence that improved coordination of care holds the potential to lower costs, or at least to offer better services at the same cost. The authors are to be commended for pursuing more rigorous studies regarding this difficult-to-quantify area of medical and social services. Moreover, they appropriately highlight the difficulties in attempting to capture direct costs of medical care and the far more elusive indirect costs.

Current Clinical Trials in Non-Hodgkin’s Lymphoma

June 01, 2002

The non-Hodgkin’s lymphomas (NHL) are the fifth most common cause of cancer in men and women in the United States, and the fifth and sixth leading causes of cancer deaths, respectively. Approximately 54,000 new cases are projected to be diagnosed in the United States this year,[1] 25% to 30% of which are indolent histologies, with the remainder being aggressive tumors.

Treatment of Dyspnea in Cancer Patients

June 01, 2002

A 54-year-old female seeks medical attention with a complaint of worsening exertional dyspnea of 3 to 4 weeks’ duration. She has a history of small-cell lung carcinoma, first diagnosed 3 months previously, and has had an excellent response to treatment, which included both chemotherapy and external-beam radiation. Consistent with her cancer diagnosis, she has a 30 pack-year history of cigarette smoking, and her pulmonary function tests indicate mild airflow obstruction, slight hyperinflation on lung volumes, and a mildly decreased diffusion capacity. In addition to her dyspnea with exertion, the patient describes symptoms of an intermittently productive cough, fatigue, and, recently, a poor appetite.

Commentary (Thigpen): Update on Radiation Therapy for Endometrial Cancer

June 01, 2002

Dr. Grigsby has done a masterful job of summarizing current information on the use of radiation in the management of patients with endometrial carcinoma. In the summary, he offers clear recommendations as to the appropriate management of various subsets of patients-recommendations that are based, at least to some extent, on the data reviewed. Such decision-making based on often incomplete information is necessary in the absence of appropriately designed randomized trials addressing the specific clinical situation. It is important, however, to understand clearly what we actually know and what we deduce from bits and pieces of data.

Surgical Management of Pancreatic Cancer

June 01, 2002

Drs. Ahrendt and Pitt should be congratulated on a comprehensive and well-presented review of the surgical management of pancreatic cancer. Unfortunately, pancreatic cancer continues to be a major cause of cancer-related death. The majority (80%) of patients still present with unresectable locally advanced or metastatic disease.

Surgical Management of Pancreatic Cancer

June 01, 2002

Adenocarcinoma of the pancreas remains a lethal malignancy: The majority of patients with pancreatic cancer continue to present with advanced disease and die within a year of diagnosis. Despite this grim fact, some progress has been made over the past decade, particularly in the surgical management of patients with resectable and advanced disease. This well-constructed review by Drs. Ahrendt and Pitt succinctly details the advances that have been made and highlights many of the unresolved issues.

Key Challenge for Antitobacco Activists

June 01, 2002

I read with interest the commentary by Drs. Michael S. Givel and Stanton A. Glantz, regarding state-level disbursement of monies generated by the Master Settlement Agreement with Big Tobacco, which appeared in the February 2002 issue of ONCOLOGY.[1] Unfortunately, the authors omitted the key challenge facing antitobacco activists. Although they accurately depicted underfunding of tobacco control programs (~5% of total annual allocated payments)-far lower than levels recommended by the Centers for Disease Control and Prevention (~25%)[2]-they failed to analyze the deceptive nature of how the remaining funds are being categorized.

The Health Economics of Palliative Care

June 01, 2002

Often, Congressional financing of programs can be secured only with indirect arguments. In the 1950s, the Eisenhower administration convinced Congress to fund the interstate highway system by claiming it was essential to enable Americans to evacuate cities in case of a nuclear attack by the Soviet Union. In the 1970s, advocates trying to persuade Congress to pay for dialysis argued that the procedure would be inexpensive, and that people would return to work and pay for themselves. Similarly, in the early 1980s, proponents of hospice advocated Medicare coverage because it was cheaper and better care for the dying.

Treatment of Dyspnea in Cancer Patients

June 01, 2002

Dyspnea is an extremely common symptom among cancer patients.[1] Like pain, it is inherently subjective and is best defined as the perception of difficulty in breathing, or an uncomfortable awareness of breathing. Although it may be associated with one or more physiologic disturbances (such as hypercapnia, hypoxia, obstructive or restrictive patterns on pulmonary function tests, or various abnormalities on chest imaging studies), it is not strongly associated with any specific abnormality and may occur in the absence of any. Patient self-report is the gold standard for assessment and may range from mild breathlessness on exertion to a terrifying sense of suffocation.

