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Rubinstein and colleagues provide an excellent review of mathematical models for estimating breast cancer risk, including the risk of carrying inherited mutations of BRCA1 and BRCA2. Since we and others reviewed early models to predict the likelihood of inherited susceptibility to breast cancer,[1] newer quantitative tools, most notably by Parmigiani and colleagues,[2] have been developed. These models have been made available on CD-ROM, over the Internet, and in other electronic versions that are accessible to most clinicians and researchers. These quantitative resources constitute useful and important aids in genetic counseling.

In their paper, Schwartz and colleagues review the risk factors for depression and suicide in patients with cancer and argue convincingly that screening for depression can be simply and quickly performed. They also delineate the efficacy and potential adverse effects of psychotherapeutic or psychopharmacologic treatments for these patients. Buttressing the identification and treatment of depression in the cancer patient are vital, ongoing scientific developments that flow from an increased understanding of interactions among the brain, endocrine system, and immune system. This rapidly evolving body of neurobiological knowledge has catalyzed fundamental changes in how we conceptualize depression in cancer patients and has important ramifications regarding the treatment and prevention of depressive syndromes in this setting.

Depression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be

Because irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.

Women at increased risk of breast cancer have important opportunities for early detection and prevention. There are, however, serious drawbacks to the available interventions. The magnitude of breast cancer risk is a crucial factor in the optimization of medical benefit when considering the efficacy of risk-reduction methods, the adverse effects of intervention, and economic and quality-of-life outcomes. Breast cancer risk assessment has become increasingly quantitative and is amenable to computerization. The assembly of risk factor information into practical, quantitative models for clinical and scientific use is relatively advanced for breast cancer, and represents a paradigm for broader risk management in medicine. Using a case-based approach, we will summarize the major breast cancer risk assessment models, compare and contrast their utility, and illustrate the role of genetic testing in risk management. Important considerations relevant to clinical oncology practice include the role of risk assessment in cancer prevention, the logistics of implementing risk assessment, the ramifications of conveying risk information with limited genetic counseling, and the mechanisms for genetics referral. Medical professionals can embrace new preventive medicine techniques more effectively by utilizing quantitative methods to assess their patients’ risks. [ONCOLOGY 16:1082-1099, 2002]

The hepatic metabolism and biliary secretion of irinotecan (CPT-11, Camptosar) and metabolites is complex and involves cytochrome P450 isoenzymes, carboxylesterases, glucuronosyltransferase, and the ATP-dependent export pumps MRP-2 and MXR. Enzyme-inducing antiepileptic drugs (EIAEDs) such as phenytoin and carbamazepine are known to induce several of the metabolic pathways relevant to ininotecan’s elimination. The North American Brain Tumor Consortium phase I study is designed to determine the maximum tolerated dose and pharmacokinetics of irinotecan given every 3 weeks to patients who are receiving EIAEDs.

Irinotecan and mitomycin (Mutamycin) possess significant single-agent activity against several tumor types, and mitomycin activates topoisomerase I, the cellular target of irinotecan. We conducted a phase I dose-escalation study of irinotecan and mitomycin in 37 evaluable patients with solid tumors. Antitumor responses included 2 complete responses, 5 partial responses, 10 minor responses, and a CA 19-9 tumor marker response.

ORLANDO-Capecitabine (Xeloda) might one day replace infusional fluorouracil (5-FU) as a radiosensitizing platform in the chemoradiation of advanced gastrointestinal malignancies, according to Tyvin A. Rich, MD, professor of radiation oncology, University of Virginia Health Sciences Center, Charlottesville. The oral fluoropyrimidine simplifies chemoradiation, is well tolerated, and is highly appealing to patients and physicians alike, he said.

HOUSTON-The COX-2 inhibitor celecoxib (Celebrex) appears to improve tumor response to capecitabine (Xeloda) and may help relieve hand-foot syndrome, according to results of a retrospective study by researchers at M.D. Anderson Cancer Center. Lead investigator Edward H. Lin, MD, assistant professor of medicine, Division of Gastrointestinal Medical Oncology, said that the group is planning a prospective trial of the combination.

MANHASSET, New York-Early results from a phase I trial at North Shore University Hospital, Manhasset, New York, found irinotecan (CPT-11, Camptosar) with capecitabine (Xeloda) to be well tolerated by patients with inoperable or metastatic solid tumors who had failed standard therapy or had no therapy options, according to an abstract published at the American Society of Clinical Oncology annual meeting (abstract 2127).

BARCELONA, Spain-A large European, multicenter phase II trial of XELOX-capecitabine (Xeloda) and oxaliplatin (Eloxatin, investigational in the United States)-as first-line therapy for patients with metastatic colorectal cancer produced an objective response in 55% of patients.

ORLANDO-Evolving targeted therapies for metastatic colorectal cancer hold promise for greater therapeutic efficacy and improved quality of life for patients, according to Edward H. Lin, MD, assistant professor of medicine, Division of Gastrointestinal Medical Oncology, M.D. Anderson Cancer Center. Speaking at an industry-sponsored symposium held in conjunction with the ASCO meeting, Dr. Lin discussed the general concepts of targeted therapy and reviewed several treatments under investigation.

BETHESDA, Maryland-Wyeth Vaccines, a unit of Wyeth Pharmaceuticals, has won a 5-year, $22.8 million contract from the National Institute of Allergy and Infectious Diseases (NIAID). The contract was awarded by NIAID’s HIV Vaccine Design and Development Teams (HVDDT) program, a public-private effort that seeks to accelerate the development of HIV vaccines.

