FDA Advises Checking Prefilled Syringes for Overfilling

The US Food and Drug Administration has advised healthcare providers to visually inspect Hospira Carpuject prefilled cartridges to check for overfill.
News Alerts

Colorectal Cancer: New Drugs, Emerging Paradigms

Dr. John Marshall highlights colorectal studies on aflibercept, regorafenib, maintenance therapy, perioperative chemotherapy, and second-line therapy, to be presented at ASCO® 2012.
Medscape Hematology-Oncology

Bomber Dies, Nearly 3 Years After Terminal Prostate Cancer

Released on compassionate grounds, as he was supposedly close to death from terminal prostate cancer, the Lockerbie bomber lived for nearly 3 years.
Medscape Medical News

Guidelines Now Available for CT Lung Cancer Screening

Joint recommendations from ACCP and ASCO recommend low-dose computed tomography (CT) scanning for individuals at high risk of developing lung cancer.
Medscape Medical News

Lack of Awareness of Late Drug Effects in Cancer Survivors

Very few primary care physicians are aware of all the main long-term complications from 4 commonly used chemotherapies.
Medscape Medical News

[Correspondence] Placebo effect in hot flush research

We commend Eleanor Mann and colleagues for their excellent Article about the use of cognitive behavioural therapy (CBT) to decrease the negative and debilitating effects of hot flushes and night sweats (HFNS) in patients who had been treated for breast cancer. The methods for this study were strong and well described, including both physiological and self-report measures, and they represent a novel approach to management of a challenging side-effect. Two large meta-analyses did not specifically identify any studies using CBT for management of hot flushes.

[Comment] Personalised medicine in oncology: questions for the next 20 years

Molecular characterisation of tumour cells enables refinement of classifications for many cancers and can sometimes guide treatment. Rare cancers can also be fragmented into subtypes. Gastrointestinal stromal tumours comprise at least ten different subtypes, which need distinct treatments for advanced or adjuvant phases. Complexity grows with recognition that heterogeneity can arise within one tumour and patient. Complex branched evolution of mutations is taking place, from primary tumour cells to metastatic cells.

[Comment] Treatment of brain metastases in patients with melanoma

Kim Margolin and colleagues' phase 2 trial of the anti-CTLA-4 antibody ipilimumab for patients with advanced melanoma and brain metastases is one of the first to specifically and prospectively address this important clinical problem, and is a result of progress made in the past 2 years. Previous phase 3 trials have shown that both ipilimumab and the BRAF inhibitor vemurafenib improve survival in metastatic melanoma. Furthermore, preliminary evidence suggests that vemurafenib and another BRAF inhibitor being assessed in clinical trials, dabrafenib (GSK2118436), have activity against brain metastases.

[News] States and US Government spar over medical marijuana

A week after the New Hampshire state legislature passed a bill allowing cancer patients and others with “debilitating medical conditions” to cultivate marijuana for pain management, federal agents raided state-sanctioned medical marijuana dispensaries in California.

[Comment] Is benefit of maintenance therapy for NSCLC best defined by progression-free survival?

Maintenance therapy for non-small-cell lung cancer (NSCLC) has gained acceptance in selected patients after the approval of pemetrexed and erlotinib for such use by the US Food and Drug Administration and European Medicines Agency. Both registration trials Furthermore, it has not been definitively established as a valid surrogate endpoint for overall survival or clinical benefit in NSCLC. In maintenance treatment, the activity of the intervention is known and would be expected to improve progression-free survival, although improvements in overall survival and quality of life are necessary to show a true benefit to patients and justify additional costs.

Synovial sarcoma in children and adolescents: A critical reappraisal of staging investigations in relation to the rate of metastatic involvement at diagnosis

