ONCOLOGY Vol 21 No 2 | Oncology

Moving Forward in Hormone-Refractory Prostate Cancer: From Understanding Biology to Advancing Therapy

February 01, 2007

Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.

Lung Cancer Alliance Launches Website to Educate Those at Highest Risk

February 01, 2007

The Lung Cancer Alliance (LCA) recently launched screenforlungcancer.org, a new website aimed at educating people at risk for lung cancer about the importance of yearly low-dose computed tomography (CT) screening to promote early detection of the disease.

Breakthroughs Fuel Nurses' Need to Learn

February 05, 2007

One cannot pick up a newspaper, magazine, or even a professional journal without reading about the increasing pace of scientific discoveries and the expanded potential for medical breakthroughs in the postgenomic era. In particular, there is great emphasis placed on the unprecedented opportunity for incredible new tools to address the cancer problem.

Intraperitoneal Therapy for Ovarian Cancer Reconsidered

February 01, 2007

Intraperitoneal (IP) chemotherapy is a preferred treatment option that should be offered to all women for front-line treatment of stage III optimally debulked ovarian cancer. Patients should be provided with information on the survival and toxicity for both IP and intravenous (IV) therapies, as well as practical information about the administration of each regimen, so that they may play an active role in the decision-making process. When making a decision between IP and IV therapeutic options, the experience and preference of the oncologist are critical factors in determining appropriate therapy for each woman.

State of the Art in Lung Cancer: A Glass One-Quarter Full?

February 01, 2007

Surgery remains the initial treatment for patients with early-stage non-small-cell lung cancer (NSCLC). Additional therapy is necessary because of high rates of distant and local disease recurrence after surgical resection. Early trials of adjuvant chemotherapy and postoperative radiation were often plagued by small patient sample size, inadequate surgical staging, and ineffective or antiquated treatment. A 1995 meta-analysis found a nonsignificant reduction in risk of death for postoperative cisplatin-based chemotherapy. Since then, a new generation of randomized phase III trials have been conducted, some of which have reported a benefit for chemotherapy in the adjuvant setting. The role of postoperative radiation therapy remains to be defined. It may not be beneficial in early-stage NSCLC but still may have utility in stage IIIA disease. Improvement in survival outcomes from adjuvant treatment are likely to result from the evaluation of novel agents, identification of tumor markers predictive of disease relapse, and definition of factors that determine sensitivity to therapeutic agents. Some of the molecularly targeted agents such as the angiogenesis and epidermal growth factor receptor inhibitors are being incorporated into clinical trials. Preliminary results with gene-expression profiles and lung cancer proteomics have been promising. These techniques may be used to create prediction models to identify patients at risk for disease relapse. Molecular markers such as ERCC1 may determine response to treatment. All of these innovations will hopefully increase cure rates for lung cancer patients by maximizing the efficacy of adjuvant therapy.

Talking About a Cancer Diagnosis

February 05, 2007

Cancer is a life-altering experience, and newly diagnosed cancer patients need information throughout the course of their disease. In the 1970s, Weissman and Worden identified the first 100 days surrounding the diagnosis of cancer as an "existential plight" in which patients suddenly confront their mortality.[1] During this fragile period of fear and anxiety, the need for information is tantamount to the patient's mental well-being. Providing quality information to cancer patients and their families is an essential aspect of care, but it is not always clear how and when information should be delivered. The purpose of this article is to suggest simple steps for talking with patients about their diagnosis, assessing their understanding, and facilitating their ability to share their concerns, fears, and hopes.

Skilled Telephone Triage Programs Streamline Symptom Management

February 05, 2007

When Kristin Cawley, RN, bgins her day at Memorial Sloan-Kettering Cancer Center (MKSCC) in New York City, she has two essential tools at her fingertips: a set of telephone triage protocols and a standard documentation form. In the next 10 hours, she will see patients and confer with their physicians. But like the 400 other RNs in ambulatory care at MSKCC, she will also talk to dozens of patients on the phone. Most of those calls will concern symptoms and will draw on Cawley's specially honed skills in telephone triage.

Avoiding Stress and Burnout in Cancer Care

February 01, 2007

Over the past 8 years, I have led discussions and had private conversations about stress and burnout with oncologists of all stripes. Several common themes have emerged with regard to what it is that stresses and burns out oncologists and what helps them the most.

GVAX Immunotherapy Produces Encouraging Survival Data in Pancreatic Cancer Patients

February 01, 2007

Cell Genesys, Inc, announced follow-up data from a phase II clinical trial of GVAX immunotherapy for pancreatic cancer in 60 patients with operable pancreatic cancer who received the immunotherapy after surgical resection of their tumor and adjuvant radiation and chemotherapy.

