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Bill, 53 years old and a 3-year survivor of non-Hodgkin’s lymphoma, reflects on his ongoing journey as a cancer survivor: “I was very sick and treatment was very rough, complete with a severe allergic reaction that was difficult to diagnose for a long time. But I made it through to the other shore…remission. Since then, I’ve been trying to rebuild a new life…Living with an 18-year-old [son], I can see how in some ways I’m in a parallel universe…Both of us are looking out at the world before us, at all the many possible options...trying to figure out what we want tomorrow to look like.

On January 20th, all eyes were on the inauguration in Washington, and most of us felt not only a sense of renewed hope but also some uncertainty about what the future will hold. In many ways, cancer patients also face these dual feelings of hope and uncertainty when treatment ends and they confront the task of finding a “new normal.” Re-establishing routines, relationships, and one’s connection to the world is eagerly wanted, but for some it can be daunting. The impact of cancer on one’s health, daily function, and body image, as well as financial and other concerns, also may present challenges.

As difficult as treatments are for many cancer patients, another difficult time awaits them at the conclusion of therapy. Until that point, patients have become accustomed to the fleeting comfort of regularly scheduled appointments for diagnostic testing, chemotherapy and/or radiation treatments, and ongoing contact with health care professionals. Conclusion of treatment can seem abrupt and the absence of attention can be unsettling for many. It is at this point that patients often ask, “What can I do now to help myself?”

In 2008, roughly 1.44 million Americans were diagnosed with cancer,[1] and accordingly were labeled as “cancer survivors.” Fortunately, for roughly 65% of those who were newly diagnosed, this label will expand to encompass issues of long-term survivorship and health maintenance.[2] Extended cancer survivorship is a relatively new concept. In the past, most people who were diagnosed with the disease did not survive it. While longer survival times are a measure of success, the dark side of this victory is that a substantial proportion of these survivors will experience recurrence or second cancers. In addition, many more will go on to develop comorbid conditions such as cardiovascular disease (CVD), diabetes, or osteoporosis, which often kill or debilitate survivors at much higher rates than the cancer itself.[3,4]

CMHB Jonathan Test Article Chapter One

In metastatic breast cancer (MBC), lapatinib (Tykerb) + letrozole (Femara) delayed disease progression in HER2+, HR+ patients, according to initial results from a phase III trial (EGF30008) presented by Stephen Johnston, MD (abstract 46).

Based on 2 meta-analyses of nearly 20,000 HR+ early breast cancer patients, AIs are superior to tamoxifen in reducing recurrences, whether as initial monotherapy or given in a “switching” strategy (abstract 12).

There is evidence that higher doses of fulvestrant (Faslodex) may have greater activity than the approved dose of 250 mg/mo. The FIRST trial (Fulvestrant First-Line Study) compared 500 mg vs anastrozole 1 mg/d in the first-line advanced disease setting, finding that a dose of 500 mg/mo achieved response rates and clinical benefit rates similar to those obtained with anastrozole 1 mg/d but gave a significantly longer time to progression (abstract 6126).

EXPERT’S CORNER-Nearly three quarters of breast cancer patients have tumors that express estrogen receptors (ERs) or progesterone receptors (PRs); approximately half of these patients are postmenopausal. We look to endocrine therapy, therefore, to prevent recurrences and save lives in the majority of early breast cancer patients and to prolong survival in the advanced disease setting.

ABCSG Trial: Survival Benefit for Tamoxifen. Anastrozole Updated results from Austrian Breast and Colorectal Cancer Study Group Trial 8 confirmed a survival difference for the sequencing strategy of tamoxifen followed by anastrozole (Arimidex), compared to 5 years of tamoxifen (abstract 14). Preliminary results (median follow-up 55 mo) had previously revealed a 24% reduction in recurrence in favor of the sequencing strategy, although the difference was not statistically significant.

The largest numbers of trial terminations occur at phase II, especially if the trial is for a marketed therapy compared with a novel drug, according to an expert analysis in the Good Clinical Practice Journal.

CHICAGO-Using imaging to monitor drug response is becoming an increasingly important fi eld of research, and radiologists who are not involved in clinical trials should at least become aware of it, said presenters at an RSNA 2008 refresher course (RC730A).

