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Adding Rituximab to CHOP Chemo Improves DLBC Lymphoma Outcomes

February 1st 2004

SAN DIEGO-The addition of rituximab (Rituxan) to CHOP chemotherapy has resulted in a dramatic improvement in outcome for patients of all ages with diffuse large B-cell (DLBC) lymphoma in a retrospective study from British Columbia. Improvements were greatest among the elderly population in the study, Laurie Sehn, MD, clinical assistant professor, British Columbia Cancer Agency and University of British Columbia, said at the 45th Annual Meeting of the American Society of Hematology (abstract 88).

Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer

Michael J. Zelefsky, MD

February 1st 2004

Dr. Beyer provides an insightful and balanced approach tothe indications for salvageprostate brachytherapy after externalbeamradiotherapy failure. As hepoints out, the challenge for the cliniciancontemplating local salvage therapyto address biochemical failure isto determine whether the biochemicalrelapse represents local relapse onlyor systemic disease. Local salvagetreatment in a patient with micrometastaticdisease would have no appreciableimpact on disease-free survivaland is more likely to be associatedwith significant potential morbidity.Unfortunately, with the current lackof reliable molecular markers or sensitiveimaging modalities, it is impossibleto determine with certainty thesource of a biochemical relapse inmost settings.

Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer

Patrick W. Mclaughlin, MD

February 1st 2004

Dr. Beyer has presented a thoroughreview of the current literatureon salvage implanttherapy following external-beamtherapy failure. Although the reviewpresents the available data clearly, Iwould characterize the data as preliminaryand suspect. I would questionconclusions drawn from these studiesand would especially question guidelinesfor patient selection based onthese conclusions. It will be necessaryto improve staging at recurrence, improvepathology postradiation, andimprove postimplant dosimetry beforewe can define the appropriate candidatefor salvage therapy.

Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer

David C. Beyer, MD

February 1st 2004

The options available for patients with recurrent prostate cancerare limited. Men who have failed external-beam irradiation as the primarytreatment are rarely considered for potentially curative salvagetherapy. Traditionally, only palliative treatments have been offered withhormonal intervention or simple observation. A significant percentageof these patients have only locally recurrent cancer and are thus candidatesfor curative salvage therapy. Permanent brachytherapy withiodine-125 or palladium-103 has been used in an attempt to eradicatethe remaining prostate cancer and prevent the need for additional intervention.It is critical in this population to identify patients most likelyto have distant metastases or who are unlikely to suffer death or morbidityfrom their recurrence, in order to avoid potential treatmentmorbidity in those unlikely to benefit from any intervention. Followingsalvage brachytherapy, up to 98% of these cancers may be locally controlled,and 5-year freedom from second relapse is approximately 50%.With careful case selection, relapse-free rates up to 83% may beachieved. A schema is presented, suggesting that it may be possible toidentify the patients most likely to benefit from salvage treatment basedon prostate-specific antigen (PSA) kinetics and other features. Suchfeatures include histologically confirmed local recurrence, clinical andradiologic evidence of no distant disease, adequate urinary function,age, and overall health indicative of at least a 5- to 10-year life expectancy,prolonged disease-free interval (> 2 years), slow PSA doublingtime, Gleason sum ≤ 6, and PSA < 10 ng/mL.

Salvage Brachytherapy After External-Beam Irradiation for Prostate Cancer

Richard G. Stock, MD

February 1st 2004

Dr. Beyer has done a good jobof summarizing the issuesconcerning the use of brachytherapyas a salvage modality to treatradiation therapy failures. This willbecome an issue of greater importanceas we continue to diagnose andtreat younger and younger patientswith prostate cancer. This trend canbe primarily attributed to the successof prostate-specific antigen (PSA)screening. With younger patients optingfor radiation treatment, the numberof patients at potential risk forfailure and hence potential candidatesfor salvage brachytherapy will increase.This, coupled with the stagemigration toward early-stage, lower-PSA disease, may result in an increasingpopulation of patients with perhapsmore curable recurrent disease.

Smart probes plus molecular biomarkers uncover cancer at the earliest signs

Karen Sandrick

January 2nd 2004

NEW ORLEANS-Molecular imaging is rapidly advancing as a biomedical modality that increases the understanding of underlying cellular mechanics and dynamics and adds a new dimension to the diagnosis and treatment of disease. It may be a sensitive and specific method for evaluating cancer by measuring the expression of genes that trigger oncogenesis and stratifying tumors on the basis of their biological characteristics

Rate of response to CyBorD is ‘truly remarkable’

Kenneth C. Anderson, MD

December 2nd 2003

There was a very rapid response [to CyBorD], which has been typical when you incorporate bortezomib into the initial regimens,” commented Dr. Anderson, from the Dana-Farber Cancer Institute in Boston.