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Reassessments of ESAs for Cancer Treatment in the US and EuropeAnemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.
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Uncertainty in Medicine: A Talk With Dr. DjulbegovicIn part 2 of this interview, Benjamin Djulbegovic, MD, PhD, discusses the uncertainty principle in clinical trials. Dr. Djulbegovic is associate professor of medicine, Divisions of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa.
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ASCO: Diet and Exercise in Cancer PreventionDr. Loprinzi discusses the role of diet and exercise in cancer prevention.
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New Practical Approaches to Chemotherapy-Induced Neuropathic Pain: Prevention, Assessment, and TreatmentWe review here the recommendations of the American Society of Clinical Oncology, as well as some new and promising approaches to neuropathy, including new neuromodulation techniques.
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Improving Adherence to Endocrine Therapy in Women With HR-Positive Breast CancerHere, we discuss how to improve adherence to endocrine therapy in women with HR-positive breast cancer, as well as the side effects and the reasons for discontinuation.
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Balancing Benefits and Risks of Melanoma Treatment: What Do We Tell Our Patients?All of us treating patients with melanoma must educate our patients about the importance of participating in clinical trials with these new agents so that we can systematically validate the benefits and risks of these agents in prospectively defined patient settings.
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Book Review: Cancer Treatment: 4th EditionThe 1995 Cancer Treatment edited by Dr. Charles Haskell is the fourth edition of his original textbook published in 1980. Cancer Treatment has kept pace with advances in oncology over these 15 years, and the fourth edition includes new
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ALK-Targeted Therapy for Lung Cancer: Ready for Prime TimeLung cancer remains the leading cause of cancer-related death in the United States. Ongoing research into the molecular basis of lung cancer has yielded insight into various critical pathways that are deregulated in lung tumorigenesis, and in particular key driver mutations integral to cancer cell survival and proliferation.
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Book Review: Cancer Therapy in the Twenty-First Century. I. Molecular and Immunologic ApproachesThe first volume of Cancer Therapy in the Twenty-First Century provides background information on some of the molecular and immunologic approaches that are becoming increasingly important in the diagnosis and management of cancer
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Artificial Intelligence in Oncology: Current Applications and Future DirectionsIn this review, we introduce the fundamentals of artificial intelligence and provide an overview of its current applications, pitfalls, and future directions in oncology.
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Moving Beyond 'Best Supportive Care'In their article, Dr. Jamie Von Roenn and Dr. Jennifer Temel demonstrate the value of enhanced symptomatic and palliative care for symptom reduction, improvement in quality of life, and, in some instances, better survival.
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Epidermal Growth Factor Receptor Inhibitors and Colorectal CancerThe epidermal growth factor receptor (EGFR) plays an importantrole in cell growth, differentiation, and survival. Targeting EGFR inpatients with colorectal cancer has become an important therapeutictool. Recently, a monoclonal antibody against the extracellular domainof the receptor (cetuximab [Erbitux]) has been approved for the treatmentof patients with EGFR-positive metastatic disease refractory toirinotecan (Camptosar)-based therapy. The role of other targeted agentsagainst EGFR, including other monoclonal antibodies as well as inhibitorsof the intracellular tyrosine kinase domain, will also be discussed.
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Commentary (Landry et al): Current Perspectives on Anal CancerThe article by Drs. Bendell andRyan reviews the associationbetween anal cancer and humanpapillomavirus (HPV) infectionand discusses current managementstrategies for patients with squamouscell carcinoma of the anal canal. Theauthors should be complimented ona thorough review of the literature,which supports that association andthe use of chemoradiation as the goldstandard for treatment of this groupof patients.
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Understanding Complex Tumor HeterogeneityWhile personalized medicine is seen as a way to target an individual cancer patient’s tumors, using targeted agents, immunotherapy, and chemotoxic drugs, researchers are increasingly finding that not only do the cancers of individuals vary widely, but that tumors within a patient can also be quite different at the molecular level.
