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SIDEBAR: Treatment Decisions for Locally Advanced NSCLC Draw on 'Art of Medicine'

With treatment advances, there are now fewer absolutes in managing locally advanced NSCLC, according to Dr. Reckamp. “We are moving toward treating performance status 2 patients, and obviously, that is a heterogeneous group of people,” she elaborated. “For those who need a lot of care, you need to...

Progress, Slow but Sure, Seen for Current Lung Cancer Therapies

This year, we have some abstracts that help move things forward in lung cancer, maybe at a little bit slower pace than in previous years. But there are important points that we can learn from some of these abstracts,” commented Karen L. Reckamp, MD, of the City of Hope, who presented findings on...

SIDEBAR: From Small Centers to Academic Centers

The use of cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) to treat carcinomatosis “came from the smaller centers,” noted Nita Ahuja, MD, Director of the Peritoneal Surface Malignancies Program at Johns Hopkins Medicine. “A lot of things in medicine come from academia and move...

Successful Use of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy May Hinge on Prior Experience

A review of 60 consecutive patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC)—sometimes called “hot chemotherapy”—found 0% mortality and 33% morbidity, with “a significant reduction of grade III/IV morbidity,...

leukemia

Adjuvant Chemotherapy for Breast Cancer Not Linked to Acute Myeloid Leukemia and Myelodysplastic Syndromes

Contradicting what some previous investigations have found, a study from The US Oncology Network found that adjuvant chemotherapy for breast cancer does not increase the risk of acute myeloid leukemia and myelodysplastic syndromes (AML/MDS), at least within the first 3 years of treatment.1 The...

21-gene Recurrence Score Predicts Outcomes of Node-positive, ER-positive Patients after Adjuvant Chemoendocrine Therapy

The 21-gene recurrence score (obtained with Oncotype DX) can help identify patients with estrogen receptor (ER)-positive, node-positive breast cancer who do not respond well to adjuvant chemoendocrine therapy, according to a retrospective analysis of the National Surgical Adjuvant Breast and Bowel...

Expert Point of View: Stephen E. Jones, MD

In a debate about the benefit of anthracycline therapy at the Symposium, Stephen E. Jones, MD, of US Oncology Research, The Woodlands, Texas, advocated for greater use of non–anthracycline-containing regimens. Dr. Jones was the principal investigator of US Oncology Research Trial 9735,1 which found ...

solid tumors

Noncolorectal GI Cancer Evidence Incorporated into Guidelines

The noncolorectal gastrointestinal cancer studies selected for this year’s Best of ASCO meetings include some whose results are being folded into practice guidelines or are good candidates for incorporation, according to Alexandria T. Phan, MD, Associate Professor at The University of Texas MD...

global cancer care

Viral Infection and Liver Cancer: A Global Health Crisis

It is estimated that at least 15% of all cancers worldwide can be attributed to infectious etiologies, mostly viral infections. At this year’s ASCO Annual Meeting, an intriguing session on virally induced cancers provided critical clues that could be of real practical value in advancing our battle...

leukemia
lymphoma

Developments in Hematologic Cancers Include New Considerations in Treating Challenging Leukemias and Multiple Myelomas

Speakers at the National Comprehensive Cancer Network (NCCN) 7th Annual Congress on Hematologic Malignancies reviewed the current standard of care for various hematologic cancers and explored new concepts in treatment. Below are highlights from presentations on chronic myelogenous leukemia (CML),...

On Mentoring: Looking Back with Gratitude and Paying It Forward

Upon graduation from medical school, doctors are given a gift that lasts a lifetime—the gift of respect. That respect needs to be re-earned every day, but it is accompanied by other rewards that come with caring for people: the ability to gain another’s trust, to reverse illness that alters the...

Breast Cancer Symposium Features Surgical Data, Updated Results from BOLERO-2, and Other Important News

The annual Breast Cancer Symposium, held September 13 to 15 in San Francisco, is jointly sponsored by ASCO, the American Society for Radiation Oncology, the American Society of Breast Disease, the American Society of Breast Surgeons, the National Consortium of Breast Cancers, and the Society of...

colorectal cancer

Patients with Lynch Syndrome Who Have Had Colorectal Cancer Are at Increased Risk of Other Cancers

Patients who have had colorectal cancer and who are carriers of the DNA mismatch repair gene mutations that cause Lynch syndrome “have an increased risk of a greater range of cancers than the recognized spectrum of Lynch syndrome cancers, including breast and prostate cancers,” according to a study ...

breast cancer

Short Interval between Initial and Contralateral Breast Cancer Increases Risk of Dying

