Reviews & Analysis

Preclinical and clinical data indicate a number of potential roles of diffusion-weighted MRI in the characterization of malignancy such as determination of lesion aggressiveness and monitoring response to therapy. This Review outlines the biological basis of observations made using this technique and the authors discuss the strength of evidence for adoption of DW-MRI as a biomarker for the assessment of tumor response.

Methotrexate-associated lymphoproliferative disorders are rare conditions mostly observed in patients receiving immunosuppression therapy. Tran and coauthors report the first documented case of methotrexate-associated mantle-cell lymphoma in a 75-year-old patient with myasthenia gravis. After cessation of methotrexate, the patient was treated with anthracycline-based combination chemoimmunotherapy and maintenance rituximab therapy and achieved complete remission. The authors discuss the management options for patients with methotrexate-associated mantle-cell lymphoma.

The incidence of skin cancer as a result of exposure to ultraviolet radiation, either through sunlight or artificial tanning facilities, is increasing. In this Viewpoint the authors discuss the risks of melanoma for adolescents using artificial tanning facilities and call on authorities to restrict access to such facilities.

Angiogenesis is a complex, highly regulated process that is crucial for tumor growth and metastasis. Insights into the molecular mechanisms of tumor angiogenesis have led to the identification of potential angiogenic targets and the development of novel antivascular agents. This Review highlights the results of the latest clinical studies of antivascular agents in ovarian cancer and discusses the challenges and opportunities for future clinical trials.

Metastasis remains the major driver of mortality in patients with cancer. The similarities and differences between primary tumors and metastases are described, and pathways controlling the colonization of a distant organ and incorporation of anti-metastatic therapies into clinical testing are discussed. The authors emphasize that the time is ripe for metastasis and metastatic colonization to enter mainstream clinical development and testing.

PET/CT imaging has rapidly emerged as an important imaging tool in oncology and provides multiple exciting new opportunities to integrate functional and morphological information for tumor staging, radiation treatment planning and monitoring of tumor response to therapy. In this Review, the authors discuss the technical features of PET/CT and its role in diagnosis, staging, restaging and treatment monitoring as well as radiation planning in cancer patients.

Cardiac angiosarcomas are characterized by a difficult clinical diagnosis and poor prognosis. Pigott et al. report the case of a 37-year-old man diagnosed with primary cardiac angiosarcoma with systemic metastases who was managed with neoadjuvant and adjuvant chemotherapy with doxorubicin, and complete resection of the tumor. The authors discuss the combination of treatments undertaken, and suggest a multidisciplinary approach to improve outcome in patients with cardiac angiosarcoma.

Steady progress has been made in our understanding of the pathogenesis of gastrointestinal stromal tumors (GIST). The tyrosine kinas inhibitor, imatinib, exhibits impressive anti-tumor effects against GIST and has become the first-line therapy for treating patients with advanced disease. The pathogenesis of GIST, the mechanisms accounting for imatinib resistance, and potential future perspectives are discussed.

Many cancer treatments induce gonadal failure, which can seriously influence the quality of life of survivors by causing infertility and, in women, menopausal symptoms. The authors of this Review discuss the published literature on treatment-induced gonadal failure with the goal of providing practical information on its management for healthcare providers.

In advanced cancer, breathlessness is complex and usually multifactorial, and therapeutic advances in the clinical management of dyspnea are limited. Palliation of breathlessness and an evidence-based approach by a committed multidisciplinary team can improve patient care considerably. A careful assessment of the patient, cause of breathlessness, and pharmacological palliation is a first step. This Review discusses the evidence for our present understanding of breathlessness and the many unanswered questions regarding the genesis and management of this symptom.

Placental-site trophoblastic tumors (PSTTs) are often resistant to chemotherapy and have a high incidence of lung metastasis. Cole et al. report the case of a 52-year-old woman who was diagnosed with metastatic chemoresistant PSTT. The patient was managed with abdominal hysterectomy, salpingo-oophrectomy, radiotherapy, chemotherapy, and thoracotomy with wedge resection. The authors discuss the treatment options for patients with PSTTs, especially for those with persistent metastatic disease.

Major advances in the first-line therapy of inoperable malignant pleural mesothelioma have occurred in the past 5 years. This Review summarizes evidence supporting the clinical activity of chemotherapy, discusses the use of end points for its assessment, and the influence of clinical and biochemical prognostic factors on the natural history of malignant pleural mesothelioma.

Ensuring adherence to cancer treatment is as important to successful treatment as the development of new therapies. In this Viewpoint the author discusses the issues surrounding compliance to medical therapy and factors affecting patient behavior.

Basal-like breast cancers are associated with a poor disease-free and overall survival. The pathologic features of breast carcinomas classified by immunohistochemical and gene-expression profiling criteria are critically discussed. The authors emphasize that basal-like tumors display a spectrum of morphologic and clinical characteristics, and that the heterogenous nature of these tumors means the most prognostically relevant subsets have yet to be defined.

Urachal adenocarcinomas are rare primary adenocarcinomas of the bladder for which there is no current chemotherapy regimen. Mohile and co-authors report the case of a 67-year-old woman who was diagnosed with metastatic urachal adenocarcinoma and achieved complete remission of the disease after irinotecan, 5-fluorouracil and leucovorin therapy. The authors discuss the current management options for patients with urachal adenocarcinomas and emphasize the need to evaluate the role of newly discovered agents in the treatment of this disease.

Sentinel lymph node biopsy is standard care for intermediate thickness melanoma despite a lack of evidence of its impact on survival. Late-stage disease is frequently wrongly predicted, leading to unnecessary treatments. These issues are discussed here and the author recommends ultrasound-based surveillance after wide excision of the primary tumor for patients assigned false-positive prognoses.

A large number of trials have improved antiemetic therapy and made evidence-based recommendations possible for the majority of patients receiving chemotherapy. This Review discusses the pathophysiology of nausea and vomiting, the development of antiemetics, highlights some of the newest antiemetics, and finally summarizes recommendations from the evidence-based guidelines developed by the Multinational Association of Supportive Care in Cancer.

Molecular imaging can stratify patients according to presence or absence of a drug target, and can distinguish between drug responders and nonresponders. The authors of this Review discuss the integration of molecular imaging in drug development and how this technology can address key questions in the preclinical and clinical evaluation of new targeted drugs.

Cervical cancer is a major cause of cancer mortality and is initiated by infection with high-risk human papillomaviruses (HPVs). An improved understanding of the virologic basis for this disease will help with prevention and treatment. This Review summarizes the main events of the HPV life cycle, the functions of the viral proteins, and the implications of HPV infection on their hosts, with an emphasis on carcinogenic mechanisms and disease outcomes in cervical and head-and-neck cancer.