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Carcinoma of the Uterine CervixOver the past four decades, the incidence and mortality rates for uterine cervical carcinoma have decreased in the United States by as much as 70% to 75% [1]. This improvement is among the largest seen for any cancer site and has been attributed to the use of cervical cytologic screening [2].
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Medical Ethicist Arthur Caplan Explains Why He Opposes ‘Right-to-Try’ LawsIn this Q&A we examine Right-to-Try drug laws and discuss tips for clinicians with terminally ill patients who have exhausted all their therapy options.
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The Prostate Cancer Intervention Versus Observation Trial (PIVOT)The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is a randomized trial designed to determine whether radical prostatectomy or expectant management provides superior length and quality of life for men with clinically localized prostate cancer. Conducted at Department of Veterans Affairs and National Cancer Institute medical centers, PIVOT will enroll over 1,000 individuals less than 75 years of age. The primary study end point is all-cause mortality. Secondary outcomes include prostate cancer- and treatment-specific morbidity and mortality, health status, predictors of disease-specific outcomes, and cost-effectiveness. Within the first 3 years of enrollment, over 400 men have been randomized. Early analysis of participants' baseline characteristics indicate that enrollees are representative of men diagnosed with clinically localized prostate cancer throughout the United States. Therefore, results of PIVOT will be generalizable. These results are necessary in order to determine the preferred therapy for clinically localized prostate cancer. [ONCOLOGY 11(8):1133-1143, 1997]
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Distant Effects of Cancer on the Nervous SystemApproximately 30 years passed between the first description of a paraneoplastic neurologic disorder[1] and the demonstration of an immunologic pathogenesis for one of these syndromes.[2] In the almost 4 decades since, the paraneoplastic neurologic disorders have been subjected to study far out of proportion to their clinical prevalence. These disorders stimulate clinical research because (1) paraneoplastic neurologic syndromes are frequently the presentation of a malignancy, (2) they may bode well for a more favorable tumor prognosis,[3,4] and most importantly, (3) they yield insight into the workings of malignancy and the pathogenesis of neurologic disorders, particularly neurologic degenerations.
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Commentary (Neel/Sober)-Mohs Micrographic Surgery: Established Uses and Emerging TrendsPennington and Leffell have reviewedthe literature with regardto the relative efficacy ofthe Mohs technique vs conventionalsurgery in the treatment of commonand uncommon cutaneous neoplasms.The reason for the success of Mohssurgery can be summarized simply: TheMohs surgeon examines the entire microscopicsurgical margin for tumor,whereas the pathologist working with aconventional surgeon does not.
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QOL and Outcomes Research in Prostate Cancer Patients With Low Socioeconomic StatusThe VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate
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Painful Osteoblastic Metastases: The Role of Nuclear MedicineAlthough bone pain from osteoblastic metastases can be ameliorated 50% to 80% of the time by use of intravenously or orally administered radiopharmaceuticals, we cannot accurately predict who will or will not
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Why Haven’t Older Adults Been Included in More Oncology Clinical Trials?In this video, Dr. Arti Hurria discusses resources addressing the disconnect between cancer as a growing problem in the elderly and the fact that clinical trials mostly enroll younger patients.
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Trastuzumab: Mechanisms of Resistance and Therapeutic OpportunitiesThe human epidermal growth factor receptor 2 (HER2) is a transmembrane receptor with tyrosine kinase activity overexpressed in about 20% to 25% of invasive carcinomas of the breast.
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Clinical Status and Optimal Use of Rituximab for B-Cell LymphomasThe standard management of low-grade lymphoma remains controversial. Long-term follow-up studies of patients treated with conventional regimens have shown that currently available treatments are not curative.
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Granulocytic Sarcoma in a Patient With Myelodysplastic SyndromeOur case illustrates the fact that MDS-associated GS can be treated palliatively with radiation and hypomethylating agents in an appropriate setting. With the growing geriatric patient population, effective treatment options are needed in this disease.
