News & Views in 2011

One year of adjuvant trastuzumab, preferentially given upfront with a taxane as part of an anthracycline–taxane containing chemotherapy, is currently considered standard therapy for treating early-stage breast cancer. The long-awaited full publication of the BCIRG-006 trial now establishes the TCH (docetaxel, carboplatin, trastuzumab) regimen as an additional option with a distinct safety profile.boxed-text

A recent study of 843 patients from three hospitals that compared the assessment of HER2 status using FDA-approved immunohistochemistry and fluorescence in situ hybridization assays versus a quantitative reverse transcription PCR (qRT-PCR) assay by Oncotype DX^®, showed a high false negative rate for the qRT-PCR assay.

A new phase III study shows superior efficacy of fludarabine plus alemtuzumab combination therapy over fludarabine alone in the treatment of relapsed or refractory chronic lymphocytic leukemia (CLL). However, the study has limitations and the findings can not be generalized to the majority of patients with CLL.

The ECOG E4201 study adds another piece of information to a growing body of evidence pointing strongly to the importance of local control and the role of radiotherapy in unresectable pancreatic cancer. Based on this evidence, we believe radiotherapy should be used routinely in this setting.boxed-text

Screening for prostate cancer using PSA is a careful balance of benefits and harms. But current US practice involves testing older men who have little to gain and aggressively treating low-risk cancers. Debates about whether to test need to be replaced by debates on how to test better.

The AZURE trial data add to the uncertainty of whether adjuvant bisphophonates are a valuable addition to the armamentarium in the treatment of early stage breast cancer. Although the overall trial results were negative, a prespecified subgroup analysis demonstrated a 25% reduction in the risk of relapse and death in postmenopausal patients.

In a trial in patients with metastatic breast cancer, the prognostic value of the number of circulating tumor cells (CTCs) at baseline was independent of tumor subtype, except in patients with HER2-positive disease treated with anti-HER2 targeted therapy. These data support the use of CTC detection as a tool contributing to personalized medicine.

The Cancer Act that was signed by President Nixon in December 1971 had a mandate “to support research and the application of the results of research, to reduce the incidence, morbidity and mortality from cancer.” It has succeeded in many of these aims, as this personal account testifies.

The optimal treatment for patients with advanced-stage Hodgkin lymphoma is an ongoing controversy. A recent trial seemed to answer some of the important open questions in the field; however, closer examination of the data indicates that the answers are not as clear as they might initially seem.

From 1989 to 2003, 709 phase III trials evaluating systemic cancer treatment were presented at ASCO meetings. Tam and collaborators have now reported that 9% of these trials were never published, and 13% were published after a 5-year delay. More than half of these studies would have had clinical impact if published promptly.

Elderly patients have often been excluded from, or under represented in, clinical trials. Now, a phase III trial has demonstrated that a platinum-based doublet regimen provides superior outcomes in elderly patients with advanced-stage non-small-cell lung cancer, and should be considered for palliative chemotherapy in this group of patients.

A retrospective study of Medicare patients over 65 years of age with stage II colon cancer, showed that adjuvant chemotherapy did not improve overall survival, even in patients with poor prognostic factors. But, does this mean that these patients should not be offered this treatment option?boxed-text

In a recent randomized trial, electromotive intravesical administration of mitomycin before transurethral resection was shown to be effective in the prevention of bladder cancer recurrence. Although this treatment seems to be promising, one question remains: can these results be reproduced by other research groups? If this is the case, it could become a new standard.

Cancer medicine frequently balances probability of cure against morbidity of treatment. A recent trial in patients with Hodgkin lymphoma compared two regimens of different intensity and toxicity and examined not only the immediate results, but also the broader algorithm of care, factoring in the effects of salvage treatment and high-dose therapy.

Large randomized phase III trials conducted in patients with non-small-cell lung cancer (NSCLC) harboring activating mutations in EGFR have demonstrated that erlotinib or gefitinib are superior to platinum-based chemotherapy. Zhou et al. have now confirmed that these agents represent the best treatment we can offer today as front-line therapy for EGFR-mutant NSCLC.boxed-text

A recent trial randomly allocated 1,979 men with localized prostate cancer to radiation therapy with or without neoadjuvant androgen deprivation. Despite the combination reducing prostate cancer-specific mortality by approximately 60% and producing a modest overall survival benefit in men with intermediate-risk cancers, the authors did not recommend changing the standard of care—why?

Abiraterone plus prednisone prolongs overall survival relative to prednisone alone in patients with metastatic castration-resistant prostate cancer who have disease progression after treatment with docetaxel. The survival gain observed in this pivotal trial is accomplished with few adverse events and conclusively demonstrates that patients with castration levels of serum testosterone remain sensitive to additional hormonal manipulation.

Three recent population studies have translated laboratory investigations into a clinical setting and concur in presenting evidence that suggest a dramatic new role for β-blockers in reducing metastases, tumor recurrence and specific mortality in breast cancer. Should we be skeptical about these controversial findings?

Recently published phase III trials involving interleukin-2, ipilimumab and vemurafenib redefine 'standard-of-care' for metastatic melanoma and demonstrate improved survival compared with dacarbazine. All three therapies are potential first-line options for patients with metastatic melanoma, with optimal treatment strategies evolving based on tumor mutation status, disease burden, performance status and comorbidities.

For many patients with invasive bladder cancer, regional or systemic metastases are present at the time of presentation. Owing to the risk of micrometastatic disease, preoperative neoadjuvant cisplatin-based chemotherapy before radical cystectomy or radiation has been assessed and shown to provide a survival advantage.