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Oncology Times:
doi: 10.1097/01.COT.0000342998.32231.11
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Clinical Notes

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New Edition of Medical Abbreviations Book

A new edition of Neil M. Davis's Medical Abbreviations, the 14th, is now available. The book (ISBN 0-931431-13-1) includes 30,000 abbreviations, acronyms, and symbols, along with a cross-referenced list of 3,400 generic and brand drug names. The book also includes access to an online version (www.medabbrev.com), and mobile versions are also available, which are updated monthly.

Neil M. Davis, MS, PharmD, FASHP, is Professor Emeritus of Temple University School of Pharmacy, Editor Emeritus of Hospital Pharmacy, published by Facts and Comparisons, a sister company of OT's publisher, and President of Safe Medication Practices Consulting Inc.

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Copies are available from www.neilmdavis.com.

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FDA Approval for Treanda for Relapsed Indolent NHL

Treanda (bendamustine) has received FDA approval for the treatment of patients with indolent B-cell non-Hodgkin's lymphoma (NHL) that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen. The data supporting the FDA approval showed that the drug, which is made by Cephalon, is effective, has a tolerable side effects profile in patients with indolent NHL, and that treatment results in a high durable response.

The drug was already approved in March for treatment of patients with chronic lymphocytic leukemia.

“Because most patients with indolent non-Hodgkin's lymphoma eventually become resistant to existing treatments, new treatment options like Treanda are needed to improve patient outcome,” Bruce Cheson, MD, Professor of Medicine at Georgetown University Hospital and one of the investigators for the drug, said in a news release. “The Treanda pivotal trial shows that it is an effective and well-tolerated chemotherapy that offers a delay in disease progression for more than nine months.”

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In Small Study, Gene-Expression Pattern Identified that Appears to Predict Treatment Response in Patients with Metastatic Colorectal Cancer

French scientists reporting at the EORTC-NCI-AACR Symposium on “Molecular Targets and Cancer Therapeutics” have shown for the first time that identifying patterns of gene expression can be used to predict response to treatment in patients with advanced metastatic colorectal cancer.

Maguy Del Rio, PhD, of Institut de Recherché en Cancérologie de Montpellier, presented the study, which found an 11-gene signature that could be used to separate patients who would respond to FOLFIRI (leucovorin, fluorouracil, and irinotecan) from those who would not.

“For cancer prognosis, three gene-expression tests are commercially available, all for breast cancer. It is more difficult to predict responses to anticancer drugs than it is to predict prognosis. Few studies have been made in this field. This and our previous study [published in 2007 in the Journal of Clinical Oncology] are the first that demonstrate the utility of gene-expression profiling for the prediction of response in colorectal patients.”

She explained that about half of patients with colorectal cancer develop liver metastases during the course of their disease, and that when that happens, it is critical for the success of overall treatment to chose a chemotherapy regime that is most likely to induce a maximal response during the first course of treatment. It is a major clinical challenge to identify a subset of patients who could benefit from a particular chemotherapy, and to identify those who will not and who therefore need to be treated using an alternative treatment.”

The researchers used microarray analysis to identify gene-expression levels in samples taken from 19 colorectal cancer patients with liver metastases who had not yet started chemotherapy. Patients were followed to see who responded to the chemotherapy and who did not, and, using this information, the researchers found a pattern of 11 genes that clearly separated responder and non-responder patients. They designed a mathematical model that was able to predict and classify the eight responding and 11 non-responding patients with 100% accuracy. Still, “the fact that we achieved 100% accuracy could be due to our small sample size of 19 patients,” Dr. Del Rio cautioned.

“And for the subset of patients identified as non-responders to FOLFIRI, other treatments such as FOLFOX [leucovorin, fluorouracil, and oxaliplatin] or newer, targeted drugs such as cetuximab and bevacizumab could be added.”

The test takes about three days to run, with the following steps: surgical removal of tumor tissue, histologic validation, RNA extraction, chip hybridization, comparative analysis of gene expression, and the patient's classification.

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Head & Neck Cancer: Chest CT Appears Helpful for Detecting Lung Metastases

Among high-risk patients with head and neck cancer, chest computed tomography (CT) may help detect lung-related metastasis, according to a study led by Yen-Bin Hsu, MD, of Taipei Veterans General Hospital in Taiwan, published in the October issue of Archives of Otolaryngology–Head & Neck Surgery.

The most common site at which such patients develop new metastases is the lungs, with an incidence of 8% to 15%. For now, chest x-rays are the most commonly used screening tool for detecting these malignancies but do not always identify early abnormalities.

Dr. Hsu and his colleagues evaluated 270 screening chest CT scans performed over 42 months in 192 patients. The scans were categorized as new cases, follow-up cases, or recurrent cases, and the results were classified as normal or abnormal.

Of the 270 scans, 79 (29%) were considered abnormal, including 54 (20%) that identified a malignant neoplasm of the lung and 25 (9%) showing indeterminate abnormalities.

The rate of an abnormal scan was significantly higher in the follow-up case group (44%) than in the new case group (14%). Patients whose cancer was classified as Stage N2 or N3 (indicating some degree of lymph node involvement), who had Stage IV disease, who had recurrent disease, or who had a distant metastasis in another site were more likely to have a malignant neoplasm of the lung.

“Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them,” the authors wrote. “Based on the progressive changes in follow-up scans, 44 percent of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small (less than 1 cm) solitary nodules, which were usually resectable, carried significantly higher chances (67%) of being a malignant neoplasm.

“For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan,” the researchers continued. “In conclusion, chest CT is recommended for high-risk patients, especially every six months for the first two years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma.

“High-risk patients include those with N2 or N3 disease, Stage IV disease, or locoregional recurrence. For patients with indeterminate small (less than 1 cm) solitary pulmonary nodules, aggressive evaluation and management are imperative because of the high rate of a malignant neoplasm of the lung.”

© 2008 Lippincott Williams & Wilkins, Inc.

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