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Anaphylaxis: Implications of Monoclonal Antibody Use in OncologyThe phenomenon of anaphylaxis was discovered by Portier and Richet in 1903.[1,2] They injected dogs with toxins from sea anemone with the intent of generating protective antibodies. Unexpectedly, they found that certain dogs became ill with a rapid heartbeat and collapse. Because this syndrome was the precise opposite of protection or prophylaxis, they termed it anaphylaxis.
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Cancer of the Cervix: Current Management and New Approaches: Review 2This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.
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Management Considerations in Cancer Patients With Rheumatoid ArthritisPatients with cancer and concomitant rheumatoid arthritis pose special challenges. Many therapies for rheumatoid arthritis can increase the risk of adverse events during cancer therapy because they are immunosuppressive.
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Changing Concepts in the Management of Endometrial CancerEndometrial carcinoma was a clinically staged disease until the late 1980s, at which point, staging changed to a surgicopathologically defined system. This change in staging, in turn, altered the clinical management of this
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ACR Appropriateness Criteria® Ductal Carcinoma in SituManagement of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
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Palliative RT Research in Prostate Cancer: Understanding the Past, Anticipating the FutureMoving forward, perhaps no recent development in the use of RT in metastatic prostate cancer has captured greater attention than the use of radium-223 in metastatic castration-resistant prostate cancer (mCRPC).
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Commentary (Frenkel): Chronic Inflammation and CancerThe review by Drs. Shacter and Weitzman is an excellent and timely contribution to the field of carcinogenesis. The issue of chronic inflammation as a progenitor of cancer development has been a controversial one. To prove the importance of chronic inflammation (and the factors released in the process) to carcinogenesis, the authors provide a thorough and logical presentation of the experimental results described in the literature, including their own work. This compilation of the existing data should dispel any doubts about the association of chronic inflammation to cancer. I will review the main points discussed by the authors.
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Book Review: The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary TherapiesMany oncologists are barraged with questions and declarations from patients regarding therapies and products that
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Time to Change the Treatment Paradigms in Anaplastic Thyroid CarcinomaIn rare diseases, the “magic” lies in close collaboration between individual investigators at academic institutions, the pharmaceutical industry, and funding institutions such as the National Cancer Institute.
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Acute Myeloid Leukemia With Adverse Cytogenetic RiskAcute myeloid leukemia (AML) encompasses multiple disease entities that differ with regard to marrow morphology, cytochemistry, immunophenotype, pretreatment clinical characteristics, and treatment outcome.
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Liposomal Doxorubicin in Combination With Bortezomib for Relapsed or Refractory Multiple MyelomaLiposomal doxorubicin received FDA approval for use in combination with bortezomib in patients with multiple myeloma who have not previously received bortezomib and have received at least one prior therapy.
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T Cell Diversity in Tumor May Influence Ovarian Cancer OutcomesIn this video Dr. Odunsi discusses a new study that found that higher T-cell diversity in ovarian cancer is associated with poor overall survival.
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Guillain-Barré Syndrome After Treatment With Sunitinib Malate?Sunitinib malate (Sutent, SU011248) is an oral multitargeted tyrosine kinase inhibitor used for treatment of renal cell carcinoma and gastrointestinal stromal tumor. We report a case of a patient who developed Guillain-Barré syndrome after initial treatment with sunitinib, with recurrent symptoms upon reintroducing the drug. This is the first report of such an effect. The literature on chemotherapy-induced Guillain-Barré syndrome is also reviewed. Oncology providers should be aware of this rare but potentially serious possible adverse effect of sunitinib.
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Evolution of Treatment Options for Patients With CRPC and Bone Metastases: Bone-Targeted Agents That Go Beyond Palliation of Symptoms to Improve Overall SurvivalThis review will examine agents with potential activity in the palliation and treatment of skeletal metastases of prostate cancer, and will weigh the clinical-outcomes evidence for and against their broad use.
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Diagnosis of Invasive Lobular Carcinoma in a Young Woman Presenting With Pleomorphic Lobular Carcinoma in Situ on Core BiopsyA 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.
