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Myalgias and Arthralgias Associated With PaclitaxelPaclitaxel-induced myalgias and arthralgias occur in a significantfraction of patients receiving therapy with this taxane, potentiallyimpairing physical function and quality of life. Paclitaxel-inducedmyalgias and arthralgias are related to individual doses; associationswith the cumulative dose and infusion duration are less clear. Identificationof risk factors for myalgias and arthralgias could distinguisha group of patients at greater risk, leading to minimization of myalgiasand arthralgias through the use of preventive therapies. Optimalpharmacologic treatment and possibilities for the prevention of myalgiasand arthralgias associated with paclitaxel are unclear, partially dueto the small number of patients treated with any one medication. Theeffectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) is themost frequently documented pharmacologic intervention, although noclear choice exists for patients who fail to respond to NSAIDs. However,the increasing use of weekly paclitaxel could necessitate daily administrationof NSAIDs for myalgias and arthralgias and leave patients at riskfor adverse effects. This concern may also limit the use of corticosteroidsfor the prevention and treatment of paclitaxel-induced myalgias andarthralgias. Data from case reports suggest that gabapentin (Neurontin),glutamine, and, potentially, antihistamines (eg, fexofenadine [Allegra])could be used to treat and/or prevent myalgias and arthralgias. Giventhe safety profile of these medications, considerable enthusiasm existsfor evaluating their effectiveness in the prevention and treatment ofpaclitaxel myalgias and arthralgias, particularly in the setting ofweekly paclitaxel administration.
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Monoclonal Antibodies and Side-Effect ManagementMonoclonal antibodies are increasingly becoming a standard part of clinical cancer treatment. Eight monoclonal antibodies are approved by the Food and Drug Administration for the treatment of cancer in the United States. Oncology nurses are expected to be familiar with these agents, their indications, and their adverse effects, to provide appropriate care and symptom management to patients receiving these agents, and to adequately educate patients and families about these treatments and their specific and overlapping side effects. Monoclonal antibody mechanisms of action and indications, infusion guidelines, and symptom management are outlined in this article.
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Melanoma Therapy Overview at SMR 2013At the 10th International Congress of the Society for Melanoma Research (SMR), we spoke with Dr. Georgina Long about current targeted approaches for the treatment of advanced-stage melanoma.
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Retroperitoneal Neuroblastoma Causing Urinary Obstruction in a 5-Month-Old BoyThe patient is a 5-month-old Caucasian boy with no developmental abnormalities who presented Christmas Eve 2004 to his pediatrician with increasing fussiness, emesis, and inability to tolerate oral intake. He had a temperature of 100.2°F but otherwise normal vital signs. Physical exam at that time revealed a distended abdomen. He was sent home with a diagnosis of viral gastroenteritis.
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The Economics of Prostate Cancer ScreeningAs health-care costs escalate, health-care planners must determine how the allocation of health-care dollars should be prioritized. One approach is to assess the cost of achieving a quality-adjusted year of life and then allocating the dollars in descending order, from least to most expensive, until all available money has been expended. Of course, calculating the cost per life-year is the real challenge because it is usually determined from mathematical decision models, which include many assumptions that may be subject to criticism.
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Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 2Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a
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Anaphylaxis: Implications of Monoclonal Antibody Use in OncologyThe phenomenon of anaphylaxis was discovered by Portier and Richet in 1903.[1,2] They injected dogs with toxins from sea anemone with the intent of generating protective antibodies. Unexpectedly, they found that certain dogs became ill with a rapid heartbeat and collapse. Because this syndrome was the precise opposite of protection or prophylaxis, they termed it anaphylaxis.
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Improving the Early Detection of Prostate Cancer: A Balancing ActImproved early detection of prostate cancer would ideally involve a noninvasive test that allows clinicians to distinguish aggressive cancers from relatively indolent ones. This distinction is especially important given that relatively few men who undergo screening are destined to die of prostate cancer.
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Radioimmunotherapy: A New Treatment Modality for B-Cell Non-Hodgkin’s LymphomaWe applaud Ghobrial andWitzig for their comprehensiveand balanced article on"Radioimmunotherapy: A New TreatmentModality for B-cell Non-Hodgkin's Lymphoma." Theseauthors have provided a review thatwill serve the oncologist and oncologypatient well. They have not engagedin arcane and tedious discussionof which anti-CD20 monoclonal antibody(ibritumomab tiuxetan [Zevalin]or tositumomab/iodine-131[I-131] tositumomab [Bexxar]), or radionuclide(yttrium-90 [Y-90] orI-131), or dosing method is better.Wisely, Ghobrial and Witzig have providedaccurate distillates of the manypublications on these exciting drugs.Because no rigorous body of dataclearly indicates that one drug is betterthan the other, these debates onlyconfuse the oncologist and are betterleft to the "technocrat."
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Economic and Quality of Life Outcomes: Managed Care PerspectivesA variety of economic factors have created a growing demand for health care reform and the rapid expansion of managed care plans. Absence of a clear, commonly accepted definition of managed care constitutes one of the
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Prostate-Specific Antigen: What’s New in 1997This review of prostate-specific antigen (PSA) by Pannek and Partin, two experts in the prostate marker field, comes at a very good time-a point at which great changes are occurring after a relatively long period of stability. I expect that this trend will continue. Moreover, given the rapid developments occurring in this area, some of the statements made in both the review and my commentary will probably need to be modified within the next 12 months, with further revisions necessary thereafter.
