Cancer

It is estimated there will be 31,900 new cases and 11,900 deaths from renal carcinoma in the U.S. in 2003. Since 1950 there has been a 126% increase reported in the incidence of renal carcinoma and a 36.5% increase in annual mortality. In the last 20 years, our understanding of tumors arising from the renal cortex has dramatically expanded because of advances in cytogenetics and histopathologic reclassification, improved abdominal imaging technology leading to a tumor stage migration, and changing surgical strategies. Despite these advances, our efforts to treat metastatic renal carcinoma either with systemic therapies or surgical intervention have been frustrated. In the article by Pantuck et al. in this issue of Cancer, the authors identify the adverse prognostic impact of metastatic regional lymph nodes in patients with metastatic disease when compared with patients with metastatic disease alone.

See also pages 2995–3002.

The author discusses an article in the current issue of Cancer that describes a laparoscopic detection method for identifying sentinel lymph nodes in women with cervical carcinoma using patent blue and radioisotope technology. The advantages and disadvantages are articulated. The possible future role of sentinel lymph node biopsy in patients with cervical carcinoma is discussed.

See also pages 3003–9.

The authors discuss a report by Ohata et al. in this issue of Cancer indicating that hepatic steatosis represents an independent risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus (HCV) infection. The importance of demonstrating that steatosis is a critical step in the hepatocarcinogenesis pathway is emphasized along with the necessity of defining the relation between steatosis, HCV, and fibrosis to clarify the individual contributions of these potentially carcinogenic factors.

See also pages 3036–43.

The authors present a breast carcinoma growth model that they used to investigate issues regarding the importance of ductal carcinoma in situ versus invasive breast disease, detection rates and undetected breast tumors in the general population, tumor growth rates, and why invasive breast carcinoma may grow more rapidly among very young women and more slowly among elderly women.

Fine-needle aspiration biopsy (FNAB) and core needle biopsy (CBX) provide equivalent RNA yield for genomic studies. Transcriptional profiles from FNABs more purely represent tumor cells, whereas profiles from CBXs contain additional transcriptional information from stromal cells.

Women with HER-2 overexpressing metastatic breast carcinoma benefit from trastuzumab-based therapy, but trastuzumab does not cross the blood-brain barrier. Metastases to the central nervous system (CNS) are common among patients receiving trastuzumab-based therapy, including patients responding to therapy outside the CNS.

The authors evaluated the prognostic impact of expression of cyclooxygenase-1 (COX-1) and COX-2 in a cohort of 221 patients with breast carcinoma. The most important result of the study was that COX-2, but not COX-1, was associated significantly with reduced disease-free survival and overall survival.

Gemcitabine at 800 mg/m² was the maximum tolerated dose when administered on a weekly schedule with a 55-μCi/kg dose of strontium-89 to patients with androgen independent prostate carcinoma in the current study. There were no responses, as measured by prostate specific antigen, but clinical improvements specific to bone were observed in approximately half of the 15 men studied.

The presence of regional lymphadenopathy exerts a detrimental effect on the survival of patients with metastatic renal cell carcinoma. Lymph node status is a strong predictor of failure to achieve either an objective immunotherapy response or an improvement in survival when immunotherapy is given as an adjunctive treatment after cytoreductive nephrectomy.

See also pages 2941–4.

The authors demonstrated the feasibility of a laparoscopic sentinel lymph node procedure based on combined detection with patent blue and radiocolloid in patients with carcinoma of the uterine cervix.

See also pages 2945–7.

The combination of weekly polyethylene glycol formulation of interferon-α-2b (PEG-IFN; Schering 54301) and daily low-dose cytosine arabinoside was studied in a Phase II study of patients with chronic myelogenous leukemia. Results indicate that the activity of this combination is similar to that of nonpegylated interferon, albeit at lower doses of PEG-IFN (3 μg/kg vs. 7.5 μg/kg) than predicted in the original Phase I studies. These results are important for the development of future combination studies including imatinib mesylate.

p38 MAPK and MKK6 activation induced apoptosis in hepatoma cells and the activities of these kinases were reduced in human hepatocellular carcinoma (HCC) tissue specimens. These findings suggest that diminished p38 MAPK and MKK6 activities lead to reduced cell death, contributing to the unrestricted cell growth of HCCs.

