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Chronic Lymphocytic Leukemia and Associated DisordersChronic lymphocytic leukemia (CLL) is the most common adult leukemia in the Western hemisphere, accounting for 30% of the leukemias in this population. The disease results from a clonal expansion of small B-lymphocytes. CLL always involves the bone marrow and peripheral blood. The disease also can be demonstrated in lymph nodes, liver, and spleen.
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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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UFT in Combination as Adjuvant Therapy for Breast CancerBetween 1989 and 1993, 409 evaluable patients with breast cancer have been treated with tegafur and uracil (UFT) in an adjuvant setting in two different trials. Data from both trials were reviewed in December 1995 after a
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Understanding the Links Between Lung Cancer, COPD, and Emphysema: A Key to More Effective Treatment and ScreeningA better delineation of the relationships between lung cancer, COPD, and emphysema may lead to significant improvements in the effectiveness of lung cancer screening programs, and to reductions in the morbidity and mortality associated with these deadly diseases.
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Nivolumab Effective in Advanced Non-Squamous NSCLCIn this video, Dr. Paz-Ares discusses a phase III study that showed that nivolumab improved survival and response rates in previously treated patients with metastatic non-squamous non-small-cell lung cancer (NSCLC).
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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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How to Evaluate Risk and Identify Stage II Patients Requiring Referral to a Medical OncologistApproximately 150,000 new cases of colorectal cancer were expected for the year 2009 in the United States. Moreover, 49,920 deaths related to colorectal cancer were also predicted for the same year. The age-adjusted cancer death rates related to colorectal cancer have steadily declined over the past 2 decades. This improvement is a direct consequence of advances in prevention and treatment, including colorectal cancer screening, diagnostic tests, surgical technique, adjuvant therapies, and medical support.
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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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Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Emerging Treatment StrategiesOver the past decade, patients with locally advanced rectal cancer at The University of Texas M. D. Anderson Cancer Center have been managed with preoperative chemoradiation. Patients achieving a complete clinical response to preoperative chemoradiation have had better pelvic tumor control, sphincter preservation, and overall survival than those with gross residual disease. Some patients achieving a complete clinical response have even had rectal-preserving surgery (full-thickness local excision).
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UFT and Its Metabolites Inhibit Cancer-Induced Angiogenesis via a VEGF - Related PathwayTreatment with UFT for spontaneous lung metastasis of murine renal carcinoma (RENCA) after resection of the primary tumor has resulted in significant prolongation of the life span of tumor-bearing animals. UFT inhibited the growth of metastatic nodules in the lung, apparently via decreased density of microvessels in the metastatic foci. Subsequent experiments used dorsal air sac assay to directly trace newly forming microvessels.
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Surgical Management of Neuroendocrine Tumors of the Gastrointestinal TractThis article reviews the surgical management of gastrointestinal neuroendocrine tumors, including the preoperative control of hormonal symptoms, extent of resection required, postoperative outcomes, and differing management strategies as determined by whether the tumor has arisen sporadically or as part of a familial disorder, such as multiple endocrine neoplasia type 1.
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Use of Brachytherapy to Preserve Function in Children With Soft-Tissue SarcomasDr. Nag and colleagues present an excellent review of several of the techniques of brachytherapy used in both the pediatric and adult populations. The authors are to be commended for their comprehensive summary of the results of the major trials of pediatric brachytherapy in the management of soft-tissue sarcomas.
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Pegylated Liposomal Doxorubicin: Antitumor Activity in Epithelial Ovarian Cancer or Cancers of Peritoneal OriginAfter pegylated liposomal doxorubicin (PEG-LD) (Doxil) was shown to be active in ovarian tumors, several trials were developed at the University of Southern California to determine its safety and efficacy in a variety of gynecologic and peritoneal malignancies. Completed phase I and phase II trials have found PEG-LD to be safe and effective in the treatment of platinum- and paclitaxel-refractory epithelial ovarian carcinoma. A new phase II trial is currently underway in similarly refractory patients with ovarian and other related cancers and various degrees of pretreatment. In addition, the efficacy of PEG-LD is being explored in combination with paclitaxel (Taxol), with cisplatin, and with hyperthermia. [ONCOLOGY 11(Suppl 11):38-44, 1997]
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Concurrent Chemotherapy and Radiotherapy in Patients With Brain TumorsBecause treatment for most brain tumors remains inadequate, there has been a sustained interest in using concurrent chemotherapy and radiotherapy to improve local control, prolong overall survival, and reduce
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Cancer Stem CellsTreatments that target cancer stem cells have been proposed as alternatives to current cancer therapies. However, the clonal evolution model suggests that multiple tumor cell populations may need to be targeted for these treatments to be successful.
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Questions We Should Be Asking About Bevacizumab for Cervical CancerThere is good evidence that angiogenesis plays a central role in cervical cancer pathogenesis, suggesting a strong rationale for adding anti-angiogenesis agents to chemotherapeutic agents for the treatment of this disease.
