Clinical advances in hematology & oncology : H&O
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Clin Adv Hematol Oncol · Feb 2014
ReviewProgrammed death-1 inhibition in renal cell carcinoma: clinical insights and future directions.
The treatment of metastatic renal cell carcinoma (mRCC) has evolved markedly over the past decade, broaden- ing beyond immune-based strategies (eg, interleukin-2 and interferon-α) to include targeted agents (eg, sunitinib [Sutent, Pfizer] and sorafenib [Nexavar, Bayer]). Recently, there has been a renewed interest in immune-based strategies, with clinical trials underway to assess vaccines and other immunomodulatory agents. ⋯ Monoclonal antibodies to PD-1 (eg, nivolumab, lambrolizumab, and pidilizumab) and PD-L1 (MPDL3280A and BMS-936559) are in various stages of clinical development. The clinical trajectory of these agents is discussed herein, with specific attention to the potential placement of PD-1/ PD-L1 inhibition in the crowded therapeutic landscape of mRCC.
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Clin Adv Hematol Oncol · Feb 2013
ReviewEmerging treatments in chemotherapy-induced nausea and vomiting.
Chemotherapy-induced nausea and vomiting (CINV) is a concern for many cancer patients. It can have an enormous impact on quality of life. CINV occurring in the first 24 hours after treatment is considered acute, and CINV occurring on days 2 through 5 after treatment is considered delayed. ⋯ Control of CINV allows patients to complete treatment and to minimize use of health care resources and additional medications. Current antiemesis agents, such as 5-hydroxytryptamine-3 (5-HT3) antagonists and neurokinin-1 (NK-1) antagonists, have markedly decreased hospitalization for chemotherapy and have nearly eliminated acute emesis. The second-generation 5-HT3 receptor palonosetron has a unique pharmacology that makes it especially effective at preventing delayed emesis.
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High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian cancer. Research over the past decade has strongly suggested that "ovarian" HGSC arises in the epithelium of the distal fallopian tube, with serous tubal intraepithelial carcinomas (STICs) being detected in 5-10% of BRCA1/2 mutation carriers undergoing risk-reducing surgery and up to 60% of unselected women with pelvic HGSC. ⋯ Salpingectomy may also reduce the incidence of the 2 next most common subtypes, endometrioid and clear cell carcinoma, by blocking the passageway linking the lower genital tract to the peritoneal cavity that enables ascension of endometrium and factors that induce local inflammation. The implementation of salpingectomy therefore promises to significantly impact ovarian cancer incidence and outcomes.
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Clin Adv Hematol Oncol · Oct 2011
ReviewImproving frontline treatment for chronic myeloid leukemia: emerging evidence for use of nilotinib and dasatinib.
The approval of imatinib in 2001 changed the landscape of chronic myeloid leukemia (CML) management, becoming the standard of care and improving the survival rates of patients. With the prevalent use of imatinib worldwide, it was observed that up to one-third of patients are resistant to or intolerant of imatinib therapy, fueling the search for safer and more effective agents. The newer and more potent tyrosine kinase inhibitors nilotinib and dasatinib were first indicated for the treatment of imatinib-resistant/-intolerant patients, for whom these agents are both safe and efficacious. ⋯ In addition, progression to advanced disease was significantly lower for nilotinib, and a trend toward lower progression was observed with dasatinib. Although both nilotinib and dasatinib are generally well tolerated in the frontline setting, they have different safety profiles that may affect their selection as treatment. Understanding the efficacy, safety profiles, and patterns of resistance to various BCR-ABL1 mutations of these newer agents, as well as implementing management strategies to treat adverse events, will help physicians to provide the best therapy options for their patients with CML.
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Clin Adv Hematol Oncol · Apr 2011
ReviewEmerging therapeutic options for platinum-sensitive ovarian cancer patients.
Ovarian cancer is a relatively infrequent malignancy, but it is the fifth leading cause of cancer-related mortality in American women. The initial diagnosis of ovarian cancer is usually made when the disease is at an advanced stage. Although advanced ovarian cancer is characteristically sensitive to initial surgical debulking followed by platinum-based combination chemotherapy, it is rarely cured, and even patients who achieve a complete remission ultimately go on to experience relapsed disease. ⋯ Finally, a description of emerging and investigational treatments, including both biologic agents and novel cytotoxic drugs, is included. Several recent and ongoing clinical trials involving these investigational agents are described. Throughout, the experts discuss the implication of these findings in the clinical setting.