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The State of Prostate MRI in 2013: Into the BreachThe concept of multiparametric MRI comes at an important time in the history of prostate cancer screening. It is a method that provides anatomic information about the location, number, size, and risk of prostate cancers. It permits more accurate targeted biopsies that will improve the quality of tissue obtained, thereby reducing the rate of upstaging associated with random biopsies.
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Screening for Prostate Cancer With PSA Testing: Current Status and Future DirectionsThis article will present a detailed review of the body of evidence regarding the PSA assay, with reflections on the resulting future of prostate cancer screening.
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The Role of Physical Activity in Cancer Prevention, Treatment, Recovery, and SurvivorshipThis article will review these intersections of exercise and oncology, discuss the known mechanisms by which exercise exerts its salutary effects, and touch upon the future directions of exercise research in the oncology setting. Finally, recommendations are provided for clinicians to help patients with and without cancer take advantage of the benefits of physical activity.
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The Breast Cancer WarsUnited States seems to have a predilection for declaring "war" on its internal problems, be they poverty, drugs, or cancer. In the latter part of the past century particularly, military metaphors became part of the vocabulary used by Americans to
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Extra Care Required When Making Opioid ConversionsVIENNA, Austria-Since most palliative care pain patients will require one or more changes in drugs due to inadequate pain relief, “physicians caring for terminally ill patients must be familiar with multiple drugs and routes of delivery,” Eduardo Bruera, MD, chairman of the Pain Department, M.D. Anderson Cancer Center, said at the 9th World Congress on Pain, sponsored by the International Association for the Study of Pain.
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HER2 Targeting in Early Breast Cancer: More Options and More QuestionsTherapies targeting HER2 have revolutionized the treatment of breast cancer. Trastuzumab is the foundation of treatment for women with HER2-positive breast cancer. The challenge ahead is to develop predictors that can identify patients for whom trastuzumab alone will be sufficient.
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Current Clinical Trials of Molecularly Targeted Agents in Children With Cancer, Part 2A number of molecularly targeted agents directed at critical cell survival and cell proliferation pathways have recently entered clinical evaluation in children with cancer. These agents offer the potential for more effective anticancer therapy while simultaneously diminishing acute and long-term toxic effects. Systematic evaluations of targeted agents are essential to achieving continued improvements in outcome for children with cancer. Brief summaries of the rationale for conducting studies of several agents in children are provided below. Following these summaries is a listing of phase I, phase I/II, phase II, and pilot studies of these and other agents in pediatric populations.
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An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainMany cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines
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Health Economic Analysis of the Burden of Infusion Reactions on Patients, Caregivers, and ProvidersIn recent years, both the cost and efficiency of medical care have emerged as important considerations and areas of research. These considerations are of particular importance in the outpatient community oncology setting, where the demands for clinical productivity and evidence for quality and effectiveness are increasing amidst an evolving reimbursement system.
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CT Lung Cancer Screening: Public Healthcare Policy and Guidelines CollideThe development of CT lung cancer screening, the publication of results from the NLST in 2011, and the grade-B recommendation for CT lung cancer screening in high-risk smokers by the USPSTF raise a number of interesting national health policy issues.
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Which Non-Hodgkin's Lymphoma Patients Benefit From ABMT?I would like to take issue with Dr. Bruce Cheson's response to a reader's question on the role of high-dose chemotherapy/autologous bone marrow transplantation (ABMT) in patients with non-Hodgkin's lymphoma (Oncology News International, December, 1995, page 25).
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Every-2-Week Darbepoetin Alfa Is Comparable to rHuEPO in Treating Chemotherapy-Induced AnemiaThe safety and efficacy of darbepoetin alfa (Aranesp) at 3.0 µg/kg administered every 2 weeks and recombinant human erythropoietin (rHuEPO) given as 40,000 U weekly or 150 U/kg three times weekly were evaluated by
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Irinotecan in Relapsed or Refractory Non-Hodgkin’s LymphomasBecause irinotecan (CPT-11, Camptosar) is a topoisomerase I inhibitor with a broad spectrum of antitumor clinical activity, we investigated its activity in relapsed or refractory non-Hodgkin’s lymphomas (NHLs). Irinotecan at 300 mg/m² IV was administered every 21 days with intensive loperamide management of diarrhea.
