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In the first of what will become an annual review process, the nation’s largest cancer-care payer has added three new formularies to its drug coverage policy, giving oncologists even greater ability to prescribe off -label cancer drugs.

Recent results from prospective, controlled trials, specifically evaluating strategies for preventing or reducing the severity of the dermatologic effects of EGFR inhibitors, represent the first step toward an evidence-based approach to the prevention and management of these important effects.

The review by LoRusso is a critical update to what could be considered the most significant dermatologic toxicity in modern oncology. This increased importance of dermatologic toxicities to epidermal growth factor receptor (EGFR) inhibitors can be attributed to several factors: 45% to 100% of patients will develop a papulopustular rash; the rash occurs in cosmetically sensitive areas (the face and upper trunk); it is associated with symptoms of pain and pruritus; and superinfections occur in approximately 30% of patients receiving these agents-all of which lead to dose modification by 76% and discontinuation by 32% of oncologists.

Epidermal growth factor receptor (EGFR) inhibitors have emerged as important drugs in cancer therapy, providing a proven survival advantage for some patients with non–small-cell lung cancer, colorectal cancer, head and neck cancer, and pancreas cancer.

States population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.

The Hippocratic principle of not harming the patient has remained up to this day an undisputed dogma in medicine. It reminds the physician of the possible detrimental, if not lethal, outcome of the treatment he prescribes and implicitly enforces good medical practice, although the true impact will unlikely be known. Oncology is one subspecialty of Medicine where this dilemma-ie, the pros and cons of treatment-is continuously put to the test, as the physician must decide on treatment for an often life-threatening illness while taking into account individual factors such as the patient’s will, performance status, available standard treatment options, and possible experimental approaches.

Acai demonstrated antioxidant and apoptotic effects in in vitro and in vivo studies, but no human studies have been conducted. Despite the lack of supportive data, acai, like many herbal products, is promoted to cancer patients on the ­Internet, often with false claims of cure.

In their informative article, Richard O’Hara and Diane Blum touch on several key challenges of cancer survivorship. Looking at cancer through the lens of social concerns and developmental issues, they have brought important psychosocial aspects of survivorship to the forefront of our attention, with a particular focus on the domain of social well-being within the parameters of interpersonal relationships, and financial, employment, insurance, and legal issues.

When my doctor told me that I would have to put my life on hold at age 25 because tests confirmed that I had Hodgkin’s disease-cancer!-my life changed totally. I had to quit my job, move back in with my parents, and wonder about the quantity and quality of the rest of my life.

Bill, 53 years old and a 3-year survivor of non-Hodgkin’s lymphoma, reflects on his ongoing journey as a cancer survivor: “I was very sick and treatment was very rough, complete with a severe allergic reaction that was difficult to diagnose for a long time. But I made it through to the other shore…remission. Since then, I’ve been trying to rebuild a new life…Living with an 18-year-old [son], I can see how in some ways I’m in a parallel universe…Both of us are looking out at the world before us, at all the many possible options...trying to figure out what we want tomorrow to look like.

On January 20th, all eyes were on the inauguration in Washington, and most of us felt not only a sense of renewed hope but also some uncertainty about what the future will hold. In many ways, cancer patients also face these dual feelings of hope and uncertainty when treatment ends and they confront the task of finding a “new normal.” Re-establishing routines, relationships, and one’s connection to the world is eagerly wanted, but for some it can be daunting. The impact of cancer on one’s health, daily function, and body image, as well as financial and other concerns, also may present challenges.

As difficult as treatments are for many cancer patients, another difficult time awaits them at the conclusion of therapy. Until that point, patients have become accustomed to the fleeting comfort of regularly scheduled appointments for diagnostic testing, chemotherapy and/or radiation treatments, and ongoing contact with health care professionals. Conclusion of treatment can seem abrupt and the absence of attention can be unsettling for many. It is at this point that patients often ask, “What can I do now to help myself?”

In 2008, roughly 1.44 million Americans were diagnosed with cancer,[1] and accordingly were labeled as “cancer survivors.” Fortunately, for roughly 65% of those who were newly diagnosed, this label will expand to encompass issues of long-term survivorship and health maintenance.[2] Extended cancer survivorship is a relatively new concept. In the past, most people who were diagnosed with the disease did not survive it. While longer survival times are a measure of success, the dark side of this victory is that a substantial proportion of these survivors will experience recurrence or second cancers. In addition, many more will go on to develop comorbid conditions such as cardiovascular disease (CVD), diabetes, or osteoporosis, which often kill or debilitate survivors at much higher rates than the cancer itself.[3,4]

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In metastatic breast cancer (MBC), lapatinib (Tykerb) + letrozole (Femara) delayed disease progression in HER2+, HR+ patients, according to initial results from a phase III trial (EGF30008) presented by Stephen Johnston, MD (abstract 46).

