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Concurrent RT With 5-FU/Epirubicin and Cisplatin or Irinotecan for Locally Advanced Upper GI AdenocarcinomaFrom the results of recent studies, it is likely that multimodality therapy with chemotherapy and radiation treatment may improve the overall outcome of locally advanced upper gastrointestinal (GI) malignancies, including esophageal, gastric, pancreatic, and biliary tract carcinomas. However, more effective, more optimal, and less toxic chemotherapy regimen(s) with concomitant radiotherapy are needed beyond the concurrent continuous-infusion fluorouracil (5-FU) with radiation that is commonly applied in general practice. Epirubicin (Ellence), cisplatin, and irinotecan (Camptosar) are all active cytotoxic chemotherapy agents in upper GI cancers. Two phase I studies were designed to test the tolerability of the combination of radiotherapy with infusional 5-FU, epirubicin, and cisplatin (ECF) or 5-FU, irinotecan, and epirubicin (EIF) in the treatment of locally advanced upper GI malignancies.
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Dramatic Effects of Quit Smart Tobacco Cessation Program Seen in Newly Diagnosed Cancer PatientsAt ONS Congress 2013, Bruce Grant explains how integrating a nurse-driven tobacco cessation program for newly diagnosed oncology patients, called Quit Smart, into regularly scheduled appointments boosted the long-term quit rate (abstract 136806).
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Measuring the Cost-Effectiveness of Cancer CareThe failure to contain health-care costs and curtail growth is a growing national economic concern and public policy issue. The marketplace is rapidly changing how health care is paid for by moving from fee-for-service mechanisms to prospective payment, diagnosis-related groups, and increasing exclusion of some treatment(s).
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Commentary (Averbook): Melanoma in the Older PersonThe relationship between age andmelanoma prognosis is growingmore apparent and presentsinteresting scientific and social questions.My colleagues and I publishedtwo papers analyzing melanoma patientsfrom our institution. Our firstpaper examined a population of 620patients during a 26-year period, andour most recent paper analyzed 1,018melanoma patients over 30 years.[1,2]In both of these studies, age remainedan important prognostic predictor ofdisease-free and disease-specific survivalbased on multivariate analysis(Cox proportional hazard). We alsoapplied a novel classification and regressiontree (CART) evaluation ofthe data that showed age maintaininga significant influence on disease-freesurvival. Age maintained importancein disease-specific survival when genderwas used as the first parameter tosegregate the entire patient populationbefore applying tree-structuredstatistics.
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AIDS-Related Kaposi’s Sarcoma: Current Treatment Options, Future TrendsIn his excellent review, Dr. Mitsuyasu correctly highlights the three most important ingredients that play a role in the pathogenesis of acquired immunodeficiency syndrome (AIDS)-related Kaposi’s sarcoma (KS)-Kaposi’s sarcoma herpesvirus/human herpesvirus type 8 (KSHV/HHV-8); altered expression and response to cytokines; and stimulation of KS growth by the human immunodeficiency virus (HIV)-1 trans-activating protein, Tat. Recent studies have provided tremendous insight into the process whereby KSHV/HHV-8 creates the inflammatory-angiogenic state that characterizes KS.
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The “Episode-of-Care” Payment Model: One Practice’s ExperienceThe episode-of-care project is the first program in which a payer has partnered with the oncology community to reduce costs while paying for the demanding and complex cognitive work of the medical oncologist. The episode-of-care payment system seems to be working smoothly and we have not experienced the same erosion of our income that we have seen with other payers.
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Recurrence and Relapse in Testicular CancerDr. Bruce Roth, Siteman Cancer Center, spoke at the 2013 ASCO meeting about topics in seminoma. Here he discusses recurrence, relapse, and seminomatous vs nonseminomatous testicular cancer.
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Updates in the Treatment of Secondary Acute Myeloid LeukemiaThis video reviews the biology of secondary acute myeloid leukemia and highlights some of the latest findings in the treatment of this disease.
