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FDA-Approved Drugs: 5-HT3 receptor antagonists Zofran (ondansetron), Kytril (granisetron), Anzamet (dolasetron), Aloxi (palonosetron); NK-1 receptor antagonist: Aprepitant (Emend)

With improved prognosis for patients with Hodgkin's lymphoma (HL), interest has increasingly focused on high-risk groups such as elderly patients. Advanced age at presentation is still one of the strongest negative risk factors. Many different factors influence the prognosis in elderly patients. These include biologic differences such as more aggressive histology, different distribution of disease, more frequent diagnosis of advanced stage, and shorter history of disease. In addition, however, aging itself and associated factors such as comorbidity, reduced tolerability of conventional therapy, more severe toxicity and treatment-related deaths, failure to maintain dose intensity, shorter survival after relapse, and death due to other causes contribute to the poorer outcome in elderly patients. Besides the evaluation of specific causes and risk factors, this review highlights recent and ongoing studies for elderly patients with HL as well as international approaches and recommendations for this age group.

Chemotherapy-induced nausea and vomiting (CINV) remains an important and common toxicity of cancer treatment. Recent guideline revisions have classified chemotherapeutic agents into four categories of emesis risk without the use of preventive agents: high (> 90%), moderate (30%-90%), low (10%-30%), and minimal (< 10%). Currently available antiemetic agents, including corticosteroids, 5-hydroxytryptamine (HT)3 receptor antagonists, and neurokinin (NK)-1 antagonists are used alone or in combination depending on the level of emetogenic potential as prophylaxis against the development of CINV during the acute period (up to 24 hours after chemotherapy) and the delayed period (up to 5 days after treatment). Newer agents, including the second-generation 5-HT3 receptor antagonist palonosetron (Aloxi) and the NK-1 antagonist aprepitant (Emend), offer additional clinical benefit in highly and moderately emetogenic therapy. However, delayed nausea and vomiting continue to occur frequently in many patients and have an impact on quality of life. Other classes of agents including the benzodiazepines and cannabinoids offer the potential for additional protective benefit. Continued research with new drugs and combinations is necessary to meet this significant unmet need of cancer patients.

This chapter provides a brief overview of the principles of radiation therapy. The topics to be discussed include the physical aspects of how radiation works (ionization, radiation interactions) and how it is delivered (treatment machines, treatment planning, and brachytherapy).

The Karnofsky performance index and WHO (Zubrod) scale (on the following page) are included here because they are commonly used as proxy measures for quality of life.

Contributors to Cancer Management:A Multidisciplinary ApproachMedical, Surgical & Radiation Oncology

Surgical oncology, as its name suggests, is the specific application of surgical principles to the oncologic setting. These principles have been derived by adapting standard surgical approaches to the unique situations that arise when treating cancer patients.

The concept for Cancer Management: A Multidisciplinary Approach arose more than 10 years ago. This 10th edition reflects the ongoing commitment of the authors, editors, and publishers to rapidly disseminate to oncologists the most current information on the clinical management of cancer patients. Important updates and revisions have been made throughout this newest edition. Substantial revisions have been made to a number of chapters, including those on non–small-cell lung cancer, prostate cancer, cervical cancer, Hodgkin lymphoma, and non-Hodgkin lymphoma. And throughout all of the book chapters, updates have been made to reflect the latest information about cancer treatment and data on ongoing and new clinical trials. This 10th volume also provides information on some of the oncology drugs that are listed below, which are newly approved or that have newly approved indications since the last edition was published, including anastrozole (Arimidex), bevacizumab (Avastin), bortezomib (Velcade), capecitabine (Xeloda), cetuximab (Erbitux), dasatinib (Sprycel), decitabine (Dacogen), docetaxel (Taxotere), erlotinib (Tarceva), exemestane (Aromasin), gefitinib (Iressa), gemcitabine (Gemzar), lapatinib (Tykerb), lenalidomide (Revlimid), letrozole (Femara), nelarabine (Arranon), panitumumab (Vectibix), pegaspargase (Oncaspar), rituximab (Rituxan), sorafenib (Nexavar), sunitinib (Sutent), thalidomide (Thalomid), topotecan (Hycamtin), trastuzumab (Herceptin), and vorinostat (Zolinza). The 47 chapters and 4 Appendices in this newest edition represent the efforts of over 100 contributors from approximately 50 institutions in the United States and Canada. Three consistent goals continue to guide our editorial policies:

