Authors

State of the Art in Umbilical Cord Transplantation

Every day thousands of babies are born in hospitals across America. These births offer opportunities to cure patients of leukemia and other life-threatening diseases. The opportunities lie in the routinely disposed placentas and umbilical cords.

28 Enhancing the Interpretation of Real-World Quality of Life (QoL) in Patients With Hormone Receptor– Positive/Human Epidermal Growth Factor Receptor 2–Negative (HR+/HER2-) Advanced Breast Cancer (ABC) Enrolled in the POLARIS Trial

Commentary (Zhong/Lynn): Some Elements of Prognosis in Terminal Cancer

The claim that physicians make substantial, systematically optimistic errors in prognostication undergirds the article by Lamont and Christakis. This claim seems to contrast with our experience in the Study to Understand Prognoses and Preferences for

Genetics of Colorectal Cancer

Approximately 6% of colorectal cancers can be attributed to recognizable heritable germline mutations. Familial adenomatous polyposis is an autosomal dominant syndrome classically presenting with hundreds to thousands of adenomatous colorectal polyps that are caused by mutations in the APC gene.

Commentary (Zujewski): Current Status of Endocrine Therapy for Metastatic Breast Cancer

Endocrine therapy has been shown to be effective therapy for women with all stages of breast cancer, and the nonsteroidal antiestrogen tamoxifen is being evaluated as a potential preventive agent for this disease. Kimmick and Muss review the use of endocrine therapy for the treatment of patients with metastatic breast cancer. They discuss the basis for endocrine therapy and potential mechanisms of endocrine resistance, currently available and new agents, as well as new areas of investigation. I would like to highlight a few practical points regarding the use of endocrine therapy in the treatment of patients with metastatic breast cancer and some key areas of research.

The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric Cancer

Gastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined

Therapeutic Radiation in Patients With a Rising Post-Prostatectomy PSA Level

The optimal management of patients with an elevated post-prostatectomy prostate-specific antigen (PSA) level remains to be determined. In the pre-PSA era, many patients received immediate adjuvant radiation therapy on

Clinical Trials and NCI Resources for Cancer in HIV-Positive Patients

The association between HIV infection and the development of cancer was noted early in the acquired immunodeficiency syndrome (AIDS) epidemic. The AIDS-defining malignancies are Kaposi’s sarcoma, intermediate- or high-grade B-cell non-Hodgkin’s lymphoma (NHL), and cervical cancer. All of these cancers feature specific infectious agents in their etiology. These agents are human herpesvirus 8/Kaposi’s sarcoma-associated herpesvirus, or HHV-8/KSHV (implicated in Kaposi’s sarcoma), Epstein-Barr virus, or EBV (in primary central nervous system lymphoma and a subset of systemic B-cell NHL) and human papillomavirus, or HPV (in cervical cancer).[1]

Resection of Pulmonary Metastases: a Mechanical Solution for a Biological Problem

Isolated pulmonary metastases (PM) represent a unique manifestation of the myriad presentations of systemic spread from a primary neoplasm.

ACR Appropriateness Criteria® Nonsurgical Treatment for Locally Advanced Non–Small-Cell Lung Cancer: Good Performance Status/Definitive Intent

The treatment of inoperable stage III non–small-cell lung cancer (NSCLC) remains a challenge due to high rates of distant metastasis, local recurrence, and toxicity associated with definitive therapy.

Oropharyngeal Mucositis in Cancer Therapy

Oropharyngeal mucositis is a common and treatment-limiting sideeffect of cancer therapy. Severe oral mucositis can lead to the need tointerrupt or discontinue cancer therapy and thus may have an impacton cure of the primary disease. Mucositis may also increase the risk oflocal and systemic infection and significantly affects quality of life andcost of care. Current care of patients with mucositis is essentially palliativeand includes appropriate oral hygiene, nonirritating diet andoral care products, topical palliative mouth rinses, topical anesthetics,and opioid analgesics. Systemic analgesics are the mainstay of painmanagement. Topical approaches to pain management are under investigation.The literature supports use of benzydamine for prophylaxisof mucositis caused by conventional fractionationated head andneck radiotherapy, and cryotherapy for short–half-life stomatoxic chemotherapy,such as bolus fluorouracil. Continuing studies are investigatingthe potential use of biologic response modifiers and growth factors,including topical and systemic delivery of epithelial growth factorsand agents. Progress in the prevention and management of mucositiswill improve quality of life, reduce cost of care, and facilitate completionof more intensive cancer chemotherapy and radiotherapy protocols. Inaddition, improved management of mucositis may allow implementationof cancer treatment protocols that are currently excessively mucotoxicbut may produce higher cure rates. Continuing research related to thepathogenesis and management of mucositis will undoubtedly lead to thedevelopment of potential interventions and improved patient care.