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 9
Andrea Ferrari, Gian Luca De Salvo, Odile Oberlin, Michela Casanova, Angela De Paoli, Annie Rey, Véronique Minard, Daniel Orbach, Modesto Carli, Bernadette Brennan, Max M. Vannoesel, Carlo Morosi, Michael C. Stevens, Gianni Bisogno
Background European protocols for paediatric synovial sarcoma (SS) require that all children routinely undergo chest computed tomography (CT) scanning and bone scanning as initial staging procedures. This study aims to determine the rate of initial metastases in paediatric SS based on specific clinical characteristics, thereby investigating whether these diagnostic procedures are really necessary in all patients. Methods Data on 258 previously-untreated SS patients <21years old were pooled from the databases of different European paediatric groups (study period 1988–2005) for this analysis, and the associations between patients’ characteristics and any presence of metastasis were estimated. Results Fifteen cases (5.8%) had distant metastases at diagnosis (86% pulmonary). The presence of metastases was unassociated with patients’ gender or age, tumour grade or site, but it was influenced by T-status, and especially primary tumour size: the risk of metastases was 32 times higher in cases of tumour >5cm than for tumours ⩽5cm. Conclusions Our findings suggest that tumour diameter can be used as a variable for identifying patients at greater risk of metastases and warranting more accurate radiological investigations. Chest CT scanning may improve the accuracy of pulmonary staging over X-ray, but requires different ionising radiation exposures that might have carcinogenic potential: it can be omitted for patients with tumours ⩽5cm. Given the very low risk of bone metastases, bone scans may be recommended only in cases with evidence of lung metastases.

Population-based evidence of increased survival in human papillomavirus-related head and neck cancer

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 9
Mari Nygård, Bjarte Aagnes, Freddie Bray, Bjørn Møller, Jon Mork
Background Evidence from clinical, population-based and molecular studies has shown that human papillomavirus (HPV) infection can be a causal risk factor for a subset of head and neck squamous cell carcinomas (HNSCC). It is proposed that HPV-associated oropharyngeal cancer is a new disease entity that requires treatment and prevention strategies distinct from present recommendations. Methods In our population-based study we estimated incidence and survival trends in 8270 patients with HPV-related HNSCC (HPV⁺HNSCC) and HPV-unrelated HNSCC (HPV^–HNSCC) in Norway over the past three decades. Results In the period 1981–1995, patients with HPV⁺HNSCC had poorer survival than HPV^–HNSCC (adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI): 1.14–1.44). By 1996–2007, survival had increased in both groups, but the increase was significantly greater among HPV⁺HNSCC patients (HR 0.57, 95% CI: 0.48–0.67). During the same period, incidence also increased, but only for HPV⁺HNSCCs. From 1981–1995 to 1996–2007, median age at diagnosis for HPV⁺HNSCC decreased from 63.2 to 59.8years, while for HPV^–HNSCC median age at diagnosis of 66.6years remained unchanged. Conclusions We demonstrate a population level improvement in survival among patients with oropharyngeal squamous cell cancers commonly related to infection with HPV. In contrast, patients with HNSCC not related to HPV only showed a modest improvement in survival in the period 1981–2007. A concomitant increase in incidence and survival was observed for HPV-related cancers only. This trend cannot be explained by changes in treatment, cancer registration nor screening, but is most likely due to an increased prevalence of HPV-positive tumours.

Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: A prospective long-term follow-up study

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 9
Mariska den Heijer, Caroline Seynaeve, Reinier Timman, Hugo J. Duivenvoorden, Kathleen Vanheusden, Madeleine Tilanus-Linthorst, Marian B.E. Menke-Pluijmers, Aad Tibben
Purpose To explore the course of psychological distress and body image at long-term follow-up (6–9years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. Methods Psychological distress (general and breast cancer specific) and body image (general and breast specific) were assessed in 36 high-risk women before PM (T0), at 6months (T1) and 6–9years (T2) after PM/BR. Investigated predictive variables (assessed at T0) for long-term body image (assessed at T2) included psychological distress, body image and coping styles. Results Breast cancer specific and general distress significantly decreased from T0 to T1 as well as from T1 to T2. Problems regarding breast related and general body image were significantly higher at T1 than at T0. Subsequently, breast related body image scores significantly decreased from T1 to T2, while the decrease in general body image scores were not significant. Active coping and seeking social support were predictive of lower scores (i.e. less problems) on breast related and general body image at long-term follow-up. Furthermore, higher scores on general body image before PM/BR were predictive for increased general body image scores at long-term follow-up. Conclusion Our findings indicate that psychological distress is decreased after PM/BR, at the cost of persistent problems regarding body image. Exploration of coping styles and body image perception before PM/BR may help to identify vulnerable women who may benefit from additional support.