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Strategies for Identification and Clinical Evaluation of Promising Chemopreventive AgentsStrategies for chemopreventative drug development are based on the use of well-characterized agents, intermediate biomarkers correlating to cancer incidence, and suitable cohorts for efficacy studies. Since
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An Argument for Aggressive Resection in MelanomaAny minimization of therapy in the name of reducing morbidity requires careful consideration. Reducing morbidity in melanoma is certainly a laudable goal, but locoregional disease control and cure must remain our primary objectives.
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Current Surgical Management of Metastatic Spinal DiseaseAt the outset of their article, Drs. Gerszten and Welch state that their primary goal is to review factors that affect surgical intervention in patients with metastatic spinal disease. On their way to achieving this goal, the authors touch on some of the
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Caring for Cancer Patients in the Future: A Perfect Storm on the Horizon?This timely manuscript by Bunnell and Shulman highlights critical issues that challenge our ability to provide care to cancer patients in the next 20 years. Each of the concerns the authors identify has a momentum of its own. In combination, they have the makings of a perfect health care storm. The time to further address these matters is now.
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Xerostomia as a Complication of Cancer TreatmentCancer is a devastating, life-altering disease. As our technology and knowledge base for the treatment of carcinomas expand, however, more and more patients' lives are being spared or prolonged. Unfortunately, the quality of life for many of these
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Near Misses: Free Lessons for Safer CareYou are a Registered Nurse working in a busy oncology unit. While assessing one of your patients, you notice that the bag of morphine used in his patient-controlled analgesia (PCA) system is running low.
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Unrelated Donor StemCell Transplantation: The Role of the National Marrow Donor ProgramApproximately 70% of patientswith life-threatening diseasestreatable with allogeneic bloodstem cell transplantation do not havematched related donors. The NationalMarrow Donor Program (NMDP) wasestablished in 1986 to provide humanleukocyte antigen (HLA)-matched,volunteer unrelated donors for thesepatients. The NMDP performs thistask by maintaining a registry of morethan 4.9 million volunteer donors ofmarrow and peripheral blood stemcells (PBSC) and 12 cord blood bankscontaining more than 25,000 units ofumbilical cord blood.
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Chau T. Dang, MD, Discusses the APHINITY TrialThe breast cancer expert spoke about the results presented in the trial, noting the benefit seen with longer follow-up.
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Irinotecan in the Management of Patients With Pancreatic CancerSynergy with no overlapping toxicities has been demonstrated for the combination of irinotecan ( Camptosar, CPT-11) and gemcitabine (Gemzar) in vitro. Results of a single-institution phase I study in which patients with
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QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic StatusThe VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate
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Health Literacy, Communication, and Treatment Decision-Making in Older Cancer PatientsThe authors review the current trends in health literacy, patient-physician communication, and the medical treatment decision process, focusing attention on the older cancer patient population.
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Who, When, Where, and How: Salvage Prostate Cancer With RadiotherapyDespite the common use of postoperative radiotherapy (RT) in patients managed initially with radical prostatectomy (RP), a number of questions remain. Raldow and colleagues build their arguments around three randomized trials that indicated a significant benefit of immediate adjuvant radiotherapy in patients with high-risk features.
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Epirubicin, Cisplatin, Oral UFT, and Calcium Folinate in Advanced Gastric CarcinomaUFT (uracil and tegafur in a 4:1 molar ratio) plus calcium folinate treatment has favorable activity and tolerable toxicity in patients with advanced gastric carcinoma. High response rates have been reported in patients with
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Current Perspectives on Pain in AIDSConcern about prescribing controlled substances underlies, in part, the undertreatment of pain, even in palliative care settings. That the same is true for human immunodeficiency virus (HIV) patients is therefore not surprising, particularly given injection drug use as a risk factor.
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Docetaxel in Combination With Flourouracil: Study Design and Preliminary ResultsThe relatively recent introduction of a new class of chemotherapeutic agents--the taxoids--has raised hope of improved survival for patients with advanced or metastatic cancer. Following encouraging preclinical results of taxoid combinations, this phase I, nonrandomized trial was designed to evaluate a 1-hour intravenous infusion of docetaxel (Taxotere) on day 1 combined with fluorouracil (5-FU) as a daily intravenous bolus for 5 consecutive days.
