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ACR Appropriateness Criteria® Borderline and Unresectable Pancreas CancerThese guidelines review the use of radiation, chemotherapy, and surgery in borderline and unresectable pancreas cancer. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.
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The Utility of Molecular Testing in Colorectal Cancer: The Promise Needs ProgressMolecularly profiling colorectal cancer has opened many potential opportunities for the use of this information in therapeutic decision-making. However, at present, only RAS testing in the metastatic setting has a definitive place in the decision-making paradigm.
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PARP Inhibition in Prostate Cancer: A Promising ApproachHaving said that, PARP inhibition is one of the most promising approaches for “precision therapy” so far. Within the next few years and with the help of ongoing clinical trials, we should have a better understanding of whether or not the high expectations raised will be translated into clinical reality.
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A Phase II Study of Doxorubicin/Paclitaxel Plus G-CSF for Metastatic Breast CancerThis phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line
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ACR Appropriateness Criteria® Management of Vaginal CancerThis article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.
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Mutation-Derived Tumor Antigens: Novel Targets in Cancer ImmunotherapyBecause of the abundance of promising preclinical and early-phase clinical data, mutation-derived tumor antigens an exciting new class of targets in cancer immunotherapy.
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Screening and Prevention of Hepatitis B Virus Reactivation During ChemotherapyThe incidence of both hepatitis B virus infection and cancer is common. The use of immunosuppressive therapy in patients with hepatitis B virus can result in reactivation of hepatitis B virus, which can, in turn, lead to significant morbidity and mortality.
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Something Old, Something New: Options for Treating Relapsed Mantle Cell LymphomaDr. Ruan and colleagues provide an excellent summary of available treatment options, as well as new drugs on the horizon, for the management of relapsed mantle cell lymphoma (MCL). As the authors emphasize, treatment of relapsed MCL is strongly influenced by the patient’s first-line therapy and needs to be individualized based on both patient and disease characteristics.
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The Evolving Care of Metastatic Colorectal CancerProgress in the care of mCRC has occurred relatively rapidly, but current methods of management have placed a significant economic burden on the healthcare system.
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Nina Shah, MD, Shares Key Takeaways From Phase 2 KarMMa Trial Sub-Analysis of Ide-Cel in R/R Multiple MyelomaNina Shah, MD, spoke about her key takeaways from a sub-analysis of the phase 2 KarMMa trial assessing correlates of complete response among those treated with idecabtagene vicleucel in relapsed/refractory multiple myeloma.
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Advanced Lab Testing in Lung CancerThe most important marker to test is epidermal growth factor receptor (EGFR). EGFR is the second most common oncogenic driver in lung cancer, present in 15% of adenocarcinoma cases, but the most common mutation to be actionable with an approved drug.
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The Many Controversies of Stage IIIA/IIIB Lung CancerThe first issue deserving comment is the heterogeneity of stage III disease. Stage IIIA N2 non–small-cell lung cancer (NSCLC) includes patients with at least one “incidental” N2 node detected at the time of surgical resection in patients who had a negative mediastinal evaluation (including mediastinoscopy) preoperatively. It also includes patients whose initial computed tomography (CT) and positron-emission tomography (PET) scans show multiple bulky (> 2 cm) nodes that are confirmed by either mediastinoscopy or endobronchial ultrasound-guided bronchoscopy.
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Obesity and Metabolic Disease After Childhood CancerIn this review, childhood cancer survivor populations at risk for metabolic late effects, as well as mechanisms and ongoing intervention studies, will be detailed.
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Propelling Immunotherapy Combinations Into the ClinicThis review summarizes promising new targets and immunotherapy combination strategies currently under clinical development.
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Advancing CLL Treatment: Latest Updates and StrategiesNitin Jain, MD, discusses a novel treatment approach for chronic lymphocytic leukemia, along with stem cell transplantation and other later-line therapies and treatment options for managing CLL.
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POINT: Routine Use of Autologous Stem Cell Transplantation in Multiple MyelomaResults of important studies addressing the optimal consolidation regimen and choice and duration of maintenance therapy are eagerly awaited, but it is evident that ASCT is imperative in the treatment of younger patients with multiple myeloma.
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Incidence and Management of AIDS-Related LymphomaThe article by Drs. Levine, Seneviratne, and Tulpule is an excellent review of the available literature on the incidence and treatment of lymphoma related to the acquired immunodeficiency syndrome (AIDS).
