ONCOLOGY Vol 14 No 1

Preliminary clinical data presented at a poster session of the 1999 annual meeting of the American Society of Clinical Oncology (ASCO) revealed that a significant number of patients with advanced colorectal cancer respond to first-line treatment with raltitrexed (Tomudex) in combination with oxaliplatin. The response rate of 59% suggests that this regimen may be one of the more active combinations under current investigation for the disease.

Researchers announced recently that they have developed a new system to deliver the p53 tumor suppressor gene directly into the tumor through the bloodstream. The system, when used in combination with radiotherapy and chemotherapy, may significantly improve treatment outcomes for prostate cancer patients. The findings were presented at the International Conference on Molecular Cancer Therapeutics sponsored by the American Association of Cancer Research (AACR), National Cancer Institute (NCI), and European Organization for Research and Treatment of Cancer (EORTC).

Genetronics Biomedical Ltd announced interim dataand results of phase II clinical trials evaluating the company’s electroporation therapy (EPT) system, which combines an intratumoral injection of a chemotherapeutic agent with a pulsed electric field, in squamous cell carcinoma of the head and neck. Data from the trials, which were conducted in the United States and Canada, were presented at the 35th annual meeting of the American Society of Clinical Oncology (ASCO). Genetronics also announced preliminary data and results from a similar study conducted in Europe.

Patients with chronic myelogenous leukemia (CML) are finding new hope in an experimental oral agent developed by Oregon Health Sciences University researcher Brian Druker, MD, in collaboration with scientists at Novartis Pharmaceuticals. Early clinical trials are producing dramatic results with minimal side effects.

Oncologists will see about a 5.5% increase in pay for CPT codes that they bill Medicare for in the year 2000. Actually, all physicians will get that same “update.” But other specialties will have that increase either boosted or shaved based on changes in the Medicare fee formula for 2000. Medicare is transferring malpractice relative value units (RVUs) from a historical charge to an actual cost basis, and is continuing to do the same to practice expense RVUs, although the latter change will not occur until 2002. Those changes will have no impact on either hematologist/oncologists or radiation oncologists, but some surgical specialties and anesthesiologists will lose upwards of 10%.

Seeking effective drugs for advanced non–small-cell lung cancer (NSCLC), researchers are trying ever more creative combinations, and at the 35th annual meeting of the American Society of Clinical Oncology (ASCO), some investigators suggested that platinums may be “on the way out” as pivotal components of regimens for the disease.

Despite recent decreases in sexual risk behaviors among high school students nationwide, human immunodeficiency virus (HIV) infection was the seventh leading cause of death for persons ages 15 to 24 years in the United States during 1997. To determine whether the prevalence of HIV-related sexual risk behaviors among high school students also has decreased in certain urban areas heavily affected by the epidemic, the Centers for Disease Control (CDC) analyzed data from the Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997 in eight large-city school districts: Boston, Massachusetts; Chicago, Illinois; Dallas, Texas; Fort Lauderdale, Florida; Jersey City, New Jersey; Miami, Florida; Philadelphia, Pennsylvania; and San Diego, California. This report summarizes the results of this analysis, which indicate that, from 1991 to 1997, the percentage of high school students engaging in HIV-related sexual risk behaviors decreased in some US cities.

Each year, cigarette smoking causes an estimated 430,000 deaths in the United States. In addition, the health risks for smoking cigars, which include mouth, throat, and lung cancers, are well documented. This report summarizes the findings from the 1998 Behavioral Risk Factor Surveillance System (BRFSS) on the prevalence of current cigarette and cigar smoking in the 50 states and the District of Columbia. The findings indicate that state-specific cigarette smoking prevalence among adults ³ 18 years old varied twofold and having ever smoked a cigar (ie, ever cigar smoking) varied nearly fourfold.

Patients with one of the most common and curable forms of breast cancer may be undergoing radiation therapy unnecessarily, according to a University of Southern California (USC) study published in the May 13, 1999, issue of The New England Journal of Medicine. The study, headed by Melvin J. Silverstein, MD, medical director of the Harold E. and Henrietta C. Lee Breast Center at the USC/Norris Comprehensive Cancer Center, examined ductal carcinoma in situ (DCIS).

This clinically oriented text focuses on the diagnosis and management of endometrial adenocarcinoma and endometrial hyperplasia. Due to its clinical orientation, the book does not include information on the molecular basis of endometrial cancer.

The interim results of an ongoing phase II trial of IntraDose (cisplatin [Platinol]/epinephrine) were presented at the 17th Annual Chemotherapy Foundation Symposium in New York City. Of 29 evaluable patients with liver cancer, 12 (41%) responded to treatment. Of the 12 responders, 6 achieved a complete response (100% reduction in viable tumor volume), while the other 6 showed a more than 50% reduction in viable tumor. To date, 10 of the 12 responders remain in remission, while the 2 other patients maintained remissions for 200+ days. Median survival time from the date of diagnosis for all patients has not yet been reached and is currently in excess of 15 months.

The Institute of Medicine (IOM) committee that released a report on medical errors in December recommended that physicians demonstrate “competence and knowledge of safety practices” through periodic reexamination and relicensing. The report, entitled “To Err is Human: Building a Safer Health System,” was written by a committee chaired by William Richardson, chief executive officer of the W. K. Kellogg Foundation. Most members of the 19-person committee were doctors.

Renal cell carcinomas include a group of epithelial neoplasms, such as clear-cell and papillary carcinomas, that continue to pose significant management challenges in patients

Surgical resection remains the cornerstone of management for localized renal cell carcinoma. No effective postsurgical adjuvant therapy has been established for

Testing further for a form of prostate-specific antigen (PSA) can help urologists find, stage, and classify prostate cancer in men whose PSA tests are ambiguous, according to a multicenter study that included The Johns Hopkins Hospital. The additional test, which is routinely available for all men taking the PSA test, can also help patients and their doctors determine the best course of treatment. The test measures free PSA, the form of PSA not bound to proteins in the blood. According to the study, the higher the percentage of free PSA compared to the bound form, the smaller the tumor is likely to be, the less chance there is that it has spread from the prostate, and the less likely it is that the disease is the most aggressive form.

Drs. Wolchok and Motzer provide a succinct, timely review of the diagnosis and management of renal carcinoma. The article leads us to ask a number of questions: What factors account for the major increase in the incidence of renal carcinoma? How has surgical management evolved with the advent of newer operative techniques? What role, if any, does chemotherapy play in the treatment of this disease? What is the current status of and future outlook for immunotherapeutic approaches?