Seminars in oncology
-
Seminars in oncology · Feb 2005
ReviewColorectal cancer vaccines: what we know and what we don't yet know.
Humans have a sophisticated immune system that functions to clear invading organisms and abnormal cells. However, cancers are able to arise despite this immune system. Vaccines have the potential of benefiting cancer patients by stimulating an immune response against tumor-associated antigens (TAA). ⋯ Most studies conducted are phase I or II in the metastatic disease setting, limiting our understanding of the role of the immune response in controlling colon cancers. Phase III trials conducted to date have conflicting data with respect to improvements in disease-free and overall survival. It is our challenge to determine if and which vaccines have sufficient benefit to warrant large-scale trials in the adjuvant and prevention settings.
-
When used appropriately, screening for colorectal cancer (CRC) can reduce disease-related morbidity and mortality. Current methods include fecal occult blood testing (FOBT), flexible sigmoidoscopy [FS], barium enema, and colonoscopy; all are cost-effective techniques. Unfortunately, offering an array of options has not increased screening utilization, which continues to lag behind that of other common cancers. Newer techniques, particularly virtual colonoscopy (VC) and stool DNA testing, may offer attractive alternatives for healthcare provider recommendation and patient use.
-
Seminars in oncology · Feb 2005
ReviewOral capecitabine: bridging the Atlantic divide in colon cancer treatment.
5-Fluorouracil (5-FU) plus leucovorin (LV) has been the mainstay of treatment for colorectal cancer (CRC), with infused schedules more widely adopted in Europe and bolus schedules preferred in North America. However, the effective, oral fluoropyrimidine capecitabine is increasingly replacing intravenous (IV) 5-FU/LV on both sides of the Atlantic. Capecitabine generates 5-FU preferentially in tumor and is a well-established, first-line treatment for metastatic CRC. ⋯ An extensive phase III clinical trial program is further establishing the potential of the simplified capecitabine combinations to improve outcomes and unify treatment practices in the metastatic and adjuvant settings. New combinations with novel agents such as capecitabine/oxaliplatin plus erlotinib or bevacizumab are currently under investigation. Capecitabine has also shown promising activity and good tolerability in combination with radiotherapy in rectal cancer.
-
The increase in the incidence of non-Hodgkin's lymphoma (NHL) that has occurred over recent decades is expected to continue. Therapeutic options for patients with NHL have improved over the past 20 years, but almost all patients with low-grade lymphoma and approximately 50% of patients with high-grade lymphoma eventually die of their disease, regardless of the regimen used. Thus, there is a continuing need for novel therapeutic options. ⋯ Similar efficacy (83% ORR, 43% CR/CRu) has been reported with 90 Y-ibritumomab tiuxetan in patients with relapsed or refractory low-grade NHL with mild thrombocytopenia (platelet counts 100,000 to 149,000/mm3 ), and in patients with rituximab-refractory NHL (ORR 74% [CR 15%] compared with an ORR 32% to last rituximab treatment). Safety data compiled from patients entered into five studies have confirmed initial observations that the toxicities encountered with 90Y-ibritumomab tiuxetan therapy are mainly hematologic and transient. As part of a consolidated clinical approach to the ongoing development of 90Y-ibritumomab tiuxetan, studies are currently being conducted in the United States and Europe to examine the role of this agent in first-line therapy of indolent NHL, in diffuse large B-cell lymphoma, and in combination with chemotherapy with peripheral blood stem cell support.
-
Seminars in oncology · Dec 2004
Clinical TrialA phase II study to assess the efficacy of amifostine for submandibular/sublingual salivary sparing during the treatment of head and neck cancer with intensity modulated radiation therapy for parotid salivary sparing.
Intensity modulated radiation therapy (IMRT) allows for relative parotid salivary gland sparing for patients undergoing treatment for head and neck squamous cell cancer, but is less reliable for sparing the submandibular glands. Cytoprotection with amifostine (Ethyol; Medimmune Inc, Gaithersburg, MD) has been shown to decrease rates of acute and late xerostomia in patients undergoing radiation therapy for head and neck squamous cell cancer. The addition of amifostine to IMRT may augment parotid salivary sparing, and add submandibular/sublingual, and minor salivary gland sparing resulting in greater salivary flow rates and a more physiologic saliva. ⋯ Xerostomia outcomes will be correlated with salivary dose volume histogram data. Accrual has not yet begun. The results of this study will give an indication of the objective and subjective benefit of combined IMRT physical parotid salivary sparing and amifostine chemical cytoprotection for combined salivary gland sparing and reduction in the rate of xerostomia in patients undergoing IMRT for head and neck squamous cell cancer.