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In 2009, approximately 35,720 men and women (25,240 men and 10,480 women) in the United States will be diagnosed with cancer of the oral cavity and pharynx, and 7,600 will succumb to these diseases. Further, an estimated 12,290 men and women (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer, and 3,660 will die from this malignancy. Most patients with head and neck cancer have metastatic disease at the time of diagnosis (regional nodal involvement in 43% and distant metastasis in 10%).

Endocrine malignancies, although relatively uncommon, are often difficult to diagnose and treat effectively. According to American Cancer Society (ACS) estimates, more than 39,000 new cases of endocrine neoplasms will be diagnosed in the United States in 2009, and approximately 2,470 deaths will result from these cancers. This chapter will focus on thyroid and parathyroid cancers. (A discussion of carcinoid tumors, insulinomas, gastrinomas, and other gastrointestinal neuroendocrine tumors, as well as adrenocortical cancer, can be found in chapter 11.)

In our exclusive on-site coverage of this event, ONCOLOGY has engaged nationally recognized breast cancer specialist Harold J. Burstein, MD, PhD, Associate Professor of Medicine, Harvard Medical School to provide insight on the meeting’s most clinically relevant sessions.

MBCC 2010 Intro Copy

The journal ONCOLOGY presents exclusive on-site coverage of the 27th Annual Miami Breast Cancer Conference. Nationally recognized breast cancer specialist Harold J. Burstein, MD, PhD, Associate Professor of Medicine, Harvard Medical School provides expert insight into the optimal multidisciplinary management of patients with breast cancer and the application of innovative approaches to practice-coverage includes special emphasis on sessions dealing with the rapidly changing advances in the treatment of metastatic disease.

The FDA granted accelerated approval for the use of lapatinib (Tykerb) with letrozole (Femara) as a first-line, oral treatment for women with metastatic disease.

Concerned that erythropoiesis-stimulating agents may actually undo what chemotherapy has done, promoting tumor progression or recurrence and shortening overall survival, the FDA is clamping down on these products, marketed by Amgen as Aranesp (darbepoetin alfa) and Epogen (epoetin alfa), and by Centocor Ortho Biotech Products as Procrit (epoetin alfa).

The epigenetic control of gene expression has been shown to play an important role in cancer initiation, progression, and resistance. Thus, agents that modify the epigenetic environment of tumors will likely be an important addition to the anticancer arsenal. Specifically, there is much interest in modulating histone acetylation using a new class of drugs, histone deacetylase (HDAC) inhibitors. Preclinical data have demonstrated the efficacy of various HDAC inhibitors as anticancer agents, with the greatest effects shown when HDAC inhibitors are used in combination with other therapies. As a result of encouraging preclinical data, numerous HDAC inhibitors are being investigated in clinical trials either as monotherapies or in conjunction with other treatments such as chemotherapy, biologic therapy, or radiation therapy. In fact, vorinostat and depsipeptide, two actively studied HDAC inhibitors, were recently approved for the treatment of refractory cutaneous T-cell lymphoma. Although the use of HDAC inhibitors has generated great enthusiasm, a significant amount of work still needs to be done in order to understand their mechanisms of action, as well as to determine the appropriate patient characteristics and subsets of cancer for which HDAC inhibitors hold the most potential for effective treatment.

Shabason and colleagues’ review of the development of histone deacetylase (HDAC) inhibitors as treatment for cancers is timely, with an emphasis on therapeutic strategies combining HDAC inhibitors and radiation therapy. As the authors indicate, vorinostat (Zolinza)-originally known as suberoylanilide hydroxamic acid, or SAHA-was the first of the HDAC inhibitors approved by the US Food and Drug Administration (FDA) for clinical use in the treatment of cutaneous T-cell lymphoma (CTCL).[1] In November 2009, a second HDAC inhibitor-romidepsin (Istodax)-received FDA approval for the treatment of CTCL. Currently there is a great deal of competition in the HDAC inhibitor field, as several new and, hopefully, more effective compounds are being developed and entering clinical trials.[2]

Shabason et al have written a thoughtful review of an exciting new class of agents, histone deacetylase (HDAC) inhibitors. While the authors focus primarily on the role of HDAC inhibitors in combination with radiation therapy, we would like to highlight some potential strategies combining these agents with systemic therapies for the treatment of cancer.

Who's News

ASCO and RSNA elect new presidents while the Children's Oncology Group selects a new leader. Read more about the latest awards and appointments in oncology and cancer care.

In the largest survey to date of US oncologists’ attitudes about the cost of cancer treatments, researchers at Tufts Medical Center and the University of Michigan found that 84% of oncologists consider their patients’ out-of-pocket costs when recommending cancer treatment. However, fewer than half of the respondents surveyed frequently discuss cost issues with patients.

Cancer patients sometimes develop neurologic complications directly caused by their cancers. Sometimes, however, these disorders are due not to the growth of a cancer tumor but to cancer-fighting antibodies that mistakenly attack cells in the nervous system. PET/CT may help physicians tell the difference.

Practitioners of Gerson therapy believe that cancer is caused by an accumulation of toxic substances in the body. They recommend a special diet including high carbohydrate and potassium intake, no sodium or fat, low animal protein, supplementation with exogenous digestive enzymes, and coffee enemas aimed at detoxifying the body and stimulating metabolism. However, available scientific evidence does not support use of Gerson therapy.