SummaryBackground-Bone metastases are a major burden in men with advanced prostate cancer. We compared denosumab, a human monoclonal antibody against RANKL, with zoledronic acid for prevention of skeletal-related events in men with bone metastases from castration-resistant prostate cancer.

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Based on in vitro studies that have demonstrated synergy between recombinant alfa-2a-interferon (rIFN alpha-2a) and the fluoropyrimidine, fluorouracil (5FU), against two human colon cancer cell lines, a pilot clinical trial was initiated to determine the effects of the combination of 5FU and rIFN alpha-2a in patients with advanced, unresectable colorectal carcinoma. A total of 30 patients were enrolled; all were evaluable. 5FU was administered as a loading course, 750 mg/m2 daily for 5 days by continuous infusion followed by weekly bolus therapy, rIFN alpha-2a, 9 MU, was administered subcutaneously three times per week. Of 17 previously untreated patients evaluable for response, 13 achieved a response. Three patients had disease progression. No previously treated patients had a major response. There was one death clearly related to therapy, an event preceded by watery diarrhea and neutropenic sepsis. Other toxicities were reversible and responded to dose reduction. With a median follow-up of 16+ months, median survival has not been reached among the previously untreated patient cohort. We conclude that the combination of 5FU and rIFN alpha-2a is an active regimen against disseminated colorectal cancer in previously untreated patients.

Denosumab is a cost-effective treatment option for the prevention of SREs in patients with advanced solid tumors and bone metastases compared to ZA. The overall value of denosumab is based on superior efficacy, favorable safety, and more efficient administration.

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the incidence of neutropenia-related endpoints when pegfilgrastim was administered in the first and subsequent chemotherapy cycles.2. Compare results with data reflecting current practice standards.3. Discuss the relevance of pegfilgrastim use beginning in the first cycle of chemotherapy.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThe impact of first-and subsequent-cycle growth factor use in the community setting has not been studied extensively. We conducted this large, prospective, noncomparative study to assess neutropenia and related complications in patients receiving myelotoxic chemotherapy with pegfilgrastim support in community practices. Patients >18 years old with cancers other than leukemia or myelodysplastic syndrome, including those with major comorbidities, were eligible. Pegfilgrastim (6 mg) was to be administered ϳ24 hours after chemotherapy in all cycles (minimum, four cycles). A total of 2,112 patients was included in the analyses. The most common tumor types were breast cancer (46%), nonHodgkin's lymphoma (15%), and non-small cell lung cancer (13%). Chemotherapies administered most often were a platinum plus a taxane (18%), and anthracycline plus an alkylating agent (18%), and a taxane plus an anthracycline plus an alkylating agent (16%). The percentage of patients with neutropenia-related hospitalization was 2.9% in cycle 1 and 5.6% across all cycles. Chemotherapy dose reductions and delays were attributed to neutropenia in 1.8% and 0.9% of patients, respectively, in cycle 2 and 2.9% and 2.1% of patients, respectively, across all cycles. Febrile neutropenia (absolute neutrophil count <1.0 ؋ 10 9 /l with temperature >38.2°C) occurred in 3.6% of patients in cycle 1 and in 6.3% of patients across all cycles. The most frequently reported serious adverse events were febrile neutropenia (3.4%), neutropenia (2.6%), and dehydration (2.6%). Bone pain (0.1%)

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The case of a 66-year-old man with pseudotumor of the spleen is presented. This rare entity can mimic malignant lymphoma clinically and radiographically. Splenectomy is diagnostic and curative. The etiology of pseudolymphoma is unknown, although a review of the literature suggests an association with prior systemic bacterial infection, as in the present case. Cancer 66:597-600,1990.NFLAMMATORY PSEUDOTUMOR (plasma cell granu-I loma) is a rare mass lesion with histologic features of inflammation and mesenchymal repair that has been observed in tissues of the respiratory tract,' gastrointestinal tract,2 orbit,3 soft tis~ues,~ lymph nodes,' and other organ^.^.^ When the lesion occurs as a primary splenic tumor, lymphoma is usually suspected clinically, and the true diagnosis is revealed only after the spleen is examined histologically. We recently observed a patient with this entity who has remained disease-free 24 months after the splenectomy. Case ReportA 66-year-old man was admitted to his community hospital in May 1988 with fever, pneumonia, hepatitis, and anemia. The liver was palpable two to three fingerbreadths below the costal margin but was not tender. A chest radiograph showed bilateral interstitial pneumonia involving all lobes except the right upper lobe, as well as small bilateral pleural effusions. An abdominal CT scan revealed mild splenomegaly and two right renal cysts.A diagnosis of Legionella pneumonia was made from sputum cultures and the patient responded to appropriate antibiotic therapy. However, hepatitis and malaise persisted and the patient was readmitted 1 month later for further evaluation. Significant physical findings were limited to jaundice and a nontender, palpable liver edge. The patient gave a history of jaundice that was treated medically at another hospital 10 years previously. He occasionally took indomethacin or ibuprofen for knee pain. Except for an appendectomy 40 years previously he had no other significant medical history. There was no history of blood donation or transfusion. The hematocrit was 30%, hemoglobin 9. gm/dl, and the platelet count was 377,OOO/pl. The leukocyte count was 12,9OO/p1 and a shift to the left was noted on a differential leukocyte count. The total serum bilirubin was 2.7 mg/ dl with a direct bilirubin of 1.4%. Serum alkaline phosphatase was 54 1 IU/l, SGOT 60 IU/l, SGPT 59 IU/l, and GGTP 52 1 IU/I. The blood urea nitrogen was 19 mg/dI and serum creatinine was I .2 mgdl. Hepatitis A antibody and hepatitis B surface antigen tests were negative. A bone marrow biopsy was hypercellular and an aspirate revealed mature granulocytic hyperplasia, moderately increased mature plasma cells, and decreased erythrocyte precursors.A repeat abdominal CT scan showed hepatosplenomegaly and a 10 cm focal solid splenic mass (Figs. 1 A and 1B). A comparison with the previous CT scan showed that the mass was barely perceptible on the previous scan. Furthermore, re-evaluation of a radionuclide bone scan done 6 months earlier for arthritic complaints revealed a suggestion of a...