ONCOLOGY Table Of Contents

The striking activity of thalidomide (Thalomid) as a single agent in refractory multiple myeloma has been confirmed in 169 patients with ³ 25% paraprotein reduction (PPR) in 36%, PPR ³ 50% in 28%, PPR ³ 75% in 20%, and complete/near

Therapy of hepatocellular carcinoma in cirrhotic patients is challenging. Liver dysfunction, portal hypertension, third spacing, thrombocytopenia, and neutropenia limit the choice of chemotherapeutic agents. However, the abundant vascularity of hepatocellular carcinoma presents an attractive target for antiangiogenic therapy, potentially tolerable even in cirrhotics.

Although the causes and natural histories of breast and cervical cancer are different, the public health responses to these diseases have been similar. Early detection of breast cancer and primary prevention of cervical cancer are possible through community-based screening programs; however, early detection of both breast and cervical cancer is less common among low-income women (defined as up to 250% of poverty level, depending on family size). This report presents morbidity and mortality data regarding breast and cervical cancer, screening recommendations, an update on the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and recommended priority activities for the NBCCEDP. The NBCCEDP is a major public health effort to increase breast and cervical cancer screening among uninsured, low-income women.

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

A comprehensive textbook on clinical oncology should have broad appeal to readers from various disciplines, including educators, clinicians, and scientists working with cancer patients. Students of the medical disciplines must also have a reference textbook to guide them in their educational exploration, whether they are in the field of medicine itself or in complementary areas. We look to comprehensive textbooks not only to provide us with the latest updates in different disease entities, but also to guide us by choosing the most relevant areas of study and investigation. The editors who compiled this textbook have met these challenges, while maintaining a readability that is suitable for various levels of expertise and comprehension

High-dose chemotherapy with hematopoietic support improves the response rate for patients with metastatic breast cancer. There are many long-term disease-free survivors following high-dose chemotherapy and autologous peripheral blood

Researchers who conducted a large, randomized clinical trial across Europe, Great Britain, and Canada found that in order to improve safety and reduce toxicity, advanced bladder cancer patients can be treated with a combination of gemcitabine (Gemzar) and cisplatin (Platinol). This combination (known as GC) did not extend survival, but it was much less toxic than the currently used combination, MVAC (methotrexate, vinblastine, doxorubicin [Adriamycin], and cisplatin).

Approximately 10% to 15% of patients with stage I/II invasive breast cancer will develop a clinically isolated local recurrence. The standard management of an ipsilateral breast tumor recurrence following breast-

This article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house

Thalidomide (Thalomid) has been demonstrated to be an antiangiogenic agent with some activity in glioblastoma multiforme. This ongoing study currently has 37 enrolled patients. Patients were started on a dose of 100 mg/d of thalidomide. This was increased by 100 mg/d, weekly, to a maximum dose of 500 mg/d, if tolerated. The mean age was 52 years (range: 27–69 years). The male/female ratio was 19/18. The mean dose tolerated was 300 mg, with a range of 200 to 500 mg/d.

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

In the phase II study of thalidomide (Thalomid) in the treatment of recurrent glioblastoma multiforme, Marx et al (abstract #613) concluded that there was no correlation with vascular endothelial growth factor (VEGF) levels and response or

At the 10th annual conference of the American Institute for Cancer Research (AICR), Dr. Leena Hilakivi-Clarke, of the Lombardi Cancer Center at Georgetown University, outlined the increasing evidence that fetal and childhood diets may have a greater impact on lifetime breast cancer risk than diets during adulthood. Dr. Hilakivi-Clarke described her own work and summarized ongoing worldwide research efforts.

This article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house

Approximately 10% to 15% of patients with stage I/II invasive breast cancer will develop a clinically isolated local recurrence. The standard management of an ipsilateral breast tumor recurrence following breast-

This article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house

The cachexia of malignancy is considered mediated through excess production of tumor necrosis factor–alpha and other cytokines. Thalidomide (Thalomid), a sedative/hypnotic, has been shown to inhibit tumor necrosis factor–alpha production.

A 67-year-old female developed metastatic angiosarcoma involving the scalp, left neck, and pulmonary nodules. Disease progression occurred while she received two cycles of doxorubicin/ifosfamide (Ifex)/mesna (Mesnex), complicated by sepsis

The majority of women with ovarian cancer present with advanced-stage disease. Women with early-stage ovarian cancer have a much better chance of achieving a cure than do women with late-stage disease. This

Approximately 10% to 15% of patients with stage I/II invasive breast cancer will develop a clinically isolated local recurrence. The standard management of an ipsilateral breast tumor recurrence following breast-

Weekly dosing of the chemotherapy agent docetaxel (Taxotere) is active and well tolerated in elderly patients with advanced non–small-cell lung cancer (NSCLC), according to the results of a phase II study published in a recent issue of Cancer (89[2]:328-333, 2000).

This year, approximately 40% of the 28,300 patients diagnosed with pancreatic carcinoma in the United States will present with locally advanced disease. Radiotherapeutic approaches are often employed, as these patients

Interest in thalidomide (Thalomid) has intensified in recent years as research has identified and elucidated its immunomodulatory, anti-inflammatory, and antiangiogenic properties. In this supplement, we present a selection of abstracts

Myelodysplastic syndrome patients present with variable cytopenias even though their bone marrows are generally hypercellular. Excessive cytokine-induced apoptosis of hematopoietic cells in the marrows has been proposed as a possible

The aim of this pilot study was to assess the safety of the angiogenesis inhibitor thalidomide (Thalomid) given in combination with standard chemotherapy to patients with advanced non–small-cell lung cancer. Patients with unresectable stage IIIA, IIIB,

In 1997 and 1998, the Division of Oncology Drug Products at the U.S. Food and Drug Administration approved 575 single-patient investigational new drug applications for the use of thalidomide (Thalomid) for advanced malignancies. We subsequently surveyed 544 practitioners with a questionnaire, and received responses from 359 (response rate: 66%) with data on 480 patients.

