Recently there is evidence that cytogenetics can refine prognostic information which can help make decision, especially about stem cell transplantation. The factors not included in the IPSS that affect survival are represented by red cell transfusion need,12 thrombocytopenia,13 and “unfavorable” karyotype. Regarding the latter, patients with unfavorable karyotype, which includes a complex karyotype or sole or 2 abnormalities such as +8, −7/7q−, i(17q), inv(3), −5/5q−, 12p−, or 11q23, had a median survival of 2 years compared with 5.2 years for those with a “favorable” karyotype, defined as no abnormality or any other apart from those included in the above category, the 5-year survival rates were 8% and 51%, respectively. The newly devised DIPSS Plus score11 incorporates these additional 3 variables for improved prognostic categorization. In a series of 793 patients, median survival times were 185, 78, 35, and 16 months for the low, intermediate-1, intermediate-2, and high-risk categories, respectively.

Based on its inclusion into a recommended prognostic tool DIPSS Plus, cytogenetics should not longer be considered investigational
.

Reilly JT, McMullin MF, Beer PA, Butt N, Conneally E, Duncombe A, Green AR, George Michaeel N, Gilleece MH, Hall GW, Knapper S, Mead A, Mesa RA, Sekhar M, Wilkins B, Harrison CN, Writing group: British Committee for Standards in Haematology. Guideline for the diagnosis and management of myelofibrosis. Br J Haematol. 2012 Aug;158(4):453-71. [123 references]
Jennifer Dunlap, MD, Katalin Kelemen, MD, PhD, Nicky Leeborg, MD, Rita Braziel, MD, Susan Olson, PhD, Richard Press, MD, PhD, James Huang, MD, Ken Gatter, JD, MD, Marc Loriaux, MD, PhD, Guang Fan, Association of JAK2 Mutation Status and Cytogenetic Abnormalities in Myeloproliferative Neoplasms and Myelodysplastic/Myeloproliferative Neoplasms Am J Clin Pathol. 2011;135(5):709-719.

For Professional version see here

Similar conclusions are reached by reviews that look at this question and are likewise limited in the same way. For example, a recent paper outlines why antibodies to infliximab (ATI) cannot be used as a surrogate marker for immunogenicity,
or to predict clinical outcome or safety. This is because up to half of patients still need dose adjustment for recurrent symptoms and 20% of patients lose response, even when treatment is optimised to avoid ATI through scheduled maintenance therapy or concomitant immunomodulators. The effects of ATI is, therefore, diluted statistically in these studies.

Thus far many questions persist about how useful ATI testing can be. Measurement of serum antibodies to infliximab has not received clearance by the FDA andthere is not sufficient peer-reviewed scientific literature that demonstrates that the procedure is effective.

For Professional version see here

Closer inspection of the data revealed that more patients with a poor prognosis were randomly assigned to the experimental arm versus the control arm, potentially attenuating the observed benefit of everolimus. Future studies will attempt to confirm the benefit of combining these two drugs.

Pavel ME, Hainsworth JD, Baudin E, Peeters M, Hörsch D, Winkler RE, Klimovsky J, Lebwohl D, Jehl V, Wolin EM, Oberg K, Van Cutsem E, Yao JC; RADIANT-2 Study Group.Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study.Lancet. 2011 Dec 10;378(9808):2005-12. doi: 10.1016/S0140-6736(11)61742-X. Epub 2011 Nov 25.

http://gicasym.org/radiant-2-reanalysis-everolimus-might-be-more-beneficial-against-advanced-nets-previously-recognized

Everolimus is beneficial

Octreotide is beneficial

For non-variant type, the use fo the first two together is based on a study reported very recently in ASCO on 3/2020 byKreitmen et al as reported in ASCO 2020. This regimen is for patients who have minimal residual disease after 6 months. In the trial, 68 patients with purine analog-naive classic hairy cell leukemia were randomly assigned to receive 0.15 mg/kg of cladribine intravenously on days 1 to 5 with eight weekly doses of rituximab at 375 mg/m2 started on day 1 (concurrent group, n = 34) or 6 months later after detection of minimal residual disease in their blood (delayed group, n = 34). Minimal residual disease tests included blood and bone marrow flow cytometry and bone marrow immunohistochemistry.

Patients in either group could receive a second course of rituximab 6 months after the first. The primary endpoint was 6-month minimal residual diseasefree complete remission rates with concurrent treatment vs cladribine monotherapy in the delayed group. THe delayed group did better nad ahd less toxicity. In the trial, 68 patients with purine analognaive classic hairy cell leukemia were randomly assigned to receive 0.15 mg/kg of cladribine intravenously on days 1 to 5 with eight weekly doses of rituximab at 375 mg/m2 started on day 1 (concurrent group, n = 34) or 6 months later after detection of minimal residual disease in their blood (delayed group, n = 34). Minimal residual disease tests included blood and bone marrow flow cytometry and bone marrow immunohistochemistry.