IP Therapy in Front-Line Care for Advanced Ovarian Cancer

February 01, 2007

Intraperitoneal (IP) chemotherapy is a preferred treatment option that should be offered to all women for front-line treatment of stage III optimally debulked ovarian cancer. Patients should be provided with information on the survival and toxicity for both IP and intravenous (IV) therapies, as well as practical information about the administration of each regimen, so that they may play an active role in the decision-making process. When making a decision between IP and IV therapeutic options, the experience and preference of the oncologist are critical factors in determining appropriate therapy for each woman.

Radioimmunotherapy: An Underutilized Alternative

February 01, 2007

Tositumomab/iodine-131 tositumomab (Bexxar) and ibritumomab tiuxetan (Zevalin) are radioimmunoconjugates targeting the CD20 antigen. Both agents are approved in the United States for use in relapsed or refractory, indolent or transformed, B-cell lymphoma. These agents are well tolerated and have the highest levels of single-agent activity observed in these histologies. This review will summarize the key trials that led to approval of both I-131 tositumomab and ibritumomab tiuxetan, and then focus on four novel therapeutic concepts in radioimmunotherapy: retreatment, therapy of de novo indolent lymphoma, therapy of aggressive histologies, and incorporation in high-dose therapy programs utilizing autologous stem cell support.

Liposomal Vincristine Receives Orphan Drug Designation for Treatment of ALL

February 01, 2007

Hana Biosciences, a biopharmaceutical company focused on advancing cancer care, recently announced that the US Food and Drug Administration (FDA) has granted orphan drug designation for vincristine sulfate liposomes injection (Marqibo) in the treatment of adult patients with acute lymphoblastic leukemia (ALL).

Managing Myelodysplastic Syndromes

February 05, 2007

Mr. CH is a 71-year-old retired naval officer who works full time as an aerospace engineer. He began experiencing increasing lethargy and malaise in August 2000 at the age of 65. He was finding it difficult to concentrate and became tired by the end of the day. An evaluation by his primary care physician revealed anemia and iron deficiency. CH received a trial of iron and erythropoietin with no substantial improvement. His anemia progressed; he required his first red blood cell transfusion in September 2001. He was referred to a hematologist at a regional comprehensive cancer center.

Cutaneous T-Cell Lymphoma: From Genetics to Clinical Practice

February 01, 2007

This challenging supplement to ONCOLOGY is based on the proceedings of a closed expert symposium, and provides an overview of our current knowledge on primary cutaneous T-cell lymphomas (CTCL). The complete spectrum from genetics to clinical practice is covered.

Tumor Lysis Syndrome

February 05, 2007

Physical exam revealed an enlarged spleen and right axillary lymph node. Her bloodwork is remarkable for an elevated lactate dehydrogenase (LDH) of 550 U/L and a creatinine of 2.0 mg/dL. Mrs. Reynolds is a retired actress and lifelong nonsmoker who drinks 1 to 2 glasses of wine a week and denies illicit drug use. Her health history includes the vaginal delivery of two healthy babies in her 20s and hypercholesterolemia, which has been controlled by diet.

Upward Trend in Liver Cancer Deaths Despite Decline in Deaths From Other Cancers

February 01, 2007

Deaths from liver cancer increased over the past year in both men and women, reported the American Liver Foundation, a national nonprofit organization that provides education, advocacy, and research on behalf of the 30 million Americans affected by liver disease. This is despite recent news focusing on the overall decline in the number of deaths due to most cancers.

sNDA Accepted for Liposomal Doxorubicin/Bortezomib in Relapsed/Refractory Multiple Myeloma

February 01, 2007

Ortho Biotech recently announced that the US Food and Drug Administration (FDA) has accepted an application for doxorubicin HCl liposome injection (Doxil) as combination therapy with bortezomib (Velcade) to treat patients with multiple myeloma who have received at least one prior therapy.

Building on the Promise of Radioimmunotherapy

February 01, 2007

Tositumomab/iodine-131 tositumomab (Bexxar) and ibritumomab tiuxetan (Zevalin) are radioimmunoconjugates targeting the CD20 antigen. Both agents are approved in the United States for use in relapsed or refractory, indolent or transformed, B-cell lymphoma. These agents are well tolerated and have the highest levels of single-agent activity observed in these histologies. This review will summarize the key trials that led to approval of both I-131 tositumomab and ibritumomab tiuxetan, and then focus on four novel therapeutic concepts in radioimmunotherapy: retreatment, therapy of de novo indolent lymphoma, therapy of aggressive histologies, and incorporation in high-dose therapy programs utilizing autologous stem cell support.

