Volume 6 Issue 7, July 2009

Brain metastases are a challenge for the oncologist, with 20–40% of cancer patients developing intracranial metastases during the course of their illness. The incidence of brain metastases is increasing as a result of improvements in systemic therapy and imaging capabilities, and increased use of screening. Brain metastases pose not only a risk to mortality but also a risk of neurologic, cognitive and emotional difficulties.

The first-line treatment for patients with unresectable metastatic colorectal cancer is chemotherapy in combination with bevacizumab. Emerging evidence, however, suggests that the addition of cetuximab—an anti-EGFR monoclonal antibody—to chemotherapy might be beneficial to patients with wild-type KRAS tumors.

The use of autologous stem-cell transplantation in the treatment of follicular lymphoma remains controversial. Results from the GOELAMS trial show a higher progression-free survival rate in patients treated with autologous stem-cell transplantation compared to those treated with chemotherapy.

Pelvic lymphadenectomy offers no therapeutic benefit to women diagnosed with early-stage endometrial cancer according to a new study. Lymphadenectomy can only be recommended as part of a clinical trial in this disease setting; however, it can offer valuable staging information in those with advanced disease.

A study of cervical cancer screening in 52 villages in India has shown that a single round of human papillomavirus testing was linked to a significant reduction in the number of deaths from cervical cancer, compared with other screening methods. This has implications for primary screening in low-resource settings.

The role of laparoscopic resection for rectal cancer is currently unclear, with little supportive evidence from randomized trials. A study by Ng et al. in a large series of patients with rectal cancer has shown that laparoscopic resection is safe with good long-term outcomes.

The long-term outcome for patients with inflammatory breast cancer is poor despite advances in combined-modality treatment. Treatments targeting the vasculolymphatic pathway have shown potential and therapies targeting cell proliferation pathways are also promising. The authors of this Review discuss the biology of inflammatory breast cancer and potential molecular targets.

Understanding the process of tumor angiogenesis and ways to modify this is a key point in the fight against cancer. This Review explores the current status of vascular-disrupting strategies, discusses how anti-VEGF-based anti-angiogenic therapies can be combined with conventional chemotherapy and radiotherapy, and highlights potential future targets for therapeutic intervention.

The mainstay of therapy of chronic lymphocytic leukemia (CLL) is cytotoxic chemotherapy; however, CLL is still an incurable disease with resistance to therapy developing in a majority of patients. This Review summarizes the progress made in understanding the biological basis of CLL pathogenesis and other aspects of CLL biology, and describes novel treatment strategies that have also been exploited in current clinical trials.

Pancreatic endocrine tumors (PETs) represent an important subset of pancreatic neoplasms. Patients with completely resected tumors generally have a good prognosis, and an aggressive surgical approach in patients with advanced disease may also prolong survival. The authors of this Review discuss the current surgical management strategies for treating PETs, focusing on insulinomas, gastrinomas and nonfunctional PETs.

The authors present a case of a 48-year-old man with a history of diarrhea, flushing and upper abdominal pain who was subsequently diagnosed with metastatic carcinoid tumor. The authors discuss the importance of a stepwise approach in a multi-disciplinary team setting to provide effective patient care.