Authors
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It’s Going to Be in the GenesDeveloping a scoring system for staging patients with hepatic colorectal metastases is important for prognosis and for identifying those who will benefit from additional systemic therapy.
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Commentary (Petrelli): Managing the Peritoneal Surface Component of Gastrointestinal CancerDr. Paul H. Sugarbaker hasspent most of his surgical oncologycareer researching andtreating patients with peritoneal surfacemalignancies. His participationin the treatment of 385 patients withappendiceal malignancy over a 15-year period is probably the largestsuch experience ever reported.[1] Dr. Sugarbaker has demonstrated that inpatients with peritoneal carcinomatosisfrom gastrointestinal malignancies,the best treatment results are associatedwith mucinous epithelial malignancyof the appendix.
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Breast Cancer in MenThe review by Dr. Buzdar emphasizesa variety of clinicalfeatures observed in male breastcancer. Although this is an uncommondiagnosis even in a busy oncologypractice (representing less than 1%of all breast cancers), it is occasionallyseen.
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The Role of Surgery in the Management of Barrett's EsophagusBarrett's esophagus represents replacement of normal distal esophageal squamous epithelium with specialized columnar epithelium containing goblet cells. Typically arising in the setting of chronic gastroesophageal reflux disease, the presence of Barrett's esophagus carries a 50- to 100-fold increased risk of developing esophageal cancer. Risk factors include male sex, smoking history, obesity, Caucasian ethnicity, age > 50 and > 5-year history of reflux symptoms. Aggressive medical or surgical antireflux therapy may ameliorate symptoms, but have not yet been proven to affect the risk of developing esophageal adenocarcinoma in randomized trials. Although dysplasia is an imperfect biomarker for the development of subsequent malignancy, random sampling of esophageal tissue for dysplasia remains the clinical standard. There have been no studies to establish that endoscopic screening/surveillance programs decrease the rates of death from cancer. Fit patients with Barrett's esophagus and high-grade dysplasia should undergo esophagectomy to prevent the risk of developing esophageal adenocarcinoma. For non–operative candidates, endoscopic ablative approaches may represent a reasonable therapeutic alternative.
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Upfront Chemotherapy in Prostate CancerIn this interview we discuss recent trials that looked at the use of upfront chemotherapy combined with androgen deprivation therapy in men with metastatic prostate cancer and how they have changed clinical practice.
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STAMPEDE: Front-Line Docetaxel Prolongs Survival in Metastatic Prostate CancerIn this video, Dr. Nicholas David James discusses the results of the STAMPEDE trial, which tested front-line docetaxel combined with hormonal therapy in patients with advanced, hormone-naive prostate cancer.
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Gleason 6 Prostate Cancer: Serious Malignancy or Toothless Lion?There is strong evidence from longitudinal cohort studies of men with both treated and untreated Gleason 6 prostate cancer to suggest that Gleason 6 disease, when not associated with higher-grade cancer, virtually never demonstrates the ability to metastasize and thus represents an indolent entity that does not require treatment.
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Neoadjuvant Chemotherapy and Surgical Management of the Axilla in Breast Cancer: A Review of Current DataThis review will discuss the current status of surgical management of the axilla for patients treated with neoadjuvant chemotherapy.
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Gynecologic Manifestations of Hereditary Nonpolyposis Colorectal CancerHereditary nonpolyposis colorectal cancer (HNPCC) is an autosomaldominant cancer susceptibility syndrome associated with inheriteddefects in the DNA mismatch repair system. HNPCC family membersare at high risk for developing colorectal, endometrial, and ovariancancers. Studies of HNPCC families have helped define the importantrole that mismatch repair genes play in the molecular pathogenesis ofendometrial and ovarian cancers. This review will describe some of theimportant clinical and molecular features of HNPCC-related endometrialand ovarian cancer and describe how genetic susceptibility can beidentified in patients with sporadic endometrial and ovarian cancers. Itis important to identify patients with HNPCC, as families of mutationcarriers may benefit from genetic counseling, testing, and intensifiedcancer surveillance.
