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Next gen EGFR targeting drug promising in NSCLCFinding an effective treatment for all the complex iterations of cancer is akin to chasing an outlaw through a treacherous mountain range, in the estimation of Louis M. Weiner, MD, director of the Georgetown Lombardi Comprehensive Cancer Center in Washington, DC.
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Pregnancy After Breast Cancer: From Psychosocial Issues Through ConceptionWomen face numerous issues if they either contemplate childbearing or become pregnant after the diagnosis of breast cancer. Based on a search of the English medical literature from 1966 to 1997, we make the following
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Current Paradigms in First-Line Treatment of Non–Small-Cell Lung CancerStandard first-line chemotherapy for the majority of patients withadvanced non–small-cell lung cancer (NSCLC) consists of platinumbasedcombination regimens including one of the newer-generationagents, such as gemcitabine (Gemzar), a taxane, vinorelbine(Navelbine), or irinotecan (Camptosar). Several effective regimens areavailable, the choice of which will depend on treatment goals, individualpatient or disease factors, as well as physician preferences. Thispaper surveys randomized trials of many of the newer-generation chemotherapycombinations in patients with advanced NSCLC to examineseveral issues, such as which new-generation regimen to use, whethera platinum agent is needed, the optimal number of drugs in the combination,and treatment duration.
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Prostate Cancer in a Man With Multiple Previous Cancerspatient is a 67-year-old male with mild obstructive symptoms and an American Urology Association symptom score of 8.[1] He was noted to have a prostate-specific antigen (PSA) level of 3.2 ng/mL. Because this represented a significant increase in his PSA velocity (rate of change over time), he proceeded to have a biopsy, which was positive for prostate cancer. He has no other complaints and visits us for an opinion on the treatment of his prostate cancer.
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Anthracycline vs Nonanthracycline Adjuvant Therapy for Breast CancerThe treatment of breast cancer has progressed substantially overthe past 15 years. Data from randomized adjuvant trials have shownthat the risk of disease recurrence and death is significantly reducedwhen adjuvant chemotherapy and/or hormonal therapy is added to treatment.As new strategies are incorporated, one of the continued controversiesin patient management is whether adjuvant anthracyclinesshould be the preferred treatment for all patients. Data from randomizedand translational clinical trials have become available and arehelping to elucidate the proper role of anthracyclines, as well as their acuteand long-term toxicities. In most situations, an anthracycline is currentlypreferred, but other single and combination chemotherapies arecurrently under evaluation and appear promising for use in the adjuvantsetting. Continued breast cancer research using molecular markers(such as topoisomerase II–alpha and gene clusters) as predictors oftreatment response, could help individualize decisions regardingwhether to incorporate anthracyclines into adjuvant therapy regimens.
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Diffusion-weighted MRI looks to add new biomarker for oncologic imagingThe technique provides a new and continuously evolving tool in oncologic imaging for lesion detection, characterization, and therapy assessment.
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Gemcitabine and Cisplatin Combination in Early-Stage Non-Small-Cell Lung CancerA number of randomized clinical trials now support the conclusion that the combined-modality regimen that includes gemcitabine (Gemzar) and cisplatin (Platinol) may improve survival in disseminated non-small-cell lung
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Gemcitabine/Epirubicin/Paclitaxel Trials in Advanced Breast CancerNumerous trials have shown that the pharmacokinetic interferences of epirubicin (Ellence)/paclitaxel (Taxol) combinations produce less pharmacodynamic effect than doxorubicin/paclitaxel regimens. Paclitaxel is more easily
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The Management of Nongastric MALT LymphomasNo definite guidelines exist for the management of nongastric MALT lymphoma. Retrospective series have included patients treated with different modalities, and excellent cause-specific and overall survival have been demonstrated, independent of the type of treatment adopted.
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Pemetrexed in Gastric CancerGastric cancer is a major clinical challenge, with poor overall prognosisand limited life expectancy for patients with advanced disease.Even with surgery and other modalities, palliation is often difficult.Improvement of response rates has evolved with the development ofstandard regimens and those incorporating newer chemotherapy agents,such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums(eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed[Alimta]). Ongoing trials with these regimens aim toward improvingsurvival, as well as improving the safety profile. It is hoped that in conjunctionwith molecular research in the pathogenesis of gastric cancerand development of targeted therapies in this disease, these trial datamight lead to the evolution of treatment strategies that could prove effective.
