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Showing 2051 - 2100Sentinel Lymph Node Biopsy for Thin Melanomas?
When sentinel lymph node biopsy for the regional staging of melanoma was first introduced, it was recommended for any patient with a melanoma 1.0 mm in Breslow thickness or greater. Patients with thin melanomas were not thought to have a sufficiently high risk to warrant the additional cost and...
Favorable Early-stage Hodgkin Lymphoma and HD.6: The Take-Home and Don’t–Take-Home Messages
The Canadian HD.6 randomized study in patients with nonbulky early-stage Hodgkin lymphoma is mostly of historic interest.1,2 It has little relevance to current treatment standards or questions, and the risk for its inappropriate interpretation is of great concern. Radical Radiation Approach Long...
Expert Point of View: Improved Survival with Chemotherapy Alone in Limited-stage Hodgkin Lymphoma
A criticism of the HD.6 trial is that current radiation techniques are probably less toxic than subtotal nodal radiation therapy, which was used in this investigation. Responding to this in an accompanying editorial in The New England Journal of Medicine,1 David J. Straus, MD, of the lymphoma...
Abiraterone: New Drug in the Treatment of Metastatic Castration-resistant Prostate 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 Abiraterone acetate (Zytiga) (an oral agent that...
Drug Shortages Hit Oncology Hard: Experts Weigh in on Challenges and Solutions
Periodic drug shortages are an unavoidable reality in our complicated pharmaceutical supply chain; however, over the past several years, drug shortages have expanded to crisis levels, putting vulnerable patients at risk. In 2010, there were 178 drug shortages reported to the FDA, 132 of which were...
Benefits of Some Bisphosphonates Confirmed in Breast Cancer Outcomes, but Questions Remain
The story of bisphosphonates, and their disease-modifying potential in breast cancer, is still evolving. While some studies presented at the 2011 San Antonio Breast Cancer Symposium failed to show gains, others found benefits. The theme that is emerging is that bisphosphonates may be most...
Addition of Bevacizumab to Neoadjuvant Chemotherapy Increases Pathologic Complete Response Rate in HER2-negative Disease
Two studies reported in The New England Journal of Medicine showed that the addition of bevacizumab (Avastin) to neoadjuvant chemotherapy significantly increased the pathologic complete response rate in women with HER2-negative breast cancer. In one study, from the German Breast Group, the benefit...
Challenges, Progress, and Future Directions in Head and Neck Cancer
Although head and neck cancer remains a major therapeutic challenge, significant advances have been made over the past few decades. The ASCO Post recently spoke with Marshall R. Posner, MD, Medical Director of the Head and Neck Oncology Program, Mount Sinai Medical Center, New York, about the...
Context May Affect Benefit of Adjuvant Clodronate in Breast Cancer
A benefit of the oral bisphosphonate clodronate when used as adjuvant therapy for early breast cancer may depend on factors such as the endpoint assessed and patient age, suggests the randomized B-34 trial conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP). The trial,...
Answer to Secondary Cancers with RAF Inhibitors May Be Concomitant MEK Inhibition
Keratoacanthomas and cutaneous squamous cell carcinomas are frequently observed in patients receiving the RAF inhibitor vemurafenib (Zelboraf) for treatment of BRAF-mutated melanoma. As discussed by Lacouture and colleagues in a recent Journal of Clinical Oncology article, these effects appear to...
Moving the Field of Geriatric Oncology Forward
With the aging of the population, virtually all of the subspecialties of oncology will soon be concerned primarily with the care of older patients. While there is not one precise definition of the age of “geriatric” patients, it is clear that the aging of our society has necessitated a focus on the ...
Re-analysis of RADIANT-2 Finds Benefit for Everolimus in Patients with Carcinoid Tumors
A re-analysis of the RADIANT-2 trial, which evaluated everolimus (Afinitor) in patients with advanced nonpancreatic neuroendocrine tumors, has yielded prognostic factors that identify a group of patients who are not only at high risk for recurrence but who may derive benefit from treatment with...