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New Testing for Lung Cancer ScreeningIn this review, the authors discuss past attempts at lung cancer screening, the results of the National Lung Cancer Screening Trial, and innovative tests for lung cancer screening currently being evaluated.
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Guiding Post-Treatment Decisions in Rectal Cancer: mrTRG Is a Practical Place to StartThe authors propose that current policies regarding the use of chemoradiotherapy or short-course preoperative radiotherapy have resulted in an approach to rectal cancer management that often represents overtreatment, with significant loss of quality of life for patients.
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Commentary (Spirtos/Eisenkop): Laparoscopy in Gynecologic MalignanciesMinimally invasive surgery is simply the use of small incisions with specialized equipment to accomplish surgical objectives that would otherwise be completed through larger incisions with conventional equipment. A priority of gyne-cologic oncologists
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The Role of Prognostic Factors and Oncogenes in the Detection and Management of Non-Small-Cell Lung CancerLike other epithelial tumors, non-small-cell lung cancer (NSCLC) is a result of a series of genetic and epigenetic changes that eventually progress to invasive cancer. The order and timing of these changes, involving specific
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Biweekly Gemcitabine, Doxorubicin, and Paclitaxel as First-Line Treatment in Metastatic Breast CancerIn a single-center, open, phase II trial, we assessed the toxicity and activity of a triple combination therapy-doxorubicin at 30 mg/m2 (day 1), paclitaxel (Taxol) at 135 mg/m2 (day 2), and gemcitabine (Gemzar) at 2,500 mg/m2
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Primary and Metastatic Brain TumorsIntracranial neoplasms can arise from any of the structures or cell types present in the cranial vault, including the brain, meninges, pituitary gland, skull, and even residual embryonic tissue.
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Reassessments of ESAs for Cancer Treatment in the US and EuropeAnemia is a widely prevalent complication among cancer patients. At the time of diagnosis, 30% to 40% of patients with non-Hodgkin lymphoma or Hodgkin lymphoma and up to 70% of patients with multiple myeloma are anemic; rates are higher among persons with myelodysplastic syndromes. Among patients with solid cancers or lymphomas, up to half develop anemia following chemotherapy. For almost 2 decades, erythropoiesis-stimulating agents (ESAs) were the primary treatment for cancer-related anemia. However, reassessments of benefits and risks of ESAs for cancer-associated anemia have occurred internationally. We reviewed guidelines and notifications from regulatory agencies and manufacturers, reimbursement policies, and utilization for ESAs in the cancer and chronic kidney disease settings within the United States, Europe, and Canada. In 2008 the US Food and Drug Administration (FDA) restricted ESAs from cancer patients seeking cure. Reimbursement is limited to hemoglobin levels < 10 g/dL. In the United States, ESA usage increased 340% between 2001 and 2006, and decreased 60% since 2007. The European Medicines Agency (EMEA) recommended that ESA benefits do not outweigh risks. In Europe between 2001 and 2006, ESA use increased 51%; since 2006, use decreased by 10%. In 2009, Canadian manufacturers recommended usage based on patient preferences. In Canada in 2007, approximately 20% of anemic cancer patients received ESAs, a 20% increase since 2004. In contrast to Europe, where ESA use has increased over time, reassessments of ESA-associated safety concerns in the United States have resulted in marked decrements in ESA use among cancer patients.
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POINT: Should Radiation Therapy After Surgery for Ductal Carcinoma In Situ Be Standard Practice?At this time RT following BCS remains the standard of care for most patients. Current tools, including prognostic scores and tumor genetics, have failed to identify a cohort for whom RT confers no benefit with respect to invasive recurrences.
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Update on Adjuvant Chemotherapy for Early Breast CancerAdjuvant chemotherapy represents a significant advance in the management of early-stage breast cancer and, as such, has saved many lives. Worldwide, adjuvant chemotherapy has benefitted all groups tested, including
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Breast Cancer Following Radiation for Hodgkin Lymphoma: Clinical Scenarios and Risk-Reducing StrategiesWe review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma.
