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Proposed Algorithm for Managing Ibrutinib-Related Atrial FibrillationAlthough ibrutinib-related atrial fibrillation (IRAF) occurs in up to 11% of patients in clinical trials, these studies have rarely fully characterized bleeding events or risk factors for bleeding when ibrutinib is combined with anticoagulation. Furthermore, guidelines do not provide direction regarding the preferred anti-arrhythmic agent for IRAF.
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Lung Cancer Screening: A New EraScreening is always an issue that generates a great deal of emotion, as recently seen with the controversies surrounding mammography and prostate-specific antigen (PSA) testing.
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Tamoxifen's Impact on the Management of Breast Cancer: The Oncologist's PerspectiveBreast cancer treatment has evolved greatly within the last 25 years. Tamoxifen was first introduced for the
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Clinical Trials in Ovarian Cancer, Part 2The American Cancer Society has estimated that 23,300 women will develop ovarian cancer in 2002, and 13,900 women will die from the disease.[1] The 5-year survival rate is about 80% for women with stage I disease, 50% for women with stage II disease, 25% for women with stage III disease, and 15% for women with stage IV disease. Among women with advanced-stage disease, optimal debulking surgery, as well as platinum/taxane-based adjuvant therapy prolongs disease-free and median survival.[2,3] Population-based data suggest that guidelines for therapy are not uniformly followed in community practice.[4] In addition, older patients appear to receive less aggressive treatment than younger patients.
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Commentary (Forman/Zaia): Vaccinations Against Infectious Diseases in Hematopoietic Stem Cell Transplant RecipientsWith the increasing successof both autologous and allogeneicmarrow transplantationin achieving cure of inheritedand acquired disorders, the numberof people who have become longtermsurvivors has steadily increasedworldwide. Concomitant with thisincrease has been greater attention tothe long-term health needs of theserecipients. Many studies have outlinedthe problems experienced bylong-term survivors and have betterinformed physicians about the medicalproblems that may require interventionand consultation.[1]
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Unfavorable, Complex, and Monosomal Karyotypes: The Most Challenging Forms of Acute Myeloid LeukemiaAlthough the overall prognosis for patients with acute myeloid leukemia (AML) associated with unfavorable, complex, or monosomal karyotypes is poor, some patients can be cured.
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Joleen Hubbard, MD, Highlights The “Exciting Space” Of Metastatic CRCNew studies and treatment options prove to be effective in treating metastatic CRC, notes Joleen Hubbard, MD.
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Individualizing Therapy for Metastatic Colorectal CancerDavies/Goldberg Article Reviewed. The past decade has seen exciting developments in the field of colorectal cancer, particularly in the setting of advanced disease.
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New and Newer Vascular Targets in OncologyThis review covers progress to date in the identification of molecular targets on blood vessels in cancers, as well as agents that act on those targets, with emphasis on those currently in clinical trials. Current vascular-targeting therapies comprise two general types—antiangiogenic therapy and antivascular therapy. Advances in antiangiogenic therapies, particularly inhibitors of vascular endothelial growth factors and their receptors, have clarified the capacity of these inhibitors to change tumor-associated vessel structure to a more normal state, thereby improving the ability of chemotherapeutics to access the tumors. The responses of other antiangiogenesis target molecules in humans are more complicated; for example, αvβ3 integrins are known to stimulate as well as inhibit angiogenesis, and cleavage of various extracellular proteins/proteoglycans by matrix metalloproteinases produces potent regulators of the angiogenic process. Antivascular therapies disrupt established blood vessels in solid tumors and often involve the use of ligand-based or small-molecule agents. Ligand-based agents, irrespective of the antiangiogenic capacity of the ligand, target antivascular effectors to molecules expressed specifically on blood vessels, such as aminopeptidase N, fibronectin extra-domain B, and prostate-specific membrane antigen. Small-molecule antivascular agents, which are not targeted to molecules on blood vessels, rely on physical differences between the vasculatures in tumors and those in normal tissues.
