Authors


Joseph G. Rajendran, MD

Latest:

Tumor Hypoxia and the Future of Cancer Management

The role of hypoxia as a key determinant of outcome for human cancers has encouraged efforts to noninvasively detect and localize regions of poor oxygenation in tumors. In this review, we will summarize existing and developing techniques for imaging tumoral hypoxia. A brief review of the biology of tumor oxygenation and its effect on tumor cells will be provided initially. We will then describe existing methods for measurement of tissue oxygenation status. An overview of emerging molecular imaging techniques based on radiolabeled hypoxic markers such as misonidazole or hypoxia-related genes and proteins will then be given, and the usefulness of these approaches toward targeting hypoxia directly will be assessed. Finally, we will evaluate the clinical potential of oxygen- and molecular-specific techniques for imaging hypoxia, and discuss how these methods will individually and collectively advance oncology.


Joseph J. Disa, MD, FACS

Latest:

Plastic Surgery: A Component in the Comprehensive Care of Cancer Patients

Part of the multidisciplinary approach to cancer care involves surgical intervention. This is harmoniously interwoven through the efforts of the surgical oncologist and the reconstructive surgeon. As elegantly pointed out by Drs. Hasen, Few, and Fine, the reconstructive surgeon’s role in the management of malignancy is critical, involving the restoration of form and function. Sometimes, as in breast reconstruction, quality of life is improved by the restoration of form; other times, as in head and neck reconstruction, it is improved by the restoration of form and function. In fact, due to the significant morbidity associated with major ablation of head and neck cancer, such radical surgery would not be feasible without concomitant reconstruction.


Joseph J. Fantony, MD

Latest:

Thromboembolism and Bleeding in Bladder Cancer

Overall, approximately 2% of patients with bladder cancer will experience a venous thromboembolism event, a rate five times higher than that in the overall population; also, such an event results in a threefold increased risk of death in patients with cancer.


Joseph K. Salama, MD

Latest:

Palliative Radiotherapy for Prostate Cancer

This review will include discussion of the role of radiation therapy for osseous metastases and metastatic spinal cord compression, as well as the use of radiopharmaceuticals for painful osseous metastases.


Joseph Lattanzi, MD

Latest:

Prostate Cancer

This management guide covers the treatment, diagnosis, and staging of prostate cancer.


Joseph M. Baron, MD

Latest:

Book Review:Wintrobe’s Clinical Hematology, 10th Edition

The 10th edition of Wintrobe’s Clinical Hematology is a two volume, multiauthored work that spans the ever-expanding discipline of hematology in over 2,600 pages. The book is appropriately introduced by an excellent short chapter written previously by Dr. Wintrobe on “The Diagnostic and Therapeutic Approach to Hematologic Problems.” There follows a valuable series of six chapters totaling 133 pages devoted to laboratory hematology, including blood and bone marrow examination, immunodiagnosis, clinical flow cytometry, cytogenetics, clusters of differentiation, and molecular genetics. These chapters contain ample illustrations, diagrams, tables, and references.


Joseph M. Colasanto, MD

Latest:

Evaluation and Definitive Management of Medically Inoperable Early-Stage Non-Small-Cell Lung Cancer: Part 2

Lung cancer is estimated to be the second most commonly diagnosed cancer in both men and women in 2006, and the leading cause of cancer mortality. Non-small-cell lung cancer represents the majority of such cases. Most of these patients have locally advanced disease at presentation and are not eligible for curative resection. For the minority of patients who are technically resectable at presentation, lobectomy or pneumonectomy and pathologic mediastinal nodal staging offer the best overall survival. The high rate of comorbid medical illness and poor baseline pulmonary function in this population, however, make many such early-stage patients medically inoperable. For these patients, conventional single-modality radiotherapy has been the primary definitive treatment option, as discussed in part 1 of this article, which appeared in last month's issue. Numerous retrospective reports demonstrate long-term disease-free and overall survival data that are modestly superior to that expected after observation, but both local and distant failure continue to be significant risks. Investigation of radiotherapy dose escalation is ongoing, in an effort to improve local control while maintaining minimal toxicity. Additionally, emerging evidence suggests that new modalities, such as stereotactic radiosurgery and radiofrequency ablation, may also be potentially curative treatment alternatives. These modalities are addressed in part 2.


Joseph M. Connors, MD

Latest:

Who Should-or Should Not-Receive RT for DLBCL?

As we examine the question of which patients with DLBCL do not need RT, the first step must be to confine our review to patients who have received optimal chemotherapy.


