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Proteomics to Diagnose Human Tumors and Provide Prognostic InformationBiomedical research is in themidst of unprecedented transformationstemming from theoverall impact of molecular biologyon medical research, including theemerging high-throughput genomicsbasedtechnologies. These new paradigmsare leading to better definitionof the disease state as well as moreprecise and less toxic therapeutic strategies.But even as we begin to understandthe implications of gene-basedinformation on the genesis, pathophysiology,and progression of disease andon the development of novel therapeuticapproaches, the dawn of theera of proteomics is heralding evenmore radical changes.
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Management of Small Bowel AdenocarcinomaSmall bowel adenocarcinoma is a relatively rare malignancy. Only limited information is available on the incidence, prognosis, and role of chemotherapy in the treatment of this disease. We present a review of currently
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Diagnostic Dilemma: GI DiseaseThis photograph is from an upper gastrointestinal endoscopy on a 15-year-old male. He has a history of a total colectomy and is being evaluated for iron deficiency anemia. He denies abdominal pain, weight loss, and melena. He notes occasional bright red blood on the toilet paper but denies hematochezia.
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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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Unusual Myelomas: A Review of IgD and IgE VariantsAlthough survival of patients with IgD or IgE multiple myeloma is shorter in comparison to those with IgG or IgA multiple myeloma, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.
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UFT Plus Cisplatin in Advanced Non-Small-Cell Lung Cancer: Interim Analysis of 67 PatientsA single-institution phase II study indicated that combination chemotherapy using UFT (tegafur and uracil) plus cisplatin (Platinol) in patients with non-small-cell lung cancer was active with less host toxicity than other cisplatin-
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POINT: HER2-Targeted Combinations in Advanced HER2-Positive Breast CancerWe acknowledge that the “more is better” approach may not always hold true. For example, preclinical data provided a rationale for combining pertuzumab with T-DM1, but recent reports suggest that this strategy may not prove more effective than single-agent T-DM1 therapy in the clinic.
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Chemotherapy for Breast Cancer During Pregnancy, With Neonatal Lupus in the NewbornA 34-year-old, gravida 2, para 1, previously healthy African-American woman presented with a right breast mass on self-examination in the second trimester of pregnancy.
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Rational Design of Irinotecan Administration Based on Preclinical ModelsMost clinical drug regimens for irinotecan (CPT-11 [Camptosar]) have been empirically based on classic in vivo pharmacokinetic and pharmacodynamic considerations. We propose an alternative approach that attempts to
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Chemotherapy for Soft-Tissue SarcomasIn patients with high-risk localized disease, the use of systemic chemotherapy should be strongly considered to delay recurrence and/or reduce the patient’s risk of developing metastatic disease. In patients with metastatic disease, systemic chemotherapy remains the mainstay of treatment.
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ACR Appropriateness Criteria® Adjuvant Management of Early-Stage Endometrial CancerAfter a review of the published literature, the panel voted on three variants to establish best practices for the utilization of imaging, radiotherapy, and chemotherapy after primary surgery for early-stage endometrial cancer.
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Irinotecan in Small-Cell Lung Cancer-Japanese TrialsIrinotecan has appeared to have significant activity against previously treated and untreated small-cell lung cancer (SCLC). The major toxicities of irinotecan are neutropenia and diarrhea, although there is interpatient
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Recent Advances in Hormonal Therapy for Advanced Prostate CancerHormonal treatment of advanced prostate cancer should be consideredfor patients who have stages C and D1 disease, a high risk of recurrenceafter local therapy, or prostate-specific antigen–measured recurrenceafter local treatment. This approach is dependent on most prostatecancer cells being androgen-dependent, but androgen-independentcells may arise after several years of hormonal therapy. Options forandrogen blockade primarily include orchiectomy, luteinizing hormone–releasing agonists and antagonists, and nonsteroidal antiandrogens.There is some controversy regarding combined androgen blockade,intermittent androgen blockade, and the question of whether earlyandrogen blockade is superior to delayed therapy. Convincing data doexist for the use of adjuvant/neoadjuvant hormonal therapy with external-beam radiation therapy. Although hormonal therapy is an importanttreatment modality for advanced prostate cancer, long-termtreatment carries significant side effects that need to be considered.
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Recap: Bladder Cancer Treatment AlgorithmThe Oncology Brothers recap the discussion on treatment practices for patients with bladder cancer.
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What Is the Current Standard of Care for Anti-HER2 Neoadjuvant Therapy in Breast Cancer?This article provides a comprehensive summary of the knowledge gained from recent neoadjuvant trials conducted with agents targeting HER2, and will put them into perspective with current treatment recommendations from American and European guidelines.
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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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Clinical Applications of The Cancer Genome Atlas Project (TCGA) for Squamous Cell Lung CarcinomaWe summarize here key findings from the comprehensive analysis of squamous cell lung cancer by The Cancer Genome Atlas group and discuss the clinical implications of these findings.
