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PSA Screening: Good Evidence Shows Little Benefit, Significant HarmsThe Task Force’s recommendation against PSA screening for prostate cancer is based on the best available science and the knowledge that, while we all want to prevent suffering and death from prostate cancer, PSA screening simply does not get us there.
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Stereotactic Radiation Therapy Combined With Immunotherapy: Augmenting the Role of Radiation in Local and Systemic TreatmentIn this review we detail the rationale supporting a combination of immunotherapy and stereotactic radiation. Additionally, we discuss the evidence for the immune stimulatory effects of focused radiation and the role that radiation may play in enhancing the systemic treatment effects of immunotherapy.
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Ipilimumab for Advanced Melanoma: Let’s Not Throw Caution to the WindsThe authors provide a timely and relevant review of the role that the immune system plays in regulating tumor growth and how immune modulation can alter tumor response. This review follows from the recently published phase III trial of ipilimumab,[1] a monoclonal antibody to cytotoxic T-lymphocyte antigen 4 (CTLA-4) and the first therapy in several decades to produce prolonged overall survival (OS) in patients with metastatic melanoma. While this outcome underscores the importance of this therapy in treating metastatic melanoma, its clinical applicability, at least on a widespread level, necessitates further exploration.
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Use of Hematopoietic Hormones for Bone Marrow Defects in AIDSAboulafia provides an extensive review of the occurrence of and treatments for bone marrow disorders that complicate HIV infection and AIDS. Understanding of the pathogenesis of these disorders is increasing, and the availability of recombinant colony-stimulating factors (CSFs) has, in many ways, facilitated the treatment of HIV-1 infection and its complications. Nonetheless, numerous critical questions remain regarding the optimal use of these expensive and powerful reagents.
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State of CML TreatmentsIn this interview, we discuss the current state of therapies available in treating CML patients and the role of newer agents.
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Second-Guessing the FDA: CMS’s Expanding Regulatory RoleNothing gets biopharma policy watchers more worked up than the possibility that the Centers for Medicare & Medicaid Services (CMS) will second-guess FDA approval decisions. In reality, though, CMS often has no choice but to apply its own interpretation to issues that also fall under the FDA’s jurisdiction-and implementation of the health care reform is bringing more of those cases to the fore.
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Management of Benign and Aggressive Intracranial MeningiomasBenign and aggressive intracranial meningiomas, as the authors state, are seemingly simple tumors (even with benign histology) that can behave in a clinically malignant fashion solely by location. Clinicians with experience in the management of patients with aggressive, recurrent, or malignant meningiomas are all too well aware of the difficulties of recommending effective therapy beyond surgery and radiation therapy. Clearly, there is much room for improvement in the treatment of recurrent or malignant meningiomas with local or systemic chemotherapy and/or biologic therapies.
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Assessing the Impact of Chemotherapy on Tumor- Related Symptoms in Advanced Colorectal CancerIn all patients with advanced colorectal cancer, disease eventually progresses following fluorouracil (5-FU) therapy, with a worsening of disease-related symptoms and quality of life (QOL). Irinotecan (CPT-11[Camptosar])
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The Pathways of Tomorrow: What Does the Future Hold for the Treatment of Colorectal Cancer?The currently available therapies for colorectal cancer have led to a significant increase in survival, but the majority of patients with advanced disease progress and eventually die of their disease. This is a particularly frustrating scenario when a patient experiences a complete remission, only to recur with refractory disease.
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Cancer Management Chapter 9: Esophageal cancerAlthough still relatively uncommon in Western countries, esophageal cancer is fatal in the vast majority of cases. In the United States, an estimated 16,470 new cases will be diagnosed in the year 2009, and 14,530 deaths will result from the disease. This high percentage of deaths rivals that of pancreatic cancer and is more than four times that of rectal cancer.
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Commentary (Needle): Long-Term Survival of Children with Brain TumorsThe diagnosis and treatment of children with brain tumors has changed radically over the last 50 years. Cross-sectional imaging, CT and MRI, has displaced angiography and pneumoencephalography. These newer imaging modalities have facilitated early diagnosis, preoperative planning, and surgical approach, resulting in an increased likelihood of achieving complete surgical extirpation. The operating microscope has improved the experienced surgeon's ability to discriminate between tumor and normal brain, making radical resection more frequent. Chemotherapy has been introduced into the arsenal of the neuro-oncologist, albeit with only modest success. The one nearly constant treatment modality has been external-beam irradiation.
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Tools for Measuring and Improving the Quality of Oncology Care: The Quality Oncology Practice Initiative (QOPI®) and the QOPI Certification ProgramThe American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI®) is a voluntary program designed to assess and improve processes of care in oncology practices.
