Interventional Therapies for the Management of Cancer Pain
THE JOURNAL OF SUPPORTIVE ONCOLOGY, MARCH/APRIL 2010, p 52
Timely interventional cancer pain therapies complement conventional pain management by reducing the need for high-dose opioid therapy and its associated toxicity. All patients with upper abdominal visceral pain should be considered for celiac plexus neurolysis soon after diagnosis. Intrathecal therapy should be considered in any patient with moderate-to-severe pain despite a reasonable therapeutic trial of opioid pharmacotherapy or in any patient intolerant of opioid therapy. Specific interventions for vertebral metastases and other sites of metastatic bone pain, including vertebroplasty, kyphoplasty, and image-guided tumor ablation, should be understood and considered. A collaborative model of care, including pain medicine specialists with expertise in interventional therapies, should be standard in all oncologic practicesin order to optimize outcomes for patients with cancer throughout the course of their treatment. more»
A New Treatment Option for Fludarabine- & Alemtuzumab-Refractory CLL
COMMUNITY ONCOLOGY, APRIL 2010, p 151
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults and is characterized by an accumulation of CD5-, CD20- and CD23-positive B lymphocytes. At this point, there is no curative therapy available for CLL, and the goal of therapy is symptom control. The current treatment options include chlorambucil, fludarabine, bendamustine (Treanda), and alemtuzumab (Campath). Median survival of patients who fail to respond to current therapy ranges from 6 to 14 months. Rituximab (Rituxan), which targets the CD20 molecule on leukemic B cells, is not an FDA-approved agent for treating CLL but, nevertheless, is extensively used and has a response rate of about 20%–25%. The other available options for refractory CLL have a response rate of about 25%, but their use is associated with significant side effects, such as an infection rate of 60%, and early mortality (16%). When we look at ofatumumab (Arzerra) in this context, it is a very encouraging development in the treatment of refractory CLL. It is a human IgG1 monoclonal antibody that targets a small-loop epitope on the CD20 molecule. Its mechanism of action entails both antibody-dependent cell-mediated cytotoxicity and complement-dependent cytotoxicity. more»
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Denosumab Bests Zoledronic Acid for Bone Metastases
THE ONCOLOGY REPORT, JANUARY/FEBRUARY 2010, p 42
Denosumab proved superior to zoledronic acid in delaying or preventing complications from bone metastases in breast cancer patients in a large phase III clinical trial. Denosumab also showed significantly less toxicity than did zoledronic acid (Zometa), the current standard treatment for bone metastases. Particularly noteworthy was the substantially lower rate of renal toxicity with denosumab: There is no need to monitor serum creatinine in patients on denosumab, unlike the bisphosphonate, Dr. Alison Stopeck said at the San Antonio Breast Cancer Symposium. Denosumab is an investigational, fully humanized monoclonal antibody targeting receptor-activated nuclear factor–kappaB ligand (RANKL), the primary mediator of osteoclast formation, function, and survival. Metastatic cancer cells stimulate RANKL activity, resulting in increased bone resorption and destruction, explained Dr. Stopeck of the cancer center of the University of Arizona, Tucson.more»