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issues in oncology

A Conversation with David Henry, MD

Given the intricate nature of oncology workflow, terminology, cancer staging, and the high risk associated with chemotherapy administration, an oncology electronic medical record (EMR) system needs to be much more than a storehouse of patient information. According to David Henry, MD, Clinical...

lung cancer

Emerging Targeted Therapies Offer Glimmer of Hope for NSCLC but Biomarkers for Response Needed

Among the newer approaches to treatment of non–small cell lung cancer (NSCLC) are heat-shock protein 90 (Hsp90) inhibitors, toll-like receptor 2 (TLR2) agonists, and vascular-disrupting agents. So far, none appears to be a “home run,” but Hsp90 inhibition may be the most promising of the three...

ASCO’s Oncology Slide Library Functions as a Share‑and‑Exchange Forum

ASCO’s Oncology Slide Library—which allows ASCO meeting attendees to upload and share their ASCO meeting presentation slides with slide-library subscribers—may only be a year old, but participation is already very high. This year’s Annual Meeting in June marked the first time ASCO gave each speaker ...

Expert Point of View: Patients with Early Breast Cancer Benefit from Regional Nodal Irradiation

Thomas Buchholz, MD, of the University of Texas MD Anderson Cancer Center, Houston, commented that the “well conducted and analyzed” MA.20 study addressed a “simple clinically relevant question,” and the findings “add to the conclusive evidence that radiation eradication of local-regional...

breast cancer

No Value for Axillary Dissection in Patients with Breast Cancer and Occult Nodal Metastases

In a subanalysis of the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 study, nearly 16% of clinically node-negative patients were found to have occult metastases upon more detailed assessment of the sentinel lymph nodes. While a slight difference in outcomes was found among this...

SIDEBAR: A Snapshot of I-SPY 2

With principal investigator Laura Esserman, MD, MBA, of the University of California, San Francisco, and co–principal investigator Donald Berry, PhD, of MD Anderson Cancer Center, I-SPY 2 will screen up to 12 different drugs in neoadjuvant therapy for breast cancer over the course of the trial. In...

sarcoma

Novel Approaches and Agents Making Headway against Sarcoma

Novel approaches and agents reported at the ASCO 2011 Annual Meeting are improving outcomes in sarcoma, a heterogeneous disease with historically poor outcomes, according to William D. Tap, MD, Section Chief of Sarcoma Oncology at Memorial Sloan-Kettering Cancer Center in New York. Dr. Tap...

kidney cancer
prostate cancer

Novel Management Strategies Assessed in Renal Cell and Prostate Cancers

At the Best of ASCO Miami meeting, William Oh, MD, of the Tisch Cancer Institute, Mount Sinai School of Medicine, New York, described new trends and remaining questions in the management of renal cell and prostate cancers. Axitinib vs Sorafenib in Second-line RCC Axitinib, a potent and selective...

health-care policy

AACR Issues Landmark Report on Cancer Progress

At a recent press conference in Washington, DC, the American Association for Cancer Research (AACR) assembled luminaries from the cancer research and care communities to discuss the salient points of the association’s newly released progress report on the current and future state of cancer research ...

breast cancer

Optimizing HER2-directed Therapy in the Clinic

Seminal research in the treatment of HER2-positive breast cancer has been led by Edith A. Perez, MD, the Serene M. and Frances C. Durling Professor of Medicine at the Mayo Clinic, Jacksonville, Florida. The ASCO Post asked Dr. Perez to share her approach to HER2-directed therapy. Testing...

issues in oncology
health-care policy

A Conversation with Ezekiel J. Emanuel, MD, PhD

Last September, Ezekiel J. Emanuel, MD, PhD, a leading scholar in bioethics and health-care policy, was named the Diane v.S. Levy and Robert M. Levy University Professor and Vice Provost for Global Initiatives at the University of Pennsylvania in Philadelphia. His appointment will be shared between ...

issues in oncology

MD Anderson Cancer Center’s New President Has a Bold Vision

On September 1, 2011, Ronald A. DePinho, MD, became only the fourth President in the 70-year history of The University of Texas MD Anderson Cancer Center in Houston. Dr. DePinho spent the previous 14 years as head of Dana-Farber’s Belfer Institute for Applied Cancer Science. In a recent interview...

lung cancer

Studies Reveal that Hormonal Factors Influence Lung Cancer Risk in Women

In an effort to understand lung cancer risk factors and develop prevention strategies for the disease, Christina S. Baik, MD, MPH, thoracic oncologist and staff scientist at the Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, has examined epidemiologic trends in lung...

breast cancer

Neoadjuvant Chemotherapy or Surgery First: Outcome Not Affected

Chemotherapy can be delivered before breast-conserving therapy or after surgery, without influencing long-term local-regional recurrence, a large study from The University of Texas MD Anderson Cancer Center confirmed. The data were presented at the 2011 Breast Cancer Symposium in San Francisco.1 “A ...

