The potential toxicity of opioids can cause depression, confusion, respiratory depression, or even hyperalgesia. Hence, not all opioids are used in cancer pain management. For example, Meperidine, propoxyphene, and nalbuphine.

There are several different classifications of CINV and each type differs in both pathophysiology and recommended treatment. Acute onset occurs within 24 hours of chemotherapy versus delayed onset which occurs after the 24 hour threshold and can last up to 5 days. Anticipatory nausea and vomiting occurs before a new cycle of chemotherapy in response to a treatment related stimuli (lights, sounds, smells of the infusion location). Breakthrough nausea and vomiting occurs despite appropriate antiemetic medications and requiring rescue therapy.

In 1951, Jane C. Wright demonstrated the use of methotrexate in solid tumors, showing remission in breast cancer. Farber's work was instrumental in showing that effective pharmacological treatment of cancer was possible, and to this day, he is regarded as the father of modern chemotherapy. Paul Ehrlich was a Nobel Prize-winning German Jewish physician and scientist who worked in the fields of hematology, immunology, and antimicrobial chemotherapy. Among his foremost achievements were finding a cure for syphilis in 1909 and inventing the precursor technique to Gram staining bacteria Dr. Alexander theorized that since mustard gas all but ceased the division of certain types of somatic cells whose nature was to divide fast, it could also potentially be put to use in helping to suppress the division of certain types of cancerous cells.

At the time of diagnosis, 78% of patients have localized cancer, 12% of patients have regional lymph node involvement, and 6% of patients have distant metastases. At the time of diagnosis, it is unusual for individuals to present symptoms that are due to prostate cancer. Most patients with prostate cancer are diagnosed in the local stage and are asymptomatic. Furthermore, among the 6% of individuals who have distant metastases at the time of diagnosis, bone pain is usually the most common symptom.

The nausea center in the brain has three separate components that integrate together within the medulla of the brain: area prostrema, nucleus tractus solitaries, and dorsal vagal complex. It is possible that chemotherapy or metabolites act directly on the area postrema, since it lies outside the blood brain barrier. Coordination of the vomiting action is likely loosely coordinated in the medulla but an anatomically distinct vomiting center likely does not exist.

In 1949, The Food and Drug Administration (FDA) approved nitrogen mustard (mechlorethamine) for the treatment of cancer. Nitrogen mustard belongs to a class of drugs called alkylating agents, which kill cells by chemically modifying their DNA. This is considered the first chemotherapy agent ever approved.

A new study supports exhausting noninvasive methods to diagnose hepatocellular carcinoma (HCC) before attempting biopsy. In an analysis of data from the National Cancer Database, overall survival was lower in HCC patients who underwent preoperative tissue diagnosis compared with those with a clinical diagnosis. “Preoperative tissue diagnosis of HCC is associated with decreased overall survival in patients in this national cohort,” said Fadi Dahdaleh, MD, a cancer surgeon and clinical assistant professor of surgery at Edward-Elmhurst Health, in Chicago, who presented the study at the 2020 annual meeting of the Society of Surgical Oncology. https://www.clinicaloncology.com/GI-Cancers/Article/01-21/Evidence-Grows-for-Avoiding-Biopsy-in-Hepatocellular-Carcinoma/62298

The COMBI-d trial was the first to demonstrate superior efficacy with combined BRAF/MEK inhibition in the form of dabrafenib plus trametinib compared to single-agent BRAF inhibition with dabrafenib. Superiority was noted for ORR (69% vs 53%), median PFS (11.0 months vs 8.8 months), and median OS (25.1 months vs 18.7 months). Subsequently, other combinations of BRAF/MEK inhibitors such as vemurafenib plus cobimetinib and encorafenib plus binimetinib were tested and also proven superior to their single-agent BRAF inhibitor counterparts. Interestingly, treatment with single-agent BRAF inhibitors was associated with increased cutaneous toxicity, including squamous cell carcinoma. When combined with a MEK inhibitor, there was significantly less cutaneous toxicity compared to single-agent BRAF inhibition.

The National Comprehensive Cancer Network recommends germline genetic testing for patients with prostate cancer and any of the following: 1) a positive family history, 2) high-risk, very-high-risk, regional, or metastatic prostate cancer (regardless of family history), 3) Ashkenazi Jewish ancestry, or 4) intraductal histology. Testing should include MLH1, MSH2, MSH6, and PMS2 and the homologous recombination genes BRCA2, BRCA1, ATM, CHEK2, and PALB.

The first generation 5-HTRA (dolasetron, granisetron, ondansetron, tropisetron) have been demonstrated to be clinically equivalent in terms of efficacy and adverse reaction. In a large meta analysis in 2008, palonosetron was compared to the first generation 5-HT3RAs in terms of efficacy and safety in MEC and HEC. The analysis showed that patients receiving palonosetron had a significantly lower incidence of emesis on the first day.

While there are debates over the opioid crisis and misuse, it can be noted that opioid-associated deaths are ten times less likely to occur in cancer survivors than in the general population.

The American College of Chest Physicians antithrombotic guidelines recommend (grade 2C) initiating prophylactic LMWH during pregnancy for antithrombotic management in a patient with a history of estrogen-related VTE.1 Warfarin is contraindicated in first-trimester pregnancy due to teratogenicity. There is not sufficient information regarding the safety and efficacy of direct oral anticoagulants in pregnancy. DOACs are not approved for use during pregnancy or lactation.