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Final Results of a Randomized Controlled Study of the Ibritumomab Tiuxetan Radioimmunotherapy Regimen vs a Standard Course of Rituximab Immunotherapy for B-Cell Non-Hodgkin’s LymphomaIbritumomab tiuxetan (Zevalin) is a murine anti-CD20 monoclonal antibody covalently bound to the chelator tiuxetan, which can securely chelate yttrium-90. We performed a randomized controlled trial
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In Vivo Purging With Rituximab Prior to Stem Cell Collection Is Associated With Persistent Molecular Evidence of t(14;18) That Often Disappears Post-Transplant in Patients With Follicular LymphomaWe previously reported that “in vivo purging” with rituximab (Rituxan) during stem-cell collection is safe and does not adversely affect engraftment. We now report on our transplant experience with rituximab. From June 1998 to December
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Applications of Genomic Sequencing in Pediatric CNS TumorsThis review will discuss examples of clinical applications of tumor and germline genomic testing for children with central nervous system (CNS) tumors, as well as promising investigative strategies.
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UFT/Leucovorin Combined With Paclitaxel for Anthracycline-Pretreated Advanced Breast CancerTaxanes are the most active drugs in the treatment of metastatic breast and ovarian cancer. Weekly therapy with paclitaxel produces notable activity, with remarkably low toxicity.
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Diagnostic Dilemma: DermatologyA 49-year-old Caucasian man presented with progressing erythematous plaques on the face and neck in December 2007. He was treated with topical steroids, presumably for dermatitis, without improvement.
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Integrating Genetics and Genomics Into Oncology NursingGenetic and genomic research is creating new and more individualized approaches to better manage a person's disease or predisposition to disease, including cancer.
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Tumor Ablation: Treatment and Palliation Using Image-Guided TherapyImagine destroying a tumor in 6minutes with a small needle electrodeplaced through the skin intoa tumor deep in the human body-thepatient is cured after spending only afew hours in the hospital and leaveswith just a small bandage. This maysound like science fiction, but it isreality in many medical centers aroundthe world.
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Diagnostic and Management Issues in Gallbladder CarcinomaThis paper by Abi-Rached and Neugut provides an overview of the diagnosis and treatment of gallbladder carcinoma, a rare, yet frustratingly difficult disease to manage [1]. Overall, we agree with the risk factors described in this review. We would add that, in addition to chronic cholecystitis, porcelain gallbladder, and retained gallbladder (secondary to cholecystostomy), cholecysto-enteric fistulas have also been associated with a higher incidence of gallbladder carcinoma [2,3] Patients with ulcerative colitis are known to be at higher risk for cholangiocarcinoma, and there is also some evidence that these patients have an increased risk of gallbladder cancer.
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Commentary (Laheru/Jaffee): Novel Vaccines for the Treatment of Gastrointestinal CancersThe identification of key signaltransduction pathways and, inparticular, specific proteins thatare involved in the regulation of cancercell growth has provided unprecedentedopportunities for researchersinterested in targeted cancer treatment.The identification of molecular target-specific therapy offers the potentialof maximal therapeutic benefitwhile minimizing toxicity to normalcells. The accomplishment that led tothe sequencing and analysis of theentire human genome in 2001 has providedresearchers with the basic criticaltools to begin to identify anddifferentiate cancer from normal tissueat the genetic level.[1,2] Whilethe implications of this landmarkachievement are still being realized,it has become evident that the identificationof critical genes and proteinsinvolved in cell division and growthare just the beginning. The complexrelationships between multiple signaltransduction pathways, the surroundingtumor microenvironment, andpathways involved in immune-systemregulation have gained new appreciation.The ability to manipulate thesemultiple interactive systems with targetedtherapies represents a new treatmentparadigm in oncology.
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Targeted Therapy in Rectal CancerEpidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are often overexpressed in colorectal cancer and are associated with inferior outcomes. Based on successful randomized phase III trials, anti-EGFR and anti-VEGF therapeutics have entered clinical practice. Cetuximab (Erbitux), an EGFR-specific antibody, is currently approved in the United States in combination with irinotecan (Camptosar) for patients with metastatic colorectal cancer refractory to irinotecan or as a single agent for patients unable to tolerate irinotecan-based therapy. In retrospective analyses, patients with EGFR-expressing rectal cancer undergoing neoadjuvant radiation therapy had a significantly inferior disease-free survival and lower rates of achieving pathologic complete response. Based on the positive data in metastatic colorectal cancer and synergy with radiation therapy seen in preclinical models, there is a strong rationale to combine cetuximab with neoadjuvant radiation therapy and chemotherapy in rectal cancer. Bevacizumab (Avastin), a VEGF-specific antibody, was the first antiangiogenic agent to be approved in the United States for use in combination with standard chemotherapy in the first- and second-line of treatment in metastatic colorectal cancer. VEGF-targeted therapy may lead to indirect killing of cancer cells by damaging tumor blood vessels, and may increase the radiosensitivity of tumor-associated endothelial cells. VEGF blockade can also "normalize" tumor vasculature, thereby leading to greater tumor oxygenation and drug penetration. This review will address completed and ongoing trials that have established and continue to clarify the effects of these agents in rectal cancer.
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Commentary (Longo)-Follicular Lymphoma: Expanding Therapeutic OptionsDr. Ganti and colleagues from the University of Nebraska provide a thorough review of the management of patients with follicular lymphoma, including many recent additions to the therapeutic armamentarium. The field is rapidly changing, and this article will be an enduring resource both for clinicians currently managing these patients and for anyone in the future who wants to understand what the state of the art was in 2004. Follicular lymphoma accounts for about one-third of non- Hodgkin’s lymphomas in the United States, making it likely that an individual oncologist will see one to three patients with follicular lymphoma each year. As the authors point out, numerous active agents have been developed for use in patients with follicular lymphoma over the past 5 years and additional promising new therapeutic agents and novel approaches (eg, vaccination) are in the development pipeline.
