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BETHESDA, Maryland-The first clinical trial of an HIV-1 vaccine based on multiple genes from three subtypes, or clades, of the virus began November 13, 2002, when researchers at the National Institute of Allergy and Infectious Diseases (NIAID) vaccinated three healthy volunteers. Researchers expect to enroll 50 participants in the 12-month phase I study. The DNA vaccine contains modified material from four genes from clades A, B, and C, which cause about 90% of HIV infections worldwide.

Venous thromboembolic disease is a common but likely underdiagnosedcondition in the cancer patient population. Timely and accuratediagnosis of venous thromboembolism is imperative due to the unacceptablemorbidity and mortality associated with a misdiagnosis.Because diagnosis of the condition based on clinical grounds alone isunreliable, physicians should select an appropriate objective diagnostictest to confirm or refute their clinical impressions. Compressionduplex ultrasound is the best initial imaging test for both suspectedupper- and lower-extremity deep venous thrombosis. Magnetic resonancevenography (MRV) is a valid alternative when ultrasound isinconclusive, but contrast venography remains the “gold standard.”Suspected pulmonary embolism should be initially evaluated by helical(spiral) computed tomography (CT) or ventilation/perfusion lungscintigraphy, the former being preferred in cases of obvious pulmonaryor pleural disease. Indeterminate studies should prompt performanceof contrast pulmonary angiography. Inferior vena cava thrombosis isalso best assessed by contrast venography, with MRV and CT reservedas alternative imaging modalities. Evidence to date suggests thatD-dimer assays remain unreliable in excluding venous thromboembolismin cancer patients. A newer latex agglutination D-dimer assay mayprove to be clinically useful in this setting.

Erectile dysfunction is a common sequela following potentiallycurative local treatment for early-stage carcinoma of the prostategland. With larger studies and longer follow-up, it is clear that erectiledysfunction following prostate brachytherapy is more common thanpreviously reported, with a myriad of previously unrecognized sexualsymptoms. Approximately 50% of patients develop erectile dysfunctionwithin 5 years of implantation. Several factors including preimplantpotency, patient age, the use of supplemental external-beam irradiation,radiation dose to the prostate gland, radiation dose to the bulb ofthe penis, and diabetes mellitus appear to exacerbate brachytherapyrelatederectile dysfunction. The majority of patients with brachytherapy-induced erectile dysfunction respond favorably to sildenafil citrate(Viagra). Despite reports questioning the potency-sparing advantageassociated with brachytherapy, recent elucidations of brachytherapyrelatederectile dysfunction may result in refinement of treatmenttechniques, an increased likelihood of potency preservation, andultimately, improved quality of life.

Drs. Basche and Kelly presentan excellent comprehensivereview of the treatment ofnon–small-cell lung cancer in olderpersons. Articles such as this, whichfocus on the older patient, are of paramountimportance for several reasons.First, cancer is a disease ofaging, with an 11-fold increased incidenceand a 16-fold increase in cancer-related mortality among patientsover age 65 compared to those under65.[1] Second, the population is aging,and in the year 2030, approximately22% will be over 65.[1] Third,data on older cancer patients are limitedsecondary to an underrepresentationof this population in clinicaltrials.[2,3] Based on these facts, acomprehensive review of the availabledata is important, especially toguide future research.

This article by Marcelo Gomes,MD, and Steven Deitcher, MD,is a well conducted, thorough,and scholarly review of the diagnosticmethods for venous thromboembolismin cancer patients. The authorshave specifically looked at upperandlower-extremity deep venousthrombosis (DVT), pulmonary embolism,and rarer conditions includingthrombosis of the inferior venacava (IVC), pelvic veins, and eventhe portal vein. They offer descriptionsof the various tests available,address the pros and cons of thosetests, and provide the reader with algorithmsfor the diagnosis of DVT andpulmonary embolism, including twofor pulmonary embolism-one basedon ventilation/perfusion (V/Q) scanningand one based on helical computedtomography (CT) scanning.

The article by Drs. Merrick,Wallner, and Butler providesan excellent overview of issuespertaining to sexual dysfunctionfollowing prostate brachytherapy.The authors were the first to addressthe historical and current problemswith diagnosing sexual dysfunction.They make a strong case for developinga quality-of-life (QOL) instrumentthat is specific for prostatebrachytherapy.

