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PHILADELPHIA--Two highlights of the 1996 American Society of Clinical Oncology (ASCO) meeting (to be held May 18-21 in Philadelphia) will be the integrated symposia, ASCO president John Glick said in an interview. Dr. Glick, of the University of Pennsylvania Cancer Center, said that the innovative symposia will integrate educational material and state-of-the-art abstracts.

For the oncology profession, the transition period to managed care will mean new relationships with other providers, some loss of control over patient care, and the need for practice and ethical guidelines, concluded panelists participating in a session on managed care at the Association of Community Cancer Centers' 1995 Oncology Symposium.

Graft-versus-host disease (GVHD) represents a significant, perhaps neglected, complication of unrelated bone marrow transplantation, stated Daniel Weisdorf, MD, Professor of Medicine at the University of Minnesota, and Associate Director of the Adult Bone Marrow Transplantation Program, at a symposium on "Clinical Issues in Unrelated Marrow Transplantation" held in association with the recent meeting of the American Society of Hematology. Prolonged immunocompromise is an additional hazard to recipients of unrelated bone marrow transplants.

FORT LAUDERDALE, Fla--The most difficult part of the guidelines process is implementation--getting physicians, nurses, and administrators to "buy in" to the process, Gale Katterhagen, MD, said at the first annual conference of the National Comprehensive Cancer Network (NCCN), a coalition of major cancer centers currently in the process of developing guidelines for its members.

Monoclonal antibodies (MoAbs) show promise as a prognostic as well as therapeutic tool in some minimal residual cancers, said Gert Riethmüller, MD, of the University of Munich's Institute for Immunology.

NEW YORK--Henry T. Lynch, MD, whose pioneering work during the 1960s and '70s helped establish the hereditary basis of certain gastrointestinal, breast, and ovarian cancers, is the recipient of the 19th annual Bristol-Myers Squibb Award for Distinguished Achievement in Cancer Research. Thanks in large part to Dr. Lynch, the specific genetic mutations responsible for a number of familial cancers have been identified.

BETHESDA, Md--The PDQ Adult Treatment Editorial Board held its March meeting in Milan, Italy, so that an international audience could observe how the board reviews recently published literature to determine if changes should be made in the information in PDQ. The experience is expected to aid the European oncology community in developing its own database, known as START (State-of-the-Art Oncology in Europe).

FORT LAUDERDALE, Fla--Unlike the piecemeal development of clinical practice guidelines in the United States--by individual institutions, networks, or managed care plans--in Canada, guidelines development is a provincial effort, with the resulting product applying to all oncologists in the province, Mark Levine, MD, said at the first annual conference of the National Comprehensive Cancer Network (NCCN).

FORT LAUDERDALE, Fla--Interest in neurotoxins derived from marine cone snails has led to development of a calcium-channel blocking agent that could potentially be used as an alternative to opioid analgesics for patients with cancer pain. Early clinical studies with the agent (SNX-111, being developed by Neurex Corporation, Menlo Park, Calif) have found it to be more potent than morphine and free of opioid side effects, Richard W. Tsien, DPhil, said at a conference on gene technology organized by the University Biochemistry & Molecular Biology Foundation, Inc. and Bio/Technology Magazine.

HOUSTON--The University of Texas M.D. Anderson Cancer Center will hold its second medical oncology conference in Spanish on May 22-24, 1996. The educational conference will bring together physicians from Spain and Latin American with the M.D. Anderson faculty, said Richard Pazdur, MD, associate professor of medicine and co-director of the conference along with Alejandro Preti, MD, assistant professor of medicine.

The use of antibodies as immunodelivery systems is still in its infancy, Sydney Welt, MD, said at a symposium on Monoclonal Antibodies and Cancer Therapy, sponsored by the Cancer Research Institute.

Efforts to improve the rate of remission and reduce the risk of relapse in patients with advanced hematologic malignancies are focusing on interleukin-2 (IL-2, aldesleukin, Proleukin), said Alexander Fefer, MD, of the University of Washington Medical School and Fred Hutchinson Cancer Research Center, Seattle.

SEATTLE--All of the government manipulations of the US health-care system will have little impact on the more potent forces--demographic, social, scientific, cultural, moral, and legal--that shape the American way of health and fuel its cost, says former Secretary of Health, Education, and Welfare Joseph A. Califano, Jr.

FORT LAUDERDALE--Attendees at the first annual conference of the National Comprehensive Cancer Network (NCCN) were enthusiastic about the presentation of the Network's preliminary guidelines for eight different cancers, calling the meeting "excellent," "informative," and "the first comprehensive effort at devising guidelines we can all live by."

