Oncologist Research Papers - Academia.edu (original) (raw)

This is a literature review about large granular lymphocyte leukemia (LGLL), a rare and misdiagnosed oncohematological disease, characterized by a clonal expansion of T-cells (T-LGLL) or NK-cells (NK-LGLL) in the bone marrow and/or peripheral blood. The clinical features of LGLL include cytopenias (anemia, neutropenia and thrombocytopenia), lymphocytosis (usually discrete), lymphadenopathy, hepatomegaly, splenomegaly, immune abnormalities and constitutional symptoms (fever, night sweats and weight loss). The diagnosis is based on the confirmation of the clonality of T-cells or NK-cells (polymerase chain reaction and Southern blot are the two methods most commonly used) and typical findings of the immunophenotypic analysis of peripheral blood lymphocytes (flow cytometry analyses for specific surface antigens). In contrast to the chronic and indolent course of T-LGLL, NK-LGLL has an acute presentation and poor clinical outcome. There are different current treatment options, depending on clinical presentation.

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- Algorithms, Adolescent, Stem Cell Transplantation, Child

Cancer is a prevalent disease in our aging population; however, few oncologists are familiar with caring for oncogeriatric patients. Surgery is presently the treatment of choice for most solid tumors, but it is frequently delivered in a suboptimal way in this patient subsetting. Undertreatment is often justified with the concern of an unsustainable toxicity, while overtreatment can be related to the lack of knowledge in optimizing preoperative risk assessment. To draw new light on this issue, several surgeons presented their series, providing hard evidence that surgical options can be offered to the elderly with cancer, with only a limited postoperative mortality and morbidity. As it is likely that much of these data suffer from selection bias, we concentrated on Comprehensive Geriatric Assessment (CGA), which can add substantial information on the functional assessment of elderly cancer patients. A validated instrument such as the CGA allows a comparison of series, predicting short-term surgical outcomes more precisely, and offers appropriate information when consenting elderly patients. Preoperative Assessment of Cancer in the Elderly is a prospective international study conceived and launched to outline the fitness of elderly surgical patients with malignant tumors. This paper reports on preliminary results and analysis from the ongoing study. The Oncologist 2005;10:262-268

- by Riccardo Audisio
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- Decision Making, Treatment Outcome, Risk assessment, Comorbidity

Using a case study of a mentally delayed minor sibling donating bone marrow for his older sister, we discuss an alternative ethical justification for minor donation. The accepted justification for permitting minor siblings to donate bone marrow or peripheral blood stem cells is that the donor will benefit because of the greater likelihood of survival and less suffering of the sibling. Based on the limited data from four small retrospective studies of the risks and benefits for minor donors, we argue that there is a possibility, illustrated by this case, that the do-nor may not benefit, particularly if the transplant is unsuccessful. We, therefore, encourage the oncology community to increase support for minor donors, particularly mentally delayed ones. We also argue that the donation can be ethically justified based on the donor's familial duty to his sister. The basis of familial duties is complex, including such factors as the nature, intimacy, and history of the relationship and the specific risks and benefits to all involved. We examine each of these factors for our case study. The Oncologist 2008;13:148 -151 Chris* is a 16-year-old young man with a mental capacity of an 8-year old. He has been chosen to be the bone marrow donor for his 19-year-old sister, Jordan, who has relapsed for the second time with leukemia. Both Chris and his mother were HLA typed; Chris shares eight of eight antigens with Jordan and the mother shares six of the eight antigens. The parents, in consultation with the physicians at the transplant center and at home, decided that Chris was the best donor for his sister, and the transplant and donation were scheduled. Chris is very excited about the donation, proclaiming "YES. YES. YES. I get to save my big sister's life." Yet other members of the family are concerned about Chris' role because of his mental age, his tendency to blame himself for mishaps, and his sensitivity to pain.

- by Pamela Hinds
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- Medical Ethics, Leukemia, Adolescent, Intellectual Disability

After completing this course, the reader will be able to:

- by Alan Simpson
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- Dentistry, Communication, Biomedical Engineering, Laughter

After completing this course, the reader will be able to:

- by Merih Guray
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- Breast Cancer, Differential Diagnosis, Risk factors, Benign Breast Disease

In spite of advances in treatment strategies, about 25%-40% of patients with breast cancer still eventually develop metastatic disease that is largely incurable. Treatment goals vary from symptom control to lengthening survival, mainly on the basis of patient age and performance status, tumor biology, site and extent of disease, and prior therapies. In particular, breast cancer molecular characterization allows for the identification of breast cancer subtypes with distinct biological features, a distinct clinical course, and distinct treatment sensitivity.