The American Cancer Society (ACS) is launching a 20-year cancer epidemiology study of 500,000 cancer-free adults across the United States. Cancer Prevention Study 3 (CPS-3) will enroll geographically and ethnically diverse participants at 64 of the 4,800 ACS-sponsored Relay for Life events taking place across the country in 2007, and it will continue the accrual process at select Relay events through 2011.

Therapy via radioembolization improves outcomes in some patients with primary or metastatic liver tumors that are unresectable or refractory to chemotherapy, and research is helping to better identify these patients upfront

A group of leading scientists and hedge fund managers have announced the annual $1 million Gotham Prize for Cancer Research, which is being launched to accelerate progress in the prevention, diagnosis, and treatment of cancer by fostering collaboration among top researchers in the field.

Rising costs are not the biggest challenge facing our healthcare system, but rather the need to improve the dollar-related value of the services being delivered

Xoft, Inc.'s Axxent Electronic Brachytherapy System for accelerated partial breast irradiation (APBI) recently had its first clinical use in two lumpectomy patients treated at WellStar Kennestone Hospital.

Merck & Co., Inc. announced that it has received an approvable letter from the US Food and Drug Administration (FDA) for the company's New Drug Application (NDA) for Emend (fosaprepitant dimeglumine) for Injection, also known as MK-0517, an investigational intravenous therapy for chemotherapy-induced nausea and vomiting.

Martin D. Abeloff, MD, Charles M. Balch, Lodovico Balducci

There's nothing new about the value of eating lots of fruits and vegetables, but the effect of this diet on cancer risk has been difficult to show.

In a randomized phase III trial, patients with advanced, previously untreated hepatocellular carcinoma (HCC) treated with sorafenib (Nexavar) lived 44% longer than those treated with placebo and had a 73% prolongation in time to progression.

The fundamental principle behind this book, as stated by the publisher, The Oncology Group (also publisher of the journal ONCOLOGY and news magazine Oncology News International) was to provide a truly integrated, multidisciplinary approach to the management of cancer patients. For this updated 10th edition, the editors have enlisted 114 medical, surgical, and radiation oncologists, whose contributions provide an excellent overview of the important principles of cancer management.

The effective use of cancer chemotherapy requires a thorough understanding of the principles of neoplastic cell growth kinetics, basic pharmacologic mechanisms of drug action, pharmacokinetic and pharmacodynamic variability, and mechanisms of drug resistance.

Myelodysplastic syndromes (MDS) are a group of hematologic malignanciesof the pluripotent hematopoietic stem cells. These disorders arecharacterized by ineffective hematopoiesis, including abnormalities inproliferation, differ­entiation, and apoptosis.

Chronic lymphocytic leukemia (CLL) is a clonal malignancy that results from expansion of the mature lymphocyte compartment. This expansion is a ­consequence of prolonged cell survival, despite a varied cell turnover. The affected lymphocytes are of B-cell lineage in 95% of cases, and the remaining cases involve T lymphocytes, representing a distinct disorder. CLL is the most common leukemia in adults in Western countries, accounting for approximately 25%-30% of all leuke­mias. The proportion of cases diag­nosed with the early stages of the disease (Rai stage 0) has risen from 10% to 50%, probably because of earlier diagnosis (routine automated blood counts).  

Chronic myelogenous leukemia (CML) is a clonal myeloproliferative disor­der resulting from the neoplastic transformation of the primitive hemato­poie­tic stem cell. The disease is monoclonal in origin, affecting myeloid, mono­cytic, erythroid, megakaryocytic, B-cell, and, sometimes, T-cell linea­ges. Bone marrow stromal cells are not involved.

Head and neck cancers encompass a diverse group of uncommon tumors that frequently are aggressive in their biologic behavior.

