Volume 12 Issue 3, March 2015

Debate continues regarding the benefit of primary tumour resection for patients with asymptomatic metastatic colorectal cancer; the largest observational study conducted to date has demonstrated prolonged survival, but was probably subject to biases, and data from previous meta-analyses of observational data are contradictory. The results of two ongoing randomized trials are eagerly awaited. In the meantime, treatment should be directed at symptom palliation.

Current guidelines recommend up to 5 years of follow-up assessment for patients with localized renal cell carcinoma treated by nephrectomy; however, the recommendations are supported only by low-level evidence, and a recent study suggests considerably prolonged follow up is needed. Thus, approaches to follow-up imaging assessments and their actual benefit on disease outcome require further clarification.

Modern genomics technologies enable the identification of genetic alterations, even those present at a low frequency, and can contribute to unveiling the mechanistic rationale behind the unexpected clinical response of 'exceptional responders'. This approach will drive the identification of molecular biomarkers that can be integrated into clinical trials and predict response to a specific therapy.

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.

Locally advanced breast cancer (LABC) constitutes a heterogeneous entity that includes advanced-stage primary tumours, cancers with extensive nodal involvement and inflammatory breast carcinomas—inoperable cancers with an unfavourable prognosis. The optimal management of LABC requires a multidisciplinary approach consisting of a well-coordinated treatment schedule and close cooperation between medical, surgical and radiation oncologists. In this Review, the authors discuss the current state of the art and possible future treatment strategies for patients with LABC.

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.

The use of image-guided ablation techniques—including radiofrequency and microwave ablation, cryoablation, and irreversible electroporation—is increasing, predominantly in the treatment of small hepatic and renal tumours (<5 cm). This Review describes the technical considerations for the various ablation modalities. In addition, the authors review the evidence that supports the clinical application of these minimally invasive techniques for the treatment of liver and kidney cancers, and discuss their potential as the standard-of-care first-line treatment, particularly for small, early stage tumours.