Authors
Latest:
Management of Difficult Germ-Cell TumorsAlthough testicular cancer is a rare disease accounting for only 1% of all male neoplasms, it represents a paradigm for cancer curability. Overall, more than 95% of patients can expect to be cured of their disease with minimal long-term toxicity. Given these expectations, it is critical that cancer care providers are familiar with the diagnostic and therapeutic challenges encountered in these rare patients. In particular, clinicians managing these patients should be aware of some of the pitfalls encountered when determining relapse. In a series of case presentations, we review the evaluation and management of patients with persistent elevation of serum tumor markers and postchemotherapy residual radiographic abnormalities.
Latest:
Breast Cancer Following Radiation for Hodgkin Lymphoma: Clinical Scenarios and Risk-Reducing StrategiesWe review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma.
Latest:
Imagery and Hypnosis in the Treatment of Cancer PatientsSpiegel and Moore provide an excellent review of the utility of psychological therapeutic techniques in cancer patients. These techniques are frequently viewed with alarm by the medical community because of unsubstantiated claims that they improve survival in cancer patients. Patients who expect such techniques as visual imagery to change the course of their illness may experience poorer psychological adjustment and needless guilt. However, it is a shame to "throw the baby out with the bath water." Psychological techniques have a significant role to play in the treatment of cancer patients.
Latest:
The Crisis of Cancer: Psychological Impact on Family CaregiversCancer causes changes in the family's identity, roles, and daily functioning. Studies document that spouses are as distressed as cancer patients and that spousal and patient distress are correlated. Three major areas of caregiver
Latest:
Postmastectomy Radiotherapy After Neoadjuvant Chemotherapy: A Review of the EvidenceMultiple randomized trials and their meta-analysis have demonstrated an overall survival benefit from postmastectomy radiotherapy in women with node-positive breast cancer. However, none of the patients treated in these trials received neoadjuvant chemotherapy, which is now an increasingly common approach.
Latest:
New Targets for Triple-Negative Breast CancerWith regard to potential research strategies relevant to the treatment of triple-negative breast cancer/basal-like breast cancer, potential targets include PTEN, INPP4B, PIK3CA, KRAS, BRAF, EGFR, FGFR1, FGFR2, IGFR1, KIT, MET, PDGFRA, and the HIF1-α/ARNT pathway. Many of these will be discussed further in this review article.
Latest:
Targeted Therapy in the Treatment of Castration-Resistant Prostate CancerIn this review, we focus on the testosterone/androgen receptor pathway that is being targeted with potent new agents; we also discuss other important alternative biologic pathways that have given rise to new therapeutics that may attenuate prostate cancer growth, survival, and propagation.
Latest:
Prophylactic Surgery in Hereditary Breast/Ovarian Cancer SyndromeDrs. Levine and Gemignani havecomposed an excellent comprehensivereview of the issuessurrounding prophylactic surgeryin patients at high risk for breast andovarian cancer. Their article focuseson the role of BRCA1/2 mutations inthe risk of developing hereditary breastand ovarian cancer and the data supportingrisk reduction in mutation carriersundergoing prophylactic surgery.
Latest:
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
Latest:
Recognizing and Managing Side Effects Associated With Novel Targeted Therapies:Nursing management of patients with advanced malignancies presents a formidable challenge. In addition to the discomfort and debilitation these diseases can cause, side effects of traditional treatment modalities such as surgery, chemotherapy, and radiation may lead to severe and sometimes fatal sequelae. New targeted therapies promise an effective treatment with more easily tolerated and managed side effects. Basic understanding of the drugs' mechanism of action contributes to the successful management of the toxicities that can be manifested. Effective patient education results in improved compliance with treatment regimens and potentially improved clinical outcomes. Nursing intervention remains a vital component in the successful use of these novel agents.
Latest:
Cost of Cancer: There Is More to It Than Containing Chemotherapy CostsIncluding the entire course of care in the efforts to improve quality and contain costs will make the short-term implementation more complex and perhaps controversial. However it will reflect the way that contemporary oncology care is delivered, and will allow for holistic care management and an optimization of cost.
