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Of the 1,870 ongoing cancer clinical trials in the world, 531 are phase I clinical trials designed to verify the safety of experimental cancer treatments and procedures for use in humans.[1]

Cancer and aging seem to go hand in hand. Most cancers and most cancer deaths occur in individuals over age 65 years. Likewise, as we age, osteoarthritis, heart disease, diabetes, and memory lapses seem to become part of our daily burden. Drs. Kimmick and Muss have detailed a strategy for managing breast cancer in older women. However, as they point out, there are several problems with defining optimal therapy for the elderly.

Among the most significant complications a neutropenic patient can experience is an invasive fungal infection. In this issue of Oncology, Drs. Wingard and Leather thoroughly review the epidemiology, clinical presentation, and empiric treatment of these infections, particularly those associated with Candida and Aspergillus. They emphasize the need for better methods of identifying individuals at high-risk for invasive fungal infections because those individuals are more likely to benefit from antifungal prophylaxis or empiric therapy. The goal of such a targeted approach is to limit the amount of antifungal agents given, thereby decreasing the number of adverse effects and diminishing the selection of antifungal-resistant species.[1]

The article written by Drs. Wingard and Leather presents a thoughtful review of the current approaches to empiric antifungal therapy in neutropenic patients. Empiric antifungal therapy has evolved as a standard of care for the prevention of invasive fungal infections in neutropenic patients who remain persistently febrile despite the use of broad-spectrum antibacterial antibiotics.[1-3] Empiric antifungal therapy in this setting provides early treatment for clinically occult invasive fungal infections and systemic prophylaxis for neutropenic patients at highest risk.

Breast cancer is a common problem in older women. As the number of medical illnesses increases with age and the life expectancy decreases, the benefits of systemic therapy for women with breast cancer become questionable. All women over age 65 years are at high enough risk of breast cancer to consider the risk/benefit ratio of preventive therapy with tamoxifen (Nolvadex) or participation in the Study of Tamoxifen and Raloxifene (STAR) trial. Adjuvant chemotherapy and hormonal therapies for early breast cancer significantly improve disease-free and overall survival; recommendations for their use are based on risk of tumor recurrence. Use of tamoxifen in the adjuvant setting in women with receptor-positive tumors is a relatively simple decision in light of its favorable toxicity profile. The delivery of adjuvant chemotherapy is a more complicated decision, and the patient’s wishes, estimated life expectancy, presence of comorbid conditions, and estimated benefit from treatment should be considered. The primary goal of the treatment of metastatic breast cancer is palliation. We discuss trials specific to older women and make appropriate treatment recommendations. Unfortunately, there is a paucity of data from clinical trials in women over age 70 years. However, because the clinical trial is the primary scientific mechanism for testing the efficacy of a treatment, every effort should be made to enter older women into treatment protocols. [ONCOLOGY 15(3):280-299, 2001]

Rituximab (Rituxan) is approved for use in patients with relapsed and refractory follicular lymphoma. Considering the immune modulating effect of interferon alfa-2a (IFN [Roferon-A]) and its efficacy as a single agent in follicular lymphoma, a

High-dose therapy (HDT) with peripheral blood stem cell transplantation is a treatment option for patients with advanced follicular, marginal, and mantle cell lymphoma. In this setting, frequent contamination of peripheral blood stem cell harvests by

Tositumomab/iodine-131 tositumomab (Bexxar) is a radioimmunotherapeutic agent in development for patients with low-grade or transformed non-Hodgkin’s lymphoma (NHL). This analysis focuses

An estimated 157,000 patients died of lung cancer in the United States in the year 2000.[1] Although surgery can be curative, only about 20% of patients are amenable to complete surgical resection. Most of the other patients are treated with radiation

Relapsed or refractory low-grade non-Hodgkin’s lymphoma (NHL) and transformed low-grade NHL are incurable diseases. Tositumomab/iodine-131 tositumomab (Bexxar) is a novel

What constitutes comprehensive cancer care? One interpretation, by the National Cancer Institute (NCI), defines it as a commitment to exploring the basic science and clinical care of patients with cancer. Cancer centers designated by the NCI as

SEATTLE-Xcyte Therapies is testing in preclinical studies the feasibility of a new technology that would take T cells from patients with B-cell chronic lymphocytic leukemia (B-CLL) and spur them into action with key antibodies, with the goal of reinfusing them into the patient ready to fight B-cell tumors. Mark L. Bonyhadi, PhD, of Xcyte Therapies in Seattle, Washington, reported that the company’s Xcellerate technology "produces activated T cells that can interact with leukemic B cells and alter their behavior in vitro. We hope this will be followed by apoptosis or clearance of B cells in B-CLL patients."

ROCHESTER, Minnesota-More than half of follicular non-Hodgkin’s lymphoma (NHL) patients who progress after rituximab (Rituxan) treatment respond to the experimental drug ibritumomab tiuxetan (Zevalin), according to a multicenter clinical trial. Although most of the study’s 54 patients had only partial remissions after treatment with ibritumomab tiuxetan, their response continued for at least 8 months. In some cases, remissions have lasted up to 2 years.

NEW YORK-Short-term, intensive multiagent chemotherapy without high-dose methotrexate produces excellent outcomes in children with advanced non-lymphoblastic non-Hodgkin’s lymphoma, according to a Children’s Cancer Group (CCG) study. The estimated 5-year event-free survival (EFS) was 77% and the overall survival rate was 80% for the 39 patients enrolled in the pilot study, according to lead researcher Mitchell S. Cairo, MD, director of Pediatric Blood and Marrow Transplantation at Columbia University, New York.

