Managing Multifocal Bronchioloalveolar Carcinoma/Lepidic Predominant Adenocarcinoma: Changing Rules for an Evolving Clinical Entity

Clinical Advances in Hematology & Oncology September 2014, Volume 12, Issue 9 Howard (Jack) West, MD Dr West is the medical director of the Thoracic […]

Sequencing Treatment in Chronic Myeloid Leukemia: The First Choice May Be the Hardest

Clinical Advances in Hematology & Oncology August 2014, Volume 12, Issue 8 Mark L. Heaney, MD, PhD Dr Heaney is an associate clinical professor of medicine […]

Yttrium 90-Ibritumomab Tiuxetan Plus Rituximab Maintenance as Initial Therapy for Patients With High-Tumor-Burden Follicular Lymphoma: A Wisconsin Oncology Network Study

Clinical Advances in Hematology & Oncology August 2014, Volume 12, Issue 8 Saurabh Rajguru, MD, Thorhildur Kristinsdottir, MD, Jens Eickhoff, PhD, Chris Peterson, MD, Christine M. […]

ALK Inhibitors in Non–Small Cell Lung Cancer: Crizotinib and Beyond

July 2014, Volume 12, Issue 7 Mark M. Awad, MD, PhD, and Alice T. Shaw, MD, PhD Dr Awad is a fellow in hematology/ -oncology at […]

Room for Improvement: Immunizations for Patients With Monoclonal B-Cell Lymphocytosis or Chronic Lymphocytic Leukemia

July 2014, Volume 12, Issue 7 Jennifer A. Whitaker, MD, MS, Tait D. Shanafelt, MD, Gregory A. Poland, MD, and Neil E. Kay, MD The authors […]

Malignancies Associated With Epstein-Barr Virus: Pathobiology, Clinical Features, and Evolving Treatments

Volume 12, Issue 6 June 2014 Natalia Neparidze, MD, and Jill Lacy, MD Dr Neparidze is an assistant professor of medicine and Dr Lacy is an […]

TNBC vs Non-TNBC: A Retrospective Review of Differences in Mean Age, Family History, Smoking History, and Stage at Diagnosis

Clinical Advances in Hematology & Oncology June 2014, Volume 12, Issue 6 Khurram Tariq, MD, Arezo Farhangi, MD, and Fauzia Rana, MD The authors are affiliated with […]

Update on the Use of Angiogenesis Inhibitors in Adult Patients With Brain Tumors

Clinical Advances in Hematology & Oncology May 2014, Volume 12, Issue 5 David A. Reardon, MD Dr Reardon is the clinical director of the Center for […]

Prescribing for Older Patients With Cancer

Clinical Advances in Hematology & Oncology May 2014, Volume 12, Issue 5 Beatriz Korc-Grodzicki, MD, PhD, Manpreet K. Boparai, PharmD, CGP, and Stuart M. Lichtman, MD […]

Endocrine Therapy for Advanced Breast Cancer

Clinical Advances in Hematology & Oncology April 2014, Volume 12, Issue 4 Payal D. Shah, MD, and Maura N. Dickler, MD Dr Shah is a medical oncology […]

Selective Bcl-2 Inhibition to Treat Chronic Lymphocytic Leukemia and Non-Hodgkin Lymphoma

Clinical Advances in Hematology & Oncology April 2014, Volume 12, Issue 4 Samuel Y. Ng, MD, PhD, and Matthew S. Davids, MD Dr Ng is a clinical […]

The Development of Bevacizumab in Noncolorectal Gastrointestinal Malignancies: Gastroesophageal, Pancreatic, and Hepatocellular Carcinoma

Clinical Advances in Hematology & Oncology April 2014, Volume 12, Issue 4 Manish A. Shah, MD Dr Shah is an associate professor of medicine at Weill Cornell […]

Targeted Therapies for Treatment of Recurrent Ovarian Cancer

Ovarian cancer remains the leading cause of death among women with gynecologic malignancies in the United States. Most women with epithelial ovarian cancer present with advanced disease. Despite good response rates to initial surgery and chemotherapy, the majority of patients experience relapse and ultimately die of their disease. A better understanding of the molecular differences underlying the histologic subtypes of epithelial ovarian cancer has led to recent advances in targeted therapeutic strategies. Here we review the most promising targeted therapeutics currently being used for the treatment of recurrent ovarian cancer.

