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Tobacco use, particularly cigarette smoking, remains the leading cause of preventable illness and death in the United States. Studies have shown that increases in the price of cigarettes will decrease the prevalence of smoking and the number of

BUFFALO, NY-Cancer care services vary widely among health care plans in the United States, speakers told the President’s Cancer Panel at a meeting hosted by Roswell Park Cancer Institute. Suggestions for helping standardize care included use of outside accreditation centers and adoption of national practice guidelines, although the methodology to be used to develop such guidelines remains open to debate.

WASHINGTON-Forget those smoke-filled cocktail lounges, tobacco addicts, and head for a local tea room. “Drinking tea after smoking reduces levels of oxidative stress,” reported James E. Klaunig, PhD, professor of pharmacology and toxicology, Indiana University School of Medicine. Oxidative stress has been linked to cancer and other diseases .

PHOENIX-A single dose of a radiolabeled anti-CD20 monoclonal antibody (MoAB), given following rituximab (Rituxan) dosing, produced responses in two thirds of patients with relapsed or refractory B-cell non-Hodgkin’s lymphoma (NHL), Gregory Wiseman, MD, of the Mayo Clinic, said at the American Society for Therapeutic Radiology and Oncology (ASTRO) annual meeting.

WASHINGTON-As Oncology News International went to press, the tobacco industry and more than 40 state attorneys general were in final negotiations of a settlement worth approximately $206 over 25 years. The settlement will reimburse the states for Medicare spending on smoking-related illnesses, place some limits on cigarette advertising, and result in a substantial increase in cigarette prices. Look for a full analysis of the settlement in the January issue.

ROCKVILLE, Md-The FDA has granted full approval to Pharmacia & Upjohn’s Camptosar (irinotecan), based on survival data. Camptosar is indicated for use in patients with metastatic colorectal cancer whose disease has recurred or spread after treatment with the current standard chemotherapy. The agent received accelerated FDA approval in June 1996.

SILVER SPRING, Md-Depo-Tech’s DepoCyt (cytarabine liposome injection) has won the backing of the Oncology Drug Advisory Committee (ODAC), which recommended that the FDA grant the drug accelerated approval for the intrathecal treatment of lympho-matous meningitis. The 6-to-1 vote came about 1 year after ODAC declined to recommend the drug for intrathecal treatment of neoplastic meningitis in patients with solid tumors.

GALVESTON, Tex-Last October, radiation oncologists at the University of Texas Medical Branch in Galveston treated their first patient with intensity modulated radiation therapy (IMRT). The patient received a computer-planned prostate boost involving seven beam angles and 25 beam segments (see Figure). This complex plan allowed for maximum targeting of the tumor while minimizing radiation to the urethra, rectum, and bladder.

WASHINGTON-Can the humble cup of tea ward off chronic diseases like cancer? Hints of the potential health benefits of tea are intriguing, but the emphasis remains on the “potential,” said Jeffrey B. Blumberg, PhD, chief of the Antioxidants Research Laboratory, Tufts University. He spoke at the Second International Scientific Symposium on Tea and Human Health.

SAN FRANCISCO-In an era of increasing fragmentation and specialization in cancer care, and a trend toward ambulatory care, the family physician’s role as a coordinator of care is more important than ever-for both patients and cancer specialists, David Rosenthal, MD, president of the American Cancer Society (ACS), said at the American Academy of Family Physicians meeting.

BUFFALO, NY-Evidence-based practice guidelines are needed to improve the quality of cancer care, several representatives from the professional cancer societies told the President’s Cancer Panel at a meeting hosted by Roswell Park Cancer Institute . But expert physicians also play a critical role in the creation of practice guidelines, particularly in situations where evidence is lacking or controversial.

A new University of California San Francisco (UCSF) study found that high school baseball players who use spit tobacco are nearly twice as likely to stop using spit tobacco when dentists or dental hygienists, as well as their teammates, actively

The investigational anti-HIV protease inhibitor amprenavir (Agenerase), formerly known as 141W94, is now available to patients who have not responded to current protease inhibitor-containing regimens through a novel early access program.

BALTIMORE-The past as prologue to the future served as an unspoken but elegant theme for the seminar that marked the 25th anniversary of the Johns Hopkins Oncology Center.

WASHINGTON-HIV testing should be made a routine but voluntary part of prenatal care for all women in the United States, an Institute of Medicine (IOM) committee has recommended.

BUFFALO, NY-The third and final meeting of the President’s Cancer Panel this year focused on defining the role of practice guidelines in the quest for quality cancer care.

WASHINGTON-About 3½ years ago, in an effort to come to terms with managed care, Dean H. Gesme, Jr., MD, and his partners in a Cedar Rapids, Iowa, oncology practice named Iowa Cancer Care (ICC), entered into a Management Service Organization (MSO) agreement with Physicians Reliance Network, Inc. (PRN), a Texas company. In making this move, they “gave up some autonomy,” in exchange for freedom from dealing with business matters, Dr. Gesme said at a symposium on negotiating contracts in oncology.

