ONCOLOGICAL DISEASE (US) – VOLUME 2 ISSUE 2 – FALL 2006

Ironically, after several decades of intensive research but much criticism from the public at large for failure to progress the outcomes of cancer, we are now facing the problem of prioritising new methods of diagnosis and treatment—the very consequences of successful research that the world cannot afford! In recent years there have, at long last, […]

However, even after primary therapy by surgery and/or chemotherapy, the risk of recurrence remains high.5 Although, classically, breast tumor biology has been classified on the basis of hormone receptor (HR) negativity or positivity, it is now becoming clear that multiple other subtypes exist within these broad categories.6 Indeed, a subset of HRpositive tumors may be […]

Yet several studies confirm that there is a significant and ongoing risk of recurrence of breast cancer that continues on in years 5–10 post-surgery.4,5 The Oxford overview meta-analyses from the Early Breast Cancer Trialists’ Collaborative Group analysed a study population of patients who were at years 5–10 following successful completion of five years of tamoxifen. […]

The basis for this standard of care derives from large randomized studies that have demonstrated that the treatment of local breast cancer does not need to be as disfiguring as in the past. The major risk of death continues to lie in our inability to prevent metastatic disease.Breast cancer is a systemic disease which requires […]

In addition, DMPM has been reported following radiation therapy, mica exposure, recurrent peritonitis, and administration of thorium dioxide.9–13 A great majority of patients present with abdominal pain and distension caused by the accumulation of tumors and ascitic fluid.14Without aggressive treatments the disease is rapidly fatal.15 In the past, DMPM was treated at most cancer centers […]

The process of cellular differentiation, proliferation, and apoptosis is a tightly regulated one with multiple interactions within the cell and the surrounding extracellular matrix. A simplistic schema of intracellular signaling is shown in Figure 1. Disruption of one or more components in these pathways is often specific to the malignant phenotype, occurs commonly in NSCLC, […]

A mutation in exon 11, 9, 13 and 17 of the KIT gene is observed in 66%, 13%, 1% and 0.6% of the tumours respectively. Within the PDGFR? gene, mutations of exon 18 or 12 are observed in 5% and 1.5% of the cases.2 GISTs occurring during childhood have a lower incidence of KIT and […]

In 2000, patients with metastatic GIST had only one viable treatment option – surgical resection. This was an appropriate option for a subset of patients; however, despite surgery, some patients were destined to relapse.6 Systemic therapy for GIST with standard chemotherapy was largely ineffective. Patients with metastatic disease had rapid progression of disease, with an […]

KIT is transmembrane protein that functions as the receptor of the stem cell factor (SCF) and as a tyrosine kinase. Most KIT mutations occur in untreated GISTs in exon 11 that encodes the intracellular juxtamembrane part of the protein, and only rarely in exons that encode the intracellular kinase domain. In imatinib-treated patients secondary mutations […]

Epidemiology of GIST The mean age at the time of first diagnosis is 63 years,2 with most patients between 40 and 80 years old.3 Men show slightly higher prevalence than woman, supported by the recent US study of 1,458 cases, with 54% and 46% incidence rate respectively.2 The stomach is the most common location for […]

Combination Chemotherapy With BSC alone, survival from gastric cancer is in the region of three to five months. Combination chemotherapy with older regimens such as 5-fluorouracil (5-FU), methotrexate and doxorubicin (FAMTX) etoposide, 5-FU and leucovorin (ELF) and 5-FU, epirubicin and methotrexate (FEMTX), resulted in superior survival (8–12 months) over BSC2-4 and better quality of life.2 […]

Intraperitoneal Chemotherapy Employed as Primary Treatment of Advanced Ovarian Cancer In early 2006, the third National Cancer Institutesponsored randomized phase III trial examining frontline regional cisplatin-based chemotherapy, compared with intravenous administration of the agent, was reported.1 As with the previous two studies,2-3 this trial demonstrated intraperitoneal delivery improved both time to disease progression and overall […]

Cytoreductive Surgery Cytoreductive surgery has played an important role in the management of advanced ovarian cancer since Griffiths demonstrated in 1975 that an inverse relationship existed between overall survival and residual tumor size.3 This has been confirmed in subsequent studies, and a meta-analysis of 81 cohorts of patients with stage III or IV disease from […]

Chemotherapy in Metastatic TCC MVAC The methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) regimen, developed at Memorial Sloan-Kettering Cancer Center in the 1980s, represented a major advance in the treatment of metastatic TCC. In the initial report, 24 patients with advanced or unresectable TCC were treated and responses were observed in 71% (95% confidence interval (CI), […]

Figure 1: Exjade Offers 24-hour Chelation with a Single Oral DoseSource: adapted from Daar S, et al., Haematologica (2006);91: Abstract 31. The response to deferasirox is dependent on both dose and the rate of transfusional iron intake.9 In patients with low transfusional requirements ( In cases of skin rashes of mild to moderate severity, deferasirox […]

Deposition of excess iron from multiple transfusions or increased absorption preferentially occurs in the liver, heart, pituitary, thyroid, pancreas, the gonads, and the skin. Saturation of transferrin receptors leaves non-transferrin-bound iron, which generates free radicals that harm membranes, proteins, and nucleic acids, resulting in tissue damage. This damage can be minimized or prevented through chelation; […]

Anemia and its associated symptoms, particularly fatigue, are debilitating for MDS patients and adversely affects quality of life (QOL). Indeed, the burden associated with anemia, in terms of reduced QOL and economic cost, is much greater than generally appreciated.5 Management of patients with MDS who are not candidates for hematopoietic stem cell transplant (HSCT) requires […]

Modern radiotherapy increasingly utilizes conformal delivery techniques, which necessitate more accurate patient positioning and tumor targeting.1 Brought about by mechanical and computing advances, the ability to deliver radiation doses to the tumor while sparing normal tissue using 3-D conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) or other conformal treatments, such as proton therapy, allows the […]

The University of North Carolina has treated approximately 1,200 patients using compensator- IMRT since 1996 and has used both MLC and compensator for IMRT delivery since MLC became available in 2001.1,2 Mail order compensator services in the US are gaining increasing acceptance and popularity, especially among smaller radiotherapy centres, by providing quality, easy-to-use and swift […]

Although the majority of worldwide bladder cancer patients presented with disease confined to the superficial layers of the bladder wall, approximately one-quarter of patients will present with or subsequently develop invasive cancer. In Egypt, these invasive stages represent 80 95% of the whole population of bladder cancer patients. Moreover, patients who underwent radical cystectomy of […]

Recent advances have led to multifunctional nanoparticle probes for molecular and cellular imaging, nanoparticle drugs for targeted therapy and integrated nanodevices for early disease detection and screening.6-13 These developments have opened exciting opportunities for personalized oncology in which cancer detection, diagnosis, and therapy are tailored to each individual’s molecular profile, and also for predictive oncology […]

Elderly patients are at particular risk of treatment-induced bone loss and for a given bone mineral density (BMD) are more likely to sustain a fracture. Assessment of BMD before and at occasional intervals during endocrine treatments is recommended, with intervention with bisphosphonates if BMD falls into the osteoporotic range. Doses and agents used in this […]

Breakthrough Pain Breakthrough pain is pain that is over and above the background pain that is being addressed by on-going pain control medications. Breakthrough pain is highly prevalent in cancer patients. In one study it was estimated that approximately one-half to two-thirds of patients with chronic cancer-related pain also experience episodes of breakthrough pain.2 Moreover, […]

Hydrophilic compounds, such as oral or sublingual morphine and oxycodone, are absorbed too slowly to address most BTP, having a Tmax of about 45 minutes, when the pain has already begun to wane. In addition, hydrophilic compounds pass easily into the gastrointestinal (GI) tract where they are likely to cause constipation and also leave behind […]

Enteral Nutrition in Head and Neck Cancer Patients Cancer of the head and neck with an annual incidence of over 41,000 cases in the US is the most common underlying malignancy in patients on home enteral feedings.6,7 The most common nutrition-related problem resulting from head and neck cancer and its therapy is dysphagia.8 In some […]

One element of this targeted approach concerns the area of nutritional oncology, a field now maturing as an important component of supportive care of the cancer patient from diagnosis through primary treatment and palliation. Loss of appetite, fat and lean body mass (LBM) are critical occurrences that negatively impact compliance with therapy and performance status, […]