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Update on Malignant MesotheliomaMesotheliomas are uncommon in the United States, with an incidenceof about 3,000 new cases per year (or a risk of about 11 per million Americansper year). Incidence and mortality, however, are probably underestimated.Most are associated with asbestos, although some have arisen inports of prior radiation, and a reported association with simian virus (SV)40remains controversial. About 85% of mesotheliomas arise in the pleura,about 9% in the peritoneum, and a small percentage in the pericardiumor tunica vaginalis testis. The histology of about half of mesotheliomas isepithelial (tubular papillary), with the remainder sarcomatous or mixed.Multicystic mesotheliomas and well-differentiated papillary mesotheliomasare associated with long survival in the absence of treatmentand should be excluded from clinical trials intended for the usual rapidlylethal histologic variants of the disease. The median survival isunder a year, although longer median survivals for selected patients,particularly those with epithelial histology, have been reported in somecombined-modality studies. Recent randomized trials have shown significantimprovement in time to progression and survival for the additionof new antifolates to platinum-based chemotherapy.
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Lobular Neoplasia: How to Manage With Partial UnderstandingIn this issue of ONCOLOGY, Drs Oppong and King provide an organized and comprehensive summary of guidelines for the clinical management of patients with lobular carcinoma in situ (LCIS).
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Diagnosis and Management of Mycosis FungoidesMycosis fungoides (MF), the most common cutaneous T-cell lymphoma, is a low-grade cutaneous lymphoma characterized by skin-homing CD4+ T cells. It is notable for highly symptomatic progressive skin lesions, including patches, plaques, tumors, and erytheroderma, and has a poorer prognosis at later stages. Diagnosis remains difficult owing to MF’s nonspecific skin presentation and identification of the optimal treatment strategy is challenging given the paucity of controlled trials and numerous and emerging treatment options. Management includes topical therapy with the addition of systemic therapy for patients with later-stage disease including tumors; erythroderma; and nodal, visceral, or blood involvement. Topical therapies include mechlorethamine (nitrogen mustard), carmustine (BCNU), steroids, bexarotene gel (Targretin Gel), psoralen plus ultraviolet A (PUVA), ultraviolet B (UVB), and either localized or total skin electron radiotherapy. Systemic therapies include interferon, retinoids, oral bexarotene (Targretin), denileukin diftitox (Ontak), vorinostat (Zolinza), extracorporeal photochemotherapy (photopheresis), and cytotoxic chemotherapy. Herein, we outline clinically relevant aspects of MF, including clinical presentation, pathology, diagnosis, and staging. We describe in detail existing and emerging therapeutics and offer specific recommendations for management of each stage of MF.
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Book Review:Nutritional OncologyNutritional Oncology provides acomprehensive review of the current scientific literature on nutritional factors affecting the prevention and treatment of cancer. The book’s primary objective is to detail findings in the new field of nutritional oncology,
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Adjuvant Therapy of MelanomaIn 2001, the American Joint Committee on Cancer Melanoma Staging Committee proposed and created a new staging system for melanoma. This new system will become official in 2002, with the publication of the sixth
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A Comparison of FDA and EMA Drug Approval: Implications for Drug Development and Cost of CareThe development and approval of oncology therapeutics has been facilitated by the cooperation and coordination of regulatory practices between the EMA and the FDA. However, there continue to be important differences between the decisions of the two agencies.
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Clinical Status and Optimal Use of the Cardioprotectant, DexrazoxaneThere are many challenges facing those involved in chemotherapy drug development. In addition to identification of new agents, clinical investigators must address questions regarding the optimal methods of administration of established agents so as to maximize efficacy and minimize toxicity. Treatment toxicity affects not only morbidity and mortality but also issues of dose intensity, quality of life, and health-care costs. Therefore, there is great interest in preventing the side effects associated with chemotherapy.
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Bernard Salick Launches a New Health Care EnterpriseBernard Salick, the man some call a medical visionary, does not brood on his setbacks. A mere 24 hours after Zeneca Group PLC had assumed total control of Salick Health Care, the Southern California nephrologist had launched yet another medical enterprise--Bentley Health Care.
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Update on Adjuvant Interferon Therapy for High-Risk MelanomaTwo of the most important predictors of relapse (and, therefore, survival) in patients with melanoma are the Breslow thickness of the primary melanoma and regional lymph node involvement. Patients with melanomas greater than 4 mm in thickness have approximately a 50% risk of recurrence, and those with lymph node involvement have a 50% to 85% risk of recurrence depending on the number of lymph nodes involved. Thus, a group of patients can be identified who are at high risk of death from melanoma and are, therefore, appropriate candidates for postsurgical adjuvant therapy.
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Evaluation and Definitive Management of Medically Inoperable Early-Stage Non-Small-Cell Lung Cancer: Part 2Lung 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.
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Stress and Burnout in OncologyThis article identifies the professional stressors experienced by nurses, house staff, and medical oncologists and examines the effect of stress and personality attributes on burnout scores. A survey was conducted of 261 house
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Coping With ‘Chemobrain’Cognitive impairment, including memory loss, inability to concentrate, and difficulty multitasking, has become a widely recognized possible late effect of chemotherapy and cancer treatment.
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ASCO: An Epidemic of Contralateral Prophylactic MastectomyWhile overall mastectomy rates have dropped in recent years, more and more women with cancer in one breast are opting to have both breasts removed. The trend has left many researchers questioning whether contralateral prophylactic mastectomy (CPM) is getting overused, or if it simply reflects a better recognition by both patients and physicians of who is likely to develop breast cancer.
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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.
