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Endometrial Cancer Patients Not Offered Genetic Counseling ReferralsAccording to a study recently presented at the 2017 American Society of Clinical Oncology Annual Meeting, held June 2–6 in Chicago, women diagnosed with endometrial cancer are oftentimes not provided with genetic counseling referrals.
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Managing Toxicities of High-Dose Interleukin-2Although high-dose interleukin-2 (IL-2, Proleukin), a highly toxic agent used in the treatment of renal cell carcinoma and melanoma, was initially associated with treatment-related mortality, it can, in the appropriate
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Ibrutinib Yields Response in Patients With Chronic GVHDThis video examines a phase I/II study of ibrutinib in patients with chronic GVHD who failed corticosteroids.
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UFT/Leucovorin Plus Weekly Paclitaxel in the Treatment of Solid TumorsThe palliation of symptoms and improvement of quality of life are important aspects of therapy in patients with incurable metastatic cancer. This article describes the preliminary results of a phase I study of uracil and tegafur, an orally available fluorouracil (5-FU) derivative combined with oral leucovorin plus weekly intravenous paclitaxel.
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Commentary (Seres/Harrison): Nutritional Support of Patients Undergoing Radiation Therapy for Head and Neck CancerDr. Colasanto and his associatesare to be commended forskillfully and comprehensivelyreviewing the issues concerning theprovision of nutritional support to patientsundergoing radiation therapy.Their recommendations are well supportedby review of scientific studies,and the article is written in such a wayas to be accessible to those not fullyversed in prescribing nutritional support.There remain a few points thatdeserve discussion.
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Improving Outcomes in Advanced DLBCL: Systemic Approaches and RadiotherapyIn this review, we will first briefly summarize prior attempts to improve outcomes in advanced DLBCL using systemic therapy approaches, and then we will highlight the potential role of RT in advanced DLBCL.
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Urothelial and Kidney CancersThis management guide covers the treatment of urothelial cancers (carcinomas of the bladder, ureters, and renal pelvis) and kidney cancers (renal tumors).
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Beyond Neutrophil Recovery: Manipulation of the Tumor Microenvironment by GM-CSF to Control CancerCancer researchers can almost feel the ground rumble beneath their feet as they walk through their clinics and laboratories. A veritable explosion of information has radically altered the way we think about cancer, and has introduced new concepts
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COUNTERPOINT: Early Salvage vs Adjuvant Radiotherapy for High-Risk Prostate CancerThe data for adjuvant radiotherapy remain strong.
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Commentary (Kavoussi)-Testicular Cancer: What’s New in Staging, Prognosis, and TherapyExperienced authors Richard Foster and Craig Nichols providea thoughtful, state-of-the-art discussion of current controversies in the management of testicular cancer. Present cure rates illustrate that significant diagnostic, chemotherapeutic, and surgical advances made over the past century have transformed testicular cancer from a once uniformly fatal disease into a tremendous oncologic success story.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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The "Epidemic" of Breast Cancer in the U.S.--Determining the FactorsDrs. King and Schottenfeld have provided an interesting review of the literature in their attempts to relate changes in breast cancer incidence over time to secular changes in postulated risk factors.
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Primary Metastatic Small Intestinal Carcinoid Tumor Without Carcinoid SyndromeSmall intestinal “carcinoid” or well-differentiated grade 1 neuroendocrine tumors can have an insidious onset or be diagnosed serendipitously at the time of surgery, during the workup for another disorder, or during a screening test.
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Improving Cancer Clinical TrialsIn this interview we discuss outcomes in clinical trials and how to improve trials by redefining clinically meaningful outcomes.
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Role of Calcium/Magnesium Infusion in Oxaliplatin-Based Chemotherapy for Colorectal Cancer PatientsThe combination of oxaliplatin plus fluorouracil/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for colorectal cancer (CRC), both as adjuvant therapy and as treatment for metastatic disease. Unfortunately, platinum-based chemotherapies also produce neurotoxicity as a side effect. Neurotoxicity is the most common dose-limiting toxicity of oxaliplatin, and it is one of the major causes for patients to stop receiving chemotherapy. It can manifest as either of two distinct syndromes: a transient, acute syndrome that can appear during or shortly after the infusion (~1%–2% of patients), and a dose-limiting, cumulative sensory neuropathy. Calcium/magnesium (Ca/Mg) infusions have been used to decrease the incidence of oxaliplatin-induced neuropathy. The actual utility of Ca/Mg infusions in this setting has been an interesting and controversial topic. They may reduce the severity of neurotoxicity, but some investigators have questioned whether they also will alter the efficacy of these chemotherapy regimens. In this paper, we review the clinical data concerning the usefulness of Ca/Mg infusions in reducing the incidence of oxaliplatin-induced neuropathy as well as their effect on responsiveness to chemotherapy.
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New Research on HER2-Positive Breast CancerDr. Gianni has been involved with new drug therapies in medical oncology for some time, and in this interview he discusses the changing use of breast cancer treatments, neoadjuvant regimens, and research and developments on HER2-positive breast cancer.
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Endometrial Carcinoma and Precursors: Diagnosis and TreatmentThis clinically oriented text focuses on the diagnosis and management of endometrial adenocarcinoma and endometrial hyperplasia. Due to its clinical orientation, the book does not include information on the molecular basis of endometrial cancer.
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Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerPlatinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
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Race and Cancer Genetics: Lessons From BRCA1Health disparities among populations within the United States are well documented. In order to eliminate these disparities, we must further understand their sources. Are they the result of the unequal distribution of resources, racism, or inherent characteristics of ethnically or "racially" defined groups? How we define and discuss "race" has major scientific and moral consequences. In this issue, Leslie Klein Hoffman asks two major questions as they pertain to research on ethnic or "racially" defined groups. When is genetic research on a population appropriate? How should researchers define a given population? These questions are timely, and it is both humbling and instructive that the answers to these questions remain unclear.
