ONCOLOGY Vol 22 No 8

The use of the term "futility" in cancer care has been prompted, in part, by increasing requests from patients for treatments thought to be ineffective as well as costly.[1] The appropriate role of chemotherapy near the end of life is a complex issue.[2]

Decision-making at the end of life is difficult, and it should be. Rather than face these time consuming and emotionally demanding discussions, doctors too often look to unsuitable conceptual models.

The article by Khatcheressian and colleagues addresses the important topic of futility in chemotherapy use. While extensive previous literature has addressed the use of futile treatment by oncologists, Khatcheressian and coauthors pose interesting perspectives on patient persistence in seeking futile treatment.

Our case illustrates the fact that MDS-associated GS can be treated palliatively with radiation and hypomethylating agents in an appropriate setting. With the growing geriatric patient population, effective treatment options are needed in this disease.

Granulocytic sarcomas have been reported in nearly every part of the body, including the gastrointestinal (GI) and genitourinary (GU) tracts, central nervous system (CNS), and respiratory, lymphatic, and skeletal systems. A few case series have been reported through the years.

This is an expertly written summary of the experience with cryotherapy as primary treatment of prostate cancer and the rationale for proceeding toward more limited, organ-sparing approaches with this procedure as focal treatment for low-risk cancers. Growing evidence of overdetection and overtreatment in many men with low-risk tumors has resulted in the recognition that alternatives to conventional treatment strategies are needed. Observation, a laudable and appropriate approach, appeals to relatively few patients.

The article by Polascik and coauthors provides a timely synopsis of modern technologic advances in prostate cryoablation and a review of the rationale for and experience with targeted prostate treatments. Prostate cryoablation has a storied past, which can be briefly summarized as high excitement followed by near-complete abandonment. Fortunately, a few practitioners improved the technique and incorporated new technologies allowing for its resurrection.

Updated results from a 482-patient, multicenter, randomized phase III clinical trial showed significant progress in multiple myeloma treatment. The study compared bortezomib (Velcade) and dexamethasone (VcD) to vincristine, doxorubicin (Adriamycin), and dexamethasone (VAD) in newly diagnosed patients. Results showed high complete remission (CR) rates of 19% in the VcD arm as induction therapy and 35% posttransplantation.

The anti-inflammatory medication celecoxib (Celebrex) has proven to be safe and reduces a specific proliferation measurement of precancerous lesions in the lung, according to a study from The University of Texas M. D. Anderson Cancer Center. This finding demonstrates the significance of COX-2 inhibition toward preventing lung cancer in individuals at higher risk of developing the disease. The study is the first large randomized trial of celecoxib in lung cancer prevention.

orafenib (Nexavar) tablets significantly improved overall survival by 47.3% (HR = 0.68; P = .014) in patients in the Asia-Pacific region with advanced hepatocellular carcinoma (HCC) vs those receiving placebo. Nexavar also significantly improved time to progression in these patients by 74% (HR = 0.57; P = .001).

The first phase III study of its kind has found that vaginal brachytherapy—in which a radioactive cylinder is inserted into the vagina—is as effective at preventing the recurrence of higher-risk endometrial cancer as external-beam radiation therapy, has fewer side effects, and results in a better quality of life for patients (abstract LBA5503).

Pfizer recently announced new follow-up data from a worldwide expanded access program supporting the efficacy and safety of single-agent, oral sunitinib malate (Sutent) in the treatment of imatinib (Gleevec)-resistant or intolerant gastrointestinal stromal tumor (GIST). These data were presented at the annual ASCO meeting in Chicago (abstract 10548).

Genta Incorporated announced that the Company has received notification from the US Food and Drug Administration (FDA) that Genta may resume clinical trials with tesetaxel, a leading oral taxane in Genta's oncology product portfolio. The notification was made in response to the Company's submission of a complete response to a prior notice from FDA that had placed the drug on "clinical hold."

Wyeth Pharmaceuticals recently announced the initiation of the INTORACT (INvestigation of TORisel and Avastin Combination Therapy) study, a worldwide randomized, open-label, phase IIIB study comparing temsirolimus (Torisel) plus bevacizumab (Avastin) vs bevacizumab plus interferon-alfa for first-line treatment of patients with advanced renal cell carcinoma (RCC). Wyeth Research is conducting the INTORACT study with the support and assistance of Roche and Genentech

Eisai Corporation of North America announced today that the US Food and Drug Administration (FDA) has accepted for priority review a supplemental biologics license application (sBLA) for denileukin diftitox (Ontak). The sBLA seeks to convert an accelerated approval indication into full approval. It is based on a placebo-controlled phase III clinical trial to confirm the clinical effectiveness of the drug in certain patients with cutaneous T-cell lymphoma (CTCL).

Caris Diagnostics (Caris Dx), a provider of diagnostic, translational development and pharmaceutical services encompassing anatomic pathology and molecular testing, announced that it is now offering KRAS mutation analysis, designed to provide information on which colon cancer patients are most likely to respond to cetuximab (Erbitux), comarketed by ImClone and Bristol-Myers Squibb, or panitumumab (Vectibix) developed by Amgen.

Immunomedics, Inc. a biopharmaceutical company focused on developing monoclonal antibodies to treat cancer and other serious diseases, today announced that adding epratuzumab (LymphoCIDE) to rituximab (Rituxan) and combined cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (ER-CHOP) for the therapy of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) produced promising results.

Cancer patients with low socioeconomic status (SES) have more advanced cancers at diagnosis, receive less aggressive treatment, and have a higher risk of dying in the 5 years following cancer diagnosis, according to a new study. The study, which will appear in the August 1, 2008, issue of CANCER, supports the need to focus on SES as an underlying factor in cancer disparities by race and ethnicity.

Wyeth Pharmaceuticals, a division of Wyeth, and Progenics Pharmaceuticals, Inc. recently announced the publication of results from a pivotal phase III trial of methylnaltrexone bromide (Relistor) subcutaneous injection in the New England Journal of Medicine. Methylnaltrexone is a newly approved therapy for the treatment of opioid-induced constipation (OIC) in patients with advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient.

BARRX Medical, Inc, a global technology leader in treating Barrett's esophagus, announced the publication of two related European trials that report a 100% eradication rate for early esophageal cancer and precancerous dysplasia using endoscopic resection followed by ablation therapy with the HALO ablation system. Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) and is a known risk factor for esophageal cancer, the fastest growing cancer in the Western world.

Meaningful pain relief at 10 minutes following dosing with intranasal fentanyl spray among patients with cancer who experience breakthrough pain was reported at the Fifth Research Forum of the European Association for Palliative Care, in Trondheim, Norway. All patients involved in the trial were already receiving effective treatment to control background pain, but still experienced episodes of breakthrough pain everyday. Intranasal fentanyl spray is aimed at managing breakthrough pain in adult patients with cancer who are

Results from an adjuvant trial in high-risk melanoma patients demonstrated that a majority of patients treated with granulocyte-macrophage colony-stimulating factor, or sargramostim (Leukine), achieved disease-free and/or overall survival.

Recently, third-generation cryosurgery has been widely introduced into clinical practice using argon-driven, ultrathin 17-gauge cryoprobes in accordance with the Joule-Thompson principle.[1-3] Contemporary cryosurgery includes these technologic advances along with the routine utilization of ultrathin needles incorporating a thermal monitoring system (TMS) for temperature surveillance, transrectal ultrasound (TRUS) imaging, and a urethral warming catheter to minimize morbidity associated with the procedure.[4-7]

he field of geriatric assessment is crowded by a variety of assessment domains, a plethora of assessment tools, and research spanning diverse care settings. In their article published in this issue of the journal ONCOLOGY, Schubert, Gross, and Hurria have synthesized the evidence and propose a subset of commonly used functional assessment tools for assessing older adults with cancer.[1]

The population of the United States and other industrialized nations is aging rapidly. The increased life span allows for longer exposure to carcinogens and the accumulation of genetic alterations. Thus, the incidence of cancer is increasing along with the aging of the population.