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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]

PHOENIX-For many men with early-stage prostate cancer, the choice between external beam radiotherapy and brachytherapy (seed implantation) can be made based solely on lifestyle issues and personal preference, according to results of a study reported at the 40th Annual Meeting of the American Society for Therapeutic Radiology and Oncology.

Duke University Medical Center is receiving $3.5 million over the next 5 years to set up a collaborative research effort to focus on discovering genetic links to cancer. The three-institution center will be one of five nationwide that will make up the

A chemical extracted from green coffee beans may be a new weapon in the fight against acquired immune deficiency (AIDS). The chemical-chicoric acid-comes from chicory, which is derived from coffee, and is identical to substances

SAN FRANCISCO--For both nurses and their patients, home care is becoming an increasingly cost-effective and satisfactory alternative to longer hospital stays. At the Oncology Nursing Society Annual Congress, several speakers discussed methods used at their institutions to improve home health services.

Phase III clinical trial data for the human immunodeficiency virus (HIV) protease inhibitor amprenavir (Agenerase) suggest that the drug may be potent and generally well-tolerated in combination with lamivudine (Epivir) and zidovudine (AZT [Retrovir]). These data, presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), support the role of amprenavir in front-line combination antiretroviral therapy.

Two of the most distressing side effects of cancer treatment, nausea and vomiting, cause enough fear in some patients to induce them to delay or abandon potentially curative treatment. Some studies of surgical patients suggest that the fear of

WASHINGTON--Genetic research has produced a growing body of information about the mutations related to breast cancer, but, so far, "no clear algorithm" to help clinicians decide how to use the new findings in the interests of patients, reported Francis S. Collins, MD, PhD, director of the National Human Genome Research Institute.

The January issue of Science reported that researchers had successfully extended the lifespan of normal human cells using the enzyme telomerase to lengthen telomeres. Reaction to these initial findings was guarded. Oncologists were concerned that the process could be cancerous. Now, new research presented at the annual meeting of the American Association for Cancer Research (AACR) demonstrated that these cells continue to divide and maintain normal structure and function and do not progress toward cancer.

WASHINGTON--It wasn’t all rhetoric and oration at The March. It was also a time for reflection on loved ones lost and hope for the future; a time to celebrate survivorship and bond in a way only survivors understand; a time to learn more about cancer

The Doris Duke Charitable Foundation announced recently its first grant awards, totaling more than $4.2 million, under the Doris Duke Clinical Scientist Award Program. The program was developed to enable promising young scientists conducting