Folate: Effects on Carcinogenesis and the Potential For Cancer Chemoprevention

A provocative array of observations from both laboratory and clinical investigations indicates that alterations in folate status modulate the process of neoplastic transformation in selected epithelial tissues. Diminished folate

Low-Risk and Very-Low-Risk Prostate Cancer: Is There a Role for Focal Therapy in the Era of Active Surveillance? No, Focal Therapy Provides a False Sense of Security and No Proven Benefits

One should not advise a patient with low- or very-low-risk prostate cancer to undergo a focal ablation. The kindest and gentlest approach is to first do no harm.

Psychological Outcomes Associated With Anemia-Related Fatigue in Cancer Patients

This article examines the relationships between chemotherapy-induced anemia, fatigue, and psychological distress among anemic cancer patients with solid tumors.

Commentary (Tepper/Kim): Are We Overtreating Some Patients With Rectal Cancer?

Adjuvant therapy, almost bydefinition, overtreats patients.It is the holy grail of those ofus involved in adjuvant therapy to definethe patients who are going to failso that we can decrease the incidenceof tumor recurrence and avoid givingadditional therapy to patients who havebeen cured by their primary treatment.

Commentary (Childers): Laparoscopy in Gynecologic Malignancies

Dr. Chi very nicely reviews the history of operative laparoscopy in gynecologic oncology and covers most of the applications currently considered to be useful.

Topotecan in Combination With Cisplatin for the Treatment of Stage IVB, Recurrent, or Persistent Cervical Cancer

Topotecan, a camptothecin analog previously approved for the treatment of ovarian cancer and small-cell lung cancer, was granted regular approval by the US Food and Drug Administration (FDA) on June 14, 2006, for use in combination with cisplatin to treat women with stage IVB, recurrent, or persistent carcinoma of the cervix not amenable to curative treatment with surgery and/or radiation therapy. The purpose of this summary is to review the database supporting this approval.

Darbepoetin Alfa: Impact on Treatment for Chemotherapy-Induced Anemia and Considerations in Special Populations

Our objective was to evaluate the effects of darbepoetin alfa (Aranesp) on hemoglobin and transfusions in anemic patients with cancer undergoing chemotherapy, and the impact of age, sex, baseline hemoglobin, chemotherapy

Commentary (Brandes/Brahmer): Perspectives on Salvage Therapy for Non–Small-Cell Lung Cancer

About 172,570 new cases ofnon–small-cell lung cancer(NSCLC) are expected to bediagnosed in 2005 in the United States,and almost as many will die of thedisease. Patients with effusions or metastaticdisease are candidates for combinationchemotherapy. The regimensof choice are platinum-based combinationchemotherapy schedules. Giventhat most patients will experience diseaseprogression despite their initialtreatment, they may be eligible for second-line chemotherapy, provided theyhave an acceptable performance status.

Targeted Therapy in Rectal Cancer

Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.

Nutritional Implications of Dental and Swallowing Issues in Head and Neck Cancer

Tumors of the head and neck account for 4% of cancers in the United States. Both the disease process itself and side effects of cancer treatment, such as xerostomia, dysphagia, and malnutrition, compromise oral health,

Improving the Early Detection of Prostate Cancer: A Balancing Act

Improved 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.

