Volume 7 Issue 9, September 2010

Nanoparticles are a promising vector-based strategy for the therapeutic administration of small interfering (si)RNA because they protect siRNA from nuclease degradation. A recent phase I study employed transferrin–targeted nanovectors to demonstrate RNA interference mechanisms in a melanoma patient. Multifunctional nanoparticles are providing patient-specific biodistributions of systemically administered siRNA.

The results from two large, prospective, randomized, controlled trials examining the role of 5-α reductase inhibitors in the prevention of prostate cancer have been published. Initial results from the Prostate Cancer Prevention Trial (PCPT) were met with both enthusiasm and skepticism. The recently published REDUCE trial seems to corroborate the findings of the PCPT and reinforce the chemopreventive potential of 5-α reductase inhibitors. This article will assess the REDUCE trial and place the results of the 5-α reductase inhibitor trials in the context of clinical practice.

A study by Atkin and coauthors has demonstrated reduced mortality by screening average-risk patients with a single use of flexible sigmoidoscopy for colorectal cancer. This large UK trial of 170,432 subjects aged 55–64 years (median 60.2 years) randomized patients 2:1 to control or single flexible sigmoidoscopy. Reduction in colorectal cancer incidence was 23% and cancer mortality was reduced by 31% in the intention-to-treat population. In this News & Views article we discuss the role of flexible sigmoidoscopy in population-based screening for colorectal cancer.

Palumbo and coauthors report on the results of a randomized trial comparing two doses of melphalan in patients with symptomatic multiple myeloma. Overall complete response rates, median progression-free survival and projected 5-year overall survival were significantly higher among patients receiving the higher melphalan dose. These results confirm that for this patient population melphalan 200 mg/m² should remain the gold standard conditioning regimen.

EGFR is one of the most studied targets in oncology, and several inhibitors have shown promising results in selected patient populations. However, intrinsic and acquired resistance to these targeted therapies is increasingly recognized. The authors of this Review describe the successful translation of EGFR inhibitors to the clinic, and highlight the mechanisms of resistance to these agents that limit their long-term efficacy. Understanding these processes will allow researchers to develop therapies that overcome resistance and ultimately lead to more successful outcomes.

Inhibitors of poly(ADP-ribose)polymerase (PARP) have shown promise as therapeutic agents for the treatment of ovarian cancers with mutations inBRCA1 or BRCA2. By exploiting the synthetic lethal interaction that exists between PARP inhibition and BRCA mutations, these agents specifically kill cancer cells by targeting their DNA repair system. The authors of this Review describe the importance of BRCAmutations for the efficacy of PARP inhibitors. They also discuss the preclinical and clinical trial results of PARP inhibitors, the challenges related to the use of these agents, and future directions.

Chronic lymphocytic leukemia has long been regarded as an incurable disease of the elderly. Consolidation strategies using non-cross resistant agents have improved the success rates of patients with residual disease at the end of induction treatment. This Review discusses chemoimmunotherapy regimens that contain purine analogs and rituximab and considers new developments in induction and consolidation strategies that are leading the path towards cure.

Castleman's disease is an infectious disease of the lymph node that causes either local symptoms or a systemic inflammatory syndrome. This Review discusses the viral causes of the disease and the mechanisms of its subsequent progression. The efficacy of established treatment options for this disease and of potential novel therapies is outlined.

Modern cancer treatment is a complex process that requires the cooperation of individuals with a range of specialties and backgrounds. In this Perspective, a multidisciplinary team of authors propose a conceptual model to improve patient-centered cancer care. This model describes the roles of the active caregivers (for example, physicians), basic supportive caregivers (for example, psychologists) and community support (for example, advocacy groups) in providing the full continuum of the cancer treatment experience.