Latest:
Formidable Challenges Ahead for Lung Cancer ScreeningTanner et al provide a concise review of lung cancer screening, including discussion of past failed attempts, the success of the National Lung Screening Trial (NLST), and promising new avenues for improving on the NLST results.
Latest:
Commentary (Szarka/O'Dwyer): New Antifolates in Clinical DevelopmentDrs. Takimoto and Allegra present a comprehensive overview of the development of antifolates over the past decade and a half. The antifolates are antimetabolite antineoplastic agents that are structurally and chemically similar to naturally occurring folates required for the synthesis of purines and pyrimidines. These drugs interfere with DNA synthesis by inhibiting key enzymes. They are transported across the plasma membrane and converted intracellularly to cytotoxic species, which must compete with endogenous substrates for target enzyme binding.
Latest:
Implications of the New Face of Head and Neck CancerAlthough screening methods for HPV-OPSCC have not yet been developed, population-based prevention may be achievable through HPV vaccination, but only if concerted efforts are made to increase vaccine uptake in the United States.
Latest:
Cancer Management Chapter 20: 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. The vast majority of skin cancers can be cured with surgery alone. Resection is the mainstay of therapy, even for skin cancer involving regional lymph nodes or, in some cases, more distant metastatic sites.
Latest:
Radiotherapy in Small-Cell Lung CancerGanti and colleagues have provided a brief review on the diagnosis of small-cell lung cancer (SCLC) and the roles of chemotherapy and surgery in its management. Notably, in the past three decades, the most significant progress in the treatment of SCLC has mainly involved the use of radiotherapy. Thus, to complement their assessment, we will provide an overview of the role of radiation in the management of limited-stage and extensive-stage SCLC.
Latest:
Treatment Disparities in Locally Advanced Cervical Cancer Impact SurvivalIn this interview we discuss a recent study that found that more than half of patients with locally advanced cervical cancer in the United States did not receive standard of care.
Latest:
Novel and Expanded Oncology Drug Approvals of 2016-PART 1: New Options in Solid Tumor ManagementThis article focuses on the new agents and indications that emerged in 2016 for solid tumor treatment. We review the drug indications, mechanisms of action, pivotal trial data, pertinent toxicities, use in special populations, and the appropriate clinical contexts for treatment planning.
Latest:
Management of Fatigue in the Cancer PatientFatigue is the most common problem experienced by oncology patients.[1-2] In this issue of ONCOLOGY, Drs. Lesage and Portenoy present an excellent overview of the potential etiologies, assessment parameters, and treatment options for this complex, multidimensional symptom. As they note in their comprehensive review, research on this symptom, which has a significant impact on oncology patients’ ability to function and quality of life, is limited. Therefore, one is left to consider what important research questions need to be answered regarding cancer-related fatigue.
Latest:
Metastatic Malignant Melanoma From an Unknown Primary Presenting as a Large Axillary MassThe patient is an otherwise healthy male transferred from an outside hospital with a newly diagnosed melanoma from an unknown primary presenting as a large, left axillary mass.
Latest:
Improving Adherence to Endocrine Therapies: The Role of Advanced Practice NursesWith the trend toward the use of oral rather than intravenous therapies for cancer, nonadherence to treatment has become an increasing concern. Advanced practice nurses are in a good position to assess and monitor adherence to oral endocrine therapies. Research on adherence has been limited; to date there are no specific published guidelines for ensuring adherence to endocrine regimens. However, studies have identified many factors that may lead to nonadherence, including demographic, social, and psychological characteristics of the patient; characteristics of the disease and the treatment regimen; and the nature and quality of the patient/clinician relationship. These factors provide a framework that advanced practice nurses can use to identify potential problems and to work collaboratively with patients.
Latest:
Prevention and Screening in Hereditary Breast and Ovarian CancerHere we review current guidelines on breast and ovarian cancer screening, prophylactic surgery, and other risk-reduction strategies in patients with these mutations, and we detail the data that drive these recommendations.