- by Valentina Conte
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- Metastatic Breast Cancer, ADJUVANT THERAPY, Oncologist

sion. The etiological pathopsychophysiology underlying CRF is multifactorial and not well delineated. Mechanisms may include abnormal accumulation of muscle metabolites, dysregulation of the homeostatic status of cytokines, irregularities in neuromuscular function, abnormal gene expression, inadequate ATP synthesis, serotonin dysregulation, abnormal vagal afferent nerve activation, as well as an array of psychosocial mechanisms, including self-efficacy, causal attributions, expectancy, coping, and social support. An important first step in the management of CRF is the identification and treatment of associated comorbidities, such as anemia, hypothyroidism, pain, emotional distress, insomnia, malnutrition, and other comorbid conditions. However, even effective clinical management of these conditions will not necessarily alleviate CRF for a significant proportion of cancer survivors. For these individuals, intervention with additional therapeutic modalities may be required. The National Comprehensive Cancer Network guidelines recommend that integrative nonpharmacologic behavioral interventions be implemented for the effective management of CRF. These types of interventions may include exercise, psychosocial support, stress management, energy conservation, nutritional therapy, sleep therapy, and restorative therapy. A growing body of scientific evidence supports the use of exercise and psychosocial interventions for the management of CRF. Research on these interventions has yielded positive outcomes in cancer survivors with different diagnoses undergoing a variety of cancer treatments. The data from trials investigating the efficacy of other types of integrative nonpharmacologic behavioral therapies for the management of CRF, though limited, are also encouraging. This article provides an overview of current research on the relative merits of integrative nonpharmacologic behavioral interventions for the effective clinical management of CRF and makes recommendations for future research. The Oncologist 2007; 12(suppl 1):52-67

- by Karen Mustian
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- Stress Management, Social Support, Fatigue, Gene expression

Wilms' tumor was the first solid malignancy in which the value of adjuvant chemotherapy was established. Multimodality treatment has resulted in a significant improvement in outcome from approximately 30% in the 1930s to more than 85% in the modern era. Although the National Wilms' Tumor Study Group and the International Society of Pediatric Oncology differ philosophically regarding the merits of preoperative chemotherapy, outcomes of patients treated with either up-front nephrectomy or preoperative chemotherapy have been excellent. The goal of current clinical trials is to reduce therapy for children with low-risk tumors, thereby avoiding acute and long-term toxicities. At the same time, current clinical trials seek to augment therapy for patients with high-risk Wilms' tumor, including those with bilateral, anaplastic, and recurrent favorable histology tumors. The Oncologist 2005;10:815-826 Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com CME CME This material is protected by U.S. Copyright law.

- by J. Dome and +1
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- Clinical Trial, Prognosis, Low Risk, Adjuvant Chemotherapy

After completing this course, the reader will be able to:

- by Richard Hurwitz
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- Radiation Therapy, Retinoblastoma, Ionizing Radiation, Oncologist

for the treatment of colorectal cancer. Severe hypersensitivity reactions to oxaliplatin rarely occur; however, they do represent a threat to the small number of patients that are occasionally affected. We developed a desensitization protocol and successfully applied it to a patient with severe, grade 3, hypersensitivity to oxaliplatin. For patients who have mild sensitivity to oxaliplatin, slowing the run rate down and giving an antihistamine and/or a steroid usually suffice. Desensitization will help to provide the small number of patients who experience severe hypersensitivity reactions with the ability to further receive an effective therapy for their colorectal cancer. The desensitization protocol is described in detail. The Oncologist

- by Deede Gammon
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- Antineoplastic Agents, Oncologist

After completing this course, the reader will be able to:

- by Javier Cortes
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- Breast Cancer, Cell Death, Learning Object, Microtubules

The article discusses Replens (Wellspring Pharmaceutical) as a vaginal lubricant/moisturizer and Estring (Pfizer) and Vagifem (Novo Nordisk) as topical estrogen replacements. W.W. has received an honorarium from Wyeth and Berlex as a guest speaker at CME events. No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