The majority of women with ovarian cancer present with advanced-stage disease. Women with early-stage ovarian cancer have a much better chance of achieving a cure than do women with late-stage disease. This

Thalidomide (Thalomid) is a potent teratogen and sedative that inhibits angiogenesis. Based on the activity of this agent in patients with multiple myeloma, we initiated a phase II study in Waldenstrom’s macroglobulinemia.

Thalidomide (Thalomid) has antiangiogenic and immunomodulatory properties with activity in myeloma and other tumors. We treated 15 patients with advanced progressive metastatic renal-cell cancer with escalating divided daily doses of thalidomide

High-dose chemotherapy with methotrexate offers up to a fivefold increase in survival to patients with primary central nervous system lymphoma. Researchers at Memorial Sloan-Kettering Cancer Center found that using significantly more methotrexate, while adding drugs that penetrate the blood-brain barrier, improved disease control and survival in patients with newly diagnosed cancer.

Temozolomide, an oral alkylating agent, has shown activity against metastatic melanoma. The drug is schedule dependent and is given daily for 5 days. Altering the schedule may enhance its activity by depletion of the protein O6-alkylguanine-DNA

The Clinton administration memorandum on coverage of Medicare patient costs in clinical trials, which drew concern from ASCO when the White House published its incipient statement last June, has apparently morphed into a “final national coverage decision”—announced in late September—that most groups are quite happy with. Ellen Stovall, president and CEO of the National Coalition for Cancer Survivorship, says her group is very happy with the coverage document published by HCFA. She does note, however, that there is a need to monitor the new rules HCFA will be developing for coverage of a subgroup of trials—so-called IND-exempt trials run by cancer centers and pharmaceutical companies—that are testing existing drugs for new uses. Some of these trials are extremely legitimate. Some are not. No one in the cancer community wants to see Medicare pay for clinical trials involving the use of tea leaves to cure colon cancer. However, in writing rules meant to exclude Medicare coverage of those kinds of questionable trials, Stovall indicates that it will be important to ensure that those rules, based on imprecise wording, don’t exclude Medicare coverage for legitimate trials.” We will be concerned with how the language develops,” she explained. One other area of possible concern is Medicare’s intention to pay only for trials that have a “therapeutic” objective. That would rule out some phase I trials designed to test the toxicity of a new medication.

Seventeen patients with myeloma (13) or Waldenstrom’s macroglobulinemia (4) have been treated at our center with a nonmyelosuppressive combination of oral clarithromycin (Biaxin) at 500 mg twice daily, low-dose oral thalidomide

Research suggests that a drug used to relieve nausea in cancer patients can help the most difficult-to-treat alcoholics significantly reduce their drinking. Success with the drug ondansetron (Zofran) comes amid growing search for new medications to help treat a disease that affects some 14 million Americans.

Patients with recurrent squamous cell carcinoma of the head and neck have a poor prognosis. Thalidomide (Thalomid) has antitumor and antiangiogenic properties. We conducted a phase II trial to determine toxicity, response rate, and survival in

The majority of women with ovarian cancer present with advanced-stage disease. Women with early-stage ovarian cancer have a much better chance of achieving a cure than do women with late-stage disease. This

The Health Care Financing Administration (HCFA) sent a letter to Medicare insurance carriers in September telling them not to cut reimbursement to oncologists for 14 oncology drugs that are administered in the oncologist’s office. This was a reversal of what HCFA said it planned to do, based on pricing data developed by the US Justice Department. Those data showed that drug manufacturers were reporting “average wholesale prices” (AWPs) to Medicare for those 14 drugs that were much higher than the actual AWPs. Medicare reimburses the oncologist for 95% of the AWP. The Justice Department alleges that the drug companies report a very high AWP and then actually sell the drug to the oncologist for a considerably lower price, allowing the oncologist to make a tidy profit after Medicare reimburses at the higher price. The American Society of Clinical Oncology (ASCO) argued that Medicare woefully under-reimburses oncologists for chemotherapy administration, and, therefore, any additional revenue the doctors can generate via AWP reimbursements is warranted. ASCO took that argument to Capitol Hill, and legislators brought pressure to bear on HCFA administrator Nancy-Ann Min DeParle. “We would like to acknowledge HCFA’s willingness to work with the cancer community on this important issue,” said Lawrence H. Einhorn, MD, president of ASCO. Of equal importance is DeParle’s commitment to increase practice expenses for the CPT codes for chemotherapy administration. That will be done in the summer of 2001, when HCFA publishes a proposed Medicare fee schedule for calendar year 2002.

These four studies further establish the remarkable antitumor activity of thalidomide (Thalomid) in a variety of hematologic disorders. This drug was initially used as a nonbarbiturate sedative/hypnotic and antiemetic during pregnancy in the 1950s.

The majority of women with ovarian cancer present with advanced-stage disease. Women with early-stage ovarian cancer have a much better chance of achieving a cure than do women with late-stage disease. This