ONCOLOGY Vol 20 No 12 | Oncology

Outliers in Testicular Cancer Management

November 01, 2006

Although testicular cancer is a rare disease accounting for only 1% of all male neoplasms, it represents a paradigm for cancer curability. Overall, more than 95% of patients can expect to be cured of their disease with minimal long-term toxicity. Given these expectations, it is critical that cancer care providers are familiar with the diagnostic and therapeutic challenges encountered in these rare patients. In particular, clinicians managing these patients should be aware of some of the pitfalls encountered when determining relapse. In a series of case presentations, we review the evaluation and management of patients with persistent elevation of serum tumor markers and postchemotherapy residual radiographic abnormalities.

Cancer of the Cervix: Current Management and New Approaches: Review 2

November 01, 2006

This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

Further Thoughts on a Rare Entity

November 01, 2006

Primary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.

Data From Pivotal Phase III SMART Trial Support NDA Filing for Novel Agent

November 01, 2006

Pharmacyclics, Inc, announced that new data and analyses supporting the company's decision to file a new drug application (NDA) for motexafin gadolinium (Xcytrin) were presented at the 2006 annual meeting of the American Society of Clinical Oncology (ASCO). This abstract was selected by the ASCO Scientific Program Committee to be featured in the "2006 Best of ASCO Meetings" in June.

'DES Daughters' at Higher Risk for Breast Cancer

November 01, 2006

So-called "DES daughters," born to mothers who used the antimiscarriage drug diethylstilbestrol (DES) during pregnancy, are at a substantially greater risk of developing breast cancer compared to women who were not exposed to the drug in utero.

FDA Approves Bevacizumab Plus Chemotherapy to Treat NSCLC

November 01, 2006

Genentech, Inc, announced recently that the US Food and Drug Administration (FDA) has approved bevacizumab (Avastin) to be used in combination with carboplatin and paclitaxel chemotherapy for the first-line treatment of patients with unresectable, locally advanced, recurrent or metastatic nonsquamous, non-small-cell lung cancer (NSCLC), the most common type of lung cancer.

Cancer of the Cervix: Current Management and New Approaches: Review 3

November 01, 2006

This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

First Oral Liquid Formulation of Tamoxifen Launched

November 01, 2006

Cytogen Corporation recently announced that Soltamox (tamoxifen citrate, oral solution 10 mg/5 mL), the first liquid form of the hormonal breast cancer therapy tamoxifen, is currently being introduced in the United States and is available in US pharmacies nationwide.

First HDAC Inhibitor Approved by FDA to Treat Cutaneous Effects of CTCL

November 01, 2006

Merck & Co, Inc, recently announced that the Food and Drug Administration (FDA) has approved oral vorinostat (Zolinza), 400 mg once daily, for the treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL), a form of non-Hodgkin's lymphoma, who have progressive, persistent, or recurrent disease on or following two systemic therapies. CTCL is a cancer of the T cells that affects the skin.

Pulmonary Carcinoid Tumors: The Need for Tailored Assessment

November 01, 2006

Primary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.

Management of Difficult Germ-Cell Tumors: Review 2

November 01, 2006

Although testicular cancer is a rare disease accounting for only 1% of all male neoplasms, it represents a paradigm for cancer curability. Overall, more than 95% of patients can expect to be cured of their disease with minimal long-term toxicity. Given these expectations, it is critical that cancer care providers are familiar with the diagnostic and therapeutic challenges encountered in these rare patients. In particular, clinicians managing these patients should be aware of some of the pitfalls encountered when determining relapse. In a series of case presentations, we review the evaluation and management of patients with persistent elevation of serum tumor markers and postchemotherapy residual radiographic abnormalities.

Advances in the Treatment of Cervical Cancer

November 01, 2006

This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

Managing Non-Small-Cell Lung Cancer: Further Considerations

November 01, 2006

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Before 1980, radiotherapy was considered the only real recourse in advanced disease. In 1995, a landmark meta-analysis of trials conducted in the 1980s and early 1990s demonstrated a survival benefit with platinum-based chemotherapy. Newer chemotherapy agents and improved supportive care measures have allowed more patients to benefit from chemotherapy with reduced toxicity. Concurrent platinum-based chemotherapy and radiotherapy has improved the survival in stage III disease, and recently chemotherapy has also demonstrated improved survival in resected early-stage disease. The majority of patients still present with advanced unresec disease for whom the prognosis remains poor, but for key subpopulations the outlook has improved markedly since the emergence of targeted therapies directed against the epidermal growth factor receptor and vascular endothelial growth factor receptor pathways. Patient selection and the incorporation of targeted therapies with cytotoxic chemotherapy are the focus of many ongoing studies, and there is an abundance of new agents undergoing clinical trials. Together, these developments have moved us away from the nihilism of 20 years ago into an era of unprecedented optimism in taking on the many remaining challenges of managing NSCLC in the 21st century.

