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Four steps to improve the profitability of your oncology practiceRunning a successful oncology practice requires you to be one part doctor, one part CEO. After all, your practice demands a skilled combination of high-quality patient care and business acumen. And with countless office procedures and mountains of paperwork involved, your practice also requires that you pay close attention to even the smallest details, which means that you must also serve as an auditor and a chief financial officer. The survival of the practice, like the quality of the care you deliver, rests in the details.
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Isolated Limb Perfusion for Stage III Melanoma: Does It Still Have a Role in the Present Era of Effective Systemic Therapy?Effective systemic therapy for the treatment of stage III melanoma has emerged. Whether this influences treatment choice in stage III melanoma patients with in-transit metastases is the subject of this review.
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The Flu Vaccine in Cancer Patients: Insights From Other Immune-Suppressed PopulationsInfluenza immunization can have four possible outcomes: (1) the vaccine is well tolerated and protects against subsequent infection; (2) the vaccine is not well tolerated-ie, it is associated with an excess risk of morbidity or mortality-but it protects against subsequent infection; (3) the vaccine is well tolerated but confers no protection; and (4) the vaccine is associated with morbidity and/or mortality and confers no protection. The CDC has evaluated the likelihood of each of these scenarios and recommends vaccination of cancer patients. Boehmer and colleagues have reviewed the efficacy data for influenza vaccination in cancer patients and have arrived at a more differentiated view.
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Current Strategies for the Immunotherapy of Multiple MyelomaHere we outline the most promising novel cellular immune strategies for patients with multiple myeloma. In addition, we highlight combinatorial approaches that, it is hoped, will further optimize cellular immunotherapies for myeloma and lead to deep and durable responses and, possibly, even cures.
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Target Folate Receptor Alpha in Ovarian Cancer?Dr. Dmitriy Zamarin speaks with Cancer Network about the findings of a phase II trial in platinum-resistant ovarian cancer patients.
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.
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FGFR Inhibitor Shows Preclinical Activity in Breast CancerThis video highlights preclinical activity of a novel FGFR inhibitor that has been tested alone and in combination with antihormonal therapy in breast cancer cell lines.
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Hormone-Resistant Prostate Cancer: New Therapies NeededHormone-refractory prostate cancer (HRCaP) is both heterogeneous and lethal. Multiple treatment options exist, including secondary hormonal manipulations, chemotherapy, experimental options, and best supportive care. Choosing the appropriate therapy for an individual patient depends on several important clinical factors such as the presence or absence of symptomatic metastatic disease, age and comorbidities, and prostate-specific antigen velocity. While only docetaxel (Taxotere)-based chemotherapy has been proven to improve survival in this setting, a wide range of therapies may be effective for any individual. Palliative maneuvers, such as external-beam radiation, bisphosphonate therapy, radiopharmaceuticals, and pain management are critical for appropriate patient management. Several promising novel therapies are in late-stage testing and will hopefully provide more treatment options for these patients.
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Current Management of Depression in Cancer PatientsIn their paper, Schwartz and colleagues review the risk factors for depression and suicide in patients with cancer and argue convincingly that screening for depression can be simply and quickly performed. They also delineate the efficacy and potential adverse effects of psychotherapeutic or psychopharmacologic treatments for these patients. Buttressing the identification and treatment of depression in the cancer patient are vital, ongoing scientific developments that flow from an increased understanding of interactions among the brain, endocrine system, and immune system. This rapidly evolving body of neurobiological knowledge has catalyzed fundamental changes in how we conceptualize depression in cancer patients and has important ramifications regarding the treatment and prevention of depressive syndromes in this setting.
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PET/CT, 3T MRI perform equally well in lung cancer stagingNo clear winner has emerged in a head-to-head comparison of whole-body FDG-PET/CT and whole-body 3T MRI for non-small-cell lung (NSCLC) cancer staging. Unenhanced PET/CT proved better for detecting metastatic lymph nodes and soft-tissue involvement, while MR was more sensitive to the presence of brain and liver metastases.
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Oncology Peer Review On-The-Go: Improving Experience of LGBTQ+ Patients in Cancer CareThis episode features Don Dizon, MD, discussing how LGBTQ+ patients with cancer navigate the world of cancer care, and the critical steps needed to improve their experiences.
