Volume 12 Issue 2, February 2015

In 2014, no major breakthroughs were made in understanding the biology of breast cancer or its management; few novel practice-changing studies were presented or published. Nevertheless, important negative results from studies that challenge some of the current concepts, particularly in drug development, underline 2014 as a year of 'failed surrogates and precocious expectations'.

Heterogeneity within and across tumours is increasingly recognized as a critical factor that limits therapeutic progress for many cancers. Key studies reported in 2014 describe previously unappreciated patterns of geographical and temporal heterogeneity for glioblastoma (the most-common primary CNS tumour in adults), with important implications for ongoing therapeutic studies evaluating molecular targeted therapies.

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 results of several clinical trials in metastatic colorectal cancer presented in 2014 will influence clinical practice. These findings include definitive data from phase III trials comparing bevacizumab and cetuximab-based therapy in the first-line, studies elucidating the value of maintenance therapy after induction treatment, and data on new agents in this disease.

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.

Delirium is a common neurocognitive manifestation in patients with cancer, particularly at advanced stages of the disease, and represents a considerable challenge for the patients, their families as well as health-care professionals involved in their care. This Review provides a comprehensive overview of the diagnosis, assessment, pathogenesis and management of delirium. The experiential impacts of delirium on patients with the condition, their family members and health-care practitioners are also discussed.

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.

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.

Surgery is the oldest oncological discipline and remains the cornerstone of treatment for most patients with cancer. However, the way surgery is used to treat cancer has evolved and outcomes continue to improve as a result of greater biological understanding, relentless technical innovation and a paradigm shift towards multimodal treatment. In this Perspectives, the authors discuss the developments in cancer surgery that have occurred over time and provide an overview of the key uses of surgery in the current era of multidisciplinary cancer care.