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The Role of UFT in Combined- Modality TherapyFluorinated pyrimidines have long been used as radiosensitizers in combined-modality therapy for solid tumors. Nonetheless, the most commonly used drug, 5-fluorouracil (5-FU), is inconvenient to administer, particularly
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Highlights From the 2008 Meeting of the American Society for Clinical OncologyThe 44th Annual Meeting of the American Society of Clinical Oncology, held May 30th to June 2nd, brought more than 30,000 attendees to Chicago for the presentation of nearly 5,000 new studies. The following research findings represent a few of the highlights, as announced by ASCO before the meeting.
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Malignant Angiomyolipoma: a Rare Entity With Unusual BiologyThe authors present an interesting case of a very rare renal neoplasm, malignant epithelioid angiomyolipoma (AML), which belongs to a family of mesenchymal tumors known as perivascular epithelioid tumors (PEComas).
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Cancer Management Chapter 41: Fluid complicationsMalignant pleural effusion complicates the care of approximately 150,000 people in the United States each year. The pleural effusion is usually caused by a disturbance of the normal Starling forces regulating reabsorption of fluid in the pleural space, secondary to obstruction of mediastinal lymph nodes draining the parietal pleura.
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UFT Plus Carboplatin for Head and Neck CancerCisplatin plus fluorouracil (5-FU) is widely accepted as neoadjuvant and adjuvant chemotherapy in the treatment of head and neck squamous cell carcinoma; UFT is also an active agent against this disease. In the first retrospective study, we examined the efficacy of UFT as adjuvant chemotherapy in patients with maxillary cancer.
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UFT Plus Cisplatin for Advanced Gastric CancerIn a laboratory study using an experimental peritoneum model of gastrointestinal cancer, the UFTP [tegafur and uracil (UFT) plus cisplatin] regimen was shown to provide a survival benefit compared with the UFTM (UFT plus
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.
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Delirium in Palliative CareDelirium is highly prevalent in cancer patients with advanced disease.Frequently a preterminal event, the condition is a sign of significantphysiologic disturbance, typically involving multiple medical etiologiesincluding infection, organ failure, adverse medication effects,and in rare situations, paraneoplastic syndromes. Unfortunately, deliriumis frequently underrecognized or misdiagnosed and, therefore,inappropriately treated or untreated in terminally ill patients. The clinicalfeatures of delirium are numerous and encompass a variety of neuropsychiatricsymptoms common to other psychiatric disorders. Threeclinical subtypes of delirium, based on arousal disturbance and psychomotorbehavior, have been described: hyperactive, hypoactive, andmixed. The differential diagnosis for delirium includes depression,mania, psychosis, and dementia. Numerous instruments have been developedto aid the clinician in rapidly screening for the disorder. Standardmanagement requires an investigation of the etiologies, correctionof the contributing factors, and management of symptoms. Symptomaticand supportive therapies, including numerous pharmacologicapproaches, are important, but several aspects of the use of neurolepticsand other agents in the management of delirium in the dying patientremain controversial.
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Head and Neck TumorsThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of head and neck cancers (including tumors of the oral cavity, oropharynx, hypopharynx, larynx, supraglottis, glottis, subglottis, and nasopharynx) using radiation, surgery, and medical treatment.
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Improving Adherence to Endocrine Therapies: The Role of Advanced Practice NursesWith the trend toward the use of oral rather than intravenous therapies for cancer, nonadherence to treatment has become an increasing concern. Advanced practice nurses are in a good position to assess and monitor adherence to oral endocrine therapies. Research on adherence has been limited; to date there are no specific published guidelines for ensuring adherence to endocrine regimens. However, studies have identified many factors that may lead to nonadherence, including demographic, social, and psychological characteristics of the patient; characteristics of the disease and the treatment regimen; and the nature and quality of the patient/clinician relationship. These factors provide a framework that advanced practice nurses can use to identify potential problems and to work collaboratively with patients.
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Face-Off: Award CeremonyFollowing a comprehensive debate on the treatment of patients with non–small cell lung cancer, Edward Kim, MD, presents the winning team with the title of victors of this CancerNetwork® Face-Off event.
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Current and Future Roles of Lapatinib in HER2-Positive Breast CancerIn this article, we review the underlying biology and pharmacology behind lapatinib and summarize clinical trials with lapatinib. We also describe the ongoing clinical trials that use lapatinib as part of adjuvant and neoadjuvant therapy. These trials could change the standard of care in the next few years.
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Current and Future Roles of Lapatinib in HER2-Positive Breast CancerIn this article, we review the underlying biology and pharmacology behind lapatinib and summarize clinical trials with lapatinib. We also describe the ongoing clinical trials that use lapatinib as part of adjuvant and neoadjuvant therapy. These trials could change the standard of care in the next few years.