Treatment Selection in Metastatic Renal Cell Carcinoma: More Confusion or a Path Forward?

Meaningful progress has been realized in the treatment of metastatic renal cell carcinoma with the recent approval of a number of new agents; more new agents are on the horizon. Despite the recent completion of many clinical trials that have changed or will change practice, many questions remain. In this manuscript, we highlight the most noteworthy developments in the first- and second-line treatment of metastatic renal cell carcinoma, as these are the areas of greatest change. We also emphasize ongoing trials and those areas that are most in need of study in order to move the field forward. Although more data are needed, exciting progress is being made.

The Clinical Management of Chronic Myelomonocytic Leukemia

Chronic myelomonocytic leukemia (CMML) is an aggressive malignancy characterized by peripheral monocytosis and ineffective hematopoiesis. It has been historically classified as a subtype of the myelodysplastic syndromes (MDSs) but was recently demonstrated to be a distinct entity with a distinct natural history. Nonetheless, clinical practice guidelines for CMML have been inferred from studies designed for MDSs. It is imperative that clinicians understand which elements of MDS clinical practice are translatable to CMML, including which evidence has been generated from CMML-specific studies and which has not. This allows for an evidence-based approach to the treatment of CMML and identifies knowledge gaps in need of further study in a disease-specific manner. This review discusses the diagnosis, prognosis, and treatment of CMML, with the task of divorcing aspects of MDS practice that have not been demonstrated to be applicable to CMML and merging those that have been shown to be clinically similar.

How Often Do Hematologists Consider Celiac Disease in Iron-Deficiency Anemia? Results of a National Survey

Background: Celiac disease (CD) is underdiagnosed, and iron-deficiency anemia (IDA) is a common presentation of CD. No guidelines exist in the literature for screening for CD among those with IDA in the United States. We surveyed hematologists to determine rates of CD screening in patients with IDA. Methods: A survey was e-mailed to members of the American Society of Hematology. Results: There were 385 complete responses from 4551 e-mails. Most respondents were practicing clinicians (74%), clinical researchers (10%), or laboratory researchers (6%). Specialists in benign hematology accounted for 45% of respondents, oncologists accounted for 33%, and specialists in malignant hematology accounted for 22%. The most common practice types were university-affiliated hospital (43%), private clinic (29%), community hospital (12%), and Veterans Affairs or military hospital (9%). Only 8.6% believed all patients with IDA should be screened for CD. Respondents who had completed their fellowship within 5 years were more likely than more experienced clinicians to believe that all patients with IDA should receive CD screening (OR, 2.8; CI; 1.1-7.5; P=.04). Having a higher volume of IDA patients per month also increased the likelihood of testing (P=.01). In multivariate analysis, specialists in malignant hematology (OR, 3.2; CI, 1.1-9.5; P=.04) and oncologists (OR, 3.5; CI, 1.3-9.5; P=.02) were more likely than specialists in benign hematology to screen all patients for CD, as were those who saw predominately pediatric patients with IDA vs adult patients (OR, 16.9; CI, 3.0-97.0; P=.002). Conclusions: Practicing hematologists infrequently screen for CD in IDA. Physicians who have recently finished their fellowship and those who see a high volume of patients with IDA are more likely to screen for CD.