- by Wendy Wolfman
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- Breast Cancer, Conflict of Interest, The, Tamoxifen
- by Melina Pectasides
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- Clinical Trial, Radiosurgery, Incidence, Anticancer
- by Daniel Sargent
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- Treatment Outcome, Data Collection, Neoplasms, Medical Audit

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to patients and support to caregivers while encouraging the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum in which caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Increasingly, cancer patients are subjected to advertisements related to oncologic therapies and other cancer-related products in the popular media. Such direct-to-consumer advertising is controversial: while it may inform, educate, and perhaps even empower patients, it also has the ability to misinform patients, and strain their relationships with oncology providers. The U.S. Food and Drug Administration requires that directto-consumer advertising provide a balanced presentation of a product's benefits, risks, and side effects, but this can be difficult to achieve. Through a discussion of this topic by an oncology fellow, ethicist, cancer survivor, and senior oncologist, the role of direct-to-consumer advertising and its often subtle effects on clinical practice in oncology are explored. Although sparse, the medical literature on this increasingly prevalent type of medical communication is also reviewed. The Oncologist 2006;11:217-226

- by Thomas Lynch and +1
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- Communication, Medical Oncology, United States, Direct to Consumer Advertising

Carcinoid tumors are rare, slow-growing neuroendocrine tumors arising from the enterochromaffin cells disseminated throughout the gastrointestinal and bronchopulmonary systems. Though they have been traditionally classified based on embryologic site of origin, morphologic pattern, and silver affinity, newer classification systems have been developed to emphasize the considerable clinical and histopathologic variability of carcinoid tumors found within each embryologic site of origin. These neoplasms pose a diagnostic challenge because they are often innocuous at the time of presentation, emphasizing the need for a multidisciplinary diagnostic approach using biochemical analysis, standard cross-sectional imaging, and newer advances in nuclear medicine. Similarly, treatment of both primary and disseminated carcinoid disease reflects the need for a multidisciplinary approach, with surgery remaining the only curative modality. The prognosis for patients with these tumors is generally favorable; however, it can be quite variable and is related to the location of the primary tumor, extent of metastatic disease at initial presentation, and time of diagnosis. The Oncologist

- by K. Holen
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- Nuclear medicine, Incidence, Cross Section, Oncologist

The introduction of bisphosphonates in oncology has dramatically changed the management of patients with metastatic bone disease. In this manuscript, we thoroughly scrutinize the available body of clinical trials supporting the use of bisphosphonates in this setting and review new and ongoing research. Additionally, we summarize the data showing the benefits of bisphosphonate use in the prevention of treatment-induced bone loss and the intriguing emerging evidence on the antitumor potential of some of these agents when used in the adjuvant setting. Finally, we address the need for a careful consideration of potential benefits of bisphosphonate therapy and the risk for osteonecrosis of the jaw, a recently recognized late-toxicity of their use.

- by Manon Huizing
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- Clinical Trial, Bone Disease, Neoplasms, Bone Loss
- by Thomas Lynch
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- Genetics, Communication, Molecular Biology, Breast Cancer
- by Franco Trevisani and +1
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- Treatment Outcome, Hepatocellular Carcinoma, Aged, Oncologist

Throughout medical history, plant products have been shown to be valuable sources of novel anti-cancer drugs. Examples are the Vinca alkaloids, the taxanes, and the camptothecins, derived from the Madagscan periwinkle plant Catharantus roseus, the Pacific yew Taxus brevifolia, and the Chinese tree Camptotheca acuminata, respectively. For this reason, the South-American Office for Anti-Cancer Drug Development has implemented a large-scale project of acquisition and testing of compounds isolated from South American medicinal plants. The species are selected on the basis of a potentially useful phytochemical composition by consulting ethnopharmacological, chemosystemic, and ecological information. The collected samples are dried and first extracted with an organic solvent, then with distilled water. These crude extracts are evaluated at a concentration of 50 µg/ml for antiproliferative activity against one cell line. Extracts that significantly inhibit the growth of the cells (≥50%) at relatively low concentrations (≤50 µg/ml) are submitted to the more comprehensive disease-oriented screen of the U.S. National Cancer Institute. In parallel, these samples are further purified by bioassay-guided purification, involving repeated fractionation by diverse chromatography methods. If the active substance is expected to represent a novel structure, it is identified by appropriate chemical techniques, mechanistic studies are performed with a wide diversity of tumor models and laboratory techniques, and efforts are undertaken for the synthesis of potentially more useful analogs.

