Volume 10 Issue 8, August 2013

As we learn more about the biology of cancer, we may be able to apply prognostic biomarkers to select patients at high risk or low risk of disease recurrence or progression. This will allow a priori stratification of patients in clinical trials and will help to tailor treatment to patients.

A randomized trial compared prophylactic platelet transfusion with transfusion given when bleeding occurred. Decreased platelet usage was noted in the therapeutic transfusion group with a very low incidence of significant bleeding in recipients of autologous transplants. This finding indicates that a 'no-prophylaxis' approach is acceptable in such patients. However, prophylactic platelet transfusion should continue to be the standard in leukaemia patients receiving induction chemotherapy.

The marriage of medicinal chemistry, molecular biology and medicine is perhaps best exemplified by the evolution of selective oestrogen-receptor modulators (SERMs). Translational studies might be useful for predicting the myriad clinical responses to SERMs, contributing to improvements in women's health.

Well-documented biorepositories are essential for cancer research. Currently, major biobanks are located in the developed world, which represents the minority global population; however, countries with low-resource settings contribute more than 50% of the global cancer burden. Therefore, there is an urgent need to establish next-generation biorepositories in developing countries.

Insights into tumour biology require biospecimens from the primary tumour and those that reflect the patient's disease in specific contexts. Tumour samples must be representative, viable, and adequate both in quantity and quality for subsequent molecular applications. This Review article outlines the existing procedures for sample procurement and processing of next-generation biospecimens, and highlights the issues involved in this endeavour.

Evidence indicates that reductions in recommended doses of chemotherapy often occur among obese patients with cancer. ASCO guidelines recommend that chemotherapy dosing in obese patients should be calculated based on actual weight, rather than the current practice based on estimation of body surface area. In this Review, chemotherapy dosing in this population is discussed along with how future research could lead to a more-personalized approach.

Definition of complete remission in patients with acute myeloid leukaemia (AML) represents a highly heterogeneous state associated with diverse clinical outcomes. The use of minimal residual disease (MRD) as a response criterion allows efficacy assessment of AML therapy. The authors review the characteristics and challenges of the modalities used to detect MRD and outline opportunities to improve clinical use of MRD measurements.

As heterogeneity increasingly needs to be taken into account in the treatment of solid tumours, methods to detect genetic variation have come to the fore. One method that might have considerable clinical utility is the detection of variations in circulating-free DNA. This Review outlines the possibilities and challenges that this technique offers in terms of predictive and prognostic markers, as well as in the detection of therapy resistance.