ASCO Launches FASCO Designation

ASCO has announced the designation of Fellow of the American Society of Clinical Oncology, otherwise known as FASCO. Formerly called the ASCO Statesman Award and launched in 2007, the distinction is designed to honor ASCO’s most active volunteer members. “The FASCO status represents recognition for ...

breast cancer
symptom management

Estrogen for Vulvovaginal Atrophy in Breast Cancer: Debate Continues

Vulvovaginal atrophy is a concern for the majority of patients with breast cancer, not only because of its physical and psychosexual consequences, but because the optimal treatment—estrogen replacement—is controversial. Patients and physicians alike remain concerned that external estradiol may...

head and neck cancer

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...

health-care policy

A Visionary Call for the ‘Creative Destruction’ of Medicine

According to nationally regarded cardiologist and geneticist Eric Topol, MD, Chief Academic Officer of Scripps Health, the next frontier of the digital revolution can create exponentially better health care. Dr. Topol, who is also Director of the Scripps Translational Science Institute and...

breast cancer

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,...

head and neck cancer
survivorship

Eating Problems and Pain Prevalent in Survivors of Head/Neck Cancer

“Eating problems due to poor oropharyngeal functioning and persistent pain are the most prevalent problems” faced by patients 5 years after being treated for head and neck cancer, according to a study published online by the Archives of Otolaryngology–Head & Neck Surgery.1 More than 50% of...

issues in oncology

2012 Annual Meeting to Highlight NCI’s ‘Provocative Questions’ and Offer First-ever Pre–Annual Meeting Seminars

As this year’s ASCO Annual Meeting was being planned, the NCI was developing and releasing its “Provocative Questions” project—an effort to stimulate the cancer community to ask itself 24 key questions in order to advance the treatment of cancer and provide better care. It quickly became clear to...

breast cancer

2012 Breast Cancer Symposium to Expand Tumor Board Session, Add ‘Meet the Professors’ Session

The days of attending the Breast Cancer Symposium, just quietly listening to useful lectures, and then going home are over. In recent years, the meeting’s sponsors and planners have worked to make the 3-day gathering far more interactive and as intimate as a meeting with 1,500 attendees can be....

lung cancer

An Expert Shares Insight into the Future of Lung Cancer Treatment

Despite growing national focus on early detection, prevention, and new molecular-based treatments, lung cancer persistently remains the number 1 cause of cancer death for men and women in the United States. The ASCO Post spoke to lung cancer specialist Paul A. Bunn, Jr, MD, Executive Director,...

Constructing a Top Five List in Oncology

The American Society of Clinical Oncology has joined the American Board of Internal Medicine (ABIM) Foundation and eight other medical specialty societies to take a collective stand in improving patient care and addressing rising health-care costs. As part of the ABIM Foundation’s Choosing Wisely®...

breast cancer

Defining Meaningful Benefit: The Debate Continues in Bevacizumab’s Wake

The events surrounding the labeling of bevacizumab (Avastin) have been well covered since last November when the FDA withdrew the drug’s accelerated approval as a treatment for metastatic breast cancer. However, the controversy initiated a debate over the value of endpoints in clinical trials in...

Expert Point of View: More New Data Support Use of Daily Aspirin to Prevent Cancers

Is it time to recommend aspirin for cancer prevention? “It’s the question we are asking,” said Andrew T. Chan, MD, Massachusetts General Hospital and Harvard Medical School, who wrote a commentary accompanying three new studies in The Lancet and Lancet Oncology. The studies, by Peter M. Rothwell,...

global cancer care
pain management
palliative care

Untreated Cancer Pain Remains a Significant Global Problem

“Physicians are afraid of morphine … Doctors [in Kenya] are so used to patients dying in pain … they think that this is how you must die. They are suspicious if you don’t die this way — [and feel] that you died prematurely.” —Human Rights Watch interview with Dr. John Weru of Nairobi Hospice,...

prostate cancer

Advances in Prostate Cancer Accompanied by Ongoing Debates

Scientific advances have markedly improved prostate cancer survival, but this clinical success story is not without its share of controversy. From screening through treatment, a growing array of options offer an admixture of promise and confusion for clinicians and patients. Moreover, today’s...

survivorship

Risk Stratification and Targeted Therapy, Abetted by Collaboration, Improve Outcomes for Children with Cancer

Outcomes for children with cancer have “improved over the course of the years incrementally, mostly not from the development of new drugs, because virtually all the drugs that we use now in leukemia were available in the 1970s. It is really through better understanding of the heterogeneity of the...

colorectal cancer

To Scan or Not to Scan for Colon Cancer Recurrence?

