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Recurrent Pancreatic Adenocarcinoma After Pancreatic ResectionThe University of Colorado Denver School of Medicine faculty hold weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologic specialist. Their history, pathology, and radiographs are reviewed during the multidisciplinary conference, and then specific recommendations are made. These cases are usually challenging, and these conferences provide an outstanding educational opportunity for staff, fellows, and residents in training.The second opinion conferences include actual cases from genitourinary, lung, melanoma, breast, neurosurgery, gastrointestinal, and medical oncology. On an occasional basis, ONCOLOGY will publish the more interesting case discussions and the resultant recommendations. We would appreciate your feedback; please contact us at second.opinion@uchsc.edu.
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Salvage Therapy for Ovarian CancerPatients with epithelial ovarian cancer must receive optimal surgical care and state-of-the-art chemotherapy in the primary treatment setting. The salvage treatment of women with recurrent or persistent ovarian cancer remains a
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The Role of PSA in the Radiotherapy of Prostate CancerDr. Roach initiates his discussion with the relevant statement that how we detect, stage, and treat carcinoma of the prostate, as well as subsequently evaluate treatment efficacy, has forever been dramatically altered by the availability of prostate specific antigen (PSA), which has been labeled "the most useful tumor marker available" [1]. However, as Dr. Roach also notes, new information and insights generate new questions and uncertainties about the best applications of this valuable tumor marker.
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A Woman With Primary Breast Cancer and a Solitary Sternal MetastasisThe patient presented to her primary care physician 3 months prior with an inverted left nipple and a palpable lump that was highly suggestive of neoplasm on mammogram. An ultrasound-guided core biopsy revealed an infiltrating solid-type ductal carcinoma in situ. The estimated size of the mass was approximately 1 cm. She had no symptoms suggestive of metastatic disease.
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Management of Pressure UlcersPressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure
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Erlotinib/Gemcitabine for First-Line Treatment of Locally Advanced or Metastatic Adenocarcinoma of the PancreasErlotinib (Tarceva) is a human epidermal growth factor receptor type 1/epidermal growth factor receptor (HER1/EGFR) tyrosine kinase inhibitor initially approved by the US Food and Drug Administration for the treatment of patients with locally advanced or metastatic non–small-cell lung cancer after failure of at least one prior chemotherapy regimen. In this report, we present the pivotal study that led to the approval of erlotinib in combination with gemcitabine (Gemzar) in patients with locally advanced/metastatic chemonaive pancreatic cancer patients. The combination demonstrated a statistically significant increase in overall survival accompanied by an increase in toxicity. Physicians and patients now have a new option for the treatment of locally advanced/metastatic adenocarcinoma of the pancreas.
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Changing paradigms for tumor response spark debate at ECR special focus sessionVIENNA-Yes, size does matter, but it is certainly not the only way to monitor the effi cacy of cancer treatment. Th e way in which lesions are measured is extremely important as well, according to a special focus session on the assessment of tumor response at the 2009 European Congress of Radiology.
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Monoclonal Antibodies and Side-Effect ManagementMonoclonal antibodies are increasingly becoming a standard part of clinical cancer treatment. Eight monoclonal antibodies are approved by the Food and Drug Administration for the treatment of cancer in the United States. Oncology nurses are expected to be familiar with these agents, their indications, and their adverse effects, to provide appropriate care and symptom management to patients receiving these agents, and to adequately educate patients and families about these treatments and their specific and overlapping side effects. Monoclonal antibody mechanisms of action and indications, infusion guidelines, and symptom management are outlined in this article.
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Surgery in the Older PatientSurgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients.
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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.
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Measure for measure: How to make practice benchmarks meaningfulMINNEAPOLIS-When it comes to taking stock of an oncology practice’s productivity, less is more. It benefits a practice to develop a few meaningful benchmarks rather than multiple overlapping, overwhelming, and meaningless measurements.
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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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Using Genomic Sequencing to Improve Management in MelanomaHere we summarize the available genomic and genetic tests for melanoma, and the level of evidence supporting each of these. We also discuss the current impact of genomic sequencing on the management of melanoma, as well as roles it may play in the near future.
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Management of Fatigue in the Cancer PatientFatigue is one of the most common symptoms experienced by patients with cancer and other progressive diseases. Although reported to be a major obstacle to maintaining normal daily activities and quality of life, remarkably few studies of this syndrome have been conducted.
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Pemetrexed in Pancreatic CancerSingle-agent gemcitabine (Gemzar) is the standard of chemotherapyfor advanced pancreatic cancer, with no phase III trials to date havingshown significantly improved survival with gemcitabine-based combinationsvs single-agent treatment. The multitargeted antifolate agentpemetrexed (Alimta) shows synergistic effects in vitro in combinationwith gemcitabine, and activity and good tolerability when used as singleagenttreatment in advanced pancreatic cancer. In a phase II trial inpatients with advanced pancreatic cancer, the combination ofgemcitabine at 1,250 mg/m2 on days 1 and 8 plus pemetrexed at 500mg/m2 on day 8 after gemcitabine every 21 days resulted in a mediansurvival of 6.5 months and a 1-year survival rate of 29%. Neutropeniawas the primary toxicity, with grade 4 toxicity in 51% of patients. Thepromising results of this trial prompted the initiation of a phase IIItrial comparing gemcitabine at 1,000 mg/m2 on days 1, 8, and 15 every28 days vs the 21-day gemcitabine/pemetrexed regimen given with vitaminsupplementation in patients with pancreatic cancer. The primaryoutcome measure was overall survival, with secondary measures includingresponse rate, progression-free survival, and quality of life.While an increase in response and time to progression was reported forthe gemcitabine/pemetrexed combination, there were no significantdifferences in survival between treatment arms.
