Table of contents
March 2007 Volume 4 No 3
Viewpoints
Future directions in tumor immunotherapy: CTLA4 blockade
136Observations that CTLA4 has a key role in regulating immune responses mediated via T cells have led to therapeutic approaches targeting this inhibitory pathway for tumor immunotherapy. It is possible that combining anti-CTLA4 antibodies with a vaccine may help to direct immune responses toward target antigens, enhancing clinical efficacy and perhaps reducing treatment-related adverse effects. These theories have been tested in clinical trials in patients with advanced prostate cancer, as discussed in this Viewpoint.
Why are our patients still suffering pain?
138Legal barriers, restricted resources, lack of physician training, and physician and patient worries about potential opioid addiction can be barriers to effective and rational pain management in patients with cancer pain. Sebastiano Mercadante discusses these issues, as well as suggesting interventions for improving care.
Research Highlights
Prolonged response duration in lymphoma after rituximab maintenance therapy
140Whole-body PET–CT colonography proves accurate for colorectal cancer staging
140Allogeneic hematopoietic stem cell transplantation increases risk of secondary malignancy
140Adult survivors of pediatric cancer at high risk of developing chronic health conditions
141An ABCG2 gene variant is associated with diarrhea in gefitinib-treated patients
141Long-term efficacy of vaccination against clinically important HPV types
142High levels of C-reactive protein predict increased risks of incident cancer
142Lenalidomide active in patients with refractory or relapsed chronic lymphocytic leukemia
143Study demonstrates clinical value of basal phenotype screening in breast cancer
143COX2 expression inhibits radiation-induced apoptosis
143Preoperative chemotherapy for ovarian cancer has a negative impact
144TIMP-1 level identifies nonresponders to chemotherapy in metastatic breast cancer
144Tumor downstaging is prognostic following treatment for rectal cancer
145Practice Points
Does erlotinib improve symptoms in patients with lung cancer?
146Adjuvant therapy for pancreatic cancer: the glass is half empty
148Is the timing of chemotherapy important in patients undergoing preoperative radiotherapy for rectal cancer?
150Can tamoxifen therapy be optimized for patients with breast cancer on the basis of CYP2D6 activity assessments?
152Reviews
The chemoradiation paradigm in head and neck cancer
156In the first review of this two-part series, Seiwert and co-authors described the rationale for the use of concurrent chemoradiotherapy for treating malignancies. Here the chemoradiotherapy platforms used for the treatment of head and neck cancer are described and the integration of novel agents such as EGFR inhibitors and antiangiogenic drugs into treatment platforms alongside multiagent-based regimens are reviewed. The authors provide guidance for clinicians based on current clinical trial evidence and suggestions for choosing the most appropriate treatment platform.
doi:10.1038/ncponc0750 | Full Text | PDF (410K)
Exploitable mechanisms for combining drugs with radiation: concepts, achievements and future directions
172Combining cytotoxic drugs with radiation is aimed at improving survival without compromising quality of life. While the current trend in treating epithelial tumors favors concurrent chemoradiation, future regimens should exploit spatial cooperation and temporal modulation mechanisms to optimize the balance between treatment risks and benefits. The authors of this review propose that effective exploration of novel strategies will require a rigorous scientific and mechanistic framework to best identify and test exploitable mechanisms of drug-radiation interaction.
doi:10.1038/ncponc0744 | Full Text | PDF (277K)
Drug Insight: VEGF as a therapeutic target for breast cancer
181Schneider and Sledge discuss the mechanisms of resistance associated with anti-angiogenic agents and the problems associated with defining which groups of patients might benefit from this class of therapy. This review highlights the rationale for targeting VEGF and how the combination of anti-angiogenic drugs with other biologic agents is also being explored in clinical trials, in an attempt to improve efficacy and to overcome resistance seen with the initially studied anti-angiogenic drugs.
doi:10.1038/ncponc0740 | Full Text | PDF (256K)
Technology Insight: MammoSite®—a new device for delivering brachytherapy following breast-conserving therapy
190The MammoSite® breast brachytherapy applicator was designed to simplify the brachytherapy procedure and make it more accessible to patients who are suitable candidates for partial-breast irradiation (PBI). Dickler highlights the advantages of this technique such as low rates of serious complications and favorable cosmetic outcome and also summarizes ongoing trials that should provide a definitive answer regarding the benefits of PBI.
doi:10.1038/ncponc0739 | Full Text | PDF (229K)
Case Study
A 25-year-old woman with a gastric GIST and a PET-positive epicardial tumor
197Carney's triad is a syndrome consisting of three rare neoplasms: gastric leiomyosarcoma, extra-adrenal paraganglioma and pulmonary chondroma. The article by Kächele et al. describes the case of a young woman who presented with a gastrointestinal stromal tumor and metastatic epicardial paraganglioma. The patient underwent an extended hemigastrectomy and cardiac surgery and remained free of recurrent disease during the follow-up period. This is the first report of an epicardial paraganglioma within a Carney's triad and the authors discuss the diagnostic workup and management of patients with Carney's syndrome.
doi:10.1038/ncponc0743 | Full Text | PDF (628K)
