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SAN FRANCISCO-Preliminary results of a prospective Centers for Disease Control and Prevention study of nearly 45,000 US patients show a dose-response relationship between anti-HIV regimens incorporating protease inhibitors (highly active antiretroviral therapy or HAART) and decreased HIV-related mortality.

COLUMBUS, Ohio-A large research study has validated a short questionnaire for cancer patients designed to assess nutritional risk and to establish a triage system for intervention, Faith Ottery, MD, PhD, president of Ottery & Associates, Oncology Care Consultants, said at the Fourth Annual Congress of the Society for Nutritional Oncology Adjuvant Therapy (NOAT). Dr. Ottery founded NOAT in 1993.

BETHESDA, Md-The presidentially appointed National Cancer Advisory Board (NCAB) has expressed its concern that President Clinton’s proposed budget increase of 2.4% for the National Cancer Institute is inadequate and will seriously damage the National Cancer Program “over the short and long term.”

The success of purine nucleoside analogs in the treatment and management of indolent leukemias has generated interest in

NEW YORK-Although a cure for non-Hodgkin’s lymphoma remains elusive, several potential new approaches could bolster remissions, Richard I. Fisher, MD, told patients during a Cancer Care, Inc. teleconference.

Clinical trials with yttrium-90 and iodine-131 radioimmunotherapy have demonstrated efficacy in the treatment of non-

WASHINGTON-About one-third of patients who undergo cancer chemotherapy and/or radiation treatments suffer serious oral complications, many of which could be mitigated. Four federal health agencies have joined together in a national campaign to make oncologists and other health care providers more aware of the problem and how to deal with it.

Unlabeled monoclonal antibodies (MoAbs) are attractive for the treatment of non-Hodgkin’s lymphoma (NHL) as they may: (1) mediate cytotoxicity with complement (complement-dependent cytotoxicity [CDC]) or effector cells (antibody-dependent cellular cytotoxicity [ADCC]); (2) effect apoptosis; (3) be less toxic, less immunogenic, and more effective than toxin- or drug-conjugated MoAbs; (4) not require the complex procedures needed for radiolabeled MoAb therapy (RIT); and (5) not produce the myelosuppression typical of high-dose RIT.

Rituximab (Rituxan) is the first monoclonal antibody (MoAb) approved for the treatment of non-Hodgkin’s lymphoma (NHL). This anti-CD20 MoAb is effective in inducing apoptosis, complement-dependent cytotoxicity (CDC), and antibody-dependent cellular cytotoxicity (ADCC). In single-agent studies in relapsed or refractory low-grade or follicular NHL (International Working Formula [IWF] types A-D), an overall response rate (ORR) of 48% has been reported.

Age is a risk factor and a prognostic parameter in elderly high-grade non-Hodgkin’s lymphoma (NHL) patients. Several

Drs. Peeters and Haller provide a thorough review of the recent historical development, current state of knowledge, and future of adjuvant therapy for early-stage colon and rectal cancers. They provide reasonable recommendations for the

This review of the use of brachytherapy (also known as interstitial or intracavitary radiation therapy) in children with soft-tissue sarcomas is well-written and timely. The authors have done an excellent job of summarizing the characteristics of the

Dr. Nag and colleagues provide an overview of brachytherapy, describe its application in pediatric oncology, and review the clinical experience in childhood solid tumors. The limited number of publications includes Dr. Nag’s own important, innovative clinical research using remote afterloading high-dose-rate (HDR) brachytherapy with twice-daily fractions in children with sarcoma.[1]

The CHOP (cyclophosphamide, doxorubicin, Oncovin, and prednisone) regimen has been the standard approach to patients with advanced-stage intermediate-grade non-Hodgkin’s lymphoma (NHL) for more than 20 years.A randomized comparison between CHOP, m-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamide, Oncovin, and dexamethasone).

The currently available nucleoside analogs, such as fludarabine, have revolutionized the approach to the treatment of indolent lymphoid malignancies. Fludarabine is the most effective agent for the treatment of chronic lymphocytic leukemia (CLL) and also exhibits major activity in low-grade NHL. Despite the impressive rates of complete remissions, patients with these malignancies remain incurable, and new agents are needed.

The role of interferon-alfa (Intron A, Roferon) in the management of patients with low-grade NHL remains controversial. More than 10 randomized trials have been reported.

Overexpression of the bcl-2 gene can be detected in approximately 80% to 90% of patients with advanced-stage follicular NHL, as well as in 20% to 30% of those with diffuse large B-cell NHL. A number of studies have attempted to correlate outcome with residual disease using PCR in patients who have achieved a clinical complete response with chemotherapy, antibody treatment, or high-dose therapy with stem-cell support. However, the studies have been inconsistent, and, therefore, the clinical value of such measurements has been limited.

High-dose chemotherapy with autologous stem-cell support has clearly demonstrated efficacy in patients with relapsed or refractory Hodgkin’s disease (Horning et al: Blood 89:801-813, 1997) and is probably superior to salvage chemotherapy in this setting (Yuen et al: Blood 89:814-822, 1997). Disease burden and chemosensitivity have been shown to be predictive of long-term outcome following the transplant. However, a clear advantage may be difficult to demonstrate because of late complications, including secondary malignancies, particularly acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) (Roberts et al, abstract #2984).

