bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Convenience of a 15-Minute Infusion of Zoledronic Acid
Authors: Berenson James , Hirschberg Raimund 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the effects of bisphosphonates on bone metabolism in patients with metastatic bone disease. Explain the ability of intravenous bisphosphonates to reduce skeletal complications in patients with metastatic bone disease. Identify differences among the different bisphosphonates in their efficacies at reversing hypercalcemia of malignancy.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Skeletal morbidity, including hypercalcemia of malignancy (HCM), places a severe burden on patients with advanced cancers. Bisphosphonates effectively correct HCM and reduce skeletal morbidity in patients with bone metastases. However, with the widespread use of bisphosphonates, the safety and convenience of therapy are emerging concerns. The delivery of effective doses of early bisphosphonates required a lengthy 24-hour i.v. infusion protocol because of renal tolerability issues. The introduction of more potent bisphosphonates with superior tolerability profiles has allowed therapy to be safely delivered via shorter i.v. infusions. Intravenous therapy with etidronate, clodronate, pamidronate, ibandronate, and zoledronic acid has been used to treat HCM and skeletal complications in cancer patients. Of these therapies, zoledronic acid (which can be safely administered via a 15-minute i.v. infusion) is the most convenient and effective and has demonstrated an excellent safety profile with long-term use. Zoledronic acid has also received the broadest regulatory approval of any bisphosphonate and can be used to treat HCM or bone lesions secondary to multiple myeloma and a wide variety of solid tumors, including breast, prostate, and lung cancers. In addition to the patient preference for shorter infusion times, the 15-minute i.v. infusion protocol of zoledronic acid can provide benefits for infusion centers by potentially increasing patient throughput.
Too Old to Care?
Authors: Penson Richard T. , Daniels Kristy J. , Lynch Thomas J. 
Published: August 2004

AbstractLearning ObjectivesAfter completing this course, the reader will be able to:Discuss the competing issues in the use of cytotoxic chemotherapy in older patients. Identify the intrinsic biases in evaluating the elderly. Explain how to inform patients in the face of uncertainty.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.comShortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH (http://www.theschwartzcenter.org/rounds.asp). The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members.Ageism is a pervasive problem throughout society. It is rooted in language, attitudes, beliefs, behaviors, and policies. Aging profoundly influences physiology, challenging the medical community to accommodate but not discriminate. The elderly are at an increased risk of disease and disability. Sixty percent of cancer occurs in people aged 65 and older, and the population is aging. The treatment of cancer in the elderly is complicated by comorbidities and other physiological factors, particularly renal, bone marrow, and metabolic reserve. Caregivers have to treat patients in a manner that optimizes treatment and avoids anticipated harm. However, the caregiver is often faced with situations where they must balance their personal beliefs, professional values, and knowledge of medicine with their patients' preferences and needs. Discussion in the Rounds focused on age bias, drug toxicity, life prolongation, and symptom relief, with the role of the caregiver, and the relationship to the patient, being pivotal.
The Molecular Perspective: Nicotine and Nitrosamines
Authors: Goodsell David S. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the role of nitrosamines in cancer.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Oncogenes and Tumor Suppressor Genes in Breast Cancer: Potential Diagnostic and Therapeutic Applications
Authors: Osborne Cynthia , Wilson Paschal , Tripathy Debu 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Differentiate between the actions of oncogenes and tumor suppressor genes in the development of breast cancer. Describe the results of studies with antibodies and small molecule drugs that target growth factor receptors. Evaluate the current and potential roles of molecular and protein profiles of breast tumors in prognosis and in predicting response to therapy.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Carcinogenesis is a multistep process characterized by genetic alterations that influence key cellular pathways involved in growth and development. Oncogenes refer to those genes whose alterations cause gain-of-function effects, while tumor suppressor genes cause loss-of-function effects that contribute to the malignant phenotype. The effects of these alterations are complex due to the high number of changes in a typical case of breast cancer and the interactions of the biological pathways involved. This review focuses on the more common abnormalities in oncogenes and tumor suppressor genes in human breast cancer and their known associations with clinical outcome in terms of tumor classification, prognosis, and response to specific therapies. A better understanding of these relationships has led to new therapeutic applications. Agents that target oncogenes and their associated pathways are now in clinical use, with many more undergoing preclinical and clinical testing. The availability of antibodies, small synthetic molecules, cyotokines, gene therapy techniques, and even natural compounds that are screened for specific biological properties has greatly increased the number of candidate drugs. Nevertheless, clinical successes have been limited because of the redundancy of many cancer-related pathways as well as the high degree of variability in genotype and phenotype among individual tumors. Likewise, strategies to replace tumor suppressor gene functions face numerous technical hurdles. This review summarizes the current achievements and future prospects for the therapeutic targeting of oncogenes and tumor suppressor genes and new technology to better classify tumors and accurately predict responses to standard and novel agents.
Imaging the Liver
Authors: Sahani Dushyant V. , Kalva Sanjeeva P. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Select an appropriate imaging modality to diagnose a suspected liver tumor or stage an existing liver tumor. Describe the relative advantages and disadvantages of various imaging modalities in characterizing liver tumors. Explain the common radiological findings in the diagnosis of focal and diffuse liver disease.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Imaging of the liver is undertaken for the detection and characterization of suspected primary or secondary neoplasms, prior to planning a surgery or chemotherapy pump placement, for assessing treatment response, for evaluating biliary pathology, and for screening for liver neoplasms in high-risk groups. In this article, we review the advantages and disadvantages of various imaging modalities in the evaluation of the liver and formulate guidelines for the imaging of common clinical indications. A brief review of imaging findings in focal and diffuse liver disease is also presented.
Dilemmas in Management: The Controversial Role of Chemotherapy in PS 2 Advanced NSCLC and the Potential Role of CT-2103 (Xyotax™)
Authors: Langer Corey J. 
Published: August 2004

