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Clinical Hypnosis for the Palliative Care of Cancer PatientsClinical hypnosis has been defined as a mind-body therapy that involves a deeply relaxed state, individualized mental imagery, and therapeutic suggestion.
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Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast CancerA phase II trial evaluated the effectiveness and toxicity of combination paclitaxel (Taxol), gemcitabine (Gemzar), and trastuzumab (Herceptin) as first-line therapy for patients with newly diagnosed HER2-overexpressing
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Neoadjuvant Androgen Deprivation Before Prostatectomy in T1-T3 PatientsAndrogen deprivation has been used prior to radical prostatectomy in an attempt to improve local control of prostate cancer and delay time to cancer progression. Thirty men (mean age of 65) with clinical stage T3 adenocarcinoma of the prostate were entered into a phase II trial at the University of California, San Francisco, examining the effects of neoadjuvant androgen deprivation (luteinizing hormone-releasing agonist and an antiandrogen) before radical prostatectomy. Twenty-six of these patients subsequently underwent radical prostatectomy. Despite impressive physiological changes in prostate and tumor volume, stage reduction was noted in only 4 patients (15%). Overall, with a mean follow-up of 32.7 months, 72% of patients had evidence of disease recurrence, including detectable PSA. Several series suggest that in patients with stage T1 and T2 disease, the likelihood of a positive surgical margin after radical prostatectomy is decreased substantially by neoadjuvant deprivation. The effect on long-term disease-free survival, however, is still unknown. [Oncol News Int 6(Suppl 3):16-17, 1997
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The Road to Romiplostim Approval and BeyondRomiplostim (Nplate) was the first thrombopoietin (TPO) receptor agonist to receive regulatory approval by the US Food and Drug Administration (FDA) for treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
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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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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
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Management of Early-Stage Lung Cancer: Past, Present, and Future Adjuvant TrialsThe standard of care with regard to adjuvant chemotherapy of lung cancer has changed remarkably over the past 3 years. Until the initial report of the International Adjuvant Lung Trial in 2003, there was no real evidence from any individual randomized clinical trial (RCT) that adjuvant chemotherapy improves survival in resectable non-small-cell lung cancer. However, five RCTs that have now been reported indicate that adjuvant chemotherapy is effective, at least in certain subgroups of resectable patients. Moreover, numerous meta-analyses have also reported a positive effect from adjuvant treatment. Nonetheless, because of methodologic issues and conflicting results, the question of who should be treated and what constitutes optimal adjuvant therapy remains controversial. This article reviews the recent randomized trials that have contributed to a change in the state of the art, as well as some of the methodologic problems that may have confounded their proper interpretation. It also considers newer approaches to adjuvant therapy, with a particular focus on strategies that incorporate our growing knowledge of molecular medicine and predictive factors to the field of adjuvant chemotherapy of lung cancer.
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Adjuvant vs Neoadjuvant Chemotherapy in Resectable NSCLC: Is That the Real Question?Besse and Le Chevalier provide us with an excellent and comprehensive review of available literature summarizing the current state of the art relating to both adjuvant and neoadjuvant (or induction) chemotherapy in resectable non–small-cell lung cancer (NSCLC).[1] They review the efficacy of adjuvant and neoadjuvant treatment in randomized clinical trials (RCTs) that employ cisplatin-based chemotherapy in stages I, II, and IIIA NSCLC, as well as meta-analyses of these RCTs.
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Management of Patients With Muscle-Invasive and Metastatic Bladder CancerBladder cancer is the fifth most common cancer diagnosed in theUnited States. Prognosis for this disease is dependent on both tumorstage and grade. Radical cystectomy has been the standard treatmentfor muscle-invasive local disease; however, combined-modality approacheswith the use of chemotherapy are gaining momentum withdata suggesting survival improvement. Patients with metastatic diseasehave poor long-term survival rates despite systemic multiagent chemotherapy.A variety of agents, including newer cytotoxic drugs and biologicallytargeted agents, are under investigation to determine the mosteffective regimen. The special needs of specific patient populations,such as the elderly, those with a suboptimal performance status, andpatients with medical comorbidities have gained more attention.Progress in the treatment of this disease is dependent on supportingongoing and future clinical trials.
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Role of Positron-Emission Tomography Scan in the Diagnosis and Management of Breast CancerIn 2008, more than 184,000 new patients were diagnosed with breast cancer, the most commonly diagnosed malignancy in women in the United States. Despite great advances over the past few years in screening, detection, and treatment, more than 40,000 women died from the disease in 2008.[1] Early breast cancer is considered a curable disease, but the curative potential of patients with locally advanced or metastatic disease is limited.