Based on 2 meta-analyses of nearly 20,000 HR+ early breast cancer patients, AIs are superior to tamoxifen in reducing recurrences, whether as initial monotherapy or given in a “switching” strategy (abstract 12).

There is evidence that higher doses of fulvestrant (Faslodex) may have greater activity than the approved dose of 250 mg/mo. The FIRST trial (Fulvestrant First-Line Study) compared 500 mg vs anastrozole 1 mg/d in the first-line advanced disease setting, finding that a dose of 500 mg/mo achieved response rates and clinical benefit rates similar to those obtained with anastrozole 1 mg/d but gave a significantly longer time to progression (abstract 6126).

EXPERT’S CORNER-Nearly three quarters of breast cancer patients have tumors that express estrogen receptors (ERs) or progesterone receptors (PRs); approximately half of these patients are postmenopausal. We look to endocrine therapy, therefore, to prevent recurrences and save lives in the majority of early breast cancer patients and to prolong survival in the advanced disease setting.

ABCSG Trial: Survival Benefit for Tamoxifen. Anastrozole Updated results from Austrian Breast and Colorectal Cancer Study Group Trial 8 confirmed a survival difference for the sequencing strategy of tamoxifen followed by anastrozole (Arimidex), compared to 5 years of tamoxifen (abstract 14). Preliminary results (median follow-up 55 mo) had previously revealed a 24% reduction in recurrence in favor of the sequencing strategy, although the difference was not statistically significant.

The largest numbers of trial terminations occur at phase II, especially if the trial is for a marketed therapy compared with a novel drug, according to an expert analysis in the Good Clinical Practice Journal.

CHICAGO-Using imaging to monitor drug response is becoming an increasingly important fi eld of research, and radiologists who are not involved in clinical trials should at least become aware of it, said presenters at an RSNA 2008 refresher course (RC730A).

The new year has begun, but controversy over erythropoiesis-stimulating agents for chemotherapy-induced anemia continues. Restrictive FDA revisions to ESA labeling have had a profound effect on the management of patients with anemia as well as on the practice of oncology itself.

SAN FRANCISCO-ASCO released a provisional clinical opinion that recommends routine KRAS testing to guide treatment of metastatic colorectal cancer with cetuximab (Erbitux) and panitumumab (Vectibix).

Oncology News International readers are on the whole in favor of “aid in dying” for terminally ill patients, but diff er on how it should be carried out.

SAN FRANCISCO – Results from two early-phase clinical trials showed that adding vorinostat (Zolinza) to bortezomib can produce favorable response rates in up to 40% in patients with refractory or relapsed multiple myeloma. In the combined results of these two phase I trials, 39% of patients refractory or relapsed aft er bortezomib treatment achieved a partial response, and 43% had stable disease, said Donna Weber, MD, of M.D. Anderson Cancer Center in Houston.

The [Godinez study] referral pattern for MRI represents a bias in this study population toward young women and women with ambiguous findings on routine imaging, who are not necessarily the same patients referred for APBI, said Dr. Woodward, assistant professor of radiation oncology at M.D. Anderson Cancer Center.

In this retrospective study by Godinez et al, 30 (38%) of 79 patients had additional foci on MRI. The researchers suggested that MRI should be used prior to APBI to rule out the presence of multifocal or multicentric disease.

The review by Balducci provides an excellent overview of issues regarding the pharmacotherapy of anticancer therapy in older patients. The introduction to geriatrics emphasizes the need to be able to determine the patient’s physiologic age.

Cancer is predicted to become the leading cause of death worldwide in the year 2010, according to the latest edition of the World Cancer Report released by the International Agency for Research on Cancer. The burden from cancer will not be shared equally, though. Researchers forecast that low- and medium-resourced countries that are least equipped to deal with rising rates of cancer in the population will be hit hardest.

Suppose you hosted a clinical trial and nobody came? That’s what happens 30% of the time, according to researchers from the Center for Management Research in Healthcare at Vanderbilt University in Nashville. “Trials get opened, but no patients are accrued,” said principal investigator David Dilts, PhD.