Authors

A 38-Year-Old Man With Pancreatic Cancer

Michael H. Levy, MD: This 38-year-old white male first came to his physician in January of 1993 complaining of epigastric and low back pain. In March of 1993, he was diagnosed with pancreatic cancer that was metastatic to his

Gemcitabine/Irinotecan/Celecoxib in Pancreatic Cancer

Unresectable pancreatic cancer has few therapeutic options and adismal prognosis. Cyclooxygenase-2 (COX-2) expression is increasedat the RNA and protein levels in most human pancreatic cancers. Thepurpose of this trial was to determine whether the addition of a COX-2inhibitor to chemotherapy was beneficial. To date, 11 patients with inoperablepancreatic cancer have been treated with the combination ofgemcitabine (Gemzar), irinotecan (Camptosar), and celecoxib(Celebrex) at 400 mg orally twice daily. Encouraging pain relief, improvementin performance status, and decreases in CA 19-9 andcarcinoembryonic antigen levels have been observed.

Changing Treatment Paradigms for Brain Metastases From Melanoma-Part 2: When and How to Use the New Systemic Agents

In this article, we provide an overview of the currently available systemic agents, including immunotherapeutic agents and targeted tyrosine kinase inhibitors. We also provide a practical management algorithm to guide the practicing oncologist in the use of both of these new therapies and the more traditional local treatments.

ACR Appropriateness Criteria® Nonsurgical Treatment for Locally Advanced Non–Small-Cell Lung Cancer: Good Performance Status/Definitive Intent

The treatment of inoperable stage III non–small-cell lung cancer (NSCLC) remains a challenge due to high rates of distant metastasis, local recurrence, and toxicity associated with definitive therapy.

Multiple Myeloma:Role of Allogeneic Transplantation

An estimated 14,600 new cases of multiple myeloma will be diagnosed in the United States in 2002. Multiple myeloma remains an incurable disease despite significant improvements in complete response rates and overall

Current Therapies for Advanced Colorectal Cancer

Significant advances have been made in the treatment of advancedcolorectal cancer over the past 5 years, namely due to the introductionof three novel cytotoxic agents-capecitabine (Xeloda), irinotecan(Camptosar), and oxaliplatin (Eloxatin)-and the recent approval oftwo biologic agents-bevacizumab (Avastin) and cetuximab (Erbitux).During this time period, the median survival of patients with advanced,metastatic disease has gone from 10 to 12 months to nearly 24 months.Intense efforts have focused on identifying novel targeted therapies thattarget specific growth factor receptors, critical signal transduction pathways,and/or key pathways that mediate the process of angiogenesis.Recent clinical trial results suggest that the anti-VEGF antibodybevacizumab can be safely and effectively used in combination witheach of the active anticancer agents used in colorectal cancer. Despitethe development of active combination regimens, significant improvementsin the actual cure rate have not yet been achieved. Combinationregimens with activity in advanced disease are being evaluated in theadjuvant and neoadjuvant settings. The goal is to integrate these targetedstrategies into standard chemotherapy regimens so as to advancethe therapeutic options for the treatment of advanced colorectal cancer.Finally, intense efforts are attempting to identify the critical molecularbiomarkers that can be used to predict for either clinicalresponse to chemotherapy and/or targeted therapies and/or the drugspecificside effects. The goal of such studies is to facilitate the evolutionof empiric chemotherapy to individually tailored treatments forpatients with colorectal cancer.

Framing the Challenges of Cancer Rehabilitation

Franklin, Delengowski, and Yeo have made a strong case for the importance of cancer rehabilitation.

Exercise in Regulation of Inflammation-Immune Axis Function in Cancer Initiation and Progression

This article provides an overview of the current state of knowledge pertaining to exercise modulation of the inflammation-immune axis in cancer. The current evidence suggests that exercise may be a promising adjunctive strategy that can favorably alter numerous components of the immune system, which, in turn, may modulate tumorigenesis.

Hypothyroidism:A Growing Complicationof Cancer Treatment

Hypothyroidism is a common and potentially serious endocrine disorder in the general population.

28 Pooled Analysis of Post- Progression Treatments After Firstline Ribociclib + Endocrine Therapy in Patients With HR+/HER2− Advanced Breast Cancer in the MONALEESA-2, -3, and -7 Studies

Hodgkin Lymphoma in Older Patients: An Uncommon Disease in Need of Study

Hodgkin lymphoma (HL) is one of the most curable malignancies in adults. However, survival rates for elderly patients with HL (often defined as ≥ 60 years of age) are inferior to those achieved by younger populations.

