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In this review, we discuss the established guidelines and current evidence regarding post-treatment surveillance, and we propose general management strategies in prostate, colorectal, and breast cancers.

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Mehmet Asim Bilen, MD, summarizes recent advances in metastatic RCC and looks towards the future of the field.

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Mehmet Sitki Copur, MD, gives his perspective on liquid biopsies and how they can be utilized in gastrointestinal cancer.

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In general, surgery has no role inthe curative treatment of metastaticbreast cancer. Metastatic breastcancer is considered incurable, associatedwith an average survival of 18 to24 months. Certain factors such as hormone-receptor negativity, HER2/neupositivedisease, and a short disease-freeinterval portend a poor prognosis. Theliver is not usually a site of initialfailure-less than 15% of patients fitthis pattern.[1] Even fewer are candidatesfor surgical resection due toextrahepatic disease. Eventually, overhalf of all patients with metastatic diseasewill have liver metastasis duringtheir clinical course.

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This text, originally published as Dameshek and Gunz's textbook Leukemia (1958), is now edited by an international team consisting of Dr. Henderson, Dr. Lister, and Dr. Greaves. This continues to be an outstanding text in its field, covering virtually all aspects of the acute and chronic leukemias.

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BETHESDA, Md--Cancer patients may be more likely to enter treatment trials if the medical centers are near their own homes. With this in mind, the National Cancer Institute and the Division of Cancer Prevention and Control developed the Community Clinical Oncology Program (CCOP).

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This management guide covers the diagnosis and treatment of early-stage breast cancers, including lobular carincoma in situ (LCIS), ductal carcinoma in situ (DCIS), and both noninvasive and invasive disease.

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This review covers progress to date in the identification of molecular targets on blood vessels in cancers, as well as agents that act on those targets, with emphasis on those currently in clinical trials. Current vascular-targeting therapies comprise two general types—antiangiogenic therapy and antivascular therapy. Advances in antiangiogenic therapies, particularly inhibitors of vascular endothelial growth factors and their receptors, have clarified the capacity of these inhibitors to change tumor-associated vessel structure to a more normal state, thereby improving the ability of chemotherapeutics to access the tumors. The responses of other antiangiogenesis target molecules in humans are more complicated; for example, αvβ3 integrins are known to stimulate as well as inhibit angiogenesis, and cleavage of various extracellular proteins/proteoglycans by matrix metalloproteinases produces potent regulators of the angiogenic process. Antivascular therapies disrupt established blood vessels in solid tumors and often involve the use of ligand-based or small-molecule agents. Ligand-based agents, irrespective of the antiangiogenic capacity of the ligand, target antivascular effectors to molecules expressed specifically on blood vessels, such as aminopeptidase N, fibronectin extra-domain B, and prostate-specific membrane antigen. Small-molecule antivascular agents, which are not targeted to molecules on blood vessels, rely on physical differences between the vasculatures in tumors and those in normal tissues.

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Prophylactic cranial irradiation(PCI) in patients with locallyadvanced non–small-cell lungcancer (NSCLC) remains an area ofcontroversy. Dr. Gore has provided areview of the literature, including randomizedand nonrandomized studiesand, in particular, the ongoing RadiationTherapy Oncology Group trial(RTOG 0214), which is randomizingNSCLC patients to PCI or observation.

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To define the differences between the subtypes of myeloma patients, not only prospective collection of clinical and laboratory data are needed, but also cytogenetics and molecular profiling.

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It is ironic that while huge strides have been made in the treatment of invasive breast carcinoma, resulting in breast conservation for many women, the most appropriate treatment of noninvasive breast carcinoma remains a topic of hot debate.

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Synergy with no overlapping toxicities has been demonstrated for the combination of irinotecan ( Camptosar, CPT-11) and gemcitabine (Gemzar) in vitro. Results of a single-institution phase I study in which patients with

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Within the relatively short time that ipilimumab and vemurafenib have been commercially available, phase II data for the investigational agents nivolumab and MK-3475, for the combination of dabrafenib and trametinib, and for adoptive cell therapy strongly suggest even further improvements in treatment outcomes.

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In this review, we will discuss multidisciplinary considerations in treating patients with neoadjuvant therapy and highlight areas of controversy and ongoing research.

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The patient, DB, is a 51-year-old white, married female with a strong family history of breast cancer. She presented for high-risk assessment and genetic testing following the discovery of a deleterious mutation in a family member.

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Osteoporosis in elderly cancer patients is an increasing problem, yet it remains under-recognized and under-managed. We commend Dr. Balducci for writing a comprehensive review of the bone complications associated with cancer and its treatment in the elderly.

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Melissa L. Johnson, MD, spoke about the design of the phase 3 POSEIDON trial how its data led to the recent approval of tremelimumab plus durvalumab and chemotherapy in patients with advanced non–small cell lung cancer.

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Here we review the evolution of sentinel lymph node biopsy for the management of clinically node-negative breast cancer, and we address the current controversies and management issues.