Higher Intake of Red Meat Associated with Increased Risk of Mortality
Eating more red meat appears to be associated with an increased risk of all-cause mortality and death from cancer and cardiovascular disease, but substituting fish, poultry, nuts, legumes, low-fat dairy products, and whole grains for red meat is associated with a lower mortality risk, according to...
PSA Screening Reduced Prostate Cancer–Specific but Not Overall Mortality
“Analyses after 2 additional years of follow-up consolidated our previous finding that [prostate-specific antigen (PSA)]-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality,” investigators from the European Randomized Study of Screening for...
Update on Novel Anticoagulants: Dabigatran Etexilate
Efficacy and safety of traditional anticoagulants (eg, vitamin K antagonists) are well recognized, given their long-standing use in clinical practice. However, the novel anticoagulants have several potential advantages over the vitamin K antagonists. Even so, in light of their recent introduction...
Treating Acute Promyelocytic Leukemia without Chemotherapy
Throughout the course of medical history, we have witnessed innovations that have initially been met with skepticism but have later revolutionized our management of patients with specific disorders. The recent history of oncology drug development is full of instances where a drug that was...
Advances in Axillary Surgery for Patients with Breast Cancer
Results from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial, which found no benefit for completion axillary nodal dissection in patients with breast cancer involving one to two positive sentinel nodes,1 have led to changes in breast cancer management, though points of...
Summary of ASCO Provisional Clinical Opinion on Palliative Care
The ASCO provisional clinical opinion on palliative care recently published1 was based largely on data from seven published randomized controlled trials, including a phase III lung cancer trial by Temel and colleagues, which was the trigger for the new recommendations.2 The trial’s principal...
Short-term Hormone Therapy Did Not Increase Risk of Cardiovascular Death in Men with Localized Prostate Cancer, RTOG 94-08 Trial Finds
Short-term androgen deprivation therapy does not appear to increase cardiovascular mortality in men with clinically localized prostate cancer, according to a post hoc analysis of a large Radiation Therapy Oncology Group (RTOG)-sponsored clinical trial.1 “Our study analyzes data from a large...
ASCO Releases Palliative Care Provisional Clinical Opinion
ASCO has released a provisional clinical opinion (PCO) addressing the integration of palliative care services into standard oncology care.1 The ASCO Post recently spoke with one of the PCO’s lead authors, Thomas J. Smith, MD, Director of Palliative Care for Johns Hopkins Medicine and the Johns...
New Guidelines Recommend Less Frequent Screening for Cervical Cancer, but That Doesn’t Mean Screening Is Less Important
In the News focuses on media reports that your patients may have questions about at their next visit. This continuing column will provide summaries of articles in the popular press that may prompt such questions, as well as comments from colleagues in the field. In March 2012, the U.S. Preventive...
Clinical Findings and Consequences of Distributing Counterfeit Drugs for Hematology and Oncology
As introduced in our report on page 1 of this issue, counterfeit pharmaceuticals are an increasingly important safety concern, and three of the most prominent drug-counterfeiting episodes in recent years have involved hematology/oncology products. Counterfeit Erythropoietin Helen B., a 61-year-old...
Caveat Oncologist: Counterfeit Pharmaceuticals
In 2002, Tim F., a 17-year-old liver transplant patient, received 40,000 units of erythropoietin weekly, beginning immediately after his transplantation procedure.1 His family had purchased the product from the local CVS Pharmacy, upon his discharge from a Manhattan hospital. After each injection,...
Integrated Genetic Profiling Can Identify Predictors of Outcome and Improve Risk Stratification in AML Patients
A mutational analysis of 18 genes in 398 patients with acute myeloid leukemia (AML) found at least one somatic alteration in 97.3% of the patients and identified genetic predictors of outcome that improved risk stratification among patients with AML, independent of age, white-cell count, induction...
Oral Rivaroxaban Is Noninferior to Standard Anticoagulant Therapy in Acute Pulmonary Embolism
Thromboembolic disease is common in patients with cancer and increases risk of mortality. Recent studies showed that the oral factor Xa inhibitor rivaroxaban (Xarelto) was as effective and safe as standard anticoagulant therapy in treating deep-vein thrombosis, with superior efficacy of rivaroxaban ...
