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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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Evaluating the Role of Serine Protease Inhibition in the Management of Tumor MicrometastasesConservation of blood is apriority during surgery, owingto shortages of donor bloodand risks associated with transfusionof blood products.[9,10] However,blood transfusions have been linkedto a number of negative postoperativesequelae, including poorer prognosisafter cardiac and cancer surgery.[11-21] In this context, recognition thatallogeneic transfusion-associatedimmunomodulation can increasemorbidity in allogeneically transfusedpatients has become a major concernin transfusion medicine.[9,22,23]
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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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Irinotecan/Cisplatin Followed by 5-FU/ Paclitaxel/Radiotherapy and Surgery in Esophageal CancerLocal-regional carcinoma of the esophagus is often diagnosed inadvanced stages because the diagnosis is established when symptomsare severe. The prognosis of patients with local-regional carcinoma ofthe esophagus continues to be grim. While preoperative chemoradiotherapyincreases the fraction of patients who achieve pathologiccomplete response, that percentage is approximately 25%. In an attemptto increase the number of patients with either no cancer in the surgicalspecimen or only microscopic cancer, we adopted a three-step strategy.The current study utilized up to two 6-week cycles of induction chemotherapywith irinotecan (CPT-11, Camptosar) and cisplatin as step 1.This was followed by concurrent radiotherapy and chemotherapy withcontinuous infusion fluorouracil (5-FU) and paclitaxel as step 2. Oncethe patients recovered from chemoradiotherapy, a preoperative evaluationwas performed and surgery was attempted. All patients signed aninformed consent prior to their participation on the study. A total of 43patients were enrolled. The baseline endoscopic ultrasonography revealedthat 36 patients had a T3 tumor, five patients had a T2 tumor, andtwo had a T1 tumor. Twenty-seven patients had node-positive cancer(N1). Thirty-nine (91%) of the 43 patients underwent surgery; all hadan R0 (curative) resection. A pathologic complete response was noted in12 of the 39 patients. In addition, 17 patients had only microscopic(< 10%) viable cancer in the specimen. Therefore, a significant pathologicresponse was seen in 29 (74%) of 39 taken to surgery or 29 (67%)of all 43 patients enrolled on the study. With a median follow up beyond25 months, 20 patients remain alive and 12 patients remain free ofcancer. Our preliminary data suggest that the proportion of patientswith significant pathologic response can be increased by using thethree-step strategy.
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Optimizing the Benefit of CNS Radiation Therapy in the Pediatric Population-PART 1: Understanding and Managing Acute and Late ToxicitiesMinimizing late treatment toxicities in these patients remains an important priority due to both the young age of the patients and the high cure rate that can be achieved.
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Osteoporosis, Fractures, and Risk of FallsOsteoporosis in elderly cancer patients is an increasing problem, yet it remains under-recognized and under-managed. We commend Dr. Balducci for writing a comprehensive review of the bone complications associated with cancer and its treatment in the elderly.
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The Double-Edged Sword of ADT: Emerging Evidence of Cardiovascular, Pulmonary, and Renal RisksAs a variety of new hormonal agents are increasing survival times for men with metastatic disease, it is becoming increasingly important to consider cardiovascular, renal, and other potentially more serious risks associated with long-term ADT, especially in an aging population.
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The Emerging Role of HE4 in the Evaluation of Epithelial Ovarian and Endometrial CarcinomasIn this review, we discuss the discovery and biologic significance of HE4 and evaluate available evidence regarding the utility of HE4 as a biomarker for ovarian and endometrial cancer.
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Starting Palliative Care Early Can Improve QoL in Family Caregivers of Cancer PatientsIn this video we discuss how palliative care early on in the process of treating patients with cancer led to an improvement in depressive symptoms and quality of life among family caregivers.
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First-Cycle CSF Use in Breast Cancer and NHL: Guidelines and RecommendationsGrade 3 and 4 neutropenia as well as febrile neutropenia have been demonstrated to occur in all tumor types and are clearly associated with major morbidity and significant mortality; this is particularly true when myelosuppressive regimens are used with curative intent as is the case in most breast cancer and non-Hodgkin's lymphoma regimens. Myeloid colony-stimulating factors (CSFs) substantially decrease the risk of severe and febrile neutropenia. Although the white cell growth factors might not be cost-effective at lower risks of febrile neutropenia, they clearly benefit other outcomes such as the incidence of severe neutropenia and febrile neutropenia, hospitalization, and mortality. Updated guidelines from the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Organisation for Research and Treatment of Cancer now recommend primary prophylaxis or first-cycle use of white cell growth factors with regimens where the occurrence of febrile neutropenia is approximately 20% (as well as when other risk factors are present). This article briefly describes the rationale for the development of several of the guideline changes as well as highlights some of the ongoing issues related to the use of CSFs.
