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Providing Supportive Care to Patients with NSCLCHelping patients manage potential treatment-related adverse events is an essential part of the overall care plan in the treatment of non-small cell lung cancer. Experts provide strategies to address adverse events and best practices for providing the supportive care needed for patients.
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Lung Cancer: New Developments Point the Way to Reduced MortalityGanti et al have described the most recent negative lung cancer chemoprevention trial, which compared selenium to placebo.
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Commentary (Fick/Gutin): Current Management of MeningiomasSurgical resection has been the preferred treatment for meningiomas since the era of the pioneering neurosurgeon, Harvey Cushing. The great majority of these tumors are histologically benign, circumscribed lesions that grow slowly and tend to compress and displace, rather than invade, the surrounding intracranial structures. In contrast to the intrinsic brain tumors of glial origin, most meningiomas have well-defined borders, enabling the surgeon to dissect the tumor capsule from the arachnoid lining of the adjacent brain, blood vessels, and cranial nerves. Consequently, complete removal can be accomplished without needing to sacrifice functional tissue. In these cases, surgery is often curative, and associated with the preservation of, if not improvements in, the neurological condition.
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Vaccine Therapy for Patients With MelanomaInvestigation into the therapeutic use of vaccines in patients with metastatic melanoma is critically important because of the lack of effective conventional modalities. The most extensively studied melanoma vaccines in clinical trials are whole-cell preparations or cell lysates that contain multiple antigens capable of stimulating an immune response. Unfortunately, in the majority of studies, immune responses to these vaccines have not translated into a survival advantage. Advances in tumor cell immunology have led to the identification of candidate tumor cell antigens that can stimulate an immune response; this, in turn, has allowed for refinements in vaccine design. However, the exact tumor antigens that should be targeted with a specific vaccine are unknown. The univalent antigen vaccines, which have greater purity, ease of manufacturing, and reproducibility compared with polyvalent vaccines, may suffer from poorer efficacy due to immunoselection and appearance of antigen-negative clones within the tumor. Novel approaches to vaccine design using gene transfection with cytokines and dendritic cells are all promising. However, the induction of immune responses does not necessarily confer a therapeutic benefit. Therefore, these elegant newer strategies need to be studied in carefully designed clinical trials so that outcomes can be compared objectively with standard therapy. If survival is improved with these vaccine approaches, their ease of administration and lack of toxicity will firmly entrench active specific vaccine immunotherapy as a standard modality in the treatment of the melanoma patient.[ONCOLOGY 13(11):1561-1574, 1999].
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Surgery for Primary Central Nervous System Lymphoma: Is It Time for Reevaluation?Relatively few patients with primary diffuse large B-cell lymphoma (PCNSL) will have tumors that are amenable to resection. In the absence of the highest quality data, at least it is good to know that in the modern era, patients with PCNSL are probably not harmed by judicious tumor resection.
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Hormone Replacement and Breast Cancer Risk: Reconsidering the DataIn their recent commentary (Oncology 23:639-641, 2009), Labriola and colleagues reviewed the data on “natural” hormone replacement and breast cancer risk. The “natural” agents were bioidentical and phytoestrogen supplements to manage vasomotor symptoms in breast cancer patients.
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HDAC Inhibitors in Cancer CareThe epigenetic control of gene expression has been shown to play an important role in cancer initiation, progression, and resistance. Thus, agents that modify the epigenetic environment of tumors will likely be an important addition to the anticancer arsenal. Specifically, there is much interest in modulating histone acetylation using a new class of drugs, histone deacetylase (HDAC) inhibitors. Preclinical data have demonstrated the efficacy of various HDAC inhibitors as anticancer agents, with the greatest effects shown when HDAC inhibitors are used in combination with other therapies. As a result of encouraging preclinical data, numerous HDAC inhibitors are being investigated in clinical trials either as monotherapies or in conjunction with other treatments such as chemotherapy, biologic therapy, or radiation therapy. In fact, vorinostat and depsipeptide, two actively studied HDAC inhibitors, were recently approved for the treatment of refractory cutaneous T-cell lymphoma. Although the use of HDAC inhibitors has generated great enthusiasm, a significant amount of work still needs to be done in order to understand their mechanisms of action, as well as to determine the appropriate patient characteristics and subsets of cancer for which HDAC inhibitors hold the most potential for effective treatment.
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Prostate Cancer Immunotherapy: the Role for Sipuleucel-T and Other Immunologic ApproachesFor many years, the results of large randomized clinical trials of cancer vaccines have not been good.
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AL Amyloidosis: New Drugs and Tests, but Old ChallengesImmunoglobulin light chain (AL) amyloidosis develops in 2% of individuals with monoclonal plasma cell dyscrasias. In this issue of ONCOLOGY, Drs. Gertz and Dispenzieri discuss AL amyloidosis, highlighting progress in the field along with outstanding challenges.
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Oncologic Imaging, Second EditionAlthough the title might be slightly misleading, Oncologic Imaging is actually a compendium of information on the detection, diagnosis, imaging, staging, and treatment of cancer. This is the second edition of a multiauthor book that first appeared in
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Prostate Cancer 2012: Where Do We Stand and Where Are We Heading?Recent progress in our understanding of the pathogenesis of advanced prostate cancer has heralded a new era in treatment. Numerous agents now populate the treatment landscape, and an impressive number of novel agents are in development. However, many questions remain unanswered, paving the path for discovery in the future.
