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In the era of personalized, systems-driven medicine, computational orin silicomodeling and the simulation of disease processes is becoming increasingly important for hypothesis generation and data integration in both experiments and clinics alike. The authors of this Review discuss selected studies on modeling malignant brain tumors and the implications for clinical practice, including trial design and outcome prediction.
Although the precise mechanisms by which histone deacetylase inhibitors exert their antitumor activity is not known, certain tumor types undergo a favorable response and consequently several agents have now entered clinical trials. Khan and La Thangue discuss recent developments in our understanding of the molecular events that underlie the anticancer effects of histone deacetylase inhibitors and relate this information to the emerging clinical picture for cutaneous T-cell lymphoma and related malignancies.
Precancerous lesions of the breast have become a considerable clinical problem. It is not always possible to identify which of these lesions will progress to invasive carcinoma, and tailoring the treatment according to each individual case remains a challenge. This Review describes the genetic alterations in these types of lesions, the importance of histological examination for diagnosis, and the most appropriate surgical and radiotherapy management options.
Patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck have a poor prognosis. Cetuximab represents a clinically relevant advance in the treatment of recurrent and metastatic disease. This rationale for cetuximab as monotherapy and its use in combination with platinum-based chemotherapy for recurrent and/or metastatic disease in the first-line setting is discussed.
There have been considerable advances in external-beam delivery and brachytherapy techniques for prostate cancer. Combined-modality therapy with external-beam radiotherapy and brachytherapy is an attractive treatment option for a selected group of patients with clinically localized prostate cancer. Hurwitz discusses the indications for use of combination therapy, choice of low-dose-rate versus high-dose-rate brachytherapy boost, and toxicity and quality of life issues.
The combination of dyspnea, exercise limitation and muscle weakness is known as cancer fatigue syndrome. Dyspnea is an important symptom in patients with cancer and also in patients with chronic heart failure. The authors of this Viewpoint hypothesize that cancer fatigue syndrome represents clinically non-overt heart failure, and postulate that cardiac-like symptoms in cancer develop in a similar manner to symptoms of chronic heart failure.
The treatment options for patients with chemoresistant diffuse large B-cell lymphoma are limited. Fenske et al. describe the case of a 41-year-old man with chemorefractory lymphoma, who was treated with yttrium-90 microsphere embolization of his hepatic tumors. The patient's lymphoma progressed and he died, but there was no evidence of recurrence in the liver. The authors discuss yttrium-90 microsphere embolization for patients who have chemoresistant lymphoma with involvement of the liver.
Cardiovascular disease in patients with cancer and cardiac complications of cancer therapy is an increasing clinical problem. Optimum management of cardiovascular disease can allow patients with cancer to successfully receive cancer therapies and it can reduce morbidity and mortality caused by cardiovascular disease in cancer survivors. The authors of this review discuss management strategies for cardiovascular disease in patients with cancer, focusing on the prevention and treatment of congestive heart failure and myocardial infarction.
Five adjuvant breast cancer trials have clearly demonstrated the benefit of trastuzumab in reducing the recurrence rate and mortality in patients with aggressive HER2-positive disease. The controversies and challenges relating to the use of trastuzumab in the adjuvant setting, such as the optimal timing and duration, its use with taxanes and radiotherapy, its role in small node-negative tumors and cost-effectiveness are discussed.