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BETHESDA, Md--The new Vaccine Research Center (VRC) at the National Institutes of Health will expand upon efforts to find an effective AIDS vaccine and will neither replace research at universities and other institutions nor diminish their federal funding, William E. Paul, MD, told a meeting of the NIH director's advisory committee. "We see this as an add-on activity," said Dr. Paul, associate NIH director for AIDS research.

Thousands of practice guidelines/practice parameters have been published by various professional organizations. The American Medical Association,[1] American College of Physicians,[2,3] and others[4-6] have written extensively about

This special series on cancer and genetics is compiled and edited by Henry T. Lynch, MD, director of the Hereditary Cancer Institute, professor of medicine, and chairman of the Department of Preventive Medicine and Public Health, Creighton University School of Medicine, and director of the Creighton Cancer Center, Omaha, Nebraska. Part I of this three-part series on pancreatic cancer appeared in June 1997. Part II (below) reviews the gene mutations thought to contribute to the development of hereditary pancreatic cancer, and Part III will explores the clinical recognition of a hereditary predisposition to pancreatic cancer.

In the May, 1997, issue of Oncology News International , the updated eight-year results of NSABP protocol B-17 were reported as presented by Dr. Bernard Fisher in Paris. B-17 randomized patients with ductal carcinoma in situ (DCIS) into two groups: One group received excision only, the other excision plus postoperative radiation therapy.

The article by Dr. Burt provides an excellent summary of the rationale for using high-dose therapy with autologous or allogeneic bone marrow transplantation (BMT) in patients with severe autoimmune diseases (SADS). The article also describes the approach to BMT adopted by Dr. Burt and colleagues at Northwestern University. Enthusiasm for this form of therapy has been contagious, and numerous US investigators have initiated similar trials, which are outlined in Table 1 of the article.

The article by Meredith and LoBuglio represents a thorough description of the clinical strategies that have been attempted with radioimmunoconjugates. The authors appropriately point to the extraordinary promise of these agents in the treatment of hematologic malignancies. They also acknowledge the disappointments that have been encountered in the systemic therapy of solid tumors, while noting that there may be some reason for optimism regarding locoregional administration of radioimmunoconjugates.

Colorectal carcinoma is a common problem in the United States, and the liver is the most frequent site of metastatic disease. Because there is a good pharmacologic rationale for the use of hepatic intra-arterial (HIA) therapy, and because of the disappointing survival observed with systemic chemotherapy, studies of hepatic arterial infusion have been conducted.

Studies of hematopoietic stem-cell transplantation as a treatment for severe autoimmune diseases (SADS) are currently in progress. Dr. Burt thoroughly reviews the rationale for these studies. It includes: (1) preclinical studies showing that marrow transplantation is an effective therapy in animal models of autoimmune disease; (2) observations of the effect of stem-cell grafts on SADS in patients transplanted for other indications; and (3) improvements in the safety of the transplant procedure.

Most patients with autoimmune diseases are thought to have a a normal life expectancy, and thus are treated conservatively. However, these diseases have a diverse clinical course. A small subset of patients have "severe autoimmune diseases," or SADS, which are rapidly progressive and are associated with early mortality. If patients with SADS can be identified before they develop irreversible organ damage, aggressive intervention would be indicated. Consequently, patients with SADS are now being enrolled in experimental protocols of immune ablation and hematopoietic stem-cell rescue (ie, bone marrow transplantation [BMT]) at several US institutions. For various reasons, including the high cost of BMT, it will probably be years before the benefits, if any, of this procedure are known. [ONCOLOGY 11(7):1001-1017, 1997]

Dihydropyrimidine dehydrogenase (DPD) is the initial, rate-limiting enzyme in the catabolism of 5-fluorouracil (5-FU). DPD has an important role in regulating the availability of 5-FU for anabolism. It is now clear that DPD also

The use of hepatic intra-arterial (HIA) chemotherapy is based on the pharmacologic principle that the regional administration of certain drugs can lead to higher drug concentrations at the site of a tumor. This has been studied most extensively in patients with liver-only colorectal metastases. Four large randomized studies have failed to demonstrate a survival advantage of regional treatment over systemic chemotherapy, although two meta-analyses confirmed an improvement in response rate and suggest a trend toward improvement in survival. Two randomized studies have shown improved survival in patients treated with HIA chemotherapy, as compared with those given supportive care, and quality of life also appears to be superior in HIA chemotherapy recipients. The treatment employed in all of the randomized studies was hindered by substantial hepatobiliary toxicity and many surgical complications. Improved surgical techniques and newer chemotherapy combinations appear to have improved phase II results with HIA therapy, leading to a randomized trial now being conducted by the Cancer and Leukemia Group B (CALGB). The role of HIA chemotherapy in adjuvant settings and in other diseases has not been as well-studied, and such uses remain appropriate only for very selected patients. Ultimately, the regional advantage gained by the HIA route may prove to be most advantageous for the delivery of newer biologic agents. [ONCOLOGY 11(7):947-957, 1997]

Data from the Radiation Therapy Oncology Groupand Eastern Cooperative Oncology Group indicate that increased survival

WASHINGTON--Laboratory studies from Rockefeller University, presented at Digestive Disease Week, suggest that caffeine may have a synergistic effect with NSAIDs in preventing the growth of cancer cells.

