Current Oncology

442 KiB

Open AccessArticle

Systemic Therapy for Advanced Gastric Cancer: A Clinical Practice Guideline

by M. MacKenzie, K. Spithoff, D. Jonker and the Gastrointestinal Cancer Disease Site Group

Curr. Oncol. 2011, 18(4), 202-209; https://doi.org/10.3747/co.v18i4.737 - 1 Aug 2011

Cited by 38 | Viewed by 681

Question: What is the optimal chemotherapy regimen in advanced gastric cancer? Perspectives: Gastric cancer is the second leading cause of cancer mortality worldwide. Despite low incidence rates for gastric cancer in Ontario, the overall prognosis is bleak, with 5-year survival rates of approximately [...] Read more.

Question: What is the optimal chemotherapy regimen in advanced gastric cancer? Perspectives: Gastric cancer is the second leading cause of cancer mortality worldwide. Despite low incidence rates for gastric cancer in Ontario, the overall prognosis is bleak, with 5-year survival rates of approximately 23% in Canada. Even with the considerable body of research available on chemotherapy for advanced gastric cancer, uncertainty remains. There is no recognized standard treatment, and there appears to be geographic variation in practice. Outcomes: Outcomes of interest were overall survival, objective response rate (complete plus partial responses), time to disease progression, adverse effects, and quality of life. Methodology: After a systematic review, a practice guideline containing clinical recommendations relevant to patients in Ontario was drafted. The practice guideline was reviewed and approved by the Gastrointestinal Disease Site Group (gi dsg) and the Report Approval Panel of the Program in Evidence-Based Care. External review by Ontario practitioners was obtained through a survey, the results of which were incorporated into the practice guideline. Practice Guideline: The gi dsg makes the following recommendations: • To improve survival, a platinum agent should be included in any combination chemotherapy regimen. • Within a combination chemotherapy regimen, oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)—that is, epirubicin–cisplatin–capecitabine is preferred over the prior standard regimen, epirubicin–cisplatin–5fu (ecf). • Epirubicin–oxaliplatin–capecitabine (eox) is a reasonable alternative to ecf. The choice between ecf and eox should be based on patient preference. • Trastuzumab in combination with cisplatin and a fluoropyrimidine (5fu or oral capecitabine) is recommended for advanced gastric cancer positive for the human epidermal growth factor receptor 2 (her2/neu). Full article

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Open AccessReview

A Single-Centre Chart Review Exploring the Adjusted Association between Breast Cancer Phenotype and Prognosis

by C. Hamm, M. El-Masri, G. Poliquin, V. Poliquin, J. Mathews, S. Kanjeekal, Y. Alam, S. Kulkarni and T. Elfiki

Curr. Oncol. 2011, 18(4), 191-196; https://doi.org/10.3747/co.v18i4.815 - 1 Aug 2011

Cited by 15 | Viewed by 526

Abstract

Using a retrospective chart review, we investigated the differences in survival and prognostic factors between patients with triple-negative breast cancer (tnbc) and those with non-tnbc. The review included 1018 breast cancer patients who were diagnosed between 2000 and 2005 in Essex, Kent, and [...] Read more.

Using a retrospective chart review, we investigated the differences in survival and prognostic factors between patients with triple-negative breast cancer (tnbc) and those with non-tnbc. The review included 1018 breast cancer patients who were diagnosed between 2000 and 2005 in Essex, Kent, and Lambton counties in Ontario, Canada. Our findings indicate that, although the unadjusted results suggested that patients with tnbc were more likely than patients with non-tnbc to die [hazard ratio (hr): 2.29; 95% confidence interval (ci): 1.33 to 2.93], an adjusted survival analysis revealed no significant difference in overall survival between the groups (hr: 1.22; 95% ci: 0.63 to 2.39). The significant predictors of survival in the adjusted analysis were age, stage of cancer, and size of cancer. Our findings support those of earlier reports, which suggest that presenting tumour size is the most important prognostic factor in tnbc. Investigations into unique screening methods to identify these tumours at an earlier stage and to prevent advanced-stage cancer in this patient subpopulation are necessary. Full article

