Current opinion in oncology
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Important studies have been reported in the past year on the biology and management of pediatric central nervous system tumors. Pediatric low-grade gliomas and adult gliomas do not share similar molecular genetic features. ⋯ Malignant gliomas in infants appear to be distinct entities compared with adult malignant gliomas. Further investigational studies are needed in ependymoma and diffuse pontine gliomas because current therapies have not resulted in improvements in outcomes.
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This review highlights the necessity of smoking cessation as a cornerstone of cancer prevention. We briefly review the literature linking smoking to various forms of cancer, the benefits of smoking cessation for cancer patients, and the Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. Also provided is an update on controlled smoking cessation studies published between March 1995 and February 1996.
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With the identification of recombinant production of the hematopoietic growth factors, these cytokines have been evaluated in the treatment of primary bone marrow failure states and after myelosuppressive chemo- or radiotherapy. Granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, and erythropoietin have been approved for clinical use, and others including c-mpl-ligand (also called megakaryocyte growth and development factor or thrombopoietin) are in phase I and II trials. ⋯ Guidelines have been published to provide a rational basis for the use of these factors in clinical practice. It should be emphasized, however, that for many of the recommendations data from randomized clinical trials are lacking.
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Chemotherapy drugs have been reported to cause cardiac side effects including cardiomyopathy, ischemia, arrhythmias, and myocardial necrosis. Most important in terms of daily practice is anthracycline-induced cardiomyopathy. The bisdioxopiperazine compound, dexrazoxane (ICRF-187, ADR-529), has been shown to prevent this cumulative side effect of the anthracyclines. ⋯ Paclitaxel also has been reported to cause arrhythmias and possibly ischemia. In a large data base, National Cancer Institute investigators found a 0.29% incidence of grade 4 or 5 cardiac toxicities, including heart block, ventricular tachycardia, and ischemic events. Other important chemotherapy-related cardiac toxicities discussed include fluorouracil-induced angina and arrhythmias, interleukin-4 induced-cardiomyopathy, and cardiotoxicity associated with autologous bone marrow transplantation procedures.
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The effectiveness of antileukemic therapy is limited by intrinsic and acquired cellular resistance. Preclinical investigations support a complex and redundant network of cytoprotective mechanisms resulting from decreased drug accumulation, intracellular drug detoxification, alterations in nuclear targets of the antineoplastic agent, impaired transduction of growth arrest signals, and inherent cytokinetic resistance to S-phase active agents. Some, but not all, of these mechanisms are coordinately regulated, and correlative studies suggest that some may indeed contribute to clinical chemotherapy resistance.