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In 2014, developments in our understanding of escape signalling circuits implicated in resistance to targeted agents in patients with lung cancer have led to improvements in tackling such resistance. The potential role for PET in the management of erlotinib therapy, novel combination therapies and pharmacogenomic-driven individualization of platinum-based chemotherapy represent other key advances.
The classical end points—overall survival, progression-free survival, and response rate—used in cancer clinical trials have important limitations that not only increase the cost and duration of the drug development process, but can also confound establishment of a statistically significant clinical benefit. This Review discusses these issues, and highlights the urgent need for biomarker-based end points, focusing on those that are under investigations in lung cancer, that closely correlate with disease outcomes and that, therefore, hold promise as surrogates for traditional clinical end points.
In 2014, strides were made in the care of haematological malignancies. In particular, the heterogeneity of multiple myeloma was unravelled, and new diagnostic criteria and frontline standards of care were proposed; new therapeutic approaches have been validated and approved in chronic lymphocytic leukaemia; and in chronic myeloid leukaemia, complete cytogenetic response was confirmed as the primary therapeutic end point.
The use of umbilical cord blood (UCB) as source of haematopoietic cell is becoming a mainstay treatment for several diseases. Its principal limitation is the low number of haematopoietic stem and progenitor cells (HSPC), which leads to prolonged engraftment times. The two main approaches to improve UCB engraftment have been to expand HSPCex vivobefore transplantation, or to augment HSPC homing. This Review focuses on approaches and clinical trials aimed at realizing these strategies.
Interventional oncology aims to develop new disease-modifying treatment options beyond conventional surgical and oncological therapies. Clinical investigators should incorporate measures of cost-effectiveness and patient-reported outcomes into large-scale studies to provide robust evidence for changing clinical practice. In particular, interventional oncology trials could be designed to show that certain treatments might be as effective as the current standard of care, but with less morbidity and better outcomes for patients with cancer.
With no large randomized phase III trials to provide definitive answers, the ideal number of platinum-based chemotherapy cycles in patients with advanced non-small-cell lung cancer has long been unclear. Most guidelines recommend a maximum of 4–6 cycles. Rossi and colleagues now suggest that four chemotherapy cycles is the optimal regimen.
The new discipline of interventional oncology, a branch of interventional radiology, involves the treatment of cancer using highly technological image-guided ablation modalities, such as laser, radiofrequency and microwave ablation, cryoablation and electroporation. The roles of these techniques in oncology are not firmly established, although the evidence base is increasing. In this Review, the relationships between interventional radiology and other oncological disciplines are discussed. In particular, the potential benefit of collaboration between the fields of interventional oncology and radiation oncology is highlighted.