ATLANTA-A novel breast imaging technology that uses radiowaves in the microwave frequency range to detect and locate lesions shows promise in preliminary case reports and will be entering clinical trials, said Allan Malmed, MD, medical director, Northwest Community Hospital Interdisciplinary Breast Center, Arlington Heights, Illinois. Dr. Malmed and his colleagues presented the findings at a poster session of the 102nd Annual Meeting of the American Roentgen Ray Society (abstract 159).

SAN FRANCISCO-The drug anethole dithiolethione (ADT)-normally used for dry mouth and marketed as Sialor or Sulfarlem-reduced the risk of new or worsening dysplastic lesions in the lungs of current and former smokers by 22%, compared with placebo, according to a study presented at a late-breaking research session of the 93rd Annual Meeting of the American Association for Cancer Research (abstract LB-119).

LOS ANGELES-The North American Brain Tumor Consortium (NABTC) reported that R115777 (Zarnesta) shows modest activity against recurrent glioblastoma multiforme and might be effective as a therapy for certain subtypes of these

SEATTLE-A response to highly active antiretroviral therapy (HAART) independently predicts the outcome of AIDS-related lymphoma, underscoring the importance of giving HIV-positive patients this therapy whenever possible, Christian

FORT LAUDERDALE, Florida-Current conservative management of pediatric intraocular retinoblastoma is very effective, especially with chemotherapy plus focal ablation of tumors. But enucleation remains the primary therapeutic choice in children, undertaken in almost three quarters of cases, investigators reported at the Association for Research in Vision and Ophthalmology (ARVO) annual meeting.

ORLANDO-Prolonged maintenance treatment improves long-term outcome in acute myeloid leukemia (AML) more than intensive consolidation, even in those patients with poor prognosis, according to a study reported by Thomas Buchner, MD, professor of internal medicine, hematology and oncology at the University of Muenster in Germany (ASCO abstract 1046).

Any new medical textbook must compete for readership under new rules. It is not just the numerous other books being published but also the wealth of information on the Internet that vies for the time and attention of the inquiring reader. Web-based general search engines and medical literature tools have made the previous frequent trips to the hospital library nearly obsolete for many of us. There is ready access to original references or discussion about almost any topic in cancer care. A successful book on cancer treatment, therefore, must provide more-something unique for the practicing physician, student, or teacher. Ideally, it will present a useful synthesis, interpretation, and, with luck, clinical wisdom

ORLANDO-Preliminary results of a French study show improved event-free survival for patients with indolent non-Hodgkin’s lymphoma (NHL) who received high-dose chemotherapy with purged autologous stem cell transplantation as first-line therapy, compared with conventional standard therapy.

NANTES, France-The farnesyl transferase inhibitor R115777 (tipifarnib, also known as Zarnestra) is well-tolerated and effective even in relapsed, refractory acute myelogenous leukemia (AML), according to interim results of a phase II study (ASCO abstract 1056). "In this multicenter trial, we have treated relapsed and refractory patients including those who never had a complete response," lead author Jean-Luc Harousseau, MD, professor and head of the hematology department at University Hospital (hotel Dieu) in Nantes, France, told Oncology News International. "Disappearance of blasts and complete response is very encouraging for the future of Zarnestra in AML."

WASHINGTON-A Delaware judge has sided with the American Legacy Foundation in its legal jousting with Lorillard Tobacco Co. The judge denied Lorillard’s request to stay or dismiss a lawsuit filed by the foundation in a series of court maneuvers that began in January. His ruling would allow the Legacy lawsuit to go forward before one filed in North Carolina by Lorillard against the foundation.

ST. PETERSBURG, Florida-As a nurse and 22-year survivor of Hodgkin’s disease, Debra Thaler-DeMers, RN, OCN, from the National Coalition for Cancer Survivorship (NCCS), brought her personal survivorship perspective to the Late Effects of Normal Tissues (LENT) IV workshop on late effects criteria and applications.

NEW YORK-"In 2002 there is a lot of activity in mesothelioma research," Nicholas J. Vogelzang, director, University of Chicago Cancer Research Center, said at a media briefing on malignant mesothelioma, sponsored by the American College of Preventive Medicine. "This was an orphan disease for many years." Roman Perez-Soler, MD, of Albert Einstein College of Medicine, added: "We’re moving from empiricism to rational therapies."

BRISBANE, Australia-Progen Industries is conducting a phase I trial combining its cancer drug PI-88 with docetaxel (Taxotere) in patients with advanced malignancies. The trial is taking place at the University of Colorado Cancer Center,

NEW YORK-The death toll associated with the World Trade Center disaster of September 11 may rise 20 or 30 years from now, according to experts who spoke at a media briefing on malignant pleural mesothelioma. Many thousands of people at or near the disaster site had some exposure to asbestos, a causative agent of mesothelioma, said Stephen M. Levin, MD, medical director, Mount Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine.

HOUSTON-Dynamic magnetic resonance imaging (MRI) has shown PTK787/ZK 222584 (PTK/ZK), an antiangiogenesis agent, to be capable of blocking vascular endothelial growth factor receptor (VEGFR)/VEGF activity in recurrent glioblastoma multiforme (ASCO abstract 315).

BETHESDA, Maryland-Total annual cancer cases will likely double in the United States during the first half of the 21st century, with 2.6 million people diagnosed with the disease in the year 2050, according to a new federal report (see Figure). The major driving force for this projected increase is the growth and aging of the American population, which will sharply increase the number of cases even if the cancer rate remains constant.

ORLANDO-Despite early mortality risks, HLA-matched sibling bone marrow transplants (BMTs) offer a greater possibility of cure for patients with relapsed chronic lymphocytic leukemia (CLL) than does chemotherapy, according to a report presented at the 43rd Annual Meeting of the American Society of Hematology (abstract 2011). A second report (abstract 2013) showed that allogeneic transplant led to better event-free survival than autologous transplant.