Why is Partial-breast Irradiation Still Investigational

The investigational nature of partial breast irradiation (PBI) remains an area of controversy in the field of breast radiotherapy. While we have a long track record of conducting and strongly supporting the research in this area, we have chosen the more cautious approach of continuing to offer PBI only as part of a trial, open to selected breast cancer patients at low risk of local recurrence. This position reflects the fact that existing whole breast radiotherapy has revealed very successful in controlling local recurrences and it remains the safest choice for the patient. Our thinking has been reinforced by the recent data linking the prevention of recurrence to long term breast cancer survival: until more is known about PBI safety, its indiscriminate use may deprive some women from their best chance of fighting breast cancer. Considerations regarding the correct interpretation of the available evidence in view of the still limited duration of follow up and of the pattern of local recurrence of breast cancer sustain our position that PBI can be offered only in the context of a clinical trial. Unfortunately, more time and data are warranted for PBI to be legitimately recognized a standard radiotherapy approach in breast conservation therapy.

Real-world Impact of Availability of Adjuvant Therapy on Outcomes in Patients With Resected Pancreatic Adenocarcinoma: A Canadian Cancer Agency Experience

Background: Patients with resected pancreatic cancer (PC) have a poor prognosis. In 2004, European Study Group for Pancreatic Cancer 1 (ESPAC1) showed that the use of adjuvant therapy (AT) with 5-fluorouracil (5-FU) improves overall survival (OS). Subsequently, the British Columbia Cancer Agency (BCCA) introduced guidelines to offer AT as the standard of care for patients with resected PC. This study reviews the OS and disease-free survival (DFS) in a pre-AT era (2000 to 2004) to the AT era (2005 to 2008) at the BCCA. Methods: Using pathology records, all PC resections at Vancouver General Hospital from 2000 to 2008 were identified. Patients referred to the BCCA and their treatment records were obtained from the Cancer Agency Information System and BCCA pharmacy database. Charts were reviewed to abstract patient and tumor characteristics, DFS, and OS. Outcomes were compared by log-rank comparison. Results: In the pre-AT era, 53 resections were recorded, with 64% referred to the BCCA. Median age was 65 years; poorly differentiated 59% and margin positive 38%. About 24% of patients received AT: all 5-FU. In the AT era, 64 resections were recorded, with 86% referred. Median age was 65 years, poorly differentiated 34% and margin positive 34%. 69% of patients received AT: 61% 5FU and 39% gemcitabine. Major reasons for no AT: delayed referral or metastases at time of referral 45% and poor performance status 35%. Pre-AT DFS 13 months versus 15 months AT era (P=0.55). Pre-AT OS 19 months versus 18 months AT era (P=0.59). Conclusions: Since the guideline for AT, there was an increase in the proportion of patients referred and treated, however, over 30% still do not receive or complete AT. In this single-institution series, there was no difference in survival outcomes between the pre-AT and AT eras. Strategies to improve rate and timeliness of referral should be explored.

Comparative Effectiveness of Filgrastim, Pegfilgrastim, and Sargramostim as Prophylaxis Against Hospitalization for Neutropenic Complications in Patients With Cancer Receiving Chemotherapy

Background: Comparative effectiveness of filgrastim, pegfilgrastim, and sargramostim in preventing hospitalization for febrile neutropenia (FN) during myelosuppressive chemotherapy has not been well characterized and is an important clinical question in oncology. Methods: This study used a retrospective cohort design and US healthcare claims data. Source population included patients with solid tumors receiving filgrastim, pegfilgrastim, or sargramostim during their first observed course of chemotherapy between July 2001 and June 2007. For each patient, every unique chemotherapy cycle during the course was identified, along with each cycle in which filgrastim, pegfilgrastim, or sargramostim was administered by the fifth day of the cycle (ie, as prophylaxis). Risks of hospitalization for neutropenic complications (broad definition: admission with a diagnosis of neutropenia, fever, or infection; narrow definition: admission with a diagnosis of neutropenia) and for any reason were examined on a cycle-specific basis during all the cycles in which colony-stimulating factor prophylaxis was administered. Unadjusted and adjusted odds ratios (ORs) for hospitalization were estimated. Results: Risk (unadjusted) of hospitalization for neutropenic complications (narrow definition) was 2.1% for filgrastim prophylaxis (n=8286), 1.1% for pegfilgrastim prophylaxis (n=67,247), and 2.5% for sargramostim prophylaxis (n=1736). Corresponding risks of hospitalization based on the broad definition were 4.0%, 2.6%, and 5.1%. Risks of all-cause hospitalization were 7.9%, 5.3%, and 9.6%, respectively. Adjusted odds of hospitalization were significantly higher for filgrastim [OR (range across the 3 alternative measures of hospitalization): 1.58-1.79; P<0.001] and sargramostim (OR: 1.89-2.68; P<0.001) versus pegfilgrastim. Conclusions: Risk of hospitalization for neutropenic complications during cancer chemotherapy is lower with pegfilgrastim prophylaxis than with filgrastim or sargramostim prophylaxis.