Abstract
Platinum-based chemotherapy improves long-term survival in patients with advanced non-small cell lung cancer (NSCLC). Meta-analyses have demonstrated an improvement in median and 1-year survival times as well as quality of life. However, these benefits are largely confined to patients with a good performance status (PS), one of the most critical determinants influencing outcome. Several clinical trials that initially included PS 2 patients ultimately discontinued their enrollment due to a high propensity of adverse reactions to treatment. The advent of more active, less toxic agents has revitalized investigator interest in treating PS 2 patients. CT-2103 is a novel paclitaxel conjugate undergoing investigation in the treatment of advanced NSCLC. The median survival for PS 2 patients treated with single-agent CT-2103 in one small trial proved similar to that reported for paclitaxel/carboplatin in NSCLC patients and was associated with an improved safety profile compared with conventional taxanes. Phase III studies comparing CT-2103 as a single agent and in combination with carboplatin to current standards of care are in progress. Unlike a well-defined population with good PS, the therapeutic index in PS 2 patients is narrower and not as clearly defined. These and other efforts will determine the optimal mode of therapy in PS 2 individuals with NSCLC.
Clinical Mimics of Lymphoma
Authors: Brown Jennifer R. , Skarin Arthur T. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Determine when lymphadenopathy is of concern and merits biopsy. Identify the benign causes of significant lymphadenopathy. Identify the unusual lymphoproliferative disorders that can cause significant lymphadenopathy.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Lymphadenopathy is a common clinical finding and is frequently benign. Warning signs suggestive of a malignant etiology include lymph nodes &gt;2 cm in size, supraclavicular location, and generalized lymphadenopathy associated with hepatosplenomegaly or systemic symptoms. A metastatic solid tumor is always in the differential diagnosis of localized lymphadenopathy, particularly in older individuals. In the case of more generalized lymphadenopathy, in addition to the more common lymphomas, benign etiologies as well as benign and atypical lymphoproliferative disorders need to be considered. Benign etiologies of lymphadenopathy can include infections, autoimmune disorders, drug hypersensitivity reactions, sarcoidosis, and amyloidosis. Rare but benign lymphoproliferative disorders include Kikuchi's disease, Rosai-Dorfman disease, and progressive transformation of germinal centers. Atypical lymphoproliferative disorders that bear close surveillance for evolution to a more aggressive malignancy include Castleman's disease, lymphomatoid granulomatosis, and lymphomatoid papulosis. Previously considered in this category but now classified as a true lymphoma is angioimmunoblastic lymphadenopathy with dysproteinemia. Physicians need to be aware of all of these disorders when evaluating suspicious lymphadenopathy, while also considering the more common lymphomas and leukemias.
Serum CA125: A Tumor Marker for Monitoring Response to Treatment and Follow-up in Patients with Non-Hodgkin's Lymphoma
Authors: Zidan Jamal , Hussein Osamah , Basher Walid , Zohar Shmuel 
Published: August 2004