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Optimal First-Line Therapy for Previously Untreated Chronic Lymphocytic Leukemia: The Case for Kinase InhibitorsGiven the favorable results seen thus far, there is no doubt that the treatment of patients with chronic lymphocytic leukemia is entering an exciting new era with the advent of these novel, relatively nontoxic and nonmyelosuppressive, oral agents.
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CYP2D6 Testing in Breast Cancer: Ready for Prime Time?This article will review and summarize the current data regarding the influence of the major cytochrome P450 2D6 (CYP2D6) genotypes and CYP2D6 inhibitors on tamoxifen metabolism and clinical efficacy. We will discuss the clinical relevance and limitations of this data and how to best incorporate our current understanding of CYP2D6 genotyping into our clinical practice and discussions with patients.
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Impact of UFT on Tumoral TS and DPD Levels in Colorectal CancerThis was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m²/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer.
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Triple-Negative Breast Cancer in the Post-Genomic EraClearly there is no single therapy for all patients with TNBC, given the molecular heterogeneity of this subtype. However, new insights from further genomic analysis of TNBC suggest approaches to rational clinical trial design, and patients will undoubtedly benefit as we define the most appropriate therapeutic targets in management of this aggressive disease.
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How to Address Sexual Problems in Female Cancer PatientsSexual health is an important aspect of human life, and cancer does not (and should not) change that. Data suggest that issues related to sexual function are quite common among women treated for cancer. However, clinicians often spend little to no time on the topic.
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Prevention and Management of Radiation ToxicityThe aim of radiation oncology is the achievement of uncomplicated locoregional control of malignancy by the use of radiation therapy (RT). Accomplishing this goal requires precise knowledge of tumoricidal and tolerance doses of the various normal tissues at risk within the RT field.
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Synopsis of Angiogenesis Inhibitors in OncologyAngiogenesis is a dynamic process essential for primary tumor growth and metastases. New insights into the basic understanding of the biologic processes responsible for angiogenesis have led to the characterization of potential therapeutic targets. Several strategies for the development of antiangiogenic therapeutic modalities have been employed, including agents that (1) decrease the activity of specific angiogenic factors, (2) decrease the activity of endothelial survival factors, (3) increase the activity of naturally occurring antiangiogenic agents, or (4) indirectly downregulate angiogenic and survival factor activity.
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Use of Molecular Biomarkers to Inform Adjuvant Therapy for Colon CancerIn this review, we will discuss adjuvant chemotherapy in non-metastatic colon cancer, the existing prognostic and predictive molecular biomarkers in the field, and how to integrate these molecular biomarkers into the decision about whether to administer adjuvant therapy.
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Multiple Myeloma and Other Plasma Cell DyscrasiasThis management guide covers the symptoms, diagnosis, screening, staging, and treatment of multiple myeloma, smoldering myeloma, and other plasma cell dyscrasias.
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Neuroendocrine Tumors of the Gastrointestinal TractNeuroendocrine tumors manifest in the gastrointestinal tract mainly as carcinoid and pancreatic islet-cell tumors. They comprise an interesting group of rare neoplasms that are derived from neuroendocrine cells interspersed within the gastrointestinal system amd throughout the body. Neuroendocrine tumors are well known for producing various hormonal syndromes and for their indolent clinical course in most patients, although some of these tumors do not produce hormones of clinical significance. Patients may have symptoms for many years before the diagnosis is suspected and confirmed.
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Opioids in Cancer Pain: Common Dosing ErrorsMany individuals with advanced malignancy continue to sufferfrom pain and, consequently, impaired quality of life. The clinicalscenarios in advanced cancer pain are complex, and successful managementmay require a more sophisticated and individualized approachthan suggested by the World Health Organization guidelines.In patients referred to the Harry R. Horvitz Center for PalliativeMedicine in Cleveland, numerous commonly occurring errors inopioid use have been noted. This article describes these errors andoffers strategies with which to improve outcomes for patients sufferingwith cancer pain.
