Seminars in oncology
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Seminars in oncology · Feb 2002
Review Clinical TrialImmunotherapy with rituximab following high-dose therapy and autologous stem-cell transplantation for mantle cell lymphoma.
Advanced-stage mantle cell lymphoma (MCL) is a disease for which no curative treatment strategy exists. Results with standard combination chemotherapy, with or without an anthracycline, are disappointing, and new and better therapies are needed. High-dose therapy and autologous stem-cell transplantation (ASCT) have been performed in patients with MCL both up front and at relapse with varying degrees of success. ⋯ Although patient numbers are low and follow-up time is short, preliminary results are encouraging. Rituximab may convert partial responders to complete responders. The durability of responses will be determined with longer follow-up.
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Seminars in oncology · Feb 2002
ReviewEmerging information on the use of rituximab in chronic lymphocytic leukemia.
Rituximab (Rituxan; Genentech, Inc, South San Francisco, CA, and IDEC Pharmaceuticals, San Diego, CA) is a chimeric monoclonal antibody that targets mature B cells in most lymphoid B-cell malignancies. While rituximab was approved by the US Food and Drug Administration for the treatment of recurrent B-cell lymphoma, initial studies suggested that it had less activity in small lymphocytic lymphoma, the nodal counterpart of chronic lymphocytic leukemia (CLL). Two studies have now investigated the activity of higher-dose and more intensive therapy with rituximab in CLL. ⋯ There is now evidence in vitro of additive or synergistic activity of rituximab with a variety of chemotherapeutic agents including fludarabine and cyclophosphamide. Combinations of fludarabine with rituximab or these two drugs combined with cyclophosphamide have given very high complete response rates in series of patients with both previously untreated and treated CLL. It is apparent that rituximab is playing a significant role in the management of patients with CLL as salvage therapy and is a potential potentiating agent for combined chemoimmunotherapy strategies for front-line or relapsed patients with CLL.
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Seminars in oncology · Dec 2001
ReviewOverview of treatment results with trastuzumab (Herceptin) in metastatic breast cancer.
HER2/neu amplification/overexpression confers more aggressive and malignant characteristics on breast cancer cells. Patients with HER2/neu-amplified breast cancer have a worse prognosis than those with normal HER2/neu expression. Over the past decade, the intracellular signaling pathways associated with this growth factor receptor have been elucidated. ⋯ In addition, when added to chemotherapy, trastuzumab improves antitumor efficacy as measured by time to progression, response rate, and survival. Additional chemotherapy/trastuzumab combinations are under active evaluation, and new schedules of administration are being tested. Thus, trastuzumab is the first successful example of molecularly targeted therapy in the management of metastatic breast cancer.
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Seminars in oncology · Oct 2001
ReviewImatinib mesylate: clinical results in Philadelphia chromosome-positive leukemias.
Targeted cancer therapy has long been sought by the oncology community as a potentially better approach than currently available therapies. One targeted therapy that has shown great success is the tyrosine kinase inhibitor imatinib mesylate (formerly STI571, [Gleevec]; Novartis Pharmaceuticals Corp, East Hanover, NJ) which was recently approved for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (CML). Basic scientific investigation into the molecular causes and pathogenesis of CML and encouraging preclinical investigations on the mechanism of action of imatinib mesylate led to the initiation of phase I clinical trials. ⋯ Furthermore, 21% of patients in accelerated-phase CML and 13.5% of patients in blastic-phase CML (patient populations with typically poor prognosis before the advent of imatinib mesylate) achieved major cytogenetic responses. Results from ongoing studies will determine the durability of these responses and will evaluate ways to optimize treatment in advanced-stage patients using imatinib mesylate in combination with other therapies. Additional trials are planned to investigate the efficacy of imatinib mesylate to treat a variety of solid tumors whose pathogenesis is driven by the other tyrosine kinase targets, c-Kit and platelet-derived growth factor receptor.
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Seminars in oncology · Oct 2001
ReviewTargeting c-kit mutations in solid tumors: scientific rationale and novel therapeutic options.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. These tumors span a wide clinical spectrum from benign to malignant and have long been recognized for their nearly absolute resistance to chemotherapy and radiation treatment. Surgery is the primary treatment modality for GISTs, but GISTs represent an incurable malignancy for patients with metastatic or unresectable disease. ⋯ These results provided the rationale to move forward with clinical testing of imatinib mesylate as an anticancer therapy for GIST. In early 2000, a dramatic clinical and radiographic response to imatinib mesylate was shown in a single patient with advanced, chemotherapy-resistant GIST. The powerful scientific rationale for this proof-of-concept study, together with the durable and significant response observed in this first GIST patient treated with imatinib mesylate, have provided the driving force for rapid clinical development of this targeted therapy in this solid tumor indication.