Some surgeons have advocated delaying resection of liver metastases to allow additional metastases which may be present, but are undetected, to be identified. This “test-of-time” approach can help to limit the number of resections performed on patients who ultimately will develop additional metastases. Current radiofrequency ablation techniques, when used as part of a test-of-time management approach, can decrease the number of resections performed. They result in complete tumor necrosis in some patients and provide an interval for others who will develop new intrahepatic and/or extrahepatic metastases to do so.

The authors studied the influence of various factors in patients with hepatocellular carcinoma (HCC) to determine the correlation between hepatic steatosis and hepatocarcinogenesis in patients with chronic hepatitis C virus infection. See also pages 2948–50.

The activation of the clotting-fibrinolytic system in cancer patients is common and represents an unfavorable clinical sign. D-dimer (DD) is a sensitive marker of fibrinolysis. The authors recommend measuring the plasma level of DD in all new lung carcinoma patients. The measurement formulated individual prognosis and could be used to recommend adjuvant treatment for surgical patients.

The authors used quality-adjusted time without symptoms or toxicity methodology to compare the quality of life of patients with solid tumor neoplastic meningitis randomized to treatment with either methotrexate or a depot cytosine arabinoside liposome injection (DepoCyt). After 12 months of follow-up, the DepoCyt patients achieved 45–79 more days of quality-adjusted survival.

The authors retrospectively studied 52 patients with primary astrocytic tumors to assess the subcellular localization of basic fibroblast growth factor (bFGF) using immunohistochemistry. The results suggest that nuclear accumulation of bFGF may be a useful predictor of survival in patients with astrocytic tumors.

The histologic subtype of primary central high-grade osteosarcoma of the extremity is strictly correlated with histologic response to chemotherapy and with prognosis. Consequently, a specific therapeutic approach based on the histologic subtype of the tumor may be indicated.

Cancer incidence was examined in the Minnesota Hmong population. Selected malignancies, including cancers of the nasopharynx and the uterine cervix, were notably higher in the Hmong compared with all Minnesotans, indicating important areas for targeted surveillance and intervention.

In a nationwide cohort of largely female radiologic technologists with occupational radiation exposure, the authors found elevated risks for breast, melanoma, and thyroid cancer and decreased risks for lung, rectal, and buccal cavity cancer. The increased risk for breast cancer likely was related to radiation exposure, whereas the elevated occurrence of melanoma and thyroid cancer may be related in part to early detection in a population with easy access to health care.

A large Phase III randomized trial was conducted to confirm the results of earlier studies, which suggested that the addition of aprepitant to standard dual therapy with a 5-hydroxytriptamine-3 antagonist and a corticosteroid would enhance protection against chemotherapy-induced nausea and vomiting (CINV). Compared with standard dual therapy, the addition of aprepitant was generally well tolerated and provided consistently superior protection against CINV in patients who were receiving highly emetogenic chemotherapy.

On the basis of cost minimization from the payer's perspective, oprelvekin administration cannot be considered a cost-saving clinical strategy compared with routine platelet transfusions for patients with severe chemotherapy-induced thrombocytopenia.

The current retrospective study describes 14 cases of focal nodular hyperplasia (FNH) in pediatric patients who previously had been treated for a malignancy. The incidence of FNH was particularly high in the current series (0.45%) compared with the incidence in the general pediatric population. FNH appears to be a late complication of an iatrogenic vascular disease in children with a history of malignancy.

The serum squamous cell carcinoma antigen level can predict the response of uterine cervical carcinoma, not only before, but also at 4 weeks and at the end of radiation therapy. It also may be useful for identifying patients who are at high risk of local recurrence and/or distant metastasis.

The conversion from transdermal to intravenous (IV) fentanyl can be accomplished safely and effectively using a 1:1 (transdermal:IV) conversion during acute exacerbations of cancer pain.