All News

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.

The introduction of highly active antiretroviral therapy (HAART) has had a dramatic impact on the morbidity and mortality of individuals living with human immunodeficiency virus (HIV). In addition to contributing to dramatic

Angiogenesis is an important component of the pathogenesis of hematologic malignancies. A negative prognostic implication of increased angiogenesis has been established for acute and chronic myeloid and lymphocytic leukemias, myeloproliferative diseases, multiple myeloma, non-Hodgkin’s lymphoma (NHL), and hairy cell leukemia. An association between the return of increased marrow vascularity to normal levels and durability of response has been established in some of these diseases.

Angiogenesis is a dynamic process essential for primary tumor growth and metastases. New insights into the basic understanding of the biologic processes responsible for angiogenesis have led to the characterization of potential therapeutic targets. Several strategies for the development of antiangiogenic therapeutic modalities have been employed, including agents that (1) decrease the activity of specific angiogenic factors, (2) decrease the activity of endothelial survival factors, (3) increase the activity of naturally occurring antiangiogenic agents, or (4) indirectly downregulate angiogenic and survival factor activity.

Tumorigenesis is a complex process, and understanding the mechanisms behind tumorigenesis is key to identifying effective targeted therapies. Prostaglandins are signaling lipophilic molecules derived from phospholipids that are involved in normal physiologic functions.

The optimal choice of treatment for early-stage Hodgkin’s disease depends on (1) knowledge of the prognostic factors that may influence treatment outcome and (2) the risk of acute and long-term complications incurred by treatment. For prognostic and therapeutic considerations, patients are divided into those with early-stage, favorable-prognosis disease (clinical stage I/II without risk factors) and those with early-stage, unfavorable-prognosis or intermediate-stage disease (clinical stage I/II with risk factors).

This comprehensive text focuses on the pathophysiology of hematologic diseases. There is no field in which molecular techniques have been applied more fruitfully. Given the large amount of rapidly accumulating information in the field, this book fills a niche that will become increasingly important.

The mouth is a frequent site of complications arising from drug or radiation cancer therapy, with mucositis, xerostomia, osteoradionecrosis, and local infections being the most common. From the standpoint of dose

WASHINGTON-The Cancer Prevention Working Group (CPWG), a consortium of leading oncologists, researchers, and patient advocates, has proposed the development of a National Cancer Prevention Education Program to increase professional and public education on the need for screening and risk assessment and to communicate cancer prevention models that incorporate appropriate use of chemopreventive agents.

LITTLE ROCK-For patients with cancer-related fatigue, "the first line of treatment, in my opinion, is to increase their hemoglobin levels so that they can begin an exercise program," noted William Evans, PhD. "Cancer patients suffering from primary fatigue should not be advised to increase the amount of daily rest. Rather, they should be counseled to carry out aerobic exercise," he explained. Dr. Evans serves as director, nutrition, metabolism, and exercise, and professor of geriatrics, physiology, and nutrition at the University of Arkansas for Medical Sciences in Little Rock.

While patients who are cured from cancer can expect to lead long and productive lives, we do not know the extent to which a diagnosis of cancer affects employability, insurability, and lifestyle of individuals with long-term survival.

CHICAGO-Central venous catheters (CVCs) used to deliver chemotherapy to cancer patients traditionally have been long-term tunneled or surgically implanted ports. These types of central venous catheters were reported as early as the 1970s to be associated with the lowest levels of infection and the greatest durability.

NEW YORK-A novel taxane/fatty acid conjugate designed to increase taxane activity in tumor cells and decrease toxicity has shown promising results in a phase I trial of patients with solid tumors. Ross Donehower, MD, professor of oncology and medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, presented the findings at the Chemotherapy Foundation Symposium XIX (abstract 73).

NEW YORK-A paclitaxel emulsion has shown antitumor activity with low toxicity in phase I data, Howard A. Burris III, MD, said at a special session on late-breaking developments at the Chemotherapy Foundation Symposium XIX. "This emulsion formulation of paclitaxel has the potential advantages of lower toxicity and higher efficacy than standard paclitaxel [Taxol]," said Dr. Burris, director of drug development, Sarah Cannon Cancer Center, Nashville.

Grant Williams, MD, recently assumed the position of deputy director of the Division of Oncology Drug Products, Center for Drug Evaluation and Research (CDER), US Food and Drug Administration (FDA). Dr. Williams joined the FDA in 1989 as a medical officer and was named oncology medical team leader in 1996.

InTouch magazine, the Good Health Guide to Cancer Prevention and Treatment, has joined forces with the American Society of Clinical Oncology (ASCO).

EAST HANOVER, New Jersey-The US Food and Drug Administration has approved the Novartis drug Zometa (zoledronic acid for injection) for the treatment of patients with multiple myeloma and patients with documented bone metastases from solid tumors, in conjunction with standard antineoplastic therapy.

I had the pleasure of reviewing the 8th edition of Philip Rubin’s Clinical Oncology: A Multidisciplinary Approach for Physicians and Students. This is another in a long line of excellent clinical textbooks edited by Dr. Rubin and associate editor Jacqueline P. Williams, PhD. Dr. Rubin is a pioneer in oncology and, in particular, radiation oncology. The current edition consists of 34 chapters authored by 95 contributors spanning all oncologic specialties and numerous institutions.

HOUSTON-Physicians at Ben Taub General Hospital, Houston, noticed that an unusual number of patients were presenting with lymphoma as their first AIDS-defining event. This observation prompted a retrospective study of all HIV-positive patients with non-Hodgkin’s lymphoma presenting between 1989 and 2000.

ROCKVILLE, Maryland-For the first time, the US Food and Drug Administration has approved the use of a radioisotope attached to a monoclonal antibody for the treatment of cancer.

WASHINGTON-Despite the enormous progress that researchers have made against cancer, the unequal disease burden borne by minority and under-served populations constitutes "a moral and ethical dilemma for society," said Harold P. Freeman, MD, who chairs the President’s Cancer Panel and also serves as director of the NCI’s Center to Reduce Cancer Health Disparities (CRCHD).

LOS ANGELES-The Lymphoma Research Foundation of America (LRFA) and the New York-based Cure For Lymphoma Foundation (CFL) have merged to become the Lymphoma Research Foundation (LRF), the nation’s only organization dedicated solely to funding lymphoma research and providing information, education, and support to all those touched by the disease.