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Commentary (Quek et al): Management of Patients With Muscle-Invasive and Metastatic Bladder CancerDrs. Henry, MacVicar, and Hussainprovide a timely reviewof the current management ofmuscle-invasive and metastaticurothelial cancer. The emerging roleof neoadjuvant chemotherapy and thepromise of novel, less toxic targetedtherapies are of particular interest inthe treatment of a disease in whichoutcomes remain poor for locally advancedand metastatic involvementdespite an aggressive multimodalityapproach.[1] We wish to briefly commenton three issues raised by theauthors: (1) the role of surgery in themanagement of invasive disease,(2) the indiscriminate use of neoadjuvantchemotherapy for clinically localizeddisease, and (3) the currentstatus of bladder-sparing approaches.
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Linezolid-A New Option for Treating Gram-Positive InfectionsThe increase in serious gram-positive infections has increased the need for treatment of gram-positive infections in patients with hematologic malignancies. Common gram-positive pathogens exhibit a variety of resistance
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Pros and Cons of Dietary Strategies Popular Among Cancer PatientsThis article discusses some of the popular diets that cancer patients pursue, and the positive and negative aspects associated with these diets.
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Disseminated Intravascular Coagulation in Patients With Solid TumorsThis review summarizes the published data regarding the association of disseminated intravascular coagulation (DIC) with solid tumors, the laboratory diagnosis of DIC, the clinical presentation and types of tumors typically seen with DIC, and the pathophysiologic mechanisms involved; it also offers suggestions for management of DIC in patients with solid tumors.
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BCG Immunotherapy for Transitional-Cell Carcinoma in Situ of the BladderPrior to the advent of BCG immunotherapy, bladder carcinoma in situ often progressed to muscle invasion. Intravesical chemotherapy completely eradicates the disease in 50% of patients, but fewer than 20% remain disease free after 5 years. Complete responses have been reported in 70% or more of BCG treated patients, nearly two-thirds of which are durable.
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Vaccine Therapy for Patients With MelanomaInvestigation into the therapeutic use of vaccines in patients with metastatic melanoma is critically important because of the lack of effective conventional modalities. The most extensively studied melanoma vaccines in clinical trials are whole-cell preparations or cell lysates that contain multiple antigens capable of stimulating an immune response. Unfortunately, in the majority of studies, immune responses to these vaccines have not translated into a survival advantage. Advances in tumor cell immunology have led to the identification of candidate tumor cell antigens that can stimulate an immune response; this, in turn, has allowed for refinements in vaccine design. However, the exact tumor antigens that should be targeted with a specific vaccine are unknown. The univalent antigen vaccines, which have greater purity, ease of manufacturing, and reproducibility compared with polyvalent vaccines, may suffer from poorer efficacy due to immunoselection and appearance of antigen-negative clones within the tumor. Novel approaches to vaccine design using gene transfection with cytokines and dendritic cells are all promising. However, the induction of immune responses does not necessarily confer a therapeutic benefit. Therefore, these elegant newer strategies need to be studied in carefully designed clinical trials so that outcomes can be compared objectively with standard therapy. If survival is improved with these vaccine approaches, their ease of administration and lack of toxicity will firmly entrench active specific vaccine immunotherapy as a standard modality in the treatment of the melanoma patient.[ONCOLOGY 13(11):1561-1574, 1999].
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Recent Advances in Hormonal Therapy for Advanced Prostate CancerOottamasathien and Crawfordadvance a hypothesis withwhich I heartily agree-androgendeprivation/antagonist (AD/A)strategies should be considered in manymore patients than urologists and oncologiststraditionally teach. However,I think the authors could substantiallysharpen their message. I would like tomake five specific points, and thenoffer a few nitpicking comments.
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Curbing Potential Radiation-Induced Cancer Risks in Oncologic Imaging: Perspectives From the ‘Image Gently’ and ‘Image Wisely’ CampaignsThe purpose of this review is to provide the oncology community with knowledge about the doses used in medical imaging, radiation-induced cancer risks from imaging, and considerations to keep in mind when balancing imaging benefits and risks in pediatric and adult oncologic settings.
