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THOUSAND OAKS, California-How do endogenous and exogenous erythropoietin (EPO) directly and indirectly affect the central nervous system (CNS)? How can erythropoietic agents penetrate the blood-brain/blood-cerebrospinal fluid (CSF) barrier so that their potential neuroprotective benefits can be realized?

BETHESDA, Maryland-The search for the ideal blood substitute continues, although with less urgency now that the nation’s blood supply is safer than it has ever been. None of the products currently being developed and nearing licensure can truly be considered substitutes for blood, according to Harvey Klein, MD.

ROCKVILLE, Maryland-The FDA-going against a recommendation of its Oncologic Drugs Advisory Committee (ODAC)-has denied the supplemental new drug application for the use of Gliadel Wafer (polifeprosan 20 with carmustine implant, Guilford Pharmaceuticals) to treat newly diagnosed malignant glioma.

KITCHAWAN, New York-Beyond its "classical" hormonal role signaling bone marrow to increase circulating red blood cells, erythropoietin (EPO) and its receptor (EPO-R) may have critical roles in the development, maintenance, protection, and repair of the brain. These roles rely on the status of the EPO and EPO-R molecules as cytokines and have been demonstrated by animal studies. Michael L. Brines, MD, PhD, senior member at the Kenneth S. Warren Institute in Kitchawan, New York, reported on these studies as well as "highly positive" results of the first human trial using recombinant human EPO to treat stroke.

TAMPA, Florida-"Increasingly we have acknowledged that there is more to cancer treatment than the eradication of disease," stated Paul Jacobsen, PhD. "The treatment of anemia and its effects on quality of life have demonstrated that a treatment can be considered effective and clinically useful if it results in significant quality-of-life benefits, even in the absence of significant survival benefits."

HOLLYWOOD, Florida-An important part of the cancer guidelines effort by the National Comprehensive Cancer Network (NCCN), a coalition of 19 major US cancer centers, is to monitor concordance with the guidelines through the use of outcomes databases. Results from the breast cancer and non-Hodgkin’s lymphoma databases were presented during the NCCN’s Seventh Annual Conference.

President Bush announced changes in the medical records privacy rule proposed by President Bill Clinton before he left office. Physicians do not have to comply with these rules until 2003.

LOS ANGELES-Progress in treating cancer-related anemia has accelerated in the almost 20 years since the human erythropoietin gene was cloned. That was in 1983. Ten years later, the Food and Drug Administration approved epoetin alfa (Epogen, Procrit) for transfusion-preventing treatment of patients with anemia-complicating therapy.

LOS ANGELES-To better manage fatigue, cancer patients need clear, concise information about what to expect and how to deal with reduced energy, memory, and other cognitive functions. The challenge for oncology nurses and physicians, noted Patricia Jakel, RN, MN, AOCN, is to provide this information in a manner that is sensitive to the individual patient’s changing attitudes toward treatment and need for information at each visit. "We need to know what the patients feel and what the patients want us to communicate to them," Ms. Jakel said. She is a clinical nurse specialist at University of California Medical Center, and associate professor, University of California School of Nursing, Los Angeles.

The National Marrow Donor Program (NMDP) has published the 2001-2002 Transplant Center Access Directory-a free resource for all patients who are undergoing a blood stem cell transplant and do not have a matching donor in their family.

WASHINGTON-Nearly 9 out of 10 American adults favor changing Medicare rules to cover all approved cancer drugs for its beneficiaries, including oral medications, according to a poll commissioned by the National Coalition for Cancer Survivorship (NCCS). Further, 83% said they would support increasing Medicare’s cancer budget by 1% to pay the additional costs, and 83% said that Congress should pass legislation this year requiring coverage of oral cancer agents.

HOLLYWOOD, Florida- The first review of the pain assessment database established by the National Comprehensive Cancer Network (NCCN) has shown that pain is documented in the vast majority of cases.

BETHESDA, Maryland-As researchers probe the complex nature of individual cancer cells, unique molecular patterns, or signatures, have emerged. Several drugs based on early findings in the field have already earned US Food and Drug Administration approval. A goal set by the National Cancer Institute (NCI) is to "catalog distinguishing molecular signatures of cancer cells to develop new diagnostic and therapeutic approaches and predict response."

Elias Zerhouni, MD, nominated by President Bush to the position of director of the National Institutes of Health, is a leading researcher in cardiovascular imaging.

Abbott Laboratories recently announced the launch of AxSYM Plus, an enhanced version of its AxSYM automated immunoassay instrument system.

SAN FRANCISCO-Drug therapies aimed at reducing or eradicating intraepithelial neoplasia (IEN) could reduce the burden of IEN and the incidence of malignancies, according to the American Association for Cancer Research (AACR) Task Force on the Treatment and Prevention of Intraepithelial Neoplasia. Three of the co-chairs of this Task Force reviewed key recommendations at a news briefing at the 93rd Annual Meeting of the AACR.

ORLANDO-Alemtuzumab (Campath-1H) can induce responses in patients with refractory B-cell chronic lymphocytic leukemia (B-CLL) who have the 17p-/p53 genetic mutation, which is usually characterized by a dismal outcome, Stephan Stilgenbauer, MD, of the Department of Internal Medicine III, University of Ulm, Germany, reported at the 43rd Annual Meeting of the American Society of Hematology (abstract 3211). The researchers used alemtuzumab to treat 11 patients with B-CLL, as well as 4 with T-prolymphocytic leukemia (T-PLL) and 1 with Sézary syndrome.