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Is Surgery Always Necessary in Rectal Cancer?In this article, we review risks and benefits of the standard treatment approach for rectal cancer and compare standard treatment with alternative methods aimed at rectal preservation.
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Stereotactic Body Radiotherapy in the Management of Painful Bone MetastasesBone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.
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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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ACR Appropriateness Criteria® Adjuvant Therapy in Vulvar CancerThe panel reviewed the pertinent literature in vulvar cancer and voted on three variants to establish appropriate use of imaging, adjuvant radiation, including dose, fields, and technique, as well as adjuvant chemotherapy. This report will aid clinicians in selecting appropriate patients for adjuvant treatment and will provide guidelines for the optimal delivery of adjuvant radiation therapy and chemotherapy.
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Reassessing Adjuvant Treatment of Early-Stage Breast Cancer in Elderly Women: Focus on Findings from 2007 ASCO MeetingApproximately 212,920 new cases of invasive breast cancer were estimated to occur in the United States in 2006.1 The incidence rate has continued to rise slowly over the past 20 years due to the continued increase of breast cancer in women aged 50 and older (375 cases per 100,000 women), peaking at 75 to 79 years of age (525 per 100,000 women).
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Oncology Nursing: Quo Vadis? A 30-Year PerspectiveThe myriad changes that oncology physicians have experienced in the last 20 years are certainly applicable to oncology nurses, in particular, the technology explosion and its effects on diagnosis, treatment, and survivorship; the emergence of cancer as a disease of the elderly; challenges posed by shortages of health care workers; and the fact that almost all cancer patients today are treated as outpatients. Recent therapeutic innovations and management approaches have been keenly felt by oncology nurses, who typically play a major role in patient education.
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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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Surgical Cytoreduction for Ovarian Cancer: Issues Awaiting Formal ClarificationThe magnitude of the role surgical exploration and extirpation play in the contemporary management of patients with advanced ovarian cancer is hard to overstate. Beyond diagnostic confirmation, the aggressive posture taken to remove bulk disease provides-among other benefits-symptomatic relief, theoretically enhanced immunologic integrity, chemosensitivity, and improved survival characteristics.
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Melanoma: An Under-recognized Cancer ThreatMelanoma continues to be a poorly understood and frequently under-recognized cancer threat to society. The authors have provided a comprehensive overview of this malignancy from diagnosis to advanced-stage therapy.
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Apoptosis and Response to Radiation: Implications for Radiation TherapyTumor growth is the result of two opposing processes--cell division and cell loss. As long as division outpaces loss, tumors will continue to grow. The form of "active" cell death called apoptosis is now known to be controlled by specific genes, and it is hoped that manipulating the expression of these genes could shift the balance in favor of cell loss.
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Commentary (Ljungman): Vaccinations Against Infectious Diseases in Hematopoietic Stem Cell Transplant RecipientsAs increasing numbers of stemcell transplant recipients becomelong-term survivors, interestin understanding their longtermimmune status also assumesgreater urgency. One important strategyfor protecting patients againstcertain infections is the use of vaccinations.Just a few years ago, therewere no published recommendationsregarding this issue. Since then, boththe European Group for Blood andMarrow Transplantation (EBMT)and the Centers for Disease Controland Prevention (CDC) have publishedrecommendations. Drs. Goldberg,Cicogna, Rowley, and Pecoracritically review the CDC recommendationsin a nicely written articleand provide important backgroundinformation.
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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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Management of Pressure UlcersPressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure
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Commentary (Shen): Radiotherapy for Cutaneous Malignant Melanoma: Rationale and IndicationsRadiation therapy is not part ofthe traditional treatment approachto cutaneous melanoma.Aggressive surgical resection ofboth the primary site and regional nodalmetastases has long been consideredthe only option for achievinglong-term disease-free and overall survival.Many patients who present withmelanoma have thin lesions (< 1 mmBreslow thickness) and are essentiallycured with a wide local excision ofthe primary site. Patients with thickermelanomas and clinically negativeregional nodal basins often undergowide excision and sentinel node biopsyto identify occult nodal metastases.Those who have a sentinel lymphnode positive for metastatic diseaseor clinically positive nodes undergo atherapeutic lymph node dissection toprovide local control and possibly preventdistant metastatic disease. Recentarticles such as the one by Balloand Ang, however, highlight the in-creasedrole of external-beam radiationtherapy in the treatment of malignantmelanoma.