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Commentary (Rosen/Forscher): Current Combined Treatment of High-Grade OsteosarcomasIn this issue of ONCOLOGY, Damron and Pritchard discuss combined therapy for high-grade osteosarcoma. This is a nice review of the current status of osteogenic sarcoma, certainly from the point of view of modern surgical management, and for
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Commentary (Chodak): Locoregional Therapies for Early-Stage Prostate CancerThe article by Stock provides a comparison of outcomes following radiation therapy and radical prostatectomy in men with clinically localized prostate cancer. The reliability of this comparison is complicated by the lack of randomized trials and the obvious selection biases inherent in uncontrolled studies. Ultimately, however, the value of either therapy depends critically on the difference between radiation or surgery and watchful waiting--an issue that is not addressed in this article.
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The Evolving Role of Cytoreductive Surgery for Metastatic Renal Cell CarcinomaMetastatic renal cell carcinoma is a devastating disease associatedwith poor survival. Immunotherapy is the mainstay of treatment, butresponse rates are low. The role of cytoreductive surgery in thepresence of metastatic disease is evolving. From both retrospective andrecently published randomized clinical trials, it is now apparent thatamong patients with metastatic renal cell carcinoma and good performancestatus, cytoreductive surgery followed by immunotherapy improvessurvival. However, this approach is likely to be detrimental inpatients with poor performance status. Clinical trials of novel agentsremain a priority in this disease.
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Issues in the Management of Cancer-Related ThrombocytopeniaDrs. Goodnough and DiPersio present an authoritative and informative discussion of the management of thrombocytopenia in the cancer patient, emphasizing the risks of platelet transfusions, the safety of a platelet count threshold of < 10,000/µL for prophylactic transfusions, and issues related to the optimal type of platelet product and dose of platelets. The authors make the important point that although the risk of transmission of viral infections has decreased markedly due to the addition of nucleic acid testing for hepatitis C and human immunodeficiency virus (HIV),[1] sepsis due to bacterial contamination remains a serious risk, particularly for the neutropenic patient.[2] The fever and chills that occur within 6 hours after a platelet transfusion usually are associated with nonhemolytic febrile transfusion reactions, but the more dangerous possibility of bacterial sepsis from contamination should be considered, particularly in the neutropenic patient, and treated empirically until bacterial cultures prove otherwise.
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New Testing for Lung Cancer ScreeningIn this review, the authors discuss past attempts at lung cancer screening, the results of the National Lung Cancer Screening Trial, and innovative tests for lung cancer screening currently being evaluated.
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Impact of UFT on Tumoral TS and DPD Levels in Colorectal CancerThis was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.
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Prophylactic Central Lymph Node Dissection: Continued ControversyLow-risk papillary thyroid carcinoma (PTC), by definition, requires careful balancing of the risks of treatment and the risks of the disease.
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Impact of UFT on Tumoral TS and DPD Levels in Colorectal CancerThis was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.
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Paclitaxel and Carboplatin as First-Line Chemotherapy for Advanced Breast CancerIn a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an
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Neoadjuvant Chemotherapy for Resectable Non–Small-Cell Lung CancerLung cancer is the most common cancer diagnosed in men and women in the United States, and is the leading cause of cancer death.Over 160,000 individuals died as a result of lung cancer in 2008.[1] This number amounted to more than the number of deaths from colon, breast, and prostate cancers combined. The majority of lung cancer cases are non–small-cell lung cancer (NSCLC), and the poor outcomes are attributed to the high rate of metastases associated with this disease.
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Hospitalization for 5-FU Toxicity in Metastatic Colorectal Cancer: Incidence and CostAlthough treatment with 5-fluorouracil (5-FU) plus calcium folinate has been reported to prolong survival in patients with metastatic colorectal cancer, it can also cause significant toxicity, potentially resulting in
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It’s Time for Clinicians to Reconsider Their Proscription Against the Use of Soyfoods by Breast Cancer PatientsRecently published research questions the need for the advised restriction against the use of soyfoods by women with a history of breast cancer.
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A Clinician’s Perspective on ASCO 2001: Going After the Epidermal Growth Factor ReceptorAmong the most exciting new anticancer products presented at the 2001 ASCO meeting were new drugs that block the epidermal growth factor receptor (EGFR). About 30% to 90% of carcinomas express high levels of EGFR. These include, among others, head and neck cancer, lung cancer, pancreatic cancer, colon cancer, breast cancer, ovarian cancer, and bladder cancer.
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Ghassan K. Abou-Alfa, MD, Discusses Next Steps in Researching Unresectable HCCFuture research into the management of unresectable hepatocellular carcinoma may involve combining local therapies with checkpoint inhibitors like durvalumab and tremelimumab, according to Ghassan K. Abou-Alda, MD.
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The Heavy Chain Diseases: Clinical and Pathologic FeaturesThis review discusses the clinical presentation; epidemiology; laboratory, radiologic, and pathologic features; and treatment options for each of the heavy chain diseases, emphasising the importance of an accurate pathologic diagnosis and correct interpretation of immunologic studies in their identification.
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Uniform Risk-Stratification and Response Criteria Are Paving the Way to Evidence-Based Treatment of AL AmyloidosisIn less than a decade, the resources available to treat light chain (AL) amyloidosis have increased impressively.
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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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Breast Cancer: Never Too Young for a Functional Assessment?Geriatricians would argue that biological age alone should not be used to estimate a patient's anticipated tolerance for cancer therapy.
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Fraudulent Interpretation of Lab ResultsIn this edition, we offer an example of how clinicians and patients can be fooled and/or injured by fraudulent healthcare practitioners and their services. The clinical care team must be sure that the references it provides to patients are safe and reliable. Keep a list of reliable references and a list of those practitioners and services/treatments that should be avoided. Maintain an open door policy with your patients designed to encourage questions and exchange such information.
