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Authors

Marc B. Garnick, MD
Latest Article

Important Considerations in LHRH Antagonist Therapy for Prostate Cancer

Drs. Crawford and Hou provide an important clinical introduction to a novel class of hormonal agents that have been under development for several decades for the treatment of advanced and metastatic prostate cancer.

Marc Bisseck, MD
Latest Article

Sentinel Lymph Node Biopsy in a Young Child With Thick Cutaneous Melanoma

Head and neck melanoma is a rare and aggressive childhoodmalignancy. Surgery remains the primary treatment, with lymphaticinvolvement determined by neck dissection. In the adult population,sentinel lymph node biopsy has emerged as a less morbid yet accuratemethod of staging regional lymph nodes. This innovative technique canalso be used in the pediatric population.

Marc C. Chamberlain, MD
Latest Article

Treatment of Meningioma, Including in Cases With No Further Surgical or Radiotherapy Options

Meningiomas are the most common primary brain tumor and comprise nearly one-third of all newly diagnosed primary brain tumors.

Marc C. Smaldone, MD, MSHP
Latest Article

The Role of Radical Prostatectomy and Lymph Node Dissection in the Treatment of Young Men With High-Grade Node-Positive Prostate Cancer: There May Be No RCTs-but There Are Good Reasons to Include Surgery

Upfront surgery allows for greater freedom to use all secondary treatment options for local and distant control, including adjuvant radiotherapy and ADT, thereby hopefully obviating the significant adverse quality-of-life sequelae from salvage surgery and brachytherapy for local relapse.

Marc D. Brown, MD
Latest Article

Commentary (Brown)-Mohs Micrographic Surgery: Established Uses and Emerging Trends

Drs. Pennington and Leffellhave provided an excellentoverview of the current uses ofMohs micrographic surgery. The procedurehas certainly come a long waysince the days of Frederic Mohs andthe application of zinc chloride paste(chemosurgery). Despite the fact that ithas indeed become the “gold standard”for the removal of basal cell carcinoma(BCC) and squamous cell carcinoma(SCC), there remain areas of controversyfor its use in melanoma and otherless common cutaneous neoplasms. Asmore dermatologists (and even a fewnondermatologists) have becometrained and gain experience in this specializedprocedure, and as more communitiesand university teaching centershave established growing Mohs practices,the procedure has become recognizedand embraced by health-careprofessionals and patients alike.

Marc Hellerstein, MD
Latest Article

Anorexia/Cachexia in Patients with HIV: Lessons for the Oncologist

Von Roenn and Knopf provide a balanced review of the pathophysiology and treatment options for anorexia and cachexia associated with HIV and cancer. This is an important topic that cuts across subspecialty lines and typically frustrates clinicians. Fortunately, more has probably been learned about HIV-associated cachexia during the past decade than about cancer-associated cachexia during the previous three decades and a number of treatment options have emerged. The reader may therefore benefit from a summary of the practical implications of recent research on HIV-associated wasting. Several clinical guidelines can be recommended:

Marc K. Wallack, MD, FACS
Latest Article

Live Viruses in Cancer Treatment

The use of live viruses for the treatment of cancer has been extensively studied in several preclinical and clinical models, as discussed in Nemunaitis’ thorough historical review of the subject.

Marc L. Citron, MD
Latest Article

Current Status of Patient-Controlled Analgesia in Cancer Patients

In patients with an advanced disease or a terminal illness, it may become necessary to institute parenteral opioid therapy either on a temporary basis (for acute breakthrough pain) or permanently. Continuous intravenous or subcutaneous opioid infusions have been the mainstay of parenteral opioid therapy for oncologic pain. Patient-controlled analgesia (PCA) now offers an alternative modality, and Drs. Bruera and Ripamonti review the current status of this relatively new technique. Is there any evidence to suggest the superiority of one modality over the other for the treatment of oncologic pain?

Marc Peeters, MD, PhD
Latest Article

Therapy for Early-Stage Colorectal Cancer

Surgery is the only curative option for patients with colorectal cancer. The goal of other modalities, such as chemotherapy, immunotherapy, and radiotherapy, is to prolong survival and reduce the risk of recurrence.

