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Research and Reviews for the Practicing Oncologist
Genomic oncology: moving beyond the tip of the iceberg
In the 15 years since the first map of the human genome emerged, genetics has become an integral part of medical practice worldwide.1 Oncology is no exception; the genetic origins of cancer were suspected more than a century ago and it is now well understood that most cancers are driven by genetic alterations that disrupt key cellular pathways involved in tumor survival and progression.2
In the 15 years since the first map of the human genome emerged, genetics has become an integral part of medical practice worldwide.1 Oncology is no exception; the genetic origins of cancer were suspected more than a century ago and it is now well understood that most cancers are driven by genetic alterations that disrupt key cellular pathways involved in tumor survival and progression.2
In the 15 years since the first map of the human genome emerged, genetics has become an integral part of medical practice worldwide.1 Oncology is no exception; the genetic origins of cancer were suspected more than a century ago and it is now well understood that most cancers are driven by genetic alterations that disrupt key cellular pathways involved in tumor survival and progression.2
Drug-induced immune hemolytic anemia associated with albumin-bound paclitaxel
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Life-threatening hypoglycemia resulting from a nonislet cell tumor
Nonislet cell tumor-induced hypoglycemia (NICTH), also known as Doege-Potter syndrome, is a rare paraneoplastic syndrome seen in association with various nonpancreatic tumors, benign and malignant, and comprising mesenchymal, vascular, or epithelial cell types. We report a case of recurrent life-threatening hypoglycemia from a large pelvic solitary fibrous tumor.
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Nonislet cell tumor-induced hypoglycemia (NICTH), also known as Doege-Potter syndrome, is a rare paraneoplastic syndrome seen in association with various nonpancreatic tumors, benign and malignant, and comprising mesenchymal, vascular, or epithelial cell types. We report a case of recurrent life-threatening hypoglycemia from a large pelvic solitary fibrous tumor.
Click on the PDF icon at the top of this introduction to read the full article.
Nonislet cell tumor-induced hypoglycemia (NICTH), also known as Doege-Potter syndrome, is a rare paraneoplastic syndrome seen in association with various nonpancreatic tumors, benign and malignant, and comprising mesenchymal, vascular, or epithelial cell types. We report a case of recurrent life-threatening hypoglycemia from a large pelvic solitary fibrous tumor.
Click on the PDF icon at the top of this introduction to read the full article.
Treatment outcomes in stage IIIA non–small-cell lung cancer in a community cancer center
Objective To analyze demographics and treatment outcomes in patients with stage IIIA NSCLC at a community cancer center.
Methods We reviewed charts of 226 patients diagnosed with stage IIIA NSCLC from January 2003 to December 2008 treated at our community cancer center. Results Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively.
Limitations Study design was retrospective and some medical records were not available. However, this population is likely representative of patients treated in similar settings.
Conclusions In our population, advanced age and male gender were associated with lower median survival. Responses to concurrent and sequential chemoradiation seemed to differ based on age group, which may be useful as a prognostic guideline for similar populations.
Funding Helen F Graham Cancer Center and Research Institute
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Objective To analyze demographics and treatment outcomes in patients with stage IIIA NSCLC at a community cancer center.
Methods We reviewed charts of 226 patients diagnosed with stage IIIA NSCLC from January 2003 to December 2008 treated at our community cancer center. Results Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively.
Limitations Study design was retrospective and some medical records were not available. However, this population is likely representative of patients treated in similar settings.
Conclusions In our population, advanced age and male gender were associated with lower median survival. Responses to concurrent and sequential chemoradiation seemed to differ based on age group, which may be useful as a prognostic guideline for similar populations.
Funding Helen F Graham Cancer Center and Research Institute
Click on the PDF icon at the top of this introduction to read the full article.
Objective To analyze demographics and treatment outcomes in patients with stage IIIA NSCLC at a community cancer center.
Methods We reviewed charts of 226 patients diagnosed with stage IIIA NSCLC from January 2003 to December 2008 treated at our community cancer center. Results Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively.
Limitations Study design was retrospective and some medical records were not available. However, this population is likely representative of patients treated in similar settings.
