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Mesa Considers Next Steps With Pacritinib in MyelofibrosisRuben Mesa, MD, spoke about why pacritinib in the treatment of myelofibrosis is beneficial.
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Momelotinib Will ‘Make an Immediate Impact’ in Myelofibrosis With AnemiaWith the approval of momelotinib by the FDA, the updated use for its role in myelofibrosis will potentially change clinical practice, according to Ruben Mesa, MD.
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Best Practices in the Management of Newly Diagnosed Multiple Myeloma Patients Who Will Not Undergo TransplantNo survival advantage of autologous stem cell transplantation (ASCT) has been documented for patients older than 65 years, and in the era of thalidomide (Thalomid), bortezomib (Velcade), and lenalidomide (Revlimid), ASCT has a diminished role in the front-line treatment of older patients with myeloma.
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Oropharyngeal Mucositis in Cancer TherapyOropharyngeal mucositis hasbeen reported as the mostbothersome side effect by patientsundergoing myeloablative regimens,and it remains a therapy-limitingtoxicity of radiation and chemotherapyfor head and neck cancer. JoelEpstein and Mark Schubert providean informative review of progressmade over more than a decade of researchon the pathophysiology andmanagement of oropharyngeal mucositisin patients undergoing cancertreatment.
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The Timing of Breast Cancer Surgery During the Menstrual CycleA number of recent studies have suggested that survival among premenopausal women after primary treatment of breast cancer may be affected by the estimated hormonal milieu at the time of surgery, especially in those with
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The Best Treatment for Diffuse Large B-Cell Lymphoma: A German PerspectiveWhile some improvement was achieved by adding etoposide and shortening the treatment intervals from 3 to 2 weeks (CHOEP-14), best results in young good-prognosis patients (age-adjusted International Prognostic Index [IPI] = 0,1) have been achieved with six cycles of CHOP (cyclophosphamide, doxorubicin HCl, vincristine [Oncovin], prednisone)-like chemotherapy in combination with the anti-CD20 antibody rituximab (Rituxan). The role of additional radiotherapy in this setting remains to be determined. With this approach, 2-year eventfree survival rates of > 90% and overall survival of > 95% can be achieved in a very favorable subgroup (patients without IPI risk factor and no bulky disease), while further improvement is warranted for the less favorable subgroup (event-free survival only 77%). For young poorprognosis patients (age-adjusted IPI ≥ 2), the 5-year survival is around 50%, and progress has not been convincingly and specifically demonstrated in these patients. Ongoing studies will show whether dose-dense conventional or high-dose chemotherapy regimens requiring stem cell support in combination with rituximab will result in similar improvements of outcome as has been reported recently for young patients with good-prognosis aggressive lymphoma. In elderly patients, CHOP interval reduction from 3 to 2 weeks (CHOP-14) and the addition of rituximab to CHOP-21 achieved similar improvements in outcome. The ongoing RICOVER-60 (rituximab with CHOP over 60) trial of the German High-Grade Non-Hodgkin’s Lymphoma Study Group (DSHNHL) evaluates whether the combination of both approaches (R-CHOP-14) can further improve the prognosis of elderly patients.
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Optimal Combination With PUVA: Rationale and Clinical Trial UpdateCutaneous T-cell lymphoma (CTCL) is relatively benign in its early stages, but survival rates decrease dramatically as the disease progresses. As no curative therapies are currently available, the goal of therapy is preventing or delaying progression from early disease stages while minimizing long-term toxicity. No single agent, including psoralen plus ultraviolet A (PUVA), can control disease progression fully, so combination therapy is needed to improve response rates. In addition, low-dose combination therapy may improve treatment safety and tolerability. A combination of PUVA and interferon (IFN)α in early disease has been shown to be effective and well tolerated. Likewise, small studies of PUVA and bexarotene (Targretin) indicate good efficacy for this combination. Reduced doses of these combinations may also be effective as maintenance therapies following complete remission. Other treatment combinations shown to be effective in early disease stages include bexarotene with IFNα, and bexarotene with denileukin diftitox (Ontak). In advanced stages of CTCL, liposomal-encapsulated doxorubicin or extracorporeal photopheresis may be combined with bexarotene or IFNα.