The use of multidrug chemotherapy and bone marrow transplantation in cancer treatment has made the utilization of reliable, long-term venous access (LTVA) an essential component of cancer therapy. The placement of LTVA devices not only permits the delivery of these complex therapeutic regimens but also drastically improves patients’ quality of life.

Psychiatricdisorders are common in the setting of malignant disease, occurring inalmost 50% of patients.

The Oncology Group, a division of CMPMedica, publisher of the journal ONCOLOGY and the news magazine Oncology News International, as well as the comprehensive cancer website, cancernetwork.com, is pleased to bring you the 10th annual edition of Cancer Management: A Multidisciplinary Approach.

Patients aged 65 years and older represent 12% of the US population yet account for approximately 56% of cancer cases and 69% of all cancer mortalities. The overall cost of cancer in 2005 was $209.9 billion&#151;$74 billion for direct medical costs and $118.4 billion for indirect mortality costs. This paper considers the direct, indirect, and out-of-pocket expenditures incurred by cancer patients ‚â • 50 years of age. Several major empirical studies on supportive care for older patients and cancer-related costs were reviewed. Insurance coverage, hematologic malignancies, squamous cell carcinoma of the head and neck, and cancers of the breast, prostate, colorectum, and lung were evaluated. Major sources of direct medical expenditures covered by third-party insurers for patients aged 65 years and older include extended length of hospital stay, home health assistance following hospital discharge, adjuvant prescription medications, lower-risk treatment (for prostate cancer), and advent of new pharmaceuticals (for colorectal cancer). The mean total direct medical cost for breast cancer is $35,164, and the cumulative cost for prostate cancer is $42,570. Emerging targeted cancer drug costs range from $20,000 to $50,000 annually per patient. Additional clinical trials and cost-effective treatments are needed for older patients to ameliorate the disproportionate economic burden among older individuals with cancer. Additional research about cancer costs may also lead to reforms in cancer care reimbursement, and therefore provide access to affordable health care for older patients.

Over the past 50 years, great strides have been made in diagnosis, treatment, and survival of childhood cancer. In the 1960s the probability of survival for a child with cancer was less than 25%, whereas today it may exceed 80%. This dramatic change has occurred through significant and steady progress in our understanding of tumor biology, creation of specialized multidisciplinary care teams, incremental improvements in therapy, establishment of specialized centers with research infrastructure to conduct pivotal clinical studies, and the evolution of a cooperative group mechanism for clinical research. Most children with cancer in the United States, Europe, and Japan receive appropriate diagnosis and treatment, although access is limited in developing countries. The price of success, however, is the growing population of survivors who require medical and psychosocial follow-up and treatment for the late effects of therapy. Here we review the progress made in pediatric oncology over the past 3 decades and consider the new challenges that face us today.

Patients aged 65 years and older represent 12% of the US population yet account for approximately 56% of cancer cases and 69% of all cancer mortalities. The overall cost of cancer in 2005 was $209.9 billion&#151;$74 billion for direct medical costs and $118.4 billion for indirect mortality costs. This paper considers the direct, indirect, and out-of-pocket expenditures incurred by cancer patients ‚â • 50 years of age. Several major empirical studies on supportive care for older patients and cancer-related costs were reviewed. Insurance coverage, hematologic malignancies, squamous cell carcinoma of the head and neck, and cancers of the breast, prostate, colorectum, and lung were evaluated. Major sources of direct medical expenditures covered by third-party insurers for patients aged 65 years and older include extended length of hospital stay, home health assistance following hospital discharge, adjuvant prescription medications, lower-risk treatment (for prostate cancer), and advent of new pharmaceuticals (for colorectal cancer). The mean total direct medical cost for breast cancer is $35,164, and the cumulative cost for prostate cancer is $42,570. Emerging targeted cancer drug costs range from $20,000 to $50,000 annually per patient. Additional clinical trials and cost-effective treatments are needed for older patients to ameliorate the disproportionate economic burden among older individuals with cancer. Additional research about cancer costs may also lead to reforms in cancer care reimbursement, and therefore provide access to affordable health care for older patients.