The last decade has seen a dramatic increase in the availability of nonopioid analgesics for the management of chronic pain. The change has been especially great in the area of adjuvant analgesics, the diverse group of drugs that have other primary

SEATTLE--The two studies most often cited as proof that psychological support can improve survival in cancer patients came under challenge at the annual meeting of the American Association for the Advancement of Science.

Patients with cancer have a significant risk for infection due to their treatment with chemotherapy, radiation, or surgery," stated Debra Wujcik, RN, MSN, AOCN, clinical director at Vanderbilt Cancer Center in Nashville, Tennessee, at the 1996

PHILADELPHIA--Personal devotion to keeping abreast of the complexity of HIV therapy identifies the "specialist," whether trained in infectious disease or as a generalist, John J. Bartlett, MD, said at the American College of Physicians annual meeting.

FORT LAUDERDALE, Fla--Writing guidelines for cancer screening that include genetic testing--the next major guidelines initiative for the National Comprehensive Cancer Network (NCCN)--will be complex because "every cancer, every gene linked to a cancer, and every patient situation is going to present different kinds of problems," Henry Greely, JD, said at the NCCN's second annual conference.

SAN DIEGO--Research involving telomerase, the protein thought to be responsible for cancer cell immortality, is experiencing explosive growth, and nowhere was that more evident than at the annual meeting of the American Association for Cancer Research (AACR).

Although it is clear that diet plays a role in the etiology of many cancers, making dietary recommendations to reduce risk is highly complicated, if, indeed, it is possible at all, according to an international cancer prevention expert. With 30% to 50%

Agouron Pharmaceuticals reported that the profound anti-HIV effects of its protease inhibitor nelfinavir mesylate (Viracept), when taken in combination with other anti-HIV drugs, continue to be observed after 10 months of treatment. Nelfinavir was

Researchers at the University of Minnesota Cancer Center have found evidence that mamographic breast density, a measure of the relative proportions of fat, connective tissue, and glandular epithelial tissue in the breast that is a strong, independent

SAN DIEGO--The bcl-2 gene, present in follicular-type B cell lymph-oma, serves as a critical checkpoint in the apoptosis pathway, and may be involved in the development of ultraviolet-induced skin cancers, in combination with the tumor-suppressor gene p53, according to two reports presented at the American Association for Cancer Research (AACR) annual meeting.

Several years ago, during Dr. Gardner's tenure as President of the Society of Surgical Oncology (SSO), the SSO's Executive Council agreed to the development of practice guidelines for early referral of potential cancer patients. This move

ROCHESTER, NY--The WHO International Network for Cancer Education (INCE) has joined with its first partner, the American Association for Cancer Education (AACE), to put together an international traveling exhibit of educational materials and resources for cancer education, to be shown at many of the smaller cancer congresses around the world, Charles D. Sherman, Jr., MD, told Oncology News International.

NEW YORK--Pain is highly prevalent in patients with HIV disease. Yet clinicians are often afraid to prescribe opioids when the patient is a former substance abuser, William Breitbart, MD, said at a conference on chemical dependency and pain management.

WASHINGTON--Cancer advocacy groups, institutions, publishers, and professional organizations are rapidly making the World Wide Web a major source of cancer and other health-related information.

NEW YORK--About 60% of the US population dies in the hospital, and many have questioned whether hospitals are the best place to care for the dying. However, the hospital setting offers many advantages, Myra Glajchen, DSW, said during a teleconference sponsored by Cancer Care Inc.

Mycobacterial cell wall therapy may be an alternative to BCG in the treatment of carcinoma in situ (CIS) of the bladder, Dr. Alvaro Morales, of Queen's University, Kingston, Ontario, reported at the AUA meeting.

ROCKVILLE, Md--Last year, the National Cancer Institute established the Office of Cancer Survivorship, and NCI director Richard D. Klausner, MD, named Anna T. Meadows, MD, to head its efforts to explore issues of the physical, psychological, and economic well being of cancer patients.