bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for the Treatment of Acute Promyelocytic Leukemia
Authors: Frankfurt Olga , Tallman Martin S.
Published: April 2017

The outcome of acute promyelocytic leukemia (APL) has improved dramatically during the past 40 years. Insights into the genetic and biologic mechanisms of APL lead to the development of specific and effective therapeutic strategies. This article discusses the therapeutic interventions that transformed APL from one of the most lethal leukemias to one that is highly curable.
Non-Transplant Therapy for Older Adults with Acute Myeloid Leukemia
Authors: Sekeres Mikkael A.
Published: April 2017

Acute myeloid leukemia is a disease of older adults, with a median age at diagnosis of 68 years. This group represents a high-risk population, because inherent disease characteristics predict for resistance to chemotherapy and advanced age is accompanied by high treatment-related mortality. Standard remission-induction and postremission therapy can result in a median disease-free survival of 10 months and rare long-term survival. Efforts to improve outcomes have not made a major impact on complete remission rates of 40% to 60%, or on overall survival. Newer therapies, divided into aggressive and nonaggressive approaches, focus on targeting the disease biology specific to older adults and on maximizing quality of life. Clinical trials should be considered at every stage of treatment in this group of patients.
Myelodysplastic Syndromes Clinical Practice Guidelines in Oncology
Authors: _ _
Published: April 2017

The myelodysplastic syndromes (MDS) represent myeloid clonal hemopathies with relatively heterogeneous spectrums of presentation. The major clinical problems in these disorders are morbidities caused by patients' cytopenias and the potential for MDS to evolve into acute myeloid leukemia (AML). Managing MDS is complicated by the generally advanced age of the patients (median ages range from 65–70 years), the attendant non-hematologic comorbidities, and older patients' relative inability to tolerate certain intensive forms of therapy. In addition, when the illness progresses into AML, these patients experience lower response rates to standard therapy than patients with de novo AML.

For the most recent version of the guidelines, please visit NCCN.org
Developmental Therapeutics for Myelodysplastic Syndromes
Authors: Naing Aung , Sokol Lubomir , List Alan F.
Published: April 2017

The management strategy for patients with myelodysplastic syndromes (MDS) has evolved from sole reliance on supportive measures to active treatment guided by disease risks. Recent progress in understanding the molecular pathogenesis of MDS has accelerated the discovery of new therapeutic targets, and consequently launched the development of several novel therapeutics that are currently in varied stages of clinical testing. One such agent is lenalidomide, which has shown remarkable effectiveness in the cytogenetically defined subset of MDS with the chromosome 5q31 deletion. The advent of new and effective targeted therapeutics may beneficially affect outcomes of an ever-increasing number of patients with MDS. This discussion summarizes the preliminary results of selected novel therapeutics.
Neuroendocrine Tumors Clinical Practice Guidelines
Authors: _ _
Published: April 2017

Neuroendocrine tumors are relatively rare. An estimated 25,690 new cases of thyroid cancer will be diagnosed in the United States in 2005, accounting for approximately 1% of all malignancies. Neuroendocrine tumors can be broadly subdivided into tumors that are benign or malignant, functional (i.e., producing a syndrome of hormonal excess) or nonfunctional. The management of neuroendocrine tumors with surgical, medical, or radiation therapies is determined by the specific endocrine glands involved, aggressiveness and stage of the tumor, hormonal concentrations detected, and specific patient needs. These guidelines have been designed to address scenarios presented by 80% of patients and to avoid scenarios relevant to less than 5% of patients.

For the most recent version of the guidelines, please visit NCCN.org
Indication and Timing of Thyroid Surgery for Patients with Hereditary Medullary Thyroid Cancer Syndromes
Authors: Ogilvie Jennifer B. , Kebebew Electron
Published: April 2017

Hereditary medullary thyroid cancer syndromes comprise familial medullary thyroid cancer (FMTC) and multiple endocrine neoplasia types 2A and 2B. Hereditary medullary thyroid cancers have an autosomal dominant pattern of inheritance and are caused by activating germline point mutations in the RET proto-oncogene. Evaluation of the onset, extent, and progression of hereditary medullary thyroid cancer associated with specific RET mutations has enabled clinicians to treat patients based on the level of risk associated with their specific mutation. Children identified by RET screening to be at risk for the development of medullary thyroid cancer can be treated with prophylactic thyroidectomy before developing the disease. This review covers the diagnosis, evaluation, timing of surgical management, and optimal follow-up of patients with hereditary medullary thyroid cancer syndromes.
Late Effects of Treatment for Hodgkin Lymphoma
Authors: Friedman Debra L. , Constine Louis S.
Published: April 2017

