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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.

On November 20, 2008, the US Food and Drug Administration (FDA) granted accelerated approval for eltrombopag (Promacta Tablets, GlaxoSmithKline) for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulin therapy, or splenectomy.

Surgical intervention for mesothelioma has become widely accepted, but controversy persists: Should surgery be the standard of care or should it be offered only to select patients? According to scientific literature, surgery decreases morbidity and mortality while also improving outcomes compared with adjunctive therapy alone.

Radiofrequency ablation can decrease disease progression in patients with dysplastic Barrett esophagus, or metaplasia of the espophageal epithelium, according to a study out of the University of North Carolina in Chapel Hill. The researchers also found that the technique eradicated dysplasia and intestinal metaplasia.

MINNEAPOLIS-When it comes to taking stock of an oncology practice’s productivity, less is more. It benefits a practice to develop a few meaningful benchmarks rather than multiple overlapping, overwhelming, and meaningless measurements.

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.

A review article asserting breast MRI does not improve surgical planning, reduce follow-up surgeries, or reduce the risk of local recurrences drew the ire of the breast imaging community.

The incidence of later-stage breast cancer has not kept pace with a substantial increase in diagnosed breast cancers, an increase achieved largely by the use of better imaging equipment and a nearly 70% screening rate among women 40 years and older. This fact, underscored in a special communication in the Journal of the American Medical Association, pokes holes in the widely held public belief that early diagnosis will prevent the majority of breast cancer deaths.

News summary of the discussion about when routine mammography screening for breast cancer should begin

Owen Witte, MD, has been a California resident for nearly 35 years, but there’s nothing laid-back about him. The director of the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research retains the rapid fire speech of a native New Yorker. Although it was getting toward late afternoon when Dr. Witte met with Oncology News International, he ushered a steady stream of visitors into and out of his office at the University of California, Los Angeles. When he spoke about his work, it was with the same energy that no doubt drew him to science in the first place.

Scientists in New Mexico are experimenting with a nanotechnology device that quantifies the amount of nanoparticle-bound tumor cells in a tissue sample and offers increased sensitivity to minimal residual disease (Cancer Res 69:6839-6847, 2009).

An investigator at Fred Hutchinson Cancer Center in Seattle has earned a $1.74 million grant under the American Recovery & Reinvestment Act of 2009.

Despite the hubbub, breast imaging researchers saw nothing new in the findings of Dr. Esserman’s group. Daniel Kopans, MD, a professor of radiology at Boston’s Massachusetts General Hospital, called her observation about mammography catching nonlethal cancers but missing aggressive ones “a fundamental concept that is older than I am. Mammography saves lives by finding moderate- and slow-growing cancer that will kill in five or more years without diagnosis and treatment,” according to Dr. Kopans.

Cannabinoids, which are a byproduct of marijuana smoke, have been recognized to have potential antitumor properties, but evidence of a relationship between marijuana use and the induction of head and neck squamous cell carcinoma has been inconsistent.

Head and neck patients who undergo surgery first are more likely to complete radiation therapy, according to Seattle-based researchers. Megan Dann Fesinmeyer, PhD, MPH, and colleagues noted that radiation dose and treatment duration correlated with tumor control and survival, but that breaks in radiotherapy have been associated with inferior tumor control.

Prometheus Laboratories has launched the ProOncDx line of cancer diagnostic tests. ProOncDx TumorSource pinpoints the tissue of origin in metastatic tumors in a number of cancers including breast, brain, kidney, colon, liver, ovary, lung, pancreas, and prostate. The test measures the expression level of 48 microRNA biomarkers

Researchers had identified a small molecule that inhibits the heat shock protein HSP70. They also demonstrated in their animal experiment that the HSP inhibitor could stop tumor formation and significantly extend survival.

An analysis by researchers at the University of Michigan Comprehensive Cancer Center shows that costs vary widely for different treatment regimens and from one delivery method to another. Yet receiving more treatments and spending extra on more sophisticated technology may do little good, at least when it comes to pain relief.