Expert Point of View: Chemoradiation with Fluorouracil and Mitomycin Reduces Recurrence of Muscle-invasive Bladder Cancer
In an editorial accompanying the recently reported UK phase III Bladder Cancer 2001 (BC2001) trial, Shipley and Zietman, from Massachusetts General Hospital and Harvard Medical School, point out that this trial shows that “the addition of a very tolerable regimen of chemotherapy to radiotherapy...
Chemoradiation with Fluorouracil and Mitomycin Reduces Recurrence of Muscle-invasive Bladder Cancer
Radiotherapy is an alternative to surgery in muscle-invasive bladder cancer, particularly in less-fit patients. However, it is associated with high rates of incomplete response or recurrence, with salvage surgery often being required. Although synchronous chemoradiotherapy has improved local...
American Lung Association Provides Guidance on Lung Cancer Screening
The American Lung Association has released new interim guidelines to assist physicians, patients, and the public in their discussions about lung cancer screening. Developed by the American Lung Association’s Lung Cancer Screening Committee chaired by Jonathan Samet, MD, MS, from the University of...
Vandetanib: New Drug for Unresectable Medullary Thyroid 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 The oral kinase inhibitor vandetanib (Caprelsa) was...
Study Shows Continued Benefit of PSA Screening in Reducing Prostate Cancer Mortality
Studies assessing the effect of prostate-specific antigen (PSA) testing on prostate cancer mortality have produced conflicting results, and recommendations regarding PSA screening vary among authorities. The recently published 11-year follow-up of the European Randomized Study of Screening for...
Managing Febrile Neutropenia: What Are the Best Antibiotic Regimens?
Management of patients with cancer who have fever and a low neutrophil count is one of the most common scenarios oncologists face today. “Physicians have to be keenly aware of the infection risks, diagnostic methods, and microbial therapies required for managing febrile neutropenic patients because ...
Maintenance of Certification in Medical Oncology
It is said that time is perhaps the most treasured asset we have. If you are a practicing oncologist, everyone wants more and more of your time, and I’m not referring to patients. Rather, there is an increasing proliferation of folks who want to make sure we’re doing a good job, and they are...
Pediatric ALL with Induction Failure Is Highly Heterogeneous with Varying Outcomes
While failure of remission-induction therapy is rare in children and adolescents with acute lymphoblastic leukemia (ALL), when it does occur it is highly adverse and heterogeneous, according to a study in The New England Journal of Medicine. “Patients who have T-cell leukemia appear to have a...
Low-dose Radioiodine as Effective as High-dose in Thyroid Ablation
Two studies in The New England Journal of Medicine found that low-dose radioiodine is as effective as a high-dose strategy in treating patients with thyroid cancer and that recombinant human thyrotropin (thyrotropin alfa [Thyrogen]) and thyroid hormone withdrawal had similar efficacy in preparing...
Maintenance Lenalidomide Improves Progression-free Survival and Time to Progression in Patients with Multiple Myeloma
Three phase III, double-blind, multicenter, randomized studies showed that lenalidomide (Revlimid) maintenance therapy for patients with multiple myeloma significantly improved progression-free survival or time to progression, the primary endpoints of the studies published in The New England...
Can Whole-genome Sequencing Predict Cancer Risk and Improve Public Health?
If, as expected, the cost of whole-genome sequencing continues to drop, perhaps down to the $1,000 vicinity, it may become an alluring option for consumers who want to know about their risks for cancer and other diseases. But can genome sequencing really provide practical information about...
Radiotherapy in Early-stage Hodgkin Lymphoma
The treatment of patients with Hodgkin lymphoma is one of the major success stories in medical oncology. Depending on clinical stage, clinical risk factors, and the treatment given, 60% to 90% of all patients can be cured of their malignancy long-term. Hodgkin lymphoma survivors represent one of...