Joseph M. Herman, MD, MSc

Latest:

ACR Appropriateness Criteria® Borderline and Unresectable Pancreas Cancer

These guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.


Joseph M. Pepek, MD

Latest:

Intensity-Modulated Radiation Therapy for Anal Cancer

Historically, the treatment of squamous cell carcinoma of the anal canal has been an abdominoperineal resection (APR), resulting in loss of the anus and rectum with need for a permanent colostomy.


Joseph M. Pyle Iii, MD, PhD

Latest:

Pathologic Evaluation of Prostatic Carcinoma: Critical Information for the Oncologist

Adenocarcinoma of the prostate is now the most common tumor in males. The use of the digital rectal examination, prostate-specific antigen (PSA), and transrectal ultrasound of the prostate with biopsies has improved the detection of prostate cancer and has increased the percentage of patients with organ-confined disease who are treated with radical prostatectomy. It is critical for the practicing urologic and medical oncologist to have accurate and precise pathologic information in order to counsel patients for appropriate therapy. Ideal biopsy and clinical predictive criteria for tumor volume in prostates are not readily available in the literature.


Joseph P. Lattanzi, MD

Latest:

Pain Management in Patients With Advanced Prostate Cancer

The article by Olson and Pienta is a thorough review of the important issues facing men with metastatic prostate cancer and their caregivers. Many recent reports have documented physicians’ lack of awareness about cancer pain, which underscores the significance of proper evaluation and management. As the authors note, any evaluation of current and future therapies must focus not only on the efficacy of pain control but also on how a particular treatment affects a patient’s overall quality of life.


Joseph Paul Eder, MD

Latest:

Prospects for Targeting PD-1 and PD-L1 in Various Tumor Types

In this review, we will discuss the current status of several anti–PD-1 and anti–PD-L1 antibodies in clinical development and their direction for the future.


Joseph R. Bertino, MD

Latest:

Commentary (Bertino): New Antifolates in Clinical Development

The excellent review by Drs. Takimoto and Allegra summarizes the current status of the new antifolates in clinical development. Based on knowledge of why methotrexate is ineffective in the treatment of many tumors (ie, either intrinsic or acquired resistance), and on the identification of new targets for folate inhibitors (eg, thymidylate synthase [TS] and glycinamide ribonucleotide [GAR] transformylase), new antifolate development has recently received a great deal of attention from both industry and academic centers.


Joseph R. Mikhael, MD

Latest:

Real World Experience of CAR-T in MM Patients

This segment examines Dr. Mikhael's approach to comparing ide-cel and cilta-cel for patient selection, emphasizing how patient traits, efficacy, and safety profiles influence treatment decisions across different groups.


Joseph R. Salvatore, MD

Latest:

Nonionizing Electromagnetic Fields and Cancer: A Review

Low-frequency electromagnetic radiation had previously been thought to cause human injury only by generation of excess heat or by shock from direct contact with electric current. Information accumulating over the past few


Joseph Ragaz, MD

Latest:

Neoadjuvant Chemotherapy for Operable Breast Cancer

Preoperative therapy delivers treatment at the earliest time in a tumor’s natural history. Is it beneficial or harmful? Should it be undertaken? The article by Drs. Green and Hortobagyi brings most aspects of neoadjuvant therapy under one umbrella and poses several key questions.


Joseph S. Bailes, MD

Latest:

International cancer diagnosis, treatment varies widely

Coverage in most countries is universal, but limited resources can sometimes hinder how much coverage a person can expect.


Joseph Skitzki, MD

Latest:

New Does Not Always Mean Better: Isolated Limb Perfusion Still Has a Role in the Management of In-Transit Melanoma Metastases

In the recent era of effective systemic therapies for melanoma, the provocative question of whether isolated limb perfusion still plays a role in the treatment of patients with in-transit melanoma metastases is timely and relevant.


Joseph Sung, MD, PhD

Latest:

Low-Dose Aspirin Reduced CRC Mortality, Increased Bleeding Risk

This video examines a population-based study that examined colorectal cancer mortality and gastrointestinal bleeding in patients with long-term use of low-dose aspirin.


Joseph Thakuria, MD

Latest:

What’s New in Genetic Testing for Cancer Susceptibility?

The dilemma for clinicians is how best to understand and manage this rapidly growing body of information to improve patient care. With millions of genetic variants of potential clinical significance and thousands of genes associated with rare but well-established genetic conditions, the complexities of genetic data management clearly will require improved computerized clinical decision support tools, as opposed to continued reliance on traditional rote, memory-based medicine.


