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In this Perspective, the clinical disappointment of mitosis-specific agents is explained in the context of the mechanism of action of microtubule-targeting agents. The authors propose a new paradigm for the anticancer activity of microtubule-targeting agents and suggest that mitosis-specific inhibitors will not result in significant clinical impact.
Chemotherapy and trastuzumab is standard therapy for HER2-positive breast cancer, although aromatase inhibitors combined with anti-HER2 therapies is an option in patients with HER2 and hormone receptor-positive tumors. The activity observed with chemotherapy and anti-HER2 therapies seems to be higher than with aromatase inhibitors and HER-2-based therapies. The authors highlight the data that have led to current treatment strategies and the importance of considering chemotherapy and anti-HER2 therapy for HER2 and hormone receptor-positive tumors.
Radio-embolization using radioactive microspheres allows the delivery of high-dose internal radiotherapy to malignant tumors of the liver. The surrogate for measuring flow dynamics for radio-embolization planning does not best represent treatment efficacy. Therefore, Morgan et al. propose that imaging protocols sensitive to changes in vasculature are likely to represent useful predictive markers of malignant lesions that could benefit from radio-embolization.
Cancer treatment in young women can lead to reduced fertility—a serious issue for patients who wish to have children. In this Perspectives, Letourneau and coauthors highlight the importance of making sure that oncologists and fertility teams are aware of this issue and work together to educate patients of the risks involved. Furthermore, options for fertility preservation are discussed.
Two seemingly contradictory methods of practicing medicine, evidence-based medicine and personalized medicine are examined with respect to PET imaging in this Perspective. The improvement that PET imaging provides for patient management in both hematologic and solid malignancies is discussed. The tailoring of therapeutic strategy by molecular imaging, with PET at its forefront, enables disease management at the individual level and strengthens the evidence-based approach in oncology.
Antiangiogenic therapy inhibits tumor growth by targeting the blood vessels of the tumor. Antiangiogenic therapy often correlates with longer survival in patients without affecting tumor growth. This positive response may be due to the off-tumor target effects of antiangiogenic drugs. In this article, Yihai Cao describes the potential mechanisms underlying the benefits of targeting off-tumor sites, and how these events improve outcomes in patients with cancer-associated systemic syndromes.
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.
The diagnostic utility of tumor size in breast cancer is dependent on multiple factors. In this Perspective, Foulkes and coauthors recommend that tumor size should not be automatically considered in treatment decisions for all breast cancer subtypes. The authors discuss how the correlation between size and survival is disrupted in triple-negative and basal-like breast cancers and propose two specific mechanisms that might be responsible for this disrupted relationship.
Defective DNA mismatch repair (MMR) occurs in approximately 15% of sporadic colorectal cancers. Studies have shown that patients with MMR-deficient colorectal cancers have a more favorable prognosis, but evidence indicates these patients do not benefit from adjuvant 5 fluorouracil-based chemotherapy. The importance of determining MMR status to inform clinical decision-making for adjuvant chemotherapy in patients with stage II colon cancer is discussed.
When cancer survival statistics worsen over time a common assumption is that care must have deteriorated. A variety of reasons cause cancer survival to drop, including improved diagnosis of premalignant lesions, deleterious changes in the distribution of prognostic factors, and changes in the distribution of sociodemographic characteristics. In this article, the pitfalls of comparing published population-based survival data from different time periods or populations are discussed.
Targeted agents directed at VEGF and EGFR have become part of the standard treatment of metastatic colorectal cancer; however, only some patients benefit from such treatment. The CAIRO2 and PACCE trials have shown a detrimental effect of adding an anti-EGFR antibody to standard chemotherapy plus bevacizumab. In this Perspective, the authors discuss issues that may explain these unexpected results.
Novel targeted therapies often result in disease stabilization rather than tumor shrinkage, which are reflected by changes in the molecular features of the tumor. Noninvasive procedures to measure such features are urgently needed. The authors of this opinion article discuss the role of PET and its impact on decisions about monitoring of systemic cytotoxic and targeted therapy.
The costs associated with innovative cancer therapeutics are excessive, placing a barrier between drug discovery and healthcare. The article discusses several strategies that might be effective in reducing the escalating costs and their impact on innovative cancer drug discovery.