STANFORD, California-Seventy percent of low-grade and transformed low-grade non-Hodgkin’s lymphoma (NHL) patients respond to the drug iodine I 131 tositumomab (Bexxar) even though progressing after rituximab (Rituxan). A study of 40 patients who had previously failed to respond or progressed on rituximab, also showed that 40% had a complete response or remission after treatment with iodine I 131 tositumomab.

ROCHESTER, Minnesota-A phase-III clinical trial has shown that 73% of B-cell non-Hodgkin’s lymphoma (NHL) patients respond to the radioimmunotherapy ibritumomab tiuxetan (Zevalin) vs 47% for rituximab (Rituxan). The study concluded that ibritumomab tiuxetan (Zevalin) is not only safe and effective, but the objective response rates achieved with it are statistically superior to those achieved with rituximab alone.

BIRMINGHAM, Alabama-Idiopathic thrombocytopenic purpura (ITP) may respond to rituximab (Rituxan) monoclonal antibody treatment, even in steroid-refractory patients, investigators reported in a poster presentation.

AMSTERDAM-Adding granulocyte colony-stimulating factor (G-CSF) to rituximab may improve response duration and increase the proportion of complete responses in patients with relapsed B-cell non-Hodgkin’s lymphoma (NHL). "Although the overall response rate seems comparable to data reported for rituximab monotherapy, the complete response rate is higher, and remission duration in this pilot phase-II study is remarkably long," Lizette E. van der Kolk, MD, reported in a poster presentation. Dr. van der Kolk is a member of the Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands.

BUFFALO-Combining rituximab (Rituxan) with fludarabine (Fludara) for low-grade or follicular B-cell lymphomas may be as effective as but less toxic than rituximab plus CHOP (cyclophosphamide, doxorubicin, Oncovin [vincristine], prednisone). Phase II trial data supporting this assertion were presented.

WASHINGTON-What a difference a year makes. Cigarette smoking dropped significantly among middle school and high school students between 1999 and 2000, according to a new federally funded report. For example, the percentage of high school seniors who had smoked at least once in the month prior to being surveyed fell from 34.6% to 31.4% (Figure). Those 12th graders who smoked a half pack of cigarettes or more each day declined from 13.2% to 11.3%.

ATLANTA-Parecoxib, the first injectable COX-2 inhibitor, demonstrated impressive analgesic efficacy in postsurgical patients, according to a study presented at the 19th Annual Scientific Meeting of the American Pain Society (APS).

NEW YORK-"Use it or lose it," exercise buffs like to say, and the dictum is just as true for cancer patients, according to physical therapist Eileen Donovan, PT, MEd, manager of rehabilitation services at the University of Texas M.D. Anderson Cancer Center. Ms. Donovan discussed the topic during a Cancer Care teleconference.

SAN FRANCISCO-Administering highly active antiretroviral therapy (HAART) to HIV-positive patients during and after treatment for non-Hodgkin’s lymphoma (NHL) can significantly reduce the risk of NHL relapse and death.

STANFORD, California-A recombinant idiotype protein vaccine for treatment of non-Hodgkin’s lymphoma (NHL) induced both cellular and anti-idiotype tumor-specific immunity in phase-I/II trials and has now progressed to phase-III studies, reported John Timmerman, MD, research fellow, Division of Oncology, Stanford University Medical Center, Stanford, California.

WASHINGTON-Medicare will soon cover or expand its coverage of the use of positron emission tomography (PET) for the primary diagnosis, staging, or restaging of six types of cancer. The Health Care Financing Administration (HCFA) said it would announce an effective coverage date shortly.

SAN ANTONIO-Women with metastatic breast cancer who experience disease progression on trastuzumab (Herceptin) may benefit from continued treatment with the antibody, according to results of a crossover study presented by Debu Tripathy, MD, associate clinical professor of medicine, University of California, San Francisco, School of Medicine. Moreover, trastuzumab cardiotox-icity was only 2.2% among long-term users.

BALTIMORE-The B-cell directed monoclonal antibody rituximab (Rituxan) can produce durable complete remissions without the need for maintenance therapy in patients with cold agglutinin autoimmune hemolytic anemia (AIHA) and might also represent a treatment option in warm agglutinin AIHA, according to Edward Lee, MD. Dr. Lee is director of hematology and medical oncology at Sinai Hospital in Baltimore, and Director of the Bone Marrow Transplantation Program.

BOSTON-An experimental mixed-beam radiation technique can reduce the total radiation dose required by a factor of two in simple cancer cases, Michelle M. Svatos, PhD, reported at the American Society for Therapeutic Radiology and Oncology (ASTRO) annual meeting.

SAN FRANCISCO-Advances in gene therapy, cancer vaccines, and a variety of new antibody therapies for hematologic malignancies were the focus of a satellite symposium to the 42nd Annual Meeting of the American Society of Hematology titled Scientific and Technical Innovations in Biology: Initiating Advances in Therapeutic Approaches to Hematological Malignancies. The program was sponsored by Fox Chase Cancer Center through an unrestricted educational grant from Genentech BioOncology and IDEC Pharmaceuticals.

SOUTH SAN FRANCISCO-A new study reveals that patients who develop HAMA (human antibodies to the murine antibody) after treatment with iodine I 131 tositumomab (Bexxar) do not develop cross-reactive antibodies or immune reactions that would interfere with later treatment with rituximab (Rituxan).