Adjuvant Radiation Therapy Increases Overall Survival in Node-Positive Gastric Cancer Patients With Aggressive Surgical Resection and Lymph Node Dissection: A SEER Database Analysis

Objectives: To determine the outcomes of postoperative radiation therapy on survival in gastric cancer. Methods: An analysis of patients with surgically resected and nonmetastatic gastric cancer from the Surveillance, Epidemiology, and End Results database from 1990 to 2003 was carried out. Survival curves were calculated according to the Kaplan-Meier method. Multivariate analysis was carried out by the Cox proportional hazard model. Results: We identified 11,630 patients who met inclusion criteria. Radiation therapy was associated with increased survival in patients with American Joint Committee on Cancer stage IB to IV. The median survival for stage IB and II patients treated with radiation was 96 months and 37 months, respectively, versus 56 months and 23 months for patients who did not receive adjuvant radiation (P=0.0281 for stage IB and <0.0001 for stage II). The 5-year overall survival for node-positive patients treated with radiation was 30.4% versus 21.4% for patients who did not receive adjuvant radiation (P<0.0001). The survival benefit of radiation therapy was maintained even if ≥15 lymph nodes were removed for N1 and N2 disease and if ≥30 lymph nodes were removed for N3 disease. For node-positive patients with ≥15 lymph nodes removed, adjuvant radiation was linked to increase survival in patients who underwent partial gastrectomy, total gastrectomy, and en bloc gastrectomy with other organs removed. Radiation was a strong independent factor for survival on multivariate analysis. Conclusions: There is a correlation between survival and radiation therapy in node-positive gastric cancer patients and is independent of the extent of surgical resection and lymph node dissection.

Screening Colonoscopy Among Colorectal Cancer Survivors Insured by Medicaid

Objectives: The objectives of this research study are to describe the proportion of Medicaid-insured colorectal cancer survivors who had a colonoscopy between 3 and 18 months after surgery of the colon or rectum and to determine if patient, health services, and community characteristics are associated with colonoscopy follow-up after treatment. Methods: A retrospective cohort study among 1044 Medicaid-insured individuals diagnosed with local or regional colorectal cancer was conducted. Multivariable logistic regression analyses assessed patient, hospital, and community characteristics associated with colonoscopy. Results: About 42% of the study population had a colonoscopy 3 to 18 months after surgery. Factors associated with receipt of colonoscopy in the multivariable model include having colon (vs rectal) cancer, having local (vs regional) cancer, and having received chemotherapy as part of first course of therapy. Being 75 or older (vs <65), having first course of therapy at a hospital with the highest surgical volume (vs lowest surgical volume), and living in an urban (vs rural) environment were associated with a decreased likelihood of colonoscopy. Colonoscopy utilization patterns diverge after 65 years of age when persons become dually insured by Medicare. By age 80 years, there seems to be an almost 3-fold difference in receipt of colonoscopy—those with comorbidity are more likely to be screened than those without comorbidity. Conclusions: Less than half of Medicaid-insured colorectal cancer survivors received a colonoscopy in 3 to 18 months after colorectal resection. Improvements in screening in this high-risk population should be the target of future interventions to reduce the probability of recurrence.

Intravascular B-Cell Lymphoma: An Elusive Diagnosis [DIAGNOSIS OF ONCOLOGY]

Outcome After Surgery Alone or With Restricted Use of Chemotherapy for Patients With Low-Risk Neuroblastoma: Results of Children's Oncology Group Study P9641 [Pediatric Oncology]

Purpose

The primary objective of Children's Oncology Group study P9641 was to demonstrate that surgery alone would achieve 3-year overall survival (OS) ≥ 95% for patients with asymptomatic International Neuroblastoma Staging System stages 2a and 2b neuroblastoma (NBL). Secondary objectives focused on other low-risk patients with NBL and on those who required chemotherapy according to protocol-defined criteria.

Patients and Methods

Patients underwent maximally safe resection of tumor. Chemotherapy was reserved for patients with, or at risk for, symptomatic disease, with less than 50% tumor resection at diagnosis, or with unresectable progressive disease after surgery alone.