FORT LAUDERDALE--Evaluations of new treatments using traditional endpoints such as response or survival may not be appropriate in advanced solid tumors that are highly symptomatic but essentially incurable, Howard A. Burris III, MD, said at the National Comprehensive Cancer Network conference.

An experimental approach combining immunotherapy with conventional chemotherapy may succeed in delivering a "one-two punch" to many common tumors of epithelial origin.

Today, the US health-care system is being driven by a desire to contain escalating health-care expenditures. Oncology has not been spared, and the cancer burden on this country is great in terms of monetary costs as well as human morbidity and mortality.

As managed care grows, oncologists will have to decide who to "bond" with, then learn how to develop financially sound contracts with their new partners, Lee E. Mortenson, DPA, said at the 1995 Oncology Symposium of the Association of Community Cancer Centers (ACCC).

WASHINGTON--As managed care health plans continue to proliferate, the need has increased for ways to differentiate and compare plans, and give purchasers and consumers information on which to base decisions about medical coverage.

In the 30 years since the first Surgeon General's report, progress has been made in educating the public about the dangers of tobacco use.

FORT LAUDERDALE, Fla--Rather than increasing the number of medical liability cases, good practice guidelines should actually decrease the number of lawsuits, particularly frivolous ones, Frances H. Miller told attendees at the first annual conference of the NCCN (National Comprehensive Cancer Network). The meeting served as a showcase for the Network's preliminary practice guidelines for eight different cancers.

Radiation Therapy Oncology Group (RTOG) trial 93-05 started slowly, but is now accruing on target, enrolling three patients per month, says Dr. Luis Souhami, chair of the study. To date, 40 patients are enrolled in the study.

BETHESDA, Md--Data on a single slide presented in November, 1994, led quickly to a key change in the hormone arm of the Women's Health Initiative (WHI), sponsored by the National Institutes of Health.

PARIS--Perfusion of an isolated limb with tumor necrosis factor (TNF)- alpha and melphalan (Alkeran) can avoid amputation in more than 80% of patients with nonresectable soft tissue sarcomas of the extremities, Alexander Eggermont, MD, PhD, reported at the Sixth International Congress on Anti-Cancer Treatment (ICACT).

NEW ORLEANS--In presentations at the Society of Gynecologic Oncologists meeting, Canadian researchers confirmed a small increased relative risk for uterine cancer in patients taking tamoxifen (Nolvadex), while investigators from Memorial Sloan-Kettering Cancer Center showed that office endometrial biopsies may be sufficient to protect tamoxifen users by findings abnormalities early.

PALM SPRINGS, Calif--Women often develop idiosyncratic ideas about their risk for breast cancer, Mary Jane Massie, MD, said at the Academy of Psychosomatic Medicine in a session on counseling high-risk women. And the higher the perceived risk, the less likely these women may be to confront their fears and comply with preventive regimens such as breast self-exam (BSE).

Drs. Finlayson and Eisenberg provide a timely, in-depth review of total pelvic exenteration in the palliation of incurable pelvic cancer. The authors conclude that total pelvic exenteration has a role as a palliative treatment for patients with recurrent pelvic cancer-a conclusion that I believe remains unproven.

We strongly agree with the authors that, although there is no compelling evidence to suggest that nonionizing electromagnetic fields represent a public health hazard, there is sufficient evidence of magnetic- and electric field-induced biologic effects to continue scientific investigation of this issue.

Do not resuscitate (DNR) orders have become an integral part of the care of the terminally ill patient. Often, the decision whether or not to resuscitate a patient in the event of cardiopulmonary arrest must be made by the patient's family members. This is a difficult decision that is made at an emotionally trying time. Our study investigated the satisfaction, understanding, and feelings of families who sign DNR orders for their relatives. We are not aware of any other studies that have evaluated this aspect of the DNR order.

The discussion by Freifeld and Pizzo is a comprehensive summary of an important recent trend: the attempt to identify low-risk patients with fever and neutropenia and relax their therapy appropriately. It is not surprising that a summary from these authors would be definitive. Dr. Pizzo and his colleagues have defined many central elements of the therapy of fever and neutropenia: that broad-spectrum antibiotics should be continued after patients become afebrile while they remain neutropenic [1]; that an antifungal agent, amphotericin, should be added to prevent potentially serious fungal superinfection when patients remain febrile and neutropenic after 7 days [2]; and that monotherapy using ceftazidime alone is as effective as combination therapy with a semisynthetic penicillin and an aminoglycoside, particularly for low-risk patients [3]. Their current review catalogs recent attempts to define less aggressive, costly, and restrictive therapy for low-risk patients with fever and neutropenia. I would add only a few comments based on our work at the Dana-Farber Cancer Institute.