With advances in multimodality therapy, survival from Hodgkin lymphoma (HL) now exceeds 80%, resulting in a large cohort of survivors who are at risk for adverse long-term sequelae of therapy. This risk is complicated by possible endogenous predispositions to developing late effects, which relate to the patient's underlying susceptibility to HL. Finally, the impact of HL on the host can compromise organ function. This article reviews the possible dominant late effects for survivors of HL and strategies for monitoring and screening. As therapy for HL has changed and evolved, so has the spectrum of late effects. Mortality from HL has decreased, whereas delayed effects of therapy have increased. Refinements in therapy to decrease toxicity have occurred in response to the success in curing HL. Thus, modifications in therapeutic protocols using a risk-adapted strategy have reduced the use of alkylating agents, anthracyclines, and radiotherapy, which are associated with adverse long-term sequelae. The most clinically evident sequelae are those involving the endocrine and cardiovascular systems, and the most morbid are hematologic and solid second malignancies. Primary and secondary prevention strategies can be developed as knowledge of delayed effects of therapy increases.
Non-Hodgkin's Lymphoma Clinical Practice Guidelines
Authors: _ _
Published: April 2017

Non-Hodgkin's lymphomas (NHLs) may be classified on the basis of morphology, natural history, and immunophenotypic and molecular characteristics. These guidelines were developed for more common NHL histologic types, including chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and diffuse large B-cell lymphoma, and for less common entities with unique natural histories and therapies, such as marginal zone lymphoma, mantle cell lymphoma, and highly aggressive lymphoma subtypes, including Burkitt's, and lymphoblastic lymphomas and AIDS-related B-cell lymphomas. Certain components of the diagnosis and therapy of the various NHLs are similar. In all cases, an accurate pathologic diagnosis must first be made.

For the most recent version of the guidelines, please visit NCCN.org
Barrett's Esophagus and Its Progression to Adenocarcinoma
Authors: Maley Carlo C. , Rustgi Anil K.
Published: April 2017

Barrett's esophagus (BE) is the only known precursor for esophageal adenocarcinoma (EA). Therefore, the presence of BE identifies a high-risk group of patients who may be followed-up for early detection of EA and treated to reduce the risk for its progression. The initiating event for BE is unknown, although it is associated with chronic gastric reflux. Many of the genetic lesions involved in BE neoplastic progression are known, including loss of CDKN2A (p16) and TP53 (p53) and the development of tetraploidy and aneuploidy. Intensive endoscopic surveillance has been shown to improve survival although it can be difficult to implement in practice. Several exposures may be altered to reduce the risk for progression, including weight, diet, and the use of nonsteroidal anti-inflammatory drugs. However, most of these results should be confirmed in additional cohorts before they are used to change clinical practice.
Colorectal Cancer Screening Clinical Practice Guidelines
Authors: _ _
Published: April 2017

Colorectal cancer is the third most frequently diagnosed cancer in men and women in the United States. An estimated 104,950 new cases of colon cancer and 40,340 new cases of rectal cancer will occur in the United States in 2005. During the same year, an estimated 56,290 people will die from colon and rectal cancer. Because patients with localized colon cancer have a 90% 5-year survival rate, screening is a critical and particularly effective procedure for colorectal cancer prevention. Screening options include colonoscopy; combined fecal occult blood test (FOBT) and sigmoidoscopy; sigmoidoscopy alone; or double-contrast barium enema.

For the most recent version of the guidelines, please visit NCCN.org
Current Perspectives on Lymphatic Mapping in Carcinomas of the Uterine Corpus and Cervix
Authors: Coleman Robert L. , Frumovitz Michael , Levenback Charles F.
Published: April 2017

Lymphatic mapping and sentinel node identification are rapidly becoming the standard of care in managing many malignancies. These procedures have allowed focused evaluation of relevant regional lymphatics, which has led not only to improved precision of nodal pathology, but also to treatment triage and the potential for reduced postoperative morbidity. Given its clinical potential, new cancer primary sites are being evaluated, including those of the female genital tract. Of these, carcinoma of the vulva seems the most apposite; however, it is a rare malignancy and therefore large randomized treatment trials based on sentinel node triage are difficult to perform. Cancers of the uterus–cervix and corpus are more common. Because the physiologic lymphatic drainage from this organ is ambiguous, principle lymphatic basins are located in many different anatomic locales, making sentinel node identification precarious, yet highly relevant and informative. Current experience in carcinoma of the cervix suggests the concept is feasible. A consensus in corpus cancer has not been reached, although both sites are of keen interest with the increasing use of laparoscopy in surgical management. Prospective multi-institutional validation studies are underway.
Breast MRI as a Screening Tool: The Appropriate Role
Authors: Le-Petross Huong T.
Published: April 2017

Magnetic resonance imaging (MRI) can detect breast cancer that is occult on mammography or ultrasound. However, although the high sensitivity of this imaging modality is desirable, its lower specificity, higher cost, variable technique and interpretation among institutions, exclusion criteria, and unproven effect on survival rate make it a less desirable screening test for the general population. Several studies have shown that using more than one imaging tool, such as MRI and mammography, increases cancer yield in high-risk patients, such as those with inherited BRCA1 and BRCA2 mutations. Recent studies show improved specificity of MRI, likely related to advances in technique and the development of interpretive guidelines.
A Brief Review of Pharmacotherapies for Smoking Cessation
Authors: Lam Cho Y. , Minnix Jennifer A. , Robinson Jason D. , Cinciripini Paul M.
Published: April 2017

