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Neuroendocrine Tumors: Novel Approaches in the Age of Targeted TherapyOne hundred years after Oberndorfer coined the word “carcinoid,” neuroendocrine tumors (NETs) are thought to be rare tumors characterized by the capacity for hormone production and often an indolent course. Recent data from population-based registries have shown a significant rise in the diagnosed incidence of NETs over the past 3 decades.
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Histology… For Want of Anything Better?Recent studies have shed new light on the role of histology in predicting sensitivity to therapeutic agents such as pemetrexed (Alimta) or bevacizumab (Avastin). Whereas during the past 30 years, the only useful histologic consideration was the absence or presence of a “non” before “small-cell lung cancer,” two US Food and Drug Administration (FDA)-approved drugs now have histologic restrictions.
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Doxorubicin and Paclitaxel (Sequential Combination) in the TreatmentBased on preclinical data, we designed a phase I/II clinical trial to determine the efficacy and toxicity of doxorubicin followed by paclitaxel in the treatment of advanced breast cancer (either untreated or relapsed after
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Management of Patients With Resistant or Refractory Chronic Myelogenous LeukemiaThe introduction of imatinib mesylate (Gleevec) has dramatically changed the management and prognostic outlook of patients with chronic myeloid leukemia (CML).
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Vaccine Therapy for Patients With MelanomaHaigh et al provide thoughtful, detailed summary of 3 decades of intensive work aimed at developing active, specific immuno-therapies (vaccines) for patients with melanoma. However, as the 20th century draws to a close, the key question is: Can any vaccine be considered an effective therapy for patients with melanoma? To rephrase the question: What constitutes proof of efficacy for a melanoma vaccine, and have any vaccines met those criteria? In a word, the answer to the first question is “no.” The answer to the second question, however, requires more elaboration.
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Improvements in Tumor Targeting, Survivorship, and Chemoprevention Pioneered by TamoxifenTwenty years ago, antiestrogen therapy with tamoxifen played only a secondary role in breast cancer care. All hopes to cure metastatic breast cancer were still pinned on either the discovery of new cytotoxic drugs or a dose-dense combination of available cytotoxic drugs with bone marrow transplantation. A similar strategy with combination chemotherapy was employed as an adjuvant for primary breast cancer. Simply stated, the goal was to kill the cancer with nonspecific cytotoxic drugs while keeping the patient alive with supportive care. However, medical research does not travel in straight lines, and an alternative approach emerged to solve the problem of controlling tumor growth with minimal side effects: targeted therapy. The approach of using long-term antihormone therapy to control early-stage breast cancer growth would revolutionize cancer care by targeting the tumor estrogen receptor (ER). The success of the strategy would contribute to a decrease in the national mortality figures for breast cancer. More importantly, translational research that targeted the tumor ER with a range of new antiestrogenic drugs would presage the current fashion of blocking survival pathways for the tumor by developing novel targeted treatments. But a surprise was in store when the pharmacology of "antiestrogens" was studied in detail: The nonsteroidal "antiestrogens" are selective ER modulators—ie, they are antiestrogens in the breast, estrogens in the bone—and they lower circulating cholesterol levels. This knowledge would establish a practical approach to breast cancer chemoprevention for women at high risk (tamoxifen) and low risk (raloxifene).
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Cancers of the Gallbladder and Biliary DuctsDr. Yee and his colleagues have offered a comprehensive overview of the epidemiology, diagnosis, and therapy of both gallbladder carcinoma and cholangiocarcinoma. They correctly note the infrequency of these two neoplasms, with approximately 7,500 cases diagnosed in the United States each year, two-thirds of which are gallbladder cancer. Unfortunately, neither the incidence rate nor prognosis of these neoplasms has changed substantially since biliary tumors were last reviewed in this journal[1]; the median 5-year survival rate has remained at 5%. Some progress has been made, however, in our understanding of the etiology of cancers of the biliary tract, and a body of literature continues to emerge exploring the question of how best to approach screening and prophylaxis in high-risk populations.
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Commentary (Cohen): Radiation Therapy for Resectable Colon CancerColon cancer is a major public health problem. The primary treatment is resection. For patients with early-stage disease, surgery results in excellent survival rates. In contrast, patients with locally advanced tumors arising in "anatomically immobile" segments of large bowel have a less satisfactory outcome, in part secondary to compromised surgical clearance. Patterns-of-failure analyses suggest that for tumors that invade adjacent organs, exhibit perforation or fistula, or are subtotally resected, local failure rates exceed 30%. Multiple single-institution retrospective studies have shown improved local control and possibly survival with the addition of external irradiation and/or intraoperative radiation. In contrast, a recent Intergroup trial failed to show any benefit by the addition of adjuvant radiation therapy combined with chemotherapy. Interpretation of this trial's results is handicapped by low patient accrual. With the advent of novel and more effective systemic therapies for metastatic colon cancer, current and future clinical research will address the efficacy of these agents in the adjuvant setting. Adjuvant radiation therapy should be considered in patients with colon cancer at high risk for local failure.
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The ABCDs of moles and melanomasWhen you inspect moles, pay special attention to their sizes, shapes, edges, and color. A handy way to remember these features is to think of the A, B, C, and D of skin cancer-asymmetry, border, color, and diameter.
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Speech and Swallowing Rehabilitation for Head and Neck Cancer PatientsHead and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients. Effective swallowing rehabilitation depends on the inclusion of a video-fluorographic assessment of the patient's oropharyngeal swallow in the post-treatment evaluation. Pilot data support the use of range of motion (ROM) exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform ROM exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises. [ONCOLOGY 11(5):651-659, 1997]
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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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Management of Anal Cancer in 2010 Part 2: Current Treatment Standards and Future DirectionsThe treatment of anal squamous cell cancer with definitive chemoradiation is the gold-standard therapy for localized anal cancer, primarily because of its sphincter-saving and colostomy-sparing potential.
