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Molecular Genetics of Hereditary Ovarian CancerApproximately 10% of all epithelial ovarian carcinoma cases are associated with inheritance of an autosomal-dominant genetic mutation conferring a predisposition to cancer with variable penetrance. Two such manifestations
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Clinical and Pathological Features Are Still the Best Determinants of Prognosis in MesotheliomaSignificant advances have been made in our understanding of the factors affecting the prognosis of malignant mesothelioma, and a number of biomarkers appear promising. However, at present it may be more fruitful to better define and characterize clinical factors that are well recognized as significantly impacting patient survival.
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Progress With a Purpose: Eliminating Suffering and Death Due to Cancercancer is the second leading cause of death in the United States, with more than 500,000 men, women, and children succumbing to the disease each year. The idea, then, that we can eliminate the suffering and death due to cancer in the United States by the year 2015 may appear impractical, if not irrational and impossible. It seems inconceivable that in the first part of the 21st century every patient could survive cancer. Doubt can be attributed to awareness of the biologic complexity of cancer and seeing the pace of clinical progress through the prism of the 20th century.
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Cancer and Healthcare Reform: Making the Pieces FitCancer service leaders must create the vision, embrace the change agenda, and drive the roadmap in order to make the strategic and clinical changeover to value.
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Recap Evolving HER2+ Metastatic Breast Cancer LandscapeExperts discussed the changing landscape in treatments for HER2-positive metastatic breast cancer.
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Risk Models for Chemotherapy-Induced Neutropenia in Non-Hodgkin’s LymphomaNon-Hodgkin’s lymphoma is primarily a disease of the elderly, with61% of the new cases reported in patients 60 years old or older. Aggressivecombination chemotherapy can cure some patients, but there arefrequently treatment failures and overall survival is low. Retrospectivestudies have found that treatment with less than standard chemotherapydoses is associated with lower survival, and surveys of practice patternshave found that many patients, especially elderly ones, are treated withsubstandard regimens and doses. Neutropenia is the major dose-limitingtoxicity of chemotherapy in patients with non-Hodgkin’s lymphoma.First-cycle use of colony-stimulating factor (CSF) can reduce the incidenceof neutropenia and its complications and help maintain the chemotherapydoses. Researchers have investigated risk factors in patientswith non-Hodgkin’s lymphoma to determine which patients are at highestrisk for neutropenia and would benefit from targeted first-cycle CSFsupport. It has been shown in several studies that advanced age, poorperformance status, and high chemotherapy dose intensity are risk factors.Other trials suggest that low serum albumin levels, elevated lactatedehydrogenase levels, bone marrow involvement, and high levelsof soluble tumor necrosis factor receptor are also risk factors. Doseintensity has also been shown in many studies to be an important predictorof survival in patients with non-Hodgkin’s lymphoma. Managingthe toxicity of chemotherapy with CSF has facilitated the deliveryof planned dose on time, as well as dose-intensified chemotherapy regimens.The promising results from recent clinical trials of dose-denseregimens with CSF support suggest that this could prove to be the beststrategy for improving patient outcomes.
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Longer Term Data Confirm Subcutaneous Rituximab Efficacy in Follicular LymphomaIn this video we discuss longer term results of the phase III SABRINA study, which tested the safety and efficacy of subcutaneous rituximab in patients with follicular lymphoma.
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Eltrombopag for the Treatment of Chronic Immune (Idiopathic) Thrombocytopenic PurpuraOn November 20, 2008, the US Food and Drug Administration (FDA) granted accelerated approval for eltrombopag (Promacta Tablets, GlaxoSmithKline) for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulin therapy, or splenectomy.
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Reducing Racial Disparities in the Treatment of Lung CancerThis video discusses possible methods to help reduce racial disparities in the treatment and outcomes of early-stage lung cancer.
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Commentary (Glass): NCI's Cancer Information Systems-Bringing Medical Knowledge to CliniciansIn 1995, everyone is on the "Information Superhighway." The National Cancer Institute, not to be upstaged, has developed its Cancer Information Systems into a powerful and easy-to-use resource for all to use. The article by Hubbard, Martin, and
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Expanding Options for Pancreatic Cancer...So Where Do We Go From Here?In light of two recent positive clinical trials for advanced pancreatic cancer, we are currently facing an interesting situation that those of us who treat this disease have not had to deal with previously: what to do with this expanding array of choices?
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Current Management of Depression in Cancer PatientsIn their paper, Schwartz and colleagues review the risk factors for depression and suicide in patients with cancer and argue convincingly that screening for depression can be simply and quickly performed. They also delineate the efficacy and potential adverse effects of psychotherapeutic or psychopharmacologic treatments for these patients. Buttressing the identification and treatment of depression in the cancer patient are vital, ongoing scientific developments that flow from an increased understanding of interactions among the brain, endocrine system, and immune system. This rapidly evolving body of neurobiological knowledge has catalyzed fundamental changes in how we conceptualize depression in cancer patients and has important ramifications regarding the treatment and prevention of depressive syndromes in this setting.
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Approval of Olaparib Combo Impacts SOC in BRCA-Mutant Metastatic CRPCAndrew J. Armstrong, MD, MSc, spoke about the recent approval of olaparib plus abiraterone acetate and prednisone in patients with BRCA-mutant metastatic castration-resistant prostate cancer.
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In Hormone-Naive Metastatic Prostate Cancer, Should All Patients Now Receive Docetaxel? No, Not YetMeta-analyses of patients with low-volume metastatic hormone-sensitive prostate cancer will likely be required to attain sufficient power to address the role of docetaxel in this setting.
