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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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Chemoprevention of Colorectal Cancer: Dietary and Pharmacologic ApproachesRemarkable progress has been made in recent years in our understanding of colorectal cancer etiology. The various hypotheses of causality continue to be tested in human observational and intervention studies, as well as experimental models. Drs. Garay and Engstrom provide a comprehensive review of the dietary and chemopreventive factors for colorectal cancer. While their conclusions are noteworthy, those related to dietary factors are debatable.
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Is Surgery Always Necessary in Rectal Cancer?In this article, we review risks and benefits of the standard treatment approach for rectal cancer and compare standard treatment with alternative methods aimed at rectal preservation.
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Advances in the Treatment of Gynecologic MalignanciesHistorically, two-thirds of patients with endometrial carcinoma had disease confined to the uterus, and the cornerstone of treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy. Since the introduction of surgical staging in 1988, however, more patients are found to have disease outside the uterine cavity. Unfortunately, the current rules for staging are not followed by every practitioner, and the required specimens for pathologic examination are not always obtained. Therefore, recommendations for postoperative adjuvant therapy are usually based on the surgico-pathologic information available for each patient.
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Intraperitoneal Drug Delivery for Ovarian Cancer: Why, How, Who, What, and When?Epithelial ovarian cancer (EOC) spreads prominently within the peritoneal cavity. In fact, we now know that high-grade serous cancers are often of tubal origin, and their presentation as tubo-ovarian masses renders it likely that intraperitoneal spread occurs as an early event in their clinical evolution.
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The Variegated Morphology of HPV-Related Neoplasms of the PenisOur commentary aims to expand on the evolution and present state of the art in the pathology of HPV in penile cancer and precancerous lesions.
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Cancer Metabolism as a Therapeutic Target: Finding the Right Target(s) in the Context of Tumor Heterogeneity, Evolution, and Metabolic PlasticitySince Otto Warburg first formulated his theory on the importance of metabolism in cancer, our knowledge of this process and of its complexity has expanded, as has our ability to target many metabolic pathways that are undoubtedly necessary for cancer proliferation.
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The UFT/Leucovorin/Etoposide Regimen for the Treatment of Advanced Gastric CancerGastric cancer is the most chemosensitive adenocarcinoma among digestive neoplasms. A few years ago, we performed a phase II trial with the FLEP regimen, in which fluorouracil (5-FU) and leucovorin are combined
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The Role of Surgery in Stage III Non-Small-Cell Lung CancerIn this edition of Clinical Quandaries, Ramalingam et al present a 67-year-old man who seeks care for a new, asymptomatic left upper lobe lung mass, which was found incidentally on a routine chest x-ray as part of a preoperative work-up for an elective surgery. Further staging studies included a computed tomography (CT) scan of the chest and a positron-emission tomography (PET) scan followed by a magnetic resonance imaging (MRI) scan of the liver. Pathology from a fine-needle aspiration biopsy of the left lingular lesion was consistent with poorly differentiated adenocarcinoma and immunohistochemical stains consistent with a lung primary. The left lingular lesion and the prevascular lymph node were felt to be the only sites of involvement, making this stage IIIA (T1, N2, M0) lung cancer.
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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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Precision Medicine in Phase I Cancer TrialsIn this video we discuss the use of biomarker-guided treatment in phase I trials, which can yield high response rates.
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Hereditary Renal Tumor Syndromes and the Use of mTOR InhibitorsA 47-year-old woman with a history of drug-resistant epilepsy during childhood presented to the emergency department with sudden dyspnea and chest pain. Upon admission, her oxygen saturation was 88%.
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Hematopoietic Stem Cell Transplantation in the ElderlyHematopoietic stem cell (HSC) transplantation may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. In some clinical settings, transplantation represents the only curative option. The feasibility and efficacy of this approach in older patients are undefined, since this population has been excluded from nearly all clinical trials. Advances in supportive care, HSC harvesting, and safer conditioning regimens have made this therapy available to patients well into their 6th and 7th decades of life. Recent evidence suggests that elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.
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ASTRO 2017: Highlights in Advanced Lung CancerThis video highlights studies on advanced lung cancer with practice-changing potential presented at the 2017 ASTRO Annual Meeting.
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Splenic Marginal Zone Lymphoma: Current Knowledge and Future DirectionsIn this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.
