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ACR Appropriateness Criteria® Postradical Prostatectomy Irradiation in Prostate CancerThe purpose of this article is to present an updated set of American College of Radiology consensus guidelines formed from an expert panel on the appropriate use of radiation therapy in postprostatectomy prostate cancer.
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Plastic Surgery: A Component in the Comprehensive Care of Cancer PatientsPlastic surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more
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Neuropathic Cancer Pain: The Role of Adjuvant AnalgesicsNeuropathic pain may be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. This pathophysiologic label is typically applied when the painful symptom is associated
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Are We Ready to Screen for Inherited Susceptibility to Cancer?The discovery of inherited gene mutations that increase the risk of certain cancers could greatly expand the use of predictive genetic testing in healthy individuals. In families with hereditary forms of cancer, the use of genetic tests to determine whether family members have inherited suseptibility mutations (ISMs} may improve out come.
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Therapeutic Options Following Orchiectomy for Stage I SeminomaOver the past 3 decades, the incidence rate of testicular seminoma has continually risen, and the majority of cases have been clinical stage I.[1] Nevertheless, the overall survival for all testicular cancers has improved significantly (P < .05) over the same period, from 83% to 96%.[2]
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An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainMany cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines
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New and Newer Vascular Targets in OncologyThis 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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Modern Immunotherapy for the Treatment of Advanced Gastrointestinal CancersAlthough immunotherapy is not yet approved for the treatment of gastrointestinal cancers, it is already clear that many gastrointestinal cancers can be sensitive to it. We will review recent clinical trial results demonstrating this, and offer our perspective on the role that immunotherapy might play in the treatment of advanced gastrointestinal malignancies in the years ahead.
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Overview: Management of Treatable but Incurable CancersThe accurate and in-depth documentation of learning gaps is a fundamental aspect of developing continuing education activities. To obtain a better understanding of community-based medical oncology practice patterns, 43 oncologists within the United States were recruited to complete a traditional clinical case–based questionnaire and to contribute specific anonymous demographic and treatment information derived from their actual patients. This information was used to create a cross-sectional case database on two types of cancer in which major clinical advances have been reported in recent years - multiple myeloma and follicular lymphoma. These diseases also are similar in that most patients experience clinically meaningful benefits from systemic treatment but are unlikely to be cured by therapy. As further described in this and the subsequent two articles, this case-based series documents that (a) clinical research advances are being quickly implemented in daily patient care and that (b) although therapeutic strategies vary based on patient age, the short-term outcomes in terms of response to and tolerance of treatment are similar in younger and older patients.
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Current Management of Cancer-Associated Anorexia and Weight LossDrs. Jatoi and Loprinzi provide a comprehensive but succinct overview of the management of cancer-associated anorexia and weight loss. These clinician researchers, who have added much to our understanding of this problem, present a balanced and reasonable approach to the management of these common paraneoplastic syndromes.
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Nutrition as an Integral Component of Supportive CarePalliative care, previously viewed by many as anend-of-life movement, is now recognized as anapproach whose principles should infuse the care ofall patients with a chronic illness throughout the fullcourse of that illness. For example, the World HealthOrganization (WHO) has redefined palliative care asfollows:
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New Practical Approaches to Chemotherapy-Induced Neuropathic Pain: Prevention, Assessment, and TreatmentWe review here the recommendations of the American Society of Clinical Oncology, as well as some new and promising approaches to neuropathy, including new neuromodulation techniques.
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Surgical Approach to Organ Preservation in the Treatment of Cancer of the LarynxThe article by Dr. Weinstein is a discussion of the newer surgical options available for the treatment of patients with laryngeal cancer. Several aspects of the article deserve mention.
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Childhood cancer haunts survivors in unexpected waysRadiation doses to the heart of about 5 Gy or greater in childhood are associated with long-term cardiovascular consequences, including early mortality. Cancer care specialists strive to balance late-stage effects without sacrificing treatment benefits.
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Front-Line TKI Therapy for Chronic-Phase CML: the Luxury of ChoicePhysicians now have the luxury of focusing attention on maximizing outcomes that are already quite favorable, and of devoting more attention to improving quality of life and addressing questions of cost-effectiveness.
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Clinical Trial Simulation of a 200-µg Fixed Dose of Darbepoetin Alfa in Chemotherapy-Induced AnemiaOur objective was to assess, using clinical trial simulation, the feasibility of a fixed 200-µg dose of darbepoetin alfa (Aranesp) administered every 2 weeks in chemotherapy-induced anemia. A pharmacokinetic/pharmacodynamic
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Hormonal Approaches in the Treatment of Bony MetastasesHormonal therapy for prostate cancer designedto reduce testosterone levels has been employed for decades andprovides objective remission rates of 40% to 60% and subjectiveresponse rates of 60% to 85%. Orchiectomy, as
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Radiation Therapy in the Management of Malignant MelanomaMelanoma has historically been considered a radioresistant tumor. Emerging data have challenged this viewpoint. The potential roles of radiation therapy in the treatment of patients with melanoma will be reviewed here.