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Current Perspectives on Preoperative Integrated Treatments for Locally Advanced Rectal Cancer: A Review of Agreement and ControversiesThe preferred integrated treatment modality for locally advanced rectal cancer is preoperative radio(chemo)therapy followed by total mesorectal excision, though certain aspects of this standard are still debated.
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Node-Positive Prostate Cancer: A Call for Level 1 EvidenceDespite the lack of level 1 evidence, retrospective studies support the need for appropriate local treatment, even in the context of node-positive disease.
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POINT: Is Lymphadenectomy Required in Endometrial Cancer for Adequate Surgical Staging?The diagnostic benefits of SLN evaluation include an ability to identify the extent of tumor dissemination and the utility of SLN mapping in guiding targeted adjuvant treatment in high-risk patients.
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The Importance of Accurately Characterizing Lymphoproliferative DiseaseThe primary cutaneous CD30-positive (CD30+) T-cell lymphoproliferative disorders are a group of largely indolent diseases that manifest as nodules or tumors of the skin. The European Organisation for Research and Treatment of Cancer (EORTC) has developed a modification of the World Health Organization (WHO) lymphoma classification system that specifically categorizes these entities.
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Response of the Normal Eye to High Dose RadiotherapyRadiation therapy of tumors near the eye or optic nerves often requires incidental irradiation of these structures, even when they are not clinically involved by tumor. Depending on the radiation treatment volume and dose required, radiation injury to the lens, lacrimal apparatus, retina, or optic nerve may result. The time to expression and severity of injury are dose-dependent. This paper reviews the results of 157 patients who were followed for a minimum of 3 years after radiotherapy for primary extracranial tumors at the University of Florida, in which the lacrimal gland, lens, retina, and/or optic nerve(s) received irradiation. This review shows that, after treatment at approximately 1.8 to 2.0 Gy per fraction, the incidence of severe dry-eye syndrome, retinopathy, and optic neuropathy appears to increase steeply after doses of 40, 50, and 60 Gy, respectively. [ONCOLOGY 10(6):837-852, 1996]
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Is Personalized Medicine Here?This review describes the achievements in therapeutic and molecular diagnostics, details evolving molecular platforms, and highlights the challenges for the translation of these developments to daily clinical practice.
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Future Prospects for Stealth Liposomes in Cancer TherapyWhile doxorubicin (Adriamycin) is among the most active single agents in the treatment of breast cancer and other solid tumors, its concomitant toxicity limits its use. Quality-of-life issues have driven the search for gentler,
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A Review of POEMS SyndromePOEMS syndrome is a rare paraneoplastic syndrome that is caused by an underlying plasma cell disorder. Its main features include polyradiculoneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes.
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Addressing Fertility Concerns in Women Diagnosed With Breast Cancer: Will Serial Reserve Screening Help?Counseling a woman with breast cancer regarding fertility ideally attempts to align two goals-one for the patient and her disease, and one for the chance of a future child. Early collaboration with a reproductive specialist should enhance discussion of the most practically available fertility-promoting options.
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UFT/Methotrexate/Leucovorin for Breast Cancer Patients in Progression After HDCT/PBPC SupportTwenty-four patients with metastatic breast cancer that had progressed after high-dose chemotherapy with peripheral blood progenitor cell (PBPC) support were given intramuscular methotrexate in combination with oral
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Tumor Heterogeneity: The Lernaean Hydra of Oncology?Intratumor heterogeneity is one of the biggest challenges in cancer diagnosis and treatment. Despite morphologic and clinical recognition of tumor heterogeneity, an understanding of it at a molecular level has only begun to emerge in recent years.
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Post-Prostatectomy Radiation Therapy: Patient Selection, Timing, Imaging, and Therapy IntensificationA 62-year-old man with prostate adenocarcinoma elected to proceed with radical prostatectomy as definitive management. After his pathology report showed stage IIIB disease, he elected for observation. What happened next?
