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Role of Calcium/Magnesium Infusion in Oxaliplatin-Based Chemotherapy for Colorectal Cancer PatientsThe combination of oxaliplatin plus fluorouracil/leucovorin is known as the FOLFOX regimen, and it has become a standard regimen for colorectal cancer (CRC), both as adjuvant therapy and as treatment for metastatic disease. Unfortunately, platinum-based chemotherapies also produce neurotoxicity as a side effect. Neurotoxicity is the most common dose-limiting toxicity of oxaliplatin, and it is one of the major causes for patients to stop receiving chemotherapy. It can manifest as either of two distinct syndromes: a transient, acute syndrome that can appear during or shortly after the infusion (~1%–2% of patients), and a dose-limiting, cumulative sensory neuropathy. Calcium/magnesium (Ca/Mg) infusions have been used to decrease the incidence of oxaliplatin-induced neuropathy. The actual utility of Ca/Mg infusions in this setting has been an interesting and controversial topic. They may reduce the severity of neurotoxicity, but some investigators have questioned whether they also will alter the efficacy of these chemotherapy regimens. In this paper, we review the clinical data concerning the usefulness of Ca/Mg infusions in reducing the incidence of oxaliplatin-induced neuropathy as well as their effect on responsiveness to chemotherapy.
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We Have Not ‘Come a Long Way, Baby’: Dr. Alan Blum on Smoking Cessation and PreventionSmoking cessation and relapse prevention expert Alan Blum, MD, discusses how oncologists and other clinicians can and should play a larger role in tobacco control.
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Shining a Warm Light on CryoglobulinemiaWe recommend screening for cryoglobulinemia in all patients with HCV infection, livedo reticularis, vasculitic cutaneous ulcers, positive rheumatoid factor or rheumatoid vasculitis, membranoproliferative glomerulonephritis, or atypical Waldenström macroglobulinemia.
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Corticosteroids in Advanced CancerCorticosteroids play a vitally important role in the treatment of patients with advanced cancer. While the scientific data, as reviewed by Wooldridge et al, are often slim, most physicians who treat patients with cancer quickly become comfortable with prescribing synthetic glucocorticoids for a variety of indications. Wooldridge et al have provided a much needed synthesis of the medical literature on the use of steroids, both as part of chemotherapeutic treatment for a variety of malignancies and in symptom control.
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Melanoma in the Older PersonMelanoma incidence and mortality continue to rise unabated in older individuals. Early clinical detection should take into account the different subtypes.
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Paclitaxel, UFT, and Calcium Folinate in Metastatic Breast CancerThis is a phase I dose-escalation study of uracil and tegafur (in a molar ratio of 4:1 [UFT]) administered in combination with calcium folinate and paclitaxel in metastatic breast cancer. This trial was initiated to 1)
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Diagnosis and Treatment of Depression in Cancer PatientsDrs. Pirl and Roth describe various problems that complicate efforts to accurately diagnose and appropriately treat depression in cancer patients. These include the subjective nature of symptoms, multiple possible diagnoses within the spectrum of mood
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Oncogenes Driving Squamous Cell Lung CarcinomaIn this interview we discuss the oncogenes driving the development of squamous cell carcinoma of the lung, a type of non-small-cell lung cancer.
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Clinical Update on PemetrexedThe articles in this supplement to ONCOLOGY, “Clinical Update onPemetrexed,” are presented by leading international clinical andpreclinical investigators in the arenas of thoracic, gastrointestinal, breast, andgynecologic cancers. They cover a wide range of topics that focus on the promisingagent pemetrexed (Alimta).
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Getting to the Heart of Improving Outcomes for Patients With Acute Promyelocytic LeukemiaThe management of patients with acute promyelocytic leukemia (APL) has been transformed over the course of the last two decades following the introduction of successful molecularly targeted therapies-all-trans retinoic acid (ATRA) and arsenic trioxide (ATO)- which act in concert to induce degradation of the PMLRARα oncoprotein formed by the chromosomal translocation t(15;17)(q22;q21).
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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.