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Neoadjuvant Therapy for Soft-Tissue Sarcomas-One Size Does Not Fit AllImprovements in neoadjuvant therapy for soft-tissue sarcomas will require the development of more efficacious systemic therapies and, if possible, the performance of histology-specific, prospective, randomized clinical trials to advance the field.
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Venous Thromboembolism and Bleeding Risk in Bladder CancerDespite the higher risk of VTE in patients with bladder cancer, ironically, their risk of bleeding and anemia, and greater need for transfusion of blood products, poses an equally significant risk of morbidity and mortality, especially among those who undergo cystectomy.
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Hypersensitivity Reactions to Oxaliplatin: Incidence and ManagementOxaliplatin (Eloxatin) is a novel platinum compound that has activityin a wide variety of tumors. Several hypersensitivity reactions distinctfrom laryngopharyngeal dysesthesia have been described. We retrospectivelyanalyzed 169 consecutive patients who received oxaliplatinfor esophageal or colorectal cancer between 1/1/00 and 7/31/02 andreviewed any significant adverse reactions labeled as hypersensitivityreactions. Thirty-two patients (19%) reportedly experienced hypersensitivity.Skin rash was the most common event (22 patients), occurringafter a median of three infusions. Fever was seen in five patients aftera median of two infusions. Five patients experienced respiratory symptomsat median infusion number 6. Ocular symptoms of lacrimationand blurring of vision were seen in two patients. Five patients experiencedmore than one type of reaction. Treatments prescribed forhypersensitivity were antihistamines, steroids, and topical emollients.One patient developed grade 4 hypersensitivity during cycle 6, characterizedby laryngeal edema, tongue swelling, and labored breathing.This patient underwent a desensitization procedure, adapted from guidelinesfor carboplatin (Paraplatin) allergy. Subsequently, three cycleswere administered over 6 hours and were well tolerated. However,during the fourth infusion postdesensitization, the patient developedrecurrent signs of hypersensitivity. In conclusion, hypersensitivity isfrequently seen with oxaliplatin, but most reactions are mild.
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CEA Monitoring in Colorectal CancerCarcinoembryonic antigen (CEA) monitoring in patients with stage I-IV colorectal cancer has been, and remains, a controversial issue in oncology practice. Recommendations vary from bimonthly monitoring to no monitoring in the surveillance setting (for stage I-III disease). In the metastatic setting, there are no clear guidelines for CEA follow-up, although continued monitoring in such patients is common in the oncology community. This manuscript reviews the accuracy of CEA testing, its value as a prognostic indicator, and its role in surveillance and response assessment. The limitations of the test in the adjuvant and metastatic settings are illustrated through several case reports from the Colorectal Oncology Clinic at Roswell Park Cancer Institute. Guidelines for CEA monitoring are provided, based on a detailed literature review and institutional experience.
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Initial Treatment of Well-Differentiated Neuroendocrine TumorsIn patients with advanced, unresectable NETs, there are several treatment options; which of these may be considered depends on the site of origin of the tumor.
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Exploring the Future of ctDNA and Novel Treatment StrategiesPanelists offer concluding perspectives on the future role of circulating tumor DNA in colorectal cancer management.
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Man With Locally Advanced, High-Risk Prostate Cancer Asks About Adding Chemotherapy to His TreatmentA 55-year-old Hispanic male presents with a family history of gastric cancer in one sibling and prostate cancer in an older brother. CT performed in March 2015 for IMT surveillance showed a heterogeneous prostate with local invasion involving the bladder, seminal vesicles, and perirectal fat.
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Book Review:Contemporary Neurology--Neurologic Complications of Cancer, Volume 45The latest addition to the Contemporary Neurology series, devoted to the neurologic complications of cancer, is authored solely by Dr. Posner. Although this book has been written for both the student and trained professional, who can quickly adapt to the definitive nature of the tables, diagrams, and clinical approaches, it is likely to be most appealing to the neuro-oncologic specialist.