Over the past 2 decades, we have seen a substantial increase in the 5-year survival of patients with stage II and III colon cancer, marking an evolving oncologic success story. However, in the postoperative setting, the value of regular CT screening to monitor for recurrence has been greeted with...

issues in oncology

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 ...

breast cancer

Older Breast Cancer Drugs Prove Superior to Newer Ones

In the treatment of metastatic breast cancer, established older agents outperformed newer, more expensive drugs in two studies that made news at the 2012 ASCO Annual Meeting. Microtubule Inhibitors In the phase III open-label CALBG 40502/NCCTG N063H trial of 799 chemotherapy-naive patients with...

Reflections from the Old World

A few years ago, I was a key witness for a patent dispute at a trial in Delaware. Acting for the complainant, I was briefed that the opening gambit of the opposition lawyer would be to discredit my CV and, therefore, the value of my testimony. “So you are a full Professor at the University of...

lung cancer

Second-line Treatments Tested in Patients with Non-Small Cell Lung Cancer

Results of two late-breaking phase III trials presented at 2012 ASCO Annual Meeting add to the evolving understanding of how best to treat non–small cell lung cancer (NSCLC). The TAILOR trial suggested the benefit of chemotherapy over EGFR-targeted therapy as second-line treatment of patients with...

lymphoma

Children with Favorable-risk Disease and Complete Response to Chemotherapy Have High Survival Rates without Radiotherapy

Among children with favorable-risk Hodgkin lymphoma, those who achieved a complete response after two cycles of chemotherapy and received no radiotherapy had high rates of survival similar to those who had a less complete response to chemotherapy and received radiotherapy, according to a study in...

Genomics vs Site of Cancer Origin as Basis for Treatment of Cancer Is ‘False Dichotomy’

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. Despite recent news reports...

prostate cancer
issues in oncology

Rethinking the Role of PSA Screening in Public Health

Population screening to identify preclinical disease is considered a central factor in the decades-long decrease in mortality seen in certain cancers. However, hope in the face of deadly disease can sometimes blind us to the scientific evidence. According to the recent U.S. Preventive Services Task ...

It’s Time to Get Ready for New Medicare Reporting Requirements

As if you didn’t already have enough to worry about, now add this: If your practice doesn’t meet the requirements of the Physicians Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive, you don’t just miss out on the bonuses the programs offered as incentive in recent years....

prostate cancer

Letter to the Editor: More Thoughts on PSA

An article that appeared in the August 15 issue of The ASCO Post (“Rethinking the Role of PSA Screening in Public Health”) contains false statements about the discovery of prostate-specific antigen (PSA) and its effectiveness as a test for early detection of prostate cancer. Contrary to what’s...

Faculty Q&A Discussion: Anaplastic Large-cell Lymphoma

 Dr. Armitage: For ALK-negative anaplastic large cell lymphoma, brentuximab vedotin is the best thing we have to deal with patients with recurrent disease, and who knows where it will end up in primary therapy. But if the patient is ALK-positive, there is a potential for crizotinib (Xalkori) to...

multiple myeloma

Will Carfilzomib Add Value to Multiple Myeloma Treatment?

Carfilzomib (Kyprolis), the next-generation proteasome inhibitor recently approved by the FDA for relapsed/refractory multiple myeloma, showed strong activity in the front-line setting when paired with lenalidomide (Revlimid) and low-dose dexamethasone (CRd).1 The study evaluated stringent complete ...

SIDEBAR: Is Watch and Wait the Best Strategy for Indolent NHL in the Rituximab Era?

Data from the RESORT and its planned subanalysis can guide oncologists in optimizing treatment for indolent non-Hodgkin lymphoma (NHL) with low–tumor burden advanced-stage disease, according to Michael E. Williams, MD, of the University of Virginia Cancer Center in Charlottesville. The phase III...

SIDEBAR: Should EGFR Tyrosine Kinase Inhibitors Be Continued Beyond Progression?

It is not yet clear if it is beneficial to continue first-line EGFR tyrosine kinase inhibitors in patients with EGFR-mutated lung cancer who experience progression and are started on chemotherapy, according to Dr. Horn. Two trials, one in Asia (looking at gefitinib [Iressa]) and one in North...

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,...

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...

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...

gynecologic cancers

SIDEBAR: All Eyes on Trials of IV vs IP Chemotherapy for Ovarian Cancer

The positive findings from the NOVEL trial add to the debate about how intravenous (IV) chemotherapy stacks up against intraperitoneal (IP) chemotherapy when treating ovarian cancer and the role of dose-dense approaches in general, according to Jonathan S. Berek, MD, of the Stanford Women’s Cancer...

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...

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 ...

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...

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