Much has been written about the oncology drug shortage crisis in the United States. In the spirit of being part of the solution to that problem, a group of oncologists has formed the Citizen’s Oncology Foundation (COF). The goal of the start-up not-for-profit association is two-pronged: to find s...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication The oral kinase inhibitor vandetanib (Caprelsa) was re...

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“Physicians are afraid of morphine … Doctors [in Kenya] are so used to patients dying in pain … they think that this is how you must die. They are suspicious if you don’t die this way — [and feel] that you died prematurely.” —Human Rights Watch interview with Dr. John Weru of Nairobi Hospice, Ken...

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Management of patients with cancer who have fever and a low neutrophil count is one of the most common scenarios oncologists face today. “Physicians have to be keenly aware of the infection risks, diagnostic methods, and microbial therapies required for managing febrile neutropenic patients becau...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication In January 2012, imatinib mesylate (Gleevec) was grant...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication Erwinia chrysanthemi asparaginase (Erwinaze) was recen...

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Efficacy and safety of traditional anticoagulants (eg, vitamin K antagonists) are well recognized, given their long-standing use in clinical practice. However, the novel anticoagulants have several potential advantages over the vitamin K antagonists. Even so, in light of their recent introduction...

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December 23, 2011, marked the 40th anniversary of the National Cancer Act. To mark that occasion, on February 2, the American Association for Cancer Research (AACR) held a Congressional briefing, attended by about 100 legislative aides, to remind Congress that the war on cancer is far from over. ...

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Thrombocytosis is defined as a platelet count greater than 400 × 109/L. In routine clinical practice, thrombocytosis is much more likely to be reactive (> 80% of cases) than primary. Reactive thrombocytosis is usually associated with infections, inflammation, trauma, hemolysis, metastatic canc...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication In January 2012, the second-generation vascular endoth...

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In the ongoing debate over how to control rising cancer care costs, it is vital to identify usage patterns of expensive new technologies. A recent study examined the relationship between Medicare reimbursement and the increasing use of intensity-modulated radiation therapy (IMRT).1 The ASCO Post ...

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More than 3 decades ago, the first trials of autologous hematopoietic cell transplantation as consolidation therapy for acute myeloid leukemia (AML) in first remission were conducted. The initial results were inconclusive; most patients survived the procedure, but post-transplant relapse was comm...

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Carfilzomib is an oral second-generation proteasome inhibitor with a mechanism of action that may increase efficacy and reduce adverse effects currently associated with proteasome inhibitor therapy. It is being investigated for use in multiple myeloma and select solid tumors, and the FDA has gran...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication Peginterferon alfa-2b (PegIntron, Sylatron) was recent...

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Personalized medicine: It’s a phrase that reverberates across all cancer meetings. “Matching the right drug to the right patient” will be accomplished, in the not too distant future, through genomic sequencing of the tumor and targeted, less toxic therapy. This much has been established—or has it...

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The World Health Organization system organizes myeloid malignancies into five major categories, which are subsequently further subclassified using a combination of bone marrow morphology and cytogenetic/molecular information (Table 1).1 JAK2 and MPL mutations are not disease-specific and occur ac...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indication Abiraterone acetate (Zytiga) (an oral agent that inhib...

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A small phase I/II clinical study from Johns Hopkins University in Baltimore found that epigenetic therapy with a combination of azacitidine (Vidaza) and entinostat (an investigational agent) produced responses in some patients with refractory advanced non–small cell lung cancer. The study result...

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Periodic drug shortages are an unavoidable reality in our complicated pharmaceutical supply chain; however, over the past several years, drug shortages have expanded to crisis levels, putting vulnerable patients at risk. In 2010, there were 178 drug shortages reported to the FDA, 132 of which wer...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Indications In September 2011, the monoclonal antibody RANKL inhi...

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Michael C. Perry, MD, a renowned cancer clinician, educator, researcher, and administrator at the University of Missouri, Columbia, for more than 35 years, passed away October 23, 2011, after a long and courageous battle with polycystic kidney disease and cancer. He was 66. Dr. Perry served as Di...