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Does This Woman Have Gestational Trophoblastic Disease?The review of the histology slides revealed predominantly decidual tissue with exaggerated placental site and a small focus of trophoblastic tissue composed of cytotrophoblast and syncytiotrophoblast with mild atypia (Figure 1). However, no necrosis or tissue invasion was identified. No villi were seen.
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Oral Oncolytics: Part 2-Legislation Targeting Cost & Access, and Other Initiatives to Reduce CostsWe examine efforts to correct cost inequities of oral anti-cancer agents through legislation, and we look at further efforts to reduce the cost of oral chemotherapy via cycle management and waste reduction.
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The Indolent LymphomasThe indolent non-Hodgkin's lymphomas constitute a heterogeneous group of lymphoproliferative disorders usually associated with relatively prolonged survival. They are categorized based on pathologic and cytologic features, and, with few exceptions [1], they are almost exclusively of B-cell origin.
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Minorities benefit from more sophisticated colon cancer screeningCurrent guidelines may be inadequate in at-risk African-American and Latino populations.
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Improving Palliative and Supportive Care in Cancer PatientsTwenty years of research in controlling symptoms such as pain andnausea have shown persistent suboptimal performance by the US oncologysystem. The data suggest that some of the tools of palliative careprograms can improve physical symptoms of seriously ill patients at acost society can afford. To fix these problems will require recognitionof the symptoms or concerns, a system such as an algorithm or careplan for addressing each, measurement of the change, and accountabilityfor the change. Symptom assessment scales such as the EdmontonSymptom Assessment Scale or Rotterdam Symptom Check List work tomake symptoms manifest. Listing symptoms on a problem list is a necessarystep in addressing them. Physical symptoms such as pain can beimproved by use of computer prompts, algorithms, dedicated staff time,team management, or combinations of these strategies. Less concreteproblems such as medically appropriate goal-setting, integrating palliativecare into anticancer care sooner, and informing patients aboutthe benefits and risks of chemotherapy near the end of life require morecomplex solutions. We review what is known about symptom control inoncology, how and why some programs do better, and make suggestionsfor practice. Finally, we suggest a practical plan for using symptomassessment scales, listing the problems, and managing them accordingto algorithms or other predetermined plans.
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High-Dose Therapy With Stem-Cell Transplantation in the Malignant LymphomasApproximately 35,000 stem (progenitor)-cell transplants are performed annually worldwide, with an estimated yearly growth rate of between 10% and 20%.[1] Non-Hodgkin’s lymphoma remains the second most common indication for stem-cell transplantation, and Hodgkin’s disease ranks approximately seventh overall.[1]
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Deferasirox for the Treatment of Chronic Iron Overload in Transfusional HemosiderosisThis report describes the Food and Drug Administration's review of data and analyses leading to the approval of the oral iron chelator, deferasirox for the treatment of chronic iron overload due to transfusional hemosiderosis.
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The Maze of PARP Inhibitors in Ovarian CancerThe development of poly(ADP-ribose) polymerase (PARP) inhibitors as a new class of anticancer agents has created a tremendous amount of hope in the ovarian cancer community, especially in the high-risk, difficult-to-screen, hereditary ovarian cancer population.
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Uracil/Tegafur Plus Oral Calcium Folinate in Advanced Breast CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) has proven activity against breast cancer and is delivered in an easy-to-administer oral formulation. Orzel, which combines UFT with the oral biomodulator, calcium folinate, may
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DEAR Study Offers ‘Hope’ to Patients With Non-Metastatic CRPCAlicia K. Morgans, MD, MPH, from Dana-Farber Cancer Institute indicates that patients with non-metastatic castration-resistant prostate cancer are able to stay on treatment for long periods of time with darolutamide vs enzalutamide and apalutamide.
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Individualized Local Treatment Strategies for In-Transit MelanomaFor localized in-transit disease, less is more, with local destruction, excision, and intralesional therapy being the cornerstones of treatment. If local therapies fail or if distant disease arises, isolated limb perfusion and systemic therapy remain effective options.
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Nutritional Implications of Dental and Swallowing Issues in Head and Neck CancerTumors of the head and neck account for 4% of cancers in the United States. Both the disease process itself and side effects of cancer treatment, such as xerostomia, dysphagia, and malnutrition, compromise oral health,
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Book Review: Surviving Childhood Cancer--A Guide for FamiliesSurviving Childhood Cancer, A Guide for Families" meets a tremendous need for easy-to-read, simple-to-understand information about the childhood cancer experience. All too often health-care professionals myopically focus attention and
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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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Eat Your VegetablesThe article by Fox and Freifeld presents a comprehensive history of the rationale for the neutropenic diet, along with important studies of this diet.
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When to Use Prophylactic Antibiotics in Neutropenic PatientsCurrent guidelines recommend antimicrobial prophylaxis with fluoroquinolones in patients at high risk for infection-related morbidity and mortality, but this practice provides a short-term benefit to individual patients.
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PET/CT shows high value in lung cancer staging trialNEW ORLEANS-An in-depth assessment of PET/CT at two German teaching hospitals has shown the fusion imaging technology improves on CT alone and pays dividends clinically and financially for staging non-small-cell lung cancer.
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Commentary (Wakoff/Porter): The Biology and Treatment of Chronic Myelogenous LeukemiaOver the past 2 decades, our understanding of the pathobiological events underlying chronic myelogenous leukemia (CML) has grown. At the same time, effective transplant and nontransplant treatment approaches to
