ONCOLOGY Vol 15 No 4

According to data presented at the American Society of Hematology (ASH) meeting and the San Antonio Breast Cancer Symposium, elderly cancer patients may be up to two times as likely as younger patients to receive chemotherapy doses

Declines in cervical cancer incidence and mortality reported in the United States since the 1950s have been attributed to early detection and treatment of precancerous and cancerous lesions through the use of the Pap test. More than 50 million

SkyePharma PLC and Chiron Corporation have received clearance from the US Food and Drug Administration (FDA) to return cytarabine liposome injection (DepoCyt) to the market. Liposomal cytarabine is the only FDA-approved treatment for

Matrix Pharmaceutical, Inc, announced that the US Food and Drug Administration (FDA) has accepted the filing of a New Drug Application (NDA) for cisplatin/epinephrine (IntraDose) injectable gel for the treatment of refractory or recurrent head

In a recently completed phase II study of the monoclonal antibody OvaRex, nearly half of the OvaRex-treated patients with advanced ovarian cancer survived 50 weeks or longer. The results of the trial were presented at the 32nd Annual Meeting of

Over the past 15 years, research into the health-related quality of life (HRQOL) of cancer patients has expanded dramatically. We have seen the development of a variety of instruments to assess both global HRQOL as well as cancer-specific symptoms. These instruments have been validated in a variety of populations. Many of the instruments have been translated into multiple languages. We have also seen the development of instruments to evaluate HRQOL in children and in adults with low literacy levels. We have learned how to integrate HRQOL questions into cancer clinical trials and how to facilitate the collection of QOL data from patients and their families. We are now beginning to evaluate interventions to maintain and enhance HRQOL among cancer patients and cancer survivors.

Congress is turning back again to managed-care reform, with Democrats and Republicans trying anew to forge a bipartisan consensus on issues such as: what options exist for a cancer patient whose health insurance company refuses to cover a quasi-

Not only has the Health Care Financing Administration (HCFA) backed off on threats to reduce Medicare and Medicaid payments to oncologists for in-office chemotherapy infusion drugs, but now HCFA is making it clear that oncologists can

Medical researchers at the 23rd annual San Antonio Breast Cancer Symposium reported the results of a study showing that automated cell imaging adapted from Star Wars missile-

At the Chemotherapy Foundation Symposium XVIII in New York City, researchers from the Arkansas Cancer Research Center, Cedars-Sinai Medical Center, M. D. Anderson, and the National Cancer Institute presented updated clinical trial data

In response to the increasing use of sentinel lymphadenectomy, a panel convened by the American Society of Breast Surgeons has issued a revised consensus statement on performance and utilization criteria for sentinel lymphadenectomy.

Amgen has announced that a prefilled syringe containing a more concentrated formulation of the white blood-cell booster, granulocyte colony stimulating factor (G-CSF, Neupogen) is now available to hospitals and health-care providers. Neupogen

A new bill called the Men’s Health Act of 2001 aims to focus more attention on diagnosing and treating men with prostate cancer. Rep. Randy Cunningham’s (R-Calif) Men’s Health

In their article, Drs. Wagman and Minsky provide an excellent overview of the current status of local treatment strategies for early rectal cancer. They have rightly pointed out that while minimal surgery is an attractive option, it must be balanced against the highly curable outcomes of radical surgical resection. Expanded experience with stapling devices has extended the level at which safe and satisfactory anastomoses can be accomplished in the distal rectum. The promise of enhanced preservation of rectal, urinary, and sexual functions makes local treatment strategies an attractive option. The most important aspect of disease management using this approach remains the process of patient selection.

The article by Dr. William Small on the role of radiation therapy in the treatment of breast cancer is a comprehensive review of the current standards of care and highlights the controversies surrounding recent trends. Breast cancer treatment has come full circle in the last 20 years, with emphasis now being placed on technical advances and treatment techniques as new data substantiate the impact of radiation therapy on survival following local surgery and mastectomy.

Dr. Small is to be commended for a well-written succinct review of the role of radiation therapy in the treatment of breast cancer. As he notes, there is still controversy in the management of these patients. However, as more evidence-based data are accumulated, the role of radiation therapy is being clarified.

In their article in this issue, Drs. Jatoi and Loprinzi review much of the data on weight loss and anorexia in cancer patients from the standpoint of the impact of nutrition and various pharmacologic agents on management, and they make some sound recommendations for therapy. The benefit of nutritional interventions in this area are often overhwhelmed by the patient’s complex disease course and, therefore, are difficult to demonstrate.

Drs. Jatoi and Loprinzi provide a comprehensive but succinct overview of the management of cancer-associated anorexia and weight loss. These clinician researchers, who have added much to our understanding of this problem, present a balanced and reasonable approach to the management of these common paraneoplastic syndromes.