- by D. Mans
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- Brazil, Drug Discovery, Drug development, Ethnopharmacology

After completing this course, the reader will be able to:

- by Sander Dijkstra and +1
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- Computed Tomography, Treatment Outcome, Conflict of Interest, Classification

Informed consent traditionally has been viewed as a safeguard for the protection of patients' decisional autonomy. While informed consent is a critical means for the protection of the patient's dominion over the integrity of his body, exclusive consideration of the doctrine as a safeguard for patients eclipses the doctrine's significant benefits for the therapeutic endeavor. Undertaking a thorough informed consent process helps the physician avoid the unilateral burdens of paternalism; furthers compliance with the doctor's legal obligations, ethical duties, and clinical responsibilities; and, as importantly, enhances the collaborative treatment enterprise.

- by Joseph J. Fins
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- Informed Consent, Medical Oncology, Oncologist, Mental Competency

Treatment of cervical cancer is usually surgery in the early stages and radiotherapy or chemoradiotherapy in more advanced stages of the disease. Recurrence may occur in multiple sites following primary treatment. Although recurrent metastatic disease is not curable, surgical treatment may be of great help if locoregional recurrence is detected early. Fluorine-18 Fluorodeoxyglucose positron emission tomography - computed tomography (F-18 FDG PET/CT) forms an important part of investigations in the diagnosis of clinically suspicious recurrent cervical cancer. To assess the role of F-18 FDG PET/CT in diagnosing recurrence in patients with clinical suspicion of recurrent cervical cancer. We retrospectively evaluated 53 histopathologically proved patients of cervical cancer. All the patients had been treated with either surgery/radiation therapy with or without chemotherapy. The standard PET/CT acquisition protocol, with delayed post void static pelvic images, wherever required, was fol...

- by Firuza Patel
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- Immunology, Magnetic Resonance Imaging, Surgical Oncology, Risk assessment

After completing this course, the reader will be able to:

- by Richard Schulick
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- Conflict of Interest, Survival Rate, Oncologist

Background Bevacizumab, a VEGF-A inhibitor, in combination with chemotherapy, has proven to increase progression-free survival (PFS) and overall survival in multiple lines of therapy of metastatic colorectal cancer (mCRC). The angiogenic factor angiopoetin-2 (Ang-2) is associated with poor prognosis in many cancers, including mCRC. Preclinical models demonstrate improved activity when inhibiting both VEGF-A and Ang-2, suggesting that the dual VEGF-A and Ang-2 blocker vanucizumab (RO5520985 or RG-7221) may improve clinical outcomes. This phase II trial evaluated the efficacy of vanucizumab plus modified (m)FOLFOX-6 (folinic acid (leucovorin), fluorouracil (5-FU) and oxaliplatin) versus bevacizumab/mFOLFOX-6 for first-line mCRC. Patients and Methods All patients received mFOLFOX-6 and were randomized 1:1 to also receive vanucizumab 2,000 mg or bevacizumab 5 mg/kg every other week. Oxaliplatin was given for eight cycles; other agents were continued until disease progression or unaccept...

- by Carlos López
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- Oncology, Medicine, Colorectal cancer, Internal Medicine