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Rationale for Trials Studying Pegylated Liposomal Doxorubicin in Metastatic Breast CancerBreast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a
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Myelodysplastic SyndromesMyelodysplastic syndromes (MDS) are a group of hematologic malignancies of the pluripotent hematopoietic stem cells. These disorders are characterized by ineffective hematopoiesis, including abnormalities in proliferation, differentiation, and apoptosis.
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The Developing Role of Anti–Epidermal Growth Factor Receptor Agents in the Treatment of Advanced or Metastatic Colorectal CancerAnti-EGFR therapy is a valuable addition to the armamentarium of treatment options for patients with metastatic colorectal cancer. However, RAS mutation status is an imperfect biomarker for prediction of therapeutic outcomes in this setting. The recent discovery of tumor sidedness as a predictor of response highlights how little we understand about which patients are the most appropriate to receive drugs that target EGFR.
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Molecular Profiling in the Practice of Radiation OncologyAs specific candidate genes become more well established and gene expression assays gain sophistication, the value in clinical outcomes prediction and treatment selection is expected to transform the practice of radiation oncology.
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Preserving Values in Managed CareIn this column, Dr. Alan Nelson, past president of the American Medical Association, has provided a set of goals for oncologic treatment under managed care contracts that can be embraced by all oncologists--choice, broad scope of practice, and communication. But the real message to oncologists is: Work together with internal medicine and primary care physicians to build a system that provides quality care of which everyone can be proud. Such cooperation is needed to help convert these treatment goals into workable contracts with primary care groups, HMOs, and/or insurers.
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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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Hodgkin's Disease: Management of First RelapseIn most patients with newly diagnosed Hodgkin's disease, initial therapy is curative. However, a small portion of patients treated with radiotherapy alone for limited favorable disease, and a larger percentage of patients treated with combination chemotherapy, with or without radiotherapy, for advanced-stage or unfavorable disease relapse after initial remission. Patients relapsing after radiotherapy alone should do as well with salvage combination chemotherapy as patients with advanced disease who have never received radiation. In patients who relapse after combination chemotherapy, retreatment with the same regimen or employment of a non-cross-resistant regimen offers high response rates among those with favorable characteristics.
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Empiric Antifungal Therapy for the Neutropenic PatientThe article written by Drs. Wingard and Leather presents a thoughtful review of the current approaches to empiric antifungal therapy in neutropenic patients. Empiric antifungal therapy has evolved as a standard of care for the prevention of invasive fungal infections in neutropenic patients who remain persistently febrile despite the use of broad-spectrum antibacterial antibiotics.[1-3] Empiric antifungal therapy in this setting provides early treatment for clinically occult invasive fungal infections and systemic prophylaxis for neutropenic patients at highest risk.
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State-of-the-Art Treatment for Advanced NonSMQ-8211-SMQSmall-Cell Lung CancerPatients with locally advanced or metastatic nonSMQ-8211-SMQsmall-cell lungcancer (stage III and IV) who are not candidates for surgery and exhibitgood performance status are typically treated with concurrent radiationand platinum-based chemotherapy for disease palliation. Platinum-based chemotherapies, used alone or with radiation therapy, offera small but significant survival benefit compared with supportivecare. The incorporation of first-line agents such as gemcitabine(Gemzar), vinorelbine (Navelbine), and paclitaxel, as well as secondlineagents such as docetaxel (Taxotere), in doublet and triplet combinationshas had a further significant therapeutic impact. Randomizedtrials have shown that cisplatin-based therapy in combination with newagents results in improved 1- and 2-year survival rates in patients withadequate performance status. The 1-year survival benefit has significantlyimproved, with greater symptom relief and improved quality oflife in these patients. Thus, delaying disease progression with combinationchemotherapy appears both beneficial and cost-effective in patientswith advanced nonSMQ-8211-SMQsmall-cell lung cancer. Newer approachesSMQ-8212-SMQincluding targeting critical signaling pathways, such as tyrosine kinasereceptors, angiogenesis, and downstream signal transductionmechanismsSMQ-8212-SMQmay provide novel agents with an improved toxicity profileand the potential for better disease management.
