Supportive Care

A preliminary report of a meta-analysis of clinical trials of mo-lecularly targeted therapies shows that they are not benign and can add to the toxicity of standard chemo­therapy. In particular, increased rates of oral mucositis and diarrhea are reported with several US Food and Drug Ad­ministration (FDA)-approved agents. In­creased mucositis seen with bevacizumab and erlotinib does not appear to be clinically significant, but severe diarrhea occurs with a number of targeted agents and has a potential impact on quality of life (QOL) and healthcare resource utilization.

SG is a 29-year-old female, recently married, who was referred to the hematology clinic due to a platelet count of 11 × 109/L. Additionally, she recently had 3 nosebleeds and heavy menstrual bleeding. She had dismissed them as another sign of stress from her hectic schedule, including her recent wedding, teaching full-time, and evening graduate school. A detailed and extensive review of her history and physical, serum chemistries, CBC, and peripheral smear does not reveal any potential underlying causes for her thrombocytopenia. She is negative for HCV and HIV, and her blood type is AB negative. Because her platelet count is <100 × 109/L without an identifiable cause, she is diagnosed with primary immune thrombocytopenia. What are considerations for appropriate first-line therapy?

Motor toxicities of chemotherapy-induced peripheral neuropathy (CIPN) are likely to lead to falls, deficits in physical performance (PP), and functional losses, according to a substudy of a phase 3 clinical trial in patients with CIPN reported at the 2012 Annual Meeting of the American Society of Clinical Oncology.1

Topical administration of a novel mouth rinse, AG013, appears safe, well tolerated, and effective in reducing the severity and course of oral mucositis (OM) in patients receiving induction chemo­therapy in a study presented at the 2012 ASCO Annual Meeting (Abstract 9024).

A new appreciation of the pathobiological foundation of mucositis, and the application of genomics to risk assessment, heralds an individualized and more effective approach to intervention for this costly, often disabling, toxicity, according to specialists who spoke at a session on mucosal injury during the 2012 Annual Meeting of the American Society of Clinical Oncology (ASCO).

The link between cancer and thrombosis has been known for many years. Recently this connection has come to the forefront with increased recognition by healthcare providers and mandates by governing bodies. The results of a thromboembolic event can be catastrophic in a patient with cancer.

With advances in the diagnosis and treatment of cancer, the estimated 5-year survival rate for cancer patients has significantly improved to approximately 67%.1 The most common malignancies in men and women in the United States—breast and prostate cancers—have 2 of the highest 5-year survival rates reported, at 90% and 99%, respectively.1 As oncology patients are living longer, bone health has become a pertinent issue in the treatment of both metastatic and nonmetastatic oncology patients.2

Outpatient management of febrile neutropenia is appropriate for carefully selected low-risk patients, according to Ashley Morris Engemann, PharmD, Duke University Medical Center, who spoke at the 2012 Pharmacy Program held in Hollywood, Florida, during the 17th Annual Conference of the National Comprehensive Cancer Network (NCCN). Engemann noted that treating patients at home is clearly the patient’s preference and is cost saving. Risk assessment is the first step, as outpatient management is not appropriate for high-risk patients but can be considered in low-risk patients.

“Chemotherapy-related nausea and vomiting (CINV) remains a concern despite recent advances. While the 5-HT3 antagonists and the NK-1 antagonists reduce vomiting, nausea continues to be a persistent problem for our patients,” she said. “There will always be patients, no matter what we do, who still have problems.” Patient risk factors drive the choice of prophylaxis and dose, she said. Young age (

Many cancer survivors who thought they were fertile now may be finding that is not the case. New research is suggesting that current estimates of the impact of chemotherapy on women’s reproductive health are too low.

Researchers at the University of California San Francisco (UCSF) say their analysis of the age-specific, longterm effects of chemotherapy provides new insights that will help patients and clinicians make more informed de cisions about future reproductive options, such as egg harvesting (Cancer. September 1, 2011. Epub ahead of print).

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