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Irinotecan/Cisplatin in Advanced, Treated Gastric or Gastroesophageal Junction CarcinomaWe conducted a phase II study to assess the response rate and toxicity profile of the irinotecan (CPT-11, Camptosar) plus cisplatin combination administered weekly to patients with at least one previous chemotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction. Patients with histologic proof of adenocarcinoma of the stomach or gastroesophageal junction with adequate liver, kidney, and bone marrow functions were treated with 50 mg/m² of irinotecan plus 30 mg/m² of cisplatin, both administered intravenously 1 day a week for 4 consecutive weeks, followed by a 2-week recovery period.
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Arkansas Pioneers 'Total Therapy' for Multiple MyelomaLITTLE ROCK, Ark--Little prog-ress has been made during the last 30 years toward improving the prognosis of patients with myeloma. Because of the patients' often brittle condition and advanced age, dose intensity concepts had not been evaluated until the late Tim McElwain from the Royal Marsden Hospital reported responses to high-dose melphalan [Alkeran] at 140 mg/m² in patients with refractory disease or high-risk newly diagnosed patients.
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Commentary (Moore): Are Cancer Patients Subject to Employment Discrimination?Mark Rothstein and colleagues have tackled a difficult and sensitive subject: the existence of, and reasons for, employment discrimination against cancer victims. Employment discrimination in any chronic disease is not uncommon, but may be even more widespread in cancer patients, whose treatment is very lengthy, often physically or mentally debilitating, and usually exceedingly expensive. Because improved therapeutic approaches to the treatment of cancer have led to increased rates of survival, there will be more and more survivors in our society in the future. In pediatric cancer, therapeutic advances continue to increase the survival rate, which now is estimated at about 70% overall [1]. Thus, the potential for increasingly greater numbers of employable cancer survivors is high. And with children, although representing only 1% of all cancers, the actual number of person-years saved will be exceedingly high [1]. Adult cancers are diagnosed at more advanced age and in many cases the patient is near retirement age. Nevertheless, the issue of employability and job discrimination is very important to resolve.
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The Promise of Pharmacogenomics: Gemcitabine and PemetrexedAlthough no overall differences in survival have been observed betweenthe many chemotherapy combinations in non–small-cell lungcancer, the clinical application of mRNA expression levels of amplifiedgenes may disclose many genetic influences on cytotoxic drug sensitivityand enable clinicians to tailor chemotherapy according to eachindividual’s gene profile. Specifically, the assessment of ribonucleotidereductase subunit M1 and thymidylate synthase mRNA expression levelsmight select patients who benefit from gemcitabine (Gemzar) orpemetrexed (Alimta) combinations. Until recently, clinical prognosticfactors such as performance status, weight loss, and lactate dehydrogenasewere the only parameters used to predict chemotherapy responseand survival. However, accumulated data indicate that overexpressionof genes involved in cancer glycolysis pathways plays an important role,and might be an independent mechanism of chemoresistance. Thedysregulation of glycolytic genes is affected by growth signals involvingthe PI3K/Akt pathway and downstream genes such as hypoxiainduciblefactor-1-alpha. One can thus envision that substantial improvementsin therapeutic outcome could benefit from the integrationof tailored ribonucleotide reductase-dependent chemotherapy, ribonucleotidereductase antisense therapy, and targeted therapy.
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When Cancer Pain Breaks Through, What Can You Do?Oncology nurses must play an integral role in improving the treatment of breakthrough pain-one patient, one in-service for colleagues, and one clinical research study at a time.
