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Decision-making at the end of life is difficult, and it should be. Rather than face these time consuming and emotionally demanding discussions, doctors too often look to unsuitable conceptual models.

The article by Khatcheressian and colleagues addresses the important topic of futility in chemotherapy use. While extensive previous literature has addressed the use of futile treatment by oncologists, Khatcheressian and coauthors pose interesting perspectives on patient persistence in seeking futile treatment.

Our case illustrates the fact that MDS-associated GS can be treated palliatively with radiation and hypomethylating agents in an appropriate setting. With the growing geriatric patient population, effective treatment options are needed in this disease.

orafenib (Nexavar) tablets significantly improved overall survival by 47.3% (HR = 0.68; P = .014) in patients in the Asia-Pacific region with advanced hepatocellular carcinoma (HCC) vs those receiving placebo. Nexavar also significantly improved time to progression in these patients by 74% (HR = 0.57; P = .001).

The first phase III study of its kind has found that vaginal brachytherapy—in which a radioactive cylinder is inserted into the vagina—is as effective at preventing the recurrence of higher-risk endometrial cancer as external-beam radiation therapy, has fewer side effects, and results in a better quality of life for patients (abstract LBA5503).

There is a large musical instrument, a vibraphone, occupying a corner of Dr. Larry Norton’s office, but it doesn’t seem out of place. He is a serious musician, so serious in fact that in his youth he thought hard about a career in music.

CHICAGO-For breast cancer patients whose tumors have become resistant to available agents, restoring the sensitivity to treatment is an important goal. Preclinical studies have suggested that drugs that inhibit the mTOR protein kinase-which acts as a central regulator of tumor cell division, cell metabolism, and blood vessel growth-may be able to do so.

Over the past 2 decades, advances in cancer treatment have greatly improved survivorship statistics in the United States. As the oncology community works to ensure that this upward survival trend continues, it’s important for us to recognize the serious challenges that lie ahead.

For some oncology practices, it makes sense to contract with a managed care organization (MCO)-a contract simply enables you to treat enrollees of an MCO.

As oncology drug costs to payers continue to soar-almost $200 billion annually and growing-new market forces are combining to allow health plans to aggressively manage oncology drug costs, which means less profit for community doctors.

CHICAGO-Newly diagnosed patients with metastatic colorectal cancer are most likely to benefit from cetuximab (Erbitux) when their tumors contain the normal version of the KRAS gene, compared to patients with KRAS mutations, according to a conclusive analysis from the phase III CRYSTAL trial presented at the ASCO 2008 plenary session (abstract 2).

Colon cancer patients who had abundant levels of vitamin D were less likely to die during a follow-up period than those who were deficient in the vitamin, according to a study by scientists at Dana-Farber Cancer Institute and the Harvard School of Public Health (J Clin Oncol 26:2984-2991, 2008).

CHICAGO-Sorafenib (Nexavar) is safe and prolongs overall survival and time to progression in Asian patients with advanced hepatocellular carcinoma (HCC), finds the randomized phase III Asia-Pacific liver cancer study. Moreover, efficacy was similar to that in the Western population even though the Asian patients had more adverse prognostic factors.

Today there are nearly 12 million individuals living in the United States who have ever received a diagnosis of cancer.[1] This number is growing, having just been recently updated to approximately 11.9 million from a previous estimate of about 10.8 million cancer survivors.[2] One half of all men and one in three women will be diagnosed with cancer in their lifetime, with the largest burden being during later life; one in seven Americans 65 years of age and older has a past or present cancer diagnosis.[3]

he field of geriatric assessment is crowded by a variety of assessment domains, a plethora of assessment tools, and research spanning diverse care settings. In their article published in this issue of the journal ONCOLOGY, Schubert, Gross, and Hurria have synthesized the evidence and propose a subset of commonly used functional assessment tools for assessing older adults with cancer.[1]

The population of the United States and other industrialized nations is aging rapidly. The increased life span allows for longer exposure to carcinogens and the accumulation of genetic alterations. Thus, the incidence of cancer is increasing along with the aging of the population.

These are trying times at FDA. The agency has its hands full regulating pharmaceuticals produced in the United States: Now come the perils of globalization, which were dramatized by the recent heparin scandal. FDA contends that the adverse events and deaths associated with Baxter’s heparin products were caused by a contaminant deliberately introduced somewhere in China’s raw material supply. Chinese regulators quickly rebuffed FDA’s claim, asserting the problem was more likely caused by impurities introduced in the final US drug production process.

ORLANDO-In a phase III study, the investigational GnRH blocker degarelix (Ferring Pharmaceuticals) significantly reduced testosterone levels within 3 days in more than 96% of study patients, Laurence Klotz, MD, of the University of Toronto, reported at AUA 2008. The fast effect on testosterone levels was close to the immediate effect achieved with surgery, he said.

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).

SAN DIEGO-A new way of harnessing the body’s immune system to attack cancer cells has produced impressive preclinical and early clinical results, according to investigators interviewed at the 2008 American Association of Cancer Research annual meeting.

SAN DIEGO-Results were disappointing for an adjuvant immunotherapy approach to follicular non-Hodgkin’s lymphoma presented at the 2008 American Association for Cancer Research annual meeting (abstract LB-204).

CHICAGO-Baseline and second-round screening results from the Dutch-Belgian NELSON randomized CT lung screening trial show a low rate of positive tests: 2.6% on baseline screening and 1.8% on second-round screening. This could make low-dose CT screening “more acceptable to the public and suitable for mass screening programs,” said Rob J. van Klaveren, MD, PhD, of Erasmus Medical College, Rotterdam. Dr. van Klaveren reported the results at ASCO 2008 (abstract 1508).

CHICAGO-Median overall survival was 13 months among 52 patients who received radioactive microspheres (SIR-Spheres) for colorectal cancer liver metastases after chemotherapy failure. The phase II Italian SITILO study was reported at ASCO 2008 (abstract 4078).

I recently attended a healthcare conference titled “Leadership Summit on Evidence-Based Medicine” in Alexandria, Virginia. As you know, private industry, insurance companies, and the government are trying to develop an evidence-based medicine approach to help check the growth of healthcare expenditures.

Cancer patients should avoid the routine use of antioxidant supplements, such as vitamin A or beta-carotene, during radiation and chemotherapy because the supplements may reduce the anticancer benefits of therapy, Brian D. Lawenda, MD, of the Naval Medical Center San Diego, and colleagues concluded (J Natl Cancer Inst 100:773-783, 2008).

I am a urologist in southwest Florida. As I discussed with one of our radiation oncologists (we use 21st Century Oncology), there are no trials comparing proton and standard radiation, eg, IMRT. If such a trial were conducted, I suspect, at best, the cancer control rates would be equivalent, and the side effect profiles would also be similar. So what is all the fuss? 

In the fashion world, the word fabulous is tossed around like bolts of fabric at a blowout sale. In the cancer treatment world, fabulous is not a common interjection. And when fashion design student Hattie Saltonstall was confronted with the disease, she felt far from fabulous.

SAN DIEGO-More than 70% of advanced pancreatic patients derived some clinical benefit when treated with nanoparticle albumin-bound (nab) paclitaxel (Abraxane) and gemcitabine (Gemzar), in a phase I study reported at the 2008 American Association of Cancer Research meeting (abstract 4179).