Results

For all 915 eligible patients, 5-year event-free survival (EFS) and OS were 89% ± 1% and 97% ± 1%, respectively. For patients with asymptomatic stage 2a or 2b disease, 5-year EFS and OS were 87% ± 2% and 96% ± 1%, respectively. Among patients with stage 2b disease, EFS and OS were significantly lower for those with unfavorable histology or diploid tumors, and OS was significantly lower for those ≥ 18 months old. For patients with stage 1 and 4s NBL, 5-year OS rates were 99% ± 1% and 91% ± 1%, respectively. Patients who required chemotherapy at diagnosis achieved 5-year OS of 98% ± 1%. Of all patients observed after surgery, 11.1% experienced recurrence or progression of disease.

Conclusion

Excellent survival rates can be achieved in asymptomatic low-risk patients with stages 2a and 2b NBL after surgery alone. Immediate use of chemotherapy may be restricted to a minority of patients with low-risk NBL. Patients with stage 2b disease who are older or have diploid or unfavorable histology tumors fare less well. Future studies will seek to refine risk classification.

Functional T Cells Targeting NY-ESO-1 or Melan-A Are Predictive for Survival of Patients With Distant Melanoma Metastasis [Melanoma]

Purpose

To analyze the prognostic relevance of circulating T cells responding to NY-ESO-1, Melan-A, MAGE-3, and survivin in patients with melanoma with distant metastasis.

Patients and Methods

We examined 84 patients with follow-up after analysis (cohort A), 18 long-term survivors with an extraordinarily favorable course of disease before analysis (> 24 months survival after first occurrence of distant metastases; cohort B), and 14 healthy controls. Circulating antigen-reactive T cells were characterized by intracellular cytokine staining after in vitro stimulation.

Results

In cohort A patients, the presence of T cells responding to peptides from NY-ESO-1, Melan-A, or MAGE-3 and the M category according to the American Joint Committee on Cancer classification were significantly associated with survival. T cells responding to NY-ESO-1 and Melan-A (hazard ratios, 0.29 and 0.18, respectively) remained independent prognostic factors in Cox regression analysis and were superior to the M category in predicting outcome. Median survival of patients possessing T cells responding to NY-ESO-1, Melan-A, or both was 21 months, compared with 6 months for all others. NY-ESO-1–responsive T cells were detected in 70% of cohort A patients surviving > 18 months and in 50% of cohort B patients. Melan-A responses were found in 42% and 47% of patients in cohorts A and B, respectively. In contrast, the proportion was only 22% for NY-ESO-1 and 23% for Melan-A in those who died within 6 months.

Conclusion

The presence of circulating T cells responding to Melan-A or NY-ESO-1 had strong independent prognostic impact on survival in advanced melanoma. Our findings support the therapeutic relevance of Melan-A and NY-ESO-1 as targets for immunotherapy.

Predictors of Early Death Risk in Older Patients Treated With First-Line Chemotherapy for Cancer [Palliative and Supportive Care]

Purpose

Objective factors for making choices about the treatment of elderly patients with cancer are lacking. This investigation aimed to help physicians select appropriate treatments through the identification of factors that predict early death (< 6 months) after initiation of chemotherapy treatment.

Patients and Methods

Previously untreated patients greater than 70 years of age who were scheduled for first-line chemotherapy for various types of cancer were included. Baseline abbreviated comprehensive geriatric assessment (aCGA), including the Mini-Mental State Exam, Timed Get Up and Go (GUG), Activities of Daily Living (ADL), Instrumental Activities in Daily Living (IADL), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS15), and comorbidities index (Cumulative Index Rating Scale-Geriatric), was carried out. Prognostic factors of early death were sought from aCGA results and traditional oncology measures.

Results

A total of 348 patients were included across 12 centers in Southwest France (median age, 77.45 years; ratio of men to women, 1.47; advanced disease, 65%). Abnormal aCGA scores were observed for 18.1% of patients on the ADL, 73.0% of patients on the IADL, 24.1% of patients on the GUG, 19.0% of patients on the MMS, 44.0% of patients on the GDS15, and 64.9% of patients on the MNA. Advanced disease (odds ratio [OR], 3.9; 95% CI, [1.58 to 9.73]), a low MNA score (OR 2.77; 95% CI, [1.24 to 6.18]), male sex (OR, 2.40; 95% CI, [1.2 to 4.82]), and long GUG (OR, 2.55; 95% CI, [1.32 to 4.94] were associated with higher risk of early death.

Conclusion

In patients greater than 70 years of age with cancer, advanced disease, a low MNA score, and poor mobility predicted early death. We recommend that the MNA and GUG, performed by a trained nurse, be maintained as part of routine pretreatment workup in these patients to identify at-risk patients and to inform the decision-making process for chemotherapy.