Conclusions In our population, advanced age and male gender were associated with lower median survival. Responses to concurrent and sequential chemoradiation seemed to differ based on age group, which may be useful as a prognostic guideline for similar populations.
Funding Helen F Graham Cancer Center and Research Institute
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Impact of bladder volume on radiation dose to the rectum in the definitive treatment of prostate cancer
Background and objective Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.
Methods Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets.
Results From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (P = .031).
Limitations Small sample size and small variations in bladder volumes.
Conclusions A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.
Funding/sponsorship None
Click on the PDF icon at the top of this introduction to read the full article.
Background and objective Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.
Methods Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets.
Results From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (P = .031).
Limitations Small sample size and small variations in bladder volumes.
Conclusions A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.
Funding/sponsorship None
Click on the PDF icon at the top of this introduction to read the full article.
Background and objective Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.
Methods Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets.
Results From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (P = .031).
Limitations Small sample size and small variations in bladder volumes.
Conclusions A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.
Funding/sponsorship None
Click on the PDF icon at the top of this introduction to read the full article.
Lung cancer in HIV-infected patients and the role of targeted therapy
Lung cancer is one of the most common malignancies in HIV-infected patients. Prevalence and mortality outcomes are higher in HIV-infected populations than in noninfected patients. There are several oral agents available for patients who harbor specific mutations, but little is known about mutations and affected pathways in HIV-infected patients with lung cancer. Recent trials have facilitated the inclusion of HIV-infected patients in clinical trials, but the population is remains underrepresented in oncology trials. Here, we review the literature on lung cancer in HIV-infected patients, and discuss common mutations in lung cancer and HIV-infected patients, the role of mutational analysis, and the potential role of targeted therapy in the treatment of lung cancer in HIV-infected populations.
Click on the PDF icon at the top of this introduction to read the full article.
Lung cancer is one of the most common malignancies in HIV-infected patients. Prevalence and mortality outcomes are higher in HIV-infected populations than in noninfected patients. There are several oral agents available for patients who harbor specific mutations, but little is known about mutations and affected pathways in HIV-infected patients with lung cancer. Recent trials have facilitated the inclusion of HIV-infected patients in clinical trials, but the population is remains underrepresented in oncology trials. Here, we review the literature on lung cancer in HIV-infected patients, and discuss common mutations in lung cancer and HIV-infected patients, the role of mutational analysis, and the potential role of targeted therapy in the treatment of lung cancer in HIV-infected populations.
Click on the PDF icon at the top of this introduction to read the full article.
Lung cancer is one of the most common malignancies in HIV-infected patients. Prevalence and mortality outcomes are higher in HIV-infected populations than in noninfected patients. There are several oral agents available for patients who harbor specific mutations, but little is known about mutations and affected pathways in HIV-infected patients with lung cancer. Recent trials have facilitated the inclusion of HIV-infected patients in clinical trials, but the population is remains underrepresented in oncology trials. Here, we review the literature on lung cancer in HIV-infected patients, and discuss common mutations in lung cancer and HIV-infected patients, the role of mutational analysis, and the potential role of targeted therapy in the treatment of lung cancer in HIV-infected populations.
Click on the PDF icon at the top of this introduction to read the full article.
Panobinostat: a novel mechanism of action shows promise in multiple myeloma
Following an initial “no” vote from the Oncologic Drugs Advisory Committee (ODAC) in late 2014, the US Food and Drug Administration eventually awarded accelerated approval in February 2015 to the histone deacetylase (HDAC) inhibitor panobinostat for use in select patients with relapsed multiple myeloma. Panobinostat has a novel mechanism of action that demonstrates synergy with the proteasome inhibitor bortezomib and the immunomodulatory agent dexamethasone, which translated into improved progression-free survival (PFS) for patients with multiple myeloma who had received at least 2 prior therapies, according to data from a prespecified subgroup analysis from the Panorama-1 trial.
Click on the PDF icon at the top of this introduction to read the full article.
