Clinical Standards

Chemosensitivity and EDR testing – pro

Lay Summary: The status of chemosensitivity testing. The issue of chemosensitivity testing is complex and controversial. The recent article by Schrag et al1 criticized the field of chemosensitivity and drug resistance, concluding that these types of in vitro assays are not yet ready for prime time. The panel of authors attempted to present evidence that in vitro drug response assays should not be used clinically. This issue was first addressed by

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Maintenance Rituxan – pro

Lay Summary: Maintenance rituximab is becoming more common although questions remain about its benefit for DLBCL. The impact of maintenance treatment with rituximab on overall survival is one of the most important open questions for patients with indolent non-Hodgkin lymphoma. Recent randomized trials performed by the German Low Grade Lymphoma Study Group (GLSG) and by the EORTC demonstrated the superiority of rituximab maintenance after immunochemotherapy

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Anemia factor guidelines – pro

Lay Summary: Procrit and Aranesp are being heavily regulated based on the guidelines presented here. In order to provide a framework for erythropoietin therapy, several evidence-based guidelines have been developed, differing in scope and methodological rigor. Evaluation of iron stores is essential to proper application of these guidelines. In iron deficiency, erythropoietic factors are presumed not to be effective and the guidelines aim to avoid

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BCR/ABL Monitoring of chronic myelogenous leukemia on Gleevec – pro

There have been no studies that demonstrate that followup with BCR/ABL assists with actual clinical management of CML but it has become standard based on a guideline recommendation.It is not clear what the best monitoring stategy of imatinib might be; however, bcr/abl analysis would be a part of any finally accepted strategy. Unfortunately no trials of such strategies have been eprfomred but there is guidance from expert consensus. Some physicians

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First, second and third line chemotherapy for non small cell lung cancer – pro

Lay Summary: Chemotherapy for non-small cell lung cancer is discussed. Palliative chemotherapy for metastatic lung cancer is now standard. Platinum-based combinations were the first regimens to convincingly have an impact on survival and have been the standard of care in NSCLC. A European study showed that gemcitabine/cisplatin was essentiall equivalent to paclitaxel and a platin and the former became standard in Europe whereas the latter is most

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Avastin for breast cancer – pro

Lay Summary: Avastin has a role on metastatic breast cancer, especially in combinations with taxanes.   Bevacizumab(Avastin) was until recently FDA approved for breast cancer. It is now an off-label treatment. A previous Phase III study of bevacizumab in metastatic breast cancer found that the addition of bevacizumab to capecitabine produced a significant increase in response rates, but this did not translate into improved progression free survival

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Autologous stem cell transplant for follicular lymphoma – pro

Follicular lymphoma is a low-grade lymphoma. This means that it is not generally curable with chemotherapy; at the same time, it grows slowly and tends to have a response and recurrence pattern. It cannot be cured by conventional chemotherapy but is sometimes cured with high dose chemo and transplantation. There are now 3 conflicitng studies of autologous transplant for follicular lymphoma but guidelines now recommend it. However, they recommend

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Taxotere Adriamycin Cytoxan for adjuvant therapy of breast cancer – pro

Since 1998, the standard of care for patients with node-positive breast cancer in the United States and other parts of the world has been treatment with doxorubicin and cyclophosphamide followed by the taxane paclitaxel. Herceptin is added for HER+ disease.  This treatment regimen was based on an intergroup study demonstrating that the addition of paclitaxel to doxorubicin and cyclophosphamide (AC) led to rates of disease-free survival of 70 percent

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Epirubicin Cytoxan followed by Taxotere Herceptin for adjuvant terapy of breast cancer – pro

Since 1998, the standard of care for patients with node-positive breast cancer in the United States and other parts of the world has been treatment with doxorubicin and cyclophosphamide followed by the taxane paclitaxel. Herceptin is added for HER+ disease.  This treatment regimen was based on an intergroup study demonstrating that the addition of paclitaxel to doxorubicin and cyclophosphamide (AC) led to rates of disease-free survival of 70 percent

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Stem Cell transplant for Scleroderma – pro

Lay Summary: Stem cell transplantation in the hope of modifying disease activity in scleroderma is under active clinical investigational. Immunosuppressive agents such as cyclophosphamide have long been used to treat autoimmune disease, but the dose is often limited by bone marrow suppression. More than ten years ago several groups considered adopting the oncological approach of myeloablative therapy followed by haematological 'rescue' using either

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