Volume 12 Issue 6, June 2015

Investigational metronomic chemotherapy involves frequent, regularly spaced, long-term administration of a sub-maximum tolerated dose. The phase III CAIRO3 trial evaluated continuous metronomic oral capecitabine, with bevacizumab, as a maintenance treatment in patients with metastatic colorectal cancer; a benefit in progression-free survival compared with observation only was observed, highlighting that metronomic chemotherapy could be a less toxic and convenient therapy.

In patients with oesophageal cancer, the effect of lymphadenectomy on survival remains unclear. A recent retrospective cohort study suggests that extensive lymphadenectomy does not improve survival and might even hamper it in patients with early T-stage tumours. The available data show conflicting results and the introduction of neoadjuvant chemoradiotherapy might decrease any positive effect of extensive lymphadenectomy on survival.

In the recent MAINSAIL trial, addition of lenalidomide to docetaxel for metastatic castration-resistant prostate cancer (mCRPC) was associated with inferior overall survival and more toxicity; thus, lenalidomide joins a long line of agents that failed to improve the efficacy of docetaxel. The process by which new therapies are advanced to phase III studies, particularly in combination with docetaxel, should be re-examined.

The survival rates of patients with pancreatic cancer are low and have not improved significantly over the past three or four decades. Thus, effective treatments for this disease are an urgent unmet need. Novel treatment paradigms will probably be required, and many new therapeutic approaches are being tested in this setting. This Review outlines the state-of-the-art therapies for patients with pancreatic cancer, as well as the novel treatment strategies that are the focus of drug-development efforts.

Although neoadjuvant chemotherapy (NACT) does not prolong survival compared with adjuvant chemotherapy, this approach does not increase the risk of locoregional recurrence, and the high rates of response following NACT have had a considerable impact on locoregional treatment considerations. In particular, NACT can decrease the need for mastectomy and axillary lymph-node dissection. This Review discusses issues relating to the identification of ideal candidates for NACT, and also those surrounding surgery of the breast and axilla in women with breast cancer who receive NACT.

The development and implementation of more effective genome analysis technologies has enabled substantial improvements in our understanding of the genomic changes that take place in patients with acute lymphoblastic leukaemia (ALL). This Review provides a detailed summary of advances in our understanding of the genomics of ALL, and describes how these advances might lead to improved patient outcomes.

Patient-reported outcome (PRO) measures, such as quality of life, have been associated with relevant clinical end points and are prognostic for survival outcomes in a variety of solid cancers in adults. The authors of this Review comprehensively assess the correlation of PROs with treatment response and survival, and explore tumour-related and patient-centric composite end points in patients with cancer participating in clinical trials.