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The management of germ cell tumors has advanced dramatically,with cure rates approaching 90% to 95%. Treatment of stage I/Aseminomas generally includes orchiectomy and adjuvant radiotherapy.Treatment of stage I/A nonseminomatous germ cell tumors involvesorchiectomy followed by retroperitoneal lymph node dissection oractive surveillance. One of the major advances has been the introductionof cisplatin-based chemotherapy for metastatic disease and thedevelopment of a system of risk attribution. The logical managementof any patient with curable disease is to provide curative therapy andthen follow the patient in a structured manner, to diagnose and treatany complications in a timely manner.

Despite many therapeutic options for chronic lymphocytic leukemia(CLL), the disease remains incurable. Since monoclonal antibodiesand recombinant toxins that bind surface antigens expressed on themalignant lymphocytes have been developed, targeted therapy hasbecome a vital option in treating CLL. Rituximab (Rituxan), a chimerichuman-mouse anti-CD20 antibody, and alemtuzumab (Campath), ahumanized anti-CD52 monoclonal antibody, have both shown activityin CLL-as single agents and in combination with conventionalchemotherapy. The possibility of combining antibodies has beenexplored as well, with some efficacy. In this review, we discuss theclinical data on the activity of commercially available antibodies inCLL, both as monotherapy and in combination with other agents.

Palliative care, previously viewed by many as anend-of-life movement, is now recognized as anapproach whose principles should infuse the care ofall patients with a chronic illness throughout the fullcourse of that illness. For example, the World HealthOrganization (WHO) has redefined palliative care asfollows:

WASHINGTON-The Department of Health and Human Service (HHS) has created a unified advisory committee on HIV and sexually transmitted diseases (STD) by merging two existing groups. The new committee brings together the Advisory Committee for HIV Prevention at the Centers for Disease Control and Prevention (CDC) and the AIDS Advisory Committee at the Health Resources and Services Administration (HRSA). The two groups have met jointly on several occasions during the last 2 years, and all current members of the two bodies will serve on the new CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment.

BETHESDA, Maryland-Two medical facilities have received the first grants awarded by the National Cancer Institute’s Cooperative Planning Grant for Cancer Disparities Research Partnerships (CDRP). The 5-year, $27 million program provides support for radiation oncology clinical research at institutions that have not traditionally participated in NCI-sponsored studies. The two grants, totaling more than $2.5 million, went to the Rapid City Regional Hospital in South Dakota ($1,404,486), which serves a largely Native American population, and the Mercy Health Center, Laredo, Texas ($1,120,013), which serves a largely Hispanic community.

ORLANDO-A randomized trial found that an implantable drug delivery system (IDDS) was superior to comprehensive medical management (CMM) in reducing pain among cancer patients and a quality of life analysis showed that decreasing pain improved quality of life not only for patients but also for their caregivers.

VANCOUVER-Inex Pharmaceuticals Corporation has announced positive results from a pivotal phase II/III clinical trial evaluating its lead anticancer product Onco TCS (liposomal vincristine) as single-agent therapy for relapsed aggressive non-Hodgkin’s lymphoma. The trial results will form the basis for a New Drug Application seeking approval for marketing from the US Food and Drug Administration (FDA). The 102 study patients had received an average of four other regimens, and 75% had resistant disease. The overall response rate with Onco TCS was 24%, including five complete responses.

ORLANDO-Intratumoral injection of dendritic cells genetically modified to express CD40 ligand (CD40L) eradicated breast tumors in mice, Zoya R. Yurkovetsky, a PhD student from the Department of Molecular Genetics and Biochemistry, University of Pittsburgh School of Medicine, reported at the Era of Hope Department of Defense Breast Cancer Research Program meeting.

WASHINGTON-The 8-year drive to test pregnant women for HIV as a means of preventing perinatal transmission of the virus had varying degrees of success, according to a new report from the Centers for Disease Control and Prevention (CDC).

BOSTON-A review of more than 1,600 patients in the Oncology Practice Pattern Study found a 50% higher risk of febrile neutropenia for elderly patients than younger patients. Most incidents occurred during the first 21 days of chemotherapy, according to a presented at the third meeting of the International Society of Geriatric Oncology (SIOG abstract P-22). Based on the analysis, Vincent Caggiano, MD, medical director, Sutter Cancer Center, Sacramento, and his colleagues urged oncologists to consider giving prophylactic colony-stimulating factors (CSFs) during the first two chemotherapy cycles-especially among older patients who are more vulnerable to the complication.

