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Every 3 years, the National Cancer Institute (NCI) asks cancer researchers, advisory groups, and advocacy organizations to recommend important areas to which it should devote additional resources. NCI defines such "extraordinary opportunities for investment" as "broad-based, overarching areas of scientific pursuit that hold tremendous promise for significantly expanding our understanding of cancer."This is the first in a series of interviews exploring the progress and promise of NCI’s six current extraordinary opportunities: genes and the environment, cancer imaging, defining the signature of cancer cells, molecular targets of prevention and treatment, research on tobacco and tobacco-related cancers, and cancer communications.

Patients with locally advanced cancers have a poor prognosis when treated with radiotherapy and/or surgery alone. The appearance of distant metastases shortly after removal of the primary tumor indicates that micrometastases are already present at the time of diagnosis. We observed a favorable outcome in patients with locally advanced breast cancer treated with a prolonged regimen of neoadjuvant chemotherapy plus granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine]) compared with patients receiving fewer chemotherapy cycles prior to surgery and radiotherapy. These results can partly be explained by the dose-intensive regimen used, but biologic and immunologic processes inherent to the prolonged presence of the primary tumor and its draining lymph nodes might also contribute to the beneficial outcome. The effects of the prolonged presence of the primary tumor during chemotherapy and GM-CSF administration on the antitumor immune response, and more specifically the functional properties of dendritic cells and T cells, are currently being investigated in a multicenter randomized clinical trial comparing prolonged neoadjuvant chemotherapy plus cytokines with a conventional treatment schedule. Aside from investigations concerning the immune system, other biologic processes, such as tumor angiogenesis, are being investigated at the same time. [ONCOLOGY 16(Suppl 1):32-39, 2002]

The effect of a patient’s race or ethnicity on cancer incidence and mortality rates remains a neglected area of cancer research. However, with cancer statistics differing among various populations, research on racial and ethnic groups could provide clues to cancer trends.

ROCHESTER, Minnesota-Fluorouracil (5-FU)-based chemotherapy after surgery can be given safely to selected elderly patients with stage II/III colon cancer, and these patients derive the same benefits from the treatment as do their younger counterparts, according to results of a pooled analysis of seven clinical trials.

HOUSTON-The Intercultural Cancer Council (ICC) promotes policies, programs, partnerships, and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the United States and its associated territories. With this issue, ONI launches a regular column devoted to intercultural facts about cancer, based on information from the ICC and other sources.

ROCKVILLE, Maryland-The Food and Drug Administration has approved Viread (tenofovir disoproxil fumarate, Gilead Sciences, Inc.) for the treatment of HIV-1 infection in combination with other antiretroviral agents. Viread, a nucleotide analog, remains in cells longer than other antiretrovirals, which enables a dosage of 300 mg taken once a day in tablet form.

NEW YORK-Researchers reported in the September 27 Nature that a surgeon on one side of the Atlantic removed the gallbladder of a patient on the other side, but the clinical usefulness of this long-distance, robot-assisted laparoscopic surgery is uncertain.

BETHESDA, Maryland-Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) have begun enrolling 21 volunteers in a phase I trial of a new plasmid DNA-based HIV vaccine (VRC4302). The randomized, controlled, double-blinded, dose-escalation study will examine the vaccine’s toxicity, dose, and immune response. It will be conducted on the National Institutes of Health campus.

TORONTO -Results from a phase I study suggest that endostatin, an inhibitor of angiogenesis, shows clear utility in treating cancer, but that this effect does not continue to increase with larger doses. Moreover, in assessing efficacy, reduction of tumor size does not provide the most useful immediate measure of the drug’s clinical benefit.

The American Cancer Society recently announced the re-launch of its website, www.cancer.org, with a broad range of new features, including personalized content, interactive health planning tools, and online discussion groups.

WASHINGTON-Life expectancy in the United States reached 76.9 years in 2000, a record high, according to preliminary figures released by the Centers for Disease Control and Prevention. CDC attributed the increase in part to continuing declines in the aged-adjusted death rates for cancer and heart disease, the nation’s two leading causes of death.

RESTON, Virginia-The Society of Nuclear Medicine (SNM) has formed an online collaboration with Medscape, a website for health care professionals and consumers, to release an educational program highlighting key content from the SNM’s 2001 annual conference.