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Multiple Hepatic Lesions in a Patient With a History of DCISAn asymptomatic 45-year-old woman presented for a screening mammogram and was noted to have a soft-tissue opacity with calcifications in the left breast. Ultrasound revealed a highly suspicious mass.
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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.
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Diagnostic and Management Issues in Gallbladder CarcinomaCarcinoma of the gallbladder is a rare malignancy, with an incidence rate in the United States of 2.2 to 4.4 per 100,000 persons. Its clinical presentation is nonspecific, and the majority of patients have advanced disease at
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Adjuvant Treatment After Orthotopic Liver Transplantation: Is It Really Necessary?This review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular cancer after orthotopic liver transplantation, as well as future prospects. No adjuvant treatment is currently advocated.
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Hodgkin's Lymphoma in the Elderly: A Different Disease in Patients Over 60With improved prognosis for patients with Hodgkin's lymphoma (HL), interest has increasingly focused on high-risk groups such as elderly patients. Advanced age at presentation is still one of the strongest negative risk factors. Many different factors influence the prognosis in elderly patients. These include biologic differences such as more aggressive histology, different distribution of disease, more frequent diagnosis of advanced stage, and shorter history of disease. In addition, however, aging itself and associated factors such as comorbidity, reduced tolerability of conventional therapy, more severe toxicity and treatment-related deaths, failure to maintain dose intensity, shorter survival after relapse, and death due to other causes contribute to the poorer outcome in elderly patients. Besides the evaluation of specific causes and risk factors, this review highlights recent and ongoing studies for elderly patients with HL as well as international approaches and recommendations for this age group.
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Cost Considerations in the Management of Cancer in the Older PatientThis paper provides an overview of several prominent articles and empirical studies on supportive care and cancer-related costs faced by older cancer patients. It focuses primarily on individuals 65 years of age and over and reviews several types of cancer.
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Biweekly Gemcitabine, Doxorubicin, and Paclitaxel as First-Line Treatment in Metastatic Breast CancerIn a single-center, open, phase II trial, we assessed the toxicity and activity of a triple combination therapy-doxorubicin at 30 mg/m2 (day 1), paclitaxel (Taxol) at 135 mg/m2 (day 2), and gemcitabine (Gemzar) at 2,500 mg/m2
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Current and Emerging Treatments for Brain MetastasesConventional methods for treating brain metastasis, such as surgery, WBRT, and SRS, each compete with and complement one another. A plethora of recent studies have helped define and expand the utility of these tools.
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Minimizing Oral Complications of Cancer TreatmentAggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have become often overlooked priorities of the treatment team.
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An Elderly Man With New Skin Plaques Consistent With Cutaneous T-Cell LymphomaAn 80-year-old man presented with a disabling pruritic rash characterized by disseminated and coalescing plaques on the trunk and proximal extremities and covering 40% of his total body surface area, without peripheral lymphadenopathy.
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Therapy for Early-Stage Colorectal CancerSurgery is the only curative option for patients with colorectal cancer. The goal of other modalities, such as chemotherapy, immunotherapy, and radiotherapy, is to prolong survival and reduce the risk of recurrence.
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Secondary Breast Cancer in a Woman Treated for Hodgkin Lymphoma as a ChildOverall survival of Hodgkin lymphoma (HL) is 90%; however, survival decreases with time owing to late complications, including subsequent malignancy. Female survivors of pediatric HL have increased morbidity and mortality associated with secondary effects of radiation therapy, most specifically the development of secondary breast cancer. It is estimated that female HL survivors have a 35- to 75-fold excess risk of developing breast cancer, with the greatest risk occurring 15 to 20 years after initial diagnosis. This risk time frame is more than 20 years before the median age (61 years) of breast cancer diagnosis among the general population. This equates to an HL survivor reaching the cumulative lifetime incidence of breast cancer by 40 years of age when compared with the general population.