The distinctive clinical and biological characteristics of large granular lymphocyte leukemia are reviewed. Background: Clonal diseases of large granular lymphocyte (LGL) disorders can arise from a CD3+ T-cell lineage or from a CD3-NK-cell lineage. CD3+ LGL leukemia is the most frequent form of LGL leukemia and is a distinct entity by FAB and REAL classifications. Methods: The clinical course, biological features, and recent data on pathogenesis of CD3+ LGL leukemia are reviewed. The spectrum of differential diagnosis is described. Results: T-LGL leukemia affects elderly people. Approximately 60% of patients are symptomatic; recurrent infections secondary to chronic neutropenia, anemia, and rheumatoid arthritis are the main clinical features. The most common phenotype is CD3+, CD8+, CD57+. Clonality is detected by clonal rearrangement of the T-cell receptor gene. Clinical and molecular remission can be obtained with oral low-dose methotrexate. Serologic findings show frequent reactivity to the BA21 epitope of HTLV-I env p21e, suggesting that a cellular or retroviral protein with homology to BA21 may be important in pathogenesis. Clonal expansion may be facilitated by IL-12 and IL-15 lymphokines. Constitutive expression of Fas ligand by leukemic LGLs support the hypothesis that leukemic cells arise from antigen-activated cytotoxic T cells. Leukemic LGLs express a multidrug-resistance phenotype that could partly explain the chemoresistance observed in aggressive cases. Conclusions: CD3+ LGL leukemia is a distinct lymphoproliferative T-cell disorder with specific clinicobiological aspects. The clinical spectrum of LGL proliferations is wide and immunophenotypic, and genotypic studies are needed to establish the diagnosis. In this article, we describe the recent developments in the clinical and biological features of CD3+ T-LGL leukemia, and the differential diagnosis is reviewed. The natural history, pathogenesis, and therapeutic aspects of this disease are also presented. Clinical and Biological Features of CD3+ LGL Leukemia This T-cell type of LGL leukemia represents 85% of the LGL leukemias. The usual patient characteristics are shown in Table 1. The disease has no specific predilection for either men or women, and it affects principally elderly people with a median age of 60 years (range: 4 to 88 years). Only 10% of the patients are younger than 40 years of age, and pediatric cases rarely have been reported. Approximately one third of patients are asymptomatic at the time of diagnosis. The initial symptoms are related to neutropenia and include fever with recurrent bacterial infections. These infections typically involve the skin, oropharynx, and perirectal areas, but severe sepsis or pneumonia can also occur. Opportunistic infections are uncommon, and fatigue or B symptoms (fever, night sweats, weight loss) are observed in 20% to 30% of cases. The physical examination reveals the presence of mild to moderate splenomegaly in 20% to 50% of cases and hepatomegaly in 20%. Lymphadenopathy is rare. Bone marrow involvement is a common feature in T-LGL leukemia. An association with other diseases is a prominent feature of this lymphoid malignancy in 40% of cases. The associated comorbid conditions are reported in Table 2. Rheumatoid arthritis (RA) is the most common associated disease, occurring in approximately 25% of patients. 2,3,9 T-LGL leukemia patients with RA resemble patients with Felty's syndrome (neutropenia, RA, and splenomegaly), 10 and the articular manifestations of typical Felty's syndrome and RA-associated T-LGL leukemia are indistinguishable. The prevalence of LGL leukemia in Felty's syndrome is probably underestimated. 11 Feature Percentage of Cases Recurrent infections 20-40% B symptoms 20-30% Splenomegaly 20-50% Hepatomegaly 1-23% Lymphadenopathy 1-23% Data on two series of 128 and 68 patients., 2,3 Table 1.-Clinical Features of CD3+LGL Leukemia

- by Lubomir Sokol
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- Algorithms, Chemistry, Autoimmune diseases, Differential Diagnosis

The purpose of this study was to determine the tolerability and activity of rofecoxib (Vioxx ® ; Merck & Co., Inc., Whitehouse Station, NJ, http://www.merck. com) combined with weekly irinotecan (Camptosar ® ; Pfizer Pharmaceuticals, New York, http://www.pfizer. com) and infusional 5-fluorouracil (5-FU) as secondline therapy in metastatic colorectal cancer (MCRC). Enrolled patients had previously treated metastatic disease, were aged ≥18 to ≤75 years, and had adequate performance status. A cycle of treatment consisted of i.v. irinotecan on days 1, 8, 15, and 22, rofecoxib at an oral dose of 50 mg/day, and infusional 5-FU at a fixed dose of 200 mg/m 2 per day for 5 weeks followed by 3 weeks of therapy with rofecoxib alone. In the dose-finding study, the starting dose of irinotecan was 87.5 mg/m 2 and further dose escalations were planned by increments of 12.5 mg/m 2 up to 125 mg/m 2 . Forty-eight consecutive patients were enrolled in the study. Among the 15 cases enrolled in the dose-finding study, one patient experienced grade 3 reversible diarrhea as the dose-limiting toxicity, at the fourth dose level tested. Therefore, the dose of irinotecan for the phase II study was 125 mg/m 2 , and 33 patients were enrolled and received a total of 75 cycles. Hematological side effects were moderate, with grade 4 neutropenia recorded in only two patients. The most common nonhematological toxicity was diarrhea, occurring in 25 patients (75.8%) and considered to be of grade 3 in 12 patients (36.4%). Sixteen patients achieved partial responses (48.5%; 95% confidence interval [CI], 30.8%-66.5%), and another 10 patients (30.3%) had stable disease. The median time to progression was 7 months (95% CI, 5-12) and the median overall survival (OS) was 18 months; the 1-year estimated OS rate was 69.4%. The unique schedule tested in this study is feasible, is well-tolerated, and has promising activity in patients with MCRC after progression on oxaliplatin (Eloxatin ® ; Sanofi-Synthelabo Inc., New York, http:// www.sanofi-synthelabo.us)-based chemotherapy.