The U.S. Department of Health and Human Services' Clinical Practice Guidelines have established both nicotine and nonnicotine-based pharmacotherapies as efficacious treatments for smoking cessation. Smokers attempting to quit smoking can significantly increase their chances by using one of several first-line agents, including nicotine transdermal patches, gum, nasal spray, inhalers, tablets, and the antidepressant bupropion. Those who cannot use either bupropion or nicotine replacement therapy because of contraindications or lack of effectiveness may benefit from the second-line treatment nortriptyline. This article also discusses several novel compounds for smoking cessation.
Computed Tomography Screening for the Early Detection of Lung Cancer
Authors: Petersen Rebecca P. , Harpole David H.
Published: April 2017

Although lung cancer is the leading cause of cancer-related death in the world and has an increased chance of cure if detected at an earlier stage, routine lung cancer screening is currently not recommended in the United States. Unfortunately, most patients with lung cancer present only after the onset of symptoms and have advanced disease that cannot be surgically resected. The overall 5-year survival rate for all patients with lung cancer is only 15%. When the cancer is detected at its earliest stage (pathologic stage IA), however, the 5-year survival rate is more than 70%. Although past randomized screening trials evaluating the use of standard chest radiography or sputum cytology have not resulted in lower mortality, recent studies suggest that computed tomography (CT) may have promise as a screening tool. This article summarizes experience over the past decade of using low-dose spiral CT imaging as a screening tool to detect early lung cancers in asymptomatic, high-risk individuals.
Pulmonary Neuroendocrine Tumors: What (Little) Do We Know?
Authors: Chen Lin-Chi , Travis William D. , Krug Lee M.
Published: April 2017

Pulmonary neuroendocrine tumors are a distinct subset of tumors composing approximately 20% of all lung cancers. The major categories of pulmonary neuroendocrine tumors include typical and atypical carcinoids, large cell neuroendocrine carcinoma, and the more common small cell lung cancer. They are classified into different categories in the 2004 World Health Organization system, but share structural and morphologic features. Despite these shared features, their clinical characteristics range from indolent to aggressive, and therefore the approach to treatment depends on the histologic subtype. This article discusses the current understanding of the epidemiology, pathologic characteristics, treatment, and prognosis of this spectrum of diseases.
Paraneoplastic Syndromes Associated With Small Cell Lung Cancer
Authors: Gandhi Leena , Johnson Bruce E.
Published: April 2017

Small cell lung cancer (SCLC) is the most frequent cancer histology associated with paraneoplastic syndromes. These syndromes are typically caused by ectopic hormone production or immune-mediated tissue destruction caused by neural antigen expression from cancer cells. This antigen expression induces the production of antibodies that cross-react with neural tissue. This article discusses the most common ectopic hormone and neurologic paraneoplastic syndromes and emphasizes the relationships among antigens, clinical syndromes, and outcomes. Although ectopic hormone production has been associated with extensive-stage disease and a poorer outcome, the antibody-mediated paraneoplastic syndromes are prognostic factors associated with more favorable outcomes. Both have the potential for improvement with cancer treatment.
Trends in Recommendations for Myelosuppressive Chemotherapy for the Treatment of Solid Tumors
Authors: Smith Robert E.
Published: April 2017

Lung, breast, and colorectal cancers are the 3 most frequent causes of cancer-related death in the United States. In the past 15 years, survival has increased dramatically for patients with these tumor types, partly because improved chemotherapy caused major changes in standard care. In addition, maintaining chemotherapy dose intensity has an established a positive effect on patient outcomes. However, delivering chemotherapy at full dose and on schedule is limited primarily by myelosuppression. To determine how expert opinion about preferred chemotherapy for lung, breast, and colorectal cancers has changed over the past decade, the National Comprehensive Cancer Network (NCCN) treatment guidelines from 1996, 2000 or 2001, and 2005 for each tumor type were compared. The myelosuppressive potentials of NCCN-recommended agents were assessed using data from their prescribing information. Many agents and combinations of agents recommended in the NCCN guidelines for treating lung, breast, and colorectal cancers are associated with myelosuppression. Several of these myelosuppressive regimens, which were previously recommended for treating advanced-stage or metastatic disease, are now preferred for early-stage disease, and neoadjuvant or adjuvant therapy is now recommended in more tumor types and stages than ever before. These findings indicate that the cytotoxic agents and regimens recommended today are associated with more myelosuppression than those preferred a decade ago and are more widely used in early-stage disease when survival benefits are possible. Because of this trend toward more intensive treatment of patients with cancer, proactive steps should be taken to minimize the risk for myelosuppression and its complications while optimizing the relative dose intensity.
Role of Dermatologists in Treating Melanoma
Authors: Halpern Allan C. , Mandal Sanjay K.
Published: April 2017

Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.
Role of Radiotherapy in the Management of Merkel Cell Carcinoma of the Skin
Authors: Decker Roy H. , Wilson Lynn D.
Published: April 2017

