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The Oncologist, the Patient and CKN — Sharing Knowledge

Prophylactic feeding tubes for patients with locally advanced head-and-neck cancer undergoing combined chemotherapy and radiotherapy–systematic review and recommendations for clinical practice

by C. Orphanidou, K. Biggs, M.E. Johnston, J.R. Wright, A. Bowman, S.J. Hotte, A. Esau, C. Myers, V. Blunt, M. Lafleur, B. Sheehan, M.A. Griffin


This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population.

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Real-world experience with adjuvant FEC-D chemotherapy in four Ontario regional cancer centres

by Y. Madarnas, MD, S.F. Dent, MD, S.F. Husain, MD, A. Robinson, MD, S. Alkhayyat, MD, W.M. Hopman, MA, J.L. Verreault, BHSc BEd, T. Vandenberg, MD


The efficacy of adjuvant chemotherapy with FEC-D (5-fluorouracil–epirubicin–cyclophosphamide followed by docetaxel) is superior to that with fec-100 alone in women with early-stage breast cancer. As the use of FEC-D increased in clinical practice, health care providers anecdotally noted higher-than-expected toxicity rates and frequent early treatment discontinuations because of toxicity. In the present study, we compared the rates of serious adverse events in patients who received adjuvant FEC-D chemotherapy in routine clinical practice with the rates reported in the PACS-01 trial.

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Triple-negative breast cancers: an updated review on treatment options

by K.B. Reddy, PhD


Morphologic features of tumour cells have long been validated for the clinical classification of breast cancers and are regularly used as a “gold standard” to ascertain prognostic outcome in patients. Identification of molecular markers such as expression of the receptors for estrogen (er) and progesterone (pgr) and the human epidermal growth factor receptor 2 (her2) has played an important role in determining targets for the development of efficacious drugs for treatment and has also offered additional predictive value for the therapeutic assessment of patients with breast cancer. More recent technical advancements in identifying several cancer-related genes have provided further opportunities to identify specific subtypes of breast cancer. Among the subtypes, tumours with triple-negative cells are identified using specific staining procedures for basal markers such as cytokeratin 5 and 6 and the absence of er, pgr, and her2 expression. Patients with triple-negative breast cancers therefore have the disadvantage of not benefiting from currently available receptor-targeted systemic therapy. Optimal conditions for the therapeutic assessment of women with triple-negative breast tumours and for the management of their disease have yet to be validated in prospective investigations. The present review discusses the differences between triple-negative breast tumours and basal-like breast tumours and also the role of mutations in the BRCA genes. Attention is also paid to treatment options available to patients with triple-negative breast tumours.

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Emerging trends in the treatment of triple negative breast cancer in Canada

by S. Verma, MD MSEd, L. Provencher, MD MA, R. Dent, MD MSc


Triple-negative breast cancer (TNBC) has a poor prognosis compared to other subtypes and lacks common therapeutic targets, including HER 2 and the estrogen and progesterone receptors. The clinicopathological heterogeneity of the disease and limited treatment options make clinical management particularly challenging. Here we present the results of a survey of Canadian clinical oncologists regarding treatment of TNBC, and review recent and ongoing clinical research in this area. Our survey results show that the majority of respondents use a combination of anthracyclines-taxanes as adjuvant therapy for early TNBC. For the first-line treatment of metastatic TNBC, most clinicians recommend taxanes, while single agent capecitabine and platinum-based therapies are more common for subsequent lines of therapy. Despite the ongoing development of novel targeted therapies, chemotherapy remains the mainstay of treatment for TNBC.

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Triple-negative and basal-like breast cancer: implications for oncologists

by J. Lachapelle, W.D. Foulkes

Since the start of the 1990s, molecular pathology has been playing an increasingly important role in cancer diagnosis and treatment. Nowhere is this role more evident than in the case of breast cancer. Traditional criteria such as the size and histologic grade of the primary tumour and the number of positive axillary lymph nodes have been the major focus for many years. Today, immunohistochemical tests and other molecular and cytogenetic tests are usually necessary for an exact diagnosis and for assessment of the degree of invasiveness. Moreover, those tests are now essential for an accurate evaluation of prognosis and initiation of the appropriate treatment.

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Establishing a multicentre clinical research network: lessons learned

by N. A. Hagen, C. R. Stiles, P. D. Biondo, G. G. Cummings, R. L. Fainsinger, D. E. Moulin, J. L. Pereira, R. Spice


Within many health care disciplines, research networks have emerged to connect researchers who are physically separated, to facilitate sharing of expertise and resources, and to exchange valuable skills. A multicentre research network committed to studying difficult cancer pain problems was launched in 2004 as part of a Canadian initiative to increase palliative and end–of–life care research capacity. Funding was received for 5 years to support network activities.

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