The relative clinical efficacy of autologous or allogeneic bone marrow transplantation (BMT) remains a controversial issue. In most series, outcomes with the two types of transplants have been comparable; relapse is more common with autologous BMT due to contamination of stem cells, whereas allogeneic BMT is associated with greater treatment-related mortality.

The use of all-trans-retinoic acid (ATRA [Vesanoid]) has revolutionized the treatment of patients with acute promyelocytic leukemia (APL)(Tallman et al: N Engl J Med 337:1021-1028, 1997). However, a significant proportion of patients still relapse and die from their disease. Studies from China have indicated that arsenic trioxide is effective even in patients who did not respond to ATRA, and subsequent research has suggested that it works by a different mechanism of action (Shen et al: Blood 89:3354-3360, 1997).

As more new therapeutic agents enter clinical trials, it becomes increasingly more important to have standardized response criteria. Uniform guidelines facilitate acquisition of comparable data, interpretation of data, comparisons of the results among various clinical trials, and identification of new agents with promising activity.

The role of combined-modality therapy for Hodgkin’s disease was the subject of several abstracts presented at the ASH meeting. Radiation therapy has traditionally been the standard approach for patients with early-stage disease. However, several recent studies have suggested an important role for chemotherapy, either alone or in combination with radiation.

Rituximab is a chimeric human-mouse anti-CD20 monoclonal antibody that has been studied most widely in patients with follicular non-Hodgkin’s lymphomas (NHLs). This antibody has induced responses in about half of these cases, including a 6% complete remission rate, with responses lasting a median of 11.6 months (McLaughlin et al: J Clin Oncol 16:2825-2833, 1998). Rituximab has only entered widespread clinical use over the past year. As a result, data are just beginning to emerge on the long-term results with this agent.

Gerhartz and coworkers (abstract #1293) and the German Hodgkin’s Group (Diehl et al, abstract #2002) presented their results with interoup (Diehl et al, abstract #2002) presented their results with intensified regimens. The former investigators used a time-intensified COPP (cyclophosphamide, Oncovin, procarbazine, and prednisone)/ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) regimen with granulocyte-macrophage colony-stimulating factor (GM-CSF [Leukine, Prokine]) support. Complete remission rates were 62% with COPP/ABVD, as compared with 79% for the intensified regimen. This was taken as evidence of benefit from the higher-dose program. However, these findings are consistent with results that have been reportedfor ABVD and other anthracycline-containing regimens (Canellos et al:N Engl J Med 327:1478-84, 1992; Duggan et al: Proc Am Soc Clin Oncol 16:12a [abstract 43], 1997).

Although thousands of patients have been treated with rituximab to date, researchers are just beginning to understand the basis on which this agent works. Rituximab is believed to induce tumor regression by several mechanisms of action, including antibody-dependent cellular cytotoxicity (ADCC), complement-mediated cytotoxicity (CDC), and induction of apoptosis. The mechanism by which apoptosis occurs also has not been clearly elucidated.

In general, rituximab has an acceptable toxicity profile. However, as the drug has been used more widely, new side effects have been identified that warranted a modification of the package insert. Approximately 70 serious infusion-related events have been reported, with 8 fatalities out of an estimated14,000 patients treated. Death was associated with bronchospasm, hypotension, and severe respiratory distress, with no clear predisposing factors.

Allogeneic BMT has generally been limited to patients younger than age 50 to 55 years, and to those with good performance status and renal function. Several approaches are being evaluated to allow these poorer-risk patients to safely undergo transplantation. The successful use of submyeloablative (“mini”) transplants has previously been reported by groups from Israel (Slavin et al: Blood 91:756-73, 1998) and M. D. Anderson (Khouri et al: J Clin Oncol 16:2817-2824, 1998). A moderately myelosuppressive agent, such as cyclophosphamide (Cytoxan, Neosar), and an immunosuppressive drug, such as fludarabine (Fludara), are used as the preparative regimen. Following BMT, allogeneic donor leukocytes may be used to eliminate residual disease or mixed chimerism. Further study of this interesting approach is ongoing.

Although rituximab was approved for the treatment of follicular, low-grade NHL, it is also being evaluated in other CD20+ tumors. Responses have previously been reported in large cell NHL and mantle cell NHL (Coiffier et al: Blood 92:1927-1932, 1998). These authors used 8 weekly infusions of rituximab at two different doses in 54 patients with intermediate- or high-grade NHL or mantle cell NHL. The complete remission rate was 9% with an overall response rate of 31%. Median time to progression as of publication was 246+ days.

The bcl-2 gene is overexpressed in 80% to 90% of patients with follicular NHL. The product of this gene, the bcl-2 protein, not only protects cells from apoptosis but also induces a form of acquired resistance to a wide array of chemotherapy agents (Kitada et al: Blood 91:3379-3389, 1998).

Early reports suggested that therapy with rituximab might be less effective in patients with bulky nodal disease. At the ASH meeting, Davis et al (abstract #1711) reported on 31 patients with indolent NHL and masses measuring ³ 10 cm who received rituximab in four weekly infusions. Of the 31 patients, 1 patient (4%) had a complete remission, and 11 patients responded partially, for an overall response rate of 43%. However, the duration of response was only 8.1 months.