Seminars in oncology
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Seminars in oncology · Apr 1997
ReviewPromising new agents under development by the Division of Cancer Treatment, Diagnosis, and Centers of the National Cancer Institute.
The Division of Cancer Treatment, Diagnosis and Centers of the National Cancer Institute (NCI) has a large program in clinical cancer therapeutics development. It currently holds investigational new drug applications for nearly 200 agents with which it sponsors clinical trials. In addition, it has a major preclinical development program. ⋯ Agents in development through the NCI are derived from a number of diverse sources including its own screening efforts, academia, and numerous collaborations with the pharmaceutical and biotechnology industries. NCI works closely with collaborators to ensure complementary, non-duplicative clinical development and attempts to ensure that the full potential of promising agents is explored. A number of compounds in early clinical development or about to enter the clinic are discussed briefly in this manuscript.
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Seminars in oncology · Apr 1997
ReviewEfficacy of single-agent gemcitabine in advanced non-small cell lung cancer: a review.
Within the last 5 years, gemcitabine, a new nucleoside analogue, has been evaluated in several international phase II trials in patients with advanced non-small cell lung cancer (NSCLC). Five trials have evaluated 438 patients. Gemcitabine was administered intravenously in four trials on days 1, 8, and 15 at a dose of 800 to 1,700 mg/m2 every 4 weeks. ⋯ The overall response rate was 21% (95% confidence limits, 16% to 25%) with a median survival of 4 weeks (range, 26 to 46 weeks). The median duration of response varied from 26 to 49 weeks. The activity of gemcitabine in NSCLC, together with its modest toxicity and distinct mode of action, suggest the need for further trials of gemcitabine in combination with other chemotherapeutic agents in the treatment of NSCLC.
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Over the last decade, platinum-based combination chemotherapy regimens have led to higher response rates and longer survival for advanced ovarian cancer patients than previous regimens based on alkylating agents. The advent of paclitaxel for salvage therapy and, more recently, as a component of first-line treatment in advanced disease has further improved response rates and prolonged survival. Nonetheless, even with current treatments, relapse rates remain high and most women with advanced ovarian cancer ultimately will die of their disease. ⋯ Results from a phase III clinical study indicate that topotecan compares favorably with paclitaxel as a second-line treatment for stage III and IV patients who have failed platinum-based regimens. Moreover, a phase II study demonstrated clinical responses with topotecan in patients who had failed both paclitaxel- and platinum-based therapies. Other agents for advanced ovarian cancer are also under investigation, including docetaxel, oral etoposide, liposome encapsulated doxorubicin, gemcitabine, ifosfamide, and hexymethylmelamine.
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Seminars in oncology · Feb 1997
Review Comparative StudyEfficacy and safety of topotecan in the treatment of advanced ovarian carcinoma.
Topotecan (Hycamtin; SmithKline Beecham Pharmaceuticals, Philadelphia, PA) has emerged as a promising new chemotherapy drug for patients with refractory and progressive stage III and IV epithelial ovarian carcinoma. A semisynthetic analog of camptothecin, topotecan exerts its antitumor effects through inhibition of the nuclear enzyme topoisomerase I. Phase I trials found antitumor activity in many topotecan dosing schedules, one of which involved the administration of topotecan daily as a 30-minute infusion for 5 consecutive days, with the cycle repeated every 21 days. ⋯ Hematologic toxicities are predictable, of short duration, and noncumulative. Mild to moderate nonhematologic toxicities are manageable. These findings demonstrate that topotecan is a viable new second-line or salvage treatment for patients with advanced ovarian cancer who are refractory or resistant to prior chemotherapy, including platinum-based agents and/or paclitaxel.
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Seminars in oncology · Feb 1997
ReviewThe incidence of breast cancer: the global burden, public health considerations.
The incidence of breast cancer continues to increase and will reach close to one million new patients annually by the year 2000. The highest age-specific rates occur in developed regions, but more than 50% of cases occur in developing regions. Effective control requires prevention, early diagnosis, and access to effective treatments. ⋯ Current trends are largely due to earlier diagnosis, mammographic screening in developed countries, a decrease in deaths in both the United States and the United Kingdom, and an increasing proportion of deaths in developing countries. The total direct medical costs of breast cancer is more than $7 billion per year worldwide. New cost-effective control strategies are required worldwide.