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New research from the AIDS Institute at the University of California, Los Angeles (UCLA), reveals that stress enables the human immunodeficiency virus (HIV) to spread more quickly in infected persons and prevents antiretroviral drugs from restoring immune system function. The study, which was reported in the Proceedings of the National Academy of Sciences (98:12695-12700, 2001), is the first to pinpoint the molecular mechanisms linking stress and HIV infection. "Popular science has widely suspected that stress weakens the immune system," said Steve Cole, MD, lead author and UCLA assistant professor of hematology-oncology. "Now we’ve uncovered two reasons why."

The Association of Community Cancer Centers (ACCC), a national interdisciplinary organization defining quality cancer care, has launched a public policy website-www.accc-cancer.org/publicpolicy/-dedicated to the regulatory and legislative issues affecting patients with cancer. The website was developed to assist in educating patients and their families about public policy that has an impact on cancer care.

SAN DIEGO--To relieve the anxiety and frustration cancer patients may feel when being put on a waiting list for enrollment into a phase I trial, clinical trials managers at Vanderbilt have developed wait list guidelines driven by compassion and ethics,

COLOGNE, Germany-Combining rituximab (Rituxan) with fludarabine (Fludara) is a feasible, effective strategy in treating chronic lymphocytic leukemia (CLL), as it produces a 90% response rate and does not increase infection risk beyond that seen with fludarabine alone, Holger Schulz, MD, reported in a poster presentation at the 43rd Annual Meeting of the American Society of Hematology. Dr. Schulz is in the Department of Hematology/Oncology at the University of Cologne, Germany.

ORLANDO, Florida-Updated data from two separate studies ratify earlier results showing that following CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) with radiation improves results for patients with early- or limited-stage non-Hodgkin’s lymphoma (NHL).

A new study published in the Journal of Clinical Oncology (19:3918-3928, 2001) reported that radioimmunotherapy with tositumomab/iodine-131 tositumomab (Bexxar), produced more durable complete or partial clinical responses in patients with low-grade and transformed low-grade non-Hodgkin’s lymphoma (NHL) than did their last round of chemotherapy. All patients in the study had chemotherapy-refractory NHL. Typically, response rates and durations of response in refractory patients decline with each successive therapy, but in this study, the tositumomab/iodine-131 tositumomab combination was shown to reverse the expected outcome.

WASHINGTON-"Cancer prevention now requires that we move from thought to reality," said Carolyn Aldigé, founder and president of the Cancer Research Foundation of America (CRFA). "This mean a new paradigm of the health care system, rather than just taking care of sick people. Treatment of advanced disease has less impact than prevention."

NASHVILLE, Tennessee-A pilot study of rituximab (Rituxan) as first-line therapy for small lymphocytic lymphoma (SLL) or chronic lymphocytic leukemia (CLL) found an overall response rate of 56%, according to John Hainsworth, MD, director of clinical research at the Sarah Cannon Cancer Center in Nashville, Tennessee. Dr. Hainsworth discussed this work in a poster session at the 43rd Annual Meeting of the American Society of Hematology.

HOMBURG, Germany-After conducting trials comparing CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) with and without etoposide and varying time intervals, the German High-Grade Non-Hodgkin’s Lymphoma Study Group concluded that CHOP plus etoposide is the new standard regimen for younger patients with low-risk non-Hodgkin’s lymphoma (NHL), and CHOP at 2-week intervals is the new standard regimen for aggressive NHL in older patients.

CHICAGO-Once-a-week dosing of recombinant human erythropoietin (epoetin alfa, Epogen, Procrit) is as effective as thrice-weekly dosing in improving hemoglobin (Hb) levels in HIV-positive patients who are anemic, Howard A. Grossman, MD, said at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC abstract 254).

ORLANDO-The investigational, single-dose cytokine pegfilgrastim worked as well as filgrastim (G-CSF, Neupogen) in decreasing the duration of severe neutropenia following chemotherapy in patients with relapsed or refractory non-Hodgkin’s lymphoma (NHL) or Hodgkin’s disease.

For the past 20 to 30 years, enormous resources have been directed toward the development of effective cancer immunotherapies. The interest in immunotherapeutic approaches comes from the potential specificity imparted by the recognition of tumor-specific antigens combined with the powerful cytolytic properties of cellular and humoral immune effector arms. Earlier attempts to induce and/or expand tumor antigen-specific immune responses in patients involved the systemic administration of cytokines such as interleukin-2 (Proleukin), or immunization with vaccines prepared from whole tumor cells or tumor cell lysates admixed with powerful immunologic adjuvants (stimulators). Unfortunately, only limited efficacy was achieved.

The title of the article by Dr. Stephen Sagar, "Carcinomatous Meningitis: It Does Not Have to Be a Death Sentence" is very provocative. Most oncology specialists consider leptomeningeal dissemination of cancer as an indication of end-stage disease, particularly in patients with solid malignancies. More than 70% of patients found to have neoplastic meningitis have evidence of concurrent progressive systemic disease.[1] Although neoplastic meningitis is thought to have less of an impact on survival in patients with lymphomas or leukemias, the presence of tumor cells in the cerebrospinal fluid (CSF) of these patients significantly complicates the treatment regimen.

