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Genetic and genomic research is creating new and more individualized approaches to better manage a person's disease or predisposition to disease, including cancer.

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.

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.

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In this January 2010 supplement to Oncology, guest editor Axel Grothey from the Mayo Clinic, explores adjuvant therapy considerations in stage II colon cancer.

      Taking place in London this year, SMi’s Imaging in Oncology will focus on a wide range of imaging techniques in a wide range of settings - from the preclinical, to the clinical, to the future of oncological imaging. 

In this January 2010 supplement to Oncology, guest editor Axel Grothey from the Mayo Clinic, explores adjuvant therapy considerations in stage II colon cancer.

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.