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Sociodemographic Disparities in the Receipt of Adjuvant Chemotherapy Among Patients With Resected Stage I–III Pancreatic Adenocarcinoma

Nina N. Sanford, Todd A. Aguilera, Michael R. Folkert, Chul Ahn, Brandon A. Mahal, Herbert Zeh, Muhammad S. Beg, John Mansour, and David J. Sher

category 1 recommendations for adjuvant therapy. 9 Despite these consensus recommendations, studies have shown that, outside of the clinical trial setting, many patients do not go on to receive adjuvant chemotherapy. 10 – 13 Variables shown to affect the

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Survival in Patients With Sentinel Node–Positive Melanoma With Extranodal Extension

Andrea Maurichi, Francesco Barretta, Roberto Patuzzo, Rosalba Miceli, Gianfranco Gallino, Ilaria Mattavelli, Consuelo Barbieri, Andrea Leva, Martina Angi, Francesco Baldo Lanza, Giuseppe Spadola, Mara Cossa, Francesco Nesa, Umberto Cortinovis, Laura Sala, Lorenza Di Guardo, Carolina Cimminiello, Michele Del Vecchio, Barbara Valeri, and Mario Santinami

into the perinodal tissues beyond the lymph node capsule—extranodal extension (ENE)—after SNB with a positive result would allow a more appropriate use of adjuvant therapy for those most likely to benefit, while also minimizing the morbidity for

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Trends in Recommendations for Myelosuppressive Chemotherapy for the Treatment of Solid Tumors

Robert E. Smith Jr.

fluorouracil and folinic acid in B2 colon cancer . J Clin Oncol 1999 ; 17 : 1356 – 1363 . 54. Gill S Loprinzi CL Sargent DJ . Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much

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Evaluation of New Tests and Interventions for Prostate Cancer Management: A Systematic Review

Ghadeer Olleik, Wassim Kassouf, Armen Aprikian, Jason Hu, Marie Vanhuyse, Fabio Cury, Stuart Peacock, Elin Bonnevier, Ebba Palenius, and Alice Dragomir

decision regarding adjuvant therapy. 37 , 92 Seven studies were found to have clinical utility evidence ( Figure 3 , supplemental eTable 2 ) on Decipher after prostatectomy, 36 , 55 – 57 , 76 – 78 and none were found on its use after a positive biopsy

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Controversies in the Surgical Management of Gastric Cancer

David A. Kooby and Daniel G. Coit

Although the incidence of gastric adenocarcinoma in the United States has declined steadily since the early 1900s, it remains a significant health problem. Progress has been made during the past few decades in several areas: Lymph node staging has been refined, perioperative mortality has fallen, and plausible adjuvant therapy has emerged. Currently, complete surgical resection is the mainstay of therapy because it is the only potentially curative option; however, considerable controversy remains regarding the specifics of a surgical approach. This article examines 4 major controversies in the management of gastric cancer: extent of gastric resection, role of extended lymph node dissection, value of elective splenectomy for proximal gastric lesions, and current state of adjuvant therapy. Pertinent retrospective and prospective studies are reviewed to help formulate meaningful conclusions.

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HER2 Testing in Breast Cancer: NCCN Task Force Report and Recommendations

Robert W. Carlson, Susan J. Moench, M. Elizabeth H. Hammond, Edith A. Perez, Harold J. Burstein, D. Craig Allred, Charles L. Vogel, Lori J. Goldstein, George Somlo, William J. Gradishar, Clifford A. Hudis, Mohammad Jahanzeb, Azadeh Stark, Antonio C. Wolff, Michael F. Press, Eric P. Winer, Soonmyung Paik, Britt-Marie Ljung, and for the NCCN HER2 Testing in Breast Cancer Task Force

NSABP B-31 and NCCTG N9831 trials of adjuvant therapy in breast cancer. From Romond et al. 19 ; with permission. HER2 Testing: Summary of Clinical Issues The use of HER2 tumor biomarker status in clinical decision-making ( Figure 1 ) has been limited by