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Managing Nausea and Vomiting in Patients With Cancer: What WorksThis article will discuss the approach to and management of both treatment-related and non–treatment-related nausea and vomiting in cancer patients.
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Recurrent EGFR-Mutated Non–Small Cell Lung Cancer Discovered by Abnormal Mammogram: Adjuvant/Frontline Metastatic Management OptionsABSTRACT: Breast metastasis from extramammary malignancy is rare, with a reported incidence rate of 0.4% to 1.3% in the published literature. The primary malignancies that most commonly metastasize to the breast are leukemia, lymphoma, and malignant melanoma. Here, we report a very rare case of metastatic EGFR-mutated non–small cell lung cancer (NSCLC) in the breast detected by screening mammography. The patient had initially been diagnosed with a clinical stage IIIA NSCLC and had been treated with neoadjuvant chemoradiation followed by curative-intent surgery. Several interesting aspects of the case, along with a discussion of evolving adjuvant and frontline metastatic management options in EGFR-mutated NSCLC, will be presented.
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Changing Treatment Paradigms for Brain Metastases From Melanoma-Part 2: When and How to Use the New Systemic AgentsIn this article, we provide an overview of the currently available systemic agents, including immunotherapeutic agents and targeted tyrosine kinase inhibitors. We also provide a practical management algorithm to guide the practicing oncologist in the use of both of these new therapies and the more traditional local treatments.
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Weekly Irinotecan and Concurrent Radiation Therapy for Stage III Unresectable NSCLCIn preclinical studies, the topoisomerase I inhibitor irinotecan (Camptosar, CPT-11) has demonstrated activity as a radiosensitizer, probably due to its ability to inhibit potentially lethal radiation damage repair. We conducted a
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Paclitaxel, Carboplatin, and Radiation Therapy for Non-Small-Cell Lung CancerPreclinically, the taxanes appear to potentiate radiation more effectively than do the platinum compounds. In our phase I trial (LUN-17) in patients with advanced non-small-cell lung cancer, we defined the maximum tolerated
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More on Futile Care: Feelings of Abandonment, Confusion, and Wishful ThinkingKhatcheressian and coauthors’ article about futile care in oncology addressed an important but uncommonly discussed aspect of oncology.[1] There are several other points that were not brought up in the excellent discussion.
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Radiotherapy in Small-Cell Lung CancerGanti and colleagues have provided a brief review on the diagnosis of small-cell lung cancer (SCLC) and the roles of chemotherapy and surgery in its management. Notably, in the past three decades, the most significant progress in the treatment of SCLC has mainly involved the use of radiotherapy. Thus, to complement their assessment, we will provide an overview of the role of radiation in the management of limited-stage and extensive-stage SCLC.
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Irinotecan/Gemcitabine Followed by Twice-Weekly Gemcitabine/Radiation in Locally Advanced Pancreatic CancerEarly clinical studies combining irinotecan (CPT-11, Camptosar) and gemcitabine (Gemzar) have yielded encouraging results. Gemcitabine administered via a twice-weekly schedule results in an enhanced radiation-sensitizing effect.
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The Management of Early Ovarian CancerApproximately one third of patients with epithelial ovarian cancer present with localized or early-stage disease. Prognostic features identify certain subsets of patients with good risk characteristics who do not require adjuvant
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Commentary (Cruciani/Portenoy)-Opioid Rotation in Cancer Patients: Pros and ConsOpioid rotation is now consideredstandard practice in themanagement of cancer pain.The rationale for the approach hasbeen well summarized by Estfan andcolleagues. Rotation should be viewedas one strategy among many to dealwith patients who demonstrate relativelypoor responsiveness to an opioid.[1] Application of well acceptedclinical guidelines for opioid administration,beginning with those originallypromulgated by the WorldHealth Organization,[1] emphasizethe need to individualize the opioiddose through a process of gradualdose titration, irrespective of the specificdrug. Most cancer patients attainan adequate balance betweenanalgesia and side effects, at leastinitially. Some, however, experiencetreatment-limiting toxicity, the sinequa non of “poor responsiveness.”This response reflects an outcome thatis related to a specific drug, route ofadministration, set of patient-relatedvariables, and time.