Following an initial “no” vote from the Oncologic Drugs Advisory Committee (ODAC) in late 2014, the US Food and Drug Administration eventually awarded accelerated approval in February 2015 to the histone deacetylase (HDAC) inhibitor panobinostat for use in select patients with relapsed multiple myeloma. Panobinostat has a novel mechanism of action that demonstrates synergy with the proteasome inhibitor bortezomib and the immunomodulatory agent dexamethasone, which translated into improved progression-free survival (PFS) for patients with multiple myeloma who had received at least 2 prior therapies, according to data from a prespecified subgroup analysis from the Panorama-1 trial.
Click on the PDF icon at the top of this introduction to read the full article.
Following an initial “no” vote from the Oncologic Drugs Advisory Committee (ODAC) in late 2014, the US Food and Drug Administration eventually awarded accelerated approval in February 2015 to the histone deacetylase (HDAC) inhibitor panobinostat for use in select patients with relapsed multiple myeloma. Panobinostat has a novel mechanism of action that demonstrates synergy with the proteasome inhibitor bortezomib and the immunomodulatory agent dexamethasone, which translated into improved progression-free survival (PFS) for patients with multiple myeloma who had received at least 2 prior therapies, according to data from a prespecified subgroup analysis from the Panorama-1 trial.
Click on the PDF icon at the top of this introduction to read the full article.
Re-personalizing precision medicine: is there a role for patient-reported outcomes?
In the opinion of most, precision medicine is the future of cancer therapeutics. By producing response rates well into double digits, and substantially extending progression-free and overall survival, the molecular testing of tumors to select optimal treatment may be a way to justify the high cost of new and emerging therapeutics. The road to this future will likely be long and winding, however, with a string of incremental successes amid inevitable disappointments. Our patients will walk this road with us, agreeing to testing and treatment when those tests come back positive for an eligible mutation.
Click on the PDF icon at the top of this introduction to read the full article.
In the opinion of most, precision medicine is the future of cancer therapeutics. By producing response rates well into double digits, and substantially extending progression-free and overall survival, the molecular testing of tumors to select optimal treatment may be a way to justify the high cost of new and emerging therapeutics. The road to this future will likely be long and winding, however, with a string of incremental successes amid inevitable disappointments. Our patients will walk this road with us, agreeing to testing and treatment when those tests come back positive for an eligible mutation.
Click on the PDF icon at the top of this introduction to read the full article.
In the opinion of most, precision medicine is the future of cancer therapeutics. By producing response rates well into double digits, and substantially extending progression-free and overall survival, the molecular testing of tumors to select optimal treatment may be a way to justify the high cost of new and emerging therapeutics. The road to this future will likely be long and winding, however, with a string of incremental successes amid inevitable disappointments. Our patients will walk this road with us, agreeing to testing and treatment when those tests come back positive for an eligible mutation.
Click on the PDF icon at the top of this introduction to read the full article.
Inflammatory metastatic breast cancer with gallbladder metastasis: an incidental finding
Breast cancer is the most frequently diagnosed cancer in women, with an estimated 231,840 new cases representing 14.0% of all new cancer cases in the United States in 2015.1 Early screening and modern techniques of imaging and diagnosis have led to a significant improvement in detecting early-stage breast cancers and to a decrease in the incidence of metastatic breast cancer (MBC).2 About 20%-30% of patients who are initially diagnosed with an early-stage, nonmetastatic breast cancer will subsequently develop a distant metastatic disease. Between 6%-10% of the new breast cancer cases present initially as stage IV, referred to as de novo MBC.
Click on the PDF icon at the top of this introduction to read the full article.
Breast cancer is the most frequently diagnosed cancer in women, with an estimated 231,840 new cases representing 14.0% of all new cancer cases in the United States in 2015.1 Early screening and modern techniques of imaging and diagnosis have led to a significant improvement in detecting early-stage breast cancers and to a decrease in the incidence of metastatic breast cancer (MBC).2 About 20%-30% of patients who are initially diagnosed with an early-stage, nonmetastatic breast cancer will subsequently develop a distant metastatic disease. Between 6%-10% of the new breast cancer cases present initially as stage IV, referred to as de novo MBC.
Click on the PDF icon at the top of this introduction to read the full article.
