ONCOLOGY Vol 22 No 5

The authors have provided a concise review of stereotactic body radiosurgery (SBRS) in the treatment of mainly spinal/paraspinal metastases. This technique was primarily developed to treat spinal metastases in the reirradiation scenario given that treatment alternatives are limited for these patients and that-in the setting of advanced metastatic disease-surgical decompression is often not a suitable option.

The goal of palliative radiotherapy is to treat symptoms as rapidly and efficiently as possible, with the fewest side effects.[1] For many years, pain medication, radiotherapy, and surgery were the only tools available for the treatment of bone metastases. This has changed significantly over the past 15 years. New systemic agents, including bisphosphonates such as zoledronic acid (Reclast, Zometa), are available to prevent the development of new lesions, strengthen the bone, and improve symptoms. In addition, targeted treatments directed at achieving tumor ablation now include radiofrequency ablation and stereotactic body radiation therapy (SBRT).

Breast Cancer is a unique effort in the world of breast cancer texts: Compact and concise, this 214-page book deals exclusively with breast cancer therapeutics, and strives to accomplish the difficult task of being as current as possible within the limited capabilities of the printed word in a rapidly evolving field. Dr. Seidman has assembled a distinguished group of authors, each of whom was assigned a topic, in the end covering all aspects of the medical oncologic scope of breast cancer treatment in one relatively short text. The book does not address issues of breast cancer epidemiology, screening, prevention, or surgical or radiation treatment-this was not the intent of this publication.

GlaxoSmithKline (GSK) recently announced the submission of a new drug application to the US Food and Drug Administration for casopitant (Rezonic, Zunrisa), a novel, investigational NK-1 receptor antagonist, for the prevention of chemotherapy-induced nausea and vomiting (CINV) as an add-on therapy to the standard dual therapy of a 5-HT3 receptor antagonist, such as ondansetron (Zofran), and dexamethasone.

Genomic Health, Inc, recently announced that its Oncotype DX report is now providing quantitative estrogen receptor (ER) and progesterone receptor (PR) scores to physicians and patients in addition to the trademarked Recurrence Score. This expansion of the assay is based on the results of a study published in the Journal of Clinical Oncology, which confirmed that reverse transcriptase polymerase chain reaction (RT-PCR) by Oncotype DX can deliver quantitative gene expression levels for assessing ER and PR status, which are critical factors in determining the use and benefit of hormonal therapy for the treatment of breast cancer.

US Oncology, Inc, is launching Oncology Reimbursement Solutions (ORS), an oncology-focused billing and reimbursement service designed to increase operational efficiency and improve the economics of independent community-based oncology practices.

A large, international trial has shown that adding the targeted therapy bevacizumab (Avastin) to the chemotherapy drug docetaxel (Taxotere) slows disease progression in patients without prior chemotherapy for locally advanced or metastatic breast cancer. The results were presented by David Miles, md, a professor and medical oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, and the study’s lead author (abstract LBA1011).

A large, international trial has shown that adding the targeted therapy bevacizumab (Avastin) to the chemotherapy drug docetaxel (Taxotere) slows disease progression in patients without prior chemotherapy for locally advanced or metastatic breast cancer. The results were presented by David Miles, md, a professor and medical oncologist at the Mount Vernon Cancer Centre in Middlesex, UK, and the study’s lead author (abstract LBA1011).

A large, multicenter study has shown that the chemotherapy drug gemcitabine (Gemzar) more than doubles overall survival in patients who have undergone surgery for pancreatic cancer. The CONKO-001 trial is the first large-scaled phase III study to show a benefit for any chemotherapy agent given to early-stage pancreatic cancer patients after surgery to remove their tumors. The trial data were presented by Hanno Riess, md, phd, a professor at Charité University Medical School in Berlin and the leader of the CONKO study group (abstract LBA4504).

The 44th Annual Meeting of the American Society of Clinical Oncology, held May 30th to June 2nd, brought more than 30,000 attendees to Chicago for the presentation of nearly 5,000 new studies. The following research findings represent a few of the highlights, as announced by ASCO before the meeting.

A multicenter study has found that the experimental targeted therapy everolimus (Cetican, RAD001) delays cancer progression in patients with metastatic kidney cancer that has progressed despite treatment with other targeted therapies. Lead author Robert J. Motzer, md, attending physician at Memorial Sloan-­Kettering Cancer Center, presented the results at the ASCO meeting (abstract LBA5026).

A new analysis of a randomized, controlled clinical trial investigating cetuximab (Erbitux) in the treatment of first-line metastatic colorectal cancer (mCRC) highlights the increased efficacy of cetuximab in patients who have tumors with nonmutated (ie, wild-type) KRAS. These results were presented by lead investigator Eric Van Cutsem, md, phd, professor of medicine and digestive oncology from the University Hospital Gasthuisberg in Leuven, Belgium, at the plenary session of the 44th Annual Meeting of the American Society for Clinical Oncology (ASCO), held May 30 through June 3 in Chicago (abstract 2).

The first randomized trial to evaluate the long-term outcome of treatment with a single dose of chemotherapy for early-stage testicular tumors has found that the approach is safe, effective, and less toxic compared to radiation therapy, the current standard of care. The study, the largest ever in testicular cancer, also showed that after 5 years, patients receiving chemotherapy had a decreased risk of developing a second tumor in the other testicle, though longer follow-up is needed. The data were presented by R.T. Oliver, md, professor emeritus of medical oncology at St. Bartholomew’s Hospital in London and the study’s lead author, at the ASCO plenary session (abstract 1).