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Peripheral Neuropathy and CancerPeople living with cancer may experience nerve pain often described as tingling, burning, or numbness. Problems with coordination also may be present. These symptoms may be associated with a peripheral neuropathy. In this condition, nerves outside the brain and spinal cord have been damaged, often by the cancer treatments themselves.
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Epidermal Growth Factor Receptor Inhibitors for the Treatment of Colorectal Cancer: A Promise Fulfilled?The epidermal growth factor receptor (EGFR) is commonly expressedin colorectal cancers but not in most normal tissues, raising the possibilitythat this receptor could serve as a target for highly selective therapy.Based on preclinical studies demonstrating that antagonists of EGFRresulted in the inhibition of tumor growth, the development of clinicalreagents has been aggressively pursued. Early clinical studies demonstratedantitumor activity of EGFR inhibitors in patients with advancedcolorectal cancer, with acceptable toxicity. This early success fueledrapid clinical development. In this article, we will review the currentstatus of EGFR inhibitors in the treatment of patients with colorectalcancer, in an effort to describe both how far we have come as well aswhere we need to go in optimizing this promising therapeutic approach.
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New Drugs for Small-Cell Lung CancerBetter efficacy of chemotherapy for small-cell lung cancer (SCLC) has not been convincingly demonstrated despite many investigations examining increased drug
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Lymphatic Mapping in the Treatment of Breast CancerDeveloped initially for the treatment of malignant melanoma, lymphatic mapping and sentinel lymph node biopsy have recently been introduced into the treatment of early breast cancer. In breast cancer patients, harvested
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Paclitaxel and Carboplatin as First-Line Chemotherapy for Advanced Breast CancerIn a phase II study, 66 patients with advanced breast cancer (median age 56 years; range, 28 to 75 years) were treated with paclitaxel (Taxol), 175 mg/m² infused over 3 hours, and carboplatin (Paraplatin), dosed to attain an
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Some Elements of Prognosis in Terminal CancerPredicting the survival of terminal cancer patients is a difficult task. To better understand this difficulty, we divide prognostication into two distinct elements: foreseeing and foretelling. Foreseeing is a physician’s silent cognitive
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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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Ovarian Cancer in Elderly WomenThe incidence of ovarian carcinoma increases with advancing age,peaking during the 7th decade of life and remaining elevated until age80 years. Despite the high prevalence of ovarian cancer in the elderly,the management of these patients is often less aggressive than that oftheir younger counterparts. As a result, many elderly cancer patientsreceive inadequate treatment. However, data do not support the conceptthat age, per se, is a negative prognostic factor. In fact, the majority ofelderly patients are able to tolerate the standard of care for ovariancancer including initial surgical cytoreduction followed by platinumand taxane chemotherapy. Because functional status has not demonstrateda reliable correlation with either tumor stage or comorbidity,each patient’s comorbidities should be assessed independently. Forelderly patients with significant medical comorbidity, the extent ofsurgery and aggressiveness of chemotherapy should be tailored to theextent of disease, symptoms, overall health, and life goals. In addition,enhanced cooperation between geriatricians and oncologists may assistthe pretreatment assessment of elderly patients and improve treatmentguidelines in this population.
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Adding Palbociclib Delays Progression in HR-Positive Breast CancerIn this video we discuss the results of the PALOMA3 trial, which tested fulvestrant and palbociclib in metastatic, hormone receptor–positive HER2-negative breast cancer.
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Bladder Cancer: Time for a Rethink?In this issue of ONCOLOGY, Kamat and Mathew provide an excellent overview of the current status and future imperatives of bladder cancer treatment and research.
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Large Bladder Mass and Renal Failure in a 14-Year-Old BoyA 14-year-old, otherwise healthy adolescent male originally presented to his primary care physician with abdominal pain and distention. Ultrasound revealed a complex mass with cystic components along the superior pole of the bladder and bilateral hydroureteronephrosis down to the level of the bladder.
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The Role of Genomic Techniques in Predicting Response to Radiation TherapyThe understanding of the relationship between genetic variation and an individual patient’s response to radiation therapy has gained significant ground over the past several years. Genetic markers have been identified that could ultimately serve as the foundation for predictive models in clinical practice, and that hold the potential to revolutionize the delivery of precision medicine in oncology.