- by Luigi Mariani
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- Colorectal cancer, The, Aged, Combination drug therapy

After completing this course, the reader will be able to:

- by Jan Vermorken
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- Hypoxia, Apoptosis, Cell Culture, Medical Oncology

We read with concern the review by Guray and Sahin [1] that adds to the body of evidence on clinical features and practical management of benign breast diseases (BBDs) . We believe that the aspects regarding fibrocystic changes contained in the article deserve some comments (in particular for cystic lesions), and furthermore, several caveats are implicit (the data tend to be correlative rather than mechanistic in nature).

- by Ferdinando Mannello
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- Differential Diagnosis, Risk factors, Benign Breast Disease, Risk Factors

In patients with proven distant metastases from solid tumors, it has been a notion that the condition is incurable, warranting palliative care only. The term "oligometastases" was coined to refer to isolated sites of metastasis, whereby the entire burden of disease can be recognized as a finite number of discreet lesions that can be potentially cured with local therapies. Stereotactic body radiation therapy (SBRT) is a novel treatment modality in radiation oncology that delivers a very high dose of radiation to the tumor target with high precision using single or a small number of fractions. SBRT is the result of technological advances in patient and tumor immobilization, image guidance, and treatment planning and delivery. A number of studies, both retrospective and prospective, showed promising results in terms of local tumor control and, in a limited subset of patients, of survival. This article reviews the radiobiologic, technical, and clinical aspects of SBRT for various anatomical sites. The

- by Filippo Alongi
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- Radiosurgery, Cost Benefit Analysis, Oncologist, Lymph nodes

Fatigue is the most commonly reported symptom in patients with cancer, with a prevalence of over 60% reported in the majority of studies. This paper system- atically reviews pharmacologic agents in the treatment of cancer-related fatigue (CRF). We conducted a lit- erature review of clinical trials that assessed pharma- cologic agents for the treatment of CRF. These agents include hematopoietics

- by Karen Mustian and +1
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- Clinical Trial, Cancer, Fatigue, The

There are several advantages of administering primary systemic therapy (PST) instead of adjuvant therapy in the management of early breast cancer patients: (a) PST allows for a quantifiable evaluation of the sensitivity or resistance of any treated case and (b) the response assessment offers the opportunity to "cross over" to a different regimen for an individual patient, leading to more flexible, "tailored" therapies. Indeed, these advantages are tenable if one assumes that the primary tumor response serves as a surrogate marker of the efficacy of PST in terms of survival. Unfortunately, this has not yet been validated. The data that are actually available show that both clinical complete response (cCR) and pathological (p)CR have prognostic significance. pCR after chemotherapy has a greater prognostic impact than cCR; however, it is frequently observed in a subset of tumorssuch as those that are estrogen receptor negative, are human epidermal growth factor receptor positive, and have elevated proliferative activity-but occurs rarely in their human epidermal growth factor receptor-2/neu counterparts. cCR is more sensitive than pCR, but its assessment presents many hindrances. cCR after chemotherapy can predict early on which tumors are destined to undergo pCR, suggesting a role for this endpoint guiding further treatment decisions early on. The pCR rate in small randomized PST studies comparing chemotherapy with chemo-therapy plus trastuzumab was able to predict the difference in survival observed in large, randomized adjuvant trials with a similar study design. Conversely pCR cannot predict the outcome benefit of patients undergoing different hormonal therapies.

