Current opinion in oncology
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The taxanes that target microtubules are among the most active drugs in breast cancer treatment; however, resistance to these agents remains a significant issue for many patients. The epothilones are a novel class of nontaxane, microtubule-targeting agents, currently being evaluated in varying stages of clinical trials. Ixabepilone is the first epothilone analogue to receive US Food and Drug Administration approval in the United States for the treatment of metastatic breast cancer and as such will be the primary focus of this review. ⋯ Phase II trials clearly demonstrate the activity of single-agent ixabepilone in both taxane-untreated and taxane-treated metastatic breast cancer. Although the highest activity was seen in early lines of therapy, there was also clear evidence of activity in heavily pretreated patients. Ixabepilone has also been evaluated in combination with capecitabine in a randomized, phase III trial demonstrating a benefit for the combination compared with single-agent capecitabine for patients resistant to anthracyclines and taxanes. In general, ixabepilone administered as a single-agent and in combination with capecitabine has been reasonably well tolerated.
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Erythropoiesis-stimulating agents reduce the transfusion requirements of anemic cancer patients receiving chemotherapy. Risks associated with the use of erythropoiesis-stimulating agents in cancer patients have more recently been identified. ⋯ To minimize risks associated with erythropoiesis-stimulating agent use in cancer patients, the most recent American Society of Clinical Oncology/American Society of Hematology clinical practice guidelines and Food and Drug Administration recommendations should be followed.
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To summarize the results of treatment of multiple myeloma in the era of novel agents. ⋯ ASCT has resulted in a modest contribution in the treatment of multiple myeloma. Hopefully, its impact will be increased with the incorporation of novel agents in the pretransplant induction regimens. The combination of thalidomide, bortezomib or lenalidomide with melphalan-prednisone or with dexamethasone has resulted in highly effective regimens for patients not eligible for high-dose therapy/stem cell transplantation.