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Vitamin B12 is part of the vitamin B complex and is essential for maintaining nerve function, fatty acid metabolism, and DNA and amino acid synthesis. By lowering homocysteine levels, it may also protect against cardiovascular disease. Vitamin B12 can be obtained through diet (including eggs, dairy products, poultry, meat, and fortified cereals) and in supplement form. Deficiency of B12 can lead to a wide variety of hematologic, neurologic, and psychiatric disorders and may increase the risk of cardiovascular diseases. Clinical evidence to support the role of vitamin B12 in decreasing cancer risk is mixed. Further research is needed.

Despite the fact that elderly patients comprise over 50% of the non-small cell lung cancer (NSCLC) population, our knowledge regarding the efficacy and safety of chemotherapy in this group is suboptimal. The “elderly” (defined as individuals ≥70 years of age) experience physiologically normal aging of their bone marrow and kidneys, which inherently increases toxicity to therapy. Standard practice has often been to discourage the use of combination chemotherapy in these patients; however, general consensus guidelines emphasize that performance status should primarily guide the choice of treatment. Elderly patients with advanced NSCLC treated with platinum doublet therapy demonstrate similar efficacy (but increased toxicity) to their younger counterparts. Patients with metastatic disease in which a targeted and/or biological agent(s) was added to chemotherapy experienced benefits similar to those treated with standard platinum doublets, but with increased morbidity and mortality. In the future, effective testing of molecular targeted therapies will have to include elderly patients among research cohorts or risk excluding a large population of eligible patients. Overall, elderly patients with advanced NSCLC, while experiencing greater toxicity, demonstrate the same response rates and survival benefits as their younger peers.

Calendar age and biological age do not always correspond. Pablo Picasso, source of the quote that begins the title of this commentary, lived a notoriously robust and active life through his later decades, dying in his nineties in the midst of a dinner party. In the oncology community, with the advent of targeted therapeutics and better supportive care, the disparity between the two is likely to be increasingly relevant to both research and practice. In this issue of ONCOLOGY, Chiappori et al review data supporting the idea that even in the context of standard cytotoxic chemotherapy, elderly patients with advanced NSCLC experience similar response rates and similar survival benefits to those seen in younger patients. They note that biases excluding elderly patients from clinical trials result in gaps in our knowledge of how to best treat older patients.

The review by Dr. Chiappori and colleagues in this issue of ONCOLOGY addresses an important challenge relating to the optimal management of elderly patients with lung cancer. The authors provide an excellent overview of the data in patients with various stages of non-small cell lung cancer (NSCLC). They also highlight the limitations of the existing data in the management of elderly NSCLC patients.

Nothing gets biopharma policy watchers more worked up than the possibility that the Centers for Medicare & Medicaid Services (CMS) will second-guess FDA approval decisions. In reality, though, CMS often has no choice but to apply its own interpretation to issues that also fall under the FDA’s jurisdiction-and implementation of the health care reform is bringing more of those cases to the fore.

Kaiser Health asked the question, see P&P contributor’s answer

The Fred Hutchinson Cancer Research Center has signed a formal agreement with China's version of the CDC. One goal is to carry out research on large datasets, with the aim of finding new cancer biomarkers.

This is important, mark your calender! Final Rules webinar on Thursday, December 2, 2010

McKesson plans to spend more than $2 billion to purchase the largest community-based cancer treatment and research network in America.

Exit polls show that health-care took a back seat to the economy. But the GOP is bent on reforming the Reform. Check out the early analysis from major news outlets.

Up-to-date drug and vendor news in hematology.

ASTRO appoints a new board of directors and bestows several awards at its 2010 meeting. Learn more about the latest appointments and accolades in cancer care.

Dear Colleague: In recent years, experts in the field of hematologic malignancies have seen a panoply of drugs gain a place in our treatment armamentarium. Some of the breakthroughs include the approval of histone deacetylase (HDAC) inhibitors in chronic lymphocytic leukemia (CLL) and peripheral lymphoma; the application of novel alkylating agents, such as bendamustine (Treanda), in CLL and various lymphomas; and the incorporation of dasatinib (Sprycel) for treating chronic myeloid leukemia patients who prove resistant to imatinib (Gleevec). We now find ourselves focusing on how to design the most effective strategies, including drug sequencing, to maximize benefit for our patients. The 2010 American Society of Hematology meeting (ASH) offers the chance to delve deeper into the best ways to maximize treatment for our patients. Join Oncology NEWS International for onsite reports from ASH 2010 as we bring you a bird’s eye view of the research, trials, scientific advances, and controversies that are changing the way hematologic malignancies are managed and treated. Check back here daily during the meeting and watch your inbox for our exciting reports from the ASH 2010 meeting.

Check out this summary of healthcare policy coverage from the major news organizations

Surveys have shown that the mean days in accounts receivable for US oncology practices averages about 36 days. With today’s slim margins, your AC department needs to do a better job.

New guidelines advise caution advised when prescribing epoetin and darbepoetin

Rhetoric aside, initiatives such as comparative effectiveness and ACOs are designed to cut the costs of healthcare. Is there a way to effectively cut the cost of cancer care and maintain quality?

Noni is an evergreen plant prevalent in Southeast Asia, Australia, and the Polynesian islands. It is used in traditional medicine for wound healing, infections, skin conditions, diarrhea, and as a tonic. Noni products have gained worldwide popularity over the past 2 decades and are aggressively marketed for immunostimulation and for treatment of chronic fatigue syndrome and cancer.Preliminary data from in vitro and animal studies suggest immunomodulatory, antioxidant, and antitumor properties. However, hepatotoxicity and hyperkalemia have also been reported with noni use.

In early 2008, based on the results of its E2100 trial, which showed significant improvements in progression-free survival when combined with paclitaxel, Avastin (bevacizumab) gained an FDA accelerated approval. Median progression-free survival in the Avastin arm was 11.3 months compared with 5.8 months for paclitaxel alone (although overall survival in the two arms was similar). However, final approval would be dependent on subsequent trials showing similar degrees of benefit. When two additional trials were submitted for review, both showed significant improvements in progression-free survival, but again with no difference in overall survival. Subsequently, on July 20th of this year, the Oncologic Drugs Advisory Committee (ODAC) voted 12 to 1 not to recommend permanent approval of Avastin as first-line therapy in advanced breast cancer.

OK, no one said implementing the new health law was going to be easy. Or, as the clueless and nameless health care executive says in the cartoon video below which has gone viral in health policy circles, "This sounds way harder than I expected."

AACR Colorectal Cancer Conference to Focus on Screening, New Treatments

The Affordable Care Act establishes a voluntary program for accountable care organizations (ACOs) by January 2012. What does it mean for oncology?

Cancer care experts describe the building blocks for creating a survivorship program.

Children undergoing anthracycline therapy for acute lymphoblastic leukemia saw cardioprotective benefits with dexrazoxane (Zinecard or Cardioxane), which signifi cantly reduced the occurrence of long-term heart damage without negatively aff ecting the eff ectiveness of chemotherapy.