Abstract
Purpose. Serum CA125 is an important prognostic factor in patients with non-Hodgkin's lymphoma (NHL). Elevation of CA125 level correlates with advanced disease, poor response to treatment, and poor survival rates. The aim of the current study is to evaluate CA125 levels in patients with NHL and to investigate the correlations between high CA125 level and other presenting features.
Materials and Methods. Thirty-eight patients (14 with low-grade and 24 with aggressive histologically proven NHL) were studied prospectively. Serum CA125 assessment was done at diagnosis, during treatment, and at follow-up. The associations between CA125 levels and other presenting features were examined.
Results. CA125 levels were elevated in 43% of patients with low-grade NHL and in 46% of patients with aggressive NHL (i.e., 45% of all patients). A higher CA125 level was associated with advanced disease, bone marrow involvement, extranodal involvement, poor performance status, the presence of B symptoms, and high serum lactate dehydrogenase level. Complete responses occurred in 86% of patients with normal CA125 levels and in 59% of patients with elevated CA125 levels. In both low-grade and aggressive NHL, the estimated 5-year overall survival rate was higher in patients with normal CA125 levels than in patients with elevated CA125 levels (88% versus 50% and 70% versus 27%, respectively).
Conclusion. High serum CA125 is an important prognostic factor in NHL and correlates with more advanced disease, low response rates, and worse survival. CA125 measurements may be used for staging, monitoring response to treatment, and follow-up of patients with NHL.
Conformal Radiation Therapy for Childhood CNS Tumors
Authors: Kirsch David G. , Tarbell Nancy J. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the difference between conventional and conformal radiation therapy. Explain why conformal radiation therapy may decrease the long-term side effects of treatment. Compare the potential risks for a radiation-induced malignancy from proton radiation therapy and intensity-modulated radiation therapy with photons (x-rays).
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Radiation therapy plays a central role in the management of many childhood brain tumors. By combining advances in brain tumor imaging with technology to plan and deliver radiation therapy, pediatric brain tumors can be treated with conformal radiation therapy. Through conformal radiation therapy, the radiation dose is targeted to the tumor, which can minimize the dose to normal brain structures. Therefore, by limiting the radiation dose to normal brain tissues, conformal radiation therapy offers the possibility of limiting the long-term side effects of brain irradiation.
In this review, we describe different approaches to conformal radiation therapy for pediatric central nervous system tumors including: A) three-dimensional conformal radiation therapy; B) stereotactic radiation therapy with arc photons; C) intensity-modulated radiation therapy; and D) proton beam radiation therapy. We discuss the merits and limitations of these techniques and describe clinical scenarios in which conformal radiation therapy offers advantages over conventional radiation therapy for treating pediatric brain tumors.
Effectiveness of Darbepoetin Alfa Versus Epoetin Alfa in Patients with Chemotherapy-Induced Anemia Treated in Clinical Practice
Authors: Patton Jeffrey , Reeves Timothy , Wallace Joel 
Published: August 2004

Abstract
Primary Purpose. The objective of this retrospective observational cohort study was to compare the effectiveness of darbepoetin alfa with that of epoetin alfa in patients with chemotherapy-induced anemia using data from noncontemporaneous chart audits conducted at a community-based oncology practice.
Materials and Methods. For the first chart audit, data were collected from consecutive patients with nonmyeloid malignancies with diagnoses of chemotherapy-induced anemia and hemoglobin levels ≤10.5 g/dl who were receiving concurrent chemotherapy and had at least 5 weeks of visits from July-September 2000. After therapeutic substitution of darbepoetin alfa for epoetin alfa for all patients with chemotherapy-induced anemia, data were collected from consecutive darbepoetin alfa-treated patients with diagnoses of chemotherapy-induced anemia and at least 8 weeks of visits from June-October 2002 (darbepoetin alfa was approved in July 2002).
Results. Most (86%) of the 212 epoetin alfa-treated patients had received an initial dose of 40,000 U once weekly, and most (85%) of the 196 darbepoetin alfa-treated patients had received a fixed dose of either 100 μg once weekly (49%) or 200 μg every 2 weeks (36%). At 8 weeks, the mean change in hemoglobin level was 1.1 g/dl for the darbepoetin alfa patient group and 1.0 g/dl for the epoetin alfa patient group.
Discussion. Utilization, dose escalation rates, and clinical outcomes were considered comparable for the darbepoetin alfa and epoetin alfa patient groups.
Conclusions. Darbepoetin alfa, 100 μg once weekly or 200 μg every 2 weeks, appears to be as effective as epoetin alfa, 40,000 U once weekly, for the treatment of chemotherapy-induced anemia in the clinical practice setting.
The Molecular Perspective: Polycyclic Aromatic Hydrocarbons
Authors: Goodsell David S. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Gain a basic understanding of the role of polycyclic aromatic hydrocarbons in cancer.
Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com
Breast Cancer Highlights: Key Findings from the San Antonio Breast Cancer Symposium: A U.S. Perspective
Authors: Cristofanilli Massimo , Hortobágyi Gabriel N. 
Published: August 2004

