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issues in oncology

Challenging Times: A Day in the Life of a Community Oncologist

Community oncologists man the front line of cancer care, treating upward of 85% of our nation’s patients. Over the past 2 decades, regulatory and economic changes have left many practices in a state of flux and uncertainty, some struggling to keep their doors open. To shed light on the community...

Ignoring Level 1 Evidence in Invasive Bladder Cancer: Is Ignorance Bliss?

I’ve been part of the uro-oncology community for more than 30 years and have been proud to be involved in a good number of well-powered, enthusiastically subscribed randomized clinical trials. These have dated back to a time before randomization was necessarily the fashion. I have had the pleasure...

skin cancer

Combination of BRAF and MEK Inhibitors Paves Way for Phase III Studies in BRAF-mutated Metastatic Melanoma

Two late-breaking studies presented at the 2012 European Society for Medical Oncology (ESMO) Congress highlight the promising potential of combining dual BRAF and MEK inhibitors for the treatment of BRAF-mutated metastatic melanoma. A phase II study showed that combining full doses of the BRAF...

issues in oncology

Media Campaign with Real Smokers a Success

Real smokers sharing in graphic terms what it is like to live with disfiguring or disabling tobacco-related diseases were the featured spokespersons for the Centers for Disease Control and Prevention (CDC) national media campaign to encourage smokers to quit. Based on short-term response, the CDC...

breast cancer

Surrounded by Breast Cancer

Nine women on my mother’s side of the family have been diagnosed with breast cancer, and nearly half have died from their disease, including my mother. With odds like these, I was determined to do what I could to stay ahead of this dreaded monster I thought was surely coming for me. First Tests...

breast cancer

HIV Protease Inhibitor Nelfinavir Selectively Inhibits HER2-positive Breast Cancer Cells

Shim and colleagues from Johns Hopkins School of Medicine in Baltimore, the National Cancer Institute in Bethesda, and Emory University School of Medicine in Atlanta have recently shown that the HIV protease inhibitor nelfinavir (Viracept) is a selective inhibitor of HER2-positive breast cancer...

SIDEBAR: Randomized Trial of Weight Loss and Cancer Risk Not Feasible

“We have not had a randomized controlled trial of weight loss among people at risk for cancer who don’t yet have the disease, where we can show that weight loss reduces the risk for cancer. And we never will,” Rachel Ballard-Barbash, MD, MPH, told The ASCO Post. “We know from a number of very...

Expect Questions from Patients about Impact of Weight on Prognosis

Increased awareness of the strong association between obesity and higher rates of cancer recurrence and mortality needs to be transmitted from oncologists to patients, but the message needs to concern more than just weight, according to Rachel Ballard-Barbash, MD, MPH, Associate Director of the...

Strong Association Increasingly Recognized Between Obesity and Cancer Incidence/Poor Prognosis

The rise in obesity in the United States coincides with greater recognition of the role of obesity in cancer and other diseases.1 While decades of research have indicated a strong association between obesity and cancer, “several forces have made that association increasingly recognized,” according...

Richard L. Schilsky, MD, Chosen to Serve in New ASCO Leadership Position, Chief Medical Officer

Richard L. Schilsky, MD, Chief of Hematology/Oncology in the Department of Medicine and Deputy Director of the University of Chicago Comprehensive Cancer Center, has been named to the newly created position of Chief Medical Officer (CMO) of ASCO. A former ASCO President and Fellow of the American...

The Nuts and Bolts of Getting into an Oncology Fellowship

Oncology continues to be one of the most sought-after specialties. Because of a shortage of oncologists and the accelerating pace of developments in the diagnosis and treatment of cancer, oncology has become an increasingly competitive field. Accreditation Council for Graduate Medical Education...

integrative oncology

Dong Quai

Scientific Name: Angelica sinensis Common Names: Chinese angelica, dang gui, tang kuei, tan kue Overview Dong quai is a perennial herb indigenous to China, Japan, and Korea. Its root has been used for centuries as a spice, tonic, and medicine. Dong quai is mentioned in Shen Nong Ben Cao Jing, the...

