Authors
Latest:
Reinventing Bone Marrow TransplantationThe article by Champlin and colleagues summarizes exciting recent clinical results in allogeneic bone marrow transplantation (BMT) for leukemia and lymphoma achieved by “reengineering” the process to take maximum advantage of the powerful
Latest:
Treatment of Pancreatic Cancer: Current Limitations, Future PossibilitiesDr. Blackstock and colleagues are to be commended for their concise review broadly outlining current advances in the management of pancreatic cancer and future avenues of development.
Latest:
Commentary (Brugge): Endoscopic Ultrasound Fine-Needle Aspiration in the Staging of Non-Small-Cell Lung CancerPrecise mediastinal staging of non-small-cell lung cancer is extremely important, as mediastinal lymph node metastases generally indicate unresectable disease. Reliance on computed tomography (CT) and positron-emission tomography (PET) alone to stage and determine resectability is limited by false-positive results. Whenever possible, pathologic confirmation of metastases is desirable. Mediastinoscopy and transbronchial fine-needle aspiration are widely established but imperfect modalities. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) has emerged as a diagnostic and staging tool because of its safety, accuracy, and patient convenience. We reviewed 13 prospective studies evaluating the comparative performance of EUS for staging lung cancer. We conclude that EUS is a valuable staging modality. Further studies of the role of EUS compared to other modalities such as integrated PET/CT and endobronchial ultrasound (EBUS) are forthcoming.
Latest:
Combinations of Hormones and Local Therapies in Locally Advanced Prostate CarcinomaEulau and Corn provide an excellent review of the current status of neoadjuvant androgen deprivation therapy combined with radiation therapy or surgery in the management of locally advanced prostatic cancer. They comprehensively describe the
Latest:
Colorectal Cancer Patients With Oligometastatic Liver Disease: What Is the Optimal Approach?In a good percentage of patients who have oligometastatic disease confined to a single organ-usually the liver-complete metastasectomy can result in cure. However, once the decision to pursue surgery is made, there remain a number of issues that must be addressed in order to ensure the best possible outcome.
Latest:
Distant Effects of Cancer on the Nervous SystemThe first descriptions of neurologic disorders in patients with cancer identified those who had peripheral neuropathy. Most neurologists thought these patients actually had a peripheral neuropathy secondary to the inanition associated with their cancer. Still other patients clearly had peripheral neurologic damage from chemotherapy (eg, vincristine).
Latest:
Irinotecan and Carboplatin in Metastatic or Recurrent NSCLC: An UpdateThe 1-year survival for patients with metastatic non–small-cell lungcancer is only around 35%. We are evaluating the combination ofirinotecan (Camptosar) and carboplatin (Paraplatin) in patients withstage IIIB and IV non–small-cell lung cancer. The first five patientsreceived irinotecan, 250 mg/m2 over 90 minutes followed by carboplatinat an area under the concentration-time curve of 5 over 1 hour. Thedose of irinotecan was subsequently reduced to 200 mg/m2 in view offebrile neutropenia in one of five patients. Chemotherapy cycles arerepeated every 21 days. Patients are reevaluated every two cycles. Of aplanned 42 patients, 37 have been enrolled so far. Of the 37 enrolledpatients, 25 received at least two cycles, 20 received at least four cycles,and 12 received all six planned cycles. Grade 4 neutropenia (absoluteneutrophil count < 500) occurred in 10 patients and 19 treatment cycles.Two of these patients also had grade 4 diarrhea. Thirty-six cycles (30%)were delayed for neutropenia, six of which occurred among the firstfive patients who received irinotecan at 250 mg/m2. Best response totherapy included 7 partial responses (23%), 11 stable disease (37%),with 12 patients having progressive disease (40%). The regimen ofirinotecan and carboplatin administered once every 3 weeks is tolerableand convenient, with early evidence of activity. The main toxicityis hematologic. This study is ongoing and actively accruing patients.
Latest:
The Absent-Minded Professor: An Unusual Complication of MelanomaThe University of Colorado Health Sciences Center holds weekly second opinion conferences focusing on cancer cases that represent most major cancer sites. Patients seen for second opinions are evaluated by an oncologist.
Latest:
Starting the End-of-Life ConversationEnd-of-life care is challenging for even the most seasoned oncologist. Here are five suggestions that can help you better navigate this difficult but critical part of your work.
Latest:
Discovery, Development, and Clinical Applications of BortezomibProteasome inhibition is a novel, targeted approach in cancertherapy. Both natural and synthetic proteasome inhibitors selectivelypenetrate cancer cells, disrupting the orderly destruction of key regulatoryproteins involved in tumorigenesis and metastasis. Disrupting theorderly destruction of regulatory proteins causes an imbalance of theseproteins within the cell, which interferes with the systematic activationof signaling pathways required to maintain tumor cell growth and survival;therefore, cellular replication is inhibited and apoptosis ensues.
Latest:
Sentinel Lymph Node Biopsy in a Young Child With Thick Cutaneous MelanomaThe article by Bisseck and colleagueshighlights an importantissue encountered increasinglyby physicians-melanoma in childrenand adolescents. The incidence andmortality of melanoma continues torise.[1] It is now the fifth most commoncancer in men and the seventhmost common cancer in women. Inour practice at the Johns HopkinsMelanoma Center, we have treated agrowing number of children and adolescentswith melanoma, includingmany with stage III disease identifiedby sentinel node technology, similarto that described by Bisseck andcolleagues.
