Expert review of anticancer therapy
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Expert Rev Anticancer Ther · Oct 2004
Review Comparative StudyClinical management of medulloblastoma in adults.
Although medulloblastoma is the most common malignant brain tumor in children, 30% of cases occur in adults. Recent therapeutic advances in the treatment of average-risk childhood medulloblastoma have emphasized the reduction of treatment-related toxicity while improving progression-free survival. However, lessons learned from the pediatric experience have not been widely applied to the adult population in Phase II or randomized clinical trials. This review will compare adult and pediatric medulloblastoma, highlight case series of adults treated at major academic institutions, and suggest directions for the contemporary management of adults with medulloblastoma.
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Expert Rev Anticancer Ther · Oct 2004
ReviewAprepitant: a neurokinin-1 receptor antagonist for the treatment of chemotherapy-induced nausea and vomiting.
Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life, and although the use of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists plus dexamethasone has significantly improved the control of acute CINV, delayed nausea and vomiting remain a significant clinical problem. Aprepitant (Emend), Merck) is the first agent available in the new drug class of neurokinin-1 receptor antagonists. When added to a standard regimen of a 5-HT3 receptor antagonist and dexamethasone in patients receiving highly emetogenic chemotherapy, it improves the complete response rate of acute CINV. ⋯ Drug interactions should be monitored when aprepitant is coadministered with agents affected by CYP3A4 and CYP2C9 isoenzymes. The safety and efficacy of aprepitant has not been established in pediatric or adolescent patients, and aprepitant has not been evaluated in the treatment of patients with established nausea and vomiting. Future studies may consider the use of aprepitant with current and other new agents in moderately and highly emetogenic chemotherapy, as well in the clinical settings of multiple-day chemotherapy and bone marrow transplantation.
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Expert Rev Anticancer Ther · Aug 2004
ReviewCurrent clinical management of gastrointestinal stromal tumors.
Gastrointestinal stromal tumors (GIST) are defined as c-KIT-positive mesenchymal neoplasias located in the gastrointestinal tract and abdomen, most of which present an activating KIT mutation, a fundamental step in the development of disease. However, recent studies reported a small subgroup of KIT-negative GIST, in which platelet-derived growth factor receptor A, protein kinase C-tau, and FLJ10261 expression was detected. ⋯ However, the optimal dose and role of imatinib in an adjuvant or neoadjuvant setting have yet to be defined. Therefore, further studies investigating the mechanism of resistance to imatinib in patients with GIST are warranted.
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Brain metastases secondary to primary non-small cell and small cell lung cancer have become an important area of research. The brain is one of the most common sites of failure following treatment for locally advanced non-small cell lung cancer, often as the only site. Treatment strategies and the outcome for brain metastases from lung cancer may differ from brain metastases arising from other primary cancers. This article reviews the prognostic factors associated with brain metastases from lung cancer, as well as current treatment approaches with chemotherapy, surgery and radiation therapy.
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Expert Rev Anticancer Ther · Feb 2004
ReviewGefitinib (Iressa): a novel treatment for non-small cell lung cancer.
Current standard therapy for advanced or metastatic non-small cell lung cancer (NSCLC) includes chemotherapy, which is often associated with limited efficacy and toxicity. Thus, there is an unmet need for novel anticancer agents that are both effective and well tolerated in patients with NSCLC. Gefitinib (Iressa) is an orally active epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor in advanced clinical development, and the first agent of its kind to receive approval. ⋯ This orally administered agent is generally well tolerated. Gefitinib has also shown promising efficacy in other solid tumors that rely on EGFR-related mechanisms for growth and survival. This article reviews the profile of gefitinib and the evidence supporting its use in the treatment of NSCLC.