The role of radiotherapy in treating local and regional disease in patients with clinically localized Merkel cell carcinoma remains controversial. Given the lack of randomized evidence and patient and treatment heterogeneity in published retrospective series, sound clinical judgment is required to assess individual patient risk factors. Although many single-institution series have shown that adjuvant radiation to the primary tumor site decreases the risk for local and regional failure, evidence is emerging that there is a cohort of patients at relatively low risk for local recurrence after wide local excision alone. Node dissection, radiotherapy, and combined modality treatment may all play a role in managing occult or clinically evident nodal disease, depending on the anatomic location of draining lymphatics and the extent of microscopic or macroscopic disease. For select patients, primary radiotherapy is a reasonable option with a low risk for local or regional recurrence.
Liver-Directed Therapies for Hepatocellular Carcinoma
Authors: Arciero Cletus A. , Sigurdson Elin R.
Published: April 2017

Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. This disease can be treated through several surgical and nonsurgical approaches. Although the only curative options for patients with HCC are surgical (resection or transplantation), most patients unfortunately present with advanced neoplastic disease or experience the effects of chronic liver disease, making surgical resection implausible. Several additional options are available for treating this population. Ablative therapies such as percutaneous ethanol injection, cryotherapy, radiofrequency ablation, laser ablation, and microwave hyperthermic ablation can be used with varying degrees of success. Transarterial chemoembolization can be used in patients with advanced disease or advanced chronic liver disease that cannot be treated with resection or ablation. This article explores the various liver-directed therapies, including surgical resection, and defines morbidity, mortality, and survival for each.
Palliative Care
Authors: _ _
Published: April 2017

Over the past 20 years, increasing attention has been paid to quality-of-life issues in oncology. As the hospice movement has grown in this country, palliative care has developed into an integral part (rather than the antithesis) of comprehensive cancer care. Palliative care must be integrated earlier into the continuum of cancer care, and palliative, symptom-modifying therapy should be provided simultaneously with disease-modifying therapy from diagnosis. The goal of the NCCN palliative care guidelines is to help assure that each patient with cancer experiences the best possible quality of life throughout the illness trajectory. These guidelines are intended to help oncology teams provide the best care possible for their patients with incurable cancer.

For the most recent version of the guidelines, please visit NCCN.org
Venous Thromboembolic Disease
Authors: _ _
Published: April 2017

Venous thromboembolic disease is a common and life-threatening condition in cancer patients. Results from a recent retrospective study of 66,106 hospitalized adult neutropenic cancer patients showed that 2.74% to 12.10% of these patients, depending on the type of malignancy, experienced a venous thromboembolism (VTE) during first hospitalization. These guidelines specifically outline strategies to prevent and treat VTE in adult inpatients with either a diagnosis of cancer or for whom cancer is clinically suspected. These guidelines evaluate the therapeutic advantages of implementing pharmacologic anticoagulation measures based on both the perceived risk for bleeding (i.e., contraindications to anticoagulation) and the status of the cancer.

For the most recent version of the guidelines, please visit NCCN.org
Risk Factors for the Assessment of Patients with Pulmonary Embolism
Authors: Fanikos John , Goldhaber Samuel Z.
Published: April 2017

Pulmonary embolism (PE) occurs frequently among cancer patients, with a spectrum ranging from small, clinically insignificant thrombi to life-threatening massive PE. It is fatal in as many as 14% of cancer patients, primarily by producing right ventricular heart failure and cardiogenic shock. PE diagnosis is difficult because the signs and symptoms imitate other commonly occurring diseases. Clinicians must be able to integrate a wide array of diagnostic imaging tools and laboratory tests to ensure rapid assessment and diagnosis. Risk stratification with the use of cardiac biomarkers and imaging tests to evaluate right ventricular function will identify treatment options. Hemodynamically stable patients can be treated effectively with anticoagulation alone, whereas those with right ventricular dysfunction require an aggressive strategy with thrombolysis, surgical embolectomy, or a catheter-based intervention. When anti-coagulation is contraindicated, a vena caval filter may be deployed. PE treatment must be customized to the individual and consider the existing thrombus burden, presence of underlying cardiopulmonary disease and right side heart dysfunction, and cancer status of the patient. Clinicians should focus on providing adequate thromboprophylaxis in hospitalized cancer patients to avoid PE treatment.
Long-Term Therapy of Venous Thromboembolism in Cancer Patients
Authors: Streiff Michael B.
Published: April 2017