PD-1 Blockade Increases Transferred T-cell Migration to Tumors

One reason that adoptive cell transfer has met with limited clinical success is that approaches based on this strategy have not fully taken into account the role of the tumor microenvironment as a limiting factor in immunotherapy. Recently reported studies by Peng and colleagues1 from The...

Expert Point of View: Jean-Yves Pierga, MD

Formal discussant of the MISSION trial, Jean-Yves Pierga, MD, Institut Curie, Paris, said that it is one of several studies to show no clear benefit in overall survival for the addition of a tyrosine kinase inhibitor targeting angiogenesis in advanced non–small cell lung cancer. Dr. Pierga noted...

Explaining Research to Patients

Everyone understands the need for medical research, especially regarding cancer. However, only a minority of the public understand what is actually involved in taking part in a clinical trial. As professionals, we are responsible for designing relevant studies, for their conduct and analysis, and...

lung cancer

Sorafenib Fails to Improve Survival as Third- or Fourth-line Treatment of Advanced Non–Small Cell Lung Cancer

Third- or fourth-line therapy with sorafenib (Nexavar) failed to extend overall survival in patients with advanced non–small cell lung cancer (NSCLC), according to the main results of the phase III MISSION trial. However, a post hoc biomarker analysis of MISSION suggested that patients with...

Ruxolitinib: Novel Drug for Myelofibrosis

In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication In November 2011, ruxolitinib (Jakafi) was approved for...

Risk Reduction for Patients with Multiple Primary Cancers

The number of patients with multiple primary cancers is increasing so that second malignant neoplasms now represent approximately 16%, or 1 in 6 cancers reported to the Surveillance, Epidemiology, and End Results (SEER) Program. While some second malignant neoplasms are treatment-related, others...

Delivering Affordable Cancer Care: Is It Possible and What Will It Entail?

Many experts agree that at 18% of gross domestic product, health care (to paraphrase Shakespeare) is eating the country out of house and home. “The average cost of treating the most common cancers has increased, and as more expensive targeted therapies and other new technologies become the...

Intermittent Androgen Suppression in Prostate Cancer Noninferior to Continuous Suppression, Associated with Some QOL Benefit

A recently reported National Cancer Institute of Canada (NCIC) Clinical Trials Group study, reported by Crook and colleagues in The New England Journal of Medicine, showed that intermittent androgen suppression was associated with noninferior overall survival when compared with continuous...

Options Shifting for First-line Treatment of Renal Cell Carcinoma

Trials with pazopanib (Votrient) have “provided significant efficacy, toxicity, and tolerability data for pazopanib to be established as a first-line standard of care” for renal cell carcinoma,” Tim Eisen, PhD, of the University of Cambridge, United Kingdom, stated at the 11th International Kidney...

A New Gift to Add to Your List—One to Conquer Cancer

Conquering cancer requires the faith, talent, and resources of all members of our community. It requires the innovation of researchers and the insight of clinicians. It requires the courage of our worldwide community of patients and survivors, and it requires the generosity of everyone who believes ...

Albumin-bound Paclitaxel in First-line Treatment of Advanced NSCLC

In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication On October 11, 2012, paclitaxel protein-bound particles...

Nab-paclitaxel vs Solvent-based Paclitaxel in First-line Treatment of Advanced Non–Small Cell Lung Cancer: Final Results

Nanoparticle albumin-bound (nab)-paclitaxel (Abraxane) is a solvent-free paclitaxel formulation intended to reduce solvent-related adverse reactions and improve tumor penetration via the physiologic transport properties of albumin. The final results of a phase III trial comparing nab-paclitaxel and ...

Adjuvant Chemotherapy for Breast Cancer Predicted by Disease, Age, and Insurance Type, but Not by Race

Breast cancer mortality has been found to be higher among black and Hispanic women than among white women, with the differences in outcome being attributed in part to more advanced disease stage and greater frequency of unfavorable tumor biology among black and Hispanic women. Studies to date have...