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Ibrutinib Improves Outcomes in CLL/SLLThis video examines a phase III trial of ibrutinib in combination with bendamustine and rituximab in patients with previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma.
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Melanoma and Other Skin CancersSkin cancer is the single most common form of cancer, accounting for more than 75% of all cancer diagnoses. More than 1 million cases of squamous cell and basal cell carcinomas are diagnosed annually, with a lifetime risk of more than one in five.
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Venous Thromboembolism and Bleeding Risk in Bladder CancerDespite the higher risk of VTE in patients with bladder cancer, ironically, their risk of bleeding and anemia, and greater need for transfusion of blood products, poses an equally significant risk of morbidity and mortality, especially among those who undergo cystectomy.
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Ashish Saxena, MD, PhD Discusses Immunotherapy Drugs Effect on OS in Lung CancerAshish Saxena, MD, PhD, from Weill Cornell Medicine, discussed how immunotherapy may lead to an increase in overall survival of patients at the Annual New York Lung Cancers Symposium®.
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Neoadjuvant Therapy for Early-Stage Breast Cancer: Current Practice, Controversies, and Future DirectionsIn this review, we will discuss multidisciplinary considerations in treating patients with neoadjuvant therapy and highlight areas of controversy and ongoing research.
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Adjuvant Therapy of Breast Cancer in Women 70 Years of Age and Older: Tough Decisions, High StakesIn this review we will discuss how to evaluate older breast cancer patients, including estimating survival, defining functional limitations, and providing guidelines for optimal adjuvant therapies.
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Management of Sleep-Wake Disturbances Comorbid With CancerIn both primary care and oncology settings, screening patients for sleep-wake disturbances comorbid with cancer and their daytime consequences can reduce the economic burden of untreated sleep problems.
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Unmet Needs and Future Perspectives in Newly-Diagnosed and Relapsed Multiple MyelomaClosing out their discussion, the panel shares remaining unmet needs in the treatment of newly-diagnosed and relapsed multiple myeloma.
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Oropharyngeal and Oral Cavity Cancer Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Tandem Transplantation in Multiple MyelomaThe use of high-dose chemotherapy and autologous stem cellsupport in the past decade has changed the outlook for patients withmultiple myeloma. In newly diagnosed patients, complete remissionrates of 25% to 50% can be achieved, with median disease-free andoverall survivals exceeding 3 and 5 years, respectively. Despite theseresults, autologous transplantation has not changed the ultimatelyfatal outcome of the disease, as there is no substantial evidence of“cure” in most published studies. An additional high-dose chemotherapycourse (with tandem transplants) appears to improve progressionfreesurvival, although the effect is not discernible until 3 to 5 yearsposttransplant. The recent reports of tandem autologous transplant formaximum cytoreduction followed by nonmyeloablative allogeneictransplant for eradication of minimal residual disease appears promisingand deserve further investigation. A central issue of tandemtransplants, whether they involve autologous or allogeneic transplants,revolves around defining the subsets of patients who will benefitfrom the procedure. Good-risk patients (defined by normal cytogeneticsand low beta-2–microglobulin levels), especially those who achievea complete or near-complete response after the first transplant, appearto benefit the most from a second cycle. High-risk patients (defined bychromosomal abnormalities usually involving chromosomes 11 and 13and high beta-2–microglobulin levels) whose median survival aftertandem transplant is less than 2 years should be offered novel therapeuticinterventions such as tandem “auto/allo” transplants. Until theefficacy and safety of this procedure is fully established, it should belimited to high-risk patients.
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AL Amyloidosis: New Drugs and Tests, but Old ChallengesImmunoglobulin light chain (AL) amyloidosis develops in 2% of individuals with monoclonal plasma cell dyscrasias. In this issue of ONCOLOGY, Drs. Gertz and Dispenzieri discuss AL amyloidosis, highlighting progress in the field along with outstanding challenges.