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Depression, anxiety, and deliriumAlthough many cancer patients cope well with their disease, psychiatric disorders occur in almost 50% of patients in the setting of malignancy. Untreated psychological and neuropsychiatric disorders can compromise quality of life as well as treatment compliance. Three behavioral syndromes that are often encountered in clinical practice will be discussed here: depression, anxiety, and delirium.
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Prostate-Specific Antigen as a Marker of Disease Activity in Prostate Cancer: Part 2Despite the impact of prostate-specific antigen (PSA) testing on the detection and management of prostate cancer, controversy about its usefulness as a marker of disease activity continues. This review, based on a
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Cancer Management Chapter 21: Bone sarcomasBone sarcomas are extremely rare neoplasms, which precludes determination of their true incidence. In 2009, approximately 2,570 new cases of cancer of the bones and joints will be diagnosed in the United States, and some 1,470 patients will succumb to the disease. Population-based tumor registries seldom separate bone sarcomas into various histologic types.
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Adult Medulloblastoma, From Spongioblastoma Cerebelli to the Present Day: A Review of Treatment and the Integration of Molecular MarkersHere we present the history, staging system, and treatment of medulloblastoma, reviewing the prognostic value and clinical application of molecular subtyping while highlighting the differences between adult and pediatric disease.
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UFT Plus or Minus Calcium Folinate for Metastatic Colorectal Cancer in Older PatientsTwo studies were carried out to determine the activity and evaluate the toxicity of oral chemotherapy with uracil and tegafur in a 4:1 molar ratio (UFT) plus or minus calcium folinate in elderly patients with advanced colorectal
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An Overview of Adenocarcinoma of the Small IntestineOf all the digestive tract tumors, small-bowel cancers are the least common. Why should we study these rare tumors, and what, if anything, can we learn from them? Sometimes the absence of an important event can provide the answer to a difficult problem. For example, consider the famous Sherlock Holmes mystery story, "Silver Blaze," in which the master sleuth solved a challenging case, simply because the watchdog didn't bark when he should have, implying that the murderer was well known to the dog.[1]
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Nonoperative Management of Rectal Cancer: A Modern PerspectiveIn this article, we provide a summary of nonoperative management of locally advanced rectal cancer in the modern era. Our focus is on technical details of tumor response and patient assessment after chemoradiotherapy, as well as a review of existing clinical data.
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Recent Progress in Radioimmunotherapy for CancerRadioimmunotherapy allows for the delivery of systemically targeted radiation to areas of disease while relatively sparing normal tissues. Despite numerous challenges, considerable progress has been made in the application of radioimmunotherapy to a wide variety of human malignancies. The greatest successes have occurred in the treatment of hematologic malignancies. Radioimmunotherapy, with or without stem-cell transplant support, has produced substantial complete remission rates in chemotherapy-resistant B-cell lymphomas. Nonmyeloablative regimens have shown so much promise that they are now being tested as initial therapy for low-grade B-cell lymphomas. Although solid tumor malignancies have been less responsive to radioimmunotherapy, encouraging results have been obtained with locoregional routes of administration, especially when the tumor burden is small. Greater tumor-to-normal tissue ratios are achievable with regional administration. Even with intraperitoneal and intrathecal administration, bone marrow suppression remains the dose-limiting toxicity. Ongoing research into new targeting molecules, improved chelation chemistry, and novel isotope utilization is likely to extend the applications of this strategy to other tumor types. The potential for radioimmunotherapy will be enhanced if this modality can be optimally adapted for integration with other agents and if the administration method can be tailored to the type and distribution of malignancy. [ONCOLOGY 11(7):979-987, 1997]
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Radium-223: Down to the Bone, and Less Is MoreRadium-223 is a promising agent that represents a new class of alpha pharmaceuticals that gets down to the site of bony metastases. The limited side-effect profile potentially allows for repeat administration to increase durability of pain control, and for its use in combination with novel biologic and chemotherapeutic agents.
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Current Techniques in Three-Dimensional CT Simulation and Radiation Treatment PlanningThe modern CT simulator is capable of interactive three-dimensional (3D) volumetric treatment planning; this allows radiation oncology departments to operate without conventional x-ray simulators. Treatment planning is performed at the time of virtual simulation by contouring the organs or volumes of interest and determining the isocenter.
