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Radiation Therapy for Cutaneous Melanoma: Clonogenic Assays to Clinical TrialsIt is incumbent on melanoma and radiation oncology researchers alike to further our understanding of when and how RT can help patients.
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Squamous Cell Carcinoma Recurring to the Great Auricular NerveA 74-year-old man presented with a 2.5-cm ulcerated mass occupying the middle third of his left outer ear, approximating the helical rim.
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Pharmacology of Anticancer Agents in the Elderly: The Pharmacist’s PerspectiveIn this issue of ONCOLOGY, Balducci[1] reviews principles for treating elderly patients with antineoplastic therapy. This paper begins by defining baseline terminology such as age and frailty, while providing an overview of applied techniques of discerning a patient’s functional impairment or disability.
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Current Surgical Management of Metastatic Spinal DiseaseThe article entitled “The Current Surgical Management of Metastatic Spinal Disease,” by Drs. Peter C. Gerszten and William C. Welch, is a timely, comprehensive review of the current state of the art in the diagnosis and surgical management of spinal
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Commentary (Lao/Brenner): The Role of Statins in Cancer Prevention and TreatmentIncreasing epidemiologic data haveemerged to support an associationbetween 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductaseinhibitor (statin) use and theprevention or delay in the developmentof invasive cancer. The inhibitionof HMG-CoA reductase resultsin the depletion of mevalonate, a precursorof cholesterol, but also of geranylgeranylpyrophosphate andfarnesyl pyrophosphate, both ofwhich are critical for the isoprenylationof important cellular signalingproteins. Alterations in function andexpression of these signaling proteins-particularly Ras and Rho-have been implicated in malignanttransformation and proliferation. Furthermore,the epidemiologic data arebeing surpassed by preclinical datasupporting the concept that inhibitionof critical signaling pathways bystatins can lead to increased cell deathand prevent the proliferation of malignantcells.
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Would Oncologists Want Chemotherapy If They Had Non-Small-Cell Lung Cancer?In 1985, a survey found that only about one-third of physicians and oncology nurses would have consented to chemotherapy for non-small-cell lung cancer. In response to statements made at a recent American Society of Oncology (ASCO) Board of Directors meeting questioning whether these data are still valid, Dr. Smith and colleagues conducted a new survey of oncologists attending a 1997 National Comprehensive Cancer Network (NCCN) annual meeting. The results of that survey are summarized and analyzed.
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Optimal Use of Antiemetics in the Outpatient SettingIn his article, Dr. Grunberg charts the history of our understanding of chemotherapy-induced nausea and vomiting, and the discovery and development of drugs for its prevention. He places appropriate emphasis on the serotonin (5-HT3) antagonists-notably, ondansetron, granisetron, and dolasetron-which have revolutionized the field over the past decade.
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Going Beyond Systemic Fluoropyrimidines With Radiation Therapy for Rectal Cancer: What Should Be the Priority?As we look forward, we suggest that the priority should be to further our understanding of the tumor’s interactions with its microenvironment and with the immune system. We think that such an understanding will be critical for advances in locally advanced rectal cancer therapy.
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Role of Radiation Therapy in Patients With Resectable Pancreatic CancerIn this article, we review the data surrounding the use of chemotherapy (CT) and chemoradiotherapy (CRT) in patients with resectable pancreatic cancer.
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Improving Long-Term Survival in Patients With Locally Advanced Pancreatic Cancer via the Delivery of Definitive Radiotherapy DosesFive randomized trials involving patients with locally advanced pancreatic cancer illustrate most clearly the substantial degree to which standard therapies are limited in their effectiveness.
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Focus on Transitional Disease: A Critical Interval to Delay Progression of Prostate CancerONCOLOGY® editorial board member E. David Crawford, MD, and colleagues, propose a new model for guiding the treatment of prostate cancer that focuses on a “transitional state,” which occurs during the interval of progression to metastatic castration-resistant prostate cancer.
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Outliers in Testicular Cancer ManagementAlthough 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.
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Addressing Psychological Challenges After Cancer: A Guide for Clinical PracticeThe person diagnosed with cancer typically is confronted with a variety of difficult challenges. Treatment for cancer can be physically arduous, it generally disrupts patients’ social and work life, and it may even limit their ability to care for themselves or live independently for some period of time. In addition to these physical and functional burdens, cancer patients often face fears of death or disability, and may be prone to feelings of isolation or depression.