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Latest Immunotherapy Research in Treating Colorectal CancerIn this interview we discuss the CheckMate 142 trial, which looked at nivolumab and ipilimumab for the treatment of metastatic colorectal cancer.
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Managing a Small Recurrence in the Previously Irradiated BreastBreast cancer is the most common newly diagnosed malignancy among American women. In 2008, an estimated 182,460 new cases of invasive breast cancer, and an additional 67,770 cases of in situ cancer were diagnosed. Approximately 40,480 women will die from breast cancer each year.
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Commentary (Perry): Cancer Management in Patients With End-Stage Renal DiseaseThe increasing number of patientson chronic renal replacementtherapy translates to additionalpatients living long enoughto develop a malignancy. For the mostpart this population will also be elderly,adding the nuances associated withpracticing oncology in a geriatric population.As discussed by Eneman andPhillips, the use of chemotherapeuticagents in patients with end-stage renaldisease (ESRD) is complicated byboth practical and ethical issues.
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The Best Treatment for Diffuse Large B-Cell Lymphoma: A German PerspectiveWhile some improvement was achieved by adding etoposide and shortening the treatment intervals from 3 to 2 weeks (CHOEP-14), best results in young good-prognosis patients (age-adjusted International Prognostic Index [IPI] = 0,1) have been achieved with six cycles of CHOP (cyclophosphamide, doxorubicin HCl, vincristine [Oncovin], prednisone)-like chemotherapy in combination with the anti-CD20 antibody rituximab (Rituxan). The role of additional radiotherapy in this setting remains to be determined. With this approach, 2-year eventfree survival rates of > 90% and overall survival of > 95% can be achieved in a very favorable subgroup (patients without IPI risk factor and no bulky disease), while further improvement is warranted for the less favorable subgroup (event-free survival only 77%). For young poorprognosis patients (age-adjusted IPI ≥ 2), the 5-year survival is around 50%, and progress has not been convincingly and specifically demonstrated in these patients. Ongoing studies will show whether dose-dense conventional or high-dose chemotherapy regimens requiring stem cell support in combination with rituximab will result in similar improvements of outcome as has been reported recently for young patients with good-prognosis aggressive lymphoma. In elderly patients, CHOP interval reduction from 3 to 2 weeks (CHOP-14) and the addition of rituximab to CHOP-21 achieved similar improvements in outcome. The ongoing RICOVER-60 (rituximab with CHOP over 60) trial of the German High-Grade Non-Hodgkin’s Lymphoma Study Group (DSHNHL) evaluates whether the combination of both approaches (R-CHOP-14) can further improve the prognosis of elderly patients.
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AACR: Insulin Signaling and Cancer Development, ProgressionAhead of the 2015 AACR Annual Meeting we discuss how insulin resistance relates to current cancer therapies.
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European Experience With Oral Solution and Intravenous ItraconazoleThe availability of an improved oral solution and an intravenous (IV) formulation of itraconazole (Sporanox) promises to have an effect on prevention and treatment of fungal infection in immunocompromised patients. Use of itraconazole in neutropenic patients with hematologic malignancies has been evaluated in a number of European studies. Treatment with IV followed by oral itraconazole resulted in response or stable disease in two-thirds of patients with invasive pulmonary aspergillosis. Empiric treatment with IV followed by oral solution itraconazole was at least as effective as, and significantly less toxic than, amphotericin B. Several studies of oral solution prophylaxis indicate effectiveness in prevention of fungal infection. Oral solution and IV itraconazole are useful in a variety of situations in prophylaxis, empiric therapy, and treatment of probable/confirmed infection. Itraconazole exhibits a broad spectrum of activity against Aspergillus and Candida species. It has potential advantages over fluconazole (Diflucan), which does not exhibit in vitro activity against Aspergillus and most non-albicans Candida species, and amphotericin B, which is associated with a high incidence of toxicity. Aggressive use of itraconazole and amphotericin B preparations in treatment of fungal infection at Royal Free Hospital may have reduced mortality associated with aspergillosis. [ONCOLOGY 15(Suppl 9):27-32, 2001]
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Radiotherapeutic Management of MedulloblastomaDr. Paulino provides a concise yet complete review of the radiotherapeutic management of patients with medulloblastoma. Radiotherapy treatment planning for medulloblastoma is complex, requires considerable attention to detail, and remains the subject of debate and clinical research. Clearly, this is an area of neuro-oncology in which multidisciplinary research has played a significant role in improving survival for children and young adults with this disease.
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Counterpoint: Should Active Surveillance Be Used for Gleason 3+4 Prostate Cancer?In this Point/Counterpoint, Drs. Madueke and Abern argue that active surveillance should not currently be considered for patients with intermediate-risk prostate cancer.
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Unmet Needs and Future Directions in CLLDrs Bishop and Bank close by outlining remaining unmet needs in CLL, emerging regimens, and hopes for the future of care.
