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In the first of a two part series on cancer chemoprevention, Drs. Singh and Lippman provide a concise, yet complete overview of the principles of chemoprevention. They discuss issues most pertinent to the design and conduct of cancer chemoprevention trials: tolerance of drug toxicities among healthy and high-risk populations, study designs used to test chemopreventive agent toxicity and efficacy, and the mechanism of action of chemopreventive agents (eg, blocking and suppressing agents).

As comprehensively described by Drs. Prow and Vadhan-Raj, lineage-specific preparations of thrombopoietin are now in clinical development: pegylated recombinant human megakaryocyte growth and develop- ment factor (PEG-rHuMGDF) and recombinant human thrombopoietin (rhTPO). These preparations produce marked increases in megakaryocyte mass and platelet count after SC dosing.

The urge to control the manifestations of incurable chronic diseases, such as the anemia, renal failure, and bony disease of myeloma and the bone disease of breast cancer, is understandable. Successful control of these disease manifestations greatly improves a patient’s quality of life. This is especially important since patients with either of these malignancies may live with the disease for 20 years or more. Considerable success has been achieved in the correction of anemia with erythopoietin (Epogen, Procrit), and simple hydration has reversed renal failure and improved the survival of patients with myeloma.[1] Anyone who has witnessed the frightening spasms of back pain in myeloma patients, precipitated by a sneeze or an attempt to turn over in bed, understands the dreadful fear that patients have of uncontrolled bone pain.

After an almost 40-year search for a primary regulatory of platelet production, thrombopoietin has recently been purified and cloned. Thrombopoietin regulates all stages in the production of platelets by promoting both the

WASHINGTON--Vice President Al Gore called on Americans to demand that their senators and representatives provide increased funding for cancer research. "We want to be the generation that wins the war against cancer," he told thousands gathered here as part of "The March," a nationwide effort to make cancer the number one medical research and health care priority.

This is the beginning of an exceedingly exciting era for the study of the non-Hodgkin’s lymphomas. A new pathologic classification system has been developed to incorporate the biology that has been developed since the introduction of the Working Formulation more than 15 years ago. Large enough numbers of patients have been uniformly treated and followed so as to enable the development of new and accurate prognostic indices. These will allow us to adapt our treatment strategies to the patients' individual risk of failure. Finally after years of similar treatment strategies that have yielded at best marginal improvement, new therapeutic modalities are now available and offer the promise of improved survival and even lessened toxicity for our patients.

It was not until 1995 that a phase III randomized trial demonstrated that autologous stem cell transplants (ASCT) improve the progression-free and overall survival of patients with relapsed refractory diffuse aggressive non-Hodgkin’s lymphoma. Investigators are now focusing on improving the clinical benefit of transplants. The relative contributions made by more intensive preparative regimens, purging, concomitant immunotherapy, and the timing of transplants are under study. Also, as transplant trials shift from relapsed disease to initial therapy, anticipated benefits must be balanced against both short-term and long-term toxicities.[ONCOLOGY 12(Suppl 8):56-62, 1998]

Significant advances have been made in the application of monoclonal antibody-based therapies to the treatment of patients with lymphoma. The most promising areas appear to be the use of unconjugated monoclonal

Successful therapy for most of the non-Hodgkin’s lymphomas requires an accurate pathologic diagnosis. Routine morphologic examination of excisional biopsies from nodal or extranodal sites provides the cornerstone for establishing a definitive diagnosis. The list of ancillary studies, however, used to complement these routine approaches is increasing both in number and complexity. Proper use of these diagnostic tools can be of great help in arriving at the correct diagnosis in difficult cases. Fine-needle aspiration and needle-core biopsies have a role in lymphoma staging and in the assessment of recurrent disease, but are limited as primary diagnostic tests. This review will focus on the standard approaches used to establish a diagnosis of malignant lymphoma, and the clinical utility of immunophenotypic, molecular genetic, and cytogenetic studies in providing useful data for diagnosis. The standard practice of synthesizing all of the data from multiparameter analysis to arrive at a diagnosis in difficult cases will be emphasized. [ONCOLOGY 12(Suppl 8):11-16, 1998]

Progress in the treatment of indolent non-Hodgkin’s lymphoma has been slow and the disease remains incurable despite the relatively long median survival of patients. Decades of clinical trials resulted in standard

Intermediate-grade lymphomas are defined by the Working Formulation to include four histologic subgroups: follicular large-cell, diffuse small-cleaved-cell, diffuse mixed small- and large-cell, and diffuse large cell (Groups

High-grade non-Hodgkin’s lymphomas generally refer to immunoblastic lymphoma, lymphoblastic lymphoma, and small-noncleaved-cell lymphoma, three histological subtypes that were associated with the worst prognosis at the

The non-Hodgkin’s lymphomas are a biologically heterogeneous group of diseases with varying clinical presentations and outcomes. A number of studies have identified variables that carried independent prognostic significance. Although several staging systems had evolved that incorporated these prognostic variables, they were still unable to predict outcome. Ideally, the object of a staging system is to predict the likelihood of treatment response, time to progression or disease-free survival, and overall survival, and to provide a way to compare the outcome of similar groups of patients among various clinical trials. The need for such a system led to the creation of prognostic models such as the M. D. Anderson Tumor Score and, more recently, the International Prognostic Index. These prognostic models may identify those patients at highest risk for treatment failure, thereby identifying those patients who may require different therapeutic approaches. [ONCOLOGY 12(Suppl 8):17-24, 1998]

BETHESDA, Md--Nutrition scientists have a responsibility to translate their research into a message that "heads straight out the lab door and onto the breakfast table," said Jerianne Heimen-dinger, ScD, a research scientist at the AMC Cancer Research Center, Denver, Colorado.

