LEARNING OBJECTIVES1. Enumerate procoagulant factors present in malignancy and the risk for thromboembolic events.2. Describe the morbidity associated with nonbacterial thrombotic endocarditis.3. List the recommended evaluations and treatments for nonbacterial thrombotic endocarditis.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThrombophilia is a well-described consequence of cancer and its treatment. The pathogenesis of this phenomenon is complex and multifactorial. Nonbacterial thrombotic endocarditis (NBTE) is a serious and potentially underdiagnosed manifestation of this prothrombotic state that can cause substantial morbidity in affected patients, most notably recurrent or multiple ischemic cerebrovascular strokes. Diagnosis of NBTE requires a high degree of clinical suspicion as well as the judicious use of two-dimensional echocardiography to document the presence of valvular thrombi. In the absence of contraindications to therapy, treatment consists of systemic anticoagulation, which may ameliorate symptoms and prevent further thromboembolic episodes, as well as control of the underlying malignancy whenever possible. The Oncologist 2007;12:518 -523 Disclosure of potential conflicts of interest is found at the end of this article.

Colorectal cancer (CRC) is the third most common malignant disease in the United States (U.S.). Almost two-thirds of CRC survivors are living 5 years following diagnosis. The prevalence of CRC survivors is likely to increase dramatically over the coming decades with further advances in early detection and treatment and the aging and growth of the U.S. population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns following treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The following guidelines are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.

No abstract

Epitope spreading is a process whereby epitopes distinct from and non‐cross‐reactive with an inducing epitope become targets of an evolving immune response. This phenomenon has been associated most notably with the progression of naturally occurring or experimentally induced chronic autoimmune diseases. We have investigated the potential occurrence of epitope spreading in the context of antitumor cytotoxic T cell (CTL) responses using chicken ovalbumin (OVA) as a model antigen. Our results indicate that following rejection of OVA‐expressing EG.7 tumor cells effectuated by a CTL response which is induced against the MHC class I‐restricted immunodominant epitope OVA257 – 264, there occurs intramolecular diversification of the CTL response to two additional OVA‐derived epitopes, OVA176 – 183 and OVA55 – 62, as well as intermolecular spreading to other endogenous tumor‐derived determinants. It seems that CTL‐mediated tumor cell destruction in vivo favors cross‐presentation of additional epitopes with the consequent activation of additional tumor‐reactive lymphocytes. The process of epitope spreading in that context has obvious important implications for the design of antigen‐specific antitumor immunotherapies.