Breast cancer survivors who develop contralateral breast cancer have an increased risk of dying from breast cancer throughout a follow-up period of 10 or more years, according to a study of a cohort of 42,670 women diagnosed with breast cancer in Sweden. “The added risk is considerable if the...

breast cancer

Feminist Author Babette Rosmond Helped Propel the Adoption of Patients’ Rights to Choose Their Cancer Treatment

Then writer and editor Babette Rosmond was diagnosed with breast cancer in 1971, the second wave of the Women’s Liberation Movement that began in the mid-1960s was in its infancy. Still, when told by her doctor that she would need a radical mastectomy—a procedure developed by William Stewart...

pancreatic cancer

Daniel Von Hoff, MD, Recognized with Award as Research Leader in Pancreatic Cancer

Daniel Von Hoff, MD, Physician-In-Chief of the Translational Genomics Research Institute (TGen) is the first recipient of the Lori Groetken Memorial Lecture and Award presented recently at Washington University in St. Louis. He delivered his lecture “A Relentless Molecular Pursuit Approach to Take...

supportive care
pain management

SIDEBAR: Don’t Expect Direct Questions from Patients about Pain

Just asking patients “Is there something else you want to address in the visit,” rather than “Is there anything else you want to address in the visit today,” dramatically reduced patients’ unmet concerns during a primary care visit, according to a 2007 study.1 That learning can be applied to...

supportive care
pain management

Pain Remains Prevalent among Oncology Outpatients, with Odds of Undertreatment Twice as High among Minority Patients

In 1994, a landmark study of pain among oncology outpatients prompted a host of pain management initiatives.1 More than 18 years later, a recent study among more than 2,000 cancer outpatients has found that “one-third of the patients who had pain or used analgesics received inadequate treatment for ...

pancreatic cancer

A Series of Medical Missteps

Since the beginning of my symptoms—occasional pain on the upper left side of my abdomen, accompanied at times by nausea—which started nearly 20 years ago, my condition, pancreatic neuroendocrine tumor, either remained undetected or was completely misdiagnosed until just recently. A series of...

Despite the Rhetoric, Cancer Care Costs Keep Skyrocketing: Is There a Solution?

Although health-care experts routinely agree that the rising costs of oncology services are untenable, there is disagreement about how to reduce expenditures without harming access and quality of care. At this year’s ASCO Annual Meeting, Thomas J. Smith, MD, FACP, offered some interesting ideas...

solid tumors

Socioeconomic Disparity in Colorectal Cancer Rates Attributed to Obesity and Behavioral Risks

More than one-third of the excess risk of invasive adenocarcinoma of the colon and rectum resulting from low socioeconomic status “could be explained by differences in exposure to behavioral risk factors, particularly a healthy diet,” researchers recently reported in the Journal of the National...

gynecologic cancers

Major Strides Seen in Treatment of Gynecologic Cancers

Research reported at this year’s ASCO Annual Meeting shows major strides in treating ovarian and cervical cancers, suggesting the potential of new agents and adding evidence in areas where optimal management is unclear, according to Jonathan S. Berek, MD, of the Stanford Women’s Cancer Center,...

multiple myeloma

Novel Drug Combinations Present New Hope for Effective Treatments in Multiple Myeloma

Developing early-phase clinical trials that incorporate combinations of novel agents targeting different pathways in the hematologic cancer multiple myeloma is a leading focus of the work of Sagar Lonial, MD, Professor of Hematology and Vice Chair of Clinical Affairs in the Department of Hematology ...

Karnofsky Award Winner Honors Mentors through Gift to Conquer Cancer Foundation

Kanti R. Rai, MD, and his wife Susan have been loyal donors to the Conquer Cancer Foundation for the past 9 years, but in 2012, a momentous occasion in his career inspired Dr. Rai to make a unique gift. A Moment of Reflection In the spring of 2012, Dr. Rai, an internationally recognized expert on ...

health-care policy

American Association for Cancer Research Mourns the Loss of Senator Arlen Specter

The American Association for Cancer Research (AACR) mourns the loss of Arlen Specter, who represented Pennsylvania in the U.S. Senate from 1981 to 2011. With his passing, the cancer research and biomedical science community lost one of its greatest supporters and promoters. During his five terms...

skin cancer

Vismodegib: Novel Agent for Treating Advanced Basal Cell Carcinoma

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 January 2012, vismodegib (Erivedge) was approved...

kidney cancer

Expert Point of View: Tim Eisen, MD, and Robert Figlin, MD

Over the past few years, we have gone from famine to feast.… We now have sorafenib [Nexavar] and sunitinib [Sutent], temsirolimus [Torisel], and everolimus [Afinitor], and interferon plus bevacizumab [Avastin] for treatment of metastatic renal cell carcinoma. If these drugs [in COMPARZ] are...

