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The Cancer Act that was signed by President Nixon in December 1971 had a mandate “to support research and the application of the results of research, to reduce the incidence, morbidity and mortality from cancer.” It has succeeded in many of these aims, as this personal account testifies.
Elderly patients have often been excluded from, or under represented in, clinical trials. Now, a phase III trial has demonstrated that a platinum-based doublet regimen provides superior outcomes in elderly patients with advanced-stage non-small-cell lung cancer, and should be considered for palliative chemotherapy in this group of patients.
In a trial in patients with metastatic breast cancer, the prognostic value of the number of circulating tumor cells (CTCs) at baseline was independent of tumor subtype, except in patients with HER2-positive disease treated with anti-HER2 targeted therapy. These data support the use of CTC detection as a tool contributing to personalized medicine.
The AZURE trial data add to the uncertainty of whether adjuvant bisphophonates are a valuable addition to the armamentarium in the treatment of early stage breast cancer. Although the overall trial results were negative, a prespecified subgroup analysis demonstrated a 25% reduction in the risk of relapse and death in postmenopausal patients.
Carcinomas of an unknown primary origin (CUP) are histologically confirmed metastases for which a primary tumor could not be found despite an extensive diagnostic workup of the patient. The authors of this Review discuss the clinical evaluation of patients with CUP, describe how to identify specific CUP subsets, and outline treatment strategies and outcomes of patients with CUP.
Cancer immunology is an interactive field that requires the skills of oncologists and immunologists, in addition to other aspects, such as pathology. This Review uses colorectal cancer as a prototypical cancer and describes how molecular features and immune reactions are inter-related.
Radioimmunotherapy is being used successfully for the treatment of patients with hematological malignancies, however similar efficacy is lacking in patients with solid tumors. Pouget and colleagues explain basic concepts of radiobiology, review the results of clinical radioimmunotherapy trials, and highlight potential strategies to improve the efficacy of radioimmunotherapy in patients with solid tumors.
The use of therapy that is truly targeted to the needs and biological requirements of an individual patient is an aim for many in the oncology field. Jackson and Sood discuss the implications of targeted therapies on patients and the health-care system and discuss methods that might be used to maximize efficiency, cost effectiveness and patient survival.
The advent of prophylactic mastectomy and the new surgical techniques that are available has encouraged the use of nipple-sparing mastectomy. This Perspectives article examines this technique in terms of aesthetics, contraindications, side effects and recurrence, and outlines why, in the authors' opinion, nipple-sparing mastectomy should be offered to patients with breast cancer and those at high risk.
