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The Role, Timing, and Clinical Use of ADT in Prostate CancerThe role, timing, and clinical use of androgen deprivation therapy (ADT) in prostate cancer remain a controversial topic for clinicians. Drs. Fang, Merrick, and Wallner provide a compelling review of the clinical benefits and side effects of ADT in high-risk prostate cancer. The number of patients presenting with advanced disease remains significant despite the stage migration of prostate cancer during the PSA (prostate-specific antigen) era.
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Impact and Implications of Lung Cancer ScreeningIn this video at ASCO 2018, James Mulshine, MD, discusses CMS coverage of low-dose CT lung cancer screening for selected Medicare beneficiaries, and clinical implications of early detection.
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Systemic Malignancies as a Cause of Unexpected Microangiopathic Hemolytic Anemia and ThrombocytopeniaThis review describes the clinical features that should suggest a search for systemic malignancy as the cause of unexpected microangiopathic hemolytic anemia and thrombocytopenia.
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Endocrine Therapy in 2009: Consideration of the Tumor and the HostBreast cancer is the most common female malignancy in the Western world. Two-thirds of all breast cancers are estrogen receptor (ER)-positive, a phenotypic characteristic that is prognostic of disease-free survival and predictive of response to endocrine therapy.
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Topoisomerase I Inhibitors in the Treatment of Head and Neck CancerTraditionally, the role of chemotherapy in the treatment ofsquamous carcinoma of the head and neck has been confined to patients with
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Taxanes in Adjuvant and Neoadjuvant Therapies for Breast CancerPaclitaxel (Taxol) is a diterpene originally obtained from the bark of the Pacific Yew Tree, Taxus Brevifolia. Its mechanism of action is unique. it stabilizes microtubule polymerization, thus blocking cells in the G2/M phase of
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From the Early Days in Oncology to NowIn this interview Dr. Armitage discusses his early career and what led him to specialize in the treatment of lymphoma, and shares his thoughts on the future of cancer treatment.
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Promoting Smoking Cessation Among Cancer Patients: A Behavioral ModelThe article, Promoting Smoking Cessation Among Cancer Patients, is an excellent complement to the clinical practice guideline on smoking cessation recently published by the Agency for Health Care Policy and Research (AHCPR).[1] The guideline presented considerable detail for clinicians on how to help smokers who are prepared to quit. For the approximately 80% of smokers who are not prepared, the guideline included only a few paragraphs. The approach of Prokhorov, Hudman, and Gritz, seasoned clinicians and scientists, can help clinicians become much more confident when counseling all smokers, including those in the precontemplation and contemplation stages.
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Silicone Breast Implants: An Oncologic PerspectiveIn 1992, the FDA decided that silicone gel-filled breast implants would be available only through controlled clinical studies, despite the fact that they had been used for mammoplasty in millions of women around the world
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Extended Transbasal Approach to Skull Base TumorsA variety of novel surgical approaches have been developed in recentyears to manage disease of the cranial base. Few offer the widthand depth of exposure achievable with the extended transbasal approach.This approach combines a bifrontal craniotomy with anorbitonasal or orbitonasoethmoidal osteotomy, and potentially asphenoethmoidotomy to provide broad access to malignancies of theanterior, middle, and posterior skull base. The approach enables the enbloc resection of tumors within the frontal lobes, orbits, paranasal sinuses,and sphenoclival corridors without brain retraction and mayobviate the need for transfacial access. This can be combined with additionalapproaches, based on the tumor's epicenter. Reconstruction isaccomplished with the use of pericranium, and in some instances, atemporalis muscle pedicle or a gracilis microvascular free flap. Complicationsinclude cerebral spinal fluid leakage, pneumocephalus, infection,and cranial neuropathies. However, the morbidity and mortalityassociated with this approach is low. The extended transbasal approachis a relatively novel exposure that enables the skilled cranialbase surgeon to safely excise many malignant lesions previously felt tobe unresectable.
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Comparison Studies of CT and MRI in Patients With Hepatic MetastasesThe increasing use of systemic and directed liver therapy for patients with hepatic metastases has created a demand for improved accuracy of noninvasive imaging techniques. Computed tomography (CT) and magnetic
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Irinotecan and UFT/Leucovorin in Patients With Advanced CancersThe combination of irinotecan and fluorouracil (5-FU) is synergistic when applied to human colon cancer cell lines in vitro and appears to be schedule-dependent: maximal activity occurs when irinotecan is administered prior to 5-FU. In this phase I study, irinotecan is administered in combination with UFT and leucovorin in patients with advanced solid tumors.
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Managing Toxicities Following BCMA-Directed Immunotherapy for MyelomaPatients treated with BCMA-directed immunotherapies for myeloma may experience susceptibility to severe infections following treatment.
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Hereditary Cancer Litigation: A Status ReportThe issues, cases, decisions and situations discussed by Severin indicate that, fortunately in one area and unfortunately in another, the more things change, the more they stay the same. Furthermore, his article raises an important medicolegal policy issue.