Researchers report that zoledronic acid (Zometa), a drug used to treat bone metastases and recently approved to treat osteoporosis, also lowers the risk of breast cancer recurrence in premenopausal patients with early-stage disease who have undergone surgery and are receiving ovarian suppression and hormone therapy. All women in this multicenter phase III trial had cancer that was estrogen-receptor– or progesterone-receptor–positive. The study was presented at the ASCO plenary session by lead author Michael Gant, md, professor of surgery at the Medical University of Vienna and the president of the Austrian Breast and Colorectal Cancer Study Group, or ABCSG (abstract LBA4).

The Cancer International Research Group (CIRG), a division of TRIO (Translational Research in Oncology) announced that, based on its study BCIRG 006, the US Food and Drug Administration (FDA) has approved a new regimen known as TCH (docetaxel [Taxotere] and carboplatin combined with trastuzumab [Herceptin]) for the adjuvant treatment of HER2-positive early breast cancer. The AC-TH regimen (doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab), also investigated in the BCIRG 006 study, received approval at the same time. This is the first taxane-based non–anthracycline-containing chemotherapy combined with trastuzumab to receive FDA approval.

Financial pressures from Medicare reimbursement changes may have caused physicians to switch from providing hormonal-induced castration to providing surgical castration for men with prostate cancer. That is the finding of a new study published in the May 15 issue of CANCER. The study suggests that factors other than evidence-based medicine may have a significant influence on treatment decisions.

Although vulvar cancer is relatively rare, accounting for less than 5% of all cancers of the female genital organs, lymph node metastasis associated with vulvar carcinoma is a common event and occurs in about 25% of cases.[1] The presence and number of lymph node metastases is the single most important prognostic factor in vulvar cancer and a critical component to the International Federation of Gynecology and Obstetrics (FIGO) staging system, as well as a major determinant in the need for adjuvant therapy

Halsted first proposed the concept of "radical surgery" for cancer in 1882, theorizing that cancer, along with all of its supporting tissues and regional lymph nodes, needs to be removed en bloc for the best chance of cure. Radical mastectomy with en bloc removal of the axillary nodes and pectoral muscles became the standard treatment for breast cancer. En bloc radical vulvectomy with complete superficial and deep inguniofemoral lymph node dissection became the standard of care for vulvar cancer. Subsequently, unilateral or bilateral pelvic node dissection extended the scope of the regional node dissection for vulvar cancer patients with metastases to groin nodes. Unquestionably, this surgically comprehensive technique improved cancer control rates for patients with locally extensive vulvar cancer, compared to results from piecemeal approaches that characterized surgical therapy in prior eras.

The National Coalition for Quality Colorectal Cancer Screening and Care, a 501(c)(6) not-for-profit association, recently announced the formation of a broad-based coalition dedicated to reducing the incidence of colorectal cancer through educational programs aimed at promoting colonoscopy screening and care options for patients in a safe and comfortable setting.

Over the past 15 years, lymphatic mapping and sentinel lymph node biopsy in vulvar, vaginal, and cervical cancers have been explored by gynecologic oncologists around the world. Based on the results of multiple single-institution studies, most in our field are optimistic that these techniques will increase the rates of detection of lymph node metastasis while decreasing the morbidity associated with lymphadenectomy. Large validation studies are currently underway in both the United States and Europe. In this review article, we present the published data on mapping techniques and discuss future considerations for these technologies.

Two common inherited genetic variations are associated with increased risk of lung cancer for smokers and former smokers, a research team led by scientists at The University of Texas M. D. Anderson Cancer Center reported April 2 in the online edition of Nature Genetics.

Choline, an essential nutrient found in foods such as eggs, is associated with a 24% reduced risk of breast cancer, according to a study supported by a grant from the US National Institutes of Health (NIH), to be published in the Federation of American Societies for Experimental Biology (FASEB) Journal's print issue in June.This study adds to the growing body of evidence that links egg consumption to a decreased risk of breast cancer.

Interventional pulmonologists at The Ohio State University Medical Center are using an improved and more efficient technique to diagnose lung cancer. Attached at the tip of the bronchoscope, an ultrasound probe identifies the location of the cancerous masses in a patient's chest, allowing for an accurate biopsy, or tissue sample, under ultrasound guidance.

A tiny lightstick called ViziLite Plus could help prevent 90% of all fatalities from oral cancer, according to the California-based Creative Dimensions in Dentistry (www.cddentists.com), a dental group that recommends all adults ask their dentists for the procedure.

The article by Calhoun and colleagues, published in this issue of ONCOLOGY, is a timely review of one of the more controversial questions in thoracic oncology: whether or not patients with stage IB non–small-cell lung cancer (NSCLC) should receive adjuvant chemotherapy.

Stage IB non–small-cell lung carcinoma (NSCLC) represents a subset of early-stage, resectable NSCLC, usually treated with curative intent, but with historically modest 5-year survival rates ranging from 40% to 67% with surgical resection alone.[1,2] Disappointingly, modern adjuvant chemotherapy trials including stage IB patients have shown little evidence of chemotherapeutic benefit.

CPM may be a rational choice for patients with known BRCA mutations, patients who have received therapeutic chest radiation, and some mastectomy patients.

A recent study has provided evidence that the use of contralateral prophylactic mastectomy (CPM) is increasing

The appropriate treatment of patients with stage IIIA (N2) non–small-cell lung cancer (NSCLC) is unclear. With this case report and review, we address the history, assessment, and management of a 67-year-old patient with this diagnosis, and then discuss the challenges in managing N2 disease, as well as the roles of systemic therapy, surgery, and postoperative radiation therapy.