Volume 12 Issue 1, January 2015

Although radiotherapy is a key component of cancer treatment, provision of this modality is not immune to limits placed on health-care expenditure. Recent studies suggest European radiation oncology resources will generally be insufficient to meet future, and in some cases current, needs. This challenge and how it might be addressed is discussed herein.

The RAINBOW study has demonstrated that ramucirumab plus paclitaxel as second-line treatment for advanced-stage gastric cancer prolongs survival compared with paclitaxel alone. These data confirm that ramucirumab represents a new effective treatment option for gastric cancer. Nevertheless, new treatment options remain eagerly awaited in this disease with dismal outcomes.

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 molecular characteristics and clinical outcomes of head and neck cancer vary widely. In this Review, the authors focus on established and emerging biomarkers that are most relevant to nasopharyngeal carcinoma and head and neck squamous-cell carcinoma (HNSCC). Applications and limitations of currently established biomarkers are discussed, and ongoing efforts to shift from prognostic to predictive biomarker development with the goal of delivering individualized cancer therapy is highlighted.

Advancement of an investigational therapy into the adjuvant and/or neoadjuvant settings without clear evidence of efficacy in metastatic disease is exceptional; however, this course is being followed in the clinical investigation of poly(ADP-ribose) polymerase (PARP) inhibitors, owing to their potential benefit for a well-defined subset of patients with tumours defective in homologous recombination. This Review provides a bench-to-bedside overview of PARP inhibitor therapy, and an update on the current status of the clinical development of such agents.

Recent developments in the treatment of multiple myeloma have led to improvements in response rates and to increased survival; however, relapse is inevitable in almost all patients. Currently, there is no standard treatment for patients with relapsed and/or refractory disease. This Review discusses the current treatment landscape for patients with relapsed and/or refractory multiple myeloma and highlights disease-related and patient-related factors that are important considerations for clinicians when selecting an appropriate treatment.

Although most patients with breast cancer have clinically negative axillary nodes at preoperative assessment, 15–20% of these women will have metastatic disease within the lymph nodes at operative sentinel node biopsy. The authors discuss the evidence base for management of the axilla after detection of a positive sentinel node, discuss why micrometastatic disease requires systemic but not axillary therapy, and describe data indicating that axillary irradiation gives equivalent control to axillary node clearance, with less morbidity.