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Routine 3D Treatment Planning: Opportunities, Challenges, and HazardsThree-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to
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PCR Can Detect Miniscule Numbers of Cells That Are Expressing PSAReverse-transcriptase polymerase chain reaction (PCR) technology can detect small numbers of cells expressing prostate-specific antigen (PSA), even when these cells are extensively diluted in a population of non-PSA expressing cells. The assay was applied to a cohort of more than 200 patients who were candidates for radical prostatectomy based on diagnostic tests that predicted that the prostate cancer was localized to the prostate gland. In this group, a positive RT-PCR test correlated significantly with early metastatic spread of prostate cancer. [Oncol News Int 6(Suppl 3):11-12, 1997]
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Disparities in Cancer Care Among Racial and Ethnic Minorities: Review 2The 2005 National Health Disparities Report found disparities related to race, ethnicity, and socioeconomic status in the United States health-care system. While varying in magnitude, disparities were observed in almost all aspects of health care including cancer. Disparities were noted across quality and access to health care, levels and types of health care, various health-care settings, and within many subpopulations. In this review, we explore the disparities in cancer care among racial and ethnic minorities. In particular we consider numerous factors that may influence health care for racial and ethnic minority groups including socioeconomic issues, access, cultural beliefs, risk factors, and comorbidities. Although there are extensive confounding factors that vary with each subgroup, trends that may help individual practitioners better understand this complex issue become evident through closer evaluation of available data.
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PORTable Indications in Non–Small-Cell Lung CarcinomaDrs. Kelsey, Marks, and Wilson open their excellent review article by asking “Where do we stand?” with respect to postoperative radiation therapy (PORT) for non–small-cell lung cancer (NSCLC).[1] Frankly, PORT has not exactly been standing tall for the past decade-leaning, crouching, or perhaps squatting might be a better verb.
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Radiation Therapy in the Treatment of CholangiocarcinomaPreliminary results of studies employing hepatic transplantation with radiation therapy are encouraging. Although these new approaches hold promise, the prognosis in patients with biliary cancers remains poor, and the integration of novel therapeutic strategies is indicated.
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Favorable vs Unfavorable Intermediate-Risk Prostate Cancer: A Review of the New Classification System and Its Impact on Treatment RecommendationsThe population of patients with intermediate-risk prostate cancer are a large and heterogeneous group with highly variable prognoses, which present a challenge to efforts to develop standardized treatment recommendations.
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Dose Reductions and Delays: Limitations of Myelosuppressive ChemotherapyThrombocytopenia occurs at various grades of severity in patients with nonmyeloid malignancies undergoing chemotherapy with myelosuppressive agents. Frequently, it is the major dose-limiting hematologic toxicity, especially in the treatment of potentially curable malignancies such as leukemia, lymphomas, and pediatric cancers.
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Soft-Tissue SarcomasThe soft-tissue sarcomas are a group of rare but anatomically and histologically diverse neoplasms. This is due to the ubiquitous location of the soft tissues and the nearly three dozen recognized histologic subtypes of soft-tissue sarcomas.
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Research on Thalidomide in Solid Tumors, Hematologic Malignancies, and Supportive CareInterest in thalidomide (Thalomid) has intensified in recent years as research has identified and elucidated its immunomodulatory, anti-inflammatory, and antiangiogenic properties. In this supplement, we present a selection of abstracts
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Oncocytic Neoplasm on Renal Mass Biopsy: A Diagnostic ConundrumA 56-year-old man presented with a 4.5-cm leftsided renal mass incidentally discovered on an ultrasound performed for workup of lupus nephritis. On dedicated contrast-enhanced magnetic resonance imaging (MRI), the tumor was found to be avidly enhancing.
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MRI for every APBI candidate: An open questionIn this retrospective study by Godinez et al, 30 (38%) of 79 patients had additional foci on MRI. The researchers suggested that MRI should be used prior to APBI to rule out the presence of multifocal or multicentric disease.
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Precision Medicine in Metastatic Colorectal Cancer: Relevant Carcinogenic Pathways and Targets-PART 1: Biologic Therapies Targeting the Epidermal Growth Factor Receptor and Vascular Endothelial Growth FactorHere we review drugs that target the EGFR and VEGF pathways, focusing on patient selection, drug toxicities, and how to choose agents for first-line therapy.
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Clinical Issues in the Surgical Management of Screen-Identified Lung CancersThis review outlines the diagnostic and therapeutic challenges associated with the increased number of screen-identified indeterminate lung nodules, highlighting currently recommended follow-up and management algorithms, as well as the various methods of nodule localization, tissue diagnosis, and definitive local therapeutic modalities.
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Rationale for Trials Studying Pegylated Liposomal Doxorubicin in Metastatic Breast CancerBreast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a
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How We Treat Tumor Lysis SyndromeWhen tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.
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Biologic Therapy: Hematopoietic Growth Factors, Retinoids, and Monoclonal AntibodiesBiologic therapies are an increasingly important part of cancer treatment. In this chapter, we review the current status of studies of colony-stimulating factors (CSFs), erythropoietin (Epogen, Procrit), thrombopoietin, the retinoids, and monoclonal antibodies (MoAbs). The interferons, interleukin-2 (IL-2, aldesleukin [Proleukin]), and adoptive cellular immunotherapy are discussed in a separate chapter.
