Volume 4, Number 9 (September 2007)

Letter from the Editor

517

Changing standards of care

Lee S. Schwartzberg, MD, FACP, Editor-in-Chief

The West Clinic, Memphis, TN

Several important advances reported in this month’s Community Oncology highlight the changing landscape in how we treat primary hepatocellular carcinoma, offering new hope for our patients and setting a new standard of care.

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Community Translations

528

Sorafenib in advanced hepatocellular carcinoma

Sorafenib was recently granted fast-track status in the setting of hepatocellular carcinoma (HCC). Currently, this agent is approved for treatment of renal cell carcinoma. In clinical trials, sorafenib significantly improved overall survival in patients with advanced HCC. It is the first agent to show a survival benefit in this setting. A review of the relevant data, and points of view of a community oncologist and practice administrator.

FROM THE COMMUNITY ONCOLOGIST'S PERSPECTIVE
Sorafenib: new reference standard for systemic treatment of advanced hepatocellular carcinoma

Yiu-Keung Lau, MD, PhD

CancerCare Manitoba, University of Manitoba, Winnipeg, Canada

FROM THE ADMINISTRATOR'S PERSPECTIVE
The financial and economic concerns

Patricia A. Policicchio, MSW, OSW-C

Mary Babb Randolph Cancer Center, Morgantown, WV

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Managing Side Effects

533

Depression in the patient with brain cancer

Percival H. Pangilinan, Jr, MD, Brian M. Kelly, DO, and Joanna Maudlin Pangilinan, PharmD, BCOP

University of Michigan Health System, Ann Arbor, MI

Depression in the patient with brain cancer is common and has emotional, cognitive, and physical sequelae. Increased morbidity and mortality may be associated with depression in this population. In addition, depression is the most important independent predictor of quality of life in patients with brain cancer. Predictors of depression in these patients have been identified, but the incidence is likely underdiagnosed. This article reviews the obstacles to detection and discusses screening techniques and treatment including psychotherapy, group therapy, and medications.

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540

Chemotherapeutics and cardiac toxicity: treatment considerations and management strategies

Tamar Safra, MD

Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

Until recently, most chemotherapy-associated cardiac toxicity that manifested as a reduction in left ventricular ejection fraction was thought to have cardiac effects and long-term sequelae similar to those seen with conventional doxorubicin. However, new insights into the nature of the cardiac toxicity seen with trastuzumab indicate that the adverse effects may be quite different from those caused by other drug classes. This paper provides an overview of the mechanisms of chemotherapy-associated cardiotoxicity along with a description of newer therapies aimed at increasing drug safety.

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Implementing Clinical Trials

553

Healthcare and clinical research: a critical link through standards

Rebecca Daniels Kush, PhD

Clinical Data Interchange Standards Consortium, Austin, TX

Our inability to readily exchange clinical trial data with other investigators and existing medical record systems is wasteful and expensive. But the inevitable shift from paper medical charts to electronic health records could provide an opportunity to improve clinical research through a standardized exchange of information. The Clinical Data Interchange Standards Consortium (CDISC) has developed the worldwide research-industry standards and tools needed to do so. CDISC’s goal is to facilitate the collection and exchange of this information to accelerate drug development and improve patients’ lives.

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Original Contribution

561

Lymphoid malignancies: a previously unrecognized risk factor for bone loss

Leslie R. Laufman, MD, C.H. Spiridonidis, MD, Sanjay Yadav, MD, Heather Meek, Holly Laufman, BS, and Douglas Reader, MD

Lymphoid malignancies can damage bone by invasion, marrow expansion, and humoral factors causing demineralization, but the frequency of these events is not well known. Fifty patients with lymphoid malignancies (particularly NHL and CLL) and a good performance status treated at a single hematology practice were queried about bone symptoms and risk factors for osteoporosis. Nuclear bone scan, metastatic bone survey, CT scan of the pelvis, and bone mineral densitometry were performed. Imaging studies were generally unproductive, but bone mineral density was abnormal in 30 patients (60%), unrelated to diagnosis, disease duration, treatment, or previously described osteoporotic risk factors. Further studies are warranted.

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Challenging Cases/Rare Cancers

571

Liver-directed therapies for hepatocellular cancer

Minsig Choi, MD, and Philip A. Philip, MD, PhD, FRCP

University of Mississippi and Jackson VAMC, Jackson, MS, and Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI

Although hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, it is relatively rare in the United States. But in the past 20 to 30 years, there has been a significant rise in its incidence in this country. Unfortunately, most patients with HCC present with advanced disease and/or major comorbidities and therefore have limited treatment options. This article reviews the diagnosis and staging of HCC and recommendations for optimizing therapy.

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Letter to the Editor

527

Liposomal doxorubicin extravasation

Jeanne Held-Warmkessel, RN, MSN, AOCN^®, APRN, BC

Fox Chase Cancer Center, Philadelphia, PA

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Washington Update

565

CMS restricts use of ESAs in cancer patients

Ted Okon

Community Oncology Alliance, Memphis, TN

In issuing a national coverage decision limiting the use of erythropoiesis-stimulating agents (ESAs) in the treatment of cancer, the Centers for Medicare & Medicaid Services appears to have overstepped its authority in ignoring FDA-approved labeling, spawned confusion among physicians and payers, and raised concerns over whether it really protects patients.

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Brief Communications

567

Complete remission of metastatic Ewing’s sarcoma/primitive neuroectodermal tumor with standard chemotherapy

Nikesh Jasani, MD, Peymon Salimi-Tari, MBBS, and Fauzia Rana, MD

Department of Hematology/Oncology, University of Florida/Shands, Jacksonville, FL

In the past 20 years, there has been little improvement in outcomes for patients with metastatic primitive neuroectodermal tumors. The authors present a case study and discuss treatment options.

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