Phase I Trial of Anti-CD22 Recombinant Immunotoxin Moxetumomab Pasudotox (CAT-8015 or HA22) in Patients With Hairy Cell Leukemia [Hematologic Malignancy]

Purpose

To conduct a phase I dose-escalation trial assessing safety and response of recombinant immunotoxin moxetumomab pasudotox (CAT-8015, HA22) in chemotherapy-resistant hairy cell leukemia (HCL).

Patients and Methods

Eligible patients had relapsed/refractory HCL after ≥ two prior therapies and required treatment because of abnormal blood counts. Patients received moxetumomab pasudotox 5 to 50 μg/kg every other day for three doses (QOD x3), with up to 16 cycles repeating at ≥ 4-week intervals if patients did not experience disease progression or develop neutralizing antibodies.

Results

Twenty-eight patients were enrolled, including three patients each at 5, 10, 20, and 30 μg/kg, four patients at 40 μg/kg, and 12 patients at 50 μg/kg QOD x3 for one to 16 cycles each (median, four cycles). Dose-limiting toxicity was not observed. Two patients had transient laboratory abnormalities consistent with grade 2 hemolytic uremic syndrome with peak creatinine of 1.53 to 1.66 mg/dL and platelet nadir of 106,000 to 120,000/μL. Drug-related toxicities in 25% to 64% of the 28 patients included (in decreasing frequency) grade 1 to 2 hypoalbuminemia, aminotransferase elevations, edema, headache, hypotension, nausea, and fatigue. Of 26 patients evaluable for immunogenicity, 10 patients (38%) made antibodies neutralizing more than 75% of the cytotoxicity of 1,000 ng/mL of immunotoxin, but this immunogenicity was rare (5%) after cycle 1. The overall response rate was 86%, with responses observed at all dose levels, and 13 patients (46%) achieved complete remission (CR). Only 1 CR lasted less than 1 year, with the median disease-free survival time not yet reached at 26 months.

Conclusion

Moxetumomab pasudotox at doses up to 50 μg/kg QOD x3 has activity in relapsed/refractory HCL and has a safety profile that supports further clinical development for treatment of this disease.

Chemotherapy-Related Thrombocytosis: Does It Increase the Risk of Thromboembolism

Oncology 2012;82:327–332 (DOI:10.1159/000337235)

Same-Day Discharge in Clinical Stage I Endometrial Cancer Patients Treated with Total Laparoscopic Hysterectomy, Bilateral Salpingo-Oophorectomy and Bilateral Pelvic Lymphadenectomy

Oncology 2012;82:321–326 (DOI:10.1159/000337573)

Front & Back Matter

Oncology 2012;82:X (DOI:10.1159/000339389)

Palliation of Symptomatic Malignant Ascites: An (Often) Unmet Need

Oncology 2012;82:313–314 (DOI:10.1159/000337690)

A Pilot Study of Long-Acting Octreotide for Symptomatic Malignant Ascites

Oncology 2012;82:315–320 (DOI:10.1159/000337246)

Total Vertebrectomy for Non-Small Cell Lung Cancer

Case Rep Oncol 2012;5:267–270 (DOI:10.1159/000339299)

Kaposi’s Sarcoma following Chronic Lymphocytic Leukemia: A Rare Entity

Case Rep Oncol 2012;5:271–274 (DOI:10.1159/000339228)

Two Cases of Cerebral Involvement in Malignant Lymphoma (CD20+) That Responded to Combination Therapy with Rituximab and Cladribine

Case Rep Oncol 2012;5:260–266 (DOI:10.1159/000339406)

Acute Generalized Exanthematous Pustulosis Induced by Erlotinib (Tarceva) with Superimposed Staphylococcus aureus Skin Infection in a Pancreatic Cancer Patient: A Case Report

Case Rep Oncol 2012;5:253–259 (DOI:10.1159/000338806)

Diffuse Large B-Cell Lymphoma Transformed from Mucosa-Associated Lymphoid Tissue Lymphoma Arising in a Female Urethra Treated with Rituximab for the First Time

Case Rep Oncol 2012;5:238–245 (DOI:10.1159/000333357)

Table of Contents

Editorial Board

The importance of exposure rate on odds ratios by cigarette smoking and alcohol consumption for esophageal adenocarcinoma and squamous cell carcinoma in the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium

Abstract: Background: Cigarette smoking is associated with esophageal adenocarcinoma (EAC), esophagogastric junctional adenocarcinoma (EGJA) and esophageal squamous cell carcinoma (ESCC), and alcohol consumption with ESCC. However, no analyses have examined how delivery rate modifies the strength of odds ratio (OR) trends with total exposure, i.e., the impact on the OR for a fixed total exposure of high exposure rate for short duration compared with low exposure rate for long duration. Methods: The authors pooled data from 12 case–control studies from the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium (BEACON), including 1242 (EAC), 1263 (EGJA) and 954 (ESCC) cases and 7053 controls, modeled joint ORs for cumulative exposure and exposure rate for cigarette smoking and alcohol consumption, and evaluated effect modification by sex, body mass index (BMI), age and self-reported acid reflux. Results: For smoking, all sites exhibited inverse delivery rate effects, whereby ORs with pack-years increased, but trends weakened with increasing cigarettes/day. None of the examined factors modified associations, except for ESCC where younger ages at diagnosis enhanced smoking effects (P<0.01). For EAC and EGJA, ORs with drink-years exhibited inverse associations in <5drinks/day consumers and no association in heavier consumers. For ESCC, ORs with drink-years increased, with trends strengthening with greater drinks/day. There was no significant effect modification, except for EAC and EGJA where acid reflux mitigated the inverse associations (P=0.02). For ESCC, younger ages at diagnosis enhanced drinking-related ORs (P<0.01). Conclusions: Patterns of ORs by pack-years and drink-years, delivery rate effects and effect modifiers revealed common as well as distinct etiologic elements for these diseases.

The descriptive epidemiology of female breast cancer: An international comparison of screening, incidence, survival and mortality

Abstract: Background: This paper presents the latest international descriptive epidemiological data for invasive breast cancer amongst women, including incidence, survival and mortality, as well as information on mammographic screening programmes.Results: Almost 1.4 million women were diagnosed with breast cancer worldwide in 2008 and approximately 459,000 deaths were recorded. Incidence rates were much higher in more developed countries compared to less developed countries (71.7/100,000 and 29.3/100,000 respectively, adjusted to the World 2000 Standard Population) whereas the corresponding mortality rates were 17.1/100,000 and 11.8/100,000. Five-year relative survival estimates range from 12% in parts of Africa to almost 90% in the United States, Australia and Canada, with the differential linked to a combination of early detection, access to treatment services and cultural barriers. Observed improvements in breast cancer survival in more developed parts of the world over recent decades have been attributed to the introduction of population-based screening using mammography and the systemic use of adjuvant therapies.Conclusion: The future worldwide breast cancer burden will be strongly influenced by large predicted rises in incidence throughout parts of Asia due to an increasingly “westernised” lifestyle. Efforts are underway to reduce the global disparities in survival for women with breast cancer using cost-effective interventions.

Analyzing the time trends of disease rates can help understand the etiology of the disease since a changing trend implies the changes of environmental risk factors while a constant trend may be explained by some genetic or stable environmental risk factors. Describing the gender difference in disease rates also has important etiological implications on risk factors with different distributions in males and females. As an integration of these two methodologies, Dyego Leandro Bezerra de Souza and colleagues provided a good example of presenting the changing epidemiology of two male predominant cancers, laryngeal and hypopharyngeal cancers, in Spain . In this recently published paper, the authors found the gap between genders in these two cancers has been narrowed in recent years and concluded that the observed trends might be explained by the different changes in tobacco and alcohol consumptions between genders.

Editorial Board

Geriatric thoracic oncology: Gaining momentum

Lung cancer accounts for the highest cancer associated mortality in the US. Of the 160,000 estimated deaths from lung cancer this year, the majority will be secondary to non-small cell lung cancer. Lung cancer is a disease of the older adult with over two-thirds of cases diagnosed in patients over the age of 65years and half of the cases diagnosed in patients over the age of 70years. With the rapid “graying” of the US population, akin to other age associated conditions, the overall incidence of lung cancer is expected to rise over the next 15–20years. With significant research in the field of lung cancer over the last 20years, the incidence and mortality from lung cancer decreased among individuals aged ≤50years, but increased among those aged ≥70years.

Perioperative care of the elderly oncology patient: A report from the SIOG task force on the perioperative care of older patients with cancer

Abstract: The increasing number of older cancer patients seen in daily practice demands reflection on how to optimize their care during the perioperative period. Optimally tailored surgical management, at present the most successful cancer treatment, firmly rests on an accurate and careful anesthesiological management.The unique peculiarities of anesthesia in older cancer patients prompted the International Society of Geriatric Oncology (SIOG) to put together a panel of international experts with the aim of reviewing the literature and drafting a consensus document. This article summarizes their views.