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Management of Progressive Metastatic Prostate CancerThis review succinctly summarizes a relatively large body of literature surrounding the treatment of advanced, stage D2 (M+) prostate cancer. However, the patient with classic stage D2 prostate cancer, presenting de novo with multiple sites of bony metastasis, pain, and other systemic symptoms, is becoming less common in clinical practice. In 1997, prostate cancer is most commonly diagnosed in a locally advanced form, either clinically or pathologically stage C (T3), and accounts for approximately 60% of all newly diagnosed cases in the United States.[1] The reasons for this “stage migration” undoubtedly lie in the widespread use of prostate-specific antigen (PSA) for the detection of prostate cancer while still organ-confined, and in the use of PSA to monitor patients who have undergone definitive local treatment.
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Management of Locally Advanced Prostate CancerThe staging and treatment of prostate cancer are complex, particularly in patients with clinical disease that has advanced locally beyond the confines of the gland. Management choices are made more difficult by a paucity of
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An Overview of Adenocarcinoma of the Small IntestineEven though the small intestine contains 90% of the gastrointestinal tract mucosa and is located between the stomach and large intestine, two organs with a high cancer incidence, adenocarcinoma of the small intestine is 1/50th as common as adenocarcinoma of the large bowel. In several other respects, small-intestinal adenocarcinoma resembles large bowel adenocarcinoma; eg, it arises from adenomatous polyps, co-occurs in the same individuals, and has a similar pattern of incidence rates by country. Small-intestinal adenocarcinoma is diagnosed prior to surgery in only about 50% of cases and often occurs in conjunction with small bowel obstruction. The mainstay of treatment is surgery; prognosis depends on stage at presentation. Little is known about the use of radiotherapy and chemotherapy in this malignancy, but most physicians utilize therapeutic strategies modeled on the management of large-intestinal adenocarcinoma. Clarification of the reason for the low incidence of small-intestinal adenocarcinoma could lead to new interventions for the prevention of colorectal cancer. [ONCOLOGY 11(4):529-536, 1997]
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Granulocyte Colony-Stimulating Factor Use in Patients With Chemotherapy-Induced Neutropenia:Neutropenia is the primary dose-limiting toxicity in patients treated with myelosuppressive chemotherapy, leading in some cases to substantial morbidity and early mortality, and disrupting treatment with potentially curative regimens. The use of granulocyte colony-stimulating factors (G-CSFs) such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), as primary prophylaxis starting in the first cycle of chemotherapy, has been shown to reduce the rates of febrile neutropenia (FN) and of FN-related hospitalization, as well as the use of intravenous anti-infectives. A recent meta-analysis has shown significantly lower infection-related mortality with the first-cycle use of G-CSFs. Both filgrastim and pegfilgrastim were originally approved on the basis of their effectiveness in patients treated with chemotherapy regimens that are associated with a 40% or greater risk of FN. Pegfilgrastim, which is given once per cycle, has been shown to reduce the risk of FN by 94% in breast cancer patients treated with docetaxel (Taxotere). In addition, a recent cost-minimization analysis has shown that first-cycle use of pegfilgrastim may be cost-neutral in patients in whom the predicted risk of FN is less than 20%. These findings have important implications for clinical guidelines for preventing chemotherapy-induced neutropenia and FN.
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The Evolving Biology of Castration-Resistant Prostate Cancer: Review of Recommendations From the Prostate Cancer Clinical Trials Working Group 3We present a joint perspective from the medical oncology and urologic disciplines on the ongoing efforts to advance clinical trial performance in order to discover new therapies for this fatal disease.
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Anthracycline Cardiotoxicity: Why Are We Still Interested?Anthracycline cardiotoxicity has been of clinical concern for more than 3 decades. Many hundreds of papers have been written about this unusual form of toxic cardiomyopathy, and yet, we are still putting pieces of the puzzle together. Our cumulative knowledge helps us to predict the risk of cardiac damage with fair accuracy for most patients, but others demonstrate an unpredictable sensitivity to anthracyclines and suffer devastating consequences. Strategies to prevent anthracycline cardiotoxicity have been developed but are underutilized.
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Nanoparticle-Delivered Chemotherapy: Old Drugs in New PackagesThis article reviews the rationale for nanoparticle formulations of existing or previously investigated cytotoxic drugs, describe currently approved nanoparticle formulations of drugs, and discusses some of the most promising clinical trials currently underway.
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Treatment of Adult Acute Lymphoblastic Leukemia (ALL) With a Focus on Emerging Investigational and Targeted TherapiesIn this review, we will discuss the management of ALL in the adult population, in the context of the recently published guidelines from the NCCN. We will focus in particular on the strides being made in salvage and targeted approaches.
