Seminars in oncology
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CNS involvement is a common feature of metastatic melanoma. Despite this, there is little evidence upon which clinicians can base decisions about treatment. The short prognosis and significant symptoms usually associated with melanoma brain metastases have excluded these patients from clinical trials. In Europe the standard treatment involves whole brain radiotherapy, although selected centers offer other modalities, including surgery, radiosurgery, and chemotherapy.
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Seminars in oncology · Aug 2002
Case ReportsBendamustine in the treatment of chronic lymphocytic leukemia: results and future perspectives.
Chronic lymphocytic leukemia (CLL) occurs predominantly in elderly patients. The treatment options for patients with CLL have increased with the introduction of purine analogs, and promising results have been reported with fludarabine and cladribine when these agents are used in newly diagnosed and relapsed disease. Monoclonal antibodies such as alemtuzumab and rituximab are also clinically active in CLL. ⋯ Bendamustine 100 mg/m(2) (days 1 and 2) was found to be an effective treatment for older patients with advanced CLL, with 14 of 21 patients responding. Complete hematologic remission was achieved in six of 21 patients and a further eight patients achieved a partial hematologic remission. The main toxicities were hematologic; nonhematologic side effects were mild and uncommon.
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Seminars in oncology · Jun 2002
ReviewTherapeutic options for essential thrombocythemia and polycythemia vera.
Several options exist for treating essential thrombocythemia and polycythemia vera. One approach is to assign the patient to a risk category from which treatment recommendations follow. The principal risks of essential thrombocythemia include thrombosis, major hemorrhage, and conversion to leukemia or myelofibrosis. ⋯ Anagrelide can be used with phlebotomy in selected patients. Women of childbearing age who are in the low-risk or intermediate-risk group can be treated with phlebotomy alone and low-dose aspirin if the platelet count is < 1,500 x 10(9)/L. For high-risk patients or pregnant patients, IFN-alpha can be added.
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Seminars in oncology · Jun 2002
ReviewTrastuzumab cardiotoxicity: Speculations regarding pathophysiology and targets for further study.
Trastuzumab, a monoclonal antibody that is selective for cells that overexpress the erbB2 receptor protein tyrosine kinase, is a promising targeted therapy for the treatment of breast cancer. Surprisingly, toxic cardiovascular side effects were discovered in late-phase clinical trials, and these effects were most prominent when trastuzumab was combined with anthracycline chemotherapy. ⋯ Further investigation of the role of normal and aberrant erbB2 signaling in the development of cardiac dysfunction could lead to an improved understanding of the pathophysiology of cardiac dysfunction and may lead to novel therapies for the treatment of heart failure, regardless of etiology. Understanding the nature and specificity of trastuzumab's cardiotoxic effects is important in better defining clinical criteria for inclusion and exclusion of patients who can safely receive trastuzumab for the treatment of breast cancer, or possibly other malignancies.
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Seminars in oncology · Jun 2002
ReviewTrastuzumab/chemotherapy combinations in metastatic breast cancer.
The past decade has seen many advances in the treatment of advanced breast cancer, including the development of both new chemotherapy drugs and novel targeted agents. Trastuzumab, a humanized monoclonal antibody directed against the HER2/neu protein, has been shown to be an efficacious treatment for HER2-overexpressing metastatic breast cancer, both as a single agent and when used in combination with chemotherapy. ⋯ Further trials are currently underway evaluating the use of trastuzumab in combination with other forms of chemotherapy, including vinorelbine, docetaxel, anthracyclines, and platinum agents. Hopefully, information from these trials will help resolve questions regarding the efficacy of various combinations and dosing schedules so that trastuzumab may be used most effectively in the treatment of HER2-overexpressing breast cancer in both the metastatic and the adjuvant settings.