In the past decade, core biopsy has largely replaced fine-needle aspiration for breast tissue evaluation. The latter technique’s inability to distinguish between invasive cancer and in situ cases and a general unease among pathologists not trained in cytopathology (in interpreting cells rather than tissue) are two of the main reasons that FNA has fallen out of favor (Diagnostic Cytopathology online, November 19, 2008).
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George Bernard Shaw once said “Youth is wasted on the young.” But for Sharon Murphy, MD, youth is in the hands of exactly the right people. As a medical student, Dr. Murphy was considering a career in internal medicine; doing rounds on the adult wards changed her mind.
The National Comprehensive Cancer Network (NCCN) has announced the addition of a survivorship section to the NCCN Clinical Practice Guidelines in Oncology for colon and rectal cancers, as well as other key updates in colorectal cancer. The NCCN also recently updated its guidelines for breast cancer and breast cancer risk reduction. These changes reflect leading developments in the treatment of cancer patients and represent the standard of clinical policy in oncology in both community and academic settings.
The entry of new technology into medical practice is complex. New technology in radiation oncology includes advances in imaging (including anatomic and molecular/functional imaging) and radiation therapy planning and delivery involving intensity-modulated radiation therapy (IMRT), stereotactic radiation therapy (SRT), and therapy with particles such as protons and carbon ions.
The recommendation to minimize sun exposure to prevent skin cancer has produced a pandemic of vitamin D deficiency. Vitamin D has generated considerable interest in the past decade, as accumulating evidence from both retrospective and prospective epidemiologic studies suggests an association between vitamin D deficiency and increased risk of autoimmune, infectious, and cardiovascular diseases, as well as cancer.
Cancer drugs and indications newly approved by the US Food and Drug Administration, May 2007 – February 2009
Celator Pharmaceuticals and the Leukemia & Lymphoma Society have partnered for the phase II development of CPX-351 (cytarabine:daunorubicin), a liposome injection for treatment of adults with acute myeloid leukemia.
The Food and Drug Administration has kicked off a voluntary pilot program to help promote the safety of drugs, and active drug ingredients, produced outside the U.S. The FDA plans to select 100 applicants to participate in the Secure Supply Chain pilot program.
The American Society for Therapeutic Radiology and Oncology (ASTRO) has changed its name to the American Society for Radiation Oncology, but will continue to use the “T’ in its logo as part of its tagline “Targeting Cancer Care.”
Varian Medical Systems, of Palo Alto, Calif., has installed new radiotherapy units at multiple sites worldwide:
SAN FRANCISCO-Adding thalidomide to a regimen of bortezomib (Velcade), melphalan, and prednisone nearly doubled the rate of complete responses and improved the overall response rate in elderly patients with newly diagnosed multiple myeloma, according to the results of a phase III trial.
SAN FRANCISCO-Mismatched cord blood can be a suitable alternative for stem cell transplants for patients with acute leukemia, especially in emergency situations, according to research presented at ASH 2008.
This study shows that in patients with acute leukemia, cord blood can be a good alternative,” said Dr. Keating, director of the division of hematology at the University of Toronto.
In a subset of 2,366 patients from NSABP B-30 with menstrual history available at follow-up, amenorrheic patients (≥ six months) had significantly improved overall and diseasefree survival across treatment arms. Mortality was significantly reduced by 24% and recurrence by 30%.
WASHINGTON, DC- In much of the developing world, exposure to mycotoxins, which are generated by various types of fungus that grow on food, is ubiquitous. Th e most well-known mycotoxin, aflatoxin, is commonly found on nuts and is a known carcinogen, according to the International Agency for Research on Cancer (IARC).
A study of Pittsburgh-area cancer patients suggests that many are opting out of clinical trials because, as members of Medicare HMO plans, they cannot afford the additional expense such trials entail.