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Open AccessReview

Prophylactic Feeding Tubes for Patients with Locally Advanced Head-and-Neck Cancer Undergoing Combined Chemotherapy and Radiotherapy—Systematic Review and Recommendations for Clinical Practice

by C. Orphanidou, K. Biggs, M.E. Johnston, J.R. Wright, A. Bowman, S.J. Hotte, A. Esau, C. Myers, V. Blunt, M. Lafleur, B. Sheehan and M.A. Griffin

Curr. Oncol. 2011, 18(4), 191-201; https://doi.org/10.3747/co.v18i4.749 - 1 Aug 2011

Cited by 26 | Viewed by 634

Abstract

Goals: This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of [...] Read more.

Goals: This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population. Methods: A national multidisciplinary panel conducted a systematic review of the evidence and formulated recommendations to guide clinical decision-making. The draft evidence summary and recommendations were distributed to clinicians across Canada for their input. Main Results: No randomized controlled trials have directly addressed this question. Evidence from studies in the target population was limited to seven descriptive studies: two with control groups (one prospective, one retrospective) and five without control groups. Results from ten controlled studies in patients treated with radiotherapy alone were also reviewed. Conclusions: The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice. Full article

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Open AccessArticle

cml Biology for the Clinician in 2011: Six Impossible Things to Believe before Breakfast on the Way to Cure

by B. Leber

Curr. Oncol. 2011, 18(4), 185-190; https://doi.org/10.3747/co.v18i4.652 - 1 Aug 2011

Cited by 6 | Viewed by 468

Abstract

Chronic myeloid leukemia (cml) is a model disease in oncology: it is the first human cancer linked to a distinct chromosomal abnormality, ultimately causing constitutive overactivity of a known oncogenic tyrosine kinase that represents a drug target. The introduction of the [...] Read more.

Chronic myeloid leukemia (cml) is a model disease in oncology: it is the first human cancer linked to a distinct chromosomal abnormality, ultimately causing constitutive overactivity of a known oncogenic tyrosine kinase that represents a drug target. The introduction of the tyrosine kinase inhibitor imatinib into clinical practice has far exceeded expectations and resurrected hope that the fundamental insights from the “war on cancer” can lead to significant therapeutic advances. Nevertheless, the current perception among clinicians is that imatinib and its newer more potent cousins offer superb long-term disease control for most patients, but that cure without transplantation has remained elusive. However, several important laboratory-based observations over the last few years have changed those perceptions. Several of those developments are discussed here, including direct manipulation of the apoptosis pathway in cancer cells and prevention of disease progression with the use of antioxidants. Intriguing results from a French study indicate that, if disease progression is halted, a small but significant group of patients may be able to stop imatinib therapy without disease recurrence. And for patients whose disease, because of resistant stem cells, needs a more direct attack than tyrosine kinase inhibitors alone, several approaches investigated in laboratory and animal models seem promising, and some are ripe for clinical testing, including inhibitors of Smoothened and 5-lipoxygenase, and suppression of autophagy. Thus, there is realistic hope that true cure of cml, without transplantation, may be a feasible goal in the near future. Full article

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Open AccessArticle

Emerging Trends in the Treatment of Triple-Negative Breast Cancer in Canada: A Survey

by S. Verma, L. Provencher and R. Dent

Curr. Oncol. 2011, 18(4), 180-190; https://doi.org/10.3747/co.v18i4.913 - 1 Aug 2011

Cited by 20 | Viewed by 937

Abstract

Triple-negative breast cancer (TNBC) has a poor prognosis compared to other subtypes and lacks common therapeutic targets, including HER 2 and the estrogen and progesterone receptors. The clinicopathological heterogeneity of the disease and limited treatment options make clinical management particularly challenging. Here we [...] Read more.