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Cancer Management Chapter 17: Cervical cancerOf the predominant gynecologic cancers, cancer of the uterine cervix is the least common, with only 11,270 new cases anticipated in the United States in 2009. Nevertheless, approximately 4,070 women die of cancer of the uterine cervix annually in the United States.
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Prophylactic Surgery in Hereditary Breast/Ovarian Cancer SyndromeDrs. Levine and Gemignanihave provided a comprehensivereview of the literatureregarding the management of patientswith hereditary breast/ovarian cancersyndrome. As noted, over 200,000new cases of breast cancer and 25,000new cases of ovarian cancer are estimatedfor 2003.[1] Only a small portionof these cases will be hereditary;however, these are the cases that maybenefit from preventive measures. Thepotential for risk-reducing strategiesin these patients has become a criticalissue over the past several years. Thisreview highlights the salient featuresof identifying “at-risk” patients, aswell as the benefits and limitations ofsurgical prophylaxis.
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Hypofractionation for Breast Cancer: Lessons Learned From Our Neighbors to the North and Across the PondIn this review we discuss the rationale and underlying radiobiologic concepts for hypofractionation, and review the clinical trials and ASTRO guidelines supporting hypofractionated radiation in the treatment of breast cancer.
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A Novel Weekday - on/Weekend - off UFT ScheduleIn a step toward a clinical trial, the tumor response and survival of a weekday-on/weekend-off schedule of UFT was compared with its conventional daily schedule in a cancer-bearing rat model. The dose-intensive schedule-600 mg of UFT for 5 days followed by 2 drug-free days-amounts to a weekly dose similar to the conventional schedule of 400 mg/day. The weekday-on/weekend-off schedule provided increased survival and significantly greater antitumor activity than the conventional daily schedule, with no difference in adverse reactions.
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Commentary (Gillette/Disaia): Extraovarian Primary Peritoneal CarcinomaDrs. Eltabbakh and Piver present a comprehensive review of the management and prognosis of patients with extraovarian primary peritoneal carcinoma (EOPPC). Increased recognition and more precise definition have led many physicians and scientists to recognize EOPPC as a distinct clinical entity with a unique etiology. However, staging and treatment criteria for EOPPC have been modeled after criteria for papillary serous ovarian cancer, which is clinically and histologically similar. The Gynecologic Oncology Group (GOG) has allowed the inclusion of patients with EOPPC into clinical trials designed for patients with epithelial ovarian cancer.
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Guillain-Barré Syndrome After Treatment With Sunitinib Malate?Sunitinib malate (Sutent, SU011248) is an oral multitargeted tyrosine kinase inhibitor used for treatment of renal cell carcinoma and gastrointestinal stromal tumor. We report a case of a patient who developed Guillain-Barré syndrome after initial treatment with sunitinib, with recurrent symptoms upon reintroducing the drug. This is the first report of such an effect. The literature on chemotherapy-induced Guillain-Barré syndrome is also reviewed. Oncology providers should be aware of this rare but potentially serious possible adverse effect of sunitinib.
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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.
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The Promise of Chimeric Antigen Receptor T-Cell TherapyIn this review, we will describe the mechanism of action of CAR T cells, discuss outcomes of current clinical trials, and highlight emerging directions for this exciting approach to cancer treatment.
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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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Commentary (Esserman/Hylton): The Application of Breast MRI in Staging and Screening for Breast CancerIn this excellent review of breastmagnetic resonance imaging (MRI),Gundry discusses the potential advantagesand disadvantages of magneticresonance in breast cancerscreening and management and givesrecommendations for how it shouldbe applied.
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Impact of T-cell Affinity in Bispecific Therapy in R/R MMNoopur Raje, MD, discusses the role of T-cell affinity in bispecific therapy for patients with relapsed/refractory multiple myeloma and how it impacts treatment practices.
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Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Emerging Treatment StrategiesOver the past decade, patients with locally advanced rectal cancer at The University of Texas M. D. Anderson Cancer Center have been managed with preoperative chemoradiation. Patients achieving a complete clinical response to preoperative chemoradiation have had better pelvic tumor control, sphincter preservation, and overall survival than those with gross residual disease. Some patients achieving a complete clinical response have even had rectal-preserving surgery (full-thickness local excision).
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DOGE: The Potential for Improved Processes, Outcomes and the Economics of Healthcare.Identifying inefficiencies in the health care system, such as excessive regulations, highlights its impact on the oncology-based audience.