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Cancer and Male Factor InfertilityWith the increasing success of multimodality anticancer therapy, most men of reproductive age will survive their malignancy. Reproductive function is a principal concern of these men. Health-care providers are shifting the
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Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s LymphomaRecords from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-
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Aromatase Inhibitor–Associated Musculoskeletal Symptoms: Etiology and Strategies for ManagementIn the United States, approximately 180,000 women are diagnosed with breast cancer annually.
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The Cost of Cancer Care: There Is More Than One Elephant in the RoomThe current system rations care in an irrational way. This irrational rationing is going to worsen, for the costs of the current system are simply not sustainable nor are they justifiable by almost any metric used.
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How Should We Care for Elderly Cancer Patients?The Hippocratic principle of not harming the patient has remained up to this day an undisputed dogma in medicine. It reminds the physician of the possible detrimental, if not lethal, outcome of the treatment he prescribes and implicitly enforces good medical practice, although the true impact will unlikely be known. Oncology is one subspecialty of Medicine where this dilemma-ie, the pros and cons of treatment-is continuously put to the test, as the physician must decide on treatment for an often life-threatening illness while taking into account individual factors such as the patient’s will, performance status, available standard treatment options, and possible experimental approaches.
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Management of Tumors of the Parapharyngeal SpaceBenign and malignant tumors can arise from any of the structures contained within the parapharyngeal space. Such tumors are very rare, however. Also, malignant tumors from adjacent areas (eg, the pharynx) can extend into the parapharyngeal space by direct growth, or distant tumors may metastasize to the lymphatics within the space. Although the history and physical examination can provide clues to the site of origin and nature of a parapharyngeal space tumor, imaging studies are more useful for defining the site of origin and extent of the mass, as well as its vascularity and relationship to the great vessels of the neck and other neurovascular structures. Surgery is the mainstay of treatment. The surgical approach chosen should facilitate complete tumor extirpation with minimal morbidity. Irradiation is administered as primary therapy in patients with unresectable tumors, poor surgical candidates, and selected other patients. Radiation therapy is also used after surgery for high-grade malignancies or when wide surgical margins cannot be achieved. [ONCOLOGY 11(5):633-640, 1997]
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The Promise of Cryotherapy in Prostate CancerThis is an expertly written summary of the experience with cryotherapy as primary treatment of prostate cancer and the rationale for proceeding toward more limited, organ-sparing approaches with this procedure as focal treatment for low-risk cancers. Growing evidence of overdetection and overtreatment in many men with low-risk tumors has resulted in the recognition that alternatives to conventional treatment strategies are needed. Observation, a laudable and appropriate approach, appeals to relatively few patients.
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Commentary (Ship): Management of Xerostomia Related to Radiotherapy for Head and Neck CancerIn 2005, an estimated 29,370 newcases of oral cavity and pharyngealcancers were diagnosed inthe United States, accounting for2.14% of all cancer cases.[1] Over7,000 individuals will die from thesecancers in this country in 2005-approximately one death per hour.Many advances have been made inthe diagnosis and treatment of thesecancers, yet the mortality rate remainshigh (5-year survival rate of ~50%).Probably the most important approachis early detection, since early-stagetumors are associated with markedlybetter survival rates than late-stagecancers that have already spread toregional tissues and lymphatics.
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Management of a Patient With Borderline Resectable Pancreatic CancerIn this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man who presented with borderline resectable, periampullary pancreatic cancer and underwent a margin-negative resection following neoadjuvant chemoradiotherapy.
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Biomarkers, Pathology Help Target Breast Cancer TreatmentThe combination of biomarkers and molecular pathology will aid oncologists in developing targeted treatments for breast cancer, according to Samuel Aparicio, MD, PhD, who will be delivering a presentation on recognizing breast cancer heterogeneity in targeted treatment at the Miami Breast Cancer Conference this week.
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Esophageal CancerThis comprehensive guide for oncologists covers the diagnosis, staging, treatment, and management of esophageal cancer.
