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On 11 March 2011, a magnitude 9.0 earthquake and subsequent tsunami caused unprecedented devastation in Japan. Over 20,000 people lost their lives or went missing and more than 100,000 people had to evacuate their homes. Many victims are patients with chronic diseases, including cancer, who face interrupted or discontinued therapy.
Despite the improved progression-free survival and overall survival demonstrated by cisplatin–gemcitabine chemoradiation in a phase III randomized trial in patients with stage IIB to IVA cervical cancer, the acute and chronic toxic effects urge caution before embracing this as a new treatment paradigm.
A recent publication presented objective evidence that patients with and without brain metastases perform similarly in phase I clinical trials for advanced-stage cancer. This finding supports what neurosurgeons and neuro-oncologists have long suspected; namely, that the presence of brain metastases need not mandate exclusion of patients from early-phase clinical trials.
Antiangiogenic therapy is thought to starve tumors by cutting their nutrient and oxygen supply. The authors review evidence for a potential link between hypoxia signaling and an invasive switch that occurs in cancer cells, through which antiangiogenic drugs could increase the risk of tumor metastasis in certain conditions, and discuss approaches to reduce tumor dissemination.
The existence of a state of limited metastasis or oligometastasis observed in selected patients is associated with favorable outcomes. This Review discusses the role of local therapy for oligometastases that arise in lung and liver, the challenge of identifying the patients who will benefit from the treatment of their oligometastatic disease and how to select the right local therapy for these patients.
The survival rate for adolescents and young adults with acute lymphoblastic leukemia has improved over the past decades. However, it is still behind the overall survival of children with this disease. In this Review, Schafer and Hunger analyze recent studies that have shown improved outcomes for adolescents and adults treated with pediatric-based regimens offering a potential solution for the “adolescents and young adults gap”.
Therapeutic advances in melanoma seem on the horizon, with the identification of BRAF as a principal therapeutic target. The authors describe the scientific basis for the targeting ofBRAFmutations in cancer, the early clinical data with BRAF inhibitors, and how combinatorial therapies may address the current limitations of their use in the clinic.
Many patients with soft-tissue sarcomas are treated with doxorubicin-based adjuvant chemotherapy, but whether this therapy translates into a survival benefit is controversial. The authors of this Perspectives article critically analyze available clinical data and discuss the implications of these data on current and future treatment efforts.
A number of biomarkers that predict clinical outcome in response to gemcitabine treatment have been identified. These markers could be used in the clinic to personalize treatment, thereby improving efficacy and reducing adverse effects. The authors of this article describe how treatment can be tailored according to the pharmacogenetics and pharmacokinetics of each patient. In particular, evaluating the status of the liver enzyme cytidine deaminase holds promise as a strategy to optimize therapy.
