ONCOLOGY Vol 22 No 9 | Oncology

Harnessing Ionizing Radiation to Enhance Immunotherapy: A Paradigm Shift

August 01, 2008

The field of cancer immunotherapy, once the sole purview of immunology, has evolved toward the harnessing of newly described properties of ionizing radiation (IR). Cancer immunotherapy now includes the combination of established cytotoxic modalities with immune manipulations, as vaccines alone are unlikely to succeed at curing bulky, established tumors.

An Odd But Synergistic Couple: Immunotherapy Combined With Radiotherapy

August 01, 2008

Radiation therapy (RT) and immunotherapy of cancer both date back more than 100 years, and yet, because radiation was often considered immunosuppressive, there had been little enthusiasm for combining them until recently. Immunotherapy has an established role in the treatment of some cancers-superficial bladder cancer treated with bacillus Calmette-Guérin (BCG), renal cell carcinoma and melanoma treated with interferon and interluekin (IL)-2 (Proleukin), and breast cancer and lymphoma treated with monoclonal antibodies such as trastuzumab (Herceptin) and rituximab (Rituxan), which partly function through antibody-dependent cellular cytotoxicity.

Reconsidering the Case for Brachytherapy Plus EBRT in High-Risk Prostate Cancer

August 01, 2008

In the article entitled "Interstitial Brachytherapy Should Be Standard of Care for Treatment of High-Risk Prostate Cancer," Merrick, Wallner, and Butler once again make the case for interstitial brachytherapy as a primary treatment for prostate cancer (see their earlier article, "Permanent Prostate Brachytherapy: Is Supplemental External-Beam Radiation Therapy Necessary?" in ONCOLOGY, April 2006).[1] This time Nathan Bittner has joined as the lead author.

High-Risk Prostate Cancer: The Rationale for Brachytherapy

August 01, 2008

In the realm of general oncology, patients who present with aggressive, poorly differentiated malignancies are usually at high risk for disseminated disease, and systemic therapy often supersedes local therapy in importance. It is not surprising, then, that a similar systemic approach to therapy is often considered for patients who present with high-risk prostate cancer. This recommendation is often supported by much of the surgical literature that cites discouraging outcomes in these patients when treated by radical prostatectomy alone.

Polypharmacy, Aging, and Cancer

August 01, 2008

Polypharmacy, defined as concurrent use of several drugs, is not uncommon in the elderly and increases their risk of adverse drug reactions and interactions.[1] Besides adverse drug reactions and drug-drug interactions, other clinical sequelae of polypharmacy include nonadherence, increased risk of hospitalizations, and medication errors.

Polypharmacy in View of Advances in Cancer Treatment

August 01, 2008

Advances in science have prolonged the average life span, and people are living relatively longer than before. Nevertheless, we have much to achieve to prolong the "healthy life span." People in old age suffer from multiple chronic ailments, and many of them succumb to death by heart disease, cancer, or stroke.[1] To survive these diseases, patients continuously depend on concurrent multiple medications-also referred to as polypharmacy-and with that comes the responsibility of appropriate selection, administration, and monitoring of therapeutic modalities.

Sorafenib Study Demonstrates Significant Improvement in Overall Survival in Liver Cancer Patients

August 01, 2008

Bayer HealthCare Pharmaceuticals and Onyx Pharmaceuticals, Inc, recently announced that The New England Journal of Medicine published results of a phase III trial demonstrating that sorafenib (Nexavar) tablets decreased the absolute risk of death by 31% in patients with unresectable hepatocellular carcinoma (HCC) vs patients who received placebo. This represents a 44% improvement in median overall survival for patients treated with sorafenib.

Hip Bone Density Helps Predict Breast Cancer Risk

August 01, 2008

Measuring a woman's bone mineral density can provide additional information that may help to more accurately determine a woman's risk of developing breast cancer. That is the conclusion of a new study to be published in the September 1, 2008, issue of CANCER.

Surgical Cytoreduction for Ovarian Cancer: Issues Awaiting Formal Clarification

August 01, 2008

The magnitude of the role surgical exploration and extirpation play in the contemporary management of patients with advanced ovarian cancer is hard to overstate. Beyond diagnostic confirmation, the aggressive posture taken to remove bulk disease provides-among other benefits-symptomatic relief, theoretically enhanced immunologic integrity, chemosensitivity, and improved survival characteristics.

Primary Cytoreduction in Advanced Ovarian Cancer: ‘Biologic and Surgical Aggressiveness’

August 01, 2008

As outlined in the comprehensive review by Dr. Schwartz, cytoreductive surgery followed by platinum-based chemotherapy is considered the standard of care in the initial management of patients with advanced ovarian cancer. Considering prognostic factors for patients with advanced disease, residual disease after primary surgery is still considered to be the most important modifiable prognostic factor influencing survival. This has again been recently confirmed by a large retrospective study including six different Gynecologic Oncology Group (GOG) studies.[1]

Interstitial Brachytherapy Should Be Standard of Care for Treatment of High-Risk Prostate Cancer

August 01, 2008

Given the poor outcomes observed with radical prostatectomy (RP) and external-beam radiation therapy (EBRT), some in the urologic community contend that high-risk disease is not curable with currently available treatment strategies.[1,2] In fact, there is a growing contingent of clinicians who advocate the use of chemotherapy in conjunction with RP. With the established efficacy of brachytherapy, these efforts are likely excessive.

Cytoreductive Surgery in the Management of Ovarian Cancer

August 01, 2008

The standard management for advanced-stage ovarian cancer was established in the mid-1970s. At a 1974 National Cancer Institute Consensus Conference on Ovarian Cancer, Griffiths presented data supporting the role for aggressive cytoreductive surgery as the first step in the management of this disease, followed by cytotoxic chemotherapy.

Synergizing Radiation Therapy and Immunotherapy for Curing Incurable Cancers

August 01, 2008

Radiation is often considered immunosuppressive, an activity that is most likely a result of the complex interplay of hormesis and the abscopal effect. The abscopal effect, also called the “distant bystander” effect, is a paradoxical effect of radiation on cellular systems whereby local radiation may have an antitumor effect on tumors distant from the site of radiation.