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Clinical Management of EGFRI Dermatologic Toxicities: US PerspectiveManagement of dermatologic toxicities from epidermal growth-factor receptor inhibitors (EGFRIs) is best tailored to the type of skin lesions present, extent of body surface involvement, and anatomic location affected. Although few randomized trials have been undertaken to address treatment of skin, hair, or nail side effects to this class of drugs, some basic principles of therapy based on experience of referral centers can help mitigate these toxicities and ensure consistent EGFRI administration and maintenance of patient quality of life. Patient education as to the expected EGFRI side effects and early physician intervention when these side effects appear can improve outcomes. Two dermatologists who treat high numbers of patients affected by these EGFRI-induced cutaneous side effects submit their recommendations for management.
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Cancer Management in Patients With End-Stage Renal DiseaseSignificant improvements in the management of patients with endstagerenal disease (ESRD) who are on chronic renal replacementtherapy (CRRT), has led to an increased prevalence of this populationamong older Americans. Since cancer is also common in the elderly,oncologists are likely to be faced with patients who suffer from bothcancer and ESRD. There is a paucity of information regarding issuessurrounding the optimal management of such patients, especially thoseneeding chemotherapy. This review surveys the relevant problemsoncologists may encounter in such patients and summarizes the availableliterature on chemotherapeutic management of common cancers.The reader is strongly urged to consult the original references for detailsof chemotherapy administration prior to use in an individualpatient.
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Treating Locally Advanced Penile CancerThis video examines the treatment of locally advanced penile cancer and whether an organ-sparing chemoradiotherapy approach might be an option instead of surgery.
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Putting Lung Cancer Clinical Trials Into PerspectiveGanti and colleagues have provided a comprehensive overview on recent presentations involving lung cancer.
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Central Nervous System Germ Cell Tumors: Controversies in Diagnosis and TreatmentThe variability and complexity of central nervous system germ cell tumors have led to controversy in both diagnosis and management. If a germ cell tumor is suspected, the measurement of cerebrospinal fluid and serum alpha-fetoprotein and beta–human chorionic gonadotropin is essential. A histologic specimen is not necessary if the patient has elevated levels; however, if the tumor markers are negative, a biopsy is needed to confirm the diagnosis of a germinoma. Germinomas are extremelyradiosensitive, enabling 5-year survival rates that exceed 90%. Treatment has traditionally included focal and craniospinal axis irradiation; however, multiple ongoing studies are being conducted to examinethe efficacy of reduction or elimination of radiation therapy with the addition of chemotherapy. Nongerminomatous germ cell tumors, on the other hand, are relatively radioresistant with a poorer outcome. The combination of chemotherapy and irradiation is associated with overall survival rates of up to 60%. This article provides a review of the controversies in diagnosis and treatment of central nervous system germ cell tumors.
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Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the OncologistDuring the last few years, pathologists have assumed several important roles in the assessment of adenocarcinomas of the prostate. The establishment of postoperative serum prostate-specific antigen (PSA)
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Chemotherapy-Induced Cardiomyopathy: Clinical Scenarios and ChallengesWe will discuss the deleterious cardiovascular effects of anthracyclines and HER2-targeted agents in a case-based format, as well as specific approaches to prevention and treatment of associated cardiotoxicity.
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Adjuvant Therapy for Rectal Cancer: Results and ControversiesIn this excellent article, Dr. Minsky examines the current state of knowledge about adjuvant therapy for resectable rectal cancer, as well as ongoing research in this area. Reasonable recommendations for the management of patients with rectal cancer are made based on data obtained from clinical trials.
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Commentary (Asgharzadeh/Finlay): Recent Advances in the Treatment of Pediatric Brain TumorsThe review by Gururangan andFriedman takes an interestingand informative approach to pediatricbrain tumors in emphasizingthe possible biologic bases for chemotherapyfailure in these neoplasmsin general, and focusing on newer, asyet largely unproven, strategies employing“biologic” therapies to circumventsuch mechanisms of tumor resistance.Many of these newer treatment strategiesare drawn from the work of theauthors and others in the field of adultmalignant gliomas. To date, minimalprogress has been achieved in improvingoutcome for children with malignantsupratentorial gliomas andbrainstem tumors. Hopefully, these newstrategies will have significant benefitin pediatric as well as adult patients.
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Unmet Needs and the Future of Multiple MyelomaExperts muse on the unmet needs of multiple myeloma, and exciting investigational therapies on the horizon.