In 1992, the FDA decided that silicone gel-filled breast implants would be available only through controlled clinical studies, despite the fact that they had been used for mammoplasty in millions of women around the world

WASHINGTON--The National Cancer Institute is getting more comfortable with the idea of seriously evaluating complementary and alternative medicine (CAM) approaches to treating cancer.

BETHESDA, Md--The National Cancer Institute (NCI) is seeking technology systems to revolutionize cancer detection, diagnosis, and treatment. Under a new $48 million, 5-year program dubbed the Unconventional Innovations Program, NCI is looking for new technologies "that will enable sensing of molecular alterations in the body in a way that is highly sensitive and specific, yet nonintrusive."

Scientists at the University of Pittsburgh have discovered how a novel form of vitamin K exerts its cancer-killing effects in primary liver cancers, which are notoriously resistant to chemotherapy. The research results, published in the May issue of the

BETHESDA, Md--The National Institute of Allergy and Infectious Diseases (NIAID) will collaborate with VaxGen, Inc. (South San Francisco), in research projects to expand the scientific range of the phase III trial of VaxGen’s AIDSVAX vaccine. The Institute will also provide the company with expertise in certain areas of immunology.

SAN FRANCISCO--Recent research assessing the skills of today’s clinicians in interpreting genetic tests for colon cancer (FAP and HNPCC) finds they fall woefully short, Francis M. Giardiello, MD, associate professor of medicine and gastroenterology, Johns Hopkins University School of Medicine, said at the American Cancer Society Second National Conference on Cancer Genetics.

SAN DIEGO--For community physicians who have an interest in clinical research, "the line between community and academic centers isn’t so far apart anymore," said Andrew Pecora, MD, chairman of the medical board of the newly created Affiliated Physicians Network (APN), Fort Lee, NJ, which helps practitioners participate in clinical trials.

BETHESDA, Md--Three months after refusing to give its blessing to Valstar (valrubicin), the Oncologic Drugs Advisory Committee (ODAC) reheard Anthra Pharmaceuticals’ new drug application and recommended that the FDA approve the new anthracycline for use in a limited population of patients with carcinoma in situ (CIS) of the urinary bladder.

HOUSTON--A new faculty center will allow M.D. Anderson Cancer Center to consolidate faculty offices currently located in several buildings on its main campus. The new facility, approved by the University of Texas System Board of Regents last August, will be constructed on the south side of Holcombe Boulevard, adjacent to the Jesse H. Jones Rotary House International patient/family hotel and directly across the street from M.D. Anderson’s main clinic and hospital complex (figure).

COLUMBUS, Ohio--Cancer pain patients on opioid therapy who request more medication, or more frequent dosing, are almost always responding to an increase in pain, said Steven Passik, PhD, director, Oncology Symptom Control and Research, Community Cancer Care, Indianapolis.

An extra margin of safety is now available to the approximately 400,000 people in the US who receive transfusions of blood plasma annually. PLAS+SD (Pooled Plasma, Solvent/Detergent Treated) is an FDA-approved product that virtually eliminates

ORLANDO--An ongoing debate within the health care industry is focusing on whether bone marrow and peripheral blood stem cell transplants (BMT/PBSCT) should be regionalized in academic centers or diffused to community hospitals.

SAN DIEGO--With the incidence of non-Hodgkin’s lymphoma (NHL) increasing throughout the United States, researchers have been searching for better ways to decrease the mortality rate of this cancer, which claims approximately 23,800 Americans each year.

Advances in Pediatric Hematology/Oncology will be held November 19 through 21, 1998, at the Hilton Clearwater Beach Resort, Florida (formerly the DoubleTree). Topics presented by nationally renowned speakers include:

WASHINGTON--The US Department of Justice is reviewing a complaint by the Campaign for Tobacco-Free Kids that the big tobacco companies may have violated election laws by promising to run TV ads that would give senators "political cover" on the tobacco issue if they voted against the McCain tobacco control bill, which was defeated last June.

SAN FRANCISCO--Susan Leigh, RN, a cancer survivor and oncology nurse, is telling a familiar story, but one that arouses her anger. Recently, a young woman with breast cancer went to the local library to research her disease. She was shocked to read in a medical text that her particular type of breast cancer had little hope of cure and was likely to be fatal in a few months.