Breast cancer is the most frequently diagnosed cancer in women, with an estimated 231,840 new cases representing 14.0% of all new cancer cases in the United States in 2015.1 Early screening and modern techniques of imaging and diagnosis have led to a significant improvement in detecting early-stage breast cancers and to a decrease in the incidence of metastatic breast cancer (MBC).2 About 20%-30% of patients who are initially diagnosed with an early-stage, nonmetastatic breast cancer will subsequently develop a distant metastatic disease. Between 6%-10% of the new breast cancer cases present initially as stage IV, referred to as de novo MBC.
Click on the PDF icon at the top of this introduction to read the full article.
Harnessing new data on immunotherapies
Immunotherapies once again took center stage at the 2015 annual meeting of the American Society for Clinical Oncology in Chicago, though many other groundbreaking clinical advances were also presented. The meeting’s theme, “Illumination and innovation: transforming data into learning,” captured the current focus, by both researchers and practicing oncologists, on the importance of being able to draw on new and enticing data and use it as the basis for improving the care of and outcomes for cancer patients.
CheckMate 067: Two immunotherapies better than one for advanced melanoma
Key clinical point Nivolumab alone or combined with ipilimumab significantly improves progression-free survival (PFS) and objective response rates (ORRs), compared with ipilimumab alone in previously untreated metastatic melanoma. Major finding Median PFS was 11.5 months with nivolumab plus ipilimumab, 6.9 months with nivolumab, and 2.9 months with ipilimumab. Data source Phase 3, double-blind randomized trial in 945 patients with previously untreated metastatic melanoma. Disclosures Bristol-Myers Squibb funded the trial. Dr Wolchok reported financial relationships with several firms including research funding from and consulting or advising for Bristol-Myers Squibb…
Click on the PDF icon at the top of this introduction to read the full article.
Immunotherapies once again took center stage at the 2015 annual meeting of the American Society for Clinical Oncology in Chicago, though many other groundbreaking clinical advances were also presented. The meeting’s theme, “Illumination and innovation: transforming data into learning,” captured the current focus, by both researchers and practicing oncologists, on the importance of being able to draw on new and enticing data and use it as the basis for improving the care of and outcomes for cancer patients.
CheckMate 067: Two immunotherapies better than one for advanced melanoma
Key clinical point Nivolumab alone or combined with ipilimumab significantly improves progression-free survival (PFS) and objective response rates (ORRs), compared with ipilimumab alone in previously untreated metastatic melanoma. Major finding Median PFS was 11.5 months with nivolumab plus ipilimumab, 6.9 months with nivolumab, and 2.9 months with ipilimumab. Data source Phase 3, double-blind randomized trial in 945 patients with previously untreated metastatic melanoma. Disclosures Bristol-Myers Squibb funded the trial. Dr Wolchok reported financial relationships with several firms including research funding from and consulting or advising for Bristol-Myers Squibb…
Click on the PDF icon at the top of this introduction to read the full article.
Immunotherapies once again took center stage at the 2015 annual meeting of the American Society for Clinical Oncology in Chicago, though many other groundbreaking clinical advances were also presented. The meeting’s theme, “Illumination and innovation: transforming data into learning,” captured the current focus, by both researchers and practicing oncologists, on the importance of being able to draw on new and enticing data and use it as the basis for improving the care of and outcomes for cancer patients.
CheckMate 067: Two immunotherapies better than one for advanced melanoma
Key clinical point Nivolumab alone or combined with ipilimumab significantly improves progression-free survival (PFS) and objective response rates (ORRs), compared with ipilimumab alone in previously untreated metastatic melanoma. Major finding Median PFS was 11.5 months with nivolumab plus ipilimumab, 6.9 months with nivolumab, and 2.9 months with ipilimumab. Data source Phase 3, double-blind randomized trial in 945 patients with previously untreated metastatic melanoma. Disclosures Bristol-Myers Squibb funded the trial. Dr Wolchok reported financial relationships with several firms including research funding from and consulting or advising for Bristol-Myers Squibb…
Click on the PDF icon at the top of this introduction to read the full article.