WASHINGTON-In selecting the new director of the National Institutes of Health (NIH) and the new surgeon general, President Bush steered a middle course through political thickets and chose two men whose views on stem cell research, human cloning, and other moral and ethical issues confronting biomedical research dovetail with his own.

NEW YORK-Agents classified as cyclin dependent kinase (CDK) inhibitors show promise in overcoming chemotherapy resistance, Gary K. Schwartz, MD, said at a media briefing on new pathways to targeted treatments sponsored by the American Society of Clinical Oncology (ASCO).

PALO ALTO, California-Varian Medical Systems has released VariSeed 7.0, the company’s newest treatment planning software for permanent seed implant brachytherapy used in treating prostate cancer. VariSeed 7.0 gives physicians the ability to use real-time images generated during the implant procedure to deliver precise accurate doses, the company said in a news release.

ORLANDO-Bioluminescent imaging may provide a noninvasive method to monitor the effect of new biologic and immunomodulatory treatments for cancer, Matthias G. Edinger, MD, said at the 43rd Annual Meeting of the American Society of Hematology (abstract 1817). Dr. Edinger is in the Division of Bone Marrow Transplantation at Stanford University School of Medicine.

DURHAM, North Carolina-Improving quality of life for cancer patients is the driving force behind clinical patterns of use of erythropoietin (EPO) therapy, at least in this country, according to Jeffrey Crawford, MD. Although the Food and Drug Administration approved epoetin alfa (Epogen, Procrit) based on evidence that it reduced the need for transfusions in cancer patients with chemotherapy-related anemia, most current clinical use of epoetin alfa is not to decrease transfusion needs. "I think we’re convinced now that there is a quality-of-life benefit," Dr. Crawford said (Figure 1), and epoetin alfa is now primarily directed at helping cancer patients realize that benefit

WASHINGTON-Despite the high rate of cancer among black men in the United States, their participation in clinical trials is low. The interaction between these patients and their physicians affects willingness to enroll in trials, Dawn L. Riddle, PhD, of the H. Lee Moffitt Cancer Center, reported at the 8th Biennial Symposium on Minorities, the Medically Underserved, and Cancer. She described pilot data indicating that when physicians go beyond simply imparting legal and medical information about the trial and make a strategic effort to answer the patient’s concerns, discover any barriers that impede his participation, and remove those barriers, black men are more likely to consent to participate.

In their review of the history of the management of stage I/II Hodgkin’s disease, Drs. Ng and Mauch describe the results of various treatment protocols and outline the questions posed by ongoing European, Canadian, and American trials. In a broad sense, the questions posed by these trials will help clinicians understand the benefits and complications of these treatments. However, as clinically oriented as they are, the current studies have yet to answer some common problems faced by private practitioners-the clinicians who, in North America, manage most patients with Hodgkin’s disease.

The article by Drs. Gates and Kaplan provides an excellent review of malignancies associated with human immunodeficiency virus (HIV)-1 disease and chronicles the epidemiologic changes seen during the past 5 years. The literature review is very thorough and well balanced.

A dramatic spike in the incidence of Kaposi’s sarcoma (KS) in never-married men in New York and California in 1981 was one of the first indications of a new disease now known as acquired immunodeficiency syndrome (AIDS). We now appreciate a number of mechanisms by which human immunodeficiency virus (HIV) infection contributes to the pathogenesis of these tumors. The article by Drs. Gates and Kaplan provides an excellent review of changes in the epidemiology, presentation, and treatment of these tumors since the development of potent combination anti-HIV therapy.

A 72-year-old woman with chronic obstructive pulmonary disease (COPD) presents with abnormal liver chemistries. She denies recent abdominal pain but recalls "gallbladder problems" after childbirth approximately 40 years ago. She has not lost any weight and denies fever. There is no history of nausea or vomiting.

Identification of targets in tumor cells vs normal cells (or at least a differential in their expression) is certainly a promising method for approaching the treatment and, indeed, the prevention of cancer. Presently, targeting of patient tumor cells has taken on even greater importance and interest with the discovery of the new agent imatinib mesylate (STI571, Gleevec), which is targeted to a kinase present in chronic myeloid leukemia (CML) cells (p210 BCR-ABL abnormal cells), which is required for CML cells to survive, but is not present in normal leucocytes.[1] The results with this agent targeted to the p210 BCR-ABL tyrosine kinase are indeed spectacular. The agent is of even greater interest in that it also works against some gastrointestinal stromal sarcomas with gain of function mutations in c-kit (CD117).[2] This activity of a targeted agent against a solid tumor increases the interest in targeted therapy to an even greater degree.

Drs. Sonis and Fey provide a nice description of the problems associated with oral mucositis, information available regarding its etiology, and the cost generated by its treatment.

Drs. Sonis and Fey are to be commended for their timely and thorough article on the oral complications of cancer therapies. It has been our experience that these side effects are not being adequately addressed in the clinical setting. This is especially true the further one is removed from large cancer treatment centers in urban areas.