Marc T. Fields, MD
Latest Article

Radiosensitization by Gemcitabine

Gemcitabine is a potent radiosensitizer in both laboratory studies and in the clinic. Initial laboratory studies showed that gemcitabine radiosensitizes a wide variety of rodent and human tumor cells in culture. Maximum

Marc Wallack, MD
Latest Article

Melanoma Surgical Practice Guidelines

The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in

Marcel Devetten, MD
Latest Article

Refractory CML: Not All Forms of Resistance Are Equal

The introduction of the tyrosine kinase inhibitor imatinib mesylate (Gleevec) has profoundly changed the treatment paradigm for patients with chronic myelogenous leukemia (CML).

Marcela Böhm-vélez, MD
Latest Article

Advances in Breast Imaging

Question 1: Breast cancer remains among the most frequent diagnoses of cancer in women in the United States. Importantly research indicates that deaths due to breast cancer are decreasing, in part due to advances in treatment and earlier detection. Could you please comment about the advances in breast cancer imaging that have helped to facilitate earlier detection?Question 2: Could you briefly comment on the role of each of these modalities used in breast imaging?A. X-Ray mammography (digital and film screen)B. UltrasoundC. Molecular imagingD. Breast-specific gamma imagingQuestion 3: Could you please discuss indications for breast-specific gamma imaging and the clinical data to support these indications?Question 4: Are you able to cite an example as to how you used breast-specific gamma imaging in the clinic?Question 5: Could you please discuss the role of imaging in staging and treating breast cancer most appropriately? Is there new or novel technology that oncologists should be aware of when imaging is used for optimal visualization to assist in staging a woman diagnosed with breast cancer?Question 6: In your own clinical experience, what advances have you witnessed in breast imaging, particularly in regard to breast cancer, over the past 5 years?Question 7: Do you have any final comments you would like to make to our audience about advances or trends in breast imaging as it pertains to women with breast cancer?

Marcela G. Del Carmen, MD, MPH
Latest Article

Recurrent Epithelial Ovarian Cancer: An Update on Treatment

Emerging therapies in the management of ovarian cancer have resulted in a shift in paradigm, including in the appropriate time to institute therapy, and in the selection of therapy. This review focuses on chemotherapy and emerging biologic agents that present a therapeutic option for patients with recurrent ovarian cancer.

Marcelle J. Shapiro, MD
Latest Article

Management of Malignant Biliary Obstruction: Nonoperative and Palliative Techniques

Biliary tract drainage, with or without placement of an endoprosthesis, is used as a palliative therapy for malignant biliary obstruction. The first truly internal endoprostheses represented a distinct improvement over internal-external catheters but still remained patent for only 4 to 6 months. Metallic stents have a long-term patency of 6 to 8 months. At present, it appears that patients with unresectable pancreatic cancer should be palliated with endoscopically placed plastic or metal stents, whereas those with malignant obstructions higher in the biliary tree are probably better managed with transhepatically placed stents. The combination of brachytherapy plus external-beam radiation followed by implantation of a Gianturco metal stent may be a viable approach to treating obstructions in patients with cholangiocarcinoma. For those with other noncholangiocarcinomas, particularly when life expectancy exceeds anticipated stent patency duration, the Wallstent may be the device of choice. [ONCOLOGY 9(6):493-504, 1995]

Marcelo C. Pasquini
Latest Article

New Questions About Transplantation in Multiple Myeloma

Multiple myeloma is now the most common indication for autologous stem cell transplantation (ASCT) in North America, with over 5,000 transplants performed yearly (Center for International Blood and Marrow Transplant Research [CIBMTR] data). While the role of ASCT as initial therapy in multiple myeloma has been established by randomized studies, newer therapies are challenging the traditional paradigm. The availability of novel induction agents and newer risk stratification tools, and the increasing recognition of durability of remissions are changing the treatment paradigm. However, even with arduous therapy designed to produce more complete remissions—for example, tandem autologous transplants—we have seen no plateau in survival curves. A tandem autologous procedure followed by maintenance therapy may be performed in an attempt to sustain remission. Sequential autologous transplants followed by nonmyeloablative allotransplants are pursued with the hope of "curing" multiple myeloma. We examine how the key challenges of increasing the response rates and maintaining responses are being addressed using more effective induction and/or consolidation treatments and the need for maintenance therapies after ASCT. We argue that given the biologic heterogeneity of multiple myeloma, risk-adapted transplant approaches are warranted. While the role of curative-intent, dose-intense toxic therapy is still controversial, conventional myeloablative allogeneic transplants need to be reexamined as an option in high-risk aggressive myeloma, given improvements in supportive care and transplant-related mortality.

