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Tumor Lysis Syndrome

Summary of Key Points Tumor lysis syndrome can occur in any patient with newly diagnosed or relapsed cancer, so all patients should undergo risk stratification and management according to their risk for clinical tumor lysis syndrome. Laboratory tumor lysis syndrome is defined as the presence of two or more of the following abnormalities present on the same day: hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia because of hyperphosphatemia.…

Hypercalcemia

Summary of Key Points Incidence Hypercalcemia is a common metabolic complication associated with malignant disease. Hypercalcemia is frequently seen in more advanced malignancy and is associated with poorer prognosis. Etiology The three main mechanisms are tumor secretion of parathyroid hormone–related peptide (PTHrP); production of 1,25(OH) 2 D by autonomous 1α-hydroxylase; and increasing bone resorption by osteolytic metastases through the RANKL pathway. Evaluation of the Patient Determine…

Infection in the Patient With Cancer

Summary of Key Points Cancer patients with fever and neutropenia require immediate evaluation, assessment of risk for complications, at least two sets of blood cultures (including one from a peripheral vein and one from any indwelling catheter), other appropriate cultures or tests to aid infection diagnosis, and prompt institution of empiric broad-spectrum antibacterial therapy within 2 hours of presentation. Appropriate empiric antibiotic regimens include those covering…

Diagnosis, Treatment, and Prevention of Cancer-Associated Thrombosis

Summary of Key Points Venous thromboembolism (VTE) is a common complication in patients with cancer, affecting approximately 15% of patients during their clinical course. VTE is fivefold to sevenfold more likely to develop in patients with cancer than in patients without cancer. VTE is the second most common cause of mortality among patients with cancer and is associated with a threefold increased risk of death compared…

Disorders of Blood Cell Production in Clinical Oncology

Summary of Key Points Anemia is very common in patients with cancer and is multifactorial. The anemia of persons with chronic disease is associated with decreased absorption of oral iron and decreased ability to access storage iron pools. Iron-restricted erythropoiesis may limit the efficacy of erythropoietic agents for the treatment of anemia in these patients and can be overcome with parenteral iron. Treatment of anemia in…

Complementary and Alternative Medicine

Summary of Key Points Complementary and alternative medicine encompasses various approaches to all aspects of medical assessment and management that are not commonly or extensively applied or recommended by conventional Western medical practitioners. Complementary and alternative medicine approaches are frequently used by patients, but patients often do not discuss their use of these approaches with their health care team. Some products purported to be dietary supplements…

Therapeutic Antibodies and Immunologic Conjugates

Summary of Key Points Because of their tumor selectivity, monoclonal antibodies offer exceptional opportunities for targeted therapy. As naked antibodies they can kill tumors by receptor blockade and by actively inducing apoptosis or by reenergizing endogenous antitumor T-cell immunity. Tumor cytotoxicity is mediated through white cells by activation of antibody-dependent cell-mediated cytotoxicity, and in the presence of serum by complement-mediated cytotoxicity. Bispecific or multifunctional constructs can…

Gene Therapy in Oncology

Summary of Key Points Recent Advances in Gene Therapy Infusion of chimeric antigen receptor (CAR) transduced peripheral blood T-lymphocytes has demonstrated therapeutic activity for patients with B cell lymphomas and leukemia and two of which have received FDA regulatory approval. Intralesional injection of Talmogene laherparepvec (T-VEC), a herpes simplex type-1 oncolytic virus modified to attenuate viral pathogenicity, increases antigen presentation and induces selective tumor lysis that,…

Hematopoietic Stem Cell Transplantation

Summary of Key Points Allogeneic or autologous hematopoietic cell transplantation (HCT) is a potentially curative treatment for many patients with high-risk hematologic malignancies, as well as a variety of other hematopoietic, immune, metabolic, and malignant diseases. Hematopoiesis and immune function can be restored with hematopoietic stem cells obtained from bone marrow, peripheral blood, or umbilical cord blood. Although the use of allogeneic HCT has been limited…

Basics of Radiation Therapy

Summary of Key Points Introduction and Historical Perspective X-rays were discovered emanating from an energized Crookes tube by Wilhelm Roentgen in 1895. That some naturally occurring elements emitted ionizing radiation was discovered by Henri Becquerel 1896. The radioactive elements radium and polonium were isolated and characterized by the Curies in 1898. Within a year or two, ionizing radiation was in use worldwide for medical imaging and…