NCCN Updates Antiemesis Guidelines

February 01, 2007

The National Comprehensive Cancer Network (NCCN) recently announced updates to the NCCN Antiemesis Guidelines. The NCCN Clinical Practice Guidelines in Oncology are used extensively by managed care companies and by Medicare as the basis for coverage policies. The guidelines have a new recommendation for breakthrough treatment—Nabilone (Cesamet, Valeant)—for chemotherapy-induced nausea/vomiting.

Non-Small-Cell Lung Cancer Adjuvant Therapy: Translating Data Into Reality

February 01, 2007

Surgery remains the initial treatment for patients with early-stage non-small-cell lung cancer (NSCLC). Additional therapy is necessary because of high rates of distant and local disease recurrence after surgical resection. Early trials of adjuvant chemotherapy and postoperative radiation were often plagued by small patient sample size, inadequate surgical staging, and ineffective or antiquated treatment. A 1995 meta-analysis found a nonsignificant reduction in risk of death for postoperative cisplatin-based chemotherapy. Since then, a new generation of randomized phase III trials have been conducted, some of which have reported a benefit for chemotherapy in the adjuvant setting. The role of postoperative radiation therapy remains to be defined. It may not be beneficial in early-stage NSCLC but still may have utility in stage IIIA disease. Improvement in survival outcomes from adjuvant treatment are likely to result from the evaluation of novel agents, identification of tumor markers predictive of disease relapse, and definition of factors that determine sensitivity to therapeutic agents. Some of the molecularly targeted agents such as the angiogenesis and epidermal growth factor receptor inhibitors are being incorporated into clinical trials. Preliminary results with gene-expression profiles and lung cancer proteomics have been promising. These techniques may be used to create prediction models to identify patients at risk for disease relapse. Molecular markers such as ERCC1 may determine response to treatment. All of these innovations will hopefully increase cure rates for lung cancer patients by maximizing the efficacy of adjuvant therapy.

Hormone-Resistant Prostate Cancer: New Therapies Needed

February 01, 2007

Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.

Antiangiogenic agents

February 05, 2007

FDA-Approved Drugs: bevacizumab (Avastin), sorafenib (Nexavar), sunitinib (Sutent) Investigational Drugs: vatalanib (PTK787, Novartis), AMG 706 (Amgen), GW-786034 (GlaxoSmithKline), ZD6474 (AstraZeneca)

Adult Sarcomas: A Missed Opportunity for Sustained Cooperative Group Translational and Clinical Research

February 01, 2007

Preclinical advances offer an opportunity to further reduce morbidity and mortality from sarcomas over the next decade. Since no single institution or North American cooperative oncology group has the expertise or patient resources for histology-specific clinical and translational research on adult sarcomas, efforts have been made to develop funding from the National Cancer Institute (NCI). One such initiative was the Intergroup Coalition Against Sarcomas (ICAS), which, building upon the strengths of the multimodality cooperative oncology groups, provided an infrastructure for broad participation by investigators from all treatment disciplines in protocol development and patient entry. However, despite an excellent evaluation in formal peer review, the Division of Cancer Treatment of NCI has ended this initiative claiming insufficient available funds—to the detriment of adult sarcoma patients now and in the future.

Pharmacologic Management of Adult Cancer Pain

February 05, 2007

The intent of this article is to provide oncology nurses with practical information on the pharmacologic management of pain. The use of chemotherapy, radiation therapy, and surgery in pain management will not be addressed in this article. It is the second in a three-part series on cancer pain management. The first in the series (September 2006) addressed cancer pain assessment. In a future issue, the third in the series will address nonpharmacologic approaches to cancer pain management.

Pharmacologic Management of Adult Cancer Pain

February 05, 2007

The intent of this article is to provide oncology nurses with practical information on the pharmacologic management of pain. The use of chemotherapy, radiation therapy, and surgery in pain management will not be addressed in this article. It is the second in a three-part series on cancer pain management. The first in the series (September 2006) addressed cancer pain assessment. In a future issue, the third in the series will address nonpharmacologic approaches to cancer pain management.

Caring for Patients at Risk for Hereditary Colorectal Cancer

February 05, 2007

About 6% of colorectal cancers are caused by genetic mutations associated with hereditary colorectal cancer syndromes. The most common hereditary cancer syndromes nurses are likely to encounter include hereditary nonpolyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MYH polyposis. Current colorectal cancer recommendations for risk management, screening, and surveillance are complex and based on level of colorectal cancer risk and whether an individual carries a genetic mutation associated with a hereditary colorectal cancer syndrome. Caring for patients with hereditary colorectal cancer syndromes requires nurses to understand how to identify individuals and families at risk for hereditary colorectal cancer, refer to appropriate resources, and provide accurate information regarding screening, surveillance, and management. Nurses play a critical role in assessing colorectal cancer risk, obtaining an accurate family history of cancer, and providing information concerning appropriate cancer screening and surveillance.