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Gemcitabine and Paclitaxel as Salvage Therapy in Metastatic Breast CancerIn a phase II trial, 29 patients with anthracycline-pretreated or anthracycline-resistant metastatic breast cancer in whom anthracycline-containing first- or second-line chemotherapy failed received combination paclitaxel
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Current Management of Opioid-Related Side EffectsThe optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient’s
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The Evolving Landscape of Gastrointestinal Infections in Neutropenic PatientsDiagnosis and management of GI complications in neutropenic patients benefit from the use of collaborative multidisciplinary teams to optimize outcomes.
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Improving Outcomes in Resectable Gastric Cancer: A Review of Current and Future StrategiesHere we review the evidence supporting current approaches to resectable gastric cancer, including discussion of the optimal extent of surgery and lymphadenectomy, adjuvant chemotherapy, postoperative chemotherapy with chemoradiation, and perioperative chemotherapy.
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EGJ and Esophageal Cancers: Choosing Induction Therapy so as to Err on the Side of Overtreatment Rather Than Undertreatment When Staging Is ImperfectUntil anatomic staging and physiologic prediction models improve, induction therapy serves as a useful crutch that can mitigate the weaknesses in both of these important preoperative tasks.
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A Role for Hepatic Metastasectomy in Stage IV Melanoma and Breast Cancer: Reestablishing the Surgical ModalityThis review summarizes the existing literature that addresses the topic of metastasectomy in patients with melanoma and breast cancer.
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Evolution of Combined Modality Therapy for Stage III Non–Small-Cell Lung CancerA number of randomized clinical trials and meta-analyses now support the conclusion that combined modality regimens that include cisplatin (Platinol)-based chemotherapy improve survival in stage III non–small-cell lung
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QUIZ: Mortality Risk and Screening CriteriaIn our lung cancer quiz, you'll get a chance to test your knowledge of the mortality risk among patients with lung cancer, and learn more about screening criteria to try reduce these rates.
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Patient Quality of Life Endpoints in Oncology Trials, Part IIThis interview covers symptom management and quality-of-life outcomes in cancer clinical trials, which are being incorporated more readily as secondary and sometimes primary trial endpoints.
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Predictive Biomarkers for Immunotherapy Response Beyond PD-1/PD-L1ABSTRACT Advances in immuno-oncology over the last several years have led to FDA approvals of novel agents. As our understanding of immune response and its checkpoints has evolved, further advances have been made in treatment for several cancer types. To predict a response to immunotherapy, the initial biomarkers used were expression of the PD-1 receptor and PD-L1, as assessed by immunohistochemistry. More recently, predictive biomarkers have included microsatellite instability, DNA mismatch repair, and tumor mutational burden. Although these markers may be clinically relevant in predicting an immunotherapy response, cancer immunotherapy fails some patients. Improved understanding of the human immune system is necessary, as is a careful evaluation of the methods used to predict and assess response to Immuno-oncology treatments. With the application of therapeutic immune-modulating agents, more comprehensive assays, and associated bioinformatics tools to accurately assess the tumor microenvironment, we may better predict responses to immuno-oncology agents and the ever-increasing complexity of their clinical use.
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Multi-epitope T-cell Vaccine Shows Promise in Ovarian, Breast CancerTPIV200 stimulates T cells to attack ovarian and triple-negative breast tumor cells that over-express the folate receptor alpha protein.
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Epirubicin, Cisplatin, Oral UFT, and Calcium Folinate in Advanced Gastric CarcinomaUFT (uracil and tegafur in a 4:1 molar ratio) plus calcium folinate treatment has favorable activity and tolerable toxicity in patients with advanced gastric carcinoma. High response rates have been reported in patients with
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Encouraging Improvement in Cytopenias of Patients With Myelodysplastic Syndromes With ThalidomideMyelodysplastic syndrome patients present with variable cytopenias even though their bone marrows are generally hypercellular. Excessive cytokine-induced apoptosis of hematopoietic cells in the marrows has been proposed as a possible
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Ovarian Carcinoma Histotypes: Their Emergence as Important Prognostic and Predictive MarkersThe movement of ovarian carcinoma histotypes from ill-defined and poorly reproducible clusters of cases to distinct disease entities clearly has beneficial implications for patient management.