Patients in either group could receive a second course of rituximab 6 months after the first. The primary endpoint was 6-month minimal residual disease-free complete remission rates with concurrent treatment vs cladribine monotherapy in the delayed group, which favored the concurrent group, but with more thrmbocytopenia..
The investigators concluded: “Achieving minimal residual disease-free complete remission of hairy cell leukemia after first-line cladribine is greatly enhanced by concurrent rituximab and less so by delayed rituximab. Longer follow-up will determine if minimal residual disease-free survival leads to less need for additional therapy or cure of hairy cell leukemia.”

NCCN lists single-agent cladribine or pentostatin in first line and a purine analog with rituximab for recurrent or refractory disease only. and Elitek, not in combination.

Jones G, Parry-Jones N, Wilkins B, Else M, Catovsky D, British Committee for Standards in Haematology. Revised guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant. Br J Haematol. 2012 Jan;156(2):186-95. [60 references]

Jones G, Parry-Jones N, Wilkins B, et al. Revised guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant. Br J Haematol 2012; 156:186.

Hagberg H, Lundholm L. Rituximab, a chimaeric anti-CD20 monoclonal antibody, in the treatment of hairy cell leukaemia. Br J Haematol 2001; 115:609.

Robak T. Current treatment options in hairy cell leukemia and hairy cell leukemia variant. Cancer Treat Rev 2006; 32:365.

Arons E, Suntum T, Stetler-Stevenson M, Kreitman RJ. VH4-34+ hairy cell leukemia, a new variant with poor prognosis despite standard therapy. Blood 2009; 114:4687.

Robak T. Hairy-cell leukemia variant: recent view on diagnosis, biology and treatment. Cancer Treat Rev 2011; 37:3.

Grever MR, Abdel-Wahab O, Andritsos LA, et al. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood 2017; 129:553.

https://www.ascopost.com/news/march-2020/first-line-cladribine-with-concurrent-or-delayed-rituximab-for-hairy-cell-leukemia/

nccn, hcl-1, A- 2020

For Lay Version see here

The proponents of this novel therapy argue that this feature of proton Beam radiotherapy justifies its use. However, there are other ways to spare normal tissue, including: Three-dimensional conformal radiation therapy (3D-CRT. Intensity modulated radiation therapy (IMRT), Conformal proton beam radiation therapy, Stereotactic radiosurgery/stereotactic radiotherapy and  Brachytherapy (internal radiotherapy). In addition, the claim that safety alone is the reason to adopt proton beam for routine use should not be made in the absence of studies that confirm better outcomes.  Because proton beam technology is available on only a number of US facilities and because craniospinal radiation  is not performed very frequently, studies to support the assertion that proton beam radiotherapy is superior have not been done and the treatment should still be considered investigational.

Proton beam therapy systems are approved by the FDA 510(k) process as a “medical device designed to produce and deliver a proton beam for the treatment of patients with localized tumors and other conditions susceptible to treatment by radiation” (FDA, 2006). Examples of such systems are the Optivus Proton Beam Therapy System (Optivus Technology Inc., Loma Linda, CA) and the IBA Proton Therapy System-Proteus 235 (Ion Beam Applications S.A., Philadelphia, PA).

The Agency for Healthcare Research and Quality published a 2009 technology report on particle beam radiation therapies for the treatment of cancers including skull base and brain tumors. They noted that there is a proposed advantage of using particle beam therapy, including PBT, where precise radiation targeting is critical in tumors of the skull base and tumors adjacent to the brain and brain stem. The report concluded that studies on charged particle therapy “do not document the circumstances in contemporary treatment strategies in which radiotherapy with charged particles is superior to other modalities. Comparative studies in general, and randomized trials in particular (when feasible) are needed to document the theoretical advantages of charged particle radiotherapy to specific clinical situations”.

In a technology assessment on the use of PBT for the treatment of cancer, the Australia and New Zealand Horizon Scanning Network (2006) stated that PBT “may be of particular benefit” in the treatment of patients with intermediate depth tumors such as those in the head, cancers that are located in difficult or dangerous-to-treat areas, and tumors in locations where “conventional radiotherapy would damage surrounding tissue to an unacceptable level” (e.g., central nervous system and head). PBT “may be ideal for use in the treatment of pediatric patients where the need to avoid secondary tumors is important due to the potentially long life span after radiation treatment when they may develop radiation induced malignancies. It is not clear how this may relate to cranio-spinal radiation.

Y. Lievens, W. den BogaertProton beam therapy: Too expensive to become true?. Radiotherapy and Oncology, Volume 75, Issue 2, Pages 131-133 2005

Yock TI, Tarbell NJ.Technology insight: Proton beam radiotherapy for treatment in pediatric brain tumors. Nat Clin Pract Oncol. 2004 Dec;1(2):97-103;

Semenova J.Proton beam radiation therapy in the treatment of pediatric central nervous system malignancies: a review of the literature. J Pediatr Oncol Nurs. 2009 May-Jun;26(3):142-9. Epub 2009 May 21.