The new year has begun, but controversy over erythropoiesis-stimulating agents for chemotherapy-induced anemia continues. Restrictive FDA revisions to ESA labeling have had a profound effect on the management of patients with anemia as well as on the practice of oncology itself.

SAN FRANCISCO-ASCO released a provisional clinical opinion that recommends routine KRAS testing to guide treatment of metastatic colorectal cancer with cetuximab (Erbitux) and panitumumab (Vectibix).

Oncology News International readers are on the whole in favor of “aid in dying” for terminally ill patients, but diff er on how it should be carried out.

SAN FRANCISCO – Results from two early-phase clinical trials showed that adding vorinostat (Zolinza) to bortezomib can produce favorable response rates in up to 40% in patients with refractory or relapsed multiple myeloma. In the combined results of these two phase I trials, 39% of patients refractory or relapsed aft er bortezomib treatment achieved a partial response, and 43% had stable disease, said Donna Weber, MD, of M.D. Anderson Cancer Center in Houston.

The [Godinez study] referral pattern for MRI represents a bias in this study population toward young women and women with ambiguous findings on routine imaging, who are not necessarily the same patients referred for APBI, said Dr. Woodward, assistant professor of radiation oncology at M.D. Anderson Cancer Center.

In this retrospective study by Godinez et al, 30 (38%) of 79 patients had additional foci on MRI. The researchers suggested that MRI should be used prior to APBI to rule out the presence of multifocal or multicentric disease.

The review by Balducci provides an excellent overview of issues regarding the pharmacotherapy of anticancer therapy in older patients. The introduction to geriatrics emphasizes the need to be able to determine the patient’s physiologic age.

Cancer is predicted to become the leading cause of death worldwide in the year 2010, according to the latest edition of the World Cancer Report released by the International Agency for Research on Cancer. The burden from cancer will not be shared equally, though. Researchers forecast that low- and medium-resourced countries that are least equipped to deal with rising rates of cancer in the population will be hit hardest.

Suppose you hosted a clinical trial and nobody came? That’s what happens 30% of the time, according to researchers from the Center for Management Research in Healthcare at Vanderbilt University in Nashville. “Trials get opened, but no patients are accrued,” said principal investigator David Dilts, PhD.

BOSTON-Retrospective data from Harvard Medical School and Massachusetts General Hospital may help alleviate fears that proton radiation therapy increases the risk of secondary cancer relative to conventional photon therapy.

SAN FRANCISCO-A regimen of perifosine, bortezomib (Velcade), and dexamethasone provides favorable outcomes with manageable toxicities, even in heavily pretreated multiple myeloma patients, according to data presented at ASH 2008.

Walter Curran, Jr., MD, has been awarded the inaugural Lawrence W. Davis Chair of Radiation Oncology at Atlanta’s Emory University School of Medicine. Dr. Curran is chairman of the department of radiation oncology and medical director of the Emory Winship Cancer Institute.

In this review, we will examine the pharmacokinetics and pharmacodynamics of antineoplastic agents after a brief introduction to geriatric medicine, as a framework of reference for clinical decisions. We will conclude with the outline of a research agenda specific for older cancer patients.

Growing up in Canton, Ohio, Fred Appelbaum, MD, dreamt of cowboys, cattle rustling, and a career in medicine- of sorts. “It wasn’t until I was an undergrad at Dartmouth College that I thought seriously about medicine. But I didn’t think about academic medicine or research. I thought I’d end up a small-town doc like in Gunsmoke,” explained Dr. Appelbaum, referring to the popular TV series from the 1950s.

With clinical trial involvement stalled at around 5% for adult cancer patients, there is much room for improvement. Oncology News International spoke with two experts who have found that common sense marketing strategies can boost enrollment.

Potential candidates for accelerated partial breast irradiation (APBI) may benefit from pretreatment MRI to ensure no cancer is missed, according to a study conducted by a multidisciplinary group of researchers.

In this issue of ONCOLOGY, Balducci[1] reviews principles for treating elderly patients with antineoplastic therapy. This paper begins by defining baseline terminology such as age and frailty, while providing an overview of applied techniques of discerning a patient’s functional impairment or disability.

The US Food and Drug Administration has approved Labopharms once-daily extended-release formulation of the analgesic tramadol (Ryzolt) for the management of moderate to moderately severe chronic pain in adults who require around-the-clock long-term treatment of pain.