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Current Challenges in the Management of Patients with Relapsed/Refractory Multiple MyelomaFor patients with multiple myeloma (MM) who experience relapse, important advances in medical therapies in the past decade have doubled the duration of survival, mainly because of the effectiveness of novel agents such as thalidomide (Thalomid), bortezomib (Velcade), and lenalidomide (Revlimid).[1]
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The Role of Irinotecan and Oxaliplatin in the Treatment of Advanced Colorectal CancerColorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]
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Selecting Adjuvant Endocrine Therapy for Breast CancerThis year alone, more than 215,000 women in the United States will bediagnosed with, and over 40,000 will die from, invasive breast cancer.Recently, mortality from female breast cancer has declined despite anincrease in its incidence. This decline corresponds with improved screeningfor prompt tumor detection, and advances in the treatment of earlydisease. Of these, endocrine therapy has played a prominent role. Forwomen with estrogen receptor (ER)-positive and/or progesterone receptor(PR)-positive breast cancers, endocrine therapy has proven to be amajor component of adjuvant therapy, but it is not effective in womenwhose breast cancers lack ERs and PRs. The selective estrogen-receptormodulator (SERM) tamoxifen has been well established as safe and effectivein the adjuvant care of both pre- and postmenopausal women withhormone-receptor–positive early breast cancer. For premenopausalwomen, ovarian suppression is an important option to be considered.Additionally, the aromatase inhibitors have recently demonstrated utilityin postmenopausal women. The ideal sequencing of treatment withtamoxifen and/or an aromatase inhibitor is the subject of several ongoingstudies. Factors involved in selecting an appropriate endocrine regimenhave grown considerably over the past decade. It is becoming more importantfor those caring for women with breast cancer to fully understandthe available endocrine treatment options and the prognostic and predictivefactors available to help select the most appropriate treatment. Thegoal of this article is to assist clinicians in making decisions regardingadjuvant hormonal therapy and to provide information regarding availableclinical trials. To achieve this, the therapeutic options for hormonaltherapy will be reviewed, as will prognostic and predictive factors used inmaking decisions. Finally, four cases illustrating these difficult decisionswill be discussed, with recommendations for treatment.
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Fertility-Preserving Options for Cervical CancerChildbearing is one of the most important life goals for many women, and fertility preservation is a very important factor in the overall quality of life of cancer survivors. Cervical cancer frequently affects young women; because some women tend to delay childbearing, fertility preservation must be considered when treatment options are discussed. Over the past decade, the radical trachelectomy procedure has become a well established fertility-preserving option for young women with early-stage cancer; this procedure is associated with low morbidity, good oncologic outcome, and a high proportion of pregnancies that reach the third trimester and babies that are delivered at term. This article will review available literature on the vaginal radical trachelectomy procedure and data from other surgical approaches, such as the abdominal radical trachelectomy. In addition, the potential future application of neoadjuvant chemotherapy followed by fertility-preserving surgery in patients with locally advanced cervical cancer will be examined. Finally, ultraconservative surgical approaches (eg, conization alone with or without laparoscopic lymphadenectomy) in very early-stage disease will be discussed.
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Sentinel Node Evaluation in Gynecologic CancerA review of sentinel node mapping in vulvar and cervical cancer, a technique intended to reduced lymphadenectomy-associated morbidity, and the related controversies.
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Early Detection of Cutaneous LymphomaCutaneous lymphomas comprise a spectrum of diseases characterized by infiltration of the skin by malignant lymphocytes. The clinical manifestations of cutaneous lymphomas vary, and they can mimic benign dermatoses,
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Adjunctive Therapy of Gastric Cancer: Moving the Field ForwardCurrent methods of treatment still have a small impact on the survival of patients with localized disease. Improved understanding of the underlying mutations seen in gastric cancer might suggest alternative treatments and ways to better select patients.
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Some Older Women Still Need Cervical Cancer ScreeningThe number of women who undergo regular screening for cervical cancer drops as they get older, and while this is acceptable if women have been followed regularly until the age of 65 years, women who are not up to date with screening should be screened when they are older.
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Exploring The Use of Enfortumab Vedotin in Rare Genitourinary CancersAttending educational sessions may help with understanding how to manage toxicities associated with enfortumab vedotin in rare genitourinary cancers.
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Caring for Cancer Patients in the Future: A Perfect Storm on the Horizon?This timely manuscript by Bunnell and Shulman highlights critical issues that challenge our ability to provide care to cancer patients in the next 20 years. Each of the concerns the authors identify has a momentum of its own. In combination, they have the makings of a perfect health care storm. The time to further address these matters is now.
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Curbing Potential Radiation-Induced Cancer Risks in Oncologic Imaging: Perspectives From the ‘Image Gently’ and ‘Image Wisely’ CampaignsThe purpose of this review is to provide the oncology community with knowledge about the doses used in medical imaging, radiation-induced cancer risks from imaging, and considerations to keep in mind when balancing imaging benefits and risks in pediatric and adult oncologic settings.
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Oral Mucositis in Radiation/Chemotherapy: Treatment SimilaritiesOral mucositis (OM), also referred to as stomatitis, can negatively impact radiation and chemotherapy treatment schedules and add to oncology patients’ emotional and physical distress. About 35% to 40% of patients treated with cytotoxic chemotherapy will develop OM, with higher rates occurring in bone marrow transplant patients.
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Clarifying the Use of Ruxolitinib in Patients With MyelofibrosisIn this article, we provide updated data on ruxolitinib therapy for patients with myelofibrosis and offer expert opinion on the appropriate use of this agent in the community practice.
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POINT: Chemotherapy vs Abiraterone for the Initial Management of Metastatic Prostate CancerChemotherapy is the best option for the initial management of metastatic prostate cancer.
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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
