Role of oncology clinical pharmacists in light of the oncology workforce study.

To date, the information published regarding workforce implications has focused on physicians, nurse practitioners, and physician assistants. But oncology clinical pharmacists also can assist with direct patient care and patient education activities.

Severe ulceration over mandibular torus in an ovarian cancer patient receiving bevacizumab therapy.

► Bevacizumab may increase the risk of mucosal ulceration and subsequent bone necrosis. ► Patients receiving bevacizumab should be closely monitored for dental symptoms.

Polyclonal immune responses to antigens associated with cancer signaling pathways and new strategies to enhance cancer vaccines.

Aberrant signaling pathways are a hallmark of cancer. A variety of strategies for inhibiting signaling pathways have been developed, but monoclonal antibodies against receptor tyrosine kinases have been among the most successful. A challenge for these therapies is therapeutic unresponsiveness and acquired resistance due to mutations in the receptors, upregulation of alternate growth and survival pathways, or inadequate function of the monoclonal antibodies.

Breast cancer screening with mammography.

There has been a great deal of controversy regarding the change in breast cancer screening recommendations released by the US Preventive Services Task Force in November 2009. Despite limited new data, the Task Force changed their previous recommendations delaying initial screening of asymptomatic women from age 40 to age 50 and recommending biennial rather than annual breast cancer screening. It is important to fully understand the nuances of the analysis and modeling upon which the revisions were based in order to accurately inform patients of the risks and benefits of breast cancer screening.

Summary and comparison of myeloid growth factor guidelines in patients receiving cancer chemotherapy.

Chemotherapy-induced neutropenia and its complications are major dose-limiting toxicities of cancer chemotherapy. The myeloid growth factors have been shown to reduce the risk of neutropenic events across malignancies, regimens, and associated risk categories often enabling the delivery of greater chemotherapy dose intensity. Three different practice guidelines for the myeloid growth factors have recently been published by major professional organizations.

A comparison of international guidelines for the prevention of chemotherapy-induced neutropenia.

Purpose Of Review: Clinical practice guidelines for the prevention of febrile neutropenia in patients receiving cancer chemotherapy utilizing the myeloid growth factors have been developed by several major international professional organizations. This review provides updates on the current status of these guidelines and summarizes recent reported studies currently under review by guideline panels which may alter guideline recommendations.

Recent Findings: Whereas the consensus guidelines from the National Comprehensive Cancer Network (NCCN) are updated annually, previous evidence-based recommendations from the American Society of Clinical Oncology (ASCO) and the European Organisation for Research and Treatment of Cancer (EORTC) are currently undergoing an update in their evidence base and recommendations.

Availability of experimental therapy outside oncology randomized clinical trials in the United States.

Purpose: Investigational cancer therapies may be available outside trials as "off-protocol therapy" (OPRx), with implications for patient safety, trial accrual, and access to care. We conducted a literature-based analysis of recent randomized trials to evaluate the potential scope and impact of OPRx in the United States.

Methods: A MEDLINE search identified all English-language phase III medical oncology randomized clinical trials (RCTs) published over a 2-year period ending April 17, 2008.

Utility and use of palliative care screening tools in routine oncology practice.

Palliative care, which seeks to alleviate suffering and optimize quality of life, is an increasingly recognized and valued medical subspecialty. With its focus on identifying and managing symptoms and problems encountered in expected functional decline, the domain of palliative care overlaps significantly with that of oncology, where patients typically experience a host of disease- and treatment-related effects. Assessment instruments have been developed and validated in the context of both disciplines, but oncology may benefit from the inclusion of palliative care screening instruments specifically developed for patients with advanced, life-limiting illnesses.

Correlates of quality of life-related outcomes in breast cancer patients participating in the Pathfinders pilot study.

Objective: In a pilot study, participation in the Pathfinders program was associated with reductions in distress and despair and improvements in quality of life (QOL) among advanced breast cancer patients. This study explores the relationship between psychosocial resources invoked through the Pathfinders intervention and outcomes.

Methods: Advanced breast cancer patients were enrolled in a prospective, single-arm, pilot study of the Pathfinders psychosocial program.

Individual responses to chemotherapy-induced oxidative stress.