Marcelo P. V. Gomes, MD
Latest Article

Diagnosis of Venous Thromboembolic Disease in Cancer Patients

Venous thromboembolic disease is a common but likely underdiagnosedcondition in the cancer patient population. Timely and accuratediagnosis of venous thromboembolism is imperative due to the unacceptablemorbidity and mortality associated with a misdiagnosis.Because diagnosis of the condition based on clinical grounds alone isunreliable, physicians should select an appropriate objective diagnostictest to confirm or refute their clinical impressions. Compressionduplex ultrasound is the best initial imaging test for both suspectedupper- and lower-extremity deep venous thrombosis. Magnetic resonancevenography (MRV) is a valid alternative when ultrasound isinconclusive, but contrast venography remains the “gold standard.”Suspected pulmonary embolism should be initially evaluated by helical(spiral) computed tomography (CT) or ventilation/perfusion lungscintigraphy, the former being preferred in cases of obvious pulmonaryor pleural disease. Indeterminate studies should prompt performanceof contrast pulmonary angiography. Inferior vena cava thrombosis isalso best assessed by contrast venography, with MRV and CT reservedas alternative imaging modalities. Evidence to date suggests thatD-dimer assays remain unreliable in excluding venous thromboembolismin cancer patients. A newer latex agglutination D-dimer assay mayprove to be clinically useful in this setting.

Marcia Grant, RN
Latest Article

The Evolving Paradigm of Adult Cancer Survivor Care

Current US statistics on cancer reveal that more than 11 million cancer survivors live among us today, and that number is expected to double by 2050.[1,2] One important contributing trend has been a fall in cancer deaths driven by earlier detection and improved treatment. Deaths resulting from cancer declined from 206.7 per 100,000 population in 1980 to 185.7 per 100,000 in 2004. Meanwhile, the adjusted 5-year survival rate for cancers overall increased from 50% to 66% between 1975–1977 and 1996–2003,[3] and these statistics speak only to relatively short-term survival. About 1 in every 7 survivors today received their diagnosis more than 20 years ago.[4]

Marcia S. Brose, MD, PhD
Latest Article

Thyroid Cancer Update: Dramatic Changes in the Treatment of a Rare Disease

The paper by Higgins et al published in this issue highlights the important advances that have been made in the treatment of advanced thyroid cancer over the past few years. Patients with iodine-refractory metastatic thyroid cancer have suffered badly due to the reputation of thyroid cancer as being a “good” cancer to have.

Marcia Ward, PhD
Latest Article

Challenges of Rural Cancer Care in the United States

Rural cancer patients often face substantial barriers to receiving optimal treatment, including availability of cancer care providers, distance to services, lack of public transportation, financial barriers, and limited access to clinical trials. However, a number of promising approaches may address some of these challenges.

Marcos G. Joppert, MD
Latest Article

Topoisomerase I-Based Nonplatinum Combinations in Non-Small-Cell Lung Cancer

Lung cancer is the leading cause of cancer-related death in males and females in the United States. Most patients have advanced disease at diagnosis. Chemotherapy is the treatment of choice for patients with good performance

Marcos J. G. De Lima, MD
Latest Article

Small-Cell Lung Cancer

Small-cell lung carcinoma (SCLC) accounts for 20% to 25% of all new cases of lung cancer in the United States. It is estimated that approximately 42,000 new cases will occur in the United States in 1995 [1,2]. Of the various histologic types of lung cancer, small-cell is the most sensitive to chemotherapy and radiotherapy, yet overall outcome is poor, with only 5% to 10% of patients surviving 5 years from diagnosis.

Marcus Chen, MD
Latest Article

A 72-Year-Old Man With Prostate Cancer

The patient, L.E., is a 72-year-old white male who has been under our care for 10 years. He initially presented to our clinic in 1992, with a diagnosis of localized prostate cancer.

Marcus L. Quek, MD
Latest Article

Commentary (Quek et al): Management of Patients With Muscle-Invasive and Metastatic Bladder Cancer

Drs. Henry, MacVicar, and Hussainprovide a timely reviewof the current management ofmuscle-invasive and metastaticurothelial cancer. The emerging roleof neoadjuvant chemotherapy and thepromise of novel, less toxic targetedtherapies are of particular interest inthe treatment of a disease in whichoutcomes remain poor for locally advancedand metastatic involvementdespite an aggressive multimodalityapproach.[1] We wish to briefly commenton three issues raised by theauthors: (1) the role of surgery in themanagement of invasive disease,(2) the indiscriminate use of neoadjuvantchemotherapy for clinically localizeddisease, and (3) the currentstatus of bladder-sparing approaches.

