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Two decades since the first demonstration that fluorouracil (5-FU)-based adjuvant chemotherapy improves outcomes in resected colon cancer,[1] clinicians are still struggling with the question of which patients with stage II colon cancer should receive postoperative therapy. It is well-accepted that the absolute survival benefit associated with 5-FU–based therapy for unselected patients with stage II colon cancer is in the range of 3% at 5 years. But it is also obvious that some patients with stage II cancers have excellent outcomes and do not require additional therapy, whereas other patients have cancers that biologically behave more like stage III tumors.

Some believed the unraveling of the human genome would lead overnight to the genetic tweaking of errant cells and the tailoring of treatments to patients. That dream’s time has not yet come, even a decade after the human genome was first sequenced. But the scientific community has made enormous progress in developing tools to examine the genome and their application. And those efforts may soon lead to practical results for mainstream oncology.

Radioactive iodine has been used traditionally as an adjuvant treatment for high-risk differentiated thyroid cancers.

Sorafenib (Nexavar) has antiangiogenic and antiproliferative activity and is FDA-approved for advanced renal and hepatocellular cancers.

In a potentially practice-changing study, bendamustine plus rituximab improved PFS compared with CHOP plus rituximab as first-line therapy for indolent lymphoma.

More is better, at least when it comes to treatments for multiple myeloma. Studies from Spanish and Italian investigators showed that upfront use of four drugs improves durable responses and progression-free survival in elderly patients.

Michael A. Caligiuri, MD (below), is the new president of the Association of American Cancer Institutes (AACI). Dr. Caligiuri is the director of the Ohio State University Comprehensive Cancer Center and CEO of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus.

The management of older patients with cancer is historically challenging because of a lack of prospective data regarding the appropriate management of this population. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients, including the withholding of medically appropriate treatment based on chronologic age, the historical omission of elderly from clinical trials, and the impact of geriatric assessment, and age-related changes in pharmacokinetics and pharmacodynamics. Finally, we conclude by discussing the existing evidence related to cancer treatment in the elderly, focusing primarily on the malignancies most commonly seen in older patients, and making general treatment recommendations where applicable.

The review article by Drs. Gillison and Chatta represents a very nice overview of cancer chemotherapy in the older individual across a number of different tumor types. The authors correctly point out that it is very important to distinguish chronologic from physiologic age, and that older individuals have been historically underrepresented in cancer clinical trials. Many of the larger phase III clinical trials in this population are either not designed or not powered to look at individuals over the age of 70. Moreover, trials that do include older individuals often select for the most functional individuals with minimal competing comorbid conditions and often do not include or report secondary analysis that examines outcomes by age, health status, or a combination of both. As a result, health-care providers face challenges when communicating and selecting treatment options with patients and their companions.

Drs. Gillison and Chatta present an up-to-date review of the systemic treatments available to elderly patients with the most common types of cancer. The only point I might add in the context of their review is about recently reported, promising data on targeted therapies in acute leukemia patients. A large proportion of older patients have acute lymphocytic leukemia positive for a t(9;22) translocation (Philadelphia chromosome–positive ALL).

Omega-3 fatty acids have gained popularity over the past decade as growing scientific evidence supports their use in preventing cardiovascular disease, depression, rheumatoid arthritis, and asthma, and in slowing cognitive decline. Because they are essential and cannot be synthesized in the human body, omega-3 fatty acids should be obtained through diet by consuming fish and nuts, or in supplemental form.

As many as one in four cancer patients develop metastatic cancers of the brain. Existing therapies seldom do more than slow the disease. Adding to the urgency to find a way to prevent brain metastasis is the increasing number of such cases.

Adding cetuximab (Erbitux) to neoadjuvant chemotherapy shrank tumors enough to increase the success of curative surgery in colon cancer patients with inoperable metastatic liver lesions, according to the CELIM trial conducted in Germany and Austria.

Precise and noninvasive, stereotactic radiosurgery is proving a godsend to some noncancer patients: Its use for applications outside oncology-such as the treatment of movement disorders, arteriovenous malformations, and neuralgia-have been around almost since the commercial introduction of this technology. The noninvasive destruction of brain tumors dominates the use of this equipment, but alternate uses are picking up steam, according to Iris C. Gibbs, MD, an assistant professor of radiation oncology at the Stanford Cancer Center in California and codirector of the CyberKnife Radiosurgery Program at the Stanford Hospital and Clinics, where the CyberKnife was invented. “The results of studies with large numbers of patients help us get a sense of the factors that contribute to either the success or failure of these techniques,” Dr. Gibbs said.