Caring for Patients at Risk for Hereditary Colorectal Cancer

February 05, 2007

About 6% of colorectal cancers are caused by genetic mutations associated with hereditary colorectal cancer syndromes. The most common hereditary cancer syndromes nurses are likely to encounter include hereditary nonpolyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MYH polyposis. Current colorectal cancer recommendations for risk management, screening, and surveillance are complex and based on level of colorectal cancer risk and whether an individual carries a genetic mutation associated with a hereditary colorectal cancer syndrome. Caring for patients with hereditary colorectal cancer syndromes requires nurses to understand how to identify individuals and families at risk for hereditary colorectal cancer, refer to appropriate resources, and provide accurate information regarding screening, surveillance, and management. Nurses play a critical role in assessing colorectal cancer risk, obtaining an accurate family history of cancer, and providing information concerning appropriate cancer screening and surveillance.

Novel Concepts in Radioimmunotherapy for Non-Hodgkin's Lymphoma

February 01, 2007

Tositumomab/iodine-131 tositumomab (Bexxar) and ibritumomab tiuxetan (Zevalin) are radioimmunoconjugates targeting the CD20 antigen. Both agents are approved in the United States for use in relapsed or refractory, indolent or transformed, B-cell lymphoma. These agents are well tolerated and have the highest levels of single-agent activity observed in these histologies. This review will summarize the key trials that led to approval of both I-131 tositumomab and ibritumomab tiuxetan, and then focus on four novel therapeutic concepts in radioimmunotherapy: retreatment, therapy of de novo indolent lymphoma, therapy of aggressive histologies, and incorporation in high-dose therapy programs utilizing autologous stem cell support.

The Role of Intraperitoneal Therapy in Advanced Ovarian Cancer

February 01, 2007

Intraperitoneal (IP) chemotherapy is a preferred treatment option that should be offered to all women for front-line treatment of stage III optimally debulked ovarian cancer. Patients should be provided with information on the survival and toxicity for both IP and intravenous (IV) therapies, as well as practical information about the administration of each regimen, so that they may play an active role in the decision-making process. When making a decision between IP and IV therapeutic options, the experience and preference of the oncologist are critical factors in determining appropriate therapy for each woman.

PET Imaging: Update on Sarcomas

February 01, 2007

Sarcomas are a group of tumors with highly variable character istics and clinical outcomes. Their locations in almost all body locations present unique challenges for diagnosis and management. These challenges have presented opportunities for evaluation and validation of new imaging techniques. Positron-emission tomography (PET) has been evaluated for use in cancer over the years, and in particular, it has been evaluated in sarcoma diagnosis and treatment evaluation.

Hormone-Refractory Prostate Cancer: Choosing the Appropriate Treatment Option

February 01, 2007

Hormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.

Adjuvant Treatment of Non-Small-Cell Lung Cancer: How Do We Improve the Cure Rates Further?

February 01, 2007

Surgery remains the initial treatment for patients with early-stage non-small-cell lung cancer (NSCLC). Additional therapy is necessary because of high rates of distant and local disease recurrence after surgical resection. Early trials of adjuvant chemotherapy and postoperative radiation were often plagued by small patient sample size, inadequate surgical staging, and ineffective or antiquated treatment. A 1995 meta-analysis found a nonsignificant reduction in risk of death for postoperative cisplatin-based chemotherapy. Since then, a new generation of randomized phase III trials have been conducted, some of which have reported a benefit for chemotherapy in the adjuvant setting. The role of postoperative radiation therapy remains to be defined. It may not be beneficial in early-stage NSCLC but still may have utility in stage IIIA disease. Improvement in survival outcomes from adjuvant treatment are likely to result from the evaluation of novel agents, identification of tumor markers predictive of disease relapse, and definition of factors that determine sensitivity to therapeutic agents. Some of the molecularly targeted agents such as the angiogenesis and epidermal growth factor receptor inhibitors are being incorporated into clinical trials. Preliminary results with gene-expression profiles and lung cancer proteomics have been promising. These techniques may be used to create prediction models to identify patients at risk for disease relapse. Molecular markers such as ERCC1 may determine response to treatment. All of these innovations will hopefully increase cure rates for lung cancer patients by maximizing the efficacy of adjuvant therapy.