News & Views in 2009

Although imatinib mesylate therapy has dramatically improved the prognosis of patients in the advanced phases of chronic myeloid leukemia, room for improvement remains. Tyrosine kinase inhibitors are undergoing evaluation as second-line therapy for patients with imatinib-resistant disease. Kantarjian et al. recently demonstrated that once-daily dasatinib 140 mg is well tolerated and achieves a high response rate.

Sunitinib is a standard first-line therapy for patients with advanced or metastatic clear-cell renal cell carcinoma. In an expanded-access study, sunitinib has demonstrated clinical benefit with an acceptable safety profile in a population of patients that is representative of those seen in clinical practice.

Jørgensen and Gøtzsche quantified the degree of overdiagnosis of breast cancer in five publicly organized mammography screening programs in different parts of the world. Overall, they estimated a total degree of breast cancer (including carcinoma in situ) overdiagnosis of 52%, while overdiagnosis for invasive breast cancer was 35%, a finding with potential implications for both clinical practice and public health.

Bortezomib-based regimens are beneficial in the treatment of patients with symptomatic, newly diagnosed and relapsed or refractory multiple myeloma. Researchers who investigated the efficacy and safety of single-agent bortezomib as first-line therapy in patients with myeloma have particularly emphasized the incidence and management of peripheral neuropathy, which is the most common adverse effect of bortezomib administration.

Pooled analyses from the Adjuvant Treatment of Colon Cancer trial suggest that most patients with stage III colon cancer develop recurrence within the first 3 years following treatment. Improved disease-free survival and improved overall survival were observed for such patients who were treated with adjuvant combination therapy of 5-fluorouracil, leucovorin and oxaliplatin versus those treated with 5-fluorouracil and leucovorin.

The monoclonal antibody, rituximab, is used to treat lymphomas. This article discusses the results of randomized trials that suggest patients with follicular lymphoma should not receive rituximab maintenance therapy.

Maintenance therapy aims to sustain a state of ongoing disease remission. This article discusses the results of randomized trials that suggest that specific subgroups of patients with follicular lymphoma should receive maintenance therapy with rituximab.

Imaging is performed in patients with early stage non-small-cell lung cancer (NSCLC) for disease staging and to identify the patients most likely to benefit from surgery. Two recent randomized trials compared conventional staging plus PET with conventional staging alone in patients with NSCLC. Patients who underwent PET were more likely to avoid futile thoracic surgery.

Thalidomide is frequently used in patients with newly diagnosed and relapsed multiple myeloma, but its role as maintenance therapy following autologous stem-cell transplantation has been an area of uncertainty. In this article we consider the efficacy of thalidomide maintenance therapy in multiple myeloma.

The results of a large, randomized, North American trial (SWOG S0124) that compared etoposide and cisplatin with irinotecan and cisplatin for patients with extensive small-cell lung cancer have failed to confirm the benefit observed with irinotecan that was demonstrated in an earlier Japan Clinical Oncology Group study (JCOG 9511).

Xerostomia and reduced quality of life are common occurrences in patients treated with radiation to the salivary gland for head and neck squamous-cell carcinoma. This article discusses outcomes after intensity-modulated radiation therapy and three-dimensional conventional radiotherapy among patients with head and neck squamous-cell carcinoma.

Second-line irinotecan regimens are efficacious in patients with advanced colorectal cancer who experience disease progression on first-line oxaliplatin-based chemotherapy. Bidard et al. investigated the impact of treatment with dose-dense irinotecan on improving survival in such patients and aimed to optimize the irinotecan combination chemotherapy platform.

A prospective, randomized trial has shown that standard adjuvant chemotherapy is superior to capecitabine in the treatment of women with breast cancer aged 65 years or older; on the basis of the results of this study, capecitabine cannot be recommended in this setting.

Meier and coauthors found that topotecan improved progression-free and overall survival compared with treosulfan in patients with recurrent ovarian cancer following platinum and taxane-based therapy. Although these results are promising, the optimum treatment strategy for patients with recurrent ovarian cancer still remains to be determined.

Peptide vaccines to PRI, WT1, and BCR-ABL have shown promising results in early trials of patients with leukemia. We discuss vaccine strategies that have been developed against leukemia, and the potential of a vaccine and stem-cell transplant combination for the cure of patients with leukemia.

In the past, myelodysplastic syndromes were managed primarily by supportive care measures, which had limited effects on symptomatic cytopenias or on the rate of leukemic transformation of these disorders. A new study reports that administration of the hypomethylation agent azacitidine significantly increases overall survival in patients with high-risk myelodysplastic syndromes compared with conventional care.

Targeting EGFR in patients with non-small-cell lung cancer (NSCLC) in addition to chemotherapy might provide survival benefits in patients with EGFR-positive tumors. Indeed, results from the FLEX trial demonstrate that cetuximab in combination with platinum-based chemotherapy is a new treatment strategy for patients with advanced NSCLC.

Sorafenib is the standard treatment for patients with advanced hepatocellular carcinoma who are not eligible for locoregional therapy. Although significant improvement in overall survival has been demonstrated in patients with Child-Pugh A cirrhosis, information is lacking on the benefits, if any, in patients with compromised liver function and Child-Pugh B or C cirrhosis.

Erythropoiesis-stimulating agents are widely used in patients with cancer; however, uncertainty persists over their effect on survival. This article discusses the results of a meta-analysis of randomized, controlled trials of these agents in patients with cancer.

Imatinib is known to be effective in the first-line treatment of metastatic gastrointestinal stromal tumors. A randomized, placebo-controlled trial has now shown that imatinib is safe and improves recurrence-free survival when used as adjuvant therapy after surgical resection of a primary gastrointestinal stromal tumor.