Commentary (Thompson): Update on Radiation Therapy for Endometrial Cancer

June 01, 2002

Dr. Grigsby does an excellent job of summarizing the accepted, stage-by-stage treatment recommendations as well as the controversies surrounding the treatment of endometrial carcinoma. This review is both important and timely, as we have seen the incidence of endometrial cancer increase over the past few years to the point where it is now the most common gynecologic malignancy.

Surgical Management of Pancreatic Cancer

June 01, 2002

It is with great pleasure that I comment on the excellent article authored by Drs. Ahrendt and Pitt, who have provided a well-written, succinct, up-to-date review focusing on adenocarcinoma of the pancreas. The authors introduce the topic, discuss preoperative staging and assessment of resectability, cover the critical issues regarding resectional therapy and palliative surgery, and provide data on the results of such therapy, including mortality, morbidity, and quality-of-life outcomes. Emphasizing the importance of this topic, the authors note that pancreatic cancer is the fifth leading cause of cancer death in the United States.

Update on Radiation Therapy for Endometrial Cancer

June 01, 2002

The best clinical outcomes for patients with endometrial cancer seem to be achieved with either surgery alone or a combination of surgery and radiation therapy. Although once administered preoperatively, irradiation is now

The Role of Docetaxel in the Management of Squamous Cell Cancer of the Head and Neck

June 01, 2002

The activity of docetaxel (Taxotere) as a single agent (overall response rates, 24%-45%) in the treatment of patients with recurrent squamous cell cancer of the head and neck has resulted in the investigation of docetaxel-based doublet and triplet combinations in both the recurrent and neoadjuvant settings. When combined with cisplatin, with or without fluorouracil (5-FU), in the treatment of recurrent disease, response rates of 33% to 44% have been observed for docetaxel, with median survival ranging from 9.6 to 11 months. In the neoadjuvant setting, response rates have been typically greater than 90%, with promising disease-free and overall survival results.

Docetaxel in the Management of Advanced or Metastatic Urothelial Tract Cancer

June 01, 2002

Phase II studies of single-agent docetaxel (Taxotere) yielded promising results in advanced or metastatic transitional cell carcinoma (TCC) of the urothelium. Antitumor responses have been demonstrated in previously treated and chemotherapy-naive TCC patients, as well as in a subgroup of patients with renal impairment unable to receive traditional cisplatin-based regimens.

Docetaxel in the Treatment of Ovarian Cancer

June 01, 2002

Docetaxel (Taxotere) has extended the armamentarium of agents with significant activity in the treatment of ovarian cancer. As a single agent in advanced ovarian cancer patients previously treated with a platinum agent, docetaxel at 100 mg/m² every 3 weeks yields a 30% overall response rate and a 6-month duration of response.

Docetaxel for Previously Treated Non-Small-Cell Lung Cancer

June 01, 2002

Two phase III trials were conducted using docetaxel (Taxotere), administered every 3 weeks, as second-line treatment of non-small-cell lung cancer (NSCLC) in patients previously treated with platinum-based chemotherapy. In the TAX 317 trial, 204 patients were randomized to receive either docetaxel (49 received 100 mg/m² and 55 received 75 mg/m²) or best supportive care (100 patients). Median survival was 7.5 months with docetaxel at 75 mg/m² (D75) vs 4.6 months for best supportive care (P = .010); and 1-year survival was 37% for D75 vs 11% for best supportive care (P = .010).

Integration of Docetaxel Into Adjuvant Breast Cancer Treatment Regimens

June 01, 2002

Adjuvant chemotherapy is an integral component of the multidisciplinary curative treatment of primary breast cancers. The experience of the last 3 decades indicates that anthracycline-containing regimens provide the most effective cytotoxic treatment for this purpose.

Surgical Management of Pancreatic Cancer

June 01, 2002

Pancreatic cancer is the fifth leading cause of cancer death in the United States, with an overall survival rate of 3%. Unfortunately, only a minority of patients present with localized disease amenable to surgical resection.

Primary Chemotherapy With Docetaxel for the Management of Breast Cancer

June 01, 2002

Several clinical trials have explored the efficacy of docetaxel (Taxotere) as primary chemotherapy for breast cancer. Docetaxel has been evaluated as single-agent therapy, sequentially as a single agent following anthracycline-containing regimens, and in combination with anthracyclines, cisplatin, and trastuzumab (Herceptin) in patients with high-risk early breast cancer.