- by Daniele Generali
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- Magnetic Resonance Imaging, Breast Cancer, Estrogen Receptor, The

Background. In the U.S., adolescents and young adults diagnosed with cancer have had less survival improvement than older or younger patients, a deficit that may be a result of delays in diagnosis in an age group with the lowest rates of... more

- by Sean Martin and +1
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- Cancer, Survival Analysis, Health insurance, Adolescent

Rapidly growing insights into the molecular biology of colorectal cancer (CRC) and recent developments in gene sequencing and molecular diagnostics have led to high expectations for the identification of molecular markers to be used in optimized and tailored treatment regimens. However, many of the published data on molecular biomarkers are contradictory in their findings and the current reality is that no molecular marker, other than the KRAS gene in the case of epidermal growth factor receptor (EGFR)targeted therapy for metastatic disease, has made it into clinical practice. Many markers investigated suffer from technical shortcomings, resulting from lack of quantitative techniques to capture the impact of the molecular alteration. This understanding has recently led to the more comprehensive approaches of global gene expression profiling or genome-wide analysis to determine prognostic and predictive signatures in tumors. In this review, an update of the most recent data on promising biological prognostic and/or predictive markers, including microsatellite instability, epidermal growth factor receptor, KRAS, BRAF, CpG island methylator phenotype, cytotoxic T lymphocytes, forkhead box P3-positive T cells, receptor for hyaluronic acid-mediated motility, phosphatase and tensin homolog, and T-cell originated protein kinase, in patients with CRC is provided. The Oncologist 2010;15:699 -731 2004 [2]. In addition, CRC continues to be one of the most common fatal types of cancer.

- by Pol Specenier and +1
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- Biomarkers, Colorectal cancer, The, Targeted Therapy

After completing this course, the reader will be able to:

- by Ahmed Rebai
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- Genetics, Polymorphism, Computational Biology, Drug metabolism

Over the past 10 years there has been a significant increase in the armamentarium of agents available for use in the treatment of advanced colorectal cancer (CRC). Among these new agents are two monoclonal antibodies targeting the epidermal growth factor receptor (EGFR): cetuximab, a mousehuman chimeric monoclonal antibody, and panitumumab, a fully human monoclonal antibody. Both are approved as monotherapy for the treatment of chemotherapy-refractory advanced CRC. Cetuximab is also indicated for use in combination with irinotecan. Here, we review 10 reports of phase II and III clinical studies of patients treated with panitu-mumab or cetuximab monotherapy. The clinical trials demonstrate similar efficacy profiles for advanced CRC patients treated with panitumumab and cetuximab monotherapy, with some differences in their adverse event profiles. In addition, the recent results of retrospective tumor KRAS gene mutational analyses in CRC patients treated with anti-EGFR monotherapy are reviewed. Data from the clinical trials reviewed here clearly demonstrate that anti-EGFR monotherapy is an effective treatment modality for patients with chemotherapy-refractory advanced CRC. The Oncologist

Background. Cetuximab was demonstrated by clinical trials to improve response rate and survival of patients with metastatic and nonresectable colorectal cancer or carcinoma of the head and neck. Appropriate management of skin toxicity associated with epidermal growth factor receptor inhibitor (EGFR-i) therapy is necessary to allow adequate drug administration and to improve quality of life and outcomes.

- by Daris Ferrari
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- Quality of life, Treatment Outcome, Monoclonal Antibodies, The

- by Thomas Lynch
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- Decision Making, Palliative Care, Medical Ethics, The

Ovarian ablation has been used for more than a century in the treatment of breast cancer. Methods of irreversible ovarian ablation include surgical oophorectomy and ovarian irradiation. Potentially reversible castration can be accomplished medically using luteinizing hormone releasing hormone (LHRH) analogues. In addition, cytotoxic chemotherapy unpredictably produces amenorrhea and primary ovarian failure in 10%-95% of premenopausal women as a function of patient age, cumulative dose, and the specific agents used. In the metastatic setting, ovarian ablation and tamoxifen monotherapies produce comparable outcomes and may be more effective when used together. While many early adjuvant trials of ovarian ablation were methodologically flawed, a more recent meta-analysis by the Early Breast Cancer Trialists' Collaborative Group of 12 properly designed randomized trials found significantly greater disease-free and overall survival rates for women under the age of 50, regardless of nodal status, receiving ovarian ablation as a single adjuvant therapy. Several important issues regarding the role of ovarian ablation in the treatment of breast cancer remain unresolved. Data suggest that ovarian ablation followed by some years of tamoxifen produces similar The Oncologist 2004;9:507-517 www.TheOncologist.com The Oncologist ®

- by Tatiana Prowell
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- Breast Cancer, Survival Analysis, Treatment Outcome, Randomized Trial