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Squamous cell anal cancer remains an uncommon entity; however,the incidence appears to be increasing in at-risk populations, especiallythose infected with human papillomavirus (HPV) and human immunodeficiencyvirus (HIV). Given the ability to cure this cancer using synchronouschemoradiotherapy, management practices of this disease arecritical. This article considers treatment strategies for HIV-positive patientswith anal cancer, including the impact on chemoradiation-inducedtoxicities and the role of highly active antiretroviral therapy in the treatmentof this patient population. The standard treatment has beenfluorouracil (5-FU) and mitomycin (or cisplatin) as chemotherapy agentsplus radiation. Consideration to modifying the standard treatment regimeis based on the fact that patients with HIV tend to experience greatertoxicity, especially when CD4 counts are below 200; these patients alsorequire longer treatment breaks. Additional changes to the chemotherapydosing, such as giving 5-FU continuously and decreasing mitomycin dose,are evaluated and considered in relation to radiation field sizes in an effortto reduce toxicity, maintain local tumor control, and limit need forcolostomy. The opportunity for decreasing the radiation field size andusing intensity-modulated radiation therapy (IMRT) is also considered,particularly in light of the fact that IMRT provides dose-sparing whilemaximizing target volume dose to involved areas. The impact of the immunesystem in patients with HIV and squamous cell carcinoma of theanus and the associated response to therapy remains unknown. Continuedstudies and phase III trials will be needed to test new treatment strategiesin HIV-infected patients with squamous cell cancer of the anus todetermine which treatment protocols provide the greatest benefits.

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The Oncology Group, a division of CMPMedica, publisher of the journal ONCOLOGY and the news magazine Oncology News International, as well as the comprehensive cancer website, cancernetwork.com, is pleased to bring you the 10th annual edition of Cancer Management: A Multidisciplinary Approach.

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FDA approval of palliative chemotherapy is largely based on disease-free and overall survival, quality of life, and symptom reduction; the latter should be routinely measured by the treating oncologist. Physician assessments of symptoms underreport symptom severity compared to patient-reported symptom assessments.

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About 50,000 hematopoietic stem cell transplantations are performed yearly, primarily for malignancies. Use of this therapy increased dramatically over the past 30 years due to its proven and potential efficacy in diverse

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Despite nearly a decade of paclitaxel’scommercial availability,the best strategy formanaging several paclitaxel-relatedtoxicities including myalgia/arthralgiaremains to be elucidated. Mostavailable data in the treatment of myalgia/arthralgia have been anecdotal,reported in the form of case studiesor within the toxicity results of publishedpaclitaxel-containing clinicaltrials. Garrison et al have provided awell-written review summarizingwhat is currently known about theincidence and management of thisquality-of-life–impacting toxicity.

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As more drugs become available in the HER2 arena, clinicians will be faced with increasing challenges regarding which sequences and combinations of drugs will be the best for their patients. In the era in which we practice, a great deal of this is likely to be dictated by the payers.

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Lannin and Haffty provide aninteresting and informative reviewon the management andclinical course of an ipsilateral breasttumor recurrence (IBTR) followinglumpectomy and breast irradiation forprimary breast cancer. They presentan engaging discussion concerningthe distinction of a true recurrencefrom a new primary tumor within theipsilateral breast. Although bothevents are included in the term IBTR,the authors point out that the morefavorable outcome follows treatmentof a new primary as opposed to a truerecurrence. Presumably, the true recurrencewould indicate tumor thathas not been eradicated by surgeryand radiotherapy (with or without systemictherapy), which would be amore aggressive malignancy. Thebetter prognosis for a new primarynotwithstanding, there is still a lackof data to indicate whether treatmentshould be different for these twoentities.

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In the May, 1997, issue of Oncology News International , the updated eight-year results of NSABP protocol B-17 were reported as presented by Dr. Bernard Fisher in Paris. B-17 randomized patients with ductal carcinoma in situ (DCIS) into two groups: One group received excision only, the other excision plus postoperative radiation therapy.

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The lung is the most frequent site of metastasis from soft-tissue sarcomas. Due to the relative resistance of sarcoma to either chemotherapy or radiotherapy, compared to other solid tumors, surgical management of

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Infections are major causes of morbidityand mortality in patientswith cancer. In certain instances,the malignancy itself can predisposepatients to severe or recurrent infections.For example, acute leukemiamay cause neutropenia and ensuingbacterial or fungal infection. Hypogammaglobulinemiaof chroniclymphocytic leukemia may be complicatedby infections due to encapsulatedbacteria. Patients withHodgkin’s lymphoma may sufferfrom recurrent varicella-zoster infections.Solid tumors may obstruct thelumens of respiratory, digestive, andurinary tracts, leading to bacterial infections.Nevertheless, the principalrisk of infectious complications is relatedto the intensity and duration ofimmunosuppressive chemotherapy.Patients with cancer constitute ahighly varied population, both interms of the underlying malignancyand in terms of their immunosuppression.In addition, a single patientmay have multiple predisposing factors,thus increasing the spectrum oflikely pathogens. When evaluating apatient with cancer for a possible infection,it is essential to develop aconceptual framework of quantitativeand qualitative immune defectsthe patient is likely to have, and thento stratify the risk for specific pathogensin the context of the history,physical exam, and laboratorydata.[1]