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Impact of Uracil/Tegafur Plus Oral Calcium Folinate on Resource UtilizationData from a multinational phase III trial were analyzed to evaluate the use of in- and outpatient services for 373 patients with metastatic colorectal cancer being administered uracil/tegafur (in a molar ratio of 4:1 [UFT]) plus
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Clinical Decision Making in Surveillance of Non–Muscle-Invasive Bladder Cancer: The Evolving Roles of Urinary Cytology and Molecular MarkersIn this article, we discuss the requirements for development and validation of urine markers and the factors that hamper their clinical implementation. We also review current surveillance guidelines for NMIBC and provide an overview of approved urine markers for the detection and surveillance of NMIBC.
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Treatment of Early-Stage Pancreatic CancerEarly trials of adjuvant therapy in pancreatic cancer had multiple limitations including small sample size, population heterogeneity, and inability to distinguish between components of combined modality treatment.
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Obesity and Metabolic Disease After Childhood CancerIn this review, childhood cancer survivor populations at risk for metabolic late effects, as well as mechanisms and ongoing intervention studies, will be detailed.
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Commentary (Goldman): Evaluating the Total Costs of CancerLongitudinal cohort studies ofspecific populations providesome of the most compellingevidence for research spanning epidemiology,medicine, and social science.The Framingham Heart Study(FHS) is a good example. Initiated in1948, the FHS tracks a cohort of whitemen and women who reside in thetown of Framingham, Massachusetts.The study population receives biennialmedical exams and personal interviews,and an additional study hasfollowed their offspring. The FHShas contributed much of our knowledgeabout cardiovascular disease incidenceand prevalence, and its riskfactors.
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Expanding Androgen- and Androgen Receptor Signaling–Directed Therapies for Castration-Resistant Prostate CancerThis article reviews the most recent advances in androgen receptor-directed therapies for castration-resistant prostate cancer, and new agents under development.
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How We Treat Tumor Lysis SyndromeWhen tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms.
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Soft-Tissue and Bone SarcomasSarcomas are a heterogenous group of tumors originating from mesenchymal tissues. According to American Cancer Society estimates, approxiately 8,070 new cases will be diagnosed in 1995, including 6,000 cases of soft-tissue sarcomas and 2,070 cases of bone tumors [1].
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US Could Save Nearly $1 Billion With Pembrolizumab Dosing ChangeThis video examines how a change to weight-based pembrolizumab dosing in first-line PD-L1–positive lung cancer could save nearly $1 billion in US healthcare costs.
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Salvage External Beam Radiotherapy for Prostate Cancer After Radical ProstatectomyThis article defines the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and makes recommendations with regard to radiotherapy volume and dose.
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Phase I/II Study of Weekly Irinotecan and Paclitaxel in Patients With SCLCThis phase I/II nonrandomized, open-label study was designed to assess the safety and benefit of sequencing irinotecan (Camptosar, CPT-11) plus paclitaxel (Taxol) immediately after cisplatin (Platinol)/etoposide (VePesid,
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Extended Pelvic Lymph Node Dissection for Prostate Cancer: Do More Nodes Mean Better Survival?At the present time, without clear data to suggest improved survival for patients undergoing extended pelvic lymph node dissection, the procedure cannot be universally recommended.
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Commentary (Carr/Goudas): An Alternative Algorithm for Dosing Transdermal Fentanyl for Cancer-Related PainTo assist in converting patients from one opioid agent to another in their daily practice, many oncologists carry pocket dosage conversion guides based on package inserts approved by the US Food and Drug Administration (FDA). One such guide issued by the manufacturer of transdermal fentanyl (Duragesic), reproduced in Table 3 of the expert consensus article written by Breitbart et al, presents the equivalent of 25 µg/h of transdermal fentanyl as 45 to 134 mg/d of oral morphine. In another guide, distributed by one of the manufacturers of controlled-release morphine, the 25 µg/h strength of transdermal fentanyl is said to be equianalgesic to 15 mg of controlled-release morphine administered every 12 hours (and both are deemed equivalent to 10 mg of controlled-release oxycodone every 12 hours). Faced with such a wide range of conversion factors, it is of little surprise-as Breitbart et al point out-that clinicians often fail to achieve equianalgesia when converting patients from one opioid to another.
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Small-Cell Lung Cancer: Treatment Progress and ProspectsAlthough small-cell lung cancer (SCLC) represents only 20% of all lung cancer cases in the United States, it is the most lethal subtype. Combination chemotherapy unequivocally offers the best chance for improved survival in
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Pentostatin Treatment of Cutaneous T-Cell LymphomaMycosis fungoides is an indolent primary cutaneous T-cell lymphoma (CTCL) that usually progresses from localized skin lesions to systemic disease. Sézary syndrome is a distinct variant characterized by generalized
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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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Melanoma Surgical Practice GuidelinesThe Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
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Multiparametric MRI: Standardizations NeededMultiparametric MRI is a promising tool for identifying cancer within the prostate. It has the potential to drastically change the way prostate cancer is staged and treated. However, work remains to make this technique reproducible and accessible to the community-based radiologist and urologist.
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Surgical Approach to Organ Preservation in the Treatment of Cancer of the LarynxThe management of cancer of the larynx has arguably become the most complicated task in the field of head and neck oncology. Both physicians and patients struggle to decide how initial treatment should be delivered. Treatment decisions