Venous thromboembolism (VTE) is a common complication in cancer patients that results in significant morbidity and mortality. Long-term treatment options for cancer patients who experience VTE include vitamin K antagonists (VKAs), low molecular weight heparins (LMWHs), and inferior vena caval (IVC) filters. Cancer patients have a two- to fourfold higher risk for experiencing recurrent VTE and major bleeding during chronic VKA therapy than patients without malignancies. Recent randomized clinical trials have shown that LMWHs rather than oral VKAs are preferred for initial chronic treatment of VTE in patients with advanced cancer. One factor potentially limiting the broader use of LMWH for chronic therapy in the United States is its higher acquisition cost. Efficacy, cost, drug availability, patient comorbidities, and concomitant medications all need to be considered when selecting chronic VTE therapy. Cancer patients with VTE should be treated for as long as their disease is active to minimize the incidence of recurrence. Use of IVC filters should generally be reserved for patients at high risk for recurrent VTE who have contraindications to anticoagulation. Several new anticoagulants are being investigated that promise greater therapeutic choices and potentially better outcomes for cancer patients with VTE.
Intraperitoneal Chemotherapy for Ovarian Cancer: Where Are We Now?
Authors: Singhal Pankaj , Lele Shashikant
Published: April 2017

Patients with advanced epithelial ovarian cancer are conventionally treated with intravenous (IV) platinum- and taxane-based chemotherapy to try to eradicate residual disease after optimal cytoreductive surgery, resulting in a median overall survival of 49 months. The Gynecologic Oncology Group (GOG) conducted 3 large randomized, phase III clinical trials of intraperitoneal (IP) chemotherapy (GOG 104, 114, and 172) that clearly showed superior progression-free and overall survival with IP chemotherapy compared with IV chemotherapy. All 3 clinical trials investigated IP cisplatin, with the last one adding IP paclitaxel. The most recent study (GOG 172) resulted in a median survival of 66 months for patients in the IP arm versus 50 months for those in the IV arm. Fewer patients in the IP arm than in the IV arm completed all 6 treatment cycles (42% vs. 83%, respectively) because of the toxic effects of chemotherapy and IP catheter-related complications. Initially, patients in the IP arm reported significantly worse quality of life than those in the IV arm. However, at 12-month follow-up, the groups experienced no difference in quality of life, except that paresthesias were more likely to persist at moderate levels among patients in the IP arm. Based on these clinical trials, the National Cancer Institute issued a clinical announcement recommending that women with stage III ovarian cancer who undergo optimal surgical cytoreduction be considered for IP chemotherapy.
Novel Non-Cytotoxic Therapy in Ovarian Cancer: Current Status and Future Prospects
Authors: Martin Lainie , Schilder Russell J.
Published: April 2017

Although significant improvements in standard therapy for ovarian carcinoma have been made over the past decade, current treatment is limited by the development of resistance to cytotoxic chemotherapy, and most women ultimately die of the disease. New knowledge of the biology of ovarian cancer has led to the identification of potential molecular targets that are differentially expressed in normal cells versus cancer cells, and advances in pharmacology have led to the development of novel agents that work differently from traditional cytotoxic chemotherapy by exploiting these targets. Many of these agents are being evaluated in clinical trials. This article discusses molecular targets that are important in ovarian carcinoma, including angiogenesis, tyrosine kinases, mitogen-activated protein kinases, and phosphatidylinositol-like kinases such as mammalian target of rapamycin, and the proteosome. This article reviews novel non-cytotoxic agents that target these pathways and are currently being evaluated in ovarian carcinoma treatment.
Importance of Node Dissection in Relation to Neoadjuvant and Adjuvant Therapy
Authors: Huang William C. , Bochner Bernard H.
Published: April 2017

Since the advent of effective chemotherapeutic regimens for treating transitional cell carcinoma, multimodal therapy has become part of the contemporary management of patients with muscle-invasive bladder cancer. However, radical cystectomy with pelvic lymphadenectomy remains the cornerstone of treatment for patients with localized and regionally advanced muscle-invasive disease. The effectiveness of chemotherapy models in bladder cancer can depend greatly on the quality of surgery. Unfortunately, without sufficient level I data, the boundaries of lymphadenectomy and the diagnostic and therapeutic ramifications of variations in the pelvic lymph node dissection remain undetermined. This article examines the role of pelvic lymph node dissection during perioperative chemotherapy and discusses the current challenges in establishing standards for lymphadenectomy in patients undergoing treatment for muscle-invasive bladder cancer.
Contemporary Intravesical Treatment Options for Urothelial Carcinoma of the Bladder
Authors: Brassell Stephen A. , Kamat Ashish M.
Published: April 2017

To provide a comprehensive review of intravesical treatment options for non–muscle-invasive bladder cancer, we performed a search of the PubMed database for articles between 1980 and 2006 that reported on intravesical agents for treating this disease. Data were compiled and analyzed, emphasizing findings from large multicenter trials, studies providing reproducible results, data that could be confirmed by cross-referencing the literature, and phase I or II studies for pertinent novel agents. A critical analysis of evidence shows that: 1) treatment with Bacillus Calmette-Guérin (BCG), including a maintenance schedule (with or without interferon-α), is the most effective therapy for limiting recurrence, is the only therapy that reduces the incidence of progression, and overall is superior to chemotherapy; 2) mitomycin C, gemcitabine, anthracyclines, and thiotepa provide similar benefits for preventing recurrence in patients with minimal effect on progression; and 3) using chemotherapeutic agents immediately after transurethral resection (when use of BCG is contraindicated because of the risk for systemic absorption) reduces the recurrence rate by up to 50% and seems to be the ideal method of chemotherapy. Although various clinical factors dictate which agent is most appropriate for an individual patient, the current literature supports a single perioperative dose of intravesical mitomycin C followed, in appropriate cases, by induction and maintenance therapy with intravesical BCG.
Testicular Cancer
Authors: _ _
Published: April 2017