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Chemotherapy in Advanced Nasopharyngeal CancerChemotherapy is an integral part of treatment for patients with nasopharyngeal carcinoma. Chemotherapy can achieve long-term survival rates of up to 15% to 20%, even in patients with recurrent or metastatic disease. In
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Dose-Dense and Sequential Strategies in Adjuvant Breast Cancer TherapySeveral attempts have been made to improve the survival rates of breast cancer patients. The benefit of adjuvant chemotherapy was clearly shown, but the absolute difference of 2% to 11% in overall survival, depending on the
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Ibritumomab Tiuxetan Radioimmunotherapy Is Safe and Well Tolerated in Patients With Relapsed or Refractory B-Cell Non-Hodgkin’s LymphomaIbritumomab tiuxetan (Zevalin) consists of an anti-CD20 murine IgG1 kappa monoclonal antibody covalently bound to tiuxetan (MX-DTPA), which stably chelates yttrium-90 for therapy. Ibritumomab tiuxetan therapy involves pretreatment with
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Rituximab Plus CHOP in the Treatment of Elderly Patients With Diffuse Large B-Cell Lymphoma: An Update of the GELA StudyAt the 2000 Annual Meeting of the American Society of Hematology, we presented the benefits of rituximab (Rituxan) combined with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone), known as R-CHOP, in comparison with CHOP alone for the treatment of elderly patients with diffuse large B-cell lymphoma (DLCL).
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Rituximab as a Single Agent and in Combination With Interferon Alfa-2a as Treatment of Untreated and First-Relapse Follicular or Other Low-Grade Lymphomas: A Randomized Phase II Study (M 39035)Rituximab (Rituxan) is approved for use in patients with relapsed and refractory follicular lymphoma. Considering the immune modulating effect of interferon alfa-2a (IFN [Roferon-A]) and its efficacy as a single agent in follicular lymphoma, a
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Rituximab Plus CHOP in the Treatment of Elderly Patients With Diffuse Large B-Cell Lymphoma: An Update of the GELA StudyAt the 2000 Annual Meeting of the American Society of Hematology, we presented the benefits of rituximab (Rituxan) combined with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone), known as R-CHOP, in comparison with CHOP alone for the treatment of elderly patients with diffuse large B-cell lymphoma (DLCL).
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Anthracycline and Trastuzumab in Breast Cancer TreatmentThis study was designed to evaluate the cardiac safety of the combined treatment of HER2-positive metastaticbreast cancer patients with trastuzumab (Herceptin) plus epirubicin and cyclophosphamide (EC) incomparison with EC alone in HER2-negative metastatic breast cancer patients. Patients included those withmetastatic breast cancer without any prior anti-HER2 treatment, anthracycline therapy, or any other chemotherapyfor metastatic disease. This was a nonrandomized, prospective, dose-escalating, multicenter, openlabel,phase II study in Germany. A control group of 23 patients received EC 90/600 mg/m2 3-weekly for sixcycles (EC90 alone). A total of 26 HER2-positive patients were treated with trastuzumab, or H (2 mg/kg weeklyafter an initial loading dose of 4 mg/kg), and EC 60/600 mg/m2 3-weekly for six cycles (EC60+H); another 25HER2-positive patients received H and EC 90/600 mg/m2 3-weekly for six cycles. Asymptomatic reductions inleft ventricular ejection fraction (LVEF) of more than 10% points were detected in 12 patients (48%) treatedwith EC60 + H and in 14 patients (56%) treated with EC90 + H vs 6 patients (26%) in the EC90 alone cohort.LVEF decreases to < 50% occurred in one patient in the EC60+H cohort and in two patients in the EC90+Hcohort during the H monotherapy. No cardiac event occurred in the cohort with EC90 alone. The overallresponse rates for EC60+H and EC90+H were >60%, vs 26% for EC90 alone. The interim results of this studysuggest the cardiac safety of the combination of H with EC may be greater than that of H with AC (doxorubicin[Adriamycin]/cyclophosphamide); however, studies in larger numbers of patients are warranted. The combinationregimen revealed promising efficacy.
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SABCS: Research From This Year's ConferenceCancer Network interviews Kent Osborne, who is the moderator of the year in review session. He has been involved with the meeting since its beginning. The international San Antonio Breast Cancer Symposium is unique as it facilitates the interaction of both basic and science researchers and clinicians to combine the efforts of laboratory research and clinical research for better treatment and patient care.