Joseph Treat, MD

Latest:

Liposomal-Encapsulated Chemotherapy: Preliminary Results of a Phase I Study of a Novel Liposomal Paclitaxel

Liposome encapsulation of antineoplastic drugs entered clinical testing in the late 1980s. As carriers for a variety of agents, liposomes can allow successful delivery of agents that may be subject to rapid degradation in


Joseph W. Kim, MD

Latest:

Mechanisms of Immunotherapy Resistance in mCRPC: Identifying the Enemy on the Visceral Metastatic Battlefield

Clinical trial results to date show that men with visceral CRPC metastases do not benefit from ipilimumab, while their counterparts with bone- or node-only metastases do. This suggests that visceral metastases should be a stratification factor for future immunotherapy clinical trials.


Josephine Faust, MD

Latest:

Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal Cancer

Local-regional carcinoma of the esophagus is often diagnosed inadvanced stages because the diagnosis is established when symptomsare severe. The prognosis of patients with local-regional carcinoma ofthe esophagus continues to be grim. While preoperative chemoradiotherapyincreases the fraction of patients who achieve pathologiccomplete response, that percentage is approximately 25%. In an attemptto increase the number of patients with either no cancer in the surgicalspecimen or only microscopic cancer, we adopted a three-step strategy.The current study utilized up to two 6-week cycles of induction chemotherapywith irinotecan (CPT-11, Camptosar) and cisplatin as step 1.This was followed by concurrent radiotherapy and chemotherapy withcontinuous infusion fluorouracil (5-FU) and paclitaxel as step 2. Oncethe patients recovered from chemoradiotherapy, a preoperative evaluationwas performed and surgery was attempted. All patients signed aninformed consent prior to their participation on the study. A total of 43patients were enrolled. The baseline endoscopic ultrasonography revealedthat 36 patients had a T3 tumor, five patients had a T2 tumor, andtwo had a T1 tumor. Twenty-seven patients had node-positive cancer(N1). Thirty-nine (91%) of the 43 patients underwent surgery; all hadan R0 (curative) resection. A pathologic complete response was noted in12 of the 39 patients. In addition, 17 patients had only microscopic(< 10%) viable cancer in the specimen. Therefore, a significant pathologicresponse was seen in 29 (74%) of 39 taken to surgery or 29 (67%)of all 43 patients enrolled on the study. With a median follow up beyond25 months, 20 patients remain alive and 12 patients remain free ofcancer. Our preliminary data suggest that the proportion of patientswith significant pathologic response can be increased by using thethree-step strategy.


Josette Brière, MD, PhD

Latest:

Splenic Marginal Zone Lymphoma: Current Knowledge and Future Directions

In this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.


Josh Kremer, MD

Latest:

Lenvatinib Delays Thyroid Cancer Progression

Josh Kremer, MD, vice president of clinical development at Eisai, Inc, discusses results of the phase III SELECT trial, which studied lenvatinib in radioiodine-refractory differentiated thyroid cancer.


Josh Lauring, MD, PhD

Latest:

TORn in Two Over Breast Cancer Drug Resistance

Knowing the genetic makeup of patient tumors permits the development of new DNA-based diagnostics, such as BEAMing and PARE. By incorporating these new tools into future trials, we should be able to concurrently learn about drug resistance and significantly improve patient responses.


Josh Wisell, MD

Latest:

Diagnosis of Invasive Lobular Carcinoma in a Young Woman Presenting With Pleomorphic Lobular Carcinoma in Situ on Core Biopsy

A 40-year-old premenopausal woman with a new diagnosis of invasive lobular carcinoma occurring in a background of lobular carcinoma in situ presents to a multidisciplinary second opinion clinic.


Joshi J. Alumkal, MD

Latest:

Targeted Therapy in Prostate Cancer: Is There Hope Beyond the Androgen Receptor?

We need to understand each patient’s cancer and its microenvironment well enough to develop targeted treatments that will kill the tumor the first time-for if we let it escape, 70 years of prostate cancer research teaches us that our job will only get harder.


Joshua A. Jones, MD, MA

Latest:

Palliative Radiotherapy for Prostate Cancer: Encouraging Single-Fraction Radiotherapy

As new data and new treatment options emerge, palliative radiotherapy algorithms will need to undergo continuous modifications and updates to ensure that patients receive optimal symptom relief.