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We believe that, when faced with cancer, it is important to understand all of your options.  Ideally, a layperson would be able to access all the information that a medical professional can access, but this is not the case. The barriers are arcane professional terminology that impedes your web searching and obscure places where the data that you need is stored or located.  However, CancerTreatmentToday.org aims to offer as much information as possible to our site visitors.  Therefore, we not only provide articles written in such a way that a layperson can generally understand, but we also make available the information written for medical professionals.  The articles for the medical professional are the same that you viewed as a layperson but with the scientific terminology and authoritative references. Having read the lay text you will easily understand the professional version and can follow up on the referenced articles, guidelines and textbooks. We thus offer all of our site visitors – layperson and professional alike – the opportunity to view content that is written for those with an educational background in the medical field.  We hope that this will give a layperson a more in-depth view of the topic they choose to research and result in better self-education.  This should lead a layperson to ask more educated and pointed questions about their care and course of action when faced with cancer and cancer treatment options.  And for the medical professional, it provides an authoritative and up to date summary of topical issues in the field, with recent references.

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It is second only to lung cancer as the most prevalent cause of cancer death in women. Most women are aware of breast cancer, and many, especially those who had seen a loved one suffer from it, fear it. One in eleven women will develop breast cancer over the course of their lives, assuming an average life span of around eighty years. It is not only a disease of older women, many young women are also affected. Because it strikes mostly, though not exclusively, women, breast cancer finds itself at the intersection of important and basic questions that preoccupy our society, issues of fairness, equitable distribution of care, gender discrimination and sexuality. As a result, it attracts a larger share of public attention, advocacy, resources and research funding than most other cancers. For this reason, it is also the cancer in which new paradigms and treatment approaches have traditionally been tested and refined before other cancers. It is for this reason, for example, that we learned in breast cancer how to combine chemotherapy, surgery and radiation, how to integrate medical, psychosocial and societal issues in cancer care, how to develop new drugs and how to combine them. The first non-chemotherapy biological ever used in cancer, Herceptin, was used for breast cancer. We learned many approaches and concepts from clinical trials in breast cancer. It is in the course of caring for this disease that many new paradigms in health care delivery were tried and evaluated, from the how to use facilitators to improve access to medical care for poor women, to how to deal with the issues of sexuality and survivorship after cancer cure.

In Cancer Treatment Today you will find short up-to-date discussions of diagnostic and treatment issues in Breast Cancer, in both Lay and Professional versions. We hope that you find them helpful and informative.

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Read more about Breast Cancer, symptoms related to Breast Cancer and the most up to date information about Breast Cancer research.

An average American has a 5% chance of developing colon cancer during his or her lifetime. During the past several decades, colon cancers have become more frequent higher up in the colon, making colonoscopy that can inspect farther in, more important for screening and diagnosis. Right-sided colon cancer rarely produces changes in bowel habits but are more likely to be the source of chronic occult bleeding that can lead to symptoms consistent with iron deficiency anemia. For this reason, the first line of defense is screening with occult stool testing.

It is sometimes called colorectal cancer because colon cancer and rectal cancers are similar in how they behave and in how they are treated. Colon cancer is a field in which a great deal of progress has recently been made. There have been major advances in screening for colon cancer, with new types of colonoscopy, capsule endoscopy, and improvement in other imaging techniques. Surgery for colon cancer has improved and it is now even possible to perform it laparoscopically. Radiation does not have much overall in treating colon cancer, but it is in integral part of treatment for rectal cancer. On the other hand, chemotherapy for both colon cancer and rectal cancer employs similar drugs. Major advances in this area include the drugs oxaliplatin, irinotecan, cetuximab, panitimumab and Avastin. Xeloda has been used for colon cancer for a long time. Most recently, the drug Zaltrapp was approved for second line therapy of colon cancer.

With these advances, people with colon cancer are living longer and have a better quality of life. We are at the cusp of an era in which colon cancer will become a chronic disease, even when it had spread, and a much more curable illness if it had not spread.

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It is related to smoking. Although smoking rates have been declining since the Surgeon General’s report of 1964, the effect on lung cancer is delayed by several decades. This means that it is still the deadliest cancer, and yet, the amount of research funding, support and public advocacy that goes into lung cancer is dwarfed by what breast or prostate cancer receive. Some speculate that as a cancer predominantly of smokers, a group that our society stigmatizes and disregards, lung cancer is unpopular and ignored.

Still, lung cancer treatment has significantly changed from a time just a decade ago, when treatments were few and disfiguring and metastatic lung cancer was viewed as a certain death sentence. Screening and prophylaxis trials taught us a great deal about how to prevent this disease and how to diagnose it in earlier stages, in which treatment has a higher chance of cure and prolongation of life. Smoking cessation has become a priority in public discourse, reducing new lung cancer rates (unfortunately, it takes decades to see the full benefit of stopping smoking). Understanding how to sequence chemotherapy, surgery and radiation increased cure rates in stages II and III, and the introduction of new drugs, such as Alimta, Avastin, Tarceva and most recently Xalkori, has brought oncologists to the point where even metastatic lung cancer may soon become a chronic disease. The revolution in cancer care has not bypassed this field, and survival rates have more than doubled in the past decade. Personalized medicine and the ongoing growth of biological therapies carry a promise, nay, a certainty that lung cancer too, like other previously deadly cancer types, can become a treatable and curable illness even in later stages.

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