The National Cancer Institute’s Dr. Robert Biggar has probably studied the impact of the acquired immunodeficiency syndrome (AIDS) epidemic on cancer trends at least as thoroughly as anyone in the field. His long-term experience is reflected in this comprehensive and well-written overview, which summarizes the evidence concerning highly active antiretroviral therapy (HAART). Indeed, patients are developing fewer opportunistic infections and living significantly longer than they did before the advent of these potent anti-human immunodeficiency virus (HIV) drugs. However, the question remains as to what extent this treatment might also change the incidence of cancers?

The article by Drs. Khayat and Gil-Delgado outlines the exciting new developments in the treatment of advanced colorectal cancer with irinotecan (CPT-11 [Camptosar]) and oxaliplatin. Although the development of these drugs provides an alternative to fluorouracil (5-FU) in the treatment of this common tumor, it is still unclear how to optimally integrate these promising compounds into therapy for colorectal cancer.

Since its development in 1957, fluorouracil (5-FU) has been the central component in the treatment of colorectal cancer. Over the past several decades, innumerable permutations of fluorouracil biomodulation have been studied. Indeed, rarely has a drug been so well understood in terms of its mechanisms and metabolism, and rarely has such an understanding been so extensively exploited in clinical strategies. But despite these efforts, overall progress in the management of advanced colorectal cancer has been modest.

The standard surgical treatment of distal, resectable, invasive rectal cancers is an abdominoperineal resection or a low anterior resection. Given the morbidity associated with these standard treatments and the frequent need

Highly active antiretroviral therapy (HAART) has shown great efficacy in reducing human immunodeficiency virus levels, increasing immunity, and prolonging the survival of persons with acquired immunodeficiency

Radiation therapy in combination with lumpectomy and axillary dissection has remained standard therapy for early-stage disease since the 1970s. Although there has been no definitive trial in patients with ductal carcinoma

The role of radiation therapy in the management of breast cancer has continued to evolve over the past several years, in both the breast-conserving and postmastectomy settings. In this issue of ONCOLOGY, Dr. William Small provides a thorough yet concise review of current practices in radiation therapy for ductal carcinoma in situ (DCIS), early-stage invasive breast cancer managed conservatively, and postmastectomy situations. These discussions are supported by a well-selected group of publications on each topic. In addition, the author summarizes the available data and some of the controversies surrounding the use of nodal irradiation, especially in this era of sentinel node biopsy. We would like to mention a few points that warrant further discussion.

Colorectal carcinoma is one of the most common malignancies in the western world, and although fluorouracil (5-FU) has been used in its treatment for almost 40 years, new agents with significant activity have been introduced recently. Irinotecan (CPT-11, Camptosar), a topoisomerase I inhibitor, administered at 300 to 350 mg/m2 every 3 weeks is significantly more active than continuous-infusion 5-FU in patients who have experienced disease progression after conventional therapy with 5-FU. In comparison to best supportive care, irinotecan improves survival and preserves quality of life despite treatment-related toxicity. Moreover, the combination of irinotecan and 5-FU has been explored in a number of different schedules. In previously untreated patients, overall response rates are high. Irinotecan can also be combined with mitomycin (mitomycin-C [Mutamycin]), oxaliplatin, or raltitrexed (Tomudex). Oxaliplatin is a new-generation platinum compound that has demonstrated activity against colorectal carcinoma in preclinical trials. It has been evaluated as a single agent against advanced colorectal carcinoma in the salvage setting and also in combination with 5-FU as initial therapy for metastatic disease (where it shows significant activity). The toxicity profile of oxaliplatin (chiefly characterized by neurotoxicity) differs from that of irinotecan (primarily producing diarrhea) and the potential, therefore, exists for combining these agents or for exploiting their possible synergy with 5-FU. The introduction of these two new active agents of different pharmacologic classes promises to enable significant improvements in the treatment of patients with colorectal carcinoma. [ONCOLOGY 15(4):415-434, 2001]

Loss of appetite and weight predict a poor prognosis for cancer patients. Although caloric supplementation might benefit subgroups of patients-specifically, perioperative, severely malnourished cancer patients, stem cell and

The article by Drs. Wagman and Minsky is an excellent overview of the history, indications, treatment considerations, and comparative results of local excision alone and local excision plus chemoradiotherapy for selected distal rectal cancers. Although the literature and experience with local excision have increased, use of the technique has probably diminished over the past decade, primarily due to the groundswell of publications that lionize total mesorectal excision with low colorectal or coloanal anastomosis for most rectal cancers, as well as our inability to stage and predict nodal involvement, even in T1 cancers.

The field of hematopoietic stem cell transplantation is evolving rapidly. Observations made in the laboratory can now be swiftly translated into clinical trials. The role of hematopoietic stem cell transplantation in older patients, the appropriate use of