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Commentary (Esteva/Pusztai)-Optimizing Outcomes in HER2-Positive Breast Cancer: The Molecular RationaleThe selective activity and demonstratedsafety of targetedtherapies has generated newhope for improving the treatment ofpatients with cancer.
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Therapeutic Options in Relapsed or Refractory Diffuse Large B-cell Lymphoma: Part 2The addition of rituximab (Rituxan) to systemic chemotherapy has improved the response rates, progression-free survival, and overall survival of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) compared to chemotherapy alone. In the front-line setting, the use of rituximab is changing the biology and clinical behavior in DLBCL patients who fail to respond or relapse following chemoimmunotherapy.
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A Patient With Newly Diagnosed Metastatic Type 2 Papillary Renal Cell CarcinomaA 42-year-old man presented with increasing right hip pain that limited his ability to walk. Magnetic resonance imaging (MRI) revealed a right lytic acetabular lesion. Further work-up included a computed tomography (CT) scan, which revealed an 8-cm left kidney tumor.
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UFT/Oral Calcium Folinate Plus Radiation in Pancreatic CancerA phase I, single-center, open-label, dose-escalation study (University of Alabama [UAB] 9614) has been undertaken to evaluate the feasibility and safety of uracil and tegafur (in a molar ratio of 4:1 [UFT]) plus oral
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Textbook of Medical Oncology, 2nd EditionIn this day of encyclopedic oncology texts, frequently updated online reference sites, and literature searches at the click of a button, is there a place for a basic medical oncology textbook? The second edition of the Textbook of Medical Oncology, edited by Drs. Cavalli, Hansen, and Kaye, is approximately 50% longer than the first edition, due in large part to the inclusion of newer therapeutic approaches.
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Pemetrexed in Gastric CancerGastric cancer is a major clinical challenge, with poor overall prognosisand limited life expectancy for patients with advanced disease.Even with surgery and other modalities, palliation is often difficult.Improvement of response rates has evolved with the development ofstandard regimens and those incorporating newer chemotherapy agents,such as oral fluoropyrimidines, the taxanes, camptothecins, novel platinums(eg, oxaliplatin [Eloxatin]), and antifolates (eg, pemetrexed[Alimta]). Ongoing trials with these regimens aim toward improvingsurvival, as well as improving the safety profile. It is hoped that in conjunctionwith molecular research in the pathogenesis of gastric cancerand development of targeted therapies in this disease, these trial datamight lead to the evolution of treatment strategies that could prove effective.
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Current Management of MeningiomasAlthough generally benign tumors, meningiomas can cause serious neurological injury and, at times, vexatious management difficulties. Currently, the accepted management of these tumors is attempted total surgical excision when technically possible and associated with an acceptable risk. However, even with innovations in instrumentation and refinements in surgical technique, the goal of total resection may not be achievable. For these patients, and for those with recurrent tumors, options for treatment include reoperation, radiation therapy, and chemotherapy. Recent developments in surgical technique and instrumentation, radiosurgery, and brachytherapy have increased the treatment options, while clinical trials with tamoxifen and mifepristone (RU486) are adding information on the effectiveness of these drugs as chemotherapeutic agents. While the search continues for a uniformly successful management plan, physicians must be aware of the available options and try to help the patient decide which treatment is appropriate, based on current medical knowledge. [ONCOLOGY 9(1):83-100]
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Commentary (Demonte): Extended Transbasal Approach to Skull Base TumorsDrs. Chandler and Silva do agood job describing the bifrontalbiorbital sphenoethmoidalapproach to the skull base.This approach allows full access tothe anterior skull base, the paranasalsinuses between the medial thirds ofthe maxillary sinuses, and the entireclivus medial to the carotid arteriesand the hypoglossal nerves and belowthe pituitary gland. It should berecognized that the full extent of theapproach is not always necessary, anda good degree of tailoring is possible.Specifically, I have not found it necessaryto perform orbital osteotomiesfor access to the paranasal sinuses orfor cribriform plate resection. A smallmidline frontal craniotomy with aninferior extension to the level of thefrontonasal suture is usually sufficient.
