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CHICAGO-Obtaining an individual patient’s genetic profile for genetic polymorphisms known to affect drug responsiveness or risk of drug toxicity will become a routine part of medical care over the next 25 years and will dramatically transform the prescribing process, Mark J. Ratain, MD, predicted at the Vanderbilt University Symposium. Dr. Ratain is professor of medicine and chairman of the Committee on Clinical Pharmacology at the University of Chicago.

PORTLAND, Oregon-Cyclooxygenase 2 (COX-2) inhibitors are attracting attention as potential anti-cancer drugs because of evidence of increased survival in patients with low levels of COX-2. Charles D. Blanke, MD, FACP, associate professor of medicine, Oregon Health Sciences University in Portland, reviewed current COX-2 research for participants at the Vanderbilt University symposium.

PISCATAWAY, New Jersey-Three aspects of topoisomerase I are currently under intensive investigation by researchers hoping to improve cancer chemotherapy: the mechanism of topoisomerase I poisoning, cellular processing and repair, and mechanisms of resistance to topoisomerase I inhibitors. These issues were reviewed at the Vanderbilt University Symposium by Leroy F. Liu, PhD, who heads the Department of Pharmacology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, in Piscataway.

The American Cancer Society is one of a number of groups supporting a new bill that would authorize Medicare to pay for smoking cessation counseling and Medicaid to pay for both prescription and nonprescription smoking cessation drugs. The

PONTE VEDRA BEACH, Florida-Cancer patients with bone metastases who received around-the-clock (ATC) analgesics took substantially more medication but did not have better pain relief than patients on as-needed (pro re nata, PRN) dosing regimens in a study reported by Christine Miaskowski, RN, PhD.

PITTSBURGH-In its most recent position statement on assisted suicide, the Oncology Nursing Society (ONS) calls for continued dialog on any and all ethical dilemmas, such as assisted suicide. The statement emphasizes the caring component of nursing and calls for effort to improve compassionate and competent care for the dying.

BETHESDA, Md-Most oncologists probably never thought they would need to worry about overdiagnosing cancer. Yet overdiagnosis-the detection of an actual cancer that will never harm the patient-is emerging as a clinical concern. In this interview, medical oncologist Barnett "Barry" Kramer, MD, discusses the issue of overdiagnosis with Patrick Young, ONI’s Washington Bureau Chief.

After nearly 30 years of dedication, the International Bone Marrow Transplant Registry (IBMTR) and the Autologous Blood and Marrow Transplant Registry (ABMTR), by nearly any criterion, can be considered a success. The Registry contains over 120,000 patient records that are an invaluable source of information on both autologous and allogeneic bone marrow transplantations. Through the voluntary efforts of more than 350 institutions, it annually registers over 20% of all transplants occurring in nearly 50 countries and, by some estimates, nearly half of all transplants in North America.

PONTE VEDRA BEACH, Fla-Breast cancer patients were less stressed by treatment-related symptoms when they used virtual reality software to solve a mystery, visit an art museum, or go deep-sea diving during chemotherapy sessions. Susan M. Schneider, PhD, RN, AOCN, reported the results of the pilot study at the Oncology Nursing Society’s Sixth National Conference on Cancer Nursing Research.

NEW BRUNSWICK, New Jersey-Although camptothecins can cure colon cancer in animals, they are active but not curative in human tumors. The question of why drugs that are effective in animal models are sometimes less effective in clinical studies, as well as issues related to resistance to cytotoxic drugs were discussed by Eric H. Rubin, MD. Dr. Rubin is associate professor at the Cancer Institute of New Jersey, Robert Wood Johnson Medical School in New Brunswick.

NEW ORLEANS-New findings reported at the 92nd Annual Meeting of the American Association for Cancer Research (AACR) support an emerging view that genetic mutations not only contribute to cancer etiology but even to individual variability in response to cancer treatment.

INDIANAPOLIS-"Preclinical models suggest a role for glutamine supplementation in patients with cancer, but confirmation of clinical efficacy is needed," according to Patrick J. Loehrer, Sr., MD. "Glutamine plays an important and varied role in normal humans, and cancer significantly alters glutamine synthesis and catabolism," explained Dr. Loehrer, who is professor of medicine at Indiana University Medical Center in Indianapolis.

SAN ANTONIO, Texas-Irinotecan is metabolized via CYP3A4 to the less active oxidative metabolites APC and NPC and is bioactivated in the liver and intestine by human carboxylesterases (hCE) to the topoisomerase I inhibitor SN-38 (Figure 1). The pharmacology of irinotecan (Camptosar, CPT-11), a water-soluble, semisynthetic derivative of camptothecin, was reviewed at the Vanderbilt University Symposium by John G. Kuhn, PharmD, of the Departments of Medicine and Pharmacology, University of Texas Health Science Center, San Antonio, and College of Pharmacy, University of Texas.

BUFFALO-New work on the role of schedule and dose in determining the efficacy of two classes of drugs-thymidylate synthase inhibitors and topoisomerase I inhibitors-was described by Youcef M. Rustum, PhD, at the Vanderbilt University Symposium. Dr. Rustum is senior vice president for scientific affairs and graduate education at Roswell Park Cancer Institute in Buffalo.

NEW ORLEANS-A genetic variant has been found to double an HIV-infected individuals’ risk of developing non-Hodgkin’s lymphoma (NHL). Charles S. Rabkin, MD, HIV/Cancer Coordinator, Viral Epidemiology Branch, National Cancer Institute, presented the report at the 92nd Annual Meeting of the American Association for Cancer Research (AACR).

