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With Decades of Perspective, Craig Henderson Observes That Treatment of Breast Cancer Has Come a Long WayIn this interview we discuss important developments in the diagnosis and management of breast cancer and more.
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UFT/Leucovorin Plus Bolus Epirubicin and Cyclophosphamide in Advanced/Metastatic Breast CancerThis article describes the design and early results of an open-label, nonrandomized phase I/II trial of oral UFT plus leucovorin therapy in combination with bolus injections of epirubicin and cyclophosphamide in patients with advanced or metastatic breast cancer. This study was designed as a cohort dose-escalation study with the principal aims being to determine dose-limiting toxicity, overall toxicity, maximum tolerated dose, tumor response, and time to disease progression.
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Neoadjuvant Therapy With Cisplatin/Fluorouracil vs Cisplatin/UFT in Locally Advanced Squamous Cell Head and Neck CancerThis study compared the activity and toxicity of fluorouracil (5-FU)/cisplatin with the combination tegafur and uracil (UFT)/cisplatin in the neoadjuvant treatment of locally advanced-stage III or IV (M0)-head and neck
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Anthracycline and Trastuzumab in Breast Cancer TreatmentThis study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastaticbreast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) incomparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those withmetastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapyfor metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, openlabel,phase II study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for sixcycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weeklyafter an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions inleft ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treatedwith EC60 + H and in 14 patients (56%) treated with EC90 + H vs 6 patients (26%) in the EC90 alone cohort.LVEF decreases to < 50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+Hcohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overallresponse rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this studysuggest the cardiac safety of the combination of H with EC may be greater than that of H with AC (doxorubicin[Adriamycin]/cyclophosphamide); however, studies in larger numbers of patients are warranted. The combinationregimen revealed promising efficacy.
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Ibritumomab Tiuxetan Radioimmunotherapy Is Safe and Well Tolerated in Patients With Relapsed or Refractory B-Cell Non-Hodgkin’s LymphomaIbritumomab tiuxetan (Zevalin) consists of an anti-CD20 murine IgG1 kappa monoclonal antibody covalently bound to tiuxetan (MX-DTPA), which stably chelates yttrium-90 for therapy. Ibritumomab tiuxetan therapy involves pretreatment with
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Reassessments of ESAs for Cancer Treatment in the US and EuropeAnemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.
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Continuous Low-Dose GM-CSF as Salvage Therapy in Refractory Recurrent Breast or Female Genital Tract CarcinomaGranulocyte-macrophage colony-stimulating factor (GM-CSF,sargramostim [Leukine]) is a powerful cytokine that is able to stimulatethe generation of dendritic cells. Adjuvant treatment with continuous lowdoseGM-CSF has been shown to prolong survival of stage III/IV melanomapatients. Data on continuous low-dose GM-CSF therapy in tumorsother than prostate cancer are still lacking.
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How to Evaluate Risk and Identify Stage II Patients Requiring Referral to a Medical OncologistApproximately 150,000 new cases of colorectal cancer were expected for the year 2009 in the United States. Moreover, 49,920 deaths related to colorectal cancer were also predicted for the same year. The age-adjusted cancer death rates related to colorectal cancer have steadily declined over the past 2 decades. This improvement is a direct consequence of advances in prevention and treatment, including colorectal cancer screening, diagnostic tests, surgical technique, adjuvant therapies, and medical support.
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Treatment of Gastroesophageal Junction CarcinomaThis video reviews first- and second-line treatment options for patients with carcinoma of the gastroesophageal junction.
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Aggressive Pituitary TumorsAlthough almost all pituitary tumors are benign adenomas, a surprisingly large number of these tumors invade tissues outside of the pituitary gland. Such invasion, by itself, is not diagnostic of pituitary carcinomas, which are
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Epirubicin, Cyclophosphamide, and UFT Plus Oral Calcium Folinate in Advanced Breast CancerUse of continuous-infusion 5-fluorouracil (5-FU) for the treatment of metastatic breast cancer has met with some success in recent years. In order to build on this experience, investigators at the Royal Marsden Hospital and
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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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FDA Approves Abiraterone/Prednisone for Metastatic Prostate CancerThe US Food and Drug Administration has approved abiraterone acetate (Zytiga) tablets in combination with prednisone for the treatment of metastatic prostate cancer patients with high-risk, castration-sensitive disease.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
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Improving Therapy for HER2-Positive Cancers Through Neoadjuvant StudiesTreatment of HER2-positive cancers has improved rapidly over the past decade, and the pace of progress continues to accelerate. The advances have been fueled in part by the conduct of neoadjuvant studies, which have aided in the development of novel therapies and more effective combination regimens.
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Radiotherapy for Hormone-Positive Breast Cancer Patients Over 65In this interview we discuss the role of radiotherapy in treating women aged 65 and older with hormone-positive breast cancer with Dr. Ian Kunkler, professor of clinical oncology at the Edinburgh Cancer Research Center.
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Book Review:Pediatric Hematology, Second EditionThe second edition of Pediatric Hematolgy, edited by the text's original editors, John S. Lilleyman and Ian M. Hann, as well as a new editor, Victor S. Blanchette, completely updates and expands upon the first edition (published in 1992). The new edition grew from 15 to 40 chapters, with contributions by many of the most well-known investigators and clinicians in pediatric hematology in the world. The textbook will especially be of value to practicing clinicians, house staff, and students.