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Cisplatin/Etoposide vs Paclitaxel/Cisplatin/G-CSF vs Paclitaxel/Cisplatin in Non-Small-Cell Lung CancerA phase III trial conducted by Eastern Cooperative Oncology Group (ECOG) investigators assessed the possible impact of paclitaxel on survival, response, and toxicity in patients with
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Quality-of-Life Improvement in Patients Receiving Paclitaxel/Platinum RegimensThe combination regimen of paclitaxel (Taxol) and cisplatin (Platinol) for non–small-cell lung cancer has shown improved response rates in some phase II trials, and because of its safety profile, it could offer patients with this
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Vaccine Therapy for Patients With MelanomaInvestigation into the therapeutic use of vaccines in patients with metastatic melanoma is critically important because of the lack of effective conventional modalities. The most extensively studied melanoma vaccines in clinical trials are whole-cell preparations or cell lysates that contain multiple antigens capable of stimulating an immune response. Unfortunately, in the majority of studies, immune responses to these vaccines have not translated into a survival advantage. Advances in tumor cell immunology have led to the identification of candidate tumor cell antigens that can stimulate an immune response; this, in turn, has allowed for refinements in vaccine design. However, the exact tumor antigens that should be targeted with a specific vaccine are unknown. The univalent antigen vaccines, which have greater purity, ease of manufacturing, and reproducibility compared with polyvalent vaccines, may suffer from poorer efficacy due to immunoselection and appearance of antigen-negative clones within the tumor. Novel approaches to vaccine design using gene transfection with cytokines and dendritic cells are all promising. However, the induction of immune responses does not necessarily confer a therapeutic benefit. Therefore, these elegant newer strategies need to be studied in carefully designed clinical trials so that outcomes can be compared objectively with standard therapy. If survival is improved with these vaccine approaches, their ease of administration and lack of toxicity will firmly entrench active specific vaccine immunotherapy as a standard modality in the treatment of the melanoma patient.[ONCOLOGY 13(11):1561-1574, 1999].
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Epidemiology of Cancer and Prevention StrategiesCancer epidemiology is the study of the distribution, determinants, and frequency of malignant disease in specific populations [1]. The objective is to define causative factors to formulate preventive strategies for control of the disease.
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In Vivo Purging With Rituximab Prior to Stem Cell Collection Is Associated With Persistent Molecular Evidence of t(14;18) That Often Disappears Post-Transplant in Patients With Follicular LymphomaWe previously reported that “in vivo purging” with rituximab (Rituxan) during stem-cell collection is safe and does not adversely affect engraftment. We now report on our transplant experience with rituximab. From June 1998 to December
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Consolidation TherapyWe previously reported the efficacy of concurrent cisplatin (Platinol)/etoposide (PE) and radiotherapy in stage IIIB non–small-cell lung cancer in which biopsy confirmation of T4 (noneffusion) or N3 status was required (S9019). In view of the activity of docetaxel (Taxotere) as second-line therapy and potential molecular mechanisms of action favoring taxane sequencing, we designed the present study to maintain a core of concurrent PE/radiotherapy, but to substitute docetaxel consolidation for the two additional cycles of PE.
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Topoisomerase I Inhibitors in the Combined-Modality Therapy of Lung CancerLocally advanced non–small-cell lung cancer represents 30% to 40%of all pulmonary malignancies. Most patients will die of the diseaseafter aggressive contemporary treatments. Therefore, significant improvementin therapeutic methods must be implemented to improveoverall survival rates. The arrival of a new generation of chemotherapeuticagents-including the taxanes, gemcitabine (Gemzar), andtopoisomerase inhibitors such as irinotecan (Camptosar) and topotecan(Hycamtin)-offers the hope of significant advances in the treatmentof lung cancer. Irinotecan and topotecan are camptothecin derivativesthat inhibit topoisomerase I enzyme. It is believed that topoisomerase Iinhibitors stabilize a DNA/topoisomerase I complex and interact withreplication machinery to cause cell death. A significant amount of datademonstrates that these topoisomerase I inhibitors also act asradiosensitizers. With the increasing data that support concurrentchemoradiation treatment for malignancies, including lung cancer andhead and neck cancers, there is an impetus to pursue the additionaldrugs that may potentially improve local control and survival. Irinotecanis undergoing early clinical trials in the combined-modality setting inseveral different disease sites. This paper will review the data on therole of camptothecin derivatives as a radiosensitizer and as a componentof combined-modality therapy for lung cancer. It is hoped thatnewer treatment strategies, like the combination of radiation andtopoisomerase I inhibitors, will have a significant impact on cure ratesin the future.
