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Commentary (Stanford/Ostrander): Prostate Cancer Risk Assessment ProgramBruner et al describe a model for risk assessment and genetic counseling of individuals and families at increased risk for prostate cancer. This model includes the establishment of a prostate cancer risk registry and screening clinic for unaffected
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Soyfood Consumption in Breast Cancer Survivors: Don't Overstate the Facts!Soyfoods are consumed by many because of cultural factors, for potentialThere are strongly conflicting data regarding soy intake and breast cancer. As such, if women (with or without breast cancer) enjoyed partaking of soy products, then it seems quite reasonable for them to partake of them. As with most things, moderation in intake is probably wise. beneficial effects on overall health, and for the unproven hope that they will ease menopausal symptoms in women.[1]
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Long-Term Toxicities of Selective Estrogen-Receptor Modulators and Antiaromatase AgentsPublished literature indicates that the selective estrogen-receptormodulators (SERMs) tamoxifen and raloxifene (Evista) have favorableeffects on bone density, lipid profiles, and the incidence of secondbreast cancers, and unfavorable effects on the incidence of venousthrombosis and hot flushes. Tamoxifen increases the risk of endometrialcancer, but raloxifene does not. The effects of SERMs on sexualfunction and cognition are unclear. Because the selective antiaromataseagents are relatively new, the long-term effects of these agentson normal tissues are less well established. It appears that the nonsteroidalagents (anastrozole [Arimidex], letrozole [Femara]) and steroidal(exemestane [Aromasin]) antiaromatase agents may have differenteffects on normal tissues. Preliminary data demonstrate that anastrozoleincreases the risk of arthralgias and produces a decrease in bonedensity. In contrast, exemestane appears to favorably affect bonedensity and lipid profile, similar to tamoxifen and raloxifene. Theincidence of contralateral breast cancer is decreased in women onadjuvant anastrozole, but data for the other antiaromatase agents arenot yet available. Hot flushes have been reported with the use ofselective aromatase inhibitors, but their incidence seems to be comparableto what is reported with SERMs. Antiaromatase agents do notappear to cause venous thrombosis. More information about the effectsof the antiaromatase agents on normal tissue will become available asdata from ongoing adjuvant and chemoprevention trials are reported.Clinically, we should be conscious of the differences between antiaromataseagents and SERMs and their impact on women’s health.
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Integrating Innovative Therapeutic Strategies Into the Management of Renal Cell CarcinomaIn the current critical review we discuss these emerging trends in localized and systemic treatment as well as possible interesting combinations of the two modalities. Finally, we discuss the role of the new systemic agents in non–clear cell RCC.
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First-Line Therapeutic Strategies in Metastatic Colorectal CancerColorectal cancer is the third most common cancer in the United States.[1] In 2008, an estimated 148,810 new cases of colorectal cancer will be diagnosed and nearly 50,000 people will die of the disease.
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Falls Are Key in Patient Assessment and PlanningFalls and the risk of falls are critical health concerns that can impact cancer treatment and recovery. In 2007, the Centers for Disease Control (CDC) reported that more than 18,000 older adults in the United States died from injuries sustained from falls (CDC, 2010).[1] Older people diagnosed with a malignancy and who are undergoing cancer treatment using chemotherapy have an increased risk of falls.[2]
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13% of patients stop aromatase inhibitors due to joint, muscle painA surprisingly high percentage of women with breast cancer who start adjuvant therapy with an aromatase inhibitor stop taking these drugs because of associated musculo-skeletal side effects
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ASH: Annual Meeting Highlights Exciting Advances in HematologyAs part of our coverage for the 2013 American Society of Hematology Annual Meeting and Exposition, we discuss some of the research that will be highlighted during this year’s meeting.