STOCKHOLM-Published data overwhelmingly support the use of trastuzumab (Herceptin) concurrently with chemotherapy, according to John Crown, MD, a consultant oncologist at St. Vincent’s Hospital in Dublin, Ireland. On the other hand, there is no evidence that sequential delivery is less effective than concurrent therapy, and it is definitely less toxic, commented Ian E. Smith, MD, head of the Breast Unit at Royal Marsden Hospital in London.
The studies presented at SABCS 2008 regarding adjuvant taxane schedules are well designed and add to a growing body of data on how best to use these drugs, although they leave some questions unresolved. NSABP B-30 nicely controlled for number of cycles of treatment. All patients received four cycles of doxorubicin and four of docetaxel (Taxotere), and some got four cycles of cyclophosphamide, so there was some control over the duration of exposure and total number of doses for each drug.
The optimal use of taxanes in the adjuvant treatment of breast cancer continues to inspire debate. Questions remain regarding the relative efficacy of sequential vs concurrent treatment, the most effective doses and schedules, and the best combinations of agents. Key studies presented at SABCS 2008 offered insight into these issues, but no definitive resolutions. In fact, two studies designed to establish optimal scheduling reached conflicting conclusions.
Adult patients with low-grade glioma had better survival if they received chemotherapy in addition to radiotherapy, according to the results of a Radiation Th erapy Oncology Group (RTOG) study. The data were presented at the 2008 Society for Neuro-Oncology meeting in Lake Las Vegas, Nev.
Cancer patients in England will no longer have to pay prescription charges for medicines that treat their side effects, starting in April. Drugs that will be exempt include those that address pain, nausea, chronic diarrhea, fatigue, and mouth ulcers. Tamoxifen and other long-term hormone treatments are also currently subject to this charge.
There is strong rationale for both the octreotide LAR and everolimus studies in NET”, said Dr. Siu, associate professor of medicine at the University of Toronto and Princess Margaret Hospital. “And I applaud both sets of authors for conducting trials in rare tumors.”
This is one of a number of studies that show that adding novel drugs to conventional treatments can achieve higher response rates in multiple myeloma,” said Dr. Anderson, who is the Kraft Family Professor of Medicine at the Dana-Farber Cancer Institute in Boston.
CHICAGO-Serious and fatal drug reactions tripled between 1998 and 2005, according to a 2007 FDA analysis. In that time period, the total number of serious adverse drug events multiplied 4 times faster than the number of prescriptions written. The number of serious drug reactions for biotechnology agents rose nearly 18-fold (T Moore et al: Analysis of FDA reported post marketing ADR database, Arch Intern Med 167:1752-1759, 2007).
Jimmie C. Holland, MD, widely recognized as the founder of “psychooncology,” grew up in a rural part of Texas with fertile black soil, known as the Blackland Bible Belt. It was a time when cotton was king and little girls were named Bobbi and Jimmie. Back then, the gender line was clearly demarcated; girls became teachers and nurses and homemakers. Interested in medicine as a youngster, Jimmie thought about nursing, but decided instead to buck the old-boy tradition and become a doctor. Her family and teachers supported her dream, and she never looked back.
In the first of what will become an annual review process, the nation’s largest cancer-care payer has added three new formularies to its drug coverage policy, giving oncologists even greater ability to prescribe off -label cancer drugs.
Recent results from prospective, controlled trials, specifically evaluating strategies for preventing or reducing the severity of the dermatologic effects of EGFR inhibitors, represent the first step toward an evidence-based approach to the prevention and management of these important effects.
The review by LoRusso is a critical update to what could be considered the most significant dermatologic toxicity in modern oncology. This increased importance of dermatologic toxicities to epidermal growth factor receptor (EGFR) inhibitors can be attributed to several factors: 45% to 100% of patients will develop a papulopustular rash; the rash occurs in cosmetically sensitive areas (the face and upper trunk); it is associated with symptoms of pain and pruritus; and superinfections occur in approximately 30% of patients receiving these agents-all of which lead to dose modification by 76% and discontinuation by 32% of oncologists.