Learning Objectives After completing this course, the reader will be able to: Discuss the basic epidemiology of pediatric CNS GCTs.Perform the diagnostic workup and full evaluation that is necessary when evaluating a patient with a suspected CNS GCT.Select among the different therapeutic alternatives employed in treating children with a CNS GCT. CME This article is available for continuing medical education credit at CME.TheOncologist.com Central nervous system (CNS) germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors and encompass a wide pathologic spectrum. CNS GCTs are most commonly located in the pineal and suprasellar regions of the brain and can be divided into major groups including germinomas and nongerminomatous GCTs (NGGCTs), with teratomas often considered a separate category. The clinical presentation varies by location and size, and it frequently includes endocrine abnormalities, visual changes, and signs of increased intracranial pressu...

- by Maria Echevarria
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- Radiation Therapy, Medicine, Cerebrospinal Fluid, Child

After completing this course, the reader will be able to: 1. Examine the level of involvement of oncologists in bereavement rituals after a patient dies, in order to improve the effectiveness of oncologists and other caregivers in helping families cope with their loss. 2. Analyze the reasons physicians do or do not participate in rituals involving direct contact or indirect contact with the bereaved families of their patients. 3. Develop formal programs for the care team to provide continuing support involving direct contact and indirect contact with bereaved families.

- by Amichay Meirovitz
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- Religion, Death, Bereavement, Radiation Therapy

After completing this course, the reader will be able to: 1. Assess the impact of oncology care on nonlicensed support staff. 2. Identify four areas that challenge support staff caring for oncology patients. 3. Evaluate the impact of... more

- by Barbara cashavelly
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- Focus Groups, Job Satisfaction, Qualitative Research, Medical Oncology

After completing this course, the reader will be able to:

- by Paolo Chiodini
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- Treatment Outcome, Conflict of Interest, Clinical research, Liposomes

After completing this course, the reader will be able to:

- by Antonie Taminiau
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- Computed Tomography, Treatment Outcome, Conflict of Interest, Classification

Metastatic spread to the spinal column is a growing problem in patients with cancer. It can cause a number of sequelae including pain, instability, and neurologic deficit. If left untreated, progressive myelopathy results in the loss of motor, sensory, and autonomic functions. Except in rare circumstances, treatment is palliative. Traditionally, conventional fractionated external beam radiotherapy has been the treatment of choice. "Surgery" for metastatic spinal disease was, and generally continues to be, equated with laminectomy by many physicians. However, there has been a remarkable evolution in surgical techniques over the last 20 years. Today, the goal of surgery is to achieve circumferential decompression of the neural elements while reconstructing and immediately stabilizing the spinal column. This has been made possible by the use of different surgical approaches and the exploitation of a burgeoning array of internal fixation devices. More recently, minimally invasive surgical techniques, such as endoscopy, kyphoplasty/vertebroplasty, and stereotactic radiosurgery, have been added to the surgeon's armamentarium. As the number of treatment options for metastatic spinal disease grows, it has become clear that effective implementation of treatment can only be achieved by a multidisciplinary approach. This will provide the surest means of maximizing the quality of the remainder of the patient's life. . Multiple lesions at noncontiguous levels occur in 10%-40% of cases .

- by Paul Klimo and +1
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- Radiosurgery, Treatment Outcome, SURGICAL TECHNIQUE, Multidisciplinary Approach

After completing this course, the reader should be able to:

- by Peter Ponsaerts
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- Immune response, Cancer treatment, Cancer Vaccines, Toll like receptor signaling

Introduction The VELOUR study evaluated the efficacy and safety of adding aflibercept to FOLFIRI (fluorouracil, leucovorin, irinotecan) in second-line therapy for metastatic colorectal cancer (mCRC). However, a nomogram that can stratify patients according to prognosis is unavailable, and the frequency and effect of the pragmatic use of modified schedules in actual practice remains unknown. Method The sample consists of 250 patients with mCRC treated with aflibercept and irinotecan-based chemotherapy at nine Spanish academic centers between January 2013 and September 2015. The result of a Cox proportional hazards model regression for overall survival (OS), adjusted for covariates available in daily practice, was represented as a nomogram and web-based calculator. Harrell's c-index was used to assess discrimination. Results The prognostic nomogram for OS includes six variables: Eastern Cooperative Oncology Group performance status, tumor location, number of metastatic sites, muta...

- by Carlos López
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- Oncology, Medicine, Colorectal cancer, Internal Medicine