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Bone is the most common site of breast cancer metastasis, resulting in substantial morbidity and mortality. A number of therapies are being developed, including bisphosphonates, which target factors that promote tumor growth in bone. The authors of this Review outline the underlying mechanisms that drive this pathological process, and highlight potential molecular targets that will improve therapeutic interventions for metastatic breast cancer. Tools that assess response in individual patients and guide appropriate treatment are also discussed.
Cancer treatment in young women can lead to reduced fertility—a serious issue for patients who wish to have children. In this Perspectives, Letourneau and coauthors highlight the importance of making sure that oncologists and fertility teams are aware of this issue and work together to educate patients of the risks involved. Furthermore, options for fertility preservation are discussed.
This Review focuses on the adverse effects of radical radiotherapy for localized prostate cancer. The authors discuss the methodological issues that make comparison between the different treatment modalities problematic, and describe the pattern of adverse effects that occur over time after radiotherapy. Recent technical advances, such as intensity modulation and image guidance, will hopefully further improve the toxicity profile of prostate radiotherapy.
Two seemingly contradictory methods of practicing medicine, evidence-based medicine and personalized medicine are examined with respect to PET imaging in this Perspective. The improvement that PET imaging provides for patient management in both hematologic and solid malignancies is discussed. The tailoring of therapeutic strategy by molecular imaging, with PET at its forefront, enables disease management at the individual level and strengthens the evidence-based approach in oncology.
Inhibitors of poly(ADP-ribose)polymerase (PARP) have shown promise as therapeutic agents for the treatment of ovarian cancers with mutations inBRCA1 or BRCA2. By exploiting the synthetic lethal interaction that exists between PARP inhibition and BRCA mutations, these agents specifically kill cancer cells by targeting their DNA repair system. The authors of this Review describe the importance of BRCAmutations for the efficacy of PARP inhibitors. They also discuss the preclinical and clinical trial results of PARP inhibitors, the challenges related to the use of these agents, and future directions.
Antiangiogenic therapy inhibits tumor growth by targeting the blood vessels of the tumor. Antiangiogenic therapy often correlates with longer survival in patients without affecting tumor growth. This positive response may be due to the off-tumor target effects of antiangiogenic drugs. In this article, Yihai Cao describes the potential mechanisms underlying the benefits of targeting off-tumor sites, and how these events improve outcomes in patients with cancer-associated systemic syndromes.
This Review discusses the advantages and disadvantages of weekly paclitaxel for the treatment of relapsed ovarian cancer. When compared with the 3 weekly schedule, weekly paclitaxel is better tolerated, with a reduced frequency of toxic effects; however, response duration can be short. Importantly, patients with tumors that are resistant to 3-weekly paclitaxel have responded to treatment with weekly paclitaxel. Current research focuses to increase response duration include the combination of weekly paclitaxel with molecular-targeted agents and the use of molecular profiling to better select patients for treatment.
Ongoing investigation into the use of thalidomide in the treatment of multiple myeloma has demonstrated efficacy as a combination treatment during induction and as maintenance therapy. Thalidomide–doxorubicin–dexamethasone combination therapy improved response rate; however, the development of drug resistance remains a concern.
The optimum approach for the treatment of rare anaplastic gliomas following surgical resection is uncertain. A recent study has now provided a greater understanding of the heterogeneous tumor biology of these tumors and has emphasized the prognostic importance of chromosome 1p19q deletion, IDH mutation and MGMT promoter methylation. The importance of radiotherapy and chemotherapy for treating these heterogeneous tumors is being elucidated for subgroups of patients.