An estimated 8250 new cases of testicular cancer will be diagnosed in the United States in 2006, with germ cell tumors (GCTs) constituting 95% of the malignant tumors arising in the testes. Although GCTs are relatively uncommon tumors, they are the most common solid tumor in men between the ages of 15 and 34 years. The worldwide incidence of these tumors has more than doubled in the past 40 years. More than 90% of all patients diagnosed with GCTs are cured, including 70% to 80% of patients with advanced tumors who are treated with chemotherapy. Standard therapy has been established at essentially all stages of management and must be closely followed to ensure the potential for cure.

For the most recent version of the guidelines, please visit NCCN.org
Review of Late Complications of Treatment and Late Relapse in Testicular Cancer
Authors: Efstathiou Eleni , Logothetis Christopher J.
Published: April 2017

With testicular cancer, a disease with a cure rate of 95%, the challenge is to restore quality of life to pretreatment levels and sustain it long-term. Although the implementation of guidelines and optimization of treatment modalities over the past years have served this purpose, some complications remain inevitable and experts are still challenged with late complications of outdated treatment standards. This article focuses on the late complications of cisplatin-based chemotherapy without disregarding those of currently applied infradiaphragmatic radiation. The most serious long-term complications of chemotherapy or radiotherapy are cardiovascular toxicity and second malignancies, as each has a 25-year risk of approximately 16%. Compared with the general population, risk for second malignancies remains significantly increased for at least 35 years after treatment. Chemotherapy-related cardiovascular toxicity is probably a result of both direct endothelial damage induced by cisplatin and indirect hormonal and metabolic changes. The increased incidence of the metabolic syndrome identified in long-term survivors is most likely associated with the lower testosterone levels reported. Cisplatin-based chemotherapy affects not only Leydig cells but also Sertoli and germ cells, resulting in infertility in 30% to 50% of testicular cancer patients treated with chemotherapy. Chronic neurotoxicity occurs in half of men, whereas permanent ototoxicity and some degree of renal function impairment occur in up to 30%. Pulmonary fibrosis, occurring in 5% to 10% of patients treated with bleomycin, is fatal in 1%. Although current treatment of advanced disease has changed its natural course, we are challenged by an increasing incidence of late relapse, an entity with a distinct tumor biology characterized by latency and chemoresistance.
Multiple Myeloma Guidelines
Authors: _ _
Published: April 2017

Multiple myeloma will account for an estimated 16,570 new cancer cases in the United States in 2006, with an estimated 11,310 deaths. It is not currently considered curable; however, treatment has evolved rapidly because of new drugs such as bortezomib, thalidomide, and lenalidomide. In addition, increased understanding of the bone marrow microenvironment is creating rationale for new combinations and new drug development. Important updates in the 2007 NCCN guidelines include new recommended single-agent and combination regimens for consideration for induction and salvage therapy.

For the most recent version of the guidelines, please visit NCCN.org
The Emerging Role of Novel Therapies for the Treatment of Relapsed Myeloma
Authors: Richardson Paul G. , Hideshima Teru , Mitsiades Constantine , Anderson Kenneth C.
Published: April 2017

Despite advances in the first-line treatment of multiple myeloma, almost all patients eventually relapse, become chemoresistant, and die of the disease. Improved understanding of potential myeloma targets and molecular mechanisms of drug resistance, along with the development and clinical investigation of targeted antitumor agents, have led to new strategies for the treatment of relapsed myeloma. The proteasome inhibitor bortezomib, the immunomodulatory agent thalidomide, and the thalidomide derivative lenalidomide, are all recently approved treatment options for myeloma. Single-agent bortezomib has been shown to provide significantly greater efficacy than high-dose dexamethasone, and bortezomib has also been investigated in combination with other agents commonly used to treat myeloma, including thalidomide and lenalidomide, with high overall and complete response rates. The safety profile of bortezomib has been well characterized, and side effects have been shown to be generally predictable and manageable, including in high-risk and elderly patients and those with renal impairment. Thalidomide has been extensively studied alone and in combination in patients with relapsed myeloma, demonstrating substantial efficacy, and is therefore widely used in this setting. The toxicity profile is dose- and duration-linked, with lower doses appearing to be better tolerated. Lenalidomide plus dexamethasone has been shown to have significantly greater activity than dexamethasone alone in the relapsed setting, with impressive duration of disease control. Other combinations are also under investigation, with promising early results. Some aspects of the toxicity profile appear significantly reduced relative to thalidomide, although myelosuppression is increased. Other novel therapies at earlier stages of development are being studied and may provide further options in the treatment of relapsed myeloma. This review focuses on results from key phase II and III trials of bortezomib, thalidomide, and lenalidomide alone or in combination, and their emerging role in improving outcomes.
Myeloid Growth Factors Guidelines
Authors: _ _
Published: April 2017

