Division of Hematology/Oncology, Weill Cancer Medical College of Cornell University, New York, NY 20021. ltv2001@med.cornell.edu

Standard cytotoxic chemotherapy of locally cancer advanced or metastatic breast cancer includes the microtubule-stabilizing taxanes, but like other cytotoxic drugs their effectiveness is compromised by resistance that is either inherent or develops during treatment. Epothilones, which also stabilize microtubules but by a different mechanism, are in clinical development primarily to overcome taxane or multidrug resistance, based on potent preclinical antitumor activity against resistant tumor lines. Ixabepilone is the best-studied epothilone clinically and is active in cancer patients with metastatic breast cancer that has been pretreated with, or had established resistance to, taxanes and/or anthracyclines. In a phase III trial in patients with anthracycline-pretreated or -resistant and taxane-resistant locally advanced or metastatic breast cancer, adding ixabepilone to capecitabine significantly improved progression-free survival and the overall response rate compared with capecitabine alone. The primary toxicities associated with ixabepilone treatment are neuropathy and neutropenia, but both are generally manageable. Other epothilones currently in clinical studies are KOS-862, patupilone, ZK-EPO, BMS-310705, and KOS-1584, which have all shown activity in patients with pretreated or resistant metastatic breast cancer.

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The University of breast cancer Texas MD Anderson Cancer Center, Houston, TX 77030, USA. festeva@mdanderson.org

Despite the recent trend toward treatment of early stage breast cancer aggressively with anthracyclines and taxanes, nearly half of those women will have metastatic recurrence. Moreover, because of the increasing prior exposure to these drugs, far more women facing first-line therapy for recurrent disease will now have developed anthracycline- and taxane-refractory metastatic breast cancer (ATRMBC), presenting a major therapeutic challenge. A number of established drugs are showing promise in this setting: capecitabine alone or combined with lapatinib; gemcitabine; vinorelbine; and oxaliplatin. At the same time, a variety of new drugs are emerging for potential use in ATRMBC. Among the drugs in clinical development that have shown promising activity include novel classes of compounds (camptothecins and epothilones), newer members of established classes (pemetrexed and vinflunine), and breast cancer agents with novel mechanisms of action (the mitosis inhibitor E7389 and the ascidian-derived anticancer compound trabectedin). Several molecularly targeted agents are also being evaluated in ATRMBC, including interleukin-2 receptor-binding denileukin diftitox, and 17-(allylamino)-17-demethoxygeldanamycin (17-AAG), which inhibits the protein chaperone heat shock protein 90.

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Hull and East Yorkshire Eye Hospital, Fountain Street, Anlaby Road, Kingston-upon-hull, Yorkshire HU3 2JZ, United Kingdom.

A 46-year-old woman presented with a peripheral vasoproliferative tumor. The tumor was treated with one session of photodynamic therapy with 6 mg/m2 body surface area of verteporfin and a dose of 100 J/cm2 delivered in 83 seconds. At the 10-month follow-up examination, involution of the vasoproliferative tumor was seen with improvement of best-corrected visual acuity to 20/80. Photodynamic therapy is an effective treatment option in cases of exudative vasoproliferative tumors. Great variability exists in the parameters used to treat vasoproliferative tumors.

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Servicio de Oncología Médica, Hospital Universitario de Salamanca. Salamanca, Spain.

At present, anaemia in the patients with cancer remains a problem of the first magnitude and of increasing interest due to the high incidence, the major knowledge of its physiopathology, the negative impact on the quality of life of the patient, the influence on the evolution of the disease and its treatments and, finally to the progressive development of new alternatives of treatment, especially the erythropoietic agents. For all this, it becomes necessary to consider the treatment of the anemia of the patients with cancer as a basic part of their support treatment. The erythropoietic agents have demonstrated in the last years that constitute a therapeutic alternative to obtain an increase of the levels of hemoglobin in the patients with anticancer treatments, considering specially that the correction of the anemia not only represents the improvement of an analytical value but also has a significant impact on the quality of life of the patients and diminishes the transfusion requirements. Erythropoietic proteins available for the treatment of the anemia of the patients with cancer are Epoetin-alfa, Epoetin-beta and Darbepoetin-alfa. The existence of different drugs, different doses and intervals of administration, clinical different situations and heterogeneous studies, made necessary the development of documents of consensus and guides of clinical recommendations which provide information on the scientific evidence that supports the use of these agents in medical care. This paper summarizes the main recommendations from panels of experts and scientific societies published so far.

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Public Health Sciences Division, Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, 1100 Fairview Avenue N, M4-B874, Seattle, WA, 98109-1024, USA, aderoos@fhcrc.org.

OBJECTIVE: Myelodysplastic syndromes (MDS) following treatment with chemotherapy or irradiation are termed ’secondary’ MDS. Clinical observations suggest a worse prognosis for secondary than for primary MDS, but differences in survival have not been studied in a general population sample. METHODS: We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) program to describe survival in MDS patients according to previous cancer diagnosis. Our study included 3,938 MDS cases diagnosed in 2001-2004 and reported by registries which have participated in SEER since the 1970s. RESULTS: A previous cancer diagnosis (26% of MDS cases) was associated with 13% increased risk of death from any cause among MDS cases (hazard ratio [HR]=1.13, 95% confidence interval [CI]: 1.02-1.25). Radiation treatment for a previous cancer was associated with 52% increased risk of death (95% CI: 1.15-2.02). Shortened survival was most pronounced if the latency between the previous cancer and MDS was less than five years, including lung cancer diagnosed in the year preceding MDS (HR = 3.43, 95% CI: 1.93-6.10) and lymphohematopoietic cancer 1-5 years before MDS (HR = 2.11; 95% CI: 1.33-3.36). CONCLUSIONS: Our results confirm a more severe prognosis for secondary MDS than for primary MDS, associated with certain types and treatments of previous cancer.

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