FLORENCE, Italy-Although breast-conserving surgery coupled with radiotherapy has been advocated as the treatment of choice for ductal carcinoma in situ (DCIS) , management remains controversial.

PHILADELPHIA-With the completion of nine new oncology practice guidelines, to be presented at the fourth annual conference of the National Comprehensive Cancer Network (NCCN), the coalition’s guidelines now cover approximately 95% of cancer patients treated in the United States, William T. McGivney, PhD, chief executive officer of the NCCN, told Oncology News International in an inverview. The NCCN is a consortium of 17 major US cancer centers.

BETHESDA, Md-Congress has appropriated the National Cancer Institute $2.93 billion for fiscal year 1999, which began Oct. 1, up from $2.54 billion in fiscal year 1998. The $390 million funding increase represents a raise of 15.35% for NCI.

WASHINGTON-“There is really no reason to doubt that mammography screening works for women in their 40s,” and saves lives, said Stephen A. Feig, MD, director of the Breast Imaging Center at Thomas Jefferson Hospital and professor of radiology at the Jefferson Medical College, both in Philadelphia.

Automated screening of Pap smears provides greater accuracy than traditional manual readings, as discussed in part 2 of this article . As this technology comes into greater use, the standard of care regarding Pap smears may shift, such that a physician’s failure to recommend automated screening could be held against him in a malpractice lawsuit.

Choice In Dying (Washington, DC) recently released a new booklet entitled, “Healthcare Agents: Appointing and Being One,” intended to serve as a reference when appointing a health care agent (proxy) or acting as one.

SILVER SPRING, Md-The Oncologic Drugs Advisory Committee (ODAC) has recommended that the FDA approve Ligand Pharmaceuticals’ Panretin gel 0.1% (alitretinoin) for the treatment of cutaneous lesions in patients with AIDS-related Kaposi’s sarcoma (KS).

Although overall death rates from the acquired immune deficiency syndrome (AIDS) are declining rapidly, the incidence of human immunodeficiency virus (HIV) in women continues to climb, and HIV-associated gynecologic disease is also likely toincrease over the next decade. In this paper on lower genital tract neoplasia in women with HIV infection, Abercrombie and Korn review some of the many studies documenting the increased incidence of cervical human papillomavirus (HPV) and HPV-asso-ciated disease in this population. The clinical importance of these studies is underscored by recent data from New York City, where the incidence of invasive cervical cancer increased significantly from 1990 to 1995 in HIV-positive women, compared to the general popu-lation of 25- to 49-year-old women.[1]

The article by Dr. McLaughlin and coauthors provides both a useful summary of the clinical trials involving rituximab (IDEC C2B8 [Rituxan]) and a practical guide for its administration. Their review summarizes the most recent clinical results with this monoclonal antibody, which have just been published in the Journal of Clinical Oncology.[1] The review also includes a section on the potential mechanism of action of rituximab. Several areas merit comment.

Monoclonal antibodies (MoAbs) for cancer have been the subject of intense clinical investigation for nearly 2 decades.[1] Although the concept of MoAb therapy is simple, a host of unforeseen difficulties hindered the realization of clinical benefit from this therapeutic approach.

Of the many novel new cancer therapeutic concepts under development, chemoprevention recognizes that malignancies derive from a long, complex interaction of environmental stress modulated by individual genetic phenotypic expression. As described in depth by Drs. Singh and Lippman in this two-part article, published in last and this month’s issues of oncology, substances with potential chemopreventive activity have been identified from multiple sources. These include: (1) human cancer epidemiology, with an emphasis on dietary assessment, geographic dietary and environmental variation, and differences in cancer incidence among similar regional populations; (2) from mechanistic hypotheses; and (3) clinical observations after treatment of cancer (eg, tamoxifen [Nolvadex] for breast cancer). Drs. Singh and Lippman ably demon-strate the wide variety of sources of potential chemopreventive agents and describe current research studies and outcomes.

The standard management of low-grade lymphoma remains controversial. Long-term follow-up studies of patients treated with conventional regimens have shown that currently available treatments are not curative.

Rituximab (IDEC-C2B8 [Rituxan]) is a chimeric anti-CD20 monoclonal antibody (MoAb) that was recently approved by the FDA for the treatment of patients with low-grade or follicular B-cell non-Hodgkin’s lymphoma. Its potential efficacy in other B-cell malignancies is currently being explored. This article reviews the mechanisms of action of rituximab, as well as preclinical data and results of the clinical trials that led to its approval. Also discussed are the mechanics of administering rituximab on the recommended weekly ´ 4 outpatient schedule. Finally, the article describes ongoing and planned trials of rituximab in other dosage schedules, in other B-cell neoplasms, and in conjunction with chemotherapy. As the first MoAb to gain FDA approval for the treatment of a malignancy, rituximab signals the beginning of a promising new era in cancer therapy. [ONCOLOGY 12(12):1763-1770, 1998]