The cancer journal
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Chronic myelogenous leukemia (CML) is a clonal hematopoietic stem cell disorder that progresses through distinct phases characterized by progressive loss of the differentiation of the malignant clone. Over the past 4 decades, it has been established that the Bcr-Abl protein, created as a consequence of a (9:22) chromosomal translocation, is the cause of the disease. ⋯ STI571, an Abl-specific tyrosine kinase inhibitor, has shown remarkable activity in all phases of CML. The clinical features, molecular pathogenesis, and current treatment options of CML are reviewed along with the development of STI571, the phase I clinical results, and the application of this paradigm to other malignancies.
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Patients with deep primaries (> or = 4 mm) or regional lymph node involvement often require adjuvant therapy in addition to surgery to successfully treat melanoma. Various adjuvant strategies are reviewed. Randomized trials of IFN-alpha adjuvant therapy have demonstrated statistically significant improvements in disease-free and overall survival rates, leading to approval by the United States Food and Drug Administration of the use of 1 year of intensive IFN-alpha2b following surgical resection of high-risk disease. ⋯ Adjuvant vaccine therapy may be useful for treatment of cutaneous melanoma. Polyvalent melanoma vaccines are discussed as a potential adjuvant therapy. Finally, nonrandomized preliminary studies suggest that postoperative radiation to the neck or axilla after radical lymph node dissection may decrease regional recurrence rates in node-positive patients, supporting the selective use of radiation therapy for melanoma.
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Pancreatic cancer continues to pose a major public health concern and clinical challenge. The incidence of the disease is nearly equivalent to the death rate associated with the diagnosis of pancreatic cancer. Thus, there exists a need for continued improvement in the diagnostic, therapeutic and palliative care of these patients. ⋯ Unfortunately, the majority of patients with pancreatic cancer present with either locally advanced or metastatic disease that precludes operative cure. The expected survival for these patients is usually less than six months from diagnosis. Therefore, a goal of therapy should be adequate palliation of symptoms of pain, biliary or duodenal obstruction and improvement of remaining quality of life with the least degree of morbidity possible.