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Lung Cancer in the Elderly: Factors to ConsiderThe issue of cancer in the elderly is of growing concern given the aging population. It is a particular issue in lung cancer, where the median age of patients is over 60.
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Stereotactic Body Radiation TherapyThe article by Song, Kavanagh,Benedict, and Schefter is an insightfuland interesting summaryof this new technologic approachto the treatment of extracranial tumors.The work summarizes thesalient aspects of the emerging stereotacticbody radiation therapy (SBRT)paradigm, and characterizes the rationale,methodologies, and perceivedpotential for this promising new approachto treatment. The authorspresent interesting perspectives on thechallenges facing early adopters ofthe approach and, as early adopters,we find that our own experience supportsmany of the conclusions drawnby the authors.
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Further Perspectives on Treating Localized Prostate CancerStandard treatment options for prostate cancer patients include surveillance, surgery, external-beam radiotherapy, brachytherapy, the combination of external-beam and brachytherapy, and the combination of radiotheraputic modalities with hormonal therapy, for appropriately chosen patients.
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Paclitaxel as First-Line Treatment for Metastatic Breast CancerWhen administered as a single agent in pretreated patients with advanced breast cancer, paclitaxel (Taxol) exhibits remarkable antitumor activity. This trial was undertaken to compare paclitaxel with standard
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Oral UFT Plus Leucovorin in Patients With Relapsed or Refractory Colorectal CancerTherapeutic options for patients with advanced colorectal cancer who have failed treatment with fluorouracil (5-FU) are limited. Responses have been reported in this setting with a protracted venous infusion of 5-FU. Daily oral therapy with tegafur and uracil (UFT) plus leucovorin (LV) has the potential to mimic the pharmacology of continuous infusion 5-FU. Therefore, we undertook a phase II study of a 28-day schedule of a combination chemotherapy regimen containing oral UFT/leucovorin in patients with measurable metastatic colorectal cancer who had failed treatment with bolus 5-FU. In addition, we sought to determine whether coadministration of UFT and leucovorin alters the bioavailability of these agents. In a pretreatment phase, each patient underwent sequential pharmacokinetic sampling following a single dose of UFT alone, leucovorin alone, and the combination of UFT plus leucovorin. The preliminary results of this trial suggest that tegafur pharmacokinetics are not affected by coadministration of leucovorin and that folate pharmacokinetics are not affected by UFT. [ONCOLOGY 11(Suppl 10):22-25, 1997]
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Gemcitabine in Combination With New Platinum Compounds: An UpdateCombinations of gemcitabine (Gemzar) with cisplatin (Platinol) are among the most active new chemotherapy regimens developed for advanced non-small-cell lung cancer. Carboplatin (Paraplatin) is a platinum analog
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ABT-414 Shows Promise Against EGFR-Amplified GlioblastomaIn this interview we discuss findings from M12-356, an open-label, phase I, escalation cohort study of the investigational anti-EGFR antibody-drug conjugate ABT-414 for patients with EGFR-amplified recurrent glioblastoma.
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Book Review: Textbook of Uncommon Cancer, Second EditionThe second edition of the Textbook of Uncommon Cancer is a useful resource for practicing oncologists who encounter unusual presentations of common tumors or esoteric subtypes of more common cancers. The text is laid out according to
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The Costs of Cancer Care in the United States: Implications for ActionThe total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high
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Mind-body medicine in cancer care: Making patients wholeA cancer diagnosis carries with it a unique set of challenges for patients, their family, and healthcar e professionals. Patients newly diagnosed with cancer and their support people are frequently in shock, fearful, and emotionally regressed.
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Recurrent Pancreatic Adenocarcinoma After Pancreatic ResectionThe University of Colorado Denver School of Medicine faculty hold weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologic specialist. Their history, pathology, and radiographs are reviewed during the multidisciplinary conference, and then specific recommendations are made. These cases are usually challenging, and these conferences provide an outstanding educational opportunity for staff, fellows, and residents in training.The second opinion conferences include actual cases from genitourinary, lung, melanoma, breast, neurosurgery, gastrointestinal, and medical oncology. On an occasional basis, ONCOLOGY will publish the more interesting case discussions and the resultant recommendations. We would appreciate your feedback; please contact us at second.opinion@uchsc.edu.
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Don't Undercode: Bill Level Five for Payment of Cognitive ServicesA large part of delivering high-value cancer care is devoted to cognitive services, which are very difficult to quantify within the current coding system. Achieving appropriate payment for cognitive services delivered is an ongoing dilemma within the oncology community.