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Empiric Antifungal Therapy for the Neutropenic PatientAmong the most significant complications a neutropenic patient can experience is an invasive fungal infection. In this issue of Oncology, Drs. Wingard and Leather thoroughly review the epidemiology, clinical presentation, and empiric treatment of these infections, particularly those associated with Candida and Aspergillus. They emphasize the need for better methods of identifying individuals at high-risk for invasive fungal infections because those individuals are more likely to benefit from antifungal prophylaxis or empiric therapy. The goal of such a targeted approach is to limit the amount of antifungal agents given, thereby decreasing the number of adverse effects and diminishing the selection of antifungal-resistant species.[1]
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Prostate Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Global lung ca staging lexicon undergoes major overhaulThe imminent publication of eagerly anticipated new international guidelines promises to transform the complex area of lung cancer staging. The International Association for the Study of Lung Cancer is expected to publish its updated recommendations in 2009. The seventh edition of the guidelines will include tumor, node, and metastasis classification. The original TNM staging of lung cancer proposed in 1973 was based on 2,155 cases from the database of Clifton Mountain, MD, from M.D. Anderson Cancer Center in Houston.
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Targeting Metastatic Colorectal Cancer in 2008: A Long Way From 5-FUColorectal cancer is one of the leading causes of cancer-related death worldwide, with almost 20% of all patients presenting with metastatic disease at the time of their diagnosis. The treatment regimens and options of metastatic colorectal cancer have significantly changed in the last 10 years, leading to an improvement of response rates to about 50%, progression-free survival of about 10 months, and overall survival reaching over 2 years.
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New Agents for the Treatment of Advanced Bladder CancerThis article will review select novel targets and approaches relevant to urothelial cancer.
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Contemporary Issues Surrounding Small Renal Masses: Evaluation, Diagnostic Biopsy, Nephron Sparing, and Novel Treatment ModalitiesIn this review, we summarize the diagnosis of small renal masses, the role of renal mass biopsy, different treatment strategies, and future directions, including emerging molecular biomarkers.
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Using Molecular Tools to Guide Breast Cancer TreatmentThis video examines the use of molecular diagnostics for guiding adjuvant endocrine therapy in patients with breast cancer.
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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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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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T1 High-Grade Bladder Cancer Recurring After BCGTherapy: A Curative Alternative to Radical Cystectomy ExistsDecades of experience now exist to support the use of chemoradiotherapy in the treatment of muscle-invasive bladder cancer. Chemoradiotherapy for T1 tumors that recur following bacillus Calmette-Guérin therapy is promising and provides an important curative alternative for those unable or unwilling to undergo radical cystectomy.
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(18)F-NaF PET/CT and (11)C-Choline PET/CT for the Initial Detection of Metastatic Disease in Prostate Cancer: Overview and Potential UtilizationWe briefly review these two imaging technologies and provide potential utilization strategies based on available data.
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Commentary (Vogelzang/Manno): Update on Malignant MesotheliomaIn their historical review of the topicof malignant mesothelioma, Drs.Antman, Hassan, Eisner, and colleaguespoint out that the naturalhistory of malignant pleural mesotheliomahas not changed “over the past2 decades.” We disagree and suggestthat it was altered with the discoverythat the combination of pemetrexed(Alimta) and cisplatin is active in thissetting.[1] Subsequently, the largestphase III trial ever conducted in pleuralmesothelioma showed that mediansurvival improved by nearly4 months for pemetrexed/cisplatinrecipients, compared to treatment withcisplatin alone (13 vs 9 months,P < .001). Based on these data, theUS Food and Drug Administrationapproved pemetrexed, cisplatin, andsupplementation with vitamin B12 andfolic acid for the treatment of pleuralmesothelioma, and this regimen is nowthe standard of care.[2]
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Considering Neoadjuvant Chemotherapy Options in Bladder CancerIn this peer-to-peer discussion Dr. Grivas and Dr. Palmbos examine the role of neoadjuvant chemotherapy in bladder cancer and weigh the various trial data guiding these treatment decisions.
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PSA Screening: The Case in FavorThe facts presented about screening should be tailored to the patient’s exact situation, and the patient’s values should be used to guide the final decision. For younger, healthy men, PSA screening should continue to be strongly considered.
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Active Surveillance in Small Renal MassesIn this interview we discuss a new study that looked at the outcomes of patients with small renal masses who were followed with active surveillance.
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Bone-Targeted Therapy in Early Breast CancerIn this article, we describe the role of bone-targeted therapies, specifically for managing early breast cancer, by reviewing their bone-specific and cancer-specific benefits.
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Metastasis-Directed Therapy in Prostate Cancer. Why, When, and How?Metastasis-directed therapy with stereotactic ablative radiotherapy has emerged as a promising complementary technique for the management of low-volume metastatic prostate cancer.
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A Randomized Trial of Fludarabine and Mitoxantrone Plus Rituximab vs CHOP Plus Rituximab as First-Line Treatment in Patients With Follicular LymphomaThe FM (fludarabine [Fludara], mitoxantrone [Novantrone]) combination is an effective strategy in follicular lymphoma. From October 1999, patients from 12 Italian centers were randomized for a comparative study of FM vs CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) chemotherapy with the addition of rituximab (Rituxan) in selected cases.
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New Combinations With Epirubicin in Advanced Breast CancerSeveral 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