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Therapeutic Options in Gastric Cancer: Neoadjuvant Chemotherapy vs Postoperative ChemoradiotherapyThe majority of patients who undergo resection for gastric cancer experience relapse and ultimately die of their disease. Therefore, considerable attention has been paid to neoadjuvant and adjuvant strategies to improve surgical outcomes. Two different approaches have been tested in major clinical trials conducted in the past several years: Postoperative chemoradiotherapy was assessed in a US Southwest Oncology Group/Intergroup study (SWOG 9008/INT 0116), and perioperative chemotherapy was studied in a UK Medical Research Council (MRC) randomized trial (the MRC Adjuvant Gastric Infusional Chemotherapy [MAGIC] trial). These trials demonstrated statistically significant survival benefits in patients with resectable gastric cancer. This review will consider these trials and their implications for clinical practice.
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How Can We Effectively Address the Medical and Psychological Concerns of Survivors of Pelvic Malignancies?Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management.
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Molecular Monitoring of Cell-Free Circulating Tumor DNA in Non-Hodgkin LymphomaIn this review, we discuss the potential applications of monitoring ctDNA in patients with diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma.
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Transplant Registries: Guiding Clinical Decisions and Improving OutcomesAbout 50,000 hematopoietic stem cell transplantations are performed yearly, primarily for malignancies. Use of this therapy increased dramatically over the past 30 years due to its proven and potential efficacy in diverse
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Adjuvant Chemotherapy for Early-Stage Breast Cancer: The tAnGo TrialThe tAnGo trial is a randomized, open-label, multicenter phase IIItrial examining adjuvant treatment with epirubicin (Ellence)/cyclophosphamide(Cytoxan, Neosar) for four cycles followed by paclitaxel aloneor combined with gemcitabine (Gemzar) for four cycles in patients withearly-stage breast cancer. In the Cancer and Leukemia Group B(CALGB) 9344 trial, addition of paclitaxel to anthracycline/cyclophosphamideadjuvant therapy resulted in increased time to recurrence andimproved survival. Because an unplanned subgroup analysis in CALGB9344 indicated a significant benefit of paclitaxel in patients with estrogenreceptor (ER)-negative disease but not ER-positive disease, the initialtAnGo trial design called for enrollment of patients with ER-negativedisease. The tAnGo trial entry criteria were recently amended toallow any ER status, given experience suggesting that clinical benefitof taxane-containing regimens in ER-positive disease may emerge overa time frame longer than that required to detect benefit in ER-negativedisease. Gemcitabine has been included as a partner for paclitaxel inthe tAnGo trial based on high response rates, including high completeresponse rates, observed in phase II trials of the combination in moreadvanced disease and based on the tolerability and safety of the combinationcompared with those of other taxane-containing two-drug combinations.The tAnGo trial is currently accruing patients and has atarget population of 3,000. Trial results should provide important informationon the role of gemcitabine in adjuvant therapy for breastcancer.
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Apoptotic Mechanisms of Gallium Nitrate: Basic and Clinical InvestigationsGallium nitrate inhibits the growth of various lymphoma cell linesin vitro and exhibits antitumor activity in patients with lymphoma.The mechanism(s) of cytotoxicity is (are) only partly understood butappears to involve a two-step process: (1) targeting of gallium to cells,and (2) acting on multiple, specific intracellular processes. Galliumshares certain chemical properties with iron; therefore, it binds avidlyto the iron transport protein transferrin. Transferrin-gallium complexespreferentially target cells that express transferrin receptors on theirsurface. Expression of transferrin receptors is particularly high onlymphoma cells. Cellular uptake of the gallium-transferrin complexleads to inhibition of cellular proliferation primarily via disruption ofiron transport and homeostasis and blockade of ribonucleotidereductase. Recent studies have shown that cellular uptake of galliumleads to activation of caspases and induction of apoptosis. In phase IItrials in patients with relapsed or refractory lymphoma, the antitumoractivity of gallium nitrate is similar to, or better than, that of othercommonly used chemotherapeutic agents. Gallium nitrate is notmyelosuppressive and may be used in patients with neutropenia orthrombocytopenia. A multicenter trial to evaluate the use of galliumnitrate in patients with relapsed non-Hodgkin's lymphoma is currentlyongoing.
