ONCOLOGY Vol 23 No 13

Eltrombopag (Promacta) is the first orally absorbed, small-molecule, thrombopoietin receptor (TPO-R) agonist, approved (on November 20, 2008) by the US Food and Drug Administration (FDA) for the treatment of chronic immune thrombocytopenia (ITP) in patients who have relapsed following treatment with corticosteroids, immunoglobulins, and/or splenectomy.

Oxygen therapies are expensive, unproven, and harmful alternatives promoted in appealing and convincing ways for the treatment of cancer and other major diseases. Supporters claim that low levels of oxygen enable cancer cells to thrive and that an oxygen-rich environment destroys them. However, these claims are unsubstantiated. Further, numerous reports of serious complications and fatalities have been reported from the use of oxygen therapies.

On November 20, 2008, the US Food and Drug Administration (FDA) granted accelerated approval for eltrombopag (Promacta Tablets, GlaxoSmithKline) for the treatment of thrombocytopenia in patients with chronic immune thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulin therapy, or splenectomy.

Primary cutaneous lymphomas represent a broad spectrum of distinct entities with multiple clinical and pathologic presentations, prognosis, and treatment approaches. Given their rarity and heterogeneity, these entities represent diagnostic and therapeutic challenges, thus requiring a multidisciplinary approach and expertise to ensure appropriate diagnosis and management.

The primary cutaneous CD30-positive (CD30+) T-cell lymphoproliferative disorders are a group of largely indolent diseases that manifest as nodules or tumors of the skin. The European Organisation for Research and Treatment of Cancer (EORTC) has developed a modification of the World Health Organization (WHO) lymphoma classification system that specifically categorizes these entities.

The purpose of this review is to familiarize oncologists with the clinical and pathologic features of this relatively rare disease spectrum. This should enable appropriate clinical management and reassurance of patients concerned about their prognosis.

Recent studies have shed new light on the role of histology in predicting sensitivity to therapeutic agents such as pemetrexed (Alimta) or bevacizumab (Avastin). Whereas during the past 30 years, the only useful histologic consideration was the absence or presence of a “non” before “small-cell lung cancer,” two US Food and Drug Administration (FDA)-approved drugs now have histologic restrictions.

More than 60 years ago, Karnofsky and colleagues reported promising results with the introduction of nitrogen mustard, the prototype of alkylating agents, for the treatment of lung cancer.[1] Subsequent milestones in the development of lung cancer chemotherapy included the use of platinum agents in the 1970s and 1980s, while the 1990s brought several active agents that could be combined with platinum, namely the taxanes, gemcitabine (Gemzar), and vinorelbine.

Our ability to treat patients with B-cell lymphomas has improved dramatically over the past few decades. Today the majority of patients with diffuse large B-cell lymphoma are cured, the survival of patients with low-grade follicular lymphoma is improving (ie, some estimates have the average survival more than doubling), most patients with Hodgkin lymphoma (also a B-cell lymphoma) are cured, most patients with Burkitt lymphoma are cured, and our ability to diagnose and treat patients with the various marginal zone lymphomas has improved considerably.

Since the publication of a meta-analysis in 1995 that demonstrated a modest survival benefit compared to best supportive care, platinum-based chemotherapy became the cornerstone of therapy in the first-line setting in advanced-stage non–small-cell lung cancer (NSCLC) for patients with good performance status.[1] A recent meta-analysis of 16 randomized trials including 2,714 patients demonstrated an advantage of chemotherapy over best supportive care with an absolute improvement in survival of 9% at 12 months.[2]