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Your Patient With Melanoma: Staging, Prognosis, and TreatmentMelanoma affects persons of all ages, causing more years of lost life than any other cancer except leukemia.[1] The American Cancer Society estimates that about 68,720 new melanomas will be diagnosed in the US in 2009, with more than 8,650 deaths, and an estimated lifetime risk of 1 in 50 for whites, 1 in 200 for Hispanics, and 1 in 1,000 for blacks.[2]
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Use of Saline-Filled Tissue Expanders to Protect the Small Bowel from RadiationThe article by Hoffman, Sigurdson, and Eisenberg updates their experience in the use of temporary saline-filled tissue expanders (TEs) for small bowel exclusion. In their initial prospective study of 34 patients with a median time of patient surveillance after TE placement of 18 months, the authors demonstrated that small bowel was displaced from more than 95% of the radiation therapy treatment volume in 70% of 27 evaluable patients and from more than 75% of the treatment volume in 89% of patients.[1]
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End Results of Salvage Therapy After Failure of Breast-Conservation SurgeryAbout 10% to 15% of patients who undergo breast-conservation surgeryand radiation therapy will subsequently develop ipsilateral breasttumor recurrence (IBTR). This paper reviews the biology, clinical management,and outcome of this entity. Risk factors for IBTR includeyoung age, positive microscopic margins, gross multifocality, an extensiveintraductal component, and lymphatic vessel invasion. The standardtherapy following IBTR has been mastectomy, but interest in furtherbreast-conservation approaches has recently arisen. Although theoutcome following salvage therapy is quite good, the risk of distantmetastases for patients with IBTR is three to five times greater than forthose without recurrence. The reason for this association has been controversial,but it now appears that IBTR is both a marker of the underlyingbiologic aggressiveness of the tumor and a source for furthertumor metastasis. Monitoring of patients following lumpectomy andradiation therapy, and aggressive therapy for IBTR when diagnosed,are clearly warranted. Prognostic factors at the time of IBTR and implicationsfor local and systemic therapy are discussed.
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Liposomal Anthracycline Chemotherapy in the Treatment of AIDS-Related Kaposi’s SarcomaThe treatments employed for Kaposi’s sarcoma in patients with acquired immunodeficiency syndrome (AIDS-KS) have been limited in their usefulness by toxicities and underlying immunodeficiency in this patient population.
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Targeting the Epidermal Growth Factor ReceptorThe epidermal growth factor receptor (EGFR) promotes the growth of different cell types and has been implicated in tumorigenesis. The EGFR comprises a family of four structurally similar tyrosine kinases with a complex link to downstream signaling molecules that ultimately regulate key cell processes. Anti-EGFR agents have been developed as promising therapeutic anticancer targets, and some have been recently approved for the treatment of non-small-cell lung cancer and colon cancer. The two anti-EGFR therapies with the greatest clinical application are monoclonal antibodies that block the binding of ligands to EGFR and small-molecule tyrosine kinase inhibitors that inhibit the binding of adenosine triphosphate to the internal tyrosine kinase receptor of EGFR. We attempt to give an overview of the EGFR function and biology, focusing on the most important clinical findings and applications of EGFR inhibitors in lung and head and neck cancer.
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Quick Reference for Oncology CliniciansAs a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.
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Could Gene Assay Help Guide Stage II Colon Cancer Treatment?In this interview we discuss the GeneFx Colon test (or the ColDx assay), which can helpful identify patients with low- or high-risk stage II colon cancer.
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Allogeneic Marrow TransplantationAllogeneic marrow transplantation is used to reconstitute hematopoiesis in patients who have received myeloablative therapy for a hematologic malignancy or in patients with irreversible marrow failure, to reconstitute the immune system in patients with severe immunodeficiency, and to normalize metabolism in patients with select inherited metabolic deficiency disorders.
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Radiosensitization by GemcitabineGemcitabine is a potent radiosensitizer in both laboratory studies and in the clinic. Initial laboratory studies showed that gemcitabine radiosensitizes a wide variety of rodent and human tumor cells in culture. Maximum
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Commentary (Fuhrmann/Suter): Radiotherapy for Cutaneous Malignant Melanoma: Rationale and IndicationsIn their article on radiotherapy forcutaneous malignant melanoma,Drs. Ballo and Ang discuss fourkey points, which we will addressbelow.