Tracing Breast Cancer Luminary’s Path to Oncology, from Hungary to Houston
Gabriel N. Hortobagyi, MD, FACP, ASCO Past President (2006-2007), grew up under the oppressive regime of communist Hungary during the Cold War. “As college-educated intellectuals, my family was among the ‘politically undesirables,’ and if we had not escaped Hungary, neither my two sisters nor I...
Multicenter Phase II Trial Supporting Approval of Brentuximab Vedotin in Anaplastic Large-cell Lymphoma
Systemic anaplastic large-cell lymphoma (ALCL) is an aggressive T-cell lymphoma subtype characterized by uniform expression of CD30. Apart from low- to intermediate-risk patients with ALK-positive disease, patients with ALCL have a poor prognosis when treated with conventional, anthracycline-based...
Medical Ethicists Reflect on Their Personal Cancer Experiences
The recently published book, Malignant: Medical Ethicists Confront Cancer, takes a personal look at the cancer experience from the perspective of seven medical ethicists who were also patients with cancer or cared for spouses with cancer.1 The book’s editor, Rebecca Dresser, JD, MS, who teaches law ...
Expert Point of View: PD-1 Immune Checkpoint Inhibitors Look Promising in Multiple Solid Tumors
Oncologists can expect to hear more about immune checkpoint blockade, according to two discussants of these abstracts. In fact, five PD-1 immune checkpoint compounds are already in the pipeline (Table 1), according to Giuseppe Giaccone, MD, PhD, of the National Cancer Institute, Bethesda, Maryland. ...
Screening Should Begin Early for Survivors of Childhood Cancer
Survivors of childhood cancer, particularly those treated for childhood Hodgkin lymphoma or Wilms tumor with abdominal radiation, procarbazine (Matulane), and platinum chemotherapy, are at an increased risk of developing gastrointestinal subsequent malignant neoplasms, according to a retrospective...
MEK Inhibitor Reduces Progression of BRAF-mutated Melanoma and Might also Benefit Others
In the News focuses on media reports that your patients may have questions about at their next visit. This continuing column will provide summaries of articles in the popular press that may prompt such questions, as well as comments from colleagues in the field. The MEK inhibitor trametinib...
Early Access to Palliative/Supportive Care vs Usual Care Improves Pain Management
Many cancer patients remain undertreated for pain despite availability of guidelines and educational efforts to improve pain treatment. In a recent Annals of Oncology article, Bandieri and colleagues from the Italian Epidemiologia Clinico-Assistenziale del Dolore in Ospedale (ECAD-O) group report a ...
Mitotane-containing Regimens Explored for a Rare Tumor
Response rates and progression-free survival rates were significantly better among patients with advanced adrenocortical carcinoma receiving mitotane (Lysodren) plus EDP (etoposide, doxorubicin, and cisplatin) than in patients receiving mitotane with streptozocin (Zanosar), according to results of...
Prognostic Value of Integrated Cytogenetic and Mutational Risk Classification in Acute Myeloid Leukemia
Jay P. Patel, BS, and colleagues from Memorial Sloan-Kettering Cancer Center in New York recently performed mutational analysis of 18 genes in a subgroup of newly diagnosed acute myeloid leukemia (AML) patients who had been randomized to receive cytarabine plus high-dose or standard-dose...
Updated Findings Further Define Role of Tyrosine Kinase Inhibitors in CML
With three available tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia (CML), attention has turned from the ability to achieve a sustained response to the possibility of “curing” patients. Updates of pivotal trials presented at ASCO may help define the role of the tyrosine...
Astragalus
The use of dietary supplements by cancer patients has risen significantly over the past 2 decades despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about dietary supplements can be daunting. Patients typically rely on family, friends, and the...
Pertuzumab: New Drug for HER2-positive Metastatic Breast 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 In June 2012, pertuzumab (Perjeta) was approved for use...
As Conflicting Guidelines Evolve, Experts Continue to Debate the Merits of Cancer Screening
In the 1930s and 1940s, when the American Cancer Society [ACS] first brought forth the message that early cancer detection saves lives, it was a broad brushstroke and an appropriate message. The problem now is that new technology enables us to find [tumors that would never progress to invasive...