FORT LAUDERDALE, Fla-Studies show that chronic lymphocytic leukemia (CLL) responds to therapy with alemtuzumab (Campath). However, the monoclonal antibody is immunosuppressive, and patients who receive it should be on prophylactic antibiotics, Susan O’Brien, MD, said at the 6th Annual Conference of the National Comprehensive Cancer Network (NCCN).

BETHESDA, Maryland-An understanding of how camptothecins intrude between topoisomerase I and DNA is helping to refine the anticancer activity of these drugs, and studies of the pathway from initial camptothecin binding to final cell death may help unravel the mechanisms behind drug resistance. Yves Pommier, MD, PhD, chief of the National Cancer Institute’s Laboratory of Molecular Pharmacology reviewed recent developments in these areas at the Vanderbilt University Symposium.

WASHINGTON-Tobacco companies are not getting the same bang for their advertising dollars as they once did. Cigarette sales in the United States in 1999, the first year affected by the Master Settlement Agreement between the tobacco industry and 46 states, dropped despite an increase in spending for advertising and promotions.

MEMPHIS-‘‘Camptothecin activity is schedule dependent and is very S-phase-specific at concentrations we can achieve in vivo," Peter J. Houghton, PhD, said while summarizing the results of preclinical studies with camptohecins. "Protracted administration is optimal, and threshold concentrations are critical," he continued. Dr. Houghton is chairman of the Department of Molecular Pharmacology at St. Jude Children’s Research Hospital in Memphis.

NEW YORK-The cisplatin/irinotecan combination produces responses among patients with gastric and esophageal cancers, David H. Ilson, MD, PhD, reported at the Vanderbilt University Symposium. Dr. Ilson is assistant attending physician in the Department of Gastrointestinal Oncology, Memorial Sloan-Kettering Cancer Center, New York.

LOS ANGELES-Researchers at Cedars-Sinai Medical Center’s Maxine Dunitz Neurosurgical Institute are conducting a clinical trial of temozolomide (Temodar) in patients with mixed gliomas or oligodendroglial tumors. They expect to enroll about 60 patients over a 30-month period.

WASHINGTON-Several House and Senate members have introduced bipartisan bills that would authorize the Food and Drug Administration (FDA) to regulate tobacco products. The measures are in response to a Supreme Court decision that rejected the FDA’s claim to such authority and held that "Congress has clearly precluded the FDA from asserting jurisdiction to regulate tobacco products."

NEW ORLEANS-A protein-based compound called BL22 produced complete remissions in patients with hairy cell leukemia resistant to standard therapy with purine analogs. Results of the phase I trial were reported at the 92nd Annual Meeting of the American Association for Cancer Research (AACR).

WASHINGTON-President Bush has asked Congress to appropriate a budget of $23.112 billion for the National Institutes of Health in fiscal year 2002, which begins Oct. 1. His request represents a $2.751 billion (13.5%) increase over the current fiscal year. The President also requested a budget of $4.177 billion for the National Cancer Institute, an increase of $439 million (11.7%).

NEW YORK-The need to test new biologically targeted therapies and the presence of vocal patient advocate groups are among the factors galvanizing the National Institutes of Health to seek wider patient participation in clinical trials, Mary McCabe, RN, said during a Cancer Care, Inc. teleconference. She also made clear that patients need to ask many questions before enrolling. Only 1% to 3% of cancer patients take part in clinical trials, said Ms. McCabe, director of the National Cancer Institute’s Office of Education and Special Initiatives. "We would like to see that change," she said.

LITTLE ROCK, Arkansas-Thalidomide appears to enhance the response rate produced by irinotecan (Camptosar) in metastatic colorectal cancer, while decreasing the drug’s gastrointestinal toxicities, reported Rangaswamy Govindarajan, MD. In addition, thalidomide is well tolerated at 400 mg/d, inhibits tumor necrosis factor-alpha, has antiangiogenic properties, and costimulates CD8+ T-cells, Dr. Govindarajan noted. He is assistant professor of medicine in the Division of Hematology/Oncology at the University of Arkansas for Medical Sciences, Little Rock, Arkansas.

NASHVILLE, Tennessee-"Camptothecins have radiosensitizing as well as cytotoxic effects, and combining a camptothecin such as irinotecan with radiation on the right schedule might produce a powerful antitumor regimen," according to Allan Chen, MD, PhD. Dr. Chen is assistant professor of radiation oncology at Vanderbilt University Medical Center in Nashville, Tennessee.

DURHAM, North Carolina- Topoisomerase I inhibitors have shown promising activity in difficult-to-treat tumors of the central nervous system (CNS), according to Henry S. Friedman, MD. In studies of camptothecins, both irinotecan (Camptosar) and topotecan (Hycamtin) showed "prodigious activity" in slowing tumor growth and causing tumor regression in subcutaneous xenografts of human gliomas, Dr. Friedman told those attending the Vanderbilt University Symposium. Dr. Friedman is Jones B. Powell, Jr., Professor of Neuro-Oncology at Duke University Medical Center in Durham, North Carolina.

PEAPACK, New Jersey-Potential directions for irinotecan (Camptosar) clinical research in the future and for the application of novel therapeutics were presented by Langdon Miller, MD, of Pharmacia Oncology Development in Peapack, New Jersey.

The article by Drs. Levine, Seneviratne, and Tulpule is an excellent review of the available literature on the incidence and treatment of lymphoma related to the acquired immunodeficiency syndrome (AIDS).