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Splenic Lymphomas Presenting as SplenomegalySeveral lymphoma subtypes may present with isolated splenomegaly. Establishing a correct histologic diagnosis is critical, since patient management is largely determined by histology.
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Immunotherapy: New Strategies for the Treatment of Gynecologic MalignanciesIn this review, we will summarize clinical trials that have used various immunotherapeutic strategies, with a particular focus on recently emerging data for new agents and combinations.
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Management of Advanced/Metastatic Prostate Cancer: 2000 UpdateOver the past several years, the clinical presentation of prostate cancer has evolved so that more patients than ever before are presenting with clinically localized disease. However, a significant number of men continue to
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Diagnostic Dilemma: GI DiseaseA 68-year-old man with a history of small-cell lung cancer with bony metastases was admitted with diarrhea. The patient had completed chemotherapy one week earlier with cisplatin and etoposide, along with radiation therapy, and irinotecan (Camptosar). The patient was found to be neutropenic.
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Diagnostic Dilemma: GI DiseaseAn 85-year-old woman presented to the emergency department with epigastric pain and nausea for 2 days. She denied vomiting, fever, or early satiety. The patient stated she had lost 10 pounds over the past 3 months. A CT scan of the abdomen revealed a 1 cm low attenuation lesion in the second portion of the duodenum.
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SBRS to Manage Painful Bone Metastases: The Challenges AheadThe authors have provided a concise review of stereotactic body radiosurgery (SBRS) in the treatment of mainly spinal/paraspinal metastases. This technique was primarily developed to treat spinal metastases in the reirradiation scenario given that treatment alternatives are limited for these patients and that-in the setting of advanced metastatic disease-surgical decompression is often not a suitable option.
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Recent Clinical Trials Explore Immunotherapies for Urothelial CarcinomaDr. Balar highlights promising evidence on the potential benefits of the use of immunotherapy in the advanced bladder cancer setting.
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Management of Resistance to EGFR TKI–Targeted Therapy of Lung Cancer: Lessons in Monitoring Cancer EvolutionCancer cells undergo accelerated evolutionary changes; thus, under the pressure of novel generations of EGFR TKIs, we should expect to see new mechanisms of resistance.
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New Directions in the Systemic Treatment of Metastatic Thyroid CancerAbout 30,000 new cases of thyroid cancer are diagnosed annually in the United States.[1] The incidence among men has risen more dramatically than any other malignancy in recent years (2.4% annual increase).[2] Thyroid cancers arise from one of two cell types, namely follicular and parafollicular cells.
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A 40-Year-Old Woman With a New Triple-Negative Breast Mass, Shown on Biopsy to Be Metaplastic CarcinomaA 40-year-old woman noted a large mass in her right breast. A diagnostic mammogram and ultrasound confirmed a 3.4-cm mass with associated microcalcifications.
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The Pathway Ahead in Melanoma TrialsReviewing treatment modalities for melanoma provides many sobering reminders that advances in our scientific understanding have not yet translated into meaningful clinical benefit. As clearly delineated by the authors, the “standard” treatment of dacarbazine chemotherapy has a poor response rate and lacks durability.
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Neoadjuvant Chemotherapy and Surgical Management of the Axilla in Breast Cancer: A Review of Current DataThis review will discuss the current status of surgical management of the axilla for patients treated with neoadjuvant chemotherapy.
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Management of Primary and Metastatic Tumors to the LiverPrimary and metastatic liver tumors continue to be a significant health problem in the United States. Hepatic resection or, in selected cases, transplantation are the only curative therapies for patients with resectable
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POEMS Syndrome: Still an Enigma?Because of challenges in making the correct diagnosis and the physician’s reluctance to administer chemotherapy for a disease characterized by such a low tumoral mass, patients may experience a delay in the initiation of appropriate treatment.
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Stereotactic Body Radiotherapy in the Management of Painful Bone MetastasesBone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.
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High-Dose Therapy for Follicular LymphomaMost patients with advanced-stage follicular non-Hodgkin’s lymphoma (NHL) are not cured with conventional therapy. The use of high-dose therapy and autologous stem-cell transplantation in patients with relapsed follicular
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Helping Patients Access Protections of the ADAWhen she learned that she had breast cancer, Patricia Garrett did what many people with cancer do: she continued working.
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Commentary (Melman): Morbidity of Contemporary Radical Retropubic Prostatectomy for Localized Prostate CancerThis article compares the results of radical retropubic prostatic surgery done by a group of urologists at the Mayo Clinic during a recent 3-year period with results obtained in a similar group of patients operated on prior to 1987. The authors show that when a surgical procedure is done often, with modern techniques and attention paid to surgical and anatomic detail, very good results can be achieved.
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Adjuvant Endocrine Therapy in Premenopausal Women With Operable Breast Cancer: Understanding the IssuesResearch and development of adjuvant therapies for premenopausal women with endocrine-responsive breast cancer is unfortunately lacking.