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Perspectives on Salvage Therapy for Non–Small-Cell Lung CancerPlatinum-based chemotherapy offers a modest survival advantage overbest supportive care in chemotherapy-naive patients with a good performancestatus and advanced/metastatic non–small-cell lung cancer(NSCLC). Despite the survival benefit associated with first-line chemotherapy,the majority of patients will experience relapse or disease progression.In clinical practice, an increasing number of patients maintaina good performance status after first-line treatment and are eligible forfurther treatments. Docetaxel (Taxotere) at 75 mg/m2 given once every3 weeks has been the standard of care for second-line chemotherapy sincethe year 2000. Pemetrexed (Alimta) is a novel multitargeted antifolateagent with single-agent activity in first- and second-line treatment ofNSCLC. A large phase III study comparing docetaxel to pemetrexed insecond-line therapy demonstrated that pemetrexed is equally active andless toxic than docetaxel. Based on these results, pemetrexed is a reasonablesecond-line chemotherapy option for patients with recurrent, advancedNSCLC. Progress made in the field of molecular biology has led to theidentification of drugs active against specific cellular targets. Gefitinib(Iressa) and erlotinib (Tarceva) are both orally active tyrosine kinase inhibitorsof the epidermal growth factor receptor. Phase II and III trialshave demonstrated that these agents are active particularly in a subgroupof patients with specific biologic characteristics. Both drugs have beenapproved for the treatment of pretreated NSCLC. Other drugs, such ascetuximab (Erbitux) and bevacizumab (Avastin) have shown promisingactivity in NSCLC and are currently being tested in clinical trials.
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Navigating the Impact of Chemotherapy Shortages on Cancer Care and FinancesPharmaceutical, gynecologic oncology, and physician perspectives shed light on potentially mitigating the ongoing carboplatin and cisplatin shortages’ effects on cancer care in the United States.
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Radiation Therapy in the Management of Brain Metastases From Renal Cell CarcinomaBrain metastases from renal cell carcinoma (RCC) cause significant morbidity and mortality. More effective treatment approaches are needed. Traditionally, whole-brain radiotherapy has been used for palliation. With advances in radiation oncology, stereotactic radiosurgery and hypofractionated stereotactic radiotherapy have been utilized for RCC brain metastases, producing excellent outcomes. This review details the role of radiotherapy in various subgroups of patients with RCC brain metastases as well as the associated toxicities and outcomes. Newer radiosensitizers (eg, motexafin gadolinium [Xcytrin]) and chemotherapeutic agents (eg, temozolomide [Temodar]) used in combination with radiotherapy will also be discussed.
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Risk of Breast and Ovarian Cancer in Women With Strong Family HistoriesAssessing the risk of breast and ovarian cancer starts with obtaining a complete and accurate family history. This can reveal evidence of inherited cancer risk. The highest risk of cancer is associated with germ-line abnormalities
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Commentary (Fuhrmann/Suter): Radiotherapy for Cutaneous Malignant Melanoma: Rationale and IndicationsIn their article on radiotherapy forcutaneous malignant melanoma,Drs. Ballo and Ang discuss fourkey points, which we will addressbelow.
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Pemetrexed in Second-Line Treatment of Non–Small-Cell Lung CancerAccording to the updated 2004 guidelines of the American Societyof Clinical Oncology (ASCO) on the treatment of advanced non–smallcelllung cancer (NSCLC), docetaxel (Taxotere) can be considered thestandard second-line chemotherapy in patients relapsing after frontlinetherapy. This was based on two phase III trials (TAX 317 and TAX320) that demonstrated the superiority of docetaxel at 75 mg/m2 in theparameters of survival, quality of life, and disease/symptom controlwhen compared to best supportive care or alternative single-agent chemotherapy.The response rate was approximately 6%, with a mediansurvival time of 7 months and a 1-year survival rate of 30%. Despitethe activity demonstrated, this schedule showed an important toxicityprofile, with grade 3/4 neutropenia and febrile neutropenia occurringin 70% and 11% of patients, respectively. However, the results obtainedby these studies stimulated research interest in new drugs for this diseasesetting. Pemetrexed (Alimta), a new multitargeted antifolate, hasachieved promising results in NSCLC treatment, as a single agent or incombination with other drugs. In the second-line setting, a large phaseII study demonstrated good activity of pemetrexed, with an acceptabletoxicity profile. This led to a phase III registration trial that comparedpemetrexed at 500 mg/m2 to the standard docetaxel dose of 75 mg/m2.While results from this trial demonstrated a similar efficacy of the tworegimens in response rate and survival, pemetrexed achieved a bettersafety profile. These results support the use of pemetrexed as a newoption in the second-line treatment of NSCLC.
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The Utility of Molecular Testing in Colorectal Cancer: The Promise Needs ProgressMolecularly profiling colorectal cancer has opened many potential opportunities for the use of this information in therapeutic decision-making. However, at present, only RAS testing in the metastatic setting has a definitive place in the decision-making paradigm.
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Uracil/Tegafur Plus Oral Calcium Folinate in Advanced Breast CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) has proven activity against breast cancer and is delivered in an easy-to-administer oral formulation. Orzel, which combines UFT with the oral biomodulator, calcium folinate, may
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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.
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Monitoring Residual Disease in Colon CancerDr. Luis Diaz spoke with Cancer Network about monitoring for residual disease in colon cancer ahead of his presentation at ESMO 2018.
