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Monoclonal Antibodies Show Some Progress Against Hairy Cell Leukemia

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NEW ORLEANS-Hairy cell leukemia (HCL) has the highest reported surface expression of CD20 of leukemias studied to date, according to research reviewed at the ASH meeting. In a symposium presentation, Deborah A. Thomas, MD, and colleagues from the M.D. Anderson Cancer Center in Houston, reported that the anti-CD20 monoclonal antibody rituximab (Rituxan) is active against HCL. Response appears to correlate with a decrease in serum interleukin-2 (IL-2) receptor levels. In a poster presentation, Robert J. Kreitman, MD, and colleagues from the National Cancer Institute reported that recombinant immunotoxins containing truncated Pseudomonas exotoxin and targeting either CD25 or CD22 can induce some major responses in patients with refractory HCL.

C. Everett Koop Initiates Online Clinical Trials Info Center for Patients

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Former US surgeon general C. Everett Koop, MD, and Quintiles Transnational Corp. have launched an interactive, consumer Internet resource to enable interested individuals to sign up online for possible participation in clinical drug trials via the

Delay Breast Reconstruction Until After Radiotherapy

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NEW ORLEANS-Patients undergoing staged breast reconstruction with saline-filled implants and subsequent radiation therapy experienced more complications and required more replacement procedures than patients who underwent reconstruction without radiation therapy, according to a retrospective study presented at the 68th Annual Scientific Meeting of the American Society of Plastic and Reconstructive Surgeons (now the American Society of Plastic Surgeons).

Major Advance in Treating Relapsed Childhood Leukemia

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In a significant advance in the treatment of acute childhood lymphoblastic leukemia (ALL), researchers from the Pediatric Oncology Group have found that the use of drugs known to cross into the central nervous system results in high survival rates

Oral Inhalation System Delivers Morphine Doses

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VIENNA, Austria-A new oral inhalation system for morphine is almost as efficient as IV dosing, Aradigm Corp and SmithKline Beecham researchers reported at the 9th World Congress on Pain. B. A. Otulana, MD, said that the dose-corrected bioavailability of morphine with the new device was 75% of that with intravenous morphine, a major increase over the 5% bioavailability achieved with other nebulizers. This approach might provide a useful, noninvasive alternative to parenteral morphine administration.

Tumor Regression Can Continue After Rituximab Therapy for Low-grade NHL Is Completed

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SAN DIEGO-Patients with relapsed or refractory low-grade or follicular non-Hodgkin’s lymphoma (NHL) may respond to rituximab (Rituxan) up to 4 months after completion of therapy. Salvage therapy should therefore be delayed at least until that time for patients with stable disease after rituximab treatment, Antonio J. Grillo-Lopez, MD, of IDEC Pharmaceutical Corp., advised in a poster presentation at the ASH meeting.

AACTG Funding Renewed for Another 5 Years

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BETHESDA, Md-The Adult AIDS Clinical Trials Group (AACTG) will continue its research activities for another 5 years under a new grant from the National Institute of Allergy and Infectious Diseases. NIAID will provide the group $80 million in the first year of renewed funding.

Caregivers Also Need to Be Care Receivers

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Just deciding to go out for an evening can be a big decision for someone taking care of a sick family member. The caregiver can feel guilty or may not have anyone to take care of the sick relative, or may simply feel too depressed to go

Agent in Phase II Testing to Prevent Drug Resistance

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HERSHEY, Pennsylvania-A phase II study is about to begin testing a novel approach to enhancing the effectiveness of chemotherapy, one that uses a new agent to deactivate a critical DNA repair mechanism in malignant cells. Shutting down this repair system appears to increase the killing power of currently available drugs that work by disrupting DNA.

Scar-Free Breast Reconstruction: New Technique

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NEW ORLEANS—A new technique for breast reconstruction, used after a new method of skin-sparing mastectomy, offers patients a scar-free result, according to the surgeon who developed the method, Gino Rigotti, MD, head of the Plastic Surgery Department, Verona General Hospital, Italy.

CLL Responds to Monoclonal Antibodies Against Both CD20 and CF52 Antigens

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NEW ORLEANS-Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) may benefit from treatment with monoclonal antibody treatments directed against the CD20 and/or CD52 antigens, according to data presented at the ASH meeting. Increasing dosing frequency of rituximab (Rituxan) to three times per week produced responses in half of CLL/SLL patients treated in a phase I/II trial reported by John C. Byrd, MD, of the Hematology-Oncology Service at Walter Reed Army Medical Center, Washington, DC. In a separate study at M.D. Anderson Cancer Center in Houston, one-third of patients with CLL refractory to fludarabine (Fludara) responded to the anti-CD52 monoclonal antibody Campath-1H.

For High-Grade NHL, High-Dose Chemotherapy With Stem Cell Transplant Beats CHOP

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NANTES, France-High-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) leads to better event-free survival and freedom from progression in people with intermediate and high-grade non-Hodgkin’s lymphomas (NHL) than does the standard therapy. That was conclusion of a randomized trial comparing autologous PBSCT with CHOP (cyclophosphamide, doxorubicin, Oncovin, prednisone) and reported by Noël Milpied, MD, of the Centre Hospitalier Regional et Universitaire de Nantes, at the ASH meeting.