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Magnetic Resonance Imaging of the Abdomen: Applications in the Oncology PatientCross-sectional imaging of the abdomen in oncology patients presents unique challenges and opportunities. A close working relationship between the oncologist and radiologist is essential for the exchange of the clinical and
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Commentary (Broaddus/Lu): Gynecologic Manifestations of Hereditary Nonpolyposis Colorectal CancerTraditionally, most hereditarynonpolyposis colorectal cancer(HNPCC) syndrome patientshave been identified and cared for bygastroenterologists, colorectal surgeons,and gastrointestinal medicaloncologists. Hence, the realization thatgynecologic tumors actually play amajor role in HNPCC has come relativelylate. Consequently, much of theclinical and basic science focus ofresearch in HNPCC has concentratedon colorectal cancer.
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Does This Woman Have Gestational Trophoblastic Disease?The review of the histology slides revealed predominantly decidual tissue with exaggerated placental site and a small focus of trophoblastic tissue composed of cytotrophoblast and syncytiotrophoblast with mild atypia (Figure 1). However, no necrosis or tissue invasion was identified. No villi were seen.
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Modulation of Dose Intensity in Aerodigestive Tract Cancers: Strategies to Reduce ToxicityDr. Rich and colleagues present a compelling argument for the manipulation of temporal and spatial treatment parameters in chemoradiation programs. In essence, the authors address the shielding of normal tissues from the effects of cytotoxic agents. With respect to radiotherapy, this can be achieved via physical shielding by computer-generated dose algorithms using elaborate new planning technology (eg, intensity-modulated radiation therapy [IMRT]), chemical shielding with radioprotectants (eg, amifostine [Ethyol]), or temporal shielding by altered-fractionation schemes that exploit the differential alpha/beta ratios between tumor and normal tissue (eg, hyperfractionation).
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Adjuvant Endocrine Therapy for Breast CancerIn this article, we review the current guidelines for adjuvant endocrine therapy in both premenopausal and postmenopausal women, and we discuss the clinical trials that were used to develop these guidelines.
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Overview of Clinical Data and Treatment Selection in Later-Line HER2+ Metastatic Breast CancerPanelists discuss how clinical data and treatment selection in later-line HER2+ metastatic breast cancer are informed by the latest therapeutic advancements, including targeted therapies like trastuzumab deruxtecan (T-DXd) and tucatinib, to optimize patient outcomes and manage progression.
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Commentary (Davis/Lagman): Improving Palliative and Supportive Care in Cancer PatientsDr. Khatcheressian and colleagueshave nicely reviewedboth barriers to palliative andsupportive care and remedies.
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Supportive Care and Managing Toxicities Related to ADCs in TNBCA panel of medical oncologists provides insights on managing toxicities in patients with triple-negative breast cancer who are receiving antibody-drug conjugates.
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Managing Psychosocial Distress: Lessons Learned in Optimizing Screening Program ImplementationThis article discusses “lessons learned” on managing psychosocial distress and the optimal strategies to promote institutions’ adoption of distress screening.
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Dr. Ryan J. Sullivan on Frontline Immunotherapy Sequencing in MelanomaCancer Network spoke with Ryan J. Sullivan, MD, of Massachusetts General Hospital, about the debate between immunotherapy sequencing vs targeted therapy for melanoma.
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PARP Inhibitors and Their Evolving Role in Breast CancerPoly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) inhibitors are designed to exploit the “synthetic lethality” concept for cancer therapy.
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Synchronous Bilateral Breast Cancer With Discordant HistologyA 48-year-old Caucasian woman presented with a palpable right breast mass. Physical examination confirmed a lump on the upper outer quadrant of her right breast. On PET/CT scan there was an incidental finding of increased metabolic activity in the left lateral breast.
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Hematopoietic Cell TransplantationHematopoietic cell transplantation (HCT) is the IV infusion of hematopoietic stem and progenitor cells designed to establish marrow and immune function in patients with a variety of acquired and inherited malignant and nonmalignant disorders.