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Colorectal Cancer Patients With Oligometastatic Liver Disease: What Is the Optimal Approach?In a good percentage of patients who have oligometastatic disease confined to a single organ-usually the liver-complete metastasectomy can result in cure. However, once the decision to pursue surgery is made, there remain a number of issues that must be addressed in order to ensure the best possible outcome.
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Cancer, Unproven Therapies, and MagicCommonly used by cancer patients, unproven therapies are treatments that the practitioner claims can alter the disease process although there is no proof to support the claim. The reasons for the popularity of uproven
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Provocative Pearls in Diagnosing and Treating Acute Promyelocytic LeukemiaThe treatment of APL in the modern era is a success of modern hematology. In this review we have attempted to plant the seeds of understanding regarding how diagnosis and treatment of APL will be pursued over the next decade.
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Modulation of Dose Intensity in Aerodigestive Tract Cancers: Strategies to Reduce ToxicityAdvances in diagnostic and therapeutic radiology and a better understanding of cell biology are being applied in practical ways to modulate treatment morbidity. Conformal radiotherapy targets the cancer precisely and can be combined with new systemically administered radiosensitizers.
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Patterns of Chemotherapy Administration in Patients With Intermediate-Grade Non-Hodgkin’s LymphomaRecords from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-
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Paclitaxel in the Treatment of Small-Cell Lung CancerNew treatment strategies for small-cell lung cancer patients are required, as there have been few developments in the past 20 years. Paclitaxel (Taxol) has been shown to be effective in non–small-cell lung cancer when given in
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UFT Plus Calcium Folinate Plus Radiotherapy for Recurrent Rectal CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) plus calcium folinate comprise the components of the oral agent, Orzel, which appears to have activity comparable to intravenously administered 5-fluorouracil. This article
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A Large Cystic Pancreatic Mass in a 45-Year-Old FemaleThe patient is an otherwise healthy 45-year-old female who presented to her primary care physician with 6 weeks of increasing left upper quadrant abdominal pain with radiation to the back. She underwent an abdominal ultrasound, which revealed a large cystic abdominal mass.
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Larger Questions About Chemotherapy in Older PatientsDrs. Gillison and Chatta present an up-to-date review of the systemic treatments available to elderly patients with the most common types of cancer. The only point I might add in the context of their review is about recently reported, promising data on targeted therapies in acute leukemia patients. A large proportion of older patients have acute lymphocytic leukemia positive for a t(9;22) translocation (Philadelphia chromosome–positive ALL).
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Trastuzumab Resistance: Bringing Tailored Therapy to the ClinicAs Calabrich and colleagues illustrate in their comprehensive review in this issue of ONCOLOGY, there is a seemingly endless array of mechanisms by which the HER2-positive breast cancer cell can escape the control of trastuzumab (Herceptin).
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Flaws in Medicare coding interpretationsWe work with medical oncologists/hematologists across the country in both the private practice and hospital settings. Based on our experience, I'd like to point out a couple of key flaws in the current Medicare code interpretations.
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Persistence of Lymphedema Reduction After Noninvasive Complex Lymphedema TherapyWe treated 119 consecutive patients with lymphedema with complex lymphedema therapy (CLT). Lymphedema reductions after CLT averaged 62.6% in the 56 patients with one affected arm and 68.6% in the 38 patients with
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Management of Pain in the Older Person With Cancer Part 2: Treatment OptionsPain in older cancer patients is a common event, and many times it is undertreated. Barriers to cancer pain management in the elderly include concerns about the use of medications, the atypical manifestations of pain in the elderly, and side effects related to opioid and other analgesic drugs. The care of older cancer patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. It is important to use appropriate tools to evaluate pain and other symptoms that can be related to it. Pain in older cancer patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions whose main goals are decreasing suffering and improving quality of life. In this two-part article, the authors present a review of the management of pain in older cancer patients, emphasizing the roles of adequate assessment and a multidisciplinary team approach.
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Molecular Testing to Optimize and Personalize Decision Making in the Management of Colorectal CancerRecent improvements in our understanding of the biology of colorectal cancer have led to the identification of several important prognostic and predictive markers of disease-associated risk and treatment response for the individual patient.
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Clinical Pearls for Treating Metastatic Colorectal CancerMarwan G. Fakih, MD, and Atif Hussein, MD, MMM, FACP, conclude their discussion with advice for clinicians treating patients with metastatic colorectal cancer.
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Management of Breakthrough Pain Due to CancerBreakthrough pain is defined as the transient exacerbation of pain occurring in a patient with otherwise stable, persistent pain. Breakthrough pain is relatively common among cancer patients, particularly those with moderate
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Biologic Basis for Radiation OncologyImproved understanding of the underlying biologic mechanisms that pertain to radiation oncology is providing an explanation for the cellular and tissue responses to ionizing radiation and is leading to the potential for novel