Docetaxel for Locally Advanced or Metastatic Non-Small-Cell Lung Cancer

June 01, 2002

Docetaxel (Taxotere) has shown activity both as a single-agent and in combination with multiple other cytotoxic agents in the front-line therapy of advanced, metastatic non-small-cell lung cancer (NSCLC). A randomized, phase III trial demonstrated a survival advantage for docetaxel over best supportive care in the front-line setting, with docetaxel achieving a 2-year survival of 12% vs 0% for best supportive care. Combinations of docetaxel with the platinum agents have been the most extensively studied in the front-line setting and have produced notably high response rates and encouraging median survivals.

Treatment of Dyspnea in Cancer Patients

June 01, 2002

Dyspnea is defined as a sensation of difficult or uncomfortable breathing. The symptom is highly prevalent among cancer patients with and without direct lung involvement. The gold standard of assessment is based on

Docetaxel for Gastric and Esophageal Carcinomas

June 01, 2002

Docetaxel (Taxotere) has been successfully investigated in the therapy for advanced gastroesophageal tumors as both a single agent and in combination regimens. As a single agent, phase II study results demonstrate an overall response rate of 17% to 24%, with occasional complete responses in a disease in which complete responses are rare. These figures classify docetaxel among the most active agents for the disease.

The Current Status of Docetaxel for Metastatic Breast Cancer

June 01, 2002

Docetaxel (Taxotere) has been intensively investigated for the treatment of metastatic breast cancer, where it has proved to be one of the most active agents. Initial phase II studies in anthracycline-resistant metastatic breast cancer demonstrated impressive response rates that have been confirmed in phase III randomized trials.

The Health Economics of Palliative Care

June 01, 2002

Only a few studies have assessed the economic outcomes of palliative therapy. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy

Current Perspectives on Pain in AIDS, Part 1

June 01, 2002

As active participants in the care of patients with acquired immunodeficiency syndrome (AIDS), oncologists need to be aware of the many facets of pain management in this population. This two-part article, which will conclude in the July 2002 issue, describes the prevalence and types of pain syndromes encountered in patients with AIDS, and reviews the psychological and functional impact of pain as well as the barriers to adequate pain treatment in this group and others with human immunodeficiency virus (HIV)-related disease.

Docetaxel in the Integrated Management of Prostate Cancer

June 01, 2002

Docetaxel (Taxotere)-based regimens can be included among the most effective treatment options for the management of patients with advanced, androgen-independent prostate cancer. Results with docetaxel as a single agent and in combination regimens with estramustine (Emcyt) have consistently achieved a palliative response, reduced serum PSA levels by 50% or more, and produced objective responses in patients with measurable disease. In addition, encouraging survival data have been demonstrated in several phase II trials.

The Current Status of Docetaxel in Solid Tumors

June 01, 2002

In less than a decade, docetaxel (Taxotere) has progressed from initial studies in anthracycline-refractory metastatic breast cancer to several large, phase III randomized trials evaluating its efficacy as adjuvant, neoadjuvant, and first-line therapy for metastatic breast cancer, non-small-cell lung cancer (NSCLC), and ovarian cancer. In other tumor types, including prostate, head and neck, gastric, and bladder cancer, ongoing phase III trials are comparing docetaxel-containing regimens to previously established regimens. For the seven tumor types reviewed in this supplement, phase III study information for docetaxel or docetaxel-based combinations are presented. Impressive results have been consistently demonstrated in the trials reported to date.

Docetaxel and Radiation as Combined-Modality Therapy

June 01, 2002

Combined-modality approaches for the treatment of non-small-cell lung cancer (NSCLC), head and neck cancer, and esophageal cancer offer survival benefits by improving locoregional control and treating micrometastatic disease. The taxanes are active, tolerable drugs in these solid tumors and have radiation-sensitizing activity.

Men Underestimate Their Prostate Cancer Risk

June 01, 2002

Men underestimate their chance of developing prostate cancer even when they are considered "at risk" for the disease, according to a new study conducted by researchers at the Fox Chase Cancer Center in Philadelphia. The findings were

Surgical Management of Pancreatic Cancer

June 01, 2002

Drs. Ahrendt and Pitt should be congratulated on a comprehensive and well-presented review of the surgical management of pancreatic cancer. Unfortunately, pancreatic cancer continues to be a major cause of cancer-related death. The majority (80%) of patients still present with unresectable locally advanced or metastatic disease.

Smoking Cessation Counseling Needed With Spiral CT Screening for Lung Cancer

June 01, 2002

Only 19% of current smokers say they would quit smoking if a computed tomography (CT) scan to detect lung cancer was negative, but 91% say they would want smoking cessation counseling. These findings are part of a Fox Chase Cancer Center study that measured attitudes and beliefs about the uses of spiral CT for early detection of lung cancer among a high-risk population. The study was presented at a recent meeting of the American Society of Preventative Oncology held in Bethesda, Md.