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In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs. Cetuximab (Erbitux) was recently approved by the FDA for use in c...

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Gastric cancer is diagnosed in nearly 1 million people globally each year and is responsible for 740,000 deaths, making it the second leading cause of cancer death in the world. According to the American Cancer Society, more than 21,000 people in the United States were diagnosed with gastric can...

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Following a priority review process for orphan diseases, ruxolitinb (Jakafi) recently became the first drug to receive FDA approval for the treatment of intermediate- and high-risk myelofibrosis. Discovery in 2004 of the JAK2V617F mutation in a significant proportion of patients with BCR-ABL1–ne...

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The potentially devastating long-term consequences on cognitive function in patients with brain cancer following cranial irradiation led Charles L. Limoli, PhD, Professor of Radiation Oncology, University of California, Irvine, to study neural stem cell transplantation and how the procedure may p...

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The editors gratefully acknowledge all contributors to The ASCO Post and thank the columnists who contributed to Volume 2, January–December 2011: Al B. Benson III, MD, FACP Richard Boxer, MD, FACS Carlton G. Brown, RN, PhD, AOCN Barrie R. Cassileth, PhD E. David Crawford, MD Emil J. Freireich, M...

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Vismodegib is a small-molecule, orally active hedgehog pathway inhibitor that has shown considerable promise in treating basal cell carcinoma and is currently being evaluated alone and in combination in early-phase trials in medulloblastoma and a long list of other cancers.1 Owing to its first-in...

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On November 18, FDA Commissioner Margaret A. Hamburg, MD, said she is revoking the agency’s approval of the breast cancer indication for bevacizumab (Avastin) after concluding that the drug has not been shown to be safe and effective for that use. Bevacizumab will remain on the market as an appro...

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Addressing a patient's physical, emotional, and spiritual needs during the cancer journey, integrative medicine combines such time-honored therapies as nutrition, exercise, and meditation alongside allopathic approaches to cancer care, with the ultimate goal of improving survival rates and...

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Indication Crizotinib (Xalkori) is an oral inhibitor of receptor tyrosine kinases including anaplastic lymphoma kinase (ALK), hepatocyte growth factor receptor (HGFR, c-Met), and recepteur d'origine nantais (RON). In August 2011, the FDA granted the drug accelerated approval for the tr...

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Expensive new cancer therapies and technologies are alluring for both physicians and their patients. Prostate cancer, because of the sheer volume of cases and the variability of treatment options, serves as a dynamic disease model in the ongoing debate over how to curb spending and maintai...

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At a recent press conference in Washington, DC, the American Association for Cancer Research (AACR) assembled luminaries from the cancer research and care communities to discuss the salient points of the association's newly released progress report on the current and future state of cancer...

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As the political environment heats up in advance of the upcoming presidential campaign season, many issues crucial to the oncology community are being placed on the political chopping block as policymakers seek ways to reduce the mounting debt and soaring health-care spending. To help clar...

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Last August, ASCO issued the policy statement, "Opportunities in the Patient Protection and Affordable Care Act to Reduce Cancer Care Disparities" in the Journal of Clinical Oncology.1 The statement builds on ASCO's policy on disparities in cancer care released in 2009. It calls on both the...

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In this introductory installment of In the Clinic, The ASCO Post provides an overview of two new melanoma agents recently approved by FDA, with discussion on pivotal data leading to approval, dosage and administration, and managing drug-related toxicities. Watch for more on clinical use of ...

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Over the past couple of decades, unregulated nonstandard oncology approaches have gained growing popularity among cancer patients. The relatively new field of integrative oncology was established to promote a more holistic and multidisciplinary approach to cancer care and to encourage scien...

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The Institute of Medicine's National Cancer Policy Forum recently convened a public workshop, "Facilitating Collaborations to Develop Combination Investigational Cancer Therapies," to address the promises and challenges involved in the development of combination oncologic drug therapies. I...