Chemotherapy-induced neutropenia can cause complications that result in dose reductions or treatment delays that can, in turn, compromise clinical outcomes. Although the prophylactic use of colony-stimulating factors (CSFs) can reduce the risk, severity, and duration of severe and febrile neutropenia, they are not routinely administered to all patients undergoing myelosuppressive chemotherapy because of the costs. Selective use may, however, enhance their cost-effectiveness. These guidelines discuss the preventative or prophylactic use of recombinant human granulocyte-CSF to reduce the incidence, length, and severity of chemotherapy-related neutropenia and and prevent life-threatening complications.

For the most recent version of the guidelines, please visit NCCN.org
Summary and Comparison of Myeloid Growth Factor Guidelines in Patients Receiving Cancer Chemotherapy
Authors: Lyman Gary H. , Kleiner Jessica Malone
Published: April 2017

Three different practice guidelines for the myeloid growth factors were recently published by major professional organizations. A comprehensive review and comparison of the guidelines using a priori structured content criteria and a previously validated quality appraisal tool are reported. The final recommendations from these guidelines are consistent for primary prophylaxis with the colony-stimulating factors (CSFs) when the risk of febrile neutropenia is in the range of 20% or greater. All 3 guidelines also recommend prophylactic use of myeloid growth factors in patients with important factors increasing individual risk of neutropenic complications. The recommendation that patients receiving regimens associated with lower risk should have CSF use guided by individual risk assessment is also consistent. Critical quality appraisal indicates that the scope, purpose, stakeholder involvement, and applicability of these guidelines differ little. The American Society of Clinical Oncology and European Organization for Research and Treatment of Cancer guidelines place more emphasis on comprehensive literature reviews, and the National Comprehensive Cancer Network guidelines are more current based on systematic annual updates. Presentation clarity also favors National Comprehensive Cancer Network guidelines, with recommendations generally presented as both text and algorithmic diagram.
Myeloid Growth Factor Therapy for Prophylaxis of Febrile Neutropenia in Non-Myeloid Malignancies: Appropriate Doses and Schedules
Authors: Althaus Betsy L.
Published: April 2017

Myeloid growth factors (MGFs) are used for the prophylaxis of febrile neutropenia and maintenance of scheduled dose delivery in the treatment of patients undergoing cancer chemotherapy. To spare cost and for patient convenience, in adults MGFs are used at schedules, doses, and durations that differ from the approved prescribing information of the U.S. Food and Drug Administration. These variations include rounding doses to convenient sizes, fewer days of treatment, a shorter interval between cycles, and same-day administration with chemotherapy. Some of these variations are supported by clinical trial results and practice guidelines.
Antibacterial Prophylaxis in Patients with Neutropenia
Authors: Segal Brahm H. , Freifeld Alison G.
Published: April 2017

Patients with cancer and chemotherapy-induced neutropenia are at risk for severe bacterial infections. This risk is not uniform among all cancer patients but is dependent primarily on the depth and duration of neutropenia and the type of underlying disease. Accordingly, the decision whether to use antibacterial prophylaxis to prevent serious infections in these patients requires a balance between expected benefit and the risks for infection, adverse drug-related events, and emergence of antibiotic resistance. Although antibacterial prophylaxis has the potential to benefit all patients with chemotherapy-induced neutropenia, the benefit regarding reduction in documented infections has been firmly established only in patients with neutropenia expected to exceed 7 days. A recent meta-analysis showed enhanced survival in patients receiving antibacterial prophylaxis during neutropenia; most patients enrolled in the analyzed trials had a hematologic malignancy. Among patients with neutropenia at lower risk for infectious complications (a category that includes most patients with solid tumor malignancies), the main benefit of antibacterial prophylaxis relates to a reduction in fever rather than documented infections. The authors advise quinolone prophylaxis (levofloxacin is preferred), in patients with an expected duration of neutropenia (absolute neutrophil count < 1000/μL) of more than 7 days. Trimethoprim-sulfamethoxazole should be used in patients at risk for Pneumocystis jiroveci (formerly P carinii), such as childhood acute lymphoblastic leukemia. In patients with neutropenia expected to last 7 days or less and not receiving immunosuppressive regimens (e.g., systemic corticosteroids), the authors recommend no initial prophylaxis. However, if such patients develop fever during neutropenia, they should be considered for outpatient empiric therapy with an oral quinolone–containing regimen if they meet criteria for low risk for complications.
NCCN Invasive Breast Cancer Clinical Practice Guidelines in Oncology
Authors: _ _
Published: April 2017

The American Cancer Society estimates that 214,640 new cases of breast cancer will be diagnosed and 41,430 will die of the disease in the United States in 2006. Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. The incidence of breast cancer has steadily increased in the United States over the past few decades, but breast cancer mortality appears to be declining, suggesting a benefit from early detection and more effective treatment. These guidelines discuss diagnosis, treatment, and follow up for invasive breast cancer.

