Expert review of anticancer therapy
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Brain tumors are the most common cause of cancer-related death and the second most common form of cancer in pediatric patients. Many of these tumors are treated primarily with surgery, either alone or in combination with radiation or chemotherapy. ⋯ Each tumor type has features in common with, and unique from, other tumors that need to be understood prior to undertaking a rational treatment plan. This article summarizes some of these features.
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Expert Rev Anticancer Ther · Dec 2007
ReviewMultimodality management of brain metastases in metastatic melanoma patients.
Brain metastases are a frequent complication of advanced melanoma. Neurosurgery (generally followed by radiotherapy) may be useful in managing solitary, superficial brain metastases in good performance status patients, as well as for diagnostic purposes. Since most patients are not felt to be resectable and concurrent extracranial metastases frequently are present, whole-brain radiotherapy (WBRT) has become the de facto treatment standard. ⋯ Recent studies have suggested that focal irradiation using linear accelerator-based stereotactic radiosurgery or gamma-knife technologies can result in excellent local control and prolonged survival in some patients. It is possible that more aggressive combined modality treatment strategies, such as addition of systemic therapy, may further improve outcome. Current data suggest that aggressive treatment of patients with up to five brain melanoma brain metastases is capable of producing prolonged survival in many patients, including some long-term complete responses.
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The current standard of care for malignant gliomas consists of surgery, radiotherapy and conventional (DNA-damaging) chemotherapies. These treatments are relatively nonspecific and may be applied to all glioma subtypes. Developments in cancer medicine, however, now offer the opportunity to direct therapies to specific molecular pathways involved in tumorigenesis. ⋯ In particular, we will review the potential role for inhibitors of: tyrosine kinases, targets of rapamycin, farnesyl transferase and histone deacetylase. Inhibitors of angiogenesis will also be discussed. Some 'targeted' therapies are less specific than others, working on more than one pathway or receptor, thus complex interactions are possible.
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Expert Rev Anticancer Ther · Dec 2007
ReviewGlioblastoma multiforme: evidence-based approach to therapy.
Glioblastoma multiforme (GBM) is the most aggressive of the infiltrating gliomas. Standards of care for treatment continue to evolve. ⋯ In other parts of the world, chemotherapy that is considered beneficial by many is excluded from standard therapy, in large part due to issues of cost; treatment may be completely palliative, even limited to corticosteroid treatment alone. This review will focus on the current standard of care in the USA for newly diagnosed GBM, focusing on the evidence supporting that care.
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Expert Rev Anticancer Ther · Dec 2007
ReviewCardiotoxicity associated with the use of trastuzumab in breast cancer patients.
The monoclonal antibody against HER2, trastuzumab (Herceptin), has become an important player in the treatment of patients with HER2-positive breast cancer. Both in the metastatic and adjuvant setting, the addition of trastuzumab to other systemic treatments has led to a striking increase in tumor response and survival. The downside with the use of this agent, however, is its inherent cardiotoxicity, which is particularly common when anthracyclines are used concurrently. This review will focus on all aspects of the cardiac side-effects of trastuzumab, ranging from epidemiology and pathophysiology to cardiac monitoring, and treatment and prevention.