The importance of cancer as aproblem in the elderly is gainingincreasing appreciationdue, in part, to the demographicchanges taking place in this countryand around the world and their associationto the incidence of cancer.Ongoing epidemiologic research overthe past several decades has consistentlyconfirmed the continuing trendtoward an aging population. In theUnited States, an anticipated 20.1%of the population will be 65 years ofage or older by 2030, the number ofpeople 75 years of age or older willhave tripled, and the 85-or-older agegroup will have doubled.[1]

The majority of individuals diagnosed with lung cancer in theUnited States are 70 years of age and older. Defining appropriatetherapy for older patients with non–small-cell lung cancer (NSCLC) isbecoming a major focus of clinical research. In this article, we reviewthe available data on clinical predictors of risk and benefit for elderlyNSCLC patients receiving treatment via a variety of modalities, includingsurgery, radiotherapy, combined radiotherapy and chemotherapy,and chemotherapy alone. The data demonstrate that subgroups ofelderly patients benefit from appropriately selected treatment. Participationof older patients in clinical trials designed to assess efficacy,toxicity, and quality-of-life outcomes for recently developed treatmentmodalities in this population is critical.

The diagnosis of venous thromboembolismon the basis ofclinical signs and symptoms isnotoriously inaccurate and, therefore,mandates confirmatory diagnostictesting. Unfortunately, all diagnostictests for deep venous thrombosis(DVT) and pulmonary embolismhave clinical or practical limitations.Contrast venography and pulmonaryarteriography are usually regarded asthe reference standards for the diagnosisof DVT and pulmonary embolism,respectively. However, evencontrast venography may be impossibleto perform in 9% to 14% ofpatients, may fail to visualize 10% to30% of venous segments, and maybe associated with postvenographythrombosis in up to 8% of patients.[1]

Over the past decade, prostatebrachytherapy has been usedincreasingly as definitivetreatment for early-stage carcinomaof the prostate gland, with the majorityof the literature on brachytherapyreporting biochemical results as favorableas those in the most positiveradical prostatectomy and externalbeamradiation therapy series.[1-4]Because of a lack of definitive evidencesupporting the efficacy of onelocal treatment approach over another,quality-of-life (QOL) parametershave assumed greater importance. Ithas been widely asserted that preservationof potency is more likely followingbrachytherapy, but longerfollow-up has raised substantialdoubts about brachytherapy’s potency-sparing advantage.[5,6] In addition,brachytherapy results in amyriad of previously unrecognizedeffects on sexual function.[7,8]

The current ONCOLOGY articleby Drs. Merrick, Wallner,and Butler is a valuable additionto the literature. An estimated189,000 American men were diagnosedwith prostate cancer in 2002,and 30,200 died of the disease, makingit the most common cancer amongmen, and the second most commoncause of cancer death.[1] The treatmentshave led to a high rate of cure,but the results of treatment oftencause a reduction in quality of life.

This article nicely describes concernsabout the underdiagnosisof deep vein thrombosis(DVT) and superficial vein thrombosisin patients with malignancy. Theincidence of these conditions in thissetting has been demonstrated to beas high as 51% in postmortem studies,as opposed to the clinically recognized15% rate. The articlereinforces the need for better diagnostictools than are currently availablein clinical practice. It alsostresses the need for a high clinicalsuspicion. Duplex ultrasound shouldbe used as a first step, and othermodalities listed in the article needto be used when appropriate.

High-dose myeloablative therapy with allogeneic hematopoietictransplantation is an effective treatment for hematologic malignancies,but this approach is associated with a high risk of complications.The use of relatively nontoxic, nonmyeloablative, or reduced-intensitypreparative regimens still allows engraftment and the generation ofgraft-vs-malignancy effects, is potentially curative for susceptiblemalignancies, and reduces the risk of treatment-related morbidity.Two general strategies along these lines have emerged, based on theuse of (1) immunosuppressive chemotherapeutic drugs, usually apurine analog in combination with an alkylating agent, and (2) lowdosetotal body irradiation, alone or in combination with fludarabine(Fludara).

Over the next 2 decades, we will see an increasing shortage of nurses if current trends continue, according to a report by the Health Resources and Services Administration. The report points to a worsening shortfall as nurses retire and too few new

WASHINGTON-There is insufficient evidence to prove or disprove whether polio vaccine doses contaminated with simian virus-40 (SV40) between 1955 and 1963 can trigger certain cancers in humans, according to a report by the Institute of Medicine (IOM), a part of the National Academy of Sciences. Although most population studies have not found an increase in the cancers among people inoculated with the vaccine between 1955 and 1963, a possible link cannot be completely ruled out because of substantial statistical and design limitations in the 13 studies, an IOM committee concluded.

WASHINGTON-In motivating women to get timely mammograms, discussions tailored to individuals’ particular reasons for not getting mammograms are far more effective than general recommendations, said Diane Ruth Lauver, PhD, RN, professor of women’s health, University of Wisconsin, Madison. Speaking at the American Psychological Association Conference on Enhancing Outcomes in Women’s Health, she reported on a study of motivational messages given to 797 Midwestern women, age 51 to 80, who had not had a mammogram in the past 13 months.

LUGANO, Switzerland-Thechemotherapy/immunotherapy regimenFCR (fludarabine, cyclophosphamide,rituximab) has produced thehighest complete response (CR) rateseen thus far in first-line treatment ofchronic lymphocytic leukemia (CLL),according to investigator Michael J.Keating, MD. The FCR regimen,which is well tolerated, also results inmolecular remissions in a "significantnumber" of complete responders, saidDr. Keating, professor of medicine,M.D. Anderson Cancer Center.