Latest:
Improving the Therapeutic Ratio in Hodgkin Lymphoma Through the Use of Proton TherapyThis review addresses the rationale and evidence for-and the challenges, cost implications, and future development of-proton therapy as an important part of the treatment strategy in Hodgkin lymphoma.
Latest:
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.
Latest:
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.
Latest:
Management of a Patient With Borderline Resectable Pancreatic CancerIn this case report, we discuss the presentation, workup, and therapeutic management of a 40-year-old man who presented with borderline resectable, periampullary pancreatic cancer and underwent a margin-negative resection following neoadjuvant chemoradiotherapy.
Latest:
Commentary (Sause): Evaluation and Definitive Management of Medically Inoperable Early Stage Non-Small-Cell Lung CancerLung cancer is estimated to be the second most commonly diagnosed cancer in both men and women in 2006, and the leading cause of cancer mortality. Non-small-cell lung cancer represents the majority of such cases. Most of these patients have locally advanced disease at presentation and are not eligible for curative resection. For the minority of patients who are technically resectable at presentation, lobectomy or pneumonectomy and pathologic mediastinal nodal staging offer the best overall survival. The high rate of comorbid medical illness and poor baseline pulmonary function in this population, however, make many such early-stage patients medically inoperable. For these patients, conventional single-modality radiotherapy has been the primary definitive treatment option, as discussed in part 1 of this article, which appeared in last month's issue. Numerous retrospective reports demonstrate long-term disease-free and overall survival data that are modestly superior to that expected after observation, but both local and distant failure continue to be significant risks. Investigation of radiotherapy dose escalation is ongoing, in an effort to improve local control while maintaining minimal toxicity. Additionally, emerging evidence suggests that new modalities, such as stereotactic radiosurgery and radiofrequency ablation, may also be potentially curative treatment alternatives. These modalities are addressed in part 2.
Latest:
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.
Latest:
In Memoriam: Dr. M. Judah FolkmanIt is with great sadness that the Angiogenesis Foundation reflects on the passing of Dr. Judah Folkman, founder and pioneer of the field of angiogenesis research.
Latest:
Current Concepts in the Diagnosis and Management of Small-Cell Lung CancerDespite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease. Surgery has not played a major part in the management of SCLC, but emerging data suggest that resection may have a role in earlier stage disease. While the frontline treatment of SCLC has not changed significantly in the past decade, newer agents that are currently being investigated provide hope for better treatment of relapsed/refractory disease for the future.
Latest:
Dr. William Wood on the Clinical Risk of Chemo in Early Breast CancerCancerNetwork® spoke with Dr. William Wood on the clinical risk of chemotherapy in early breast cancer.
Latest:
ACR Appropriateness Criteria® Management of Vaginal CancerThis article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.
Latest:
Renal Cancer Management in a Patient With Chronic Kidney DiseaseA 69-year-old man presented in the urology clinic for evaluation of bilateral renal masses, discovered incidentally during routine exams for follow-up of his chronic kidney disease.
Latest:
Adult Burkitt Lymphoma: Advances in Diagnosis and TreatmentBurkitt lymphoma (BL) is a unique B-cell lymphoma characterized by a high proliferation rate and cytogenetic changes related to c-myc proto-oncogene overexpression. Burkitt lymphoma is a highly aggressive B-cell lymphoma that is most frequently seen in children and young adults in endemic areas.
Latest:
Current Management of Nasal NK/T-cell LymphomaWith better disease definition, staging, and monitoring, treatment of extranodal NK/T-cell lymphoma is becoming more rational. A large proportion of patients with localized nasal disease may enjoy prolonged disease-free survival. On the other hand, early HSCT or novel therapy may be recommended for aggressive extranasal disease.
Latest:
UFT Plus Calcium Folinate Plus Radiotherapy for Recurrent Rectal CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) plus calcium folinate comprise the components of the oral agent, Orzel, which appears to have activity comparable to intravenously administered 5-fluorouracil. This article
Latest:
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
Latest:
Are We Approaching a Fourth Generation of Therapies for Metastatic Kidney Cancer?Drs. Rini and Bukowski do an excellent job of updating and commenting on the rapidly evolving field of therapy for metastatic renal cell carcinoma (RCC).
Latest:
Cutaneous T-Cell Lymphoma: Molecular and Cytogenetic FindingsChromosomal changes have been identified early in the disease process in cutaneous T-cell lymphoma (CTCL): both losses and gains of chromatin have been found on several chromosomes. The extent of chromosomal aberrations increases with disease stage and in more aggressive subtypes of the disorder. Changes in specific genes, such as NAV3, have been characterized in patients with CTCL, and may produce a proliferation advantage for affected cells. In addition, the expression of some genes can discriminate between controls and patients with CTCL. Therefore, the over- or under-expression of certain genes may be of diagnostic and pathogenic relevance in this disease, and may allow the development of selective treatments.
Latest:
Friend or Foe: The Bifunctional Role of Steroid Hormones in Prostate CancerWhile the multifunctional role of steroid hormones in prostate cancer and men’s health was recognized early, the apparent clinical benefit afforded by ADT tipped the scales in favor of androgen deprivation in men with advanced prostate cancer.
Latest:
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.