Expert Point of View: Fausto Roila, MD

Thromboprophylaxis for patients with a central venous catheter is at present not recommended by the international oncologic associations. This is based on the results of four recent randomized controlled trials, three of them double-blind, in which there was no statistically significant difference...

Novel Agents for Breast Cancer and Prostate Cancer Impressive in Early Trials

Several sessions at the 2012 European Society for Medical Oncology (ESMO) Congress in Vienna focused on novel targeted therapies in various stages of development. Summarized here are data on two promising drugs for breast cancer and two for prostate cancer. E-3810 in Breast Cancer Two experimental...

Integrative Medicine Showing Benefits in Cancer Management

Donald I. Abrams, MD, Chief of Hematology-Oncology at San Francisco General Hospital and Integrative Oncologist at the University of California, San Francisco, Osher Center for Integrative Medicine, has been investigating and incorporating integrative medicine approaches in his clinical treatment...

Regorafenib, Multikinase Inhibitor, for Previously Treated Metastatic Colorectal Cancer

In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication On September 27, 2012, regorafenib (Stivarga) was...

FDA Approves Noninvasive Radiation Therapy to Treat Pain from Bone Metastases

InSightec Ltd announced that the FDA has approved ExAblate MRI-guided focused ultrasound as a therapy to treat pain from bone metastases in patients who do not respond or cannot undergo radiation treatment for their pain. This is the second FDA approval for ExAblate since it was approved in 2004 as ...

Contralateral Breast Cancer Risk Is Highly Overestimated

Breast cancer is highly unlikely to develop in the contralateral breast of women treated for primary breast cancer, yet many women continue to fear it and undergo prophylactic mastectomies. “Regardless, the perceived risk of developing and dying from a contralateral breast cancer is highly...

Expert Point of View: John L. Marshall, MD

The pendulum continues to swing in the treatment of stage II and III colon cancer. Not 5 years ago, our party line was that essentially all patients should receive 6 months of adjuvant FOLFOX (leucovorin, fluorouracil [5-FU], oxaliplatin): patients with stage II or III disease, whether rectal or...

No Survival Benefit for Oxaliplatin Added to Adjuvant Therapy in Stage II or Elderly Patients with Colon Cancer

Oxaliplatin plus fluorouracil (5-FU)/leucovorin or capecitabine (Xeloda) is a standard of care in adjuvant therapy for stage III colorectal cancer. There is ongoing debate about whether any adjuvant therapy is of benefit in patients with stage II disease, and it is not routinely recommended in this ...

SIDEBAR: Mammography Study Stokes Overdiagnosis Debate

Overdiagnosis and the harms associated with unnecessary procedures is becoming a vibrant subject in today’s health-care dialogue, with serious implications for providers and patients alike. A new study from the Norwegian Screening Program concluded that 15% to 25% of breast cancers identified on...

Who Should Receive First-line BEACOPP Therapy for Hodgkin Lymphoma?

At the Pan Pacific Lymphoma Conference, held this year in Maui, Hawaii, Andreas Engert, MD, Chairman of the German Hodgkin Study Group, University Hospital of Cologne, Germany, led off the Hodgkin lymphoma section of the conference with a presentation on optimizing the use of BEACOPP (bleomycin,...

Seeking Solutions to the Dilemmas of Overdiagnosis and Overtreatment

Widespread use of screening technologies has markedly increased early detection rates of cancer, saving countless lives. However, while screening technologies have remarkable sensitivity, their  inability to identify which tumors will progress and which will not has created the phenomenon of...

Updated Results from T-DM1 and Regorafenib Trials, plus Other Highlights from ESMO 2012

The 35th European Society for Medical Oncology (ESMO) Congress in Vienna broke all records for attendance, with about 16,000 attendees from all over the world. Some sessions were standing room only, including the Presidential Symposia, the ESMO-ASCO Joint Symposium on genomics in breast cancer, and ...

Defining a Cure for Chronic Myeloid Leukemia and Strategies to Achieve this Goal

In chronic myeloid leukemia (CML), continued long-term therapy that prevents both progression to accelerated-phase disease and the emergence of resistance may be thought of as an “operational” or “functional” cure. However, long-term disease control without the requirement for continuous treatment...