Role of Crizotinib in Previously Treated ALK-positive Advanced NSCLC

In yet another success story for personalized medicine, a targeted therapy extended survival in patients whose cancers expressed the target. Crizotinib (Xalkori), the first-in-class ALK inhibitor, extended progression-free survival and improved response rates compared with single-agent chemotherapy ...

breast cancer

Will mTOR Inhibitors Change the Treatment of Endocrine-sensitive HER2-negative Breast Cancer?

For the treatment of endocrine-sensitive metastatic breast cancer, the combination of an mTOR inhibitor and an endocrine agent represents a promising new option. At the 2012 Breast Cancer Symposium, the 18-month update of BOLERO-2, which tested therapy with everolimus (Afinitor) plus exemestane,...

lung cancer
issues in oncology

Phase II Study Suggests Advantage of Irreversible Pan-HER Inhibition in Advanced NSCLC

Dacomitinib is a new tyrosine kinase inhibitor that forms irreversible covalent bonds with the ATP domain of each of the three kinase-active members of the HER family—EGFR/HER1, HER2, and HER4. Agents such as erlotinib (Tarceva) and gefitinib (Iressa), which are of proven benefit in advanced...

leukemia

Challenges Persist in Treatment of Elderly Patients with CLL, but Novel Agents Hold Promise for Future Strategies

Chronic lymphocytic leukemia (CLL) is mainly a disease of the elderly, and the lack of a standard regimen for elderly patients has been a major challenge. The myelosuppressive regimens used to treat younger patients are not well tolerated by the elderly. However, some newer approaches currently...

pain management

Study Reveals Global Picture of Obstacles to Pain Control in Patients with Cancer

Hundreds of millions of patients with cancer around the world are suffering from unrelieved cancer pain, despite the availability of morphine and other drugs that could alleviate that suffering. The major barriers are twofold: governments failing to ensure an adequate supply of morphine and other...

breast cancer

One Year of Trastuzumab Remains the Standard of Care in HER2-positive Breast Cancer

For HER2-positive early breast cancer, 1 year of treatment with trastuzumab (Herceptin)—rather than 6 months or 2 years—remains the standard of care, based on two pivotal studies presented at the 2012 European Society for Medical Oncology (ESMO) Congress. The optimal duration of anti-HER2 adjuvant ...

issues in oncology

Nab-paclitaxel Approved in First-line Metastatic NSCLC

The FDA has approved paclitaxel protein-bound particles for injectable suspension, albumin-bound (nab-paclitaxel, Abraxane) for use in combination with carboplatin for the initial treatment of patients with locally advanced or metastatic non–small cell lung cancer (NSCLC) who are not candidates for ...

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...

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...

Nobel Laureate E. Donnall Thomas, MD, Dies at 92

In his 1990 Nobel Prize Lecture, Eduard Donnall Thomas, MD, with characteristic humility, acknowledged that the success he celebrated “was made possible by the work of many others in this and related fields.” Dr. Thomas, whose groundbreaking work in bone marrow transplantation marked a new era in...

kidney cancer

Pulmonary Radiotherapy Can Usually Be Omitted for Nephroblastoma and Pulmonary Metastases

For the majority of patients with nephroblastoma and pulmonary metastases, pulmonary radiotherapy can be omitted and the patients will still have a relatively good outcome, according to a study published in the Journal of Clinical Oncology. “The rationale of omitting pulmonary [radiotherapy] for...

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...

lymphoma

Novel Mechlorethamine Gel Considered Safe and Effective for Treatment of Mycosis Fungoides

A novel mechlorethamine, 0.02%, gel produced comparable or higher response rates (depending on the measurement used) than did mechlorethamine, 0.02%, compounded ointment, in a randomized controlled, multicenter study among 260 patients with stage IA to IIA mycosis fungoides, the most common form of ...

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...

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...

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...

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...

IOM Elects New Members, Foreign Associates

The Institute of Medicine (IOM) recently announced the names of 70 new members and 10 foreign associates during its 42nd Annual Meeting, in Washington, DC. Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have...

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...

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...

Rituximab Infusion Approved for NHL

The FDA recently approved a 90-minute infusion for rituximab (Rituxan) starting at cycle 2 for patients with non-Hodgkin lymphoma (NHL) who did not experience a grade 3 or 4 infusion-related adverse reaction during cycle 1.  Patients with clinically significant cardiovascular disease and high...

FDA Approves New Use of Pemetrexed in the Maintenance Setting for NSCLC

The FDA has expanded labeling to include the results of an additional trial evaluating the safety and efficacy of pemetrexed (Alimta) for the initial treatment of patients with locally advanced or metastatic, nonsquamous, non–small cell lung cancer (NSCLC) followed by pemetrexed maintenance in...

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