Volume 13 Issue 11, November 2016

A theoretical radiobiological rationale supports the use of hypofractionated radiotherapy (higher radiation doses per fraction over a shorter period of time compared with conventional fractionation) for the treatment of prostate cancer. The investigators of two recently published phase III clinical trials with different designs have come to opposing conclusions regarding whether hypofractionated radiotherapy should be considered a new standard of care.

Eaton et al. report a very strong association between institutional clinical trial accrual volume and the survival of patients with stage III NSCLC. The observed volume effect might have been exaggerated by artefact. More work is required to quantify the volume effect and understand its causes, before rushing to centralize care.

In a paper published recently in Cell, Guarnerio et al. suggest that circular RNAs derived from cancer-associated chromosomal translocations have an oncogenic role; however, the experimental approach that the authors used was inadequate to generate sufficient evidence to prove this role, calling their study into question.

Metronomic chemotherapy regimens were developed to optimize the antitumour efficacy of antiangiogenic agents and to reduce toxicity of antineoplastic drugs, but the effectiveness of this approach also relies on other mechanisms, such as the stimulation of the immune system. Investigating the pharmacokinetic and pharmacodynamic properties of agents administered in metronomic regimens will enable a more-personalized therapeutic approach. Herein, Bocci and Kerbel discuss results from early phase and pilot clinical studies that support the important link between pharmacokinetics and metronomic chemotherapy.

Triple-negative breast cancer has a poor outcome compared with other breast cancer subgroups, and chemotherapy is the primary treatment for this disease. 'Omics' technologies have revealed high levels of heterogeneity and helped to identify potentially actionable molecular features in some triple-negative breast cancer subtypes. Proof-of-principle studies suggest a potential benefit from immunotherapy in patients with this disease. Herein, Bianchini et al. discuss the most promising therapeutic opportunities for triple-negative breast cancer.

Contrary to other cancer types, histopathology remains the mainstay of diagnosis and classification of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). Increasing knowledge of the molecular genetics and biology of GEP-NENs promises to improve classification of disease subtypes, and thus the management of the disease. Herein, the authors discuss the features of GEP-NENs that, as prognostic or predictive biomarkers, could form the basis for a novel, clinically useful molecular classification system.

Unwarranted variations, which cannot be attributed to patients' underlying illnesses or comorbidities, medical needs, or the dictates of evidence-based medicine, can account for substantial variations in patient outcomes. In this Perspectives, the authors describe possible approaches intended to address these variations in the context of colorectal cancer care.