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Solitary Extramedullary Plasmacytoma of the BladderPlasmacytoma is a rare B-lymphocyte neoplastic disorder that usually presents as the generalized disease multiple myeloma. Less than 5% of the cases present as a solitary mass of monoclonal plasma cells in the bone or soft tissue. Although solitary extramedullary plasmacytoma (SEP) may arise in any organ, it rarely involves the urinary bladder. A 67-year-old male without a history of multiple myeloma presented with urinary frequency and nocturia; he was later diagnosed with SEP of the bladder. The patient was initially treated with a course of radiation therapy without symptomatic improvement; therefore a chemotherapy regimen consisting of lenalidomide and dexamethasone was subsequently given for six cycles. SEP usually carries a better prognosis and higher cure rate than solitary plasmacytoma of bone, as SEP is radiation sensitive. The role of adjuvant chemotherapy in the treatment of SEP that is resistant to radiation therapy is not clear, since most of the recommendations have been derived from the experience of head and neck SEP. The literature also lacks recommendations for choice of a chemotherapy regimen and surveillance of isolated bladder plasmacytoma. Here we present the first case of a radiation-resistant solitary plasmacytoma of the bladder that was successfully treated with lenalidomide and dexamethasone with successful clinical remission.
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Single-Agent Docetaxel in Previously Untreated Non-Small-Cell Lung CancerFour phase II trials have beenconducted to evaluate the efficacy and tolerability of single-agent docetaxel
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Chemotherapy in Advanced Nasopharyngeal CancerChemotherapy is an integral part of treatment for patients with nasopharyngeal carcinoma. Chemotherapy can achieve long-term survival rates of up to 15% to 20%, even in patients with recurrent or metastatic disease. In
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Book Review: Comprehensive Cancer Care: Integrating Alternative, Complementary, and Conventional TherapiesWhat constitutes comprehensive cancer care? One interpretation, by the National Cancer Institute (NCI), defines it as a commitment to exploring the basic science and clinical care of patients with cancer. Cancer centers designated by the NCI as
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Salvage Chemotherapy for Refractory Germ Cell TumorsWhen relapse occurs in patients with germ cell tumors, two salvage treatment paradigms exist: standard-dose chemotherapy, or high-dose chemotherapy with autologous stem cell rescue.
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Permanent Prostate Brachytherapy: Lessons Learned, Lessons to LearnDr. Potters has provided an excellent and timely overview of transperineal interstitial permanent prostate brachytherapy (TIPPB). The historical context, as the title suggests, nicely illustrates the lessons already learned and those still to be learned. There are a few points I would like to discuss in further detail.
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Novel and Expanded Oncology Drug Approvals of 2016-PART 1: New Options in Solid Tumor ManagementThis article focuses on the new agents and indications that emerged in 2016 for solid tumor treatment. We review the drug indications, mechanisms of action, pivotal trial data, pertinent toxicities, use in special populations, and the appropriate clinical contexts for treatment planning.
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Clinical Management Updates in Mantle Cell LymphomaRecent advances in mantle cell lymphoma include: (1) identification of new pathways to target, (2) novel therapeutics to treat patients with relapsed/refractory disease, and (3) monitoring of minimal residual disease and adoption of a maintenance therapy approach to prevent relapses post induction or post stem cell transplantation.
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Managing Glioblastoma in the Elderly Patient: New OpportunitiesThis review discusses best practices for the treatment of glioblastoma in patients older than 65 years, and highlights management concerns in caring for this particular patient population.
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Economic and Quality of Life Outcomes: The Four-Step Pharmacoeconomic Research ModelIncreasingly, economic data are being considered in formulary decisions. In oncology, pharmacoeconomic evaluations are essential to help decision makers weigh the associated costs and outcomes of competing
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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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Management of Hepatocellular CarcinomaThe article, “Management of Hepatocellular Carcinoma,” by Drs. Nakakura and Choti, is an excellent, comprehensive overview of the treatment modalities used for one of the most challenging cancers. The thoroughness of this review underscores the current frustration of the clinician in the management of this disease and the inadequacies of available therapies. The authors list more than 17 treatments for the various stages of this disease. However, if any one of the therapies mentioned offered cure to a majority of patients, there would be little need for more review articles or randomized controlled trials. There are few cancers that command such a vast array of differing therapies from so many different specialties.
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Prostate Cancer Risk Assessment ProgramProstate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and
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Synergizing Radiation Therapy and Immunotherapy for Curing Incurable CancersRadiation is often considered immunosuppressive, an activity that is most likely a result of the complex interplay of hormesis and the abscopal effect. The abscopal effect, also called the “distant bystander” effect, is a paradoxical effect of radiation on cellular systems whereby local radiation may have an antitumor effect on tumors distant from the site of radiation.
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In-Transit Melanoma: An Individualized ApproachThe management of in-transit metastases is challenging, since the treatments and extent of disease vary greatly based on the number, depth, location, and distribution of lesions, and on their biological behavior.
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Management of Congenital Vascular Lesions of the Head and NeckCongenital vascular lesions are often misdiagnosed and, for the most part, left untreated. The absence of a uniformly accepted classification of these lesions and confusion over their natural history are partly responsible. A new classification of these lesions recognizes two distinct groups of lesions, hemangiomas and vascular malformations.
