Chemotherapy-induced peripheral neuropathy (CIPN) is a troubling side effect that can lead to dose reductions and discontinuation of treatment. This can be quite distressing for patients. Current treatments for CIPN are limited, can have side effects, and are generally of limited efficacy. There is recent evidence from several small pilot studies that the use of vitamin E might help prevent or lessen the side effects of CIPN. To date, a large, randomized clinical trial evaluating the efficacy of vitamin E as prevention for CIPN has not been conducted. A clinical trial is currently being conducted by the North Central Cancer Treatment Group to study the relationship between vitamin E and CIPN.

Despite the widespread use of 5-HT3 receptor antagonist antiemetics such as ondansetron and granistron, up to 70% of patients with cancer receiving highly emetogenic chemotherapy agents experience postchemotherapy nausea and vomiting. Delayed postchemotherapy nausea (nausea that occurs >/= 24 hours after chemotherapy administration) and anticipatory nausea (nausea that develops before chemotherapy administration, in anticipation of it) are poorly controlled by currently available antiemetic agents. Scientific studies suggest that ginger (Zingiber officinale) might have beneficial effects on nausea and vomiting associated with motion sickness, surgery, and pregnancy. In 2 small studies of patients with cancer receiving chemotherapy, addition of ginger to standard antiemetic medication further reduced the severity of postchemotherapy nausea. This article describes a phase II/III randomized, dose-finding, placebo-controlled, double-blind clinical trial to assess the efficacy of ginger for nausea associated with chemotherapy for cancer. The study is currently being conducted by private practice oncology groups that are funded by the National Cancer Institute's Community Clinical Oncology Program and affiliated with the University of Rochester Cancer Center Community Clinical Oncology Program Research Base.

Most patients who receive epidermal growth factor receptor (EGFR) inhibitors develop a rash. To date, no effective palliative therapy has been developed for these rashes. This review describes the rationale behind N05C4, a placebo-controlled trial of sunscreen as an intervention to prevent EGFR inhibitor-related rash.

Oral mucositis is a painful ulceration of the mucosal lining of the oropharynx. It occurs frequently in patients receiving radiation therapy and/or chemotherapy for solid tumors and has been reported in up to 98% of patients undergoing hematopoietic stem cell transplantation. The development of mucositis is associated with significant morbidity, including longer hospital stays, increased bacteremia, and pain that interferes with talking, eating, and sleeping. Palifermin, a recombinant humanized keratinocyte growth factor, is the first pharmacologic agent that has been Food and Drug Administration-approved to decrease the incidence and duration of mucositis in patients with hematologic malignancies receiving chemotherapy requiring hematopoietic stem cell transplantation support. Results from phase I/II trials suggest that it might also benefit patients receiving treatment for solid tumors; however, the results from ongoing phase III trials will need to be available and examined before it can be incorporated into general clinical practice for this patient population.

Bone is the most common site of metastases in patients with advanced breast cancer. In these patients, the primary aim of therapy is to prevent and delay the occurrence of skeletal-related events (SREs), which can be defined as follows: (1) pain requiring radiation or surgical intervention, (2) spinal cord compression, (3) pathologic fracture, or (4) hypercalcemia. Unfortunately, determining which patients are at highest risk for an SRE is difficult with current imaging techniques. In contrast, the urinary biomarker of bone resorption, collagen N-telopeptide, is under intensive study after repeat validation as a rapid and reliable predictor of SREs as well as prognosis and survival. Herein, we review this new role of collagen N-telopeptide as a predictor of bone involvement and response to treatment, and of the palliative benefit of bisphosphonate therapy in patients with metastatic breast cancer.

Bevacizumab is the first successful example of targeting the vasculature for the treatment of solid tumors. Although generally well tolerated in combination with different chemotherapy regimens, bevacizumab has side effects that are unique to this class of agents. In this review, we discuss the side effects associated with bevacizumab and potential treatments to ameliorate these toxicities.