For the most recent version of the guidelines, please visit NCCN.org
The Role of Radiation Treatment in the Contemporary Management of Bone Tumors
Authors: Hristov Borislav , Shokek Ori , Frassica Deborah A.
Published: April 2017

Radiotherapy is integral in the multidisciplinary approach to patients with musculoskeletal neoplasms. Multiple studies have established a role for radiotherapy as a definitive local treatment of unresectable lesions or when surgery might yield unacceptable functional outcomes, such as in Ewing's tumor or base of skull chondrosarcoma. Radiotherapy is also used as an adjuvant treatment after surgery with close or positive margins. In the metastatic setting, external beam radiotherapy and bone-seeking intravenous radioisotopes are used on a case-by-case basis for palliation. As radiotherapy and its delivery techniques have evolved, so has its role in treating tumors such as Ewing's sarcoma, chordoma and chondrosarcoma, osteosarcoma, primary lymphoma of bone, malignant fibrous histiocytoma of bone, and vascular tumors. Radiation can also be successfully used to treat unresectable or recurrent benign tumors, such as giant cell tumor and aneurysmal bone cyst. This article reviews the indications for radiotherapy for various bone tumors and summarizes some of the important data supporting its use.
Monitoring Chronic Myelogenous Leukemia in the Age of Tyrosine Kinase Inhibitors
Authors: Radich Jerald P. , Oehler Vivian
Published: April 2017

Tyrosine kinase inhibitors (TKIs) are now standard up-front therapy for chronic myeloid leukemia (CML). Patients with newly diagnosed chronic-phase CML treated with the TKI imatinib mesylate typically experience a complete cytogenetic remission. Outcomes for patients with advanced-phase disease are distinctly worse. Unfortunately, a small proportion of chronic-phase patients experience relapse during this therapy, and most with advanced-phase disease develop resistance to imatinib mesylate after months of therapy. Hematopoietic cell transplantation remains the only curative approach for CML and can salvage patients with advanced-phase disease. Therefore, physicians must carefully monitor patients with chronic-phase CML treated with TKIs so that they can undergo hematopoietic cell transplant (or treatment with another TKI or experimental therapy) before frank progression occurs. Fortunately, monitoring CML using cytogenetic and molecular methods (i.e., quantitative polymerase chain reaction) effectively defines end points that correlate highly with outcome.
Transplant-Associated Skin Cancer: Role of Reducing Immunosuppression
Authors: Neuburg Marcy
Published: April 2017

This article explores the role of reducing immunosuppression as a therapeutic strategy for the problem of transplant-associated skin cancer. The specific issue of immunosuppression reduction is based on a brief historic review of the epidemiology of skin cancer in transplant patients, followed by a description of the role of immunosuppression as a cause of skin cancer. Finally, the literature pertaining to the hypothesis that reducing immunosuppression in solid organ transplant recipients favorably impacts both the incidence of cutaneous malignancy and outcomes relating to individual aggressive malignancies is presented.
Molecular Targeting of Dermatofibrosarcoma Protuberans: A New Approach to a Surgical Disease
Authors: McArthur Grant A.
Published: April 2017

Dermatofibrosarcoma protuberans (DFSP) is a low-grade malignancy of the skin and subcutaneous tissues that only rarely forms distant metastases. More than 90% of cases are associated with a chromosomal translocation involving the COL1A1 gene on chromosome 17 and the platelet-derived growth factor B gene on chromosome 22. Management of this disease is primarily surgical with excellent rates of local control obtained using either wide local excision or Mohs micrographic surgery. Data have recently shown that inhibiting platelet-derived growth factor receptors (PDGFR) with imatinib can induce high rates of clinical response in patients with unresectable or metastatic DFSP. These data have led to approval of imatinib by the U.S. Food and Drug Administration for treating uresectable DFSP. Although wide surgical excision remains standard care, patients with locally advanced disease not suitable for surgical excision can be treated with the PDGFR-inhibitor imatinib, which sometimes allows residual DFSP to be surgically excised.
Thyroid Carcinoma
Authors: _ _
Published: April 2017

Although thyroid carcinoma is relatively uncommon, approximately 33,550 new cases will be diagnosed in the United States in 2007. It occurs 2 to 3 times more often in women than in men, and with the incidence increasing by 4% per year, it is currently the eighth most common malignancy diagnosed in women. Although it occurs more often in women, mortality rates are higher for men, probably because they are usually older at the time of diagnosis (65–69 years vs. 50–54 years in women). Interestingly, the incidence of thyroid carcinoma increased almost 240% between 1950 and 2000, but mortality rates decreased more than 44%. Important updates to the 2007 guidelines include revised criteria for categorizing disease, revised recommendation for thyroid-stimulating hormone–stimulated thyroglobulin in some cases, and expanded CT recommendations for anaplastic carcinoma.

For the most recent version of the guidelines, please visit NCCN.org