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Supporting Decision-Making on Fertility Preservation Among Adolescent and Young Adult Women With CancerABSTRACT Adolescents and young adults (AYAs) with cancer constitute approximately 70,000 patients diagnosed each year. Survival rates for AYAs with cancer have increased steadily in recent decades due to improvements in therapeutic regimens and early detection. Given the large and growing number of AYA cancer survivors, additional research is needed on the immediate and long-term psychosocial support required for this population including family planning and fertility. Fertility and fertility preservation in female AYAs, in particular, is historically understudied and has psychologically relevant ramifications distinct from male AYAs. Decision science can contribute to this area of oncological care and has implications for clinical encounters and research concerning female AYA patients with cancer. Patient-centered care and shared decision-making that integrates recent research regarding fertility preservation in the context of cancer treatment can improve outcomes for AYA cancer survivors.
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Bacterial Infections in Patients With Solid TumorsEarly and appropriate management of infection in the patient with cancer is critical to optimizing patient outcomes.
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The State of Prostate MRI in 2013Our aims in this article are to describe the various imaging sequences that comprise the multiparametric MRI exam, as well as to review current literature on the strengths/weaknesses of these sequences; to delineate strategies for standardizing interpretation and reporting of MRI results; and to expound on the role of prostate MRI in clinical practice.
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Radiation-Induced Lung Injury: Assessment, Management, and PreventionRadiation therapy (RT) is an important treatment modality for multiple thoracic malignancies. Incidental irradiation of the lungs, which are particularly susceptible to injury, is unavoidable and often dose-limiting. The most radiosensitive subunit of the lung is the alveolar/capillary complex, and RT-induced lung injury is often described as diffuse alveolar damage. Reactive oxygen species generated by RT are directly toxic to parenchymal cells and initiate a cascade of molecular events that alter the cytokine milieu of the microenvironment, creating a self-sustaining cycle of inflammation and chronic oxidative stress. Replacement of normal lung parenchyma by fibrosis is the culminating event. Depending on the dose and volume of lung irradiated, acute radiation pneumonitis may develop, characterized by dry cough and dyspnea. Fibrosis of the lung, which can also cause dyspnea, is the late complication. Imaging studies and pulmonary function tests can be used to quantify the extent of lung injury. While strict dose-volume constraints to minimize the risk of injury are difficult to impose, substantial data support some general guidelines. New modalities such as intensity-modulated radiation therapy and stereotactic body radiation therapy provide new treatment options but also pose new challenges in safely delivering thoracic RT.
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Use of Neoadjuvant Chemotherapy in Elderly Patients With Muscle-Invasive Bladder Cancer: A Population-Based Study, 2006-2017Patients 70 years or older that received neoadjuvant chemotherapy and radical cystectomy had better overall survival than those undergoing radical cystectomy alone.
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Challenges to the FDA Review Process: Cost Considerations and Long-Term Benefit BenchmarksIn this interview, Christopher-Paul Milne and Kenneth Kaitin, Tufts Center for the Study of Drug Development. discuss the current challenges of the US Food and Drug Administration review process as it relates to oncology therapeutics and upcoming changes to the Prescription Drug User Fee Act.
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Pathogenesis of AIDS-Related Kaposi's SarcomaThe occurrence of Kaposi's sarcoma (KS) in patients with HIV infection is more than 7,000 times higher than in the non-HIV infected population. The reason for this association is unclear but may involve decreased immune surveillance as a result of the profound cellular immune deficiency caused by HIV, a sexually transmitted KS-inducing virus, whose KS-transforming capabilities may be enhanced by HIV, or a direct or indirect effect of HIV itself in susceptible individuals.
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Gemcitabine and Platinum-Based Chemotherapy in Metastatic Breast CancerAlthough anthracyclines and the taxanes comprise the most activefirst-line cytotoxic treatments in patients with hormone-insensitive orlife-threatening metastatic breast cancer, many patients progress andrequire other chemotherapeutic agents. Development of new combinationsand/or agents is thus needed. Gemcitabine (Gemzar) and platinumcompounds have been employed as single agents, and the additionof gemcitabine to the platinums results in significant clinical benefitand response rates. Correlative biologic studies are expected fromseveral already-reported trials and may help elucidate predictive factorsfor both response and toxicity when combining gemcitabine andthe platinums. Trials incorporating these doublets in earlier stages ofbreast cancer or in the neoadjuvant setting may further elucidate theirrole in breast cancer treatment.
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ACR Appropriateness Criteria® Recurrent Hodgkin LymphomaBy combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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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.