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Commentary (Raijman/Wallace): Management of Malignant Biliary Obstruction: Nonoperative and Palliative TechniquesThe first description of percutaneous biliary drainage in the United States appeared in 1965 [1]. The percutaneously placed catheters were left in the obstructed biliary tract for drainage for up to 5 days. Since then, biliary drainage techniques have advanced substantially, and options have proliferated. Now, the nonsurgical palliation of malignant biliary obstruction, accomplished either endoscopically or percutaneously, is a well-established therapeutic modality.
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Paclitaxel and UFT Plus Oral Calcium Folinate in Pretreated Metastatic Breast CancerThis phase I study was designed to determine the maximum tolerated dose (MTD) and dose-limiting side effects of combination treatment with paclitaxel (Taxol) and UFT (uracil and tegafur in a 4:1 molar ratio) plus oral
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Clinical Management of EGFRI Dermatologic Toxicities: The European PerspectiveDermatologic treatment of epidermal growth factor receptor inhibitor (EGFRI) skin toxicity is supportive and aims at maintaining quality of life while continuing EGFRI therapy. Despite the lack of randomized controlled trials or evidence-based guidelines, most cases of acneiform eruption are well controlled by topical metronidazole and oral minocycline 100 mg qd. For severe reactions, the minocycline dose is doubled and saline compresses are used. For superinfection with Staphylococcus aureus, oral cefuroxime axetil can be added for a short term. Emollients and topical steroids can be administered for skin dryness or eczema. Paronychia is the hardest to treat but antiseptic soaks and a corticosteroid paste can alleviate symptoms to some degree.
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Chronic Inflammation and Cancer: The Role of the MitochondriaWe review the evidence implicating a strong association between chronic inflammation and cancer, with an emphasis on colorectal and lung cancer.
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Inflammatory Breast Cancer: the Road to ProgressDrs. Dawood and Cristofanilli provide a concise review of inflammatory breast cancer (IBC) and succinctly cover its most salient features, including its clinicopathologic characteristics, its key molecular features, and an overview of treatment outcomes.
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Immunotherapy Plus Stereotactic Radiosurgery: Building on the Promise of Precision Medicine for CNS Malignancies-PART 2: Existing Experience and Considerations for Future TrialsIn Part 2 of this two-part series, we review the clinical evidence in support of combining immunotherapy with stereotactic radiosurgery for the treatment of brain metastases; examine controversies regarding radiation dose and fractionation, as well as temporal sequencing of multimodality treatment; and discuss future directions in combined therapy.
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Rare Myelomas: Sometimes When You Hear Hooves, It’s a Zebra...The use of newer methods of disease assessment that focus on minimal residual disease may facilitate the long-term evaluation of IgD and IgE myeloma patients, even if the rare Ig subtype is not identified at diagnosis.
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Uracil/Tegafur Plus Oral Calcium Folinate in Advanced Breast CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) has proven activity against breast cancer and is delivered in an easy-to-administer oral formulation. Orzel, which combines UFT with the oral biomodulator, calcium folinate, may
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Pemetrexed in Front-Line Chemotherapy for Advanced Non–Small-Cell Lung CancerPemetrexed (Alimta) possesses broad antitumor activity. It has beenevaluated in non–small-cell lung cancer (NSCLC) as front-line chemotherapyin a comprehensive phase II evaluation. While variousantifolates have been previously evaluated in clinical trials, drug developmentwas stopped or delayed in light of their lack of efficacy oroccurrence of life-threatening toxicities. While similar trends were observedwith pemetrexed early in development, investigators institutedfolic acid and vitamin B12 supplementation to minimize these toxicitieswithout hampering drug efficacy. This article briefly summarizes thecurrent evidence that supports the role of pemetrexed-based combinationsin clinical trials for chemonaive patients with advanced NSCLC.
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Tailoring Treatment in Elderly PatientsAs noted in part 1 of this two-part article, non-Hodgkin's lymphoma is one of a few malignancies that have been increasing in incidence over the past several decades. Likewise, these disorders are more common in elderly patients, with a median age of occurrence of 65 years. Therapy in elderly patients may be affected by multiple factors, especially attendent comorbidities. The approaches to management of these patients, with either indolent or aggressive disease processes, have been based on prospective clinical trial results, many of which have included a younger patient population. Fortunately over the past decade, results of treatment trials that have targeted an older patient population have emerged. The disease incidence and treatment approaches for both follicular (part 1) and diffuse aggressive (part 2) histologies in elderly patients are reviewed, as well as the impact of aging on the care of these patients.
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Prevention and Screening in Hereditary Breast and Ovarian CancerHere we review current guidelines on breast and ovarian cancer screening, prophylactic surgery, and other risk-reduction strategies in patients with these mutations, and we detail the data that drive these recommendations.
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The Role of Radical Prostatectomy and Lymph Node Dissection in the Treatment of Young Men With High-Grade Node-Positive Prostate Cancer: There May Be No RCTs-but There Are Good Reasons to Include SurgeryUpfront surgery allows for greater freedom to use all secondary treatment options for local and distant control, including adjuvant radiotherapy and ADT, thereby hopefully obviating the significant adverse quality-of-life sequelae from salvage surgery and brachytherapy for local relapse.
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QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic StatusThe VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate
