News

Until recently, standard treatment of multiple myeloma (MM) in elderly patients who were not candidates for autologous stem cell transplantation was with the combination of melphalan plus prednisone (MP). Novel agents (thalidomide, lenalidomide, bortezomib) are dramatically changing frontline therapy of MM. Randomized studies have shown the superiority of adding one novel agent to MP, either thalidomide (MPT) or bortezomib (MPV). The combination of lenalidomide with low doses of dexamethasone is another attractive alternative. Recent results show that maintenance therapy with low-dose lenalidomide may prolong progression-free survival. The objective of these improved treatment regimens should be to achieve complete response, as in younger patients. However, toxicity is a significant concern, and doses of thalidomide and of myelotoxic agents should be reduced in patients who are older than 75 years or who have poor performance status. Weekly bortezomib appears to induce severe peripheral neuropathy less frequently than the same agent administered twice weekly. Autologous stem cell transplantation is feasible in selected fit patients over 65 years of age, and its results are improved by the addition of novel agents before and after high-dose therapy. However, considering the progress in non-intensive therapy, autologous transplantation should not currently be offered to elderly patients outside of a clinical trial.

XCell-Center's stem cell treatment helps patient avoid knee replacement.

News items reported in this issue: 1) 186-Gene Signature in Cancer Stem Cells Predicts Recurrence 2) National Prostate Cancer Coalition Commences Clinical Trial Education Program 3) Concomitant High-Dose Radiation Therapy Plus Cetuximab Improves Locoregional Control and Reduces Mortality, with No Increase in Radiation Therapy–Associated Toxicity in Patients with Advanced Squamous-Cell Carcinoma of the Head and Neck 4) STAT3 Pathway Inhibitor (Degrasyn) Drug Class Shows Promise in the Treatment of Malignant Brain Tumors

News items reported in this issue: 1) 186-Gene Signature in Cancer Stem Cells Predicts Recurrence 2) National Prostate Cancer Coalition Commences Clinical Trial Education Program 3) Concomitant High-Dose Radiation Therapy Plus Cetuximab Improves Locoregional Control and Reduces Mortality, with No Increase in Radiation Therapy%u2013Associated Toxicity in Patients with Advanced Squamous-Cell Carcinoma of the Head and Neck, and more

Primary surgery with an abdominoperineal resection (APR) was historically the standard of care for localized anal squamous cell carcinoma. APR achieved 40%-70% survival rates at five years, with local failures from 27%-47%.[1,2] With modern technology and radiation dose escalation, external beam radiation therapy (EBRT) studies have improved complete response rates, decreased morbidity, and improved sphincter preservation rates. Nigro et al added 5-fluorouracil (5FU) and mitomycin C (MMC) to concurrent EBRT [3,4] and impressive complete response rates inspired other groups to investigate the role of chemotherapy as a component of sphincter-preserving therapy. The European Organization for Research and Treatment of Cancer (EORTC) and United Kingdom Coordinating Committee on Cancer Research (UKCCCR) studies reported improved local control and colostomy-free survival when chemotherapy (5FU/MMC) was administered in conjunction with radiation.[5,6] The five-year survival rate for patients receiving standard chemoradiation approaches 70%; however, 20%-40% experience grade 3-4 toxicity, and administration with MMC causes profound hematologic toxicity.

The Clinical Trials reported in this issue include: PHASE I: 1) Cell Genesys and Medarex Remain Positive on Combination Immunotherapy Study 2) Active Biotech Achieves Success with TASQ for Prostate Cancer PHASE II: 1) Myriad Initiates Evaluation of Brain Cancer Drug that Crosses the Blood-Brain Barrier 2) Second Lung Cancer Trial Adds Data to Novel Therapy PHASE III: 1) Nexavar Could Soon Add Primary Liver Cancer to its Label 2) Point Therapeutics Provides Clinical Update for NSCLC Studies

The Clinical Trials reported in this issue include: PHASE I: 1) Cell Genesys and Medarex Remain Positive on Combination Immunotherapy Study 2) Active Biotech Achieves Success with TASQ for Prostate Cancer PHASE II: 1) Myriad Initiates Evaluation of Brain Cancer Drug that Crosses the Blood-Brain Barrier 2) Second Lung Cancer Trial Adds Data to Novel Therapy, and more

Induction chemotherapy has led to improved survival and organ preservation. Combining induction therapy with other treatment modalities is critical for treating this complex disease and attaining optimal outcomes.

Data from French trial should inform treatment decisions in the majority of lung cancer patients aged 70 and up.

A preclinical study provides the rationale for combining BRAF-targeted therapy with immunotherapy agents in patients with BRAF mutations. These mutations activate the MAPK signaling pathway, which leads to increased oncogenic potential. The researchers showed that in BRAF-mutant melanoma cell lines, a selective BRAF inhibitor (PLX4720) blocked the MAPK pathway and increased tumor antigen expression without affecting T-cell function.

Drug is indicated for the treatment of patients with cutaneous T-cell lymphoma (CTCL) who have received at least one prior systemic therapy.

Physicians' Financial News focuses on newsmaking and/or notable companies in the oncology/biotech sector. In this issue: 1) Pharmion: Oncology-Centered Focus Fuels Continued Pharmion Growth 2) Bristol-Myers Squibb: Treatment-Resistant Breast Cancer Targeted 3) Merger-Mania Poised to Envelop Biotech Sector? 4) GlaxoSmithKline: Oral Therapy Option Offered for Small-Cell Lung Cancer Relapse 5) Immunomedics,Inc.: Immunomedics Wins Pancreatic Cancer Patent 6) ZymoGenetics: Promising Kidney Cancer Therapy Moves Toward Phase II

Topics covered in this issue include:1) Dosing Patterns and Costs of Erythropoesis-Stimulating Agents in Patients With Cancer2) New Practice Guideline Updates Treatment of Nonâ%uFFFD%uFFFDSmall Cell Lung Cancer3) Large Health Insurer Begins Genetic Risk Counseling for Cancer4) Multiple Myeloma Guidelines Now Include Combination Therapy With Bortezomib5) Survey Finds That Managed Car Executives Are Misinformed About the Value and Cost of Cancer Biologics

The Clinical Trials reported in this issue include: PHASE III: 1) What Factors Predict Prognosis in Patients With Malignant Pleural Mesothelioma? 2) Treatment for Patients With High-Risk Postoperative Breast Cancer PHASE II: 1) Epratuzumab Plus Rituximab Equals Non-Hodgkin's Lymphoma Response 2) Topotecan Added to Twice-Daily Chemoradiation to Treat Limited- Stage, Small-Cell Lung Cancer 3) First-Line Therapy for Patients With Advanced or Metastatic Non–Small-Cell Lung Cancer 4) Radiotherapy for Nasal Squamous Cell Carcinoma Therapy PHASE I/II: 1) A New Combination Approach for Advanced-Stage Germ-Cell Tumors

Articles in this issue include: 1) South Korea: Is Intermittent Imatinib Therapy for Chronic Myelogenous Leukemia an Option? Genetic Marker Predicts Treatment Resistance and Poor Outcomes in Esophageal Cancer 2) France: Pelvic Radiation in Addition to Prostate Radiotherapy for Localized Prostate Cancer 3) Multiple Sites in Europe: European Guidelines for Oral Mucositis Released 4) Japan: The Care of Delirium in Terminal Illness and Bereavement Needs 5) The Netherlands: Cancer Pain and Adherence to Analgesic Treatment 6) Switzerland, Belgium & France: Confirmation of Gene Expression Link to Chemotherapy Response in Breast Cancer

Clinical Trial Reports in this issue include: Phase IV: 1) Long-Term Aspirin Therapy Reduces Colorectal Cancer Risk Phase III: 1) Does Adding Cisplatin to Adjuvant Chemotherapy Improve Outcomes in Advanced Gastric Cancer? 2) FOLFIRI Plus Bevacizumab Provides Better Survival Than Other Irinotecan-Containing Regimen in First-Line Colorectal Cancer Phase II: 1) Single-Agent Activity of Sunitinib in Refractory Non������¢���¯���¿���½���¯���¿���½Small Cell Lung Cancer 2) The Importance of Targeting Androgen Receptor Signaling for Prostate Cancer Response Rate 3) Improving Survival in Gastrointestinal Stromal Tumor 4) Improving Overall Survival in Patients With Hormone- Resistant Prostate Cancer 5) Breast Cancer Stem Cells Decreased With Neoadjuvant Lapatinib Phase I/II: 1) Patients With Recurrent Glioblastoma May Benefit From Implant Combinations

Phase IV:1) Cancer Risks and Postmenopausal Hormone Link ConfirmedPhase III:1) Do Vitamins Protect Against Lung Cancer?2) Longer Life Expectancy in Pancreatic Cancer When Gemcitabine Is Added to Chemotherapy3) Outcomes Improve With Letrozole Treatment in Women With Early-Stage Breast Cancer4. Pemetrexed vs. Docetaxel for Non-Small Cell Lung Cancer TreatmentPhase II:1) Talactoferrin-Alfa Treatment for Non-Small Cell Lung Cancer2) Advanced Carcinoid Systemic Therapy