Therapeutic Targeting of Cancer Cells: Era of Molecularly Targeted Agents

Summary of Key Points Molecularly targeted anticancer agents (MTAs) are designed to target specific molecular features that are either uniquely or differentially expressed in cancer cells compared with normal host cells. Molecular targets include the following: products of activating mutations and translocations, growth factors and receptors, aberrant signal transduction and apoptotic pathways, factors that control tumor angiogenesis and microenvironment, dysregulated proteins, DNA repair machinery, and aberrant…

Cancer Pharmacology

Summary of Key Points Cancer pharmacology encompasses the spectrum of therapeutic issues from everyday clinical treatment to the earliest stages of new drug discovery. Translational research has led to more sophisticated identification of targets that are relevant for therapy, and clinical success has attracted wide corporate involvement. Regulatory flexibility has made new therapies available to patients at an unprecedented rate and has provided a variety of…

Nicotine Dependence: Current Treatments and Future Directions

Summary of Key Points Prevalence of Tobacco Use and Nicotine Dependence in Patients With Cancer Approximately one in six American adults is a current smoker. Smoking accounts for one-third of all cancer deaths. In general, patients with cancer have a higher dependence on nicotine and are more likely to be smokers or ex-smokers. Approximately 15.1% of adult cancer survivors are current smokers. Biologic Characteristics and Genetics…

Screening and Early Detection

Summary of Key Points Cancer incidence is on the rise in the United States and worldwide. Beyond therapeutics, substantial reduction in cancer mortality necessitates improved understanding of cancer risk, implementation of effective preventive intervention strategies, and early detection of cancers that are likely to progress. Genomic- and proteomic-based approaches have the potential to refine risk assessment and stratification, allowing for more tailored screening and early detection…

Lifestyle and Cancer Prevention

Summary of Key Points Approximately one-third to one-half of cancers can be prevented through adoption of healthy lifestyles and avoidance of known risk factors. The findings of several large observational studies from the United States and Europe strongly suggest that following current cancer prevention recommendations from either the American Cancer Society (ACS) or the American Institute for Cancer Research (AICR) leads to significant health benefits. Advanced…

Discovery and Characterization of Cancer Genetic Susceptibility Alleles

Summary of Key Points The discovery of cancer susceptibility regions across the genome provides opportunities to understand defining events in tumor development, specifically identifying cellular pathways that contribute to the complex development of cancer. Regions of the genome harboring susceptibility alleles and genes can be identified in families or unrelated populations by using association studies, next-generation sequencing, and linkage studies. Technologic advances in sequence analysis in…

Oncology and Health Care Policy

Summary of Key Points Policies promulgated by government at the federal, state, and local levels have profound effects on virtually every aspect of the day-to-day practice of oncology. In the face of growing financial pressures, policy makers will continue to make decisions that may have tremendous impacts on the cancer community. Federal policies play a critical role in cancer research. Although the national resources devoted to…

Structures Supporting Cancer Clinical Trials

Summary of Key Points Cancer clinical trials provide the evidence on which sound oncology practice is based. Providing greater efficiency in implementing clinical trials and achieving enrollment rapidly have been major goals of the National Cancer Institute (NCI), cancer centers, the biopharmaceutical industry, and patient advocacy groups. Oncology specialists in private practice have many opportunities to participate in clinical trials sponsored by the NCI, private foundations,…

Clinical Trial Designs in Oncology

Summary of Key Points Phase I trials to determine recommended doses and schedules for further testing of new treatments need to be designed to minimize the number of patients exposed to unacceptable toxicity. The use of formal interim monitoring of accruing outcome data in phase II and phase III trials is important in order to allow trials to be stopped as soon as possible because of…

Biostatistics and Bioinformatics in Clinical Trials

Summary of Key Points The process of conducting cancer research must change in the face of prohibitive costs and limited patient resources. Biostatistics has a tremendous impact on the level of science in cancer research, especially in the design and conducting of clinical trials. The bayesian statistical approach to clinical trial design and conduct can be used to develop more efficient and effective cancer studies. Modern…