Programmed Death-1 Inhibition in Renal Cell Carcinoma: Clinical Insights and Future Directions

The treatment of metastatic renal cell carcinoma (mRCC) has evolved markedly over the past decade, broadening beyond immune-based strategies (eg, interleukin-2 and interferon-α) to include targeted agents (eg, sunitinib [Sutent, Pfizer] and sorafenib [Nexavar, Bayer]). Recently, there has been a renewed interest in immune-based strategies, with clinical trials underway to assess vaccines and other immunomodulatory agents. Of particular interest are agents that inhibit the interaction between the programmed death-1 (PD-1) receptor and its ligand (PD-L1) at the T-cell/antigen-presenting cell interface. This interaction produces T-cell anergy and therefore stifles the antitumor immune response. Monoclonal antibodies to PD-1 (eg, nivolumab, lambrolizumab, and pidilizumab) and PD-L1 (MPDL3280A and BMS-936559) are in various stages of clinical development. The clinical trajectory of these agents is discussed herein, with specific attention to the potential placement of PD-1/PD-L1 inhibition in the crowded therapeutic landscape of mRCC.

FDG-PET Imaging for Hodgkin Lymphoma: Current Use and Future Applications

A significant amount of data has been published over the past decade regarding the clinical utility of F-fluorodeoxyglucose positron emission tomography (FDG-PET) in the diagnosis and management of Hodgkin lymphoma (HL). This includes studies examining interim FDG-PET, which has been shown to be a strong tool for predicting relapse and survival, especially in advanced-stage HL. Despite progress, a number of questions remain regarding the precise role and value of FDG-PET in the diagnosis, risk stratification, and management of HL. These questions include the need for concomitant contrast enhanced computed tomography with FDG-PET, reproducibility and interpretability of FDG-PET, optimal imaging for the treatment surveillance of HL following definitive treatment, and the use of FDG-PET for patients with relapsed/refractory disease, including stem cell transplantation. In this review, these issues are critically examined and the study designs and results of observational and prospective FDG-PET response-adaptive clinical trials in HL are described in detail. In addition, novel techniques and future applications of FDG-PET, such as metabolic tumor volume, tumor proliferation via 3’-deoxy-3’-18F-fluorothymidine, and integrated PET/magnetic resonance imaging are discussed.

The Role of Tyrosine Kinase Inhibitors in Hepatocellular Carcinoma

Since the approval of the multityrosine kinase inhibitor (TKI) sorafenib (Nexavar, Bayer and Onyx) as the standard of care for intermediate to advanced stages of hepatocellular carcinoma (HCC), there has been considerable interest in developing more potent TKIs to improve morbidity and mortality for patients with HCC. Much of the research on TKIs targets pathways implicated in angiogenesis, given that HCC is a highly vascularized cancer type. It was theorized that the efficacy of sorafenib is primarily attributable to its angiogenesis targets—namely, vascular endothelial growth factor receptors, platelet-derived growth factor receptors, FLT-3, and RAF kinases. Over the past 2 years, several pivotal phase 3 trials of newer TKIs targeting similar pathways have failed to meet criteria for superiority or noninferiority to sorafenib. Reasons for this may stem from the genetic and biologic heterogeneity of HCC. Genomic studies of tumor samples have shown scarce uniformity in kinase mutations, underscoring the variability that exists in HCC. This beckons the question of whether efforts should shift to other potential targets, either within the realm of TKIs or other targets entirely. Receptor tyrosine kinases, such as those encoded by the MET proto-oncogene, are expressed in certain individuals and have shown to be susceptible to targeted TKIs. As researchers continue to investigate therapies, the goal is to further research efforts into culprit oncogenes that mediate tumor progression, which will likely lead to more personalized and targeted regimens.

Clinical Biomarkers in Colorectal Cancer

Colorectal cancer remains the second leading cause of cancer-related death in the United States. While chemotherapy remains the backbone upon which treatment for metastatic colorectal cancer is built, targeted therapies have been employed, albeit with mixed results, in the management of this disease. Nonetheless, increased understanding in recent years of the complexity and heterogeneity of cellular abnormalities driving these tumors has identified potential targets for future interventions. This article will review the seminal biomarkers of predictive and prognostic importance currently used in the treatment of patients with colorectal cancer, and will highlight additional promising biomarkers which may be incorporated into clinical practice in the future.