Latest:
Gemcitabine, Anthracycline, and Taxane Combinations for Advanced Breast CancerIn patients with advanced breast cancer, treatment with paclitaxeland doxorubicin has been shown to produce impressive overall responserates (up to 94%) and to prolong overall survival significantly over acombination of fluorouracil (5-FU), doxorubicin, and cyclophosphamide(Cytoxan, Neosar) in one prospective phase III clinical study.
Latest:
Sifting Through the Multitude of Novel Therapies for Prostate CancerMetastatic hormone-resistant prostate cancer has proven largely resistant to cytotoxic therapy. Since 2004, docetaxel (Taxotere)/prednisone has become the standard chemotherapy used to treat advanced hormone-resistant prostate cancer. However, the survival advantage is modest and a significant number of patients do not respond to chemotherapy. It is hoped that an increased understanding of the mechanisms underlying the progression of prostate cancer will lead to new treatment modalities. With the growing number of biologic and targeted agents under development, the potential armamentarium of prostate cancer treatments is steadily growing. However, none of the new treatment modalities has yet been shown to be more effective than standard treatments. This article will provide an overview of targeted or innovative therapies in the treatment of prostate cancer.
Latest:
Sorafenib Demonstrates Activity in AMLIn this video from the 2014 ASH Annual Meeting, Dr. Röllig discusses the results of the SORAML trial that tested sorafenib in patients with acute myeloid leukemia.
Latest:
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.
Latest:
The Role of Integrins in Colorectal CancerIntegrins have direct effects in stimulating proliferation and preventing apoptosis in cancer cells and mediating proangiogenic interactions between endothelial cells and extracellular matrix. Alterations of expression of various integrins and their receptors have been observed in various cancers in which angiogenesis is known to play a role, including colorectal cancer. Inhibition of specific integrins might thus inhibit both direct effects of integrins on cancer cells and tumor angiogenesis. Inhibitory peptides and anti-integrin monoclonal antibodies are currently being investigated in clinical trials in patients with solid tumors, with early evidence suggesting clinical benefit in disease stabilization with use of an anti-αvβ3 antibody in the settings of colorectal cancer, renal cell carcinoma, and melanoma. Integrin inhibition alone and with other targeted therapeutic approaches should be further investigated in clinical trials in patients with colorectal cancer.
Latest:
Pemetrexed in Advanced Colorectal CancerPemetrexed (Alimta) shows single-agent activity in advancedcolorectal cancer. In two phase II studies in which patients receivedpemetrexed at 600 mg/m2 or 500 mg/m2 as first-line treatment for metastaticdisease, objective response rates were 15.4% and 17.2%.
Latest:
UFT Plus Calcium Folinate Plus Radiotherapy for Recurrent Rectal CancerUracil and tegafur (in a molar ratio of 4:1 [UFT]) plus calcium folinate comprise the components of the oral agent, Orzel, which appears to have activity comparable to intravenously administered 5-fluorouracil. This article
Latest:
Adjuvant Therapy for Early Lung Cancer: Reflections and PerspectivesThe standard of care with regard to adjuvant chemotherapy of lung cancer has changed remarkably over the past 3 years. Until the initial report of the International Adjuvant Lung Trial in 2003, there was no real evidence from any individual randomized clinical trial (RCT) that adjuvant chemotherapy improves survival in resectable non-small-cell lung cancer. However, five RCTs that have now been reported indicate that adjuvant chemotherapy is effective, at least in certain subgroups of resectable patients. Moreover, numerous meta-analyses have also reported a positive effect from adjuvant treatment. Nonetheless, because of methodologic issues and conflicting results, the question of who should be treated and what constitutes optimal adjuvant therapy remains controversial. This article reviews the recent randomized trials that have contributed to a change in the state of the art, as well as some of the methodologic problems that may have confounded their proper interpretation. It also considers newer approaches to adjuvant therapy, with a particular focus on strategies that incorporate our growing knowledge of molecular medicine and predictive factors to the field of adjuvant chemotherapy of lung cancer.