Precision Medicine in the Care of Patients With Leukemia/Lymphoma

The leukemias and lymphomas represent a group of heterogeneous myeloid or lymphoid clonal stem cell disorders with variable clinical presentation, pathological characteristics, prognosis and recommendations for treatment.[1]

GM-CSF and IL-2 Combination as Adjuvant Therapy in Cutaneous Melanoma

Cytokines have been used in the treatment of patients with cutaneousmelanoma. Granulocyte-macrophage colony-stimulating factor(GM-CSF, sargramostim [Leukine]) leads to dendritic cell/macrophagepriming and activation, and also increases interleukin-2 (IL-2)receptor expression on T lymphocytes. IL-2 creates lymphokineactivatedkiller cells and tumor-infiltrating lymphocyte cells. In thisopen-label, single-arm study of 16 high-risk patients, we combined thesetwo agents to take advantage of their different but complementary functions.All patients underwent potentially curative surgery. Postoperatively,each patient received GM-CSF at 125 μg/m2/d subcutaneously(SC) for 14 days; this was followed by IL-2 at 9 million IU/m2/d SC for4 days, and then 10 to 12 days of no treatment. In addition, patientswho had large tumors that could yield over 100 million live tumor cellsreceived autologous melanoma vaccines. The duration of follow-upranged from 21 to 42 months (median: 27 months). During follow-up,five patients developed metastases. This program was carried out on anoutpatient basis, and no hospitalization was required. It was well toleratedwith minimal side effects. The combination treatment regimen ofGM-CSF and IL-2 with or without autologous vaccine used adjuvantlyappears to benefit high-risk melanoma patients; further clinical testingof this regimen is warranted.

Pertuzumab: Increasing the Options

At this point, there is expectation that pertuzumab given in the neoadjuvant setting will improve long-term efficacy. We welcome the opportunity to include pertuzumab in the neoadjuvant regimen of patients with HER2-positive breast cancer.

Melanoma Vaccines: What We Know So Far

Vaccines are a promising but still experimental treatment for melanoma.They are intended to stimulate immune responses against melanomaand by so doing, increase resistance against and slow the progressionof this cancer. Key requirements for vaccines to be effectiveare that they contain antigens that can stimulate tumor-protective immuneresponses and that some of these antigens are present on thetumor to be treated. Unfortunately, these antigens are still not known.To circumvent this problem, polyvalent vaccines can be constructedcontaining a broad array of melanoma-associated antigens. Severalstrategies are available to construct such polyvalent vaccines; each hasadvantages and disadvantages. Clinical trials have shown that vaccinesare safe to use and have much less toxicity than current therapy formelanoma. Vaccines can stimulate both antibody and T-cell responsesagainst melanoma, with the type of response induced, its frequency,and its magnitude depending on the vaccine and the adjuvant agentused. A growing body of evidence suggests that vaccines can be clinicallyeffective. This evidence includes correlations between vaccineinducedantibody or T-cell responses and improved clinical outcome,clearance of melanoma markers from the circulation, improved survivalcompared to historical controls, and most convincingly, two randomizedtrials in which the recurrence-free survival of vaccine-treatedpatients was significantly longer than that of control groups.

Expanded Treatment Options for Leukemia/Lymphoma

Leukemias and lymphomas are estimated to contribute up to 7% of all new malignant cases in the United States.[1]

The Role of Integrins in Colorectal Cancer

Integrins have direct effects in stimulating proliferation and preventing apoptosis in cancer cells and mediating proangiogenic interactions between endothelial cells and extracellular matrix. Alterations of expression of various integrins and their receptors have been observed in various cancers in which angiogenesis is known to play a role, including colorectal cancer. Inhibition of specific integrins might thus inhibit both direct effects of integrins on cancer cells and tumor angiogenesis. Inhibitory peptides and anti-integrin monoclonal antibodies are currently being investigated in clinical trials in patients with solid tumors, with early evidence suggesting clinical benefit in disease stabilization with use of an anti-αvβ3 antibody in the settings of colorectal cancer, renal cell carcinoma, and melanoma. Integrin inhibition alone and with other targeted therapeutic approaches should be further investigated in clinical trials in patients with colorectal cancer.