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Oncology has a drug shortage problem, and the FDA says that it is getting worse. Drug shortages are not a new phenomenon, but over the past few years we have seen a rapidly growing number of shortfalls that are limiting providers’ ability to care for their patients. In 2004, the FDA reported 58 d...

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Vemurafenib (Zelboraf) received FDA approval on August 17, 2011, for treatment of metastatic or unresectable melanoma, based on the results of the phase III BRIM3 trial.1 BRIM3 compared vemurafenib to dacarbazine in 675 untreated patients with the BRAF V600E mutation. Vemurafenib targets the muta...

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The antibody-drug conjugate brentuximab vedotin (Adcetris) was granted accelerated approval on August 19 for the treatment of relapsed or refractory Hodgkin lymphoma and systemic anaplastic large cell lymphoma. Brentuximab vedotin is the first new drug to be approved in Hodgkin lymphoma in more t...

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If the clinical trials endeavor in oncology is falling short of its goals and if targeted agents have not kept their promise, can a new approach to drug development provide a solution? Very possibly, said John Hohneker, MD, Chair of the Workshop Planning Committee for the conference, “Facilitatin...

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Some oncology drugs are in such short supply that the situation is now critical, with almost 200 drugs affected—triple that of 2003. This was the background described by speakers at a July 2011 congressional briefing sponsored by the Association of Community Cancer Centers (ACCC), ASCO, and other...

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For our ongoing series on the rising costs of cancer care, The ASCO Post spoke with Lee N. Newcomer, MD, Senior Vice President of Oncology for UnitedHealthcare. Dr. Newcomer is responsible for improving cost-effective cancer care at the nation’s largest health insurer. He shed light on areas of c...

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The challenges of life-threatening physical illness can sometimes lead to suicide. In fact, given the critical stressors that a person with cancer faces, we might expect suicide to be a more common reaction. Patients with cancer are at increased risk of completed suicide, though the prevalence of...

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The results of the National Lung Screening Trial (NLST) will have important implications for practicing oncologists if low-dose helical CT screening is used routinely in the clinic. First, we will begin to find many more small tumors than we do now. This will pose new sets of questions for resear...

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The findings from a phase I study of crizotinib in non–small cell lung cancer (NSCLC) were presented in a Plenary Session at the 2010 ASCO Annual Meeting—an unusual event, since such early-phase data are not generally the topic of plenary sessions. The study showed that a majority of mostly pretr...

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Cardiac toxicity related to chemotherapy is not a new topic but it is an increasingly important one, as concerns are no longer limited to the anthracyclines. Targeted agents unfortunately “target” the cardiovascular system as well, especially bevacizumab (Avastin), trastuzumab (Herceptin) when gi...

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Results from the Women’s Health Initiative1 showing a decreased incidence of breast cancer among postmenopausal hysterectomized women who took estrogen replacement therapy (ERT) may seem paradoxical, but “comply exactly” with laboratory research, according to V. Craig Jordan, OBE, PhD, DSc, Scien...

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While overall cancer survival rates continue to rise—there are nearly 12 million cancer survivors today, according to the latest figures from NCI—most of that improvement is among pediatric and older adult patients. For adolescent and young adult patients with cancer, defined by the NCI as those ...

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In his opening remarks at a workshop, “Implementing a National Cancer Clinical Trials System for the 21st Century,” Richard Schilsky, MD, said, “There is something for everyone to do here to optimize the system.” The goal of the workshop was to examine efforts to implement IOM’s 2010 recommendati...

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Volker Diehl, MD, Professor of Medicine, Emeritus, University of Cologne, Germany, recently shared a snapshot of his oncologic journey with The ASCO Post. Career Beginnings What inspired you to become an oncologist? I became an oncologist by serendipity. I did my thesis on tissue culture work wi...

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On April 9, 1964, ASCO's original founding committee met in a small room in the Edgewater Beach Hotel in Chicago. The minutes of that meeting indicate they were united by "their common concern for the patient with cancer." ASCO's first meeting in 1964 had slightly more than 70 attendees. This mon...