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Liver Transplantation for Hepatocellular Carcinoma: An Update

Jean F. Botha and Alan N. Langnas

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide and the most common primary hepatic malignancy. It arises on a background of hepatic cirrhosis in approximately 95% of the cases in the United States. A wide variety of treatment modalities have been applied in the treatment of HCC. Liver transplantation has emerged as the preferred treatment for patients with small HCC. Transplantation for patients whose tumors do not exceed the Milan criteria yields results equivalent to those of transplantation for non-HCC indications. Controversy now exists regarding the use of living donors, expansion of selection criteria, and role of adjuvant therapy.

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Biologics in Cervical Cancer Therapy

Lyndsay J. Willmott, Daniele A. Sumner, and Bradley J. Monk

Though cervical cancer incidence and prevalence have decreased in the United States, the disease remains a very important cause of morbidity and mortality worldwide. Current therapy for early-stage disease is surgical with adjuvant therapy being administered according to histopathologic findings. Pelvic radiation with concomitant platinum-based chemotherapy is used to treat locally advanced disease, whereas metastatic and recurrent lesions continue to be difficult to effectively treat and cure. Clinical trials in this latter scenario have suggested that clinical benefit may be associated with biologic therapies. This article focuses on the use of targeted therapies in cervical cancer, specifically evaluating antiangiogenesis and endothelial growth factor receptor–related treatments.

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Bone Mineral Density Testing Disparities Among Patients With Breast Cancer Prescribed Aromatase Inhibitors

John Charlson, Elizabeth C. Smith, Alicia J. Smallwood, Purushottam W. Laud, and Joan M. Neuner

Objectives: Aromatase inhibitors (AIs) are standard adjuvant therapy for postmenopausal women with early-stage, estrogen receptor–positive breast cancer. We designed our study to determine whether women initiating adjuvant therapy with an AI underwent baseline bone mineral density testing, as well as what factors predicted adherence with testing guidelines. Methods: Medicare Parts A, B, and D claims were used to identify a cohort of women aged 67 years and older with incident breast cancer in 2006 and 2007 who started AI therapy. Medicare claims provided information about bone density testing, as well as demographic and other treatment data through 2012. We also ascertained which patients were treated with bisphosphonates and studied the relationship of bisphosphonate therapy with bone density testing. Results: Approximately two-thirds of patients had baseline bone density testing. Older age, comorbidity, low income, and black race were associated with lower rates of baseline bone density testing. Testing rates decreased substantially with increasing age from 73% for women aged 67 to 70 years to 51% for those 85 years of age and older (adjusted odds ratio for not being tested, 2.48 [Cl, 2.17–2.82]). The proportion of women who had neither bone density testing nor bisphosphonate therapy increased with age as well. Conclusions: Despite the importance of age as a risk factor for fractures, older women starting treatment with AIs for treatment of breast cancer are less likely to undergo recommended bone density assessment.

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Non–Small Cell Lung Cancer

UCSF Helen Diller Family Comprehensive Cancer Center

Lung cancer is the leading cause of cancer-related death in both men and women in the United States. An estimated 213,380 new cases (114,760 men and 98,620 women) of lung and bronchus cancer will be diagnosed in 2007, and 160,390 deaths (89,510 in men, 70,880 in women) are estimated to occur because of the disease. Non-small cell lung cancer (NSCLC) accounts for 80% to 85% of all lung cancer cases and includes 3 major types: (1) adenocarcinoma; (2) squamous cell (epidermoid) carcinoma; and (3) large-cell carcinoma. Adenocarcinoma is the most common type of lung cancer seen in the United States and is also the most frequently occurring cell type in nonsmokers. Important updates to the 2008 guidelines on NSCLC include the addition of tables on drugs and dosing information on chemotherapy regimens for adjuvant therapy.

For the most recent version of the guidelines, please visit NCCN.org