Thalidomide Added to Standard Therapy Improves Survival in Newly Diagnosed Multiple Myeloma

November 01, 2006

Data presented at the 42nd annual meeting of the American Society of Clinical Oncology (ASCO) in Atlanta demonstrates that the addition of thalidomide to standard therapy improves overall survival in patients with newly diagnosed multiple myeloma. These data from a three-arm phase III study in newly diagnosed, elderly multiple myeloma patients were presented at an ASCO plenary session.

Quick Reference for Oncology Clinicians

November 01, 2006

As a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.

Early Lung Cancer Detection: Approaching the 'Tipping Point'?

November 01, 2006

On October 20, 2006, the International-Early Lung Cancer Action Program (I-ELCAP), an international consortium of leading early lung cancer detection researchers and allied health-care providers including radiologists, thoracic surgeons, pulmonologists, oncologists, statisticians, research nurses, and computer scientists

Developing CT Image-Processing Tools to Accelerate Progress in Lung Cancer Drug Development

November 01, 2006

On April 21, 2005, the Cancer Research and Prevention Foundation (CRPF), in conjunction with academic researchers, federal scientists, lung cancer advocates, and representatives of a number of pharmaceutical and diagnostic imaging companies, participated in a workshop held in Annapolis, Md, on the development of high-resolution spiral computed tomography (CT) imaging tools to assess therapeutic response in lung cancer clinical trials. In this report, we will address developments that led up to that workshop, what was discussed, and recommendations that came out of the meeting.

Management of Difficult Germ-Cell Tumors

November 01, 2006

Although testicular cancer is a rare disease accounting for only 1% of all male neoplasms, it represents a paradigm for cancer curability. Overall, more than 95% of patients can expect to be cured of their disease with minimal long-term toxicity. Given these expectations, it is critical that cancer care providers are familiar with the diagnostic and therapeutic challenges encountered in these rare patients. In particular, clinicians managing these patients should be aware of some of the pitfalls encountered when determining relapse. In a series of case presentations, we review the evaluation and management of patients with persistent elevation of serum tumor markers and postchemotherapy residual radiographic abnormalities.

Cancer of the Cervix: Current Management and New Approaches

November 01, 2006

This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

Primary Carcinoid Tumors of the Lung: A Role for Radiotherapy

November 01, 2006

Primary neuroendocrine neoplasms of the lung represent a clinical spectrum of tumors ranging from the relatively benign and slow-growing typical carcinoid to the highly aggressive small-cell lung carcinoma. The rarity of carcinoids has made the role of radiation therapy in their management controversial. This review considers the results of published studies to generate treatment recommendations and identify areas for future research. Surgery remains the standard of care for medically operable disease. Histology plays the most important role in determining the role of adjuvant radiation. Resected typical carcinoids likely do not require adjuvant therapy irrespective of nodal status. Resected atypical carcinoids and large-cell neuroendocrine carcinomas have a significant risk of local failure, for which adjuvant radiation likely improves local control. Definitive radiation is warranted in unresectable disease. Palliative radiation for symptomatic lesions has demonstrated efficacy for all histologies. Collaborative group trials are warranted.

From Radiotherapy to Targeted Therapy: 20 Years in the Management of Non-Small-Cell Lung Cancer

November 01, 2006

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Before 1980, radiotherapy was considered the only real recourse in advanced disease. In 1995, a landmark meta-analysis of trials conducted in the 1980s and early 1990s demonstrated a survival benefit with platinum-based chemotherapy. Newer chemotherapy agents and improved supportive care measures have allowed more patients to benefit from chemotherapy with reduced toxicity. Concurrent platinum-based chemotherapy and radiotherapy has improved the survival in stage III disease, and recently chemotherapy has also demonstrated improved survival in resected early-stage disease. The majority of patients still present with advanced unresec disease for whom the prognosis remains poor, but for key subpopulations the outlook has improved markedly since the emergence of targeted therapies directed against the epidermal growth factor receptor and vascular endothelial growth factor receptor pathways. Patient selection and the incorporation of targeted therapies with cytotoxic chemotherapy are the focus of many ongoing studies, and there is an abundance of new agents undergoing clinical trials. Together, these developments have moved us away from the nihilism of 20 years ago into an era of unprecedented optimism in taking on the many remaining challenges of managing NSCLC in the 21st century.