SEATTLE-Cigarette smoking appears to be a significant risk factor for colon polyps, equal to a family history of colon cancer, according to Rajeev Attam, MD, a senior fellow in the Division of Gastroenterology, Stony Brook University School of Medicine, New York. In a large colon cancer screening study, approximately 19% of ex-smokers and 17% of nonsmokers had polyps, compared with 25% of current smokers.

BETHESDA, Maryland-With its budget frozen at last year’s level, National Cancer Institute (NCI) officials have cut back on the number of competing research grants awarded during the first 3 months of fiscal year 2003, which began last October 1.

NEW YORK-Dose escalation of irinotecan (Camptosar) is continuing in a phase I trial of a four-drug regimen that has shown encouraging activity in patients with pancreatic and gallbladder cancer, according to a report at the Mount Sinai School of Medicine Chemotherapy Foundation Symposium XX.

NEW YORK-New data suggests that granisetron (Kytril) can effectively prevents postoperative nausea and vomiting at doses as low as 0.1 mg. Robert D’Angelo, MD, Department of Anesthesiology, Wake Forest University, Baptist Medical Center, presented the study results at the 56th Annual Post Graduate Assembly in Anesthesiology.

BETHESDA, Maryland-The National Cancer Institute (NCI) has launched a 5-year, $7.6 million project at seven leading cancer centers to address the disease among Asian Americans. Although Asian Americans have a relatively low overall risk, their cancer incidence is rising faster than that of any other racial or ethnic group in the United States.

NEW ORLEANS-The addition of concurrent cisplatin (Platinol) chemotherapy to radiation therapy after surgery failed to significantly improve locoregional control of high-risk head and neck cancers in the RTOG 9501/Intergroup phase III trial reported at the plenary session of the American Society for Therapeutic Radiology and Oncology (abstract plenary 3).

TARRYTOWN, New York-Aton Pharma, Inc and its collaborators presented phase I data on its oral histone deacetylase inhibitor SAHA (suberoylanilide hydroxamic acid) at the 14th Annual EORTC/NCI/AACR symposium, held in Frankfurt, Germany. The trial of patients with refractory solid tumors, lymphomas, and leukemias, being conducted with researchers at Memorial Sloan-Ket-tering Cancer Center, defined a safe daily oral dosing regimen.

BETHESDA, Maryland-A 6-year prostate cancer research plan released by the National Institutes of Health (NIH) contains a detailed outline of the National Cancer Institute’s (NCI) future strategy for dealing with the disease, which includes a shift in the standard treatment model from seek-and-destroy to target-and-control.

NEW YORK-The disadvantaged, once they have cancer, are then more likely to die from it, according to Prof. Harry Burns. "Poverty influences cancer in some quite unexpected ways," said Prof. Burns, director of public health, Greater Glasgow Health Board, Glasgow, Scotland. "The politicians, and all of us as voters, have a responsibility to think about this."

MELVILLE, New York-ONI is pleased to announce the creation of an Editorial Advisory Board for Oncology Nursing, to work with Sharon Krumm, PhD, RN, the Editor of Oncology Nursing, and staff to report research by oncology nurses and issues of special interest to oncology nurses. The first two appointees to the board are Catherine (Cathy) Coleman, RN, OCN, and Mary McCabe, BSN, MA.

PHILADELPHIA-Salvage therapy with the radiolabeled monoclonal antibody tositumomab (Bexxar) produced durable complete remissions in patients with multiply relapsed or refractory non-Hodgkin’s lymphoma (NHL) or transformed indolent lymphoma when used as second-line therapy, and first-line tositumomab produced 5-year progression-free survival of 58.9% in patients with advanced follicular lymphoma.

NEW ORLEANS-Template-based interstitial brachytherapy is an effective method for treating breast cancer, according to a study presented at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 147). The study is one of the first to use a template to position interstitial implants in its entire study population as part of its protocol.

NIAGARA-ON-THE-LAKE, Ontario, Canada-Survivors of childhood cancer generally enjoy good quality of life (QOL) as adults, according to two reports presented at the 7th International Conference for Long-Term Complications of Treatment of Children and Adolescents for Cancer, hosted by Roswell Park Cancer Institute.

