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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.
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Maximizing Radiation Benefit in Breast CancerWe read with interest the article and reviews of "Current Status of Radiation in the Treatment of Breast Cancer," which appeared in the April 2001 issue of ONCOLOGY.[1] These papers suggest that one of the most controversial areas in this
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
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Oncology Peer Review On-The-Go: Two Experts Review Important R/R DLBCL Treatment Decisions and DataGilles Salles, MD, PhD, and Kami Maddocks, MD, discuss relapsed/refractory diffuse large B-cell lymphoma therapeutic options and important data from the L-MIND trial.
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Guiding Post-Treatment Decisions in Rectal Cancer: mrTRG Is a Practical Place to StartThe authors propose that current policies regarding the use of chemoradiotherapy or short-course preoperative radiotherapy have resulted in an approach to rectal cancer management that often represents overtreatment, with significant loss of quality of life for patients.
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Tailoring Endocrine Therapy in Breast Cancer PatientsThe majority of invasive breast cancer patients present with hormone receptor-positive disease, and modulation of estrogen receptor (ER) activation is an essential component of systemic adjuvant therapy for these women. While tamoxifen has traditionally been the primary adjuvant endocrine therapy for all ER-positive women, recent trials evaluating the use of aromatase inhibitors (AIs) have challenged this standard in postmenopausal women, and ongoing trials are examining the optimal use of endocrine therapy in younger women. Issues regarding the optimal approach to endocrine therapy in both pre- and postmenopausal women are examined in this review.
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POINT: LHRH Agonists vs Ovarian Ablation for Suppression of Ovarian Function in Premenopausal Breast Cancer PatientsReversible ovarian function suppression using LHRH agonists is the preferred first treatment for most premenopausal breast cancer patients.
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Management of a Patient With Inflammatory Breast CancerTwo years after her first mammogram the patient, EC, noticed swelling and skin changes in one breast. A bone scan, chest and abdomen CT, and PET scan were negative for metastatic spread, staging the cancer at IIIB.
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Node-Positive Prostate Cancer: A Call for Level 1 EvidenceDespite the lack of level 1 evidence, retrospective studies support the need for appropriate local treatment, even in the context of node-positive disease.