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Integrating Hormonal Therapy With External-Beam Radiation and Brachytherapy for Prostate CancerThe use of hormonal therapy with external-beam radiation (EBRT)to treat prostate cancer is a topic that has been well explored. The potentialuse of hormonal therapy and brachytherapy in the treatment ofprostate cancer, however, continues to be controversial. This review isbased on our current interpretation of the available literature assessingthe outcomes of patients treated with EBRT and brachytherapy withor without hormonal therapy. Extrapolating from the findings of theRadiation Therapy Oncology Group (RTOG) 9413 trial, there appearsto be a favorable interaction between hormonal therapy and irradiationin the lymph nodes. The benefits demonstrated with whole-pelvicEBRT and hormonal therapy are likely to extend to patients treatedwith brachytherapy as well. Studies suggest that the role of hormonaltherapy in brachytherapy is limited without the application of wholepelvicEBRT due to the inability of brachytherapy to address potentiallymph nodes at risk. The potential role of hormonal therapy in conjunctionwith brachytherapy without pelvic radiotherapy, is limited byinconclusive data and abbreviated follow-up times.
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UFT and Oral Calcium Folinate as First-Line Chemotherapy for Metastatic Gastric CancerLocally advanced or metastatic adenocarcinoma of the stomach still carries a poor prognosis, with 5-year survival rates of < 15%. Palliative chemotherapeutic regimens for this disease are largely 5-FU–based. We
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Historic Evidence and Future Directions in Clinical Trial Therapy of Solid TumorsAlthough improved survival is the "gold standard" for proving clinical benefit of oncologic therapy, the US Food and Drug Administration (FDA) has accepted significant results in clinical trials using surrogate endpoints as the basis for drug approval. One surrogate is the amount of tumor reduction, or tumor response. Although tumor shrinkage would seem to be a necessary precondition for improved survival, clinical studies of a variety of oncologic agents have not consistently demonstrated a correlation between the two in patients with renal cell carcinoma. Moreover, tumor response may not be an appropriate endpoint for evaluating the effects of the new targeted therapies, whose putative mechanisms are generally cytostatic rather than cytotoxic. Clinical trials suggest that some patients with other solid tumors, such as lung cancer, may derive clinical benefit from treatment that helps stabilize their disease. There is also controversy as to whether the Response Evaluation Criteria in Solid Tumors (RECIST) provides the most appropriate instrument for assessing tumor burden. Ultimately, use of a variety of endpoints as well as different trial designs may provide an adequate basis for investigating the benefits/risks of newer therapies.
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High-Dose Chemotherapy With Autologous Stem Cell Rescue in the Outpatient SettingOutpatient bone marrow transplant (BMT) strategies, as reviewed by Dix and Geller, have evolved for various reasons—from social to medical. If high-dose approaches are to become a viable treatment for common cancers, such as breast cancer, the refinement of transplants to a “kinder and gentler” approach is essential.
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Uncertainty in Medicine: A Talk With Dr. DjulbegovicIn part 2 of this interview, Benjamin Djulbegovic, MD, PhD, discusses the uncertainty principle in clinical trials. Dr. Djulbegovic is associate professor of medicine, Divisions of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa.
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Advanced Lab Testing in Lung CancerThe most important marker to test is epidermal growth factor receptor (EGFR). EGFR is the second most common oncogenic driver in lung cancer, present in 15% of adenocarcinoma cases, but the most common mutation to be actionable with an approved drug.
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Pneumonitis From Anti–PD-1/ PD-L1 TherapyWhile the incidence of irAEs is relatively low, the absolute number of patients receiving immune checkpoint inhibitors is steadily increasing. Thus, it is likely that, with time, larger numbers of patients will develop irAEs, including pneumonitis.
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Early Detection of Cutaneous LymphomaCutaneous lymphomas comprise a spectrum of diseases characterized by infiltration of the skin by malignant lymphocytes. The clinical manifestations of cutaneous lymphomas vary, and they can mimic benign dermatoses,
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Peripheral T-Cell Lymphomas: Incorporating New Developments in Diagnostics, Prognostication, and Treatment Into Clinical Practice-PART 2: ENKTL, EATL, Indolent T-Cell LDP of the GI Tract, ATLL, and Hepatosplenic T-Cell LymphomaIn Part 2 of this two-part series, this review covers extranodal natural killer/T-cell lymphoma, enteropathy-associated T-cell lymphoma, indolent T-cell lymphoproliferative disorder of the gastrointestinal tract, adult T-cell leukemia/lymphoma, and hepatosplenic T-cell lymphoma.
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Proton Radiotherapy for Prostate Cancer: How Did We Get Here, and Where Do We Go From Here?Despite the promise of proton therapy, comparative evidence has yet to definitively demonstrate its clinical benefit over other forms of contemporary radiation for prostate cancer.
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The Role of Statins in Cancer Prevention and TreatmentStatins inhibit the activity of the rate-limiting enzyme in the cholesterolbiosynthetic pathway, HMG-CoA reductase, and are widely prescribedfor lowering plasma lipid levels. Several statins have antitumor effects inexperimental models, and observational studies suggest that this anticanceractivity in the laboratory may translate into effective treatments and/orpreventive strategies for certain human cancers. This paper reviews thelaboratory and clinical evidence that statins have anticancer activity, discussesthe possible mechanisms by which tumor growth may be inhibitedby this class of drugs, and outlines strategies for the evaluation of theseagents in the prevention and treatment of human cancers.
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Melanoma and Other Skin CancersSkin cancer is the single most common form of cancer, accounting for more than 75% of all cancer diagnoses. More than 1 million cases of squamous cell and basal cell carcinomas are diagnosed annually, with a lifetime risk of more than one in five.
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Brachytherapy for Carcinoma of the LungAn estimated 157,000 patients died of lung cancer in the United States in the year 2000.[1] Although surgery can be curative, only about 20% of patients are amenable to complete surgical resection. Most of the other patients are treated with radiation
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Response to Antiangiogenesis Therapy in a Patient With Advanced Adult-Type Testicular Granulosa Cell TumorWe have presented the first case of a patient with metastatic ATGCT with peritoneal carcinomatosis, who responded to treatment with a VEGFR tyrosine kinase inhibitor. Because of the relative paucity of such cases in the literature, no clear treatment strategy exists. For patients with metastatic ATGCT, enrollment in clinical trials testing novel therapies, including angiogenesis inhibitors, is a reasonable option.
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Assessing Cosibelimab’s Future in Cutaneous Squamous Cell CarcinomaAccording to Jason Luke, MD, FACP, there is still room to improve response rates in CSCC treatment, but there is excitement surrounding future of treatment outcomes.
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Commentary (Konner/Abu-Rustum): Neoadjuvant Chemotherapy for Ovarian CancerThe review by Vergote et al[1]presents a well-organized andcomprehensive summary of thedata addressing neoadjuvant chemotherapyfor ovarian cancer. The timingof debulking surgery for thisdisease is a common and clinicallyimportant question, but one that lacksdefinitive trial data. The assembleddata suggest a rationale for decisionmaking.The European Organizationfor Research and Treatment of Cancer(EORTC) and Gynecologic OncologyGroup (GOG) 152 trialspresent compelling evidence supportinga “maximal surgical effort” by anexperienced gynecologic surgeon,preferably at a specialty hospital, atsome point during primary therapy.
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Prophylaxis Against Fungal Infections and Cytomegalovirus Disease After Bone Marrow TransplantationAmong the serious complications associated with bone marrow transplantation are invasive fungal infections caused by organisms such as Candida and Aspergillus species and end-organ disease caused by
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Hopes and Dreams for Quality Improvement in Radical ProstatectomyWe fervently hope that all surgeons will participate in a comparative outcomes project for the purpose of quality improvement. However, today we will settle for one, we hope, skilled surgeon, open or robotic.
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Diagnosing and Treating Chronic Lymphocytic Leukemia in 2009Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the Western hemisphere. Both the Rai and Binet staging systems have been important clinical tools for predicting outcomes of this heterogeneous disease.
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Seventy-Year-Old Man With Large Bladder Mass: Diagnostic and Clinical Challenges of an Uncommon NeoplasmA 70-year-old man presented at our institution for a second opinion regarding diagnosis of a urinary bladder mass. He had a 3-year history of worsening urinary incontinence and urgency, for which he had undergone colonoscopy, as well as testing for prostate issues; all test results were negative.
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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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Incidence and Management of Renal Adverse Events in Patients With Relapsed and/or Refractory Multiple Myeloma Treated With Single-Agent CarfilzomibThis article reviews the etiology and incidence of renal adverse events in patients with multiple myeloma, the renal safety profile of single-agent carfilzomib from four phase II studies in patients with relapsed and/or refractory multiple myeloma, and the management of patients with multiple myeloma who receive carfilzomib and are at risk for renal complications.