Combination Rituximab/CHOP Therapy Produces Prolonged Results in NHL

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NEW ORLEANS-Combining rituximab (Rituxan) with the conventional CHOP regimen can produce prolonged disease-free survival in low-grade lymphomas and can increase complete response (CR) rates to over 60% in patients with intermediate-grade or high-grade non-Hodgkin’s lymphoma (NHL). These results from two separate studies were reported at poster presentations at the American Society of Hematology (ASH) meeting.

Rituximab Retreatment Produces Longer Responses Than Initial Use in NHL

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ROCKVILLE, Maryland—The monoclonal antibody rituximab (Rituxan), which is directed against the CD20 antigen expressed in most B-cell malignancies, can be given repeatedly to patients with non-Hodgkin’s lymphoma (NHL) and may produce longer responses with retreatment. This unusual increase in response duration is in contrast to the ever-diminishing efficacy seen with repeated rounds of chemotherapy, researchers reported at the ASH meeting. The increase may indicate that some novel anti-tumor immune response is acting in addition to classic antibody-dependent, cell-mediated cytotoxicity (ADCC) in patients who respond to rituximab.

New Antibody-targeted Chemotherapy Induces Remission in Some AML Patients

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SEATTLE-A new chemotherapy agent called CMA-676 that specifically targets tumor cells led to remissions in 34% of patients with acute myeloid leukemia (AML) in relapse and was well tolerated. Eric Sievers, MD, of the Fred Hutchinson Cancer Research Center reported the results of the phase II trial at the ASH meeting.

NANTES, France-The anti-CD20 monoclonal antibody rituximab (Rituxan) produced a 69% overall response rate in patients with B-cell post-transplant lymphoproliferative disease (PTLD), according to a retrospective analysis presented at the ASH meeting by Noël Milpied, MD, of the Centre Hospitalier Regional et Universitaire de Nantes. The analysis also showed that rituximab is effective in both solid organ and bone marrow transplant recipients (see Table 1).

ROCHESTER, Minnesota-Adding a radioactive antibody aimed at the CD20 antigen to rituximab (Rituxan), a chimeric anti-CD-20 antibody, raised overall response rates to 80% and complete response rates to 21% in patients with relapsed or refractory B-cell non-Hodgkin’s lymphoma (NHL). Preliminary data from this multicenter trial was reported at the ASH meeting by Thomas E. Witzig, MD, of the Mayo Clinic.

Potential Role of Tumor Vaccines in GI Malignancies

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The article by Laheru and Jaffee offers an excellent summary of immunotherapies for gastrointestinal malignancies. Thoughtful descriptions of the antibody, cytokine, and cel- lular components of the immune system provide useful background information that facilitates an understanding of specific passive and active cancer immunotherapies. Immunotherapies that have demonstrated efficacy in colon cancer clinical trials, including levamisole (Ergamisol), passive monoclonal antibody vaccines, and bacillus Calmette- Guérin (BCG)–autologous tumor vaccines, are appropriately reviewed. In addition, novel approaches at varying stages of clinical testing are clearly summarized; these include the use of an anti-idiotypic antibody, genetically modified tumor and dendritic cells, recombinant protein, and viral and DNA vaccines. Some additional approaches, studies, and perspectives are also worthy of mention as a supplement to this review.

Cancer and Male Sexual Dysfunction

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Dr. Costabile presents a thorough review of the biological causes of erectile dysfunction after cancer treatment and of our current range of medical treatments to restore erections. I believe, however, that despite the technical progress made in understanding and remediating erectile dysfunction during the last 20 years, the majority of men who develop such problems following cancer treatment still do not resume a satisfying sex life.

Update on the Management of Primary CNS Lymphoma

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Primary central nervous system (CNS) lymphoma is a non-Hodgkin’s lymphoma restricted to the nervous system. The incidence of this lymphoma is rising in the immunocompetent population but may be decreasing in patients

Cancer and Male Sexual Dysfunction

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Erectile dysfunction is a common occurrence as men age. Approximately 20% of men over the age of 50 years report difficulty in achieving or maintaining an erection, and as many as 60% of men age 70 and older suffer from erectile dysfunction.[1]

Update on the Management of Primary CNS Lymphoma

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Primary central nervous system (CNS) lymphoma is a non-Hodgkin’s lymphoma restricted to the nervous system. The incidence of this lymphoma is rising in the immunocompetent population but may be decreasing in patients

Laheru and Jaffee review the potential role of tumor vaccines in the management of gastrointestinal (GI) malignancies, which represent the leading cause of cancer death and are believed to be poorly immunogenic. The authors carefully review the questions and controversies surrounding currently available immunotherapeutic strategies and describe ongoing clinical protocols using tumor vaccine therapy, a few of which deserve special comment.

Intensive outpatient care is rapidly becoming the primary mode of care for selected patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation. Although the traditional inpatient model of care may still be necessary for high-risk patients, published data suggest that outpatient care is safe and feasible during or after administration of high-dose chemotherapy and autologous PBSC transplant. Blood and marrow transplant (BMT) centers have developed programs to provide more outpatient care under three basic models: an early discharge model, a delayed admission model, and a comprehensive, or total, outpatient model. This review will describe these models of care and address the elements necessary for the development of an outpatient BMT program, including patient selection, staff development, and patient and caregiver education. Available supportive care strategies to facilitate outpatient care will also be highlighted.