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Romiplostim for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn August 22, 2008, the US Food and Drug Administration (FDA) granted marketing approval (licensure) to romiplostim (Nplate, Amgen Inc) for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
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High-Dose Therapy and Transplantation of Haematopoietic Stem CellsThe field of hematopoietic stem cell transplantation is evolving rapidly. Observations made in the laboratory can now be swiftly translated into clinical trials. The role of hematopoietic stem cell transplantation in older patients, the appropriate use of
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Anthracycline Cardiotoxicity: Why Are We Still Interested?Anthracycline cardiotoxicity has been of clinical concern for more than 3 decades. Many hundreds of papers have been written about this unusual form of toxic cardiomyopathy, and yet, we are still putting pieces of the puzzle together. Our cumulative knowledge helps us to predict the risk of cardiac damage with fair accuracy for most patients, but others demonstrate an unpredictable sensitivity to anthracyclines and suffer devastating consequences. Strategies to prevent anthracycline cardiotoxicity have been developed but are underutilized.
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New Developments in the Management of Chemotherapy-Induced Emesis: Do They Impact on Existing Guidelines?Guidelines for the management of chemotherapy-induced emesisare necessary to help clinicians match the emetogenicity of antineoplasticagents with the abundance of antiemetic agents now available. Numerousguidelines for antiemetic therapy currently exist, but compliancewith them is inconsistent, in part because optimal antiemetic protectionis not yet possible, even with the best guidelines. For this reason,guidelines must be dynamic and evolve as knowledge increases.Revision of antiemetic guidelines should be prompted by changes ingeneral principles of treatment, not changes in specific details. Recentrecognition of the unique benefits of incorporating selective neurokinin-1 receptor antagonists into regimens for the prevention of nauseaand vomiting caused by highly emetogenic chemotherapy, particularlyin delayed emesis, justifies modification of existing antiemeticguidelines.
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Commentary (Keller): Surgical Staging of Lung CancerAs Matin and Goldberg note, the accurate staging of non-small-cell lung cancer (NSCLC) is necessary to provide patients with correct information regarding prognosis and appropriate treatment recommendations. Therefore, physicians who treat
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Radioiodine-Resistant Differentiated Thyroid Cancer: Hope for the FutureIn this helpful review, the authors catalog a number of the novel molecular agents now being examined for treatment of radioiodine-resistant, metastatic differentiated thyroid cancer. They also call for increased systematic study of outcomes through recruitment of patients into large-scale trials.
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Oncocytic Neoplasm on Renal Mass Biopsy: A Diagnostic ConundrumA 56-year-old man presented with a 4.5-cm leftsided renal mass incidentally discovered on an ultrasound performed for workup of lupus nephritis. On dedicated contrast-enhanced magnetic resonance imaging (MRI), the tumor was found to be avidly enhancing.
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The Real CER: Lost in Translation“Comparative effectiveness research, ” or CER, has become a loaded term in our ongoing wrangling over healthcare policy. Often, however, what even knowledgeable people understand by CER is significantly at odds with what actual policy makers have in mind.
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Colon, Rectal, and Anal CancersThis management guide covers the risk factors, symptoms, diagnosis, staging, and treatment of colorectal and anal cancers.
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Economic and Quality of Life Outcomes: The Four-Step Pharmacoeconomic Research ModelIncreasingly, economic data are being considered in formulary decisions. In oncology, pharmacoeconomic evaluations are essential to help decision makers weigh the associated costs and outcomes of competing
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Commentary (Deitcher): Thromboembolic Complications of MalignancyThe two-part article, "ThromboembolicComplications ofMalignancy," by Drs. Linenbergerand Wittkowsky, provides a contemporaryand clear review of thepathogenesis, prevention, and treatmentof cancer-associated hypercoagulabilityand venous thrombosis. Questionsabout the cancer and coagulation connectioncontinue to abound and greatlyoutnumber evidence-based answers. Asthe relationship between cancer and coagulationgains attention from the medicaland surgical oncology communities(ie, not only from the coagulation community),the gap between questions andanswers will likely close.
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Applications of QOL Measurements: A Managed Care PerspectiveThe current application of QOL measurements and outcomes in managed care organizations is minimal, but potential applications are significant, since a fundamental goal of managed care is to optimize member/patient
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Esophagogastric Junction and Gastric Adenocarcinoma: Neoadjuvant and Adjuvant Therapy, and Future DirectionsThe purpose of this review is to update, present some of the new data on, and outline the controversies regarding neoadjuvant and adjuvant therapy of esophagogastric junction and gastric adenocarcinoma.
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Is Guillain Barré Syndrome Likely in This Patient?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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Update on Hepatic Intra-Arterial ChemotherapyTheoretically, effective regional cancer chemotherapy should afford the opportunity to deliver a significantly higher concentration of a cytotoxic agent than is possible with systemic administration of the same agent. Furthermore, regional chemotherapy should cause its greatest stress on the site of administration, producing a lesser burden of toxicity on the whole body.
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Dose Intensity for Breast CancerDrs. Armstrong and Davidson have nicely reviewed the use of dose-intensive chemotherapy in the treatment of metastatic and high-risk early-stage breast cancer, and we agree with the basic premise of the article-that there are no conclusive data
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Peripheral T-Cell Lymphomas: Incorporating New Developments in Diagnostics, Prognostication, and Treatment Into Clinical Practice-PART 2: ENKTL, EATL, Indolent T-Cell LDP of the GI Tract, ATLL, and Hepatosplenic T-Cell LymphomaIn Part 2 of this two-part series, this review covers extranodal natural killer/T-cell lymphoma, enteropathy-associated T-cell lymphoma, indolent T-cell lymphoproliferative disorder of the gastrointestinal tract, adult T-cell leukemia/lymphoma, and hepatosplenic T-cell lymphoma.
