Volume 12 Issue 9, September 2015

Risk-reducing salpingo-oophorectomy (RRSO) is a standard intervention in BRCA1 or BRCA2 mutation carriers owing to its associated reduction in mortality related to ovarian and breast cancer. A study has now reported a beneficial impact of adjuvant RRSO in patients with BRCA1 mutations and breast cancer. However, various biases confound these results.

An analysis of reports from phase III trials (published between 2011 and 2013) investigating patients with solid tumours found widespread failings in both the conduct and reporting of subgroup analyses. Readers might well be misled by such analyses. Editors should, therefore, implement policies to reduce the risk of publishing misleading results.

Taxane-based regimens are among the preferred first-line chemotherapy options for metastatic breast cancer, with weekly paclitaxel considered equivalent to 3-weekly docetaxel. The CALGB 40502/NCCTG N063H (Alliance) trial has now compared bevacizumab plus weekly paclitaxel, nab-paclitaxel, or ixabepilone in this setting; ixabepilone was inferior and nab-paclitaxel was not superior, with a trend towards inferiority. Paclitaxel thus remains the standard-of-care taxane chemotherapy.

The recognition of non-small-cell lung cancer (NSCLC) as a heterogeneous disease and ongoing efforts to characterize disease subtypes based on genotype and histology have resulted in dramatic improvements in outcomes for select patient subgroups. However, many challenges remain, not least acquired therapeutic resistance and the related issue of how to best use the available therapies. In this Review, the authors provide an overview of the key developments in NSCLC therapy, describe efforts to tackle therapeutic resistance, and discuss potential strategies to further optimize patient outcomes by stratifying treatments according to particular disease subtypes.

Although dramatic changes in the delivery of radiation therapy have occurred, the impact of radiobiology on the clinic has been far less substantial. New advances are uncovering some of the mechanistic processes that underlie the differences between the tumour and host tissue characteristics. The authors of this Review focus on how these processes might be targeted to improve the outcome of radiotherapy for patients.

Hormone-receptor-positive breast cancer accounts for the majority of all breast cancers. The evolution of this disease from early stage to the metastatic setting leads to increased heterogeneity and the development of treatment resistance representing a great challenge for management decisions. In this Review, we examine the current evidence that can guide treatment decisions in patients with advanced-stage ER+ breast cancer, discuss how to tackle these therapeutic challenges and provide suggestions for the optimal management of this patient population.

Predictive biomarkers are invaluable for successful and cost-effective treatment of cancer, however, biomarker discovery is difficult and requires multiple independent studies to identify suitable predictors of efficacy. Clinical trials performed in the USA, Europe or Asia can offer unique opportunities for biomarker discovery and validation. In this Perspectives, the authors describe the current fragmented approach to biomarker discovery and validation, highlighting how collaborative engagement of the academic, regulatory and pharmaceutical communities can help address these issues.