News & Views in 2009

Patients with extensive small-cell lung cancer who are treated with prophylactic cranial irradiation experience fewer brain metastases and prolonged survival compared with their counterparts. Slotman and colleagues have presented a detailed analysis of the effects of prophylactic cranial irradiation on health-related quality of life in these patients.

The incidence of tonsillar cancer in the UK has doubled over the past decade and the discovery of the human papillomavirus in tonsillar cancer specimens has been hypothesized to be the cause. We discuss and propose an explanation of how a reduction in tonsillectomy rates may be responsible for this increase in tonsillar cancer.

Central nervous system prophylaxis is recommended with the administration of high-dose methotrexate and/or intrathecal injection of chemotherapy in patients with anaplastic large-cell lymphoma (ALCL). Researchers investigated whether methotrexate dose, infusion duration and intrathecal mode of administration had an impact on the risk of systemic and central nervous system relapses in children with ALCL.

Brain metastases are a challenge for the oncologist, with 20–40% of cancer patients developing intracranial metastases during the course of their illness. The incidence of brain metastases is increasing as a result of improvements in systemic therapy and imaging capabilities, and increased use of screening. Brain metastases pose not only a risk to mortality but also a risk of neurologic, cognitive and emotional difficulties.

The role of laparoscopic resection for rectal cancer is currently unclear, with little supportive evidence from randomized trials. A study by Ng et al. in a large series of patients with rectal cancer has shown that laparoscopic resection is safe with good long-term outcomes.

Pelvic lymphadenectomy offers no therapeutic benefit to women diagnosed with early-stage endometrial cancer according to a new study. Lymphadenectomy can only be recommended as part of a clinical trial in this disease setting; however, it can offer valuable staging information in those with advanced disease.

The first-line treatment for patients with unresectable metastatic colorectal cancer is chemotherapy in combination with bevacizumab. Emerging evidence, however, suggests that the addition of cetuximab—an anti-EGFR monoclonal antibody—to chemotherapy might be beneficial to patients with wild-type KRAS tumors.

A study of cervical cancer screening in 52 villages in India has shown that a single round of human papillomavirus testing was linked to a significant reduction in the number of deaths from cervical cancer, compared with other screening methods. This has implications for primary screening in low-resource settings.

The use of autologous stem-cell transplantation in the treatment of follicular lymphoma remains controversial. Results from the GOELAMS trial show a higher progression-free survival rate in patients treated with autologous stem-cell transplantation compared to those treated with chemotherapy.

Targeted therapies offer new hope in overcoming the challenges encountered with conventional chemotherapy. However, little is known about the precise mechanisms that cause resistance. These issues are discussed in light of data from the BRiTE study, which indicate that the antiangiogenic effects of bevacizumab might persist despite the development of resistance to first-line chemotherapy.

A randomized phase III trial evaluated the effect of adding lapatinib to paclitaxel as first-line therapy for patients with metastatic breast cancer whose tumors were negative or untested for human epidermal growth factor receptor 2 (HER2) overexpression. Progression-free survival was prolonged significantly in patients with HER2-overexpressing tumors, which indicates that lapatinib exerts its main effects via the HER2 pathway.

Mathis et al. aimed to determine the effect of multimodality therapy on recurrence and survival in patients with locally advanced colorectal cancer. Use of multimodality treatment led to excellent local control with five year disease-free and overall survival rates comparable to that of stage-matched resectable colorectal cancers.

The association of a treatment-related adverse effect with treatment success has been reported in various clinical situations. The development of vasomotor or joint symptoms is an indication of therapeutic benefit in women receiving endocrine treatment for hormone-receptor-positive breast cancer.

Treatment interruptions during radiotherapy may have a negative effect on patient outcome. D'Ambrosio et al. demonstrated that prolonging treatment duration has an adverse effect in low-risk patients with prostate cancer. Thus, limiting or modifying the overall elapsed time between treatments is necessary.

On the basis of the results of KRAS analysis from the CO.17 randomized, controlled, phase III study by Karapetis et al., KRAS mutations have emerged as a valid predictive marker associated with resistance to cetuximab and lack of survival benefit from this anti-EGFR antibody in patients with chemoresistant colorectal cancer.

Haller et al. demonstrated that irinotecan plus oxaliplatin (IROX) is more efficacious than irinotecan alone after fluoropyrimidine failure in advanced colorectal cancer. IROX does not change, but enriches the treatment algorithm of advanced colorectal cancer at the second-line level.

Rini and colleagues provide additional data on bevacizumab and interferon-α in clear-cell carcinoma of the kidney; a comparison of these results with the findings from contemporary trials suggests that bevacizumab and interferon-α is another clinically useful treatment option for patients with metastatic renal-cell carcinoma.

Preclinical studies have shown that new agents such as bortezomib not only demonstrate anti-multiple-myeloma activity as single agents but also enhance the efficacy of both chemotherapy and steroids. A randomized trial has established that bortezomib not only improves response rates but also prolongs the lives of patients with multiple myeloma who are not candidates for high-dose chemotherapy.

The disappointing results of the large, randomized, controlled trials showing no benefit of vaccines in patients with advanced and metastatic melanoma call for a reassessment of the development of therapeutic vaccines and the importance of better immune monitoring methodology, such as adoptive T-cell therapy with lymphodepletion.

In the movement towards individualized treatment regimens, Rothenberg et al. validate XELOX as another available systemic therapy for patients being treated with second-line treatment for metastatic colorectal cancer. This paper adds to a growing body of data in the first-line and second-line setting that confirms the noninferiority of oral fluoropyrimidine-containing regimens.