Impact of age, comorbidity and symptoms on physical function in long-term breast cancer survivors (CALGB 70803)

Abstract: Objective: The purpose of this study was to assess the impact of aging, comorbidities and symptoms on physical function in patients surviving 20years since adjuvant treatment for breast cancer.Patients and methods: Patients were originally treated on CALGB 7581 (from 1975 to 1980), a randomized trial of three adjuvant therapies and reassessed (153 of 193 eligible survivors) 20years from the onset of therapy for physical function and symptoms by the EORTC QLQ-C30 and comorbidities by the OARS questionnaire.Results: The average age at reassessment was 64.5years. 66% of patients had at least two comorbidities and 22% had four or more, but relatively little interference with activities. Older patients had greater multimorbidity. Physical function was generally high and comparable to matched population norms. Older patients had greater difficulty with strenuous activities. For every increase in number of comorbidities, physical function score decreased by 5.1 (p<.001). Symptoms were also frequent (80%) and correlated strongly with decreases in function (0–100u scale) (p<.001), to an even greater degree than comorbidities.Conclusion: Very long-term cancer survivors have changes in physical function and symptoms largely consistent with their aging suggesting that the impact of cancer and its treatment is attenuated over time and largely replaced by the impact of age-related comorbidities and functional decline.

Ageing and other factors behind recent cancer incidence and mortality trends in Italy

Abstract: Objective: The aim of this paper is to outline the age effect on cancer trends observed in Italy between 1998 and 2005.Methods: We analysed crude and age-adjusted cancer incidence and mortality trends for 36 sites and both sexes using data from 22 population-based registries of the Italian Network of Cancer Registries (AIRTUM). Some 818,017 incident cancers and 342,444 cancer deaths were analysed.Results: The population aged 65years and older increased from 19.0% to 20.6% between 1998 and 2005 with a significant effect on the cancer burden. The all-cancer, age-adjusted incidence rate was quite stable over the period (all sites excluding non-melanoma skin cancers: annual percent change (APC) men +0.3 CI +0.1/+0.5, women +0.2 CI −0.1/+0.4), but population ageing resulted in a growing number of new cases (crude rates: APC men +1.3 CI +1.0/+1.7, women +0.9 CI +0.6/+1.2). This effect was not evident for those cancer sites with high incidence rates among young subjects. The all-cancer, age-adjusted mortality rate decreased in both sexes but the crude rate changed in women only. Mortality increased for lung cancer among women (APC +1.5; CI +0.5/+2.5) and for melanoma among men (APC +2.7; CI +0.5/+4.8).Conclusions: Recent cancer trends in Italy are quite favourable, showing decreasing mortality rates for most sites (except for lung cancer among women and melanoma among men) and showing overall stable incidence. However, it follows that population ageing will have increased the cancer diagnostic and therapeutic needs and costs.

Advocacy in Action: Metastatic Breast Cancer Network

Shirley Mertz, board member of the Metastatic Breast Cancer Network (MBCN.org) and metastatic breast cancer survivor, introduces us to the work of MBCN informing, educating and supporting both men and...

Author: vitaloptions
Added: 05/23/2012

Musa Mayer: AdvancedBC.org

Musa Mayer, a research advocate and founder of the website, AdvancedBC,org, talks about her journey as an advocate for metastatic breast cancer.

Author: vitaloptions
Added: 05/23/2012

Musa Mayer: Issues and Challenges Surrounding Tissue Collection in Cancer Research

Musa Mayer, a research advocate and founder of the website, AdvancedBC,org, has a frank discussion with Selma Schimmel on the issues and challenges surrounding tissue and specimen collection and shari...

Author: vitaloptions
Added: 05/23/2012

Voice For Life®: Bob Payne and Sheri Haddock

In this episode of Voice for Life, native Texans, Bob Payne (prostate and non-Hodgkin's lymphoma cancer survivor), and his daughter, Sheri Haddock (currently battling esophageal cancer) tell their sto...

Author: vitaloptions
Added: 05/23/2012

Advocacy in Action: Inflammatory Breast Cancer Research Foundation

Advocacy in Action sat down with Ginny Mason to learn more about the Inflammatory Breast Cancer Research Foundation (www.ibcresearch.org...) and the work they do to help those with inflammatory breast ca...

Author: vitaloptions
Added: 05/23/2012