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The research efforts of Rafat Abonour, MD, Professor of Medicine in the Division of Hematology/Oncology and Associate Dean for Clinical Research at Indiana University School of Medicine, Indianapolis, and a physician/researcher at the Indiana University Melvin and Bren Simon Cancer Center, focus ...

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The worldwide oncology community shares a common language based on evidence, clinical trials, and shared anecdotal results of the day-to-day care of patients with cancer. However, diverse political, economic, and cultural issues in different geographic regions present varying challenges to the de...

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What are the most effective and humane ways to plan cancer treatment, and how can caregivers and patients make these decisions together? These questions have been plaguing oncology since the beginning of modern care. Although suggested answers abound, implementation has not always been successful...

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Unrelieved cancer pain can render a patient bedbound, leading to depression, fear, and suicidal ideation. Along with physical distress, severe pain is associated with existential suffering, a complex tormentor of patients with cancer and their families. Studies show that most patients with advanc...

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James F. Holland, MD, Distinguished Professor of Neoplastic Diseases, Mount Sinai School of Medicine, New York, has been at the forefront of cancer research for more than half a century. In a recent interview with The ASCO Post, Dr. Holland looked back at his research at NCI and explained why our...

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A recent study in the Journal of Medical Ethics found that 788 research papers published in medical journals between 2000 and 2010 were retracted for serious errors or falsified data.1,2 Study author Grant Steen, PhD, told The ASCO Post that U.S. scientists were responsible for 169 of the papers...

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Alcohol consumption is highly prevalent in the United States. National surveys indicate that approximately 52% of persons aged 12 and older are current drinkers. Heavy drinking, defined as having five or more drinks per day on at least 5 days in the past 30 days, was reported in 6.8% o...

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The 111th Congress is gone but not forgotten, having passed into law the landmark Affordable Care Act of 2010. Although this legislation has several interesting appropriations for cancer research, a core principle of the bill is finding ways to reduce health-care spending, which gives the oncolo...

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While the overall expenditure on cancer care in general has remained relatively steady over the past 2 decades-encompassing 4.8% of the total $513 billion spent on medical care in 1987, vs 4.9% of the average $979 billion spent annually from 2001 to 2005-the cost of oncology drugs...

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Because of the relatively significant incidence of both clinical depression and debilitating hot flashes (20%-30%), clinicians caring for women with breast cancer who are taking tamoxifen for the treatment or prevention of cancer recurrence are often faced with the need to prescribe antidepressa...

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The FDA's Oncologic Drugs Advisory Committee (ODAC) concluded that bevacizumab (Avastin) conveys little benefit in advanced breast cancer, but the occasional patient has prolonged remission with little toxicity. This is the patient subset that may stand to lose the most, should the FDA withdraw ...

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The oncology community was recently stirred with potentially practice-changing news: the 12-to-1 vote by the FDA's Oncologic Drugs Advisory Committee (ODAC) to remove the advanced breast cancer indication for bevacizumab (Avastin). The Committee's vote does not affect the current availability of...

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The recent recommendation by the Oncologic Drugs Advisory Committee (ODAC) to withdraw conditional approval of bevacizumab (Avastin) in combination with chemotherapy for previously untreated metastatic breast cancer has been received with controversy. While many are genuinely concerned about wit...

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Dr. Wright was a pioneer in 20th century medicine, overcoming obstacles placed on her by society as a woman and as an African-American, but most of all she was a pioneer in chemotherapy, taking those first small steps into the unknown, and paving the way for the giant steps to come. On April 9,...

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When the poliovirus vaccine put polio specialist Janet Wolter, MD, "out of business" in 1963, she began looking for a new job. She found one--and a new specialty--at Presbyterian-St. Luke's Hospital in Chicago, Illinois, which later became Rush University Medical Center. Dr. Wolter worked with en...

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Sweet Home Chicago is home not just to the ASCO Annual Meeting but also five medical school-affiliated cancer centers that have accomplished many breakthroughs in the treatment and understanding of cancer. "We don't get the press here in Chicago that other regions do, but that doesn't mean we d...

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