AbstractThe San Antonio Breast Cancer Symposium has become one of the leading forums for communication of important discoveries in breast cancer research. Over the past couple of years, seminal, practice-changing results have been presented at this meeting. The aromatase inhibitors represent the most effective endocrine interventions for postmenopausal women with hormone receptor-positive breast cancer. Their introduction into the adjuvant therapy of primary breast cancer was prompted by evidence from the ATAC trial. Progress in adjuvant chemotherapy included the introduction to taxanes, and more recently, the demonstration that the dose-dense administration of paclitaxel in association with doxorubicin and cyclophosphamide resulted in significant improvements in relapse-free and overall survival rates. Molecular targets have become accepted as rational targets, and targeted therapies are proceeding through clinical trials. The success of trastuzumab elicited much excitement, but a number of theoretical and practical hurdles must be overcome before other molecularly targeted agents are incorporated into standard therapy of primary and metastatic breast cancer.
Targeted Therapy of Colorectal Cancer: Clinical Experience with Bevacizumab
Authors: Fernando Nishan H. , Hurwitz Herbert I. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Describe the clinical experience of bevacizumab in colorectal cancer. Explain the relevant biology and preclinical drug development of bevacizumab in colorectal cancer. Discuss future directions of research.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit atCME.TheOncologist.com
Advanced colorectal cancer remains an urgent health concern, despite improvements in systemic chemotherapy. Targeted therapeutics promise effective tumor therapy with minimal side effects. Angiogenesis (the formation of new blood vessels) is essential for tumor growth and metastasis and may be an ideal target in the search for new antineoplastic agents. Vascular endothelial growth factor is one of the best characterized of the proangiogenic growth factors that regulate angiogenesis and is a logical target in colorectal cancer therapy. Bevacizumab (AvastinTM; Genentech Inc.; South San Fransisco, CA), a humanized murine monoclonal antibody directed at vascular endothelial growth factor, is being evaluated in the treatment of various types of cancer. It has shown promising efficacy in phase II clinical trials in patients with metastatic colorectal cancer. Addition of bevacizumab at a dose of 5 mg/kg to chemotherapy (5-fluorouracil plus leucovorin) resulted in a higher objective response rate (40% versus 17%), longer time to disease progression (9.0 versus 5.2 months), and longer median survival time (21.5 versus 13.8 months). Hypertension and thrombosis were the principal safety concerns, but were manageable. Further phase II/III studies of bevacizumab, administered with 5-fluorouracil plus leucovorin, with or without irinotecan and/or oxaliplatin, in colorectal cancer, are under way.
Non-Small Cell Lung Cancer and Antiangiogenic Therapy: What Can Be Expected of Bevacizumab?
Authors: Herbst Roy S. , Sandler Alan B. 
Published: August 2004

Abstract

Learning Objectives
After completing this course, the reader will be able to:
Identify the role of angiogenesis in non-small cell lung cancer (NSCLC). Explain the role of bevacizumab in apparently producing greater response, time to progression, and overall survival rates in a randomized phase II trial comparing carboplatin, paclitaxel, and bevacizumab with carboplatin and paclitaxel without bevacizumab and the limitations of this interpretation. Define the main toxicity concerns with the use of bevacizumab in the treatment of NSCLC.
Access and take the CME test online and receive one hour of AMA PRA category 1 credit atCME.TheOncologist.com
There is an urgent need for new therapies to treat non-small cell lung cancer (NSCLC), as progress with current chemotherapy regimens has been limited. The roles of vascular endothelial growth factor (VEGF) in promoting tumor angiogenesis, maintaining existing vasculature, and contributing to resistance to traditional therapies, together with its negative prognostic significance in NSCLC, make it an appropriate target for therapy. Bevacizumab (AvastinTM; Genentech Inc., South San Fransisco, CA), a monoclonal antibody directed against VEGF, has shown promise in treating a number of different cancers. In a recent phase II trial in patients with advanced metastatic NSCLC, the addition of bevacizumab to standard carboplatin/paclitaxel chemotherapy produced a significantly longer time to progression (32.1 versus 18.4 weeks) and greater response rate (31% versus 19% [not significant]) than chemotherapy alone. In the subset of patients with nonsquamous histologies, response rates and survival were further enhanced, with a mean survival time of 17.9 months versus 12.3 months with chemotherapy alone.
Bevacizumab was generally well tolerated and did not appear to increase the incidences or severities of the nausea/vomiting, neuropathy, and renal toxicity that are typically associated with carboplatin/paclitaxel chemotherapy. Adverse events in phase I and II studies included hypertension, thrombosis, proteinuria (with occasional nephrotic syndrome), and epistaxis. Serious tumor-related bleeding episodes (hemoptysis/hematemesis) appear to be the main safety concern in patients with NSCLC, with squamous cell histology as a possible risk factor.
Further work is needed to identify the best way to use bevacizumab in NSCLC, including use in combination with other biologic agents and in the adjuvant setting.