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Androgen Deprivation Therapy: A Survival Benefit or Detriment in Men With High-Risk Prostate Cancer?Androgen deprivation therapy (ADT) has been used in the management of prostate cancer for more than four decades. Initially, hormone therapy was given largely for palliation of symptomatic metastases. Following several randomized trials of patients with intermediate- to high-risk prostate cancer that demonstrated improvements in biochemical control and survival with the addition of ADT to external beam radiotherapy, there was a dramatic increase in the use of hormone therapy in the definitive setting. More recently, the safety of ADT has been questioned, as some studies have suggested an association of hormone therapy with increased cardiovascular morbidity and mortality. This is particularly worrisome in light of practice patterns that show ADT use extrapolated to situations for which there has been no proven benefit. In the setting of dose escalation with modern radiotherapy, in conjunction with the latest concerns about cardiovascular morbidity with ADT, the magnitude of expected benefit along with potential risks of ADT use must be carefully considered for each patient.
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Therapeutic Activity of Humanized Anti-CD20 Monoclonal Antibody and Polymorphism in IgG FcReceptor FcgRIIIa GeneRituximab (Rituxan) is a chimeric IgG1 anti-CD20 monoclonal antibody increasingly used in the treatment of non-Hodgkin’s lymphoma (NHL). Previous in vitro studies have suggested the role of antibody-dependent cellular cytotoxicity (ADCC) and FcgR-positive effector cells (natural killer and macrophage) in the antitumor effects of anti-CD20 antibodies, but the actual mechanism of rituximab action in vivo remains largely unknown. The FCGR3A gene coding for the FcgRIIIa receptor displays a functional dimorphism with either a phenylalanine (FCGR3A-158F) or a valine (FCGR3A-158V) at amino acid 158, with a higher affinity of human IgG1 and increased ADCC for the latter. The aim of this study was thus to determine the influence of this FCGR3A polymorphism on clinical and molecular responses to rituximab.
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Gamma Knife Radiosurgery for 5 to 10 Brain Metastases: A Good Option for Upfront TreatmentThe aggressive management of brain metastases with SRS has supplanted radiation therapy in an effort to maintain patient quality of life in an era of advancing systemic cancer options.
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Docetaxel vs Mitomycin Plus Vinblastine in Anthracycline-Resistant Metastatic Breast CancerThis nonblinded, multicenter, randomized phase III study compares the median time to progression (primary endpoint), response rate, and quality of life, safety, and survival of
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Activity of Rituximab in Extranodal Marginal Zone Lymphomas (MALT Type)This phase II study aimed to evaluate the tolerability and activity of the monoclonal anti-CD20 antibody rituximab (Rituxan) in patients with either untreated or relapsed biopsy-proven extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, with measurable or evaluable disease.
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Cost-Effectiveness of Rituximab in Treatment of Diffuse Large B-Cell LymphomaRituximab (Rituxan), when combined with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) chemotherapy (R-CHOP) in the treatment of patients with CD20-positive diffuse large B-cell lymphoma (DLCL), significantly prolongs event-free and overall survival (GELA [Groupe d’Etude des Lymphomes de l’Adulte] LNH 98-5 study). Our objective was to estimate the cost-effectiveness of R-CHOP based on the evidence currently available.
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Irinotecan in Relapsed or Refractory Non-Hodgkin’s LymphomasBecause irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.
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Efficacy and Safety of Tositumomab/Iodine-131 Tositumomab in the Expanded Access Study: Interim Report From Two InstitutionsRelapsed or refractory low-grade non-Hodgkin’s lymphoma (NHL) and transformed low-grade NHL are incurable diseases. Tositumomab/iodine-131 tositumomab (Bexxar) is a novel