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Hodgkin's DiseaseAlthough there have been many advances in the treatment of Hodgkin's disease, diagnosis of the disease still rests on the identification of the Reed-Sternberg cell. This distinctive, though nonspecific, cell was first described by Sternberg in 1898 and further elucidated by Reed in 1902. In most biopsies, the Reed-Sternberg cell accounts for only 1% of the cells present, with the remainder consisting of lymphocytes, granulocytes, histiocytes, plasma cells, and fibroblasts
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Commentary(McDermott/Hudes)-Testicular Cancer: Maintaining the High Cure RateDr. Raghavan is to be commendedfor a concise andcomprehensive overview ofthe management of germ cell tumors.As he suggests, given the demographicsof this relatively uncommon diseaseand the high cure rate that canbe achieved with proper treatmentand follow-up, it behooves us to maintainthese excellent results, even whilestriving to reduce the toxicity of treatment.We will highlight a few additionalpoints to complement thissuperb review.
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GingerGinger, the rhizome of Zingiber officinale Roscoe, is best known for its role as a flavoring agent for food in Asian and Indian recipes.
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Beyond Futility: Good Shared End-of-Life Decision-Making Takes Ongoing Discussions, Realistic GoalsDecision-making at the end of life is difficult, and it should be. Rather than face these time consuming and emotionally demanding discussions, doctors too often look to unsuitable conceptual models.
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Long-Term Effects of Chemo on the Cognitive Function of Cancer PatientsIn this podcast we discuss the long-term effects of chemotherapy on the cognitive function of cancer patients and the current status of research in this field.
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Chemoradiation for Locally Advanced, Unresectable NSCLCThe optimal therapy for locally advanced, unresectable, stage III non–small-cell lung cancer (NSCLC) continues to evolve. The critical determinants of overall survival include local tumor control and the
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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate CancerThe purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.
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Canadians Wait Longer for Radiotherapy Than US PatientsSAN FRANCISCO--Delays for radiation treatment are longer in Ontario than in the United States, Canadian researchers reported in a poster presentation at the annual meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO).
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Need for Mature Evidence to Validate HIFUThe use of high-intensity focused ultrasound (HIFU) as a method for ablation of a localized tumor growth is not new. Several attempts have been made to apply the principles of HIFU to the treatment of pelvic, brain, and gastrointestinal tumors. However, only in the past decade has our understanding of the basic principles of HIFU allowed us to further exploit its application as a radical and truly noninvasive, intent-to-treat, ablative method for treating organ-confined prostate cancer. Prostate cancer remains an elusive disease, with many questions surrounding its natural history and the selection of appropriate patients for treatment yet to be answered. HIFU may play a crucial role in our search for an efficacious and safe primary treatment for localized prostate cancer. Its noninvasive and unlimited repeatability potential is appealing and unique; however, long-term results from controlled studies are needed before we embrace this new technology. Furthermore, a better understanding of HIFU's clinical limitations is vital before this treatment modality can be recommended to patients who are not involved in well-designed clinical studies. This review summarizes current knowledge about the basic principles of HIFU and its reported efficacy and morbidity in clinical series published since 2000.
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Management of Anal Cancer in 2010 Part 2: Current Treatment Standards and Future DirectionsThe treatment of anal squamous cell cancer with definitive chemoradiation is the gold-standard therapy for localized anal cancer, primarily because of its sphincter-saving and colostomy-sparing potential.
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Salivary Gland Cancers: Biology and Systemic TherapyThis article reviews the pathology and current evidence on systemic therapies for the management of advanced salivary gland cancers that are not amenable to local therapy.
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The War on Pancreatic Cancer: We Are Not There YetAfter 2 decades of disappointing phase III trials and years of single-agent gemcitabine therapy, the pancreatic cancer community is relieved to expand the front-line armamentarium in patients with mPAC. Here we evaluate the current landscape and ask some provocative questions about response rate, dosing, and predictive markers.
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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The Natural History of Hormone Receptor–Positive Breast Cancer: Attempting to Decipher an Intriguing ConceptIt is time to develop more active treatments in the early-disease setting that actually eradicate ER-positive breast cancer before new mutations and secondary resistance have a chance to develop. In this regard, standard chemotherapy is not the answer.
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Whole-Body PET Imaging of Breast Cancer Characteristics to Improve Precision TreatmentHowever, it is becoming ever clearer that tumor characteristics can change during the course of disease. Given this change over time, other supporting techniques for guiding therapy would be of value. Molecular radionuclide imaging with positron emission tomography (PET) can potentially fulfill this need.
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Screening and Prevention of Hepatitis B Virus Reactivation During ChemotherapyThe incidence of both hepatitis B virus infection and cancer is common. The use of immunosuppressive therapy in patients with hepatitis B virus can result in reactivation of hepatitis B virus, which can, in turn, lead to significant morbidity and mortality.
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Patient Adherence to Cancer Prevention GuidelinesIn this interview we discuss how patient adherence to the American Cancer Society’s cancer prevention guidelines affects cancer risk and mortality.
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Current Treatment of Esophageal Cancer and Promising Clinical Trials UnderwayDr. Ku discusses considerations in the treatment of esophageal cancer, current treatments, and the emerging role of immunotherapy.