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New Therapeutic Options for Chronic Lymphocytic LeukemiaFor decades, initial therapy for chronic lymphocytic leukemia (CLL) consisted of alkylators such as chlorambucil (Leukeran). The introduction of nucleoside analogs such as fludarabine and monoclonal antibodies such as rituximab (Rituxan) markedly changed the initial therapy of CLL, particularly in the United States. Fludarabine and combination regimens such as fludarabine/cyclophosphamide (FC) have achieved higher complete response (CR) rates and progression-free survival (PFS) than chlorambucil in previously untreated CLL, but long-term overall survival has not improved, due to concurrent improvement in salvage therapy of relapsed CLL patients. Upfront chemoimmunotherapy regimens such as fludarabine/rituximab (FR) and fludarabine/cyclophosphamide/rituximab (FCR) have similarly improved CR rates and PFS in previously untreated CLL patients, but it is unclear whether overall survival is improved. Advances in cytogenetic analysis and other biologic prognostic factors have greatly enhanced clinicians' ability to risk-stratify newly diagnosed CLL patients, and knowledge of such prognostic factors is necessary to properly interpret results of clinical treatment studies. The choice of initial therapy for an individual patient should depend upon the patient's age and medical condition, cytogenetic and other prognostic factors, and whether the goal of therapy is maximization of CR and PFS or palliation of symptoms with minimal toxicity.
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Liposomal-Encapsulated Chemotherapy: Preliminary Results of a Phase I Study of a Novel Liposomal PaclitaxelLiposome encapsulation of antineoplastic drugs entered clinical testing in the late 1980s. As carriers for a variety of agents, liposomes can allow successful delivery of agents that may be subject to rapid degradation in
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Language, the Literature, and the PatientThe articles and accompanyingcommentaries in ONCOLOGYprovide important clinical informationbut also an opportunity tocall attention to language projectingattitudes and judgments that are unintended,probably unconscious, andgenerally unchallenged. We note thatrecent articles and reviews refer tothe “patient having failed” treatment;patients are identified with their canceras if they are one, and the descriptionof therapy as “salvage” indirectlycompares the human experience oftreating patients to saving, rescuing,or restoring goods.
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Role of Temozolomide in the Treatment of Cancers Involving the Central Nervous SystemIn this article, we review the role of temozolomide in the management of patients with primary brain tumors, brain metastases, leptomeningeal carcinomatosis, and other selected CNS cancers.
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Concomitant Cisplatin, Vinorelbine, and Radiation in Advanced Chest MalignanciesNewer chemotherapy drugs have shown encouraging activity in advanced non-small-cell lung cancer. Based on these improved outcomes, as well as the high rate of distant relapse in patients with locally advanced disease, several recent studies have evaluated the use of systemic therapy in patients with earlier-stage disease.
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A 38-Year-Old Man With Pancreatic CancerMichael H. Levy, MD: This 38-year-old white male first came to his physician in January of 1993 complaining of epigastric and low back pain. In March of 1993, he was diagnosed with pancreatic cancer that was metastatic to his
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Liver Transplantation for the Treatment of Hepatocellular CarcinomaIn the majority of cases, hepatocellular carcinoma develops in the setting of cirrhosis. Treatment with curative intent is possible in only 20% to 25% of cases and consists of resection or liver transplantation.
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Stuart L. Goldberg, MD, Discusses How Physicians Can Better Communicate Cancer DiagnosesThe expert from Hackensack University Medical Center explained how the complexity of cancer makes it important for physicians to spend time communicating with their patients what their diagnosis entails.
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Optimizing Treatment Benefit in Older Breast Cancer PatientsBreast cancer is predominantly a disease of older women. Many of these older patients with breast cancer have low-risk disease owing to low proliferation indices, positive hormone receptors, node-negativity, or p53-negative and HER-2 (human epidermal growth factor 2)-negative tumors.[1,2] They do well without chemotherapy and will receive adjuvant hormonal therapy with tamoxifen or an aromatase inhibitor. Yet there are older women who do not have these favorable tumor characteristics and so are potential candidates for chemotherapy. The review by Muss points out this issue, highlighting benefits of chemotherapy and describing appropriate treatment regimens for these patients.
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Pediatric Anaplastic Large Cell Lymphoma Presenting as Generalized LymphadenopathyHere we present the case of a 3-year-old girl with generalized lymphadenopathy and fever, in whom the cause of the symptoms was initially thought to be infectious. Ultimately, however, anaplastic large cell lymphoma (ALCL) was diagnosed. Using this case as a backdrop, we discuss the wide range of systemic illnesses that the differential diagnosis of generalized lymphadenopathy encompasses.
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Commentary (Lim et al): Revisiting Induction Chemotherapy for Head and Neck CancerArgiris and colleagues report asystematic review evaluatingthe activity and potential roleof induction chemotherapy in patientswith previously untreated, locoregionallyadvanced squamous cell head andneck cancer.[1] They consider bothphase II and III published trials. Thedata reviewed in their paper, and theirthoughtful synthesis and interpretationof these data, highlight certain themes:
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Routine 3D Treatment Planning: Opportunities, Challenges, and HazardsThree-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to
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Emergence of the EpothilonesEpothilones, representing a newer class of naturally occurring antimicrotubule macrolides, have emerged as cytotoxic agents with significant antitumor activity against tumors that are resistant to taxanes.
