All News

Proton Radiation Therapy for Lung Cancer: Is There Enough Evidence?

ONCOLOGY Nurse Edition Continuing Medical Education October 2010

David A. Bush, MD

Current Concepts in the Diagnosis and Management of Small-Cell Lung Cancer

Proton radiation for cancer offers the ability to conform the high-dose region of radiation therapy to the tumor while reducing the dose of radiation to adjacent normal tissues. In lung cancer, this equates to greater sparing of uninvolved lung, heart, esophagus, and spinal cord. Sparing these normal tissues permits the delivery of higher-radiation doses to the tumor. Studies that compare the distribution of radiation doses for lung cancer show that proton radiation is superior, even when factors such as respiratory motion are considered. Clinical experience confirms the feasibility of proton radiation for early-stage non-small-cell lung cancers, and clinical trials are being conducted in locally advanced tumors: To date, evidence indicates that proton radiation should be further explored.

Apar Kishor Ganti, MD, MS;William W. West, MD;Rudy P. Lackner, MD;Anne Kessinger, MD

Multiple Myeloma in the Elderly: When to Treat, When to Go to Transplant

Despite a decreasing incidence in the United States, small-cell lung cancer (SCLC) remains a major clinical problem, with approximately 30,000 new cases each year. The diagnosis of SCLC is usually not difficult. The Veterans Administration Lung Study Group (VALSG) staging system is less accurate than the American Joint Committee of Cancer tumor-node-metastasis (TNM) system (7th edition) at predicting survival in SCLC, especially in lower stage disease. Surgery has not played a major part in the management of SCLC, but emerging data suggest that resection may have a role in earlier stage disease. While the frontline treatment of SCLC has not changed significantly in the past decade, newer agents that are currently being investigated provide hope for better treatment of relapsed/refractory disease for the future.

Jean-luc Harousseau, MD

The Treatment of Elderly Patients With Multiple Myeloma: Is More Better?

Until recently, standard treatment of multiple myeloma (MM) in elderly patients who were not candidates for autologous stem cell transplantation was with the combination of melphalan plus prednisone (MP). Novel agents (thalidomide, lenalidomide, bortezomib) are dramatically changing frontline therapy of MM. Randomized studies have shown the superiority of adding one novel agent to MP, either thalidomide (MPT) or bortezomib (MPV). The combination of lenalidomide with low doses of dexamethasone is another attractive alternative. Recent results show that maintenance therapy with low-dose lenalidomide may prolong progression-free survival. The objective of these improved treatment regimens should be to achieve complete response, as in younger patients. However, toxicity is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status. Weekly bortezomib appears to induce severe peripheral neuropathy less frequently than the same agent administered twice weekly. Autologous stem cell transplantation is feasible in selected fit patients over 65 years of age, and its results are improved by the addition of novel agents before and after high-dose therapy. However, considering the progress in non-intensive therapy, autologous transplantation should not currently be offered to elderly patients outside of a clinical trial.

William Bensinger, MD

Providing coverage for all through private health insurance

The variety of treatment options available to patients of all ages who have multiple myeloma has improved considerably in the past decade. However, elderly patients have benefited more than patients of other ages. Because elderly patients, as a group, are usually not offered autologous stem cell transplant (ASCT) as a treatment option, they have been unable to benefit from the wide application of this technique, first introduced in the late 1980s. In the past 8 years, however, thalidomide, bortezomib, and very recently lenalidomide, when combined with conventional doses of alkylators and corticosteroids, have produced marked improvements in progression-free survival (PFS) and overall survival (OS) in elderly patients. Harousseau has thoroughly reviewed the important studies documenting these benefits for this population.

Who's News

October 9th 2010

David S. Alberts, MD, director of Tucson’s Arizona Cancer Center, is honored by the Association of Community Cancer Centers. Learn more about the latest accolades and appointments in cancer care.

October 7th 2010

The United States is unique in the developed world in that the majority of Americans have private health insurance that they receive through the workplace.

Three new studies confirm cancer outcomes related to insurance, race, income

Look for upcoming Practice & Policy in November edition of ONCOLOGY

October 6th 2010

Researchers find that patients lacking private health insurance or are poor or black fare worse than other cancer patients.

Michael Mccaughan

Common Bone Metastases Medications

Second-Guessing FDA: CMS’ Expanding Regulatory Role

Common Breast Cancer Medications

Common Myeloid Leukemia Medications

Common Colorectal Cancer Medications

Common Gastrointestinal Stromal Tumor Medications

Common Leukemia and Lymphoma Medications

Common Lung Cancer Medications

Common Multiple Myeloma Medications

Common Prostate Cancer Medications

Common Testicular Cancer Medications

Common Renal Cell Carcinoma Medications

FDA issues final rule on safety information during clinical trials

The U.S. Food and Drug Administration issued a final rule that clarifies what safety information must be reported during clinical trials of investigational drugs and biologics.

Crisis is cancer care

The Oregon experiment failed

October 4th 2010

Medicare only covers 57% of the actual costs of delivering chemotherapy and provided related infusion room services to seniors with cancer: Watch this important video: Cancer Care is in Crisis: Stop The Cancer Care Cuts

John Goodman, PhD

October 1st 2010

The Oregon Health Plan was considered by many to be a masterpiece of health care delivery for the poor. It attracted international attention when its plan of explicit rationing of care promised to provide basic health care to virtually every Oregonian living in poverty. Did the plan live up to its promise?

FDA not included in PCORI

EGFRI-induced rash may be two-phase phenomenon

September 28th 2010

The regulatory agency isn’t represented on the board of governors of the new Patient Centered Outcomes Research Institute.

Lois Wingerson;Lois Wingerson

September 27th 2010

The skin eruptions that plague most patients on EGFR inhibitor therapy and disrupt treatment in some may occur in two recognizable stages, which could have implications for both research and treatment.

First stage of Obamacare is rolled out