Differences in redox homeostatic control between cancer patients may underlie predisposition to drug resistance and toxicities. To evaluate interindividual differences in redox response among newly diagnosed breast cancer patients undergoing standard chemotherapy, urine samples were collected before (T0), and at 1 (T1) and 24 h (T24) after chemotherapy administration. Oxidative status was assessed by urinary levels of allantoin and four F2-isoprostanes, quantified by LC-MS/MS.

How we treat febrile neutropenia in patients receiving cancer chemotherapy.

Although improved supportive care has reduced mortality associated with febrile neutropenia, it continues to cause chemotherapy limitations, morbidity, mortality, and cost among patients with cancer.

Targeting Ras-RAF-ERK and its interactive pathways as a novel therapy for malignant gliomas.

Malignant gliomas are the most common and the deadliest brain malignancies in adults. Despite the lack of a complete understanding of the biology of these tumors, significant advances have been made in the past decades. One of the key discoveries made in the area of malignant gliomas is that these tumors can be induced and maintained by aberrant signaling networks.

Risk of mortality in patients with cancer who experience febrile neutropenia.

Background: Febrile neutropenia (FN) is a serious and potentially life-threatening condition that may develop in patients with cancer who receive myelosuppressive chemotherapy. The risk of mortality from FN is not well characterized in current clinical practice.

Methods: Patients with cancer who were receiving chemotherapy in clinical practice were identified from a large US healthcare claims database, and mortality was confirmed using the National Death Index.

Rapid-learning system for cancer care.

Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is "rapid-learning health care.

Urinary biomarkers of oxidative status in a clinical model of oxidative assault.

Background: We used doxorubicin-based chemotherapy as a clinical model of oxidative assault in humans.

Methods: The study recruited newly diagnosed breast cancer patients (n = 23). Urine samples were collected immediately before (T0) and at 1 hour (T1) and 24 hours (T24) after i.

A pharmacodynamic study of rapamycin in men with intermediate- to high-risk localized prostate cancer.

Purpose: Given discrepancies between preclinical and clinical observations of mammalian target of rapamycin (mTOR) inhibition in prostate cancer, we sought to determine the pharmacodynamic effects of the mTOR/TORC1 inhibitor rapamycin in men with intermediate- to high-risk prostate cancer undergoing radical prostatectomy.

Experimental Design: Rapamycin was given at 3 or 6 mg orally for 14 days before radical prostatectomy in men with multifocal Gleason sum > or =7 prostate cancer; 10 untreated control subjects were included. The primary outcome was inhibition of phosphorylation of ribosomal S6 in posttreatment radical prostatectomy versus pretreatment biopsy tumor tissue, evaluated using a Simon two-stage design for pharmacodynamic efficacy.

Impact of a chemoresponse assay on treatment costs for recurrent ovarian cancer.

Objective: We sought to estimate mean costs of chemotherapy treatment for recurrent ovarian cancer with or without use of a chemoresponse assay.

Study Design: We estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist's choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.

Acute myeloid leukemia or myelodysplastic syndrome in randomized controlled clinical trials of cancer chemotherapy with granulocyte colony-stimulating factor: a systematic review.

Purpose: To evaluate the risk of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) and overall mortality in patients receiving chemotherapy with or without granulocyte colony-stimulating factor (G-CSF), a systematic review of randomized controlled trials (RCTs) was conducted.

Methods: Electronic databases searched through October 2008 identified 3,794 articles for initial screening. Eligibility included solid tumor or lymphoma patients randomly assigned to chemotherapy with or without G-CSF support, > or = 2 years of follow-up, and reporting AML/MDS or all second malignancies.

An adenoviral vaccine encoding full-length inactivated human Her2 exhibits potent immunogenicty and enhanced therapeutic efficacy without oncogenicity.

Purpose: Overexpression of the breast cancer oncogene HER2 correlates with poor survival. Current HER2-directed therapies confer limited clinical benefits and most patients experience progressive disease. Because refractory tumors remain strongly HER2+, vaccine approaches targeting HER2 have therapeutic potential, but wild type (wt) HER2 cannot safely be delivered in immunogenic viral vectors because it is a potent oncogene.