Maree Ferguson, PhD
Latest Article

Patient-Generated Subjective Global Assessment

Traditionally, dietitians have relied on objectiveparameters (such as anthropometric, biochemical,and immunologic measures) to assess nutritionalstatus. The usefulness of these parameters has beenquestioned in view of the many non-nutritional factorsaffecting the results. Hence, subjective assessmentof nutritional status has been used to overcomethese difficulties.

Margaret Barton-burke, PhD, RN
Latest Article

Graft-Versus-Host Disease: A Complex Long-Term Side Effect of Hematopoietic Stem Cell

Consider the following case study, which illustrates the complex physical and psychosocial care required for the patient developing graft-versus-host disease (GVHD) following an allogeneic hematopoietic stem cell transplantation (HSCT): Mr. SR is a 38-year-old male with a diagnosis of anaplastic large cell non-Hodgkin’s lymphoma (NHL).

Margaret Hansen Frogge, RN, MS
Latest Article

Cancer Nursing: Principles and Practice, 5th Edition

Cancer Nursing: Principles and Practice is widely considered to be the basic textbook on cancer nursing. With this edition, every chapter has been updated to reflect the latest research and references, and many of the chapters now include

Margaret Joyce, MSN, RN, AOCN, PhD
Latest Article

The Patient With Cancer-Related Dyspnea

The patient, "JD," is a 62-year-old Caucasian female who had stage IV non–small cell lung cancer (NSCLC) diagnosed 3 months ago. Her medical history is significant for chronic obstructive pulmonary disease (COPD). She quit smoking cigarettes more than 6 months ago after having smoked a pack per day for 40 years.

Margaret K. Callahan, MD, PhD
Latest Article

Improving the Therapeutic Benefits of Ipilimumab

Currently there are only three FDA-approved drugs available for the treatment of metastatic melanoma: dacarbazine, interleukin-2, and the lesser-used hydroxyurea. None of these drugs has been shown to improve overall survival (OS). The review by Thumar and Kluger provides a well-balanced overview of ipilimumab, the first agent to demonstrate a survival benefit in patients with metastatic melanoma.[1] The response to ipilimumab is most notable for its durability, a feature rarely observed in patients with high tumor burden or in response to other systemic therapies. However, a minority of patients (10% to 15%) treated with ipilimumab meet standard criteria for radiographic response. In this commentary, we focus on the question of how we can build on the success of ipilimumab. We briefly review one area of active investigation: the combination of ipilimumab with targeted inhibitors of BRAF.

Margaret K. Ma, PharmD
Latest Article

Phase II Study of Docetaxel and Irinotecan in Metastatic or Recurrent Esophageal Cancer: A Preliminary Report

The outcomes for patients with metastatic or recurrent esophagealcancer are dismal, with 1-year survival rates of approximately 20%. Inthis phase II study, we studied the combination of docetaxel (Taxotere)and irinotecan (CPT-11, Camptosar) in patients with metastatic orrecurrent esophageal cancer. Eligible patients included those withhistologic or cytologic diagnosis of adenocarcinoma or squamouscancer of the esophagus or gastroesophageal junction who had receivedno previous chemotherapy for metastatic esophageal cancer. Previouschemotherapy in the neoadjuvant or adjuvant setting was allowed.Patients received irinotecan at 160 mg/m2 over 90 minutes followed bydocetaxel at 60 mg/m2 intravenously over 1 hour, with chemotherapycycles repeated every 21 days. Patients were reevaluated every twocycles. Of a planned 40 patients, 15 were enrolled, with 14 patientsevaluable for toxicity and 10 evaluable for response and survival. Thecombination of docetaxel and irinotecan resulted in a response rate of30%. An additional 40% achieved stable disease. The median survivalwas 130 days, with three patients still alive at the time of this analysis.The toxicities included 71% incidence of grade 4 hematologic toxicities,with 43% febrile neutropenia. One patient died of cecal perforationafter one cycle. There was no evidence of pharmacokinetic interaction,as systemic clearance of both drugs was similar to that seen after singleagentadministration. In conclusion, the regimen of docetaxel andirinotecan is active in metastatic or recurrent esophageal cancer.However, this combination chemotherapy regimen has an unacceptablerate of febrile neutropenia. This regimen needs to be modified toreduce the incidence of febrile neutropenia.
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