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Focal Therapy of Prostate Cancer-The ChallengeThe ideal utilization of focal therapy is to treat a smaller prostate cancer in which you can ablate, excise, or render inconsequential a tumor that affects a relatively small fraction of the gland.
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Laura Esserman and Ian Thompson Discuss Strategies for Screening and Treatment of Early-Stage Cancers, and How Clinicians Can Learn From Each Other’s ExperiencesIn this interview we review recent breast cancer screening guidelines from the ACS and USPSTF, and discuss the changing way that early-stage breast and prostate cancers are being treated.
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Commentary (Zlotolow): Minimizing Oral Complications of Cancer TreatmentMinimizing oral manifestations of cancer treatment is a major concern for both dentists and physicians. This article, by dentists from the M. D. Anderson Cancer Center in Houston, Texas, addresses the prevention and minimization of oral complications by describing their observations and considerations for a wide range of oncologic treatments.
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Antiestrogen Therapy: Uncertainties and Risk AssessmentTamoxifen is by far the most clinically tested antiestrogenic drug currently used as adjuvant therapy for breast cancer and it continues to provide considerable benefit in this setting. The balance from clinical trials indicates a strong association between the use of tamoxifen and an increase in uterine tumors (three to sixfold). In rats, tamoxifen is a mutagenic, genotoxic hepatocarcinogen.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
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Integrating Gemcitabine Into Breast Cancer TherapyThe rapid emergence of gemcitabine (Gemzar) as a viable component inchemotherapy for breast cancer is indeed an encouraging development.Specifically, until relatively recently, the focus of research and treatmentwith gemcitabine was primarily on lung cancer. Growing opinion amongmany experts in breast cancer held that studies of gemcitabine in breast cancer werenoticeably lacking and that such research was warranted. Fortunately, these voiceswere heard, and the manufacturers of gemcitabine responded with an acceleratedinitiative to explore further the role of gemcitabine in breast cancer. Rapid progresswas made.
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Diagnostic DilemmaA 68-year-old man is referred for further evaluation and treatment of jaundice. He describes pruritus, intermittent mild midabdominal discomfort, and progressive weight loss. There is no history of fever. His history is significant for renal cell carcinoma with pulmonary metastasis.
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Management of High-Grade LymphomasHigh-grade non-Hodgkin’s lymphomas generally refer to immunoblastic lymphoma, lymphoblastic lymphoma, and small-noncleaved-cell lymphoma, three histological subtypes that were associated with the worst prognosis at the
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Prostate Cancer Controversies: PSA Screening; Treatment or Observation for Early DiseaseWe discuss the current controversies in prostate cancer-PSA screening and approaches to initial treatment for men diagnosed with the disease.
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Treatment of Acute Lymphoblastic Leukemia in Adults: Applying Lessons Learned in ChildrenIn this article we discuss the challenges and new advances in adult ALL, as well as our approach to the treatment of these patients.
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Neoadjuvant Chemotherapy for Ovarian CancerPrimary debulking surgery by a gynecologic oncologist remains thestandard of care in advanced ovarian cancer. Optimal debulking surgeryshould be defined as no residual tumor load. In retrospective analyses,neoadjuvant chemotherapy followed by interval debulking surgerydoes not seem to worsen prognosis compared to primary debulking surgeryfollowed by chemotherapy. However, we will have to wait for theresults of future randomized trials to know whether neoadjuvant chemotherapyfollowed by interval debulking surgery is as good as primarydebulking surgery in stage IIIC and IV patients. Interval debulking isdefined as an operation performed after a short course of induction chemotherapy.Based on the randomized European Organization for Researchand Treatment of Cancer–Gynecological Cancer Group (EORTC-GCG)trial, interval debulking by an experienced surgeon improves survival insome patients who did not undergo optimal primary debulking surgery.Based on Gynecologic Oncology Group (GOG) 152 data, intervaldebulking surgery does not seem to be indicated in patients who underwentprimarily a maximal surgical effort by a gynecologic oncologist.Open laparoscopy is probably the most valuable tool for evaluating theoperability primarily or at the time of interval debulking surgery.
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Bronchioloalveolar Carcinoma: a Translational PerspectiveIn this issue of Oncology, Levy and colleagues provide a comprehensive review of bronchioloalveolar carcinoma [BAC], with a focus on the management of this rare disease, which represents 4% of all lung cancers.[1] The definition of BAC was revised by the World Health Organization (WHO) in 2004, with changes made to the diagnostic criteria and classification.[2] BAC was defined as an adenocarcinoma of the lung that grows in a lepidic fashion along the alveolar septa without invasion of stroma, blood vessels, or pleura. BAC has been sub-classified into three types: nonmucinous, mucinous, and mixed.
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New Hutchinson Center Study Helps Lift the Fog on ChemobrainBecause there has been little empirical evidence to back up patients’ stories, chemobrain has been met with skepticism by the medical community and has been a painful puzzle for many patients who couldn’t quite put a name to what they were feeling. This cognitive impairment-characterized by loss of memory and stumbling on words, among other symptoms-has come to be known as “chemobrain” or “chemofog.”
