Reviews & Analysis

Life expectancy of most patients with differentiated thyroid cancer is normal, so adverse treatment effects should be minimized. Lower activities of radioiodine for ablation of thyroid remnants are non-inferior to higher activities and quality of life can be maintained by preparation of radioiodine remnant ablation using recombinant human thyrotropin.

In a randomized phase III trial of induction therapy in adult acute myeloid leukaemia, the addition of cladribine, but not fludarabine, to daunorubicin and cytarabine seemed to improve complete response rates and overall survival. However, serious methodological problems make it difficult to estimate the actual clinical importance of the result.

Recent evolution of prostate cancer treatment reflects technological arms races driven by economic incentives rather than high-quality evidence—as exemplified by proton-beam radiation, recently found markedly inferior to far less-expensive alternatives. Another study found promise for focal treatment, but much research is required before this could become a standard option.

Of three randomized trials testing lenalidomide maintenance in myeloma, a survival benefit is apparent in one. An increased risk of second cancers is seen in all three trials. Maintenance must be considered after a review of risks and benefits, but it is premature to recommend lenalidomide maintenance for all patients.

Multimodal organ-sparing treatment strategies have shown similar survival rates when compared to radical surgery for muscle-invasive bladder cancer; however, up to 80% of surviving patients retained their own, well-functioning bladder. Within an interdisciplinary bladder-preserving treatment protocol, concurrent chemoradiotherapy was superior to radiotherapy alone—supporting its use as an alternative to radical cystectomy.

The benefit of salvage chemotherapy in gastric cancer refractory to first-line platinum and fluoropyrimidine therapy was previously unknown. A randomized multicentre study has shown that irinotecan or docetaxel administered as single agents improved survival compared with best supportive care alone. Hence, salvage chemotherapy is now a proven option in pretreated gastric cancer.

A qualitative study indicates that there is a positive selection bias towards favourable economic analysis of targeted therapies, when these are funded by the manufacturer. At a time of increasing budgetary constraints and public scrutiny of the relationship between industry and the professions, we need a more mixed economy of funding for this field.

Gemtuzumab ozogamicin was withdrawn from the market after being evaluated in combination with chemotherapy in the frontline treatment of patients aged 18 to 60 years with acute myeloid leukaemia (AML). More-recent randomized trials demonstrate that low doses of gemtuzumab added to cytarabine and anthracycline-based chemotherapy benefit patients with better-risk AML.

Patients undergoing removal of adenoma have a 53% reduction in colorectal cancer-related death. However, to translate these results into a screening programme, participation rates should also be taken into account. The results of a large, first screening round of once-only colonoscopy demonstrated a low participation rate compared with biennial faecal immunochemical test.

Reductions in breast cancer risk for women with a hysterectomy receiving oestrogen-alone therapy have persisted since termination of active treatment on the Women's Health Initiative trial. The few deaths among women diagnosed with breast cancer during this trial limit the interpretation of the reduced mortality for women receiving oestrogen alone compared with placebo.

Patients with cancer in the UK often have multiple consultations with their family doctor before diagnosis, which is partly due to different symptoms each cancer type presents. Tumours with one main symptom and a simple investigative pathway are easier to diagnose, but structural investigational barriers also contribute to delayed diagnosis.

A safety substudy of the MAP.3 trial included 242 women who had completed 2-year follow up (124 given exemestane, 118 given placebo). Exemestane resulted in a significantly higher decrease of bone structural parameters and bone mineral density. Patients receiving exemestane for primary breast cancer prevention should be monitored and treated accordingly.

Neoadjuvant bevacizumab, when added to standard chemotherapy for operable breast cancer, improved the rate of complete pathological response in two large, well-conducted trials. However, the modest incremental benefits, combined with uncertain long-term effects on disease recurrence, mean that this approach remains experimental until follow-up data are available.

Recent neoadjuvant studies have examined the effects of adding single or dual agents targeting HER2 to chemotherapy, finding unanimously that dual HER2 targeting markedly improves pathologic response. These findings have significant implications for future trial designs, particularly if the impact on pathologic response is accompanied by improved disease-free survival or overall survival.

In the CLASSIC study, capecitabine–oxaliplatin was an effective chemotherapy after D2 gastrectomy for stage II–IIIB gastric cancer. We compared these data with the ACTS-GC study, which was the only pivotal study proving the benefit of adjuvant chemotherapy in these patients. Long-term survival data from CLASSIC are awaited with interest.boxed-text

Demonstration of the clinically significant activity of bevacizumab in advanced-stage ovarian cancer has attracted a great deal of interest. Here, we summarize the two positive phase III trials that led to EMA approval of bevacizumab as first-line therapy and discuss the optimum use of the drug in this disease.boxed-text

The BOLERO-2 and CLEOPATRA trials evaluated everolimus for estrogen receptor-positive and pertuzumab for HER2-positive metastatic breast cancer. Both agents enhanced the efficacy of standard therapy, were relatively well tolerated and should be approved for therapeutic use. These data confirm that targeting both major driver and escape pathways improves treatment outcomes.

Clinical trials have consistently demonstrated the superior sensitivity of human papillomavirus (HPV) testing compared with cytology (Pap) testing for identifying women at risk of cervical cancer. Rijkaart et al. have now shown that adding HPV testing to routine cervical cancer screening can further reduce the risk of cervical cancer compared to Pap testing alone.

Late toxicities from radiation therapy are frequent in patients with Hodgkin lymphoma and can hamper survival. These late toxicities should decrease with modern radiation therapy but results are not mature and so the importance of this decrease is still unknown. Hence, all studies in Hodgkin lymphoma must report long-term outcome.