NEW ORLEANS-Toxicity for low-dose-rate and high-dose-rate accelerated partial breast irradiation (APBI) (brachytherapy) is comparable to that observed in women treated with conventional whole breast external beam radiation therapy after lumpectomy, according to a 10-year study (RTOG 95-17) presented at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract 146).

WASHINGTON-A seven-state pilot project will study the best way to help older smokers kick their nicotine habit. The program, financed by the Centers for Medicare & Medicaid Services (CMS), will test counseling in person and by phone, a prescription smoking cessation drug, nicotine patches, and education materials.

BETHESDA, Maryland-The first clinical trial of an HIV-1 vaccine based on multiple genes from three subtypes, or clades, of the virus began November 13, 2002, when researchers at the National Institute of Allergy and Infectious Diseases (NIAID) vaccinated three healthy volunteers. Researchers expect to enroll 50 participants in the 12-month phase I study. The DNA vaccine contains modified material from four genes from clades A, B, and C, which cause about 90% of HIV infections worldwide.

Venous thromboembolic disease is a common but likely underdiagnosedcondition in the cancer patient population. Timely and accuratediagnosis of venous thromboembolism is imperative due to the unacceptablemorbidity and mortality associated with a misdiagnosis.Because diagnosis of the condition based on clinical grounds alone isunreliable, physicians should select an appropriate objective diagnostictest to confirm or refute their clinical impressions. Compressionduplex ultrasound is the best initial imaging test for both suspectedupper- and lower-extremity deep venous thrombosis. Magnetic resonancevenography (MRV) is a valid alternative when ultrasound isinconclusive, but contrast venography remains the “gold standard.”Suspected pulmonary embolism should be initially evaluated by helical(spiral) computed tomography (CT) or ventilation/perfusion lungscintigraphy, the former being preferred in cases of obvious pulmonaryor pleural disease. Indeterminate studies should prompt performanceof contrast pulmonary angiography. Inferior vena cava thrombosis isalso best assessed by contrast venography, with MRV and CT reservedas alternative imaging modalities. Evidence to date suggests thatD-dimer assays remain unreliable in excluding venous thromboembolismin cancer patients. A newer latex agglutination D-dimer assay mayprove to be clinically useful in this setting.

Erectile dysfunction is a common sequela following potentiallycurative local treatment for early-stage carcinoma of the prostategland. With larger studies and longer follow-up, it is clear that erectiledysfunction following prostate brachytherapy is more common thanpreviously reported, with a myriad of previously unrecognized sexualsymptoms. Approximately 50% of patients develop erectile dysfunctionwithin 5 years of implantation. Several factors including preimplantpotency, patient age, the use of supplemental external-beam irradiation,radiation dose to the prostate gland, radiation dose to the bulb ofthe penis, and diabetes mellitus appear to exacerbate brachytherapyrelatederectile dysfunction. The majority of patients with brachytherapy-induced erectile dysfunction respond favorably to sildenafil citrate(Viagra). Despite reports questioning the potency-sparing advantageassociated with brachytherapy, recent elucidations of brachytherapyrelatederectile dysfunction may result in refinement of treatmenttechniques, an increased likelihood of potency preservation, andultimately, improved quality of life.

Drs. Basche and Kelly presentan excellent comprehensivereview of the treatment ofnon–small-cell lung cancer in olderpersons. Articles such as this, whichfocus on the older patient, are of paramountimportance for several reasons.First, cancer is a disease ofaging, with an 11-fold increased incidenceand a 16-fold increase in cancer-related mortality among patientsover age 65 compared to those under65.[1] Second, the population is aging,and in the year 2030, approximately22% will be over 65.[1] Third,data on older cancer patients are limitedsecondary to an underrepresentationof this population in clinicaltrials.[2,3] Based on these facts, acomprehensive review of the availabledata is important, especially toguide future research.

This article by Marcelo Gomes,MD, and Steven Deitcher, MD,is a well conducted, thorough,and scholarly review of the diagnosticmethods for venous thromboembolismin cancer patients. The authorshave specifically looked at upperandlower-extremity deep venousthrombosis (DVT), pulmonary embolism,and rarer conditions includingthrombosis of the inferior venacava (IVC), pelvic veins, and eventhe portal vein. They offer descriptionsof the various tests available,address the pros and cons of thosetests, and provide the reader with algorithmsfor the diagnosis of DVT andpulmonary embolism, including twofor pulmonary embolism-one basedon ventilation/perfusion (V/Q) scanningand one based on helical computedtomography (CT) scanning.