Bone renewal is essential for bone strength. During childhood and early adulthood, bone formation prevails over bone resorption, as bones increase in size and strength. Peak bone mass is achieved during the third decade in life, with a higher peak bone mass being protective against osteoporosis later in life.[1] Bone loss is most prominent in women at menopause due to the effects of a natural decline in estrogen levels. However, bone mass begins to decrease with age, and bone loss is most prominent in women at menopause due to the effects of a natural decline in estrogen levels.[2]

Micromet and Sanofi-aventis announced a global collaboration and license agreement to develop a BiTE antibody against a carcinoma cell antigen. Micromet will be responsible for the discovery, research, and development of the BiTE antibody through the completion of phase I clinical trials and under a joint steering committee’s supervision. Sanofi-aventis will have full responsibility for additional as well as worldwide commercialization of the BiTE antibody.

From naked antibodies to arsenic-laced molecules to anti-survivin antibodies, three up-and-coming agents are potential standouts in the lymphoma treatment arsenal. SGN-35 is an immunoconjugate that could offer a novel approach to Hodgkin’s lymphoma therapy. Then there are darinaparsin, an organic arsenic molecule, and YM155, which may be able to restore normal apoptotic activity in advanced and aggressive lymphoma, respectively. Researchers working with these drugs discuss their studies and trials while hematologic experts offer some perspective on the future of these agents.

Oncology specialists heaved a sigh of relief in November, after analysts from ASCO and ASTRO concluded that the worst had, in fact, not happened. A 6% cut proposed last summer by the Centers for Medicare & Medicaid Services to affect medical oncology practice in 2010 under Medicare’s final physician fee schedule would instead be only 1%, according to an October announcement made by CMS.

Shortages in funding, manpower, and willing patients have created the proverbial perfect storm in the current clinical trial system. The fact that traditional clinical trial endpoints in assessing novel agents are being reconsidered only puts more pressure on an already strained system. As the cancer research community navigates the troubled waters of clinical trials, one question is: Should traditional phase II trials be phased out?

This review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular cancer after orthotopic liver transplantation, as well as future prospects. No adjuvant treatment is currently advocated.

This review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). The authors review prognostic factors for disease recurrence and adjuvant therapy after OLT, including systemic chemotherapy, intra-arterial chemoembolization, immunosuppressant effects, and sorafenib (Nexavar). Several interesting questions are raised in the article, including: (1) When is the best time to apply systemic chemotherapy?

In this issue of ONCOLOGY, Kim et al discuss adjuvant therapy after liver transplantation to decrease recurrence of hepatocellular carcinoma (HCC). Liver transplantation offers the best overall and recurrence-free survival for the treatment of stage I and II HCC. The landmark study in 1996 by Mazzaferro demonstrated that liver transplantation of patients with one lesion less than 5 cm or with up to three lesions but all less than 3 cm (the Milan criteria) resulted in low recurrence rates and similar survival to patients without HCC.[1]

More than 50% of patients with advanced breast or prostate cancer have identifiable bone metastasis, and 30% to 40% of patients with non–small-cell lung cancer ultimately develop metastases to bone.[1,2]

The “Mediterranean diet” represents the food consumed in about 16 countries bordering the Mediterranean Sea. Accumulating evidence points to the many health benefits conferred by this diet.

The methods and outcomes for stem cell transplants are constantly improving as leading experts continue to investigate new approaches for reducing the serious adverse events associated with the procedure. Research presented at the 51st Annual ASH Meeting took a closer look at complications of stem cell transplants, including veno-occlusive disease and graft-vs-host disease.

Research presented at the 51st Annual Meeting of the American Society of Hematology (ASH) in New Orleans introduced potential new treatment options and improved diagnostic methods for patients suffering from acute promyelocytic leukemia (APL), chronic myeloid leukemia (CML), infant acute lymphoblastic leukemia (ALL), and myelofibrosis that are based on a better understanding of the underlying genetic causes of these conditions.

Ultrasound elastography may be the link bridging the gap between suspicion and definitive proof, a noninvasive means to distinguish between benign and malignant tissue. The technology for doing so appeared some years ago at the annual meeting of the Radiological Society of North America as an experimental curiosity. It’s been evolving since then until it appears now to have reached a clinical tipping point.

SAN ANTONIO, TEX.-Clinical updates on the mother of all monoclonal antibodies and the link between bone and breast health will be ones-to-watch at SABCS 2009. Peter Ravdin, MD, PhD, shared his presentation picks at this year’s meeting with Oncology News International. Dr. Ravdin is on the SABCS executive committee and is based at the University of Texas Health Science Center in San Antonio.

The oncology community is happy about next year’s cut in Medicare reimbursement. Well, maybe not so much happy as relieved.

Oxygen therapies are expensive, unproven, and harmful alternatives promoted in appealing and convincing ways for the treatment of cancer and other major diseases. Supporters claim that low levels of oxygen enable cancer cells to thrive and that an oxygen-rich environment destroys them. However, these claims are unsubstantiated. Further, numerous reports of serious complications and fatalities have been reported from the use of oxygen therapies.