ONCOLOGY Vol 20 No 7

According to a new study, women who gain weight in adulthood face a higher lifetime risk of all types of breast cancer even if they do not take hormone replacement therapy after menopause. To be published in the July 1, 2006, issue of CANCER, the study reveals that the greater the weight gain as an adult, the greater the risk for all histologic types, tumor stages, and grades of breast cancer, particularly advanced malignancies.

Celgene Corporation announced that the US Food and Drug Administration (FDA) has granted accelerated approval to its Supplemental New Drug Application (sNDA) for thalidomide (Thalomid) in combination with dexamethasone for the treatment of newly diagnosed multiple myeloma.

The Lung Cancer Alliance applauded a recent court decision on the rights of terminally ill cancer patients to take experimental drugs. In 2003, The Abigail Alliance and the Washington Legal Foundation filed suit against the Food and Drug Administration (FDA) in order to give terminally ill cancer patients access to drugs that have passed initial safety tests but not the full regalia of clinical trials normally required for approval.

A combination of radiation and suicide-gene therapy is eliminating the spread of prostate cancer; and providing a long-term vaccine against the disease, according to a study presented at the American Society of Clinical Oncology's annual prostate cancer meeting in San Francisco recently.

Valleylab recently announced that the US Food and Drug Administration (FDA) approved marketing of the Cool-tip radiofrequency (RF) ablation system. The Cool-tip RF ablation system is the first and only device cleared for marketing to physicians for use in ablating nonresectable liver tumors. This minimally invasive alternative for patients with hepatic cancer, who are not ideal surgical candidates or are otherwise unable to be successfully treated with other methods, solidifies the company's commitment to the oncology market.

In medicine today, we all promise to offer the best medical care available to each of our patients, and I would argue that most of us believe we are delivering on this promise. But how do we know that we are living up to that promise? Outside of board exams and CME requirements, there is virtually no internal scoring of our performance. The legal community has been happy to judge us, and they created a legal term—standard of care—against which we are all to be compared. The original intent of this term was to define a minimum level of care, a lowest common denominator. If we at least offered the standard of care, we were delivering acceptable care. We would not be committing malpractice. This is nothing to brag about, but at least we were not dangerous.

Nancy E. Davidson, MD, a medical oncologist who has specialized in breast cancer for more than 20 years, has been elected to become president of the American Society of Clinical Oncology (ASCO) for a 1-year term beginning in June 2007. She took office as president-elect this month, during ASCO's 42nd annual meeting in Atlanta.

MGI Pharma, Inc, and SuperGen, Inc, recently announced that the US Food and Drug Administration (FDA) has approved the hypomethylating agent decitabine (Dacogen) for injection. Decitabine is indicated for treatment of patients with myelodysplastic syndromes (MDS) including previously treated and untreated, de novo, and secondary MDS of all French-American-British (FAB) subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia), and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System (IPSS) groups.

Data published recently in the Journal of the American Medical Association showed that in the estrogen-alone substudy of the Women's Health Initiative (WHI), conjugated estrogens at a dose of 0.625 mg did not increase breast cancer incidence in postmenopausal women.

Smoking history contributes to poor outcomes in the treatment of lung cancer, according to a new study. Non-small-cell lung cancer (NSCLC) patients who have never smoked before have better overall survival rates and respond better to chemotherapy than current or former smokers.

The Journal of Clinical Oncology has published results of a large-scale trial conducted with the National Surgical Adjuvant Breast and Bowel Project (NSABP) confirming that the Oncotype DX 21-gene panel, which quantifies the risk of breast cancer recurrence, also predicts the likelihood of response to chemotherapy in a large portion of women with early-stage breast cancer. This study successfully challenges the common assumption that

Cytogen Corporation recently announced the presentation of clinical data demonstrating that a high level of prostate-specific membrane antigen (PSMA) in prostate tissue is a strong predictor of prostate cancer recurrence. The data were presented at the 101st American Urological Association (AUA) Annual Meeting held May 20-25 in Atlanta.

The 20th anniversary feature article on "Twenty Years of Systemic Therapy for Breast Cancer" and its reviews in the January 2006 issue of ONCOLOGY are incomplete from a global perspective. I must gently protest the suggestion that the "end of breast cancer as a serious cause of human mortality is now in sight."

Valeant Pharmaceuticals International announced that the US Food and Drug Administration (FDA) has given marketing approval for nabilone (Cesamet, CII) oral capsules. Nabilone is used to treat nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.

US Food and Drug Administration (FDA) has approved Pfizer's antismoking pill, varenicline (Chantix). The first new prescription medication approved for smoking cessation in nearly a decade, varenicline received priority review designation by the FDA because of its potential to be a significant therapeutic advance over existing therapies.

OXiGENE, Inc, recently announced that the Office of Orphan Products Development of the US Food and Drug Administration (FDA) has granted orphan drug designation to the company's lead vascular-disrupting agent, combretastatin A4 phosphate (CA4P), for the treatment of ovarian cancer.

Patients receiving chemotherapy for cancer often develop anemia, which can contribute to increased morbidity and reduced quality of life.[1] It is important for clinicians to be aware of current clinical studies in the treatment of chemotherapy-induced anemia. In patients with nonmyeloid malignancies, chemotherapy-induced anemia can be successfully treated using erythropoiesis-stimulating agents (ESAs). The application of these agents has evolved from more frequent to less frequent administration and from weight-based to single, fixed doses. Emerging data show that ESAs can be given safely on the same day as chemotherapy without loss of efficacy,[2] and that these agents may be administered as infrequently as every 3 weeks.[3,4] The every-3-week schedule is convenient and may reduce the burden on patients and their caregivers by reducing the number of visits to the clinic.

As a 20-plus-year cancer survivor, I have been heartened to see the number of cancer survivors increase (currently estimated at well over 10 million Americans), and new attention paid to the unique, wide-ranging, and long-term issues that follow the diagnosis and treatment of cancer. This volume reflects that trend. It reports the work of an Institute of Medicine (IOM) and National Research Council (NRC) of the National Academies "Committee on Cancer Survivorship: Improving Care and Quality of Life."

The 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.

An increasing body of evidence suggests that geriatric patients can benefit from and tolerate standard chemotherapy similarly to younger patients in the settings of both early- and advanced-stage colorectal cancer. Assessment of this unique population requires more comprehensive evaluation in addition to routine history, physical examination, and laboratory tests. Specific considerations of their physiologic functional changes will help physicians better manage these patients. Ongoing studies are now designed to better understand the decision-making process, safety profile, and efficacy of various treatment regimens in geriatric patients.

An increasing body of evidence suggests that geriatric patients can benefit from and tolerate standard chemotherapy similarly to younger patients in the settings of both early- and advanced-stage colorectal cancer. Assessment of this unique population requires more comprehensive evaluation in addition to routine history, physical examination, and laboratory tests. Specific considerations of their physiologic functional changes will help physicians better manage these patients. Ongoing studies are now designed to better understand the decision-making process, safety profile, and efficacy of various treatment regimens in geriatric patients.

An increasing body of evidence suggests that geriatric patients can benefit from and tolerate standard chemotherapy similarly to younger patients in the settings of both early- and advanced-stage colorectal cancer. Assessment of this unique population requires more comprehensive evaluation in addition to routine history, physical examination, and laboratory tests. Specific considerations of their physiologic functional changes will help physicians better manage these patients. Ongoing studies are now designed to better understand the decision-making process, safety profile, and efficacy of various treatment regimens in geriatric patients.

Molecular discoveries and clinical advances over the past few decades have made the treatment of chronic myeloid leukemia (CML) one of the great success stories of modern medicine. Before the 1980s, the focus was on maintaining normal white blood cell counts with agents such as hydroxyurea and busulfan. With the use of interferon, treatment strategies turned more toward cytogenetic remission. In 1998, targeted therapy was introduced to this setting with the first studies of imatinib mesylate. Since then, treatment objectives have shifted toward the attainment of molecular remission. In this review, we consider the variety of approaches to treating CML, efforts to minimize treatment failures, and possible future directions in therapy.

Molecular discoveries and clinical advances over the past few decades have made the treatment of chronic myeloid leukemia (CML) one of the great success stories of modern medicine. Before the 1980s, the focus was on maintaining normal white blood cell counts with agents such as hydroxyurea and busulfan. With the use of interferon, treatment strategies turned more toward cytogenetic remission. In 1998, targeted therapy was introduced to this setting with the first studies of imatinib mesylate. Since then, treatment objectives have shifted toward the attainment of molecular remission. In this review, we consider the variety of approaches to treating CML, efforts to minimize treatment failures, and possible future directions in therapy.

Molecular discoveries and clinical advances over the past few decades have made the treatment of chronic myeloid leukemia (CML) one of the great success stories of modern medicine. Before the 1980s, the focus was on maintaining normal white blood cell counts with agents such as hydroxyurea and busulfan. With the use of interferon, treatment strategies turned more toward cytogenetic remission. In 1998, targeted therapy was introduced to this setting with the first studies of imatinib mesylate. Since then, treatment objectives have shifted toward the attainment of molecular remission. In this review, we consider the variety of approaches to treating CML, efforts to minimize treatment failures, and possible future directions in therapy.

Lung cancer is estimated to be the second most commonly diagnosed cancer in both men and women in 2006, and the leading cause of cancer mortality. Non-small-cell lung cancer represents the majority of such cases. Most of these patients have locally advanced disease at presentation and are not eligible for curative resection. For the minority of patients who are technically resectable at presentation, lobectomy or pneumonectomy and pathologic mediastinal nodal staging offer the best overall survival. The high rate of comorbid medical illness and poor baseline pulmonary function in this population, however, make many such early-stage patients medically inoperable. For these patients, conventional single-modality radiotherapy has been the primary definitive treatment option, as discussed in part 1 of this two-part article. Numerous retrospective reports demonstrate long-term disease-free and overall survival data that are modestly superior to that expected after observation, but both local and distant failure continue to be significant risks. Investigation of radiotherapy dose escalation is ongoing, in an effort to improve local control while maintaining minimal toxicity. Additionally, emerging evidence suggests that new modalities, such as stereotactic radiosurgery and radiofrequency ablation, may also be potentially curative treatment alternatives. These modalities will be addressed in part 2.

The Lung Cancer Alliance hailed the US Senate's action declaring lung cancer a national public health priority and calling for an interagency coordinated attack on the number one cancer killer. Laurie Fenton, president of the Lung Cancer Alliance, praised Senator Chuck Hagel (R-NE) and Senator Hillary Clinton (D-NY) for their leadership in reaching across party lines to give the resolution their full support and expedite its passage by the Senate.