Triple-negative breast cancer (TNBC) has a poor prognosis compared to other subtypes and lacks common therapeutic targets, including HER 2 and the estrogen and progesterone receptors. The clinicopathological heterogeneity of the disease and limited treatment options make clinical management particularly challenging. Here we present the results of a survey of Canadian clinical oncologists regarding treatment of TNBC, and review recent and ongoing clinical research in this area. Our survey results show that the majority of respondents use a combination of anthracyclines-taxanes as adjuvant therapy for early TNBC. For the first-line treatment of metastatic TNBC, most clinicians recommend taxanes, while single agent capecitabine and platinum-based therapies are more common for subsequent lines of therapy. Despite the ongoing development of novel targeted therapies, chemotherapy remains the mainstay of treatment for TNBC. Full article

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Open AccessArticle

Canadian Expert Group Consensus Recommendations: KRAS Testing in Colorectal Cancer

by F. Aubin, S. Gill, R. Burkes, B. Colwell, S. Kamel–Reid, S. Koski, A. Pollett, B. Samson, M. Tehfe, R. Wong, S. Young and D. Soulières

Curr. Oncol. 2011, 18(4), 180-184; https://doi.org/10.3747/co.v18i4.779 - 1 Aug 2011

Cited by 22 | Viewed by 744

Abstract

Monoclonal antibodies against the epidermal growth factor receptor (anti-egfr) when used in the treatment of metastatic colorectal cancer are associated with improved survival. Patients whose tumours harbor a KRAS mutation in codon 12 or 13 have been shown not to benefit [...] Read more.

Monoclonal antibodies against the epidermal growth factor receptor (anti-egfr) when used in the treatment of metastatic colorectal cancer are associated with improved survival. Patients whose tumours harbor a KRAS mutation in codon 12 or 13 have been shown not to benefit from anti-egfr antibodies. The importance of KRAS mutation status in the management of patients with metastatic colorectal cancer has led to the elaboration of Canadian consensus recommendations on KRAS testing, with the aim of standardizing practice across Canada and reconciling testing access with the clinical demand for testing. The present guidelines were developed at a Canadian consensus meeting held in Montreal in April 2010. The best available evidence and expertise were used to develop recommendations for various aspects of KRAS testing, including indications and timing for testing, sample requirements, recommendations for reporting requirements, and acceptable turnaround times. Full article

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Open AccessArticle

Shaping Policy: The Canadian Cancer Society and the Hormone Receptor Testing Inquiry

by M. Mathews, J. Newbury and E. M. Housser

Curr. Oncol. 2011, 18(4), 174-179; https://doi.org/10.3747/co.v18i4.910 - 1 Aug 2011

Cited by 4 | Viewed by 458

Abstract

Background: In 2007, the Government of Newfoundland and Labrador established the Commission of Inquiry on Hormone Receptor Testing to examine problems with estrogen and progesterone hormone receptor tests conducted in the province between 1997 and 2005. Using the Inquiry as a case study, [...] Read more.

Background: In 2007, the Government of Newfoundland and Labrador established the Commission of Inquiry on Hormone Receptor Testing to examine problems with estrogen and progesterone hormone receptor tests conducted in the province between 1997 and 2005. Using the Inquiry as a case study, we examine the knowledge transfer activities used by the Canadian Cancer Society – Newfoundland and Labrador Division (CCS-NL) to shape policy and improve cancer control in the province. implementation: CCS-NL established a panel to advise its legal counsel and asked academic researchers to prepare papers to submit to the Commission. CCS-NL also interviewed patients to better inform its legal arguments, used its province-wide networks to raise awareness of the Inquiry, and provided a toll-free number that people could call. It also provided basic information, resources, and contact information for people who were affected by the flawed hormone receptor tests. The effectiveness of CCS-NL’s activities is reflected by the inclusion of its key messages in the Commission’s recommendations, and the investment in cancer care following the Inquiry. discussion: The success of the CCS-NL knowledge transfer efforts stemmed from its reputation as an advocate for cancer patients and its long-standing relationship with researchers, especially at the local level. The case illustrates real-world application of knowledge transfer practices in the development of public policy, and describes how community-based non-government organizations can identify and draw attention to important issues that otherwise might not have been addressed. Full article

477 KiB

Open AccessArticle

Triple-Negative Breast Cancers: An Updated Review on Treatment Options

by K.B. Reddy

Curr. Oncol. 2011, 18(4), 173-179; https://doi.org/10.3747/co.v18i4.738 - 1 Aug 2011

Cited by 62 | Viewed by 1018

Abstract

Morphologic features of tumour cells have long been validated for the clinical classification of breast cancers and are regularly used as a “gold standard” to ascertain prognostic outcome in patients. Identification of molecular markers such as expression of the receptors for estrogen ( [...] Read more.