MIAMI BEACH-The combination of exisulind (Aptosyn) and irinotecan (Camptosar) had no dose-limiting toxicity in a phase I trial presented at Molecular Targets and Cancer Therapeutics (abstract 295), a conference sponsored by the American Association for Cancer Research, National Cancer Institute, and European Organization for Research and Treatment of Cancer.

CLEVELAND-In research presented at the North American Spine Society, Isador Lieberman, MD, described a new approach to repair of vertebral compression fractures that may offer significant pain relief and other benefits to myeloma patients.

Data presented at the Joint International Congress on Acute Promyelocytic Leukemia and Differentiation Therapy demonstrated that patients with acute promyelocytic leukemia (APL) treated with arsenic trioxide achieved an overall survival

NEW ORLEANS-After brachytherapy for prostate cancer, a small proportion of the radioactive seeds migrate into the lungs of more than a third of patients, according to a report from the American College of Surgeons 87th Clinical Congress.

WASHINGTON-He was the man the tobacco industry loved to hate-and for good reason. While serving as Commissioner of the US Food and Drug Administration (FDA) from 1990 to 1997, David Kessler, MD, led a long investigation of the tobacco companies.

MIAMI BEACH-Sequential Tri-com vaccines against cancers testing positive for carcinoembryonic antigen (CEA) have produced one clinical response and no toxicity among 23 patients in a phase I clinical trial.

BETHESDA, Maryland-Secretary of Health and Human Services Tommy G. Thompson has named Alan S. Rabson, MD, deputy director of the National Cancer Institute since 1995, to serve as acting director of the Institute. Dr. Rabson will fill the post formerly held by Richard D. Klausner, MD, until a new director is named. Dr. Klausner resigned to become president of the new Case Institute of Health, Science, and Technology.

TORONTO, Canada-Positron emission tomography (PET) proved superior to both CT and MRI for both diagnosis and therapeutic monitoring of pediatric cancer patients in a study conducted at the University of Munich. Ute Porn, Jr., MD, described the results at the 48th Annual Meeting of the Society of Nuclear Medicine (abstract 144).

NEW ORLEANS -Updated results from two clinical trials of ductal carcinoma in situ (DCIS) continue to support the use of radiation therapy and tamoxifen (Nolvadex) after lumpectomy in these patients. D. Lawrence Wickerham, MD, associate chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP), reported the findings at the American College of Surgeons 87th Clinical Congress.

BETHESDA, Maryland-When Richard D. Klausner, MD, became director of the National Cancer Institute in 1995, he took over an agency with low morale and internal conflicts that had angered some influential members of Congress and drawn critical assessments from several outside review panels.

SAN DIEGO--Despite acknowledged oral complications associated with chemotherapy agents, there is nothing in the literature pointing to the causes.

Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore,

Dr. Rich and colleagues present a compelling argument for the manipulation of temporal and spatial treatment parameters in chemoradiation programs. In essence, the authors address the shielding of normal tissues from the effects of cytotoxic agents. With respect to radiotherapy, this can be achieved via physical shielding by computer-generated dose algorithms using elaborate new planning technology (eg, intensity-modulated radiation therapy [IMRT]), chemical shielding with radioprotectants (eg, amifostine [Ethyol]), or temporal shielding by altered-fractionation schemes that exploit the differential alpha/beta ratios between tumor and normal tissue (eg, hyperfractionation).

Chronic pain occurs in about one-third of all cancer patients and in about three-quarters of those with advanced disease.[1] A major factor in the undertreatment of cancer pain is inadequate pain assessment.[2] Pain assessment provides the basis for inferred pathophysiology that directs diagnostic evaluation and treatment decisions. Pain syndrome identification plays an important role in this process-much of clinical medicine is based on pattern recognition of symptoms and signs, leading to a specific diagnosis and therapeutic strategy.

Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore,

The problem of pain among cancer patients is endemic. Appropriate and effective clinical responses to this problem require that the physician appreciate the cause of the pain, its underlying mechanism, its natural history, and its significance.

Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore,

In part 2 of this interview, Benjamin Djulbegovic, MD, PhD, discusses the uncertainty principle in clinical trials. Dr. Djulbegovic is associate professor of medicine, Divisions of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa.