Authors
Latest:
Pemetrexed in Pancreatic CancerSingle-agent gemcitabine (Gemzar) is the standard of chemotherapyfor advanced pancreatic cancer, with no phase III trials to date havingshown significantly improved survival with gemcitabine-based combinationsvs single-agent treatment. The multitargeted antifolate agentpemetrexed (Alimta) shows synergistic effects in vitro in combinationwith gemcitabine, and activity and good tolerability when used as singleagenttreatment in advanced pancreatic cancer. In a phase II trial inpatients with advanced pancreatic cancer, the combination ofgemcitabine at 1,250 mg/m2 on days 1 and 8 plus pemetrexed at 500mg/m2 on day 8 after gemcitabine every 21 days resulted in a mediansurvival of 6.5 months and a 1-year survival rate of 29%. Neutropeniawas the primary toxicity, with grade 4 toxicity in 51% of patients. Thepromising results of this trial prompted the initiation of a phase IIItrial comparing gemcitabine at 1,000 mg/m2 on days 1, 8, and 15 every28 days vs the 21-day gemcitabine/pemetrexed regimen given with vitaminsupplementation in patients with pancreatic cancer. The primaryoutcome measure was overall survival, with secondary measures includingresponse rate, progression-free survival, and quality of life.While an increase in response and time to progression was reported forthe gemcitabine/pemetrexed combination, there were no significantdifferences in survival between treatment arms.
Latest:
Multiple Myeloma in the Elderly: When to Treat, When to Go to TransplantUntil recently, standard treatment of multiple myeloma (MM) in elderly patients who were not candidates for autologous stem cell transplantation was with the combination of melphalan plus prednisone (MP). Novel agents (thalidomide, lenalidomide, bortezomib) are dramatically changing frontline therapy of MM. Randomized studies have shown the superiority of adding one novel agent to MP, either thalidomide (MPT) or bortezomib (MPV). The combination of lenalidomide with low doses of dexamethasone is another attractive alternative. Recent results show that maintenance therapy with low-dose lenalidomide may prolong progression-free survival. The objective of these improved treatment regimens should be to achieve complete response, as in younger patients. However, toxicity is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status. Weekly bortezomib appears to induce severe peripheral neuropathy less frequently than the same agent administered twice weekly. Autologous stem cell transplantation is feasible in selected fit patients over 65 years of age, and its results are improved by the addition of novel agents before and after high-dose therapy. However, considering the progress in non-intensive therapy, autologous transplantation should not currently be offered to elderly patients outside of a clinical trial.
Latest:
Docetaxel/Doxorubicin/Cyclophosphamide in the Treatment of Metastatic Breast CancerPreliminary results from phase I trials suggest that the use of docetaxel (Taxotere) and doxorubicin (Adriamycin) is a well tolerated and highly active combination regimen for
Latest:
Natural History and Treatment of Malignant ThymomaThymomas are rare, slow-growing neoplasms that are considered to be malignant because of their potential invasiveness. The most widely used staging system is that of Masaoka and colleagues, which takes into account
Latest:
In Patients With Colorectal Liver Metastases, Can We Still Rely on Number to Define Treatment and Outcome?The surgical strategies of “classic, reversed, or combined” resection of colorectal cancer and colorectal liver metastases have to be tailored to a specific patient, and all three strategies have a role in the treatment of stage IV colorectal cancer today.
Latest:
Improving Radiotherapy After Breast-Conserving SurgeryIn assessing the value of innovations in breast cancer radiotherapy, it is important to consider not only the basis of their impact on mortality, local recurrence, and cosmesis; emphasis should also be placed on factors such as treatment tolerance, convenience, and delayed morbidities.
Latest:
Commentary (Droz): Prognostic Factors in Low-Stage Nonseminomatous Testicular CancerPrognostic Factors in Low-Stage Nonseminomatous Testicular Cancer
Latest:
Epigenetics in Cancer: What's the Future?The understanding that epigenetic changes are prevalent in cancer and play a causative role in its biology has led to the development of new therapeutic approaches that target the epigenetic machinery.
Latest:
Unknown Primary Carcinomas: Diagnosis and ManagementUnknown primary carcinomas are a significant health problem, constituting 3% to 10% of all tumors diagnosed in the United States each year [1,2]. While the majority of patients with metastatic carcinoma of unknown primary origin have short survival times and disease resistant to treatment, recent findings suggest that certain subsets of patients have tumors that are responsive to chemotherapy. Others can be successfully treated with regional therapy.
Latest:
Adjuvant Therapy for Early Lung Cancer: Reflections and PerspectivesThe standard of care with regard to adjuvant chemotherapy of lung cancer has changed remarkably over the past 3 years. Until the initial report of the International Adjuvant Lung Trial in 2003, there was no real evidence from any individual randomized clinical trial (RCT) that adjuvant chemotherapy improves survival in resectable non-small-cell lung cancer. However, five RCTs that have now been reported indicate that adjuvant chemotherapy is effective, at least in certain subgroups of resectable patients. Moreover, numerous meta-analyses have also reported a positive effect from adjuvant treatment. Nonetheless, because of methodologic issues and conflicting results, the question of who should be treated and what constitutes optimal adjuvant therapy remains controversial. This article reviews the recent randomized trials that have contributed to a change in the state of the art, as well as some of the methodologic problems that may have confounded their proper interpretation. It also considers newer approaches to adjuvant therapy, with a particular focus on strategies that incorporate our growing knowledge of molecular medicine and predictive factors to the field of adjuvant chemotherapy of lung cancer.
Latest:
Update on European Adjuvant Trials With Irinotecan for Colorectal CancerRecent combinations of chemotherapy have significantly improved the response rate and survival time for patients with metastatic colorectal cancer.
Latest:
Pharmacologic Management of Adult Cancer PainThe intent of this article is to provide oncology nurses with practical information on the pharmacologic management of pain. The use of chemotherapy, radiation therapy, and surgery in pain management will not be addressed in this article. It is the second in a three-part series on cancer pain management. The first in the series (September 2006) addressed cancer pain assessment. In a future issue, the third in the series will address nonpharmacologic approaches to cancer pain management.
Latest:
Mounting Evidence for Postmastectomy Locoregional Radiation TherapyThe recommendations derived from the existing clinical trials of postmastectomy adjuvant radiation therapy seem to parallel the lessons learned from the trials of postoperative adjuvant chemotherapy conducted during the previous 20 to 30 years. From
Latest:
Reproductive Issues in the Gynecologic Cancer PatientFor women with a gynecologic cancer, reproductive concerns may vary not only by site of disease but also by the presentation and manifestation of the disease. Gynecologic cancer can present before childbearing has been started or completed, during pregnancy, or can even arise out of pregnancy.
Latest:
A Patient With Tumor Lysis SyndromeTumor lysis syndrome (TLS) is a potentially life-threatening metabolic disorder characterized by an elevated uric acid level, elevated serum potassium and phosphorus levels, and a decreased calcium level.
Latest:
Hospice and Palliative Care: Program Needs and Academic IssuesWith the renaissance of interest in how best to care for patients with terminal illness comes the need to recognize palliative care and hospice programs as the completion of comprehensive cancer care, not as its antithesis. In
Latest:
Recognizing and Managing Side Effects Associated With Novel Targeted Therapies:Nursing management of patients with advanced malignancies presents a formidable challenge. In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. Nursing intervention remains a vital component in the successful use of these novel agents.
Latest:
Chemobrain: Is It Time to Initiate Guidelines for Assessment and Management?Cognitive dysfunction during and following treatment for cancer, often referred to as “chemobrain,” is an adverse effect of cancer treatment that may interfere with patients’ ability to resume their precancer lifestyle, with subsequently reduced quality of life.
Latest:
Psychological Outcomes Associated With Anemia-Related Fatigue in Cancer PatientsThis article examines the relationships between chemotherapy-induced anemia, fatigue, and psychological distress among anemic cancer patients with solid tumors.
Latest:
Gemcitabine/Paclitaxel as First-Line Treatment of Advanced Breast CancerGemcitabine (Gemzar) and paclitaxel exhibit good activity and goodsafety profiles when used alone and together in the treatment of advancedbreast cancer. In a phase II trial, 45 patients with metastaticbreast cancer received gemcitabine at 1,200 mg/m2 on days 1 and 8 andpaclitaxel at 175 mg/m2 on day 1 every 21 days. Twenty-seven patients(60.0%) had prior adjuvant therapy. Objective response was observedin 30 patients (objective response rate 66.7%, 95% confidence interval[CI] = 52%–71%), including complete response in 10 (22.2%) and partialresponse in 20 (44.4%). Median duration of response was 18 months(95% CI = 11–26.7 months), median time to tumor progression for theentire population was 11 months (95% CI = 7.1–18.7 months), medianoverall survival was 19 months (95% CI = 17.3–21.7 months), and the1-year survival rate was 69%. Treatment was well tolerated, with grade3/4 toxicities being infrequent. Grade 3/4 leukopenia, neutropenia, andthrombocytopenia were each observed in six patients (13.3%). No patientwas discontinued from the study due to hematologic ornonhematologic toxicity. Thus, the gemcitabine/paclitaxel combinationshows promising activity and tolerability when used as first-line treatmentin advanced disease. The combination recently has been shownto be superior to paclitaxel alone as first-line treatment in anthracyclinepretreatedadvanced disease according to interim results of a phase IIItrial and it should be further evaluated in comparative trials in breastcancer.
Latest:
Self-Care for Oncology Nurses When Dealing With Compassion FatigueNurses need to be able to provide self-care to themselves because compassion fatigue can have negative physical, psychosocial, and spiritual effects.
Latest:
Managing Cancer Pain With Non-Opioid ModalitiesJeannine Brant, PhD, APRN-CNS, discussed the importance of using non-opioid modalities to manage cancer patients' pain, during the 2018 ONS Congress.
Latest:
Myalgias and Arthralgias Associated With PaclitaxelPaclitaxel-induced myalgias and arthralgias occur in a significantfraction of patients receiving therapy with this taxane, potentiallyimpairing physical function and quality of life. Paclitaxel-inducedmyalgias and arthralgias are related to individual doses; associationswith the cumulative dose and infusion duration are less clear. Identificationof risk factors for myalgias and arthralgias could distinguisha group of patients at greater risk, leading to minimization of myalgiasand arthralgias through the use of preventive therapies. Optimalpharmacologic treatment and possibilities for the prevention of myalgiasand arthralgias associated with paclitaxel are unclear, partially dueto the small number of patients treated with any one medication. Theeffectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) is themost frequently documented pharmacologic intervention, although noclear choice exists for patients who fail to respond to NSAIDs. However,the increasing use of weekly paclitaxel could necessitate daily administrationof NSAIDs for myalgias and arthralgias and leave patients at riskfor adverse effects. This concern may also limit the use of corticosteroidsfor the prevention and treatment of paclitaxel-induced myalgias andarthralgias. Data from case reports suggest that gabapentin (Neurontin),glutamine, and, potentially, antihistamines (eg, fexofenadine [Allegra])could be used to treat and/or prevent myalgias and arthralgias. Giventhe safety profile of these medications, considerable enthusiasm existsfor evaluating their effectiveness in the prevention and treatment ofpaclitaxel myalgias and arthralgias, particularly in the setting ofweekly paclitaxel administration.
Latest:
Neuroblastoma: Biology and TherapyNeuroblastoma is a clinically heterogeneous disease which can have a benign, localized behavior or a rapidly progressive, widely disseminated, lethal character. In recent years, knowledge of tumor biology-genetic changes and other biological markers-has allowed for reliable prediction of patient outcomes. These markers, when combined with clinical staging and histologic findings, determine the relative risk for a given patient and allow therapy to be tailored to that particular level of risk.
Latest:
CTLA-4 Antibodies: New Directions, New CombinationsThis review will summarize the preclinical and clinical development of CTLA-4–blocking antibodies, discuss recent insights into the biology of CTLA-4 blockade, review the use of these antibodies in combination with established and novel therapeutic modalities, and comment on ongoing questions regarding their administration.
Latest:
Molecular Genetics of Hereditary Ovarian CancerApproximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations
Latest:
Myth Busting: Does Real-World Experience Lead to Better Drug Choices?In the era of evidence-based medicine, clinical guidelines, and personalized medicine, one would think that convincing clinical trial data would influence clinical practice if disseminated in an appropriate manner. However, it has been estimated that only 50% of current medical practice is evidence-based, clearly demonstrating a compelling need to collect and analyze additional data to better inform practice. Current data are usually gathered from a variety of sources, including clinical trials, observational studies, and meta-analyses. Yet according to Jeff Forringer, CEO of IntrinsiQ, data from oncology practices provide real-world outcomes that give better insight into the efficacy of cancer therapeutics.
Latest:
Association Between the Rates of Synchronous and Metachronous Metastases: Analysis of SEER DataPatients with cancer are usually staged based on the presence of detectable regional and/or distant disease. However, staging is inexact and cM0 patients may have microscopic metastases (cM0pM1) that later cause relapse and death. Since the clinical tools used to stage patients are fairly similar for different tumors, the ratio of the rates of metachronous to synchronous metastases should be similar for different tumors (hypothesis #1). Improvements in diagnostic tools should have caused the ratio of metachronous-to-synchronous metastases to have decreased over time (hypothesis #2). Finally, the fraction of patients with either metachronous or synchronous metastases should have declined over time due to increased screening and earlier diagnoses (hypothesis #3). To test these hypotheses, Surveillance, Epidemiology, and End Results (SEER) data from 1973-1998 were analyzed for 19 solid tumors. A linear relationship was seen between the rates of metachronous and synchronous metastases, with modestly strong correlation coefficients, consistent with hypothesis #1. Over time, changes in staging methods have not significantly altered the ratio of metachronous/synchronous metastases, contrary to hypothesis #2. Also over time, a decrease in the number of patients with metastases was found, consistent with hypothesis #3. Therefore, the rate of anticipated metachronous metastases can be estimated from the rate of clinically evident metastases at presentation. Changes in screening/staging of disease over time may have reduced the overall fraction of patients with metastases.
Latest:
PSA Screening for Colorectal Cancer Patients: Proceeding With CautionIt may be appropriate to offer prostate cancer screening to carefully selected men with a previous history of colorectal cancer. However, the risks and benefits of establishing the diagnosis in this setting need to be considered and discussed with them.
Latest:
ICD-10: Getting Sucked in and SurvivingICD-10 is a massive undertaking that expands our current 13,000 codes to 68,000 codes. It will impact nearly all business processes in a physician's practice: verification of eligibility, pre-authorization, clinical documentation, research activities, public health reporting, quality reporting, and claim submission.
