Gabriel Carabulea, M.D. 27800 Medical Center Road, Suite 310 |
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Ocean View Hematology/Oncology Medical Group (OVHOMG) |
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Issue No. 2, March 2009 |
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NEW THERAPIES ROMIPLOSTIM (NPlate) is a second-generation thrombopoietin analog that stimulates platelet production by binding to and activating the thrombopoietin receptors. It has been approved for the treatment of patients with chronic, refractory ITP. ISSUES IN CANCER SCREENING AND PREVENTION Colorectal Cancer screening has been deemed unnecessary beyond 75 years. An analysis conducted by the USPSTF found little cost benefit for conducting periodic screening in patients aged above 75 years. The authors noted that half of the eligible patients are still failing to receive recommended screenings. Should patients older than 75 be screened for prostate cancer? The U.S. Preventative Services Task Force reviewed evidence-based literature and concluded that the risks of screening and therapy in this age group outweighed the benefits, and therefore it does not recommend screening of this age group. Vitamin D deficiency linked to worse prognosis in breast cancer. Canadian researchers found for the first time that women with vitamin D deficiency at the time of breast cancer diagnosis were more likely to experience metastasis of their cancer, and more likely to die, compared with women with adequate vitamin D levels. They were also more likely to have high-grade cancers. This data is preliminary, and it is too early to conclude whether the association is causal.
BSGI– BREAST SPECIFIC GAMMA IMAGING relies on the use of radiotracer to detect cancer cells. When 159 women who'd been found to have a suspicious lesion after mammography underwent BSGI scanning, an additional suspicious lesion was found in 29 percent of the women. Of these, another third were found to be cancerous. At this time, BSGI is an adjunct to mammography that remains the mainstay of breast cancer screening CIRCULATING TUMOR CELL TECHNOLOGY . Veridex LLC markets the CTC measurement technology known as CellSearch System. It is FDA approved as a tool to predict PFS and overall survival in patients with metastatic breast, colorectal, or prostate cancer.
KRAS MUTATION was linked to ineffectiveness of cetuximab in colorectal cancer. A retrospective analysis of the CRYSTAL trial patients showed 65% of them were KRAS wild-type (normal), and 35% were KRAS mutated. The one year progression-free survival for those who received cetuximab and FOLFIRI was 43% vs. 25% for those who received FOLFIRI alone. The response rate in the KRAS wild-type population was 59% for cetuximab containing regimen vs. 43% for chemotherapy alone. CYP2D6 GENOTYPING. Decreases in CYP2D6 activity can reduce concentrations of tamoxifen's active metabolites. Clinical studies demonstrate that breast cancer patients treated with adjuvant tamoxifen who have decreased CYP2D6 may have an increased risk of recurrence and reductions in disease-free survival. Therapeutic alternatives should be considered in poor metabolizers. DEFICIENT MISMATCH REPAIR (dMMR) patients with colon cancer did not benefit from fluorouracil-based chemotherapy, compared with patients with proficient mismatch repair, who were more likely to benefit. These results, derived from a pooled reanalysis of randomized chemotherapy trials, suggest that mismatch repair status should be considered when choosing therapy for patients with colon cancer.
Cancer screening and prevention
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Ocean View Hematology/Oncology Medical Group (OVHOMG) |
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NEW THERAPIES RECLAST (zoledronic acid-Novartis) is a once-a-year osteoporosis drug. A three-year trial of the 15-minute infusion approved for women with postmenopausal osteoporosis, was found to reduce the risk of spine fractures by 70%, and hip fractures by 41%. Bone mineral density increased in the spine by 6.7%. TORISEL (temsirolimus-Wyeth) a targeted, first-in-class mTOR inhibitor, is “the new kid on the block” treatment for metastatic renal cell carcinoma, and the first such targeted agent to extend survival. Torisel is recommended first-line therapy for poor-prognosis patients and subsequent therapy after cytokine therapy or tyrosine kinase inhibitors. |
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Could a diagnosis of skin cancer (not melanoma) be good news? Recently publish data indicates that patients with evidence of high levels of sun exposure, were at a lower risk for most types of internal solid cancers later in life. The theory speculates that cumulative sun exposure also triggers vitamin D production in the skin, which may play a role in staving off more malignant cancers. Studies have also shown that levels of 25-hydroxyvitamin D below 20 ng/ml are associated with a 30 to 50% increased risk of incident colon, prostate, and breast cancer. |
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MRI scans of the breast can identify potential tumors earlier than mammograms. The American Cancer Society now recommends annual MRI screenings, in addition to yearly mammograms, for women at high risk of developing breast cancer. Included are women who have a BRCA1 or BRCA2 gene mutation, or first –degree relative (mother, father, sister, brother, daughter, or son) with a BRCA, TP53 or PTEN gene mutation. MammoSite - a new minimally invasive method for delivering a more concentrated radiation dose to the affected areas of breast, rather than treating the entire breast. The treatment starts at the time of lumpectomy, and is given on an outpatient basis twice daily for five days, rather than several weeks, allowing patients to quickly return to their former quality of life. Specific criteria for treatment have to be met. PERSONALIZED MEDICINE Services provided by OVHOMG: Cancer screening and prevention
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