High-Dose Chemotherapy in Poor-Risk Germ-Cell Tumors

Testicular cancer is a highly curable cancer. However, 30% of patients are refractory to standard therapy and will need additional therapy. This article focuses on the use of high-dose chemotherapy in germ-cell tumors.

Oral UFT and Leucovorin in Patients With Advanced Gastric Carcinoma

Thirty-nine patients with locally advanced or metastatic gastric carcinoma received oral UFT (tegafur and uracil) plus leucovorin. Treatment consisted of UFT 360 mg/m2/day plus leucovorin 25 mg/m2/day, given orally in divided

Prostate Cancer 2004: Insights From National Disease Registries

In 2004, the large majority of prostate cancers are detected via prostate-specific antigen (PSA) screening. Most are diagnosed at an earlystage and are amenable to aggressive local treatment. However, thenatural history of the disease may be prolonged, and all available activetreatments exert a potential negative effect on patients’ HRQOL.Management options for localized prostate cancer have become increasinglycomplex in recent years, and rigorous trials are frequently difficultto perform due to the extended follow-up required to reach meaningfuloutcomes. In this context, the advent of the national prostatecancer disease registries-Prostate Cancer Outcomes Study (PCOS),Center for Prostate Disease Research (CPDR), Cancer of the ProstateStrategic Urologic Research Endeavor (CaPSURE), and Shared EqualAccess Regional Cancer Hospital (SEARCH)-has greatly facilitatedclinical research in prostate cancer. This review summarizes key findingsfrom the registries in the areas of risk migration, practice patterns,outcome prediction, and quality-of-life outcomes. The availabilityof these large databases of patients will be a tremendous asset asprostate cancer management continues to evolve in the coming years.

Subdividing NSCLC: Reflections on the Past, Present, and Future of Lung Cancer Therapy

More than 60 years ago, Karnofsky and colleagues reported promising results with the introduction of nitrogen mustard, the prototype of alkylating agents, for the treatment of lung cancer.[1] Subsequent milestones in the development of lung cancer chemotherapy included the use of platinum agents in the 1970s and 1980s, while the 1990s brought several active agents that could be combined with platinum, namely the taxanes, gemcitabine (Gemzar), and vinorelbine.

Infectious Complications

Infections are among the most common, potentially serious complications of cancer and its treatment.

The Role of Intralesional Therapies in Melanoma

Through the emergence of new immunotherapies, treatment of melanoma is undergoing a long-awaited revolution. Ongoing research will clarify the outlines of the place that intralesional therapies will occupy in the therapeutic armamentarium in the years ahead.

'Futile Care': What to Do When Your Patient Insists on Chemotherapy That Likely Won’t Help

The use of the term "futility" in cancer care has been prompted, in part, by increasing requests from patients for treatments thought to be ineffective as well as costly.[1] The appropriate role of chemotherapy near the end of life is a complex issue.[2]

New Combinations With Epirubicin in Advanced Breast Cancer

Several trials have shown that anthracyclines and taxanes can be combined to achieve response rates ranging from 70% to 90%, with complete responses ranging from 19% to 41%. In an attempt to increase the activity while

Tailored Strategies for DCIS Management

Few areas in breast disease elicit as much controversy as the management of DCIS. The review by Sanders and Simpson, “Can We Know What to Do When DCIS Is Diagnosed?”

GOP docs challenge AMA support

Physicians in Congress voice their displeasure with the AMA's endorsement of the House's healthcare reform bill.

Biological Basis of Radiation Sensitivity

Recent studies have elucidated some of the molecular and cellular mechanisms that determine the sensitivity or resistance to ionizing radiation. These findings ultimately may be useful in devising new strategies to improve the

Supportive Care of the Patient With Advanced Pancreatic Cancer

This review covers symptoms and complications in patients with late-stage pancreatic cancer, including venous thromboembolism, anorexia-cachexia, pain, and depression.

Is This Patient With Metastatic Bladder Cancer a Candidate for Second-Line Immunotherapy Treatment?

A 67-year-old man, a former smoker, presented with gross hematuria. A CT urogram showed a bladder tumor in the anterior wall and multiple enlarged retroperitoneal lymph nodes. Two vertebral metastases were seen on a bone scan. He underwent a transurethral resection of the bladder, and the pathology report revealed muscle-invasive urothelial carcinoma.