Morphologic features of tumour cells have long been validated for the clinical classification of breast cancers and are regularly used as a “gold standard” to ascertain prognostic outcome in patients. Identification of molecular markers such as expression of the receptors for estrogen (er) and progesterone (pgr) and the human epidermal growth factor receptor 2 (her2) has played an important role in determining targets for the development of efficacious drugs for treatment and has also offered additional predictive value for the therapeutic assessment of patients with breast cancer. More recent technical advancements in identifying several cancer-related genes have provided further opportunities to identify specific subtypes of breast cancer. Among the subtypes, tumours with triple-negative cells are identified using specific staining procedures for basal markers such as cytokeratin 5 and 6 and the absence of er, pgr, and her2 expression. Patients with triple-negative breast cancers therefore have the disadvantage of not benefiting from currently available receptor-targeted systemic therapy. Optimal conditions for the therapeutic assessment of women with triple-negative breast tumours and for the management of their disease have yet to be validated in prospective investigations. The present review discusses the differences between triple-negative breast tumours and basal-like breast tumours and also the role of mutations in the BRCA genes. Attention is also paid to treatment options available to patients with triple-negative breast tumours. Full article

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Open AccessLetter

Kissing: Hullo hpv

by Louis Z. G. Touyz

Curr. Oncol. 2011, 18(4), 167-168; https://doi.org/10.3747/co.v18i4.835 - 1 Aug 2011

Cited by 1 | Viewed by 411

Abstract

There are at least 5 types of kisses, including ges-tural, cultural, osculum, basium, saviolum, and oro-genital.[...] Full article

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Open AccessEditorial

Consensus-Based Nutritional Recommendations for Patients with Head-And-Neck Cancer

by E. Isenring

Curr. Oncol. 2011, 18(4), 165-166; https://doi.org/10.3747/co.v18i4.936 - 1 Aug 2011

Cited by 2 | Viewed by 319

Abstract

Patients with head-and-neck cancer constitute one of the diagnostic groups that most commonly experi-ence deterioration of nutrition status.[...] Full article

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Open AccessArticle

A Comprehensive Bone-Health Management Approach for Men with Prostate Cancer Receiving Androgen Deprivation Therapy

by C.E. Lee, W.D. Leslie, P. Czaykowski, J. Gingerich, M. Geirnaert and Y.K.J. Lau

Curr. Oncol. 2011, 18(4), 163-172; https://doi.org/10.3747/co.v18i4.746 - 1 Aug 2011

Cited by 30 | Viewed by 699

Abstract

For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay of treatment. Awareness of the potential bone-health complications consequent to adt use is increasing. Many studies have shown that prolonged adt leads to significant bone loss and increased [...] Read more.

For advanced and metastatic prostate cancer, androgen deprivation therapy (adt) is the mainstay of treatment. Awareness of the potential bone-health complications consequent to adt use is increasing. Many studies have shown that prolonged adt leads to significant bone loss and increased fracture risk that negatively affect quality of life. Clinical practice guidelines for preserving bone health in men with prostate cancer on adt vary across Canada. This paper reviews recent studies on bone health in men with prostate cancer receiving adt and the current evidence regarding bone-health monitoring and management in reference to Canadian provincial guidelines. Based on this narrative review, we provide general bone-health management recommendations for men with prostate cancer receiving adt. Full article

371 KiB

Open AccessEditorial

Triple-Negative and Basal-Like Breast Cancer: Implications for Oncologists

by J. Lachapelle and W.D. Foulkes

Curr. Oncol. 2011, 18(4), 161-164; https://doi.org/10.3747/co.v18i4.824 - 1 Aug 2011

Cited by 34 | Viewed by 552

Abstract

Since the start of the 1990s, molecular pathology has been playing an increasingly important role in cancer diagnosis and treatment.[...] Full article

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Curr. Oncol., Volume 18, Issue 4 (August 2011) – 12 articles

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