Phase IV: 1) Cancer Risks and Postmenopausal Hormone Link Confirmed Phase III: 1) Do Vitamins Protect Against Lung Cancer? 2) Longer Life Expectancy in Pancreatic Cancer When Gemcitabine Is Added to Chemotherapy 3) Outcomes Improve With Letrozole Treatment in Women With Early-Stage Breast Cancer 4. Pemetrexed vs. Docetaxel for Non-Small Cell Lung Cancer Treatment Phase II: 1) Talactoferrin-Alfa Treatment for Non-Small Cell Lung Cancer 2) Advanced Carcinoid Systemic Therapy

T umor human papillomavirus (HPV) status is confirmed as a strong and independent prognostic factor for survival of patients with oropharyngeal cancer, report investigators for a large phase III trial established by the Radiation Therapy Oncology Group. Results were presented at the 44th annual meeting of the American Society of Clinical Oncology (ASCO abstract 5510) and published in the New England Journal of Medicine on June 7. Investigators performed a retrospective analysis of the association between tumor HPV status and survival among 323 patients with stage III or IV oropharyngeal squamous cell carcinoma who were enrolled in a randomized trial comparing cisplatin therapy combined with either accelerated- or standard-fractionation radiotherapy. Risk of death among patients with HPV-positive vs HPV-negative cancer was compared using a proportional-hazards model.

German researchers sought to confirm the results of a previous Japanese trial that found patients with extensive-disease small–cell lung cancer (ED SCLC) treated with irinotecan plus cisplatin lived longer than subjects given therapy with etoposide plus cisplatin.

German researchers sought to confirm the results of a previous Japanese trial that found patients with extensive-disease small–cell lung cancer (ED SCLC) treated with irinotecan plus cisplatin lived longer than subjects given therapy with etoposide plus cisplatin.

At the 2010 Gastrointestinal Cancers Symposium, new data from the CRYSTAL trial identified BRAF gene mutations as a poor prognostic indicator in metastatic colorectal cancer (mCRC) but not predictive of response to therapy.

At the 2010 Gastrointestinal Cancers Symposium, new data from the CRYSTAL trial identified BRAF gene mutations as a poor prognostic indicator in metastatic colorectal cancer (mCRC) but not predictive of response to therapy.

Mycosis fungoides (MF), the most common cutaneous T-cell lymphoma, is a low-grade cutaneous lymphoma characterized by skin-homing CD4+ T cells. It is notable for highly symptomatic progressive skin lesions, including patches, plaques, tumors, and erytheroderma, and has a poorer prognosis at later stages. Diagnosis remains difficult owing to MF’s nonspecific skin presentation and identification of the optimal treatment strategy is challenging given the paucity of controlled trials and numerous and emerging treatment options. Management includes topical therapy with the addition of systemic therapy for patients with later-stage disease including tumors; erythroderma; and nodal, visceral, or blood involvement. Topical therapies include mechlorethamine (nitrogen mustard), carmustine (BCNU), steroids, bexarotene gel (Targretin Gel), psoralen plus ultraviolet A (PUVA), ultraviolet B (UVB), and either localized or total skin electron radiotherapy. Systemic therapies include interferon, retinoids, oral bexarotene (Targretin), denileukin diftitox (Ontak), vorinostat (Zolinza), extracorporeal photochemotherapy (photopheresis), and cytotoxic chemotherapy. Herein, we outline clinically relevant aspects of MF, including clinical presentation, pathology, diagnosis, and staging. We describe in detail existing and emerging therapeutics and offer specific recommendations for management of each stage of MF.

The review by Oxnard and Miller provides a thoughtful update on the use of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) gefitinib (Iressa) and erlotinib (Tarceva) as front-line therapy in patients with non–small-cell lung cancer (NSCLC).

The treatment of anal squamous cell cancer with definitive chemoradiation is the gold-standard therapy for localized anal cancer, primarily because of its sphincter-saving and colostomy-sparing potential.

With better disease definition, staging, and monitoring, treatment of extranodal NK/T-cell lymphoma is becoming more rational. A large proportion of patients with localized nasal disease may enjoy prolonged disease-free survival. On the other hand, early HSCT or novel therapy may be recommended for aggressive extranasal disease.

Highlighting the many developments in the area of oculogenetics, Edwin M. Stone, MD, PhD, is concentrating on a gene therapy experiment.

NCCN included a dinner symposium on Maintenance Therapy for Non-Small Cell Lung Cancer.