The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]

With this insightful manuscript, Drs. Termuhlen and Kemeny shed some light on the surgical management of older cancer patients. The authors highlight pitfalls in patient selection and offer proposals to improve the surgical oncologist’s approach to patient care. They review the role of curative surgical management of the most common forms of cancer in the elderly, while emphasizing the role of surgical palliation to improve the quality of life of older cancer patients.

Leptomeningeal metastases are a growing problem, particularly among patients whose solid tumors have been controlled with increasingly effective systemic therapies. The central nervous system (CNS) can represent a sanctuary where disease can persist even if it is eradicated or controlled systemically. This is due to the blood-brain barrier that prevents most water-soluble chemotherapeutic agents from reaching tumor cells sequestered in the CNS.

Each year, tobacco use kills nearly 500,000 Americans (430,000 smokers and 53,000 from secondhand smoke)[1]-more than the combined annual number of national deaths from the acquired immunodeficiency syndrome, alcohol, automobile accidents, murders, suicides, and fires. The annual cost of treating tobacco-related diseases is about $89 billion.[2]

The elderly population in the United States increased by a factor of 11 in the past century, while the under age 65 population tripled in that same period.[1] Given that the majority of cancers occur in patients over 65 years old, there is an increasing need for surgical interventions in the elderly.

The review by Drs. Shacter and Weitzman is an excellent and timely contribution to the field of carcinogenesis. The issue of chronic inflammation as a progenitor of cancer development has been a controversial one. To prove the importance of chronic inflammation (and the factors released in the process) to carcinogenesis, the authors provide a thorough and logical presentation of the experimental results described in the literature, including their own work. This compilation of the existing data should dispel any doubts about the association of chronic inflammation to cancer. I will review the main points discussed by the authors.

Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.

LILLE, France-As front-line treatment for chronic lymphocytic leukemia (CLL), the combination of fludarabine (Fludara) and cyclophosphamide (Cytoxan, Neosar) administered orally "could be a good compromise with a good efficacy and an acceptable tolerance," reported Bruno Cazin, MD, of the Hôpital Claude Huriez in Lille, France, and his colleagues at the French Cooperative Group for CLL. An intermediate analysis of 59 of 76 patients that were enrolled in a multicenter phase II trial supports this claim, producing an overall response rate of 78% and mostly manageable toxicities.

Every 3 years, the National Cancer Institute (NCI) asks cancer researchers, advisory groups, and advocacy organizations to recommend important areas to which it should devote additional resources.

This and future reports are written by oncologists from Pacific Shores Medical Group (a large group practice in Long Beach, California). The reports are primarily based on notes taken at the American Society of Clinical Oncology

ORLANDO, Florida-Rituximab (Rituxan) shows promise in the treatment of immune thrombocytopenic purpura (ITP), according to two poster presentations at the 43rd Annual Meeting of the American Society of Hematology (ASH). Nichola Cooper, MRCP, fellow, and James B. Bussel, MD, professor of pediatrics, both at Weill Medical College of Cornell University, and Mansoor N. Saleh, MD, professor of medicine at the University of Alabama at Birmingham, reported the results of separate studies investigating the efficacy and toxicity of rituximab in adults with refractory ITP. Rituximab binds to the antigen CD20 and depletes circulating B-lymphocyte cells. "In theory," Dr. Cooper said, "if you get rid of the B cells, it decreases the autoimmune response."

TORONTO-Monoclonal antibodies directed against red blood cells can be used to inhibit immune forms of thrombocytopenia, according to the results of studies with mice. These results were reported by Alan H. Lazarus, PhD, assistant professor of medicine, Department of Hematology, St. Michael’s Hospital, University of Toronto.

WASHINGTON-The American Cancer Society (ACS) has offered a 13-point legislative agenda for 2002. The agenda backs President Bush’s request that Congress provide the National Institutes of Health $27.3 billion for fiscal year (FY) 2003, thus completing the doubling of the agency’s budget over 5 years.

A substantial body of evidence supports the conclusion that chronic inflammation can predispose an individual to cancer, as demonstrated by the association between chronic inflammatory bowel diseases and the increased risk of colon carcinoma. Chronic inflammation is caused by a variety of factors, including bacterial, viral, and parasitic infections, chemical irritants, and nondigestible particles.

PITTSBURGH-The Oncology Nursing Certification Corporation (ONCC) has announced the results of certification tests taken September 22, 2001. In a news release, the ONCC said that 154 registered nurses have earned their Advanced Oncology Certified Nurse (AOCN) credential. Of the 233 nurses who took the test, 66% earned a passing score, including 123 newly certified AOCNs and 31 renewals.

ORLANDO-Presentations at the 43rd Annual Meeting of the American Society of Hematology (ASH) showed increased survival for patients with aggressive and indolent non-Hodgkin’s lymphoma (NHL) who received the anti-CD20 monoclonal antibody rituximab (Rituxan) in addition to standard CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone).

SILVER SPRING, Maryland-The FDA’s Oncologic Drugs Advisory Committee (ODAC) has unanimously recommended that the agency amend the labeling of Herceptin (trastuzumab, Genentech) to include a new gene-detection test to identify women with metastatic breast cancer who are likely to benefit from the therapy. The 16-to-0 vote backed adding the PathVysion HER-2 DNA Probe Kit to the labeling. The kit is made by Vysis, Inc., now owned by Abbott Laboratories.