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gSevere, debilitating fatigue is common in cancer patients. For many,it is the symptom that interferes most with normal routines. Virtuallyevery modality used to treat cancer may cause fatigue, as can complicationsof the disease such as sleep disturbances, infections, malnutrition,hypothyroidism, and anemia. There is a significant overlap betweendepression and fatigue in many patients. Given the high prevalenceof cancer-related fatigue, frequent assessment of patients is essential.The evaluation should include an attempt to identify reversiblecauses of fatigue, and screening for depression. However, many cancerpatients suffer from fatigue even in the absence of any identifiable,reversible cause. For these patients, consideration can be given to suitableexercise programs, educational support and counseling, and energyconservation strategies. A trial of a stimulant medication is alsoreasonable. Given the heterogeneity of patients, individualized approachesare needed. For anemic patients undergoing chemotherapy,erythropoietic agents can increase hemoglobin levels. The impact ofthese drugs on fatigue and quality of life is uncertain. Recent reports ofincreased mortality and thrombotic events in cancer patients treatedwith epoetin require further investigation.
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Vitamin B3 Supplement Reduced Occurrences of Basal and Squamous Cell CarcinomasIn this video, Dr. Martin discusses the phase III ONTRAC study, which found that the use of nicotinamide, a form of vitamin B3, reduced the incidence of non-melanoma skin cancers by 23% among a group of high-risk patients.
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Healthcare Financing and the Cost of Cancer CareControlling healthcare spending has been, and appears destined to remain, at the center of the public policy debate at each level of government, given that much of the healthcare bill is paid by taxpayers.
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Psychiatric Assessment and Symptom Management in Elderly Cancer PatientsThe number of older adults in the general population continues togrow. As their numbers rise, the elderly and the management of theirmedical problems must be of increasing concern for health-care professionals.Within this older population, cancer is a leading cause ofmorbidity and mortality. Although many studies have looked at the psychiatricimplications of cancer in the general population, few studiestackle the issues that may face the older adult with cancer. This articlefocuses on the detection and treatment of depression, anxiety, fatigue,pain, delirium, and dementia in the elderly cancer patient.
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Targeted therapies address hard-to-treat liver tumorsNot long ago, our approach to treating difficult metastatic tumors was to “spray and pray.” We knew that chemotherapy and other traditional treatment approaches could cause great damage and had a limited chance of successfully destroying the entire tumor. At the time, a proven safer and more effective option did not exist, and patients were desperately in need of treatment. Fortunately, as our knowledge of the complexities of advanced liver tumors has grown, so has our ability to develop treatments that target and treat tumors while avoiding harmful side effects to normal tissue.
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A 72-Year-Old Man With Prostate CancerThe patient, L.E., is a 72-year-old white male who has been under our care for 10 years. He initially presented to our clinic in 1992, with a diagnosis of localized prostate cancer.
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Vaccinations Against Infectious Diseases in Hematopoietic Stem Cell Transplant RecipientsBlood and marrow transplantation, a curative treatment for avariety of serious diseases, induces a period of sustained immunosuppressionpredisposing recipients to opportunistic infections. Both forthe protection of the individual transplant recipient and as a matter ofpublic health policy, the US Centers for Disease Control and Prevention(CDC) has developed guidelines for the use of vaccination in theprevention of infectious disease following transplantation. This reviewexamines the primary clinical research supporting vaccinationpolicies in this target population. Widely accepted recommendationsfor transplant recipients based on scientific data are sparse, as fewlarge studies have been conducted in this population. Anecdotalreports, expert advice, summaries, and limited series involving lessthan 50 patients using surrogate end points form the basis of thescientific literature, with the result being a wide variation in practice.Although based largely on inadequate scientific data, the CDC recommendationsoffer a pragmatic approach to the prevention of opportunisticdisease in hematopoietic transplant recipients and serve as auseful starting point for standardization of practice while defining thedirection of future studies in transplant recipients and other immunocompromisedhosts.
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COUNTERPOINT: Standard vs Investigational Agents as Upfront Treatment for High-Risk AMLAs we learn more about the biology of AML, it appears that 7+3 only rarely clears residual leukemic clones in patients with higher-risk disease. New therapies are needed that can target and eradicate resistant subclones early in the disease course.
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Ensuring Holistic, Individualized Transitions of Care for Cancer SurvivorsAndrew M. Evens, DO, MBA, MSc, discusses the importance of meeting the emotional and physical needs of cancer survivors to help them lead fruitful lives.
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ASCO: Advances in the Management of Gastrointestinal CancersAs part of our coverage of the ASCO Annual Meeting, we discuss advances in the management of upper gastrointestinal (GI) tract tumors, as well as highlighting clinical trial results that will be reported at the meeting.
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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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Contemporary Issues Surrounding Small Renal Masses: Evaluation, Diagnostic Biopsy, Nephron Sparing, and Novel Treatment ModalitiesIn this review, we summarize the diagnosis of small renal masses, the role of renal mass biopsy, different treatment strategies, and future directions, including emerging molecular biomarkers.
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Clinical Status and Optimal Use of Rituximab for B-Cell LymphomasThe article by Dr. McLaughlin and coauthors provides both a useful summary of the clinical trials involving rituximab (IDEC C2B8 [Rituxan]) and a practical guide for its administration. Their review summarizes the most recent clinical results with this monoclonal antibody, which have just been published in the Journal of Clinical Oncology.[1] The review also includes a section on the potential mechanism of action of rituximab. Several areas merit comment.