Managing Treatment Failure in Chronic Myeloid Leukemia

As John Goldman, DM, FRCP, FRCPath, FMedSci, discussed earlier, a substantial minority of patients with chronic myeloid leukemia (CML) experience treatment failure. Jorge Cortes, MD, of The University of Texas MD Anderson Cancer Center, introduced this session with two patient cases to illustrate...

Defining and Recognizing the Causes of Imatinib Resistance and the Importance of Adherence

Imatinib (Gleevec) is a highly effective therapy for the majority of patients with chronic myeloid leukemia (CML). In the IRIS study, only 30% of patients could be considered to have failed imatinib treatment after 6 years.1 However, these 30% of patients are a substantial minority. John Goldman,...

Beyond Molecular Monitoring: Cytogenetic Testing and Mutational Analysis in Chronic Myeloid Leukemia

Cytogenetic analysis remains an important component of patient monitoring until a complete cytogenetic response is achieved. In addition, the ability of conventional cytogenetics to identify additional chromosomal abnormalities not detected by fluorescence in situ hybridization is noteworthy. Jorge ...

Treatment Goals, Molecular Monitoring, and the Role and Use of Guideline Recommendations

The importance of achieving a certain level of response with imatinib (Gleevec) by 3 months in patients with chronic myeloid leukemia (CML) had previously been established in the IRIS (International Randomized Study of Interferon and STI571) trial.1 Analysis of data from this trial showed that...

CE Activity Instructions

*Corresponding author, MediCom Worldwide, Inc, 101 Washington Street, Morrisville, PA 19067, e-mail: gtombler@medicaled.com Activity Release Date: November 15, 2012Period of Validity: November 15, 2013 Program Overview This activity presents highlights from a satellite symposium held in...

hepatobiliary cancer

Lower Risk of Recurrence in Patients with HBV-related Liver Cancer Receiving Nucleoside Analogs

Patients with hepatitis B virus (HBV)-related hepatocellular carcinoma who received nucleoside analogs after curative liver resection had an associated lower risk of hepatocellular carcinoma in a nationwide cohort study using data from the Taiwan National Health Research Data Base. The study was...

sarcoma

Interval-compressed Chemotherapy More Effective with No Increase in Toxicity

A randomized controlled trial among patients with newly diagnosed localized Ewing sarcoma found that “chemotherapy administered every 2 weeks is more effective than chemotherapy administered every 3 weeks, with no increase in toxicity,” investigators from the Children’s Oncology Group reported in...

breast cancer

Small Increase in Cardiac Events for Trastuzumab plus Anthracycline in HER2-positive Disease

A 7-year follow-up of the phase III National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-31 found that the cumulative difference in the rate of cardiac events was 3.1% between patients with HER2-positive, node-positive breast cancer who received trastuzumab (Herceptin) in addition ...

Promoting a More Balanced Approach to Cancer Prevention and Treatment

Margaret I. Cuomo, MD, is a board-certified radiologist who served for many years as an attending physician in diagnostic radiology at North Shore University Hospital, Manhasset, New York. Dr. Cuomo is the daughter of former New York Governor Mario Cuomo and sister to Governor Andrew Cuomo. She is...

SIDEBAR: Expect Questions and Respond with Reasoned Explanations

“Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver,” three physicians from Memorial Sloan-Kettering Cancer Center (MSKCC) in New York...

MSKCC’s Decision Not to Purchase New Cancer Drug Sparks Editorial and Unprecedented Actions

“At Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenomenally expensive new cancer drug to our patients.” That was the opening sentence of a New York Times op-ed piece written by three physicians from Memorial...

Dr. Lewis C. Cantley to Lead New Cancer Center at Weill Cornell Medical College and NewYork-Presbyterian Hospital

Leading cancer researcher Lewis C. Cantley, PhD, has been named Director of the newly established Cancer Center at Weill Cornell Medical College and NewYork-Presbyterian Hospital. According to Weill Cornell Medical College’s new Dean, Laurie H. Glimcher, MD, and NewYork-Presbyterian Hospital’s CEO, ...

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