SEATTLE-Intraoperative colon-oscopy with lesion tattooing and lymphatic mapping during laparoscopic colectomy can improve accuracy in identifying a small primary colorectal neoplastic lesion and its lymphatic drainage, according to a study presented at the President’s Plenary Session of the 67th Annual Scientific Meeting of the American College of Gastroenterology (ACG abstract 4).

ORLANDO-Presentations atthe 43rd Annual Meeting of theAmerican Society of Hematology(ASH) showed increased survival forpatients with aggressive and indolentnon-Hodgkin’s lymphoma(NHL) who received the anti-CD20monoclonal antibody rituximab(Rituxan) in addition to standardCHOP chemotherapy (cyclophosphamide,doxorubicin, vincristine,prednisone).

NEW ORLEANS-In stage III and low-volume stage IV laryngeal cancer, concurrent chemotherapy and radiotherapy was superior to two other approaches in controlling tumor and preserving the larynx, according to a three-arm Intergroup trial presented at the 44th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (abstract plenary 4). Moshe H. Maor, MD, of the Radiation Oncology Department, M.D. Anderson Cancer Center, presented the results.

O R L A N D O - A d d i n grituximab (Rituxan) to paclitaxel(Taxol)/topotecan (Hycamtin) salvagetherapy raises response rates byabout 25%, more than triples completeresponse rates, and is effectivein both primary refractory and relapsedaggressive B-cell lymphomas.

LUGANO, Switzerland-For low-grade lymphomas, fludarabine (Fludara)-based combination therapy may have greater efficacy than single-agent flu-darabine, especially when a monoclonal antibody is part of the combination, a series of recent European investigations suggest. The investigations, presented at the Eighth International Conference on Malignant Lymphoma (ICML), show that various combination therapies hold promise, although a lack of coordination among non-US study groups has hampered progress somewhat.

BOSTON-Most advanced cancer patients suffer from pain that could be relieved with broader use of opioid analgesics, according to Eduardo Bruera, MD, F.T. McGraw Chair in the Treatment of Cancer, M.D. Anderson Cancer Center.

WASHINGTON-A 2-year, $1 million study by the Institute of Medicine (IOM) will explore the scientific and policy implications of complementary and alternative medicine (CAM). The study is being funded by 16 units of the National Institutes of Health, including the National Cancer Institute, and the Agency for Healthcare Research and Quality. The IOM, a part of the National Academy of Sciences, will name a committee of about 16 experts to carry out the study. Panel members will be chosen from among leading CAM specialists and more conventional disciplines.

MIAMI BEACH -The Bcr-Abl tyrosine kinase inhibitorPD173955 (PD17) binds to the targetATP binding pocket even moreefficiently than STI-571 (imatinibmesylate, Gleevec). It shows 15 to20 times greater efficacy in chronicmyelogenous leukemia (CML) celllines because it can bind to eitheropen or closed activation loops.

BETHESDA, Maryland-A national survey, now in progress, will enable the National Cancer Institute (NCI) for the first time to examine the interrelationship of people’s knowledge about cancer, their sources of cancer information, and their cancer-related behavior. The Health Information National Trends Survey (HINTS), a telephone survey of 8,000 randomly selected, representative US adults, began in late October. Data collection is expected to take 5 months.

ROCKVILLE, Maryland-A quick HIV-1 diagnostic test with high specificity and sensitivity has received conditional approval by the US Food and Drug Administration (FDA) for use in detecting antibodies to the most common form of the virus found in the United States.

BOSTON-Darbepoetin alfa (Ara-nesp), the new long-lasting erythropoietic agent, is safe and effective for treatment of chemotherapy-induced anemia in older patients, Lodovico Balducci, MD, of the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, told ONI at the third meeting of the International Society of Geriatric Oncology (SIOG abstract P-12).

WASHINGTON-Young women who are depressed, think of themselves as being at low risk for breast cancer, or have relatively painless mammograms are likely to skip diagnostic follow-up, according to Alexis Bakos, PhD, MSN, RN,C. In a podium presentation at the Oncology Nursing Society’s 27th Annual Congress (abstract 10), Dr. Bakos said that 25% to 60% of women do not return for follow-up and that the goal of her study was to determine who does not return, and why.

BUFFALO, New York-Medianprogression-free survival hasstill not been reached after 6 yearsmedian follow-up of 40 patientswith low-grade or follicular non-Hodgkin’s lymphoma (NHL) treatedin the first clinical trial ofrituximab (Rituxan) in combinationwith CHOP (cyclophosphamide[Cytoxan, Neosar], doxorubicinHCl, vincristine [Oncovin],and prednisone), Myron S.Czuczman, MD, reported.