Principles of Chemoradiation: Theoretical and Practical Considerations

Chemotherapy agents known to enhance the effects of radiation in preclinical studies have been used concurrently with radiotherapy in numerous clinical trials with the prospect of further enhancing radiation-induced

Darbepoetin Alfa Controversies, From Dosage Issues to Safety Concerns: the Larger Lesson

Our paper, “Darbepoetin Alfa Administered Every 2 Weeks Alleviates Anemia in Cancer Patients Receiving Chemotherapy,” at the time of its publication almost a decade ago, was impactful and frequently cited.

Clinical Development of Eniluracil: Current Status

Eniluracil is a potent inactivator of dihydropyrimidine dehydrogenase (DPD), which is the first enzyme in the degradative pathway of systemically administered 5-fluorouracil (5-FU). Two completely oral regimens of eniluracil plus 5-FU are being evaluated in clinical trials: (1) a chronic schedule with both agents administered BID in a 10:1 ratio for 28 days of a 5-week course, and (2) a 5-day schedule of eniluracil once daily on days 1 through 7 and 5-FU once daily on days 2 through 6. The clinical development of eniluracil is being pursued in several tumor types, including colorectal cancer, breast cancer, and pancreatic cancer. Response rates achieved in a phase II study of the chronic schedule of oral eniluracil/5-FU in patients with colorectal cancer compare favorably with those obtained in trials of intravenous 5-FU and leucovorin, while results from other trials are awaited. Safety analysis for the 28-day schedule has revealed a low incidence of severe toxicities, particularly as compared with standard 5-FU regimens. [ONCOLOGY 12(Suppl 7):52-56, 1998]

Combined-Modality Therapy for Bladder Cancer

Radical cystectomy remains standard management for patients with locally advanced T2 through T4, N0, M0 transitional cell carcinoma of the urinary bladder.

Comparing Radical Prostatectomy and Brachytherapy for Localized Prostate Cancer

There are two problems with thepaper by Quaranta et al, neitherof which can be overcomewith discussion or sophistry. The firstconcerns the criteria used to determinewhether a report would be includedin this analysis. Specifically,any series with a median follow-up ofonly 3 years was included if it alsomet the other inclusion criteria. Thisis simply inadequate, as there is greatconsensus that studies with 3-year follow-up miss many recurrences. Thesecond problem with the paper is thedefinition of recurrence. The AmericanSociety for Therapeutic Radiologyand Oncology (ASTRO) criteriaused by the authors has proven inferiorto using a cutoff of 0.2 ng/mL forprostate-specific antigen (PSA) nadirfollowing brachytherapy. The inaccuracyin using ASTRO criteria fordetermining cure by brachytherapy isparticularly pronounced in series withshort follow-up such as the 3-yearmedian follow-up criterion used inthis paper.

Systemic Therapy of Metastatic Melanoma: On the Road to Cure

In this article, we summarize the systemic therapies now available for melanoma, with a focus on the recently approved agents for cutaneous melanoma; discuss important considerations in selecting a treatment from the available options; and highlight some of the promising investigational approaches for this disease.

Head and Neck Tumors

This management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of head and neck cancers (including tumors of the oral cavity, oropharynx, hypopharynx, larynx, supraglottis, glottis, subglottis, and nasopharynx) using radiation, surgery, and medical treatment.

Successful Treatment of Melanoma Metastatic to the Left Atrium Using External Beam Radiation Therapy

The successful treatment of a patient with primary nasal melanoma metastatic to the lung, pulmonary vein, and left atrium using radiation therapy is described. The patient was effectively treated with a conventional external beam radiation fractionation scheme (rather than a more commonly used hypofractioned regimen) that was utilized to minimize risk of arterial embolus of the tumor or rupture of a vessel wall. A post-treatment CT demonstrated a significant decrease in the caliber of the right pulmonary vein and tumor thrombus. The patient never developed cardiac valvular dysfunction or acute life-threatening massive embolism of tumor from the atrium. Unfortunately, the patient experienced clinical decline secondary to the massive progression of intra-abdominal disease and subsequently died from multiple liver metastases and liver failure. Numerous studies and this case report demonstrate that radiation therapy can be very effective in the treatment of malignant melanoma, especially when only small volumes of disease need to be treated and adequate total doses are used. Therefore, radiation therapy appears to play an important yet underutilized role in the treatment of metastatic melanomas.