Reviews & Analysis

Palliative care is a crucial part of the treatment spectrum for patients with cancer because these patients frequently undergo aggressive therapy, sometimes in discordance with their wishes. This Review article outlines the different elements of palliative care, including communication, quality of life, symptom control, patient satisfaction and resource utilization, and shows how it can benefit patients.

Preoperative 5-fluorouracil-based chemoradiation with optimal surgery provides very effective local control in locally advanced rectal cancer. Does adding oxaliplatin as a radiosensitizer provide any additional benefit? Is more always better?

Patients with colorectal cancer with mutated PIK3CA, identified from two large observational cohorts, had increased cancer-specific and overall survival if they used aspirin regularly after diagnosis compared to non-users. No effect of aspirin was seen in patients with wild-type PIK3CA. Mutated PIK3CA might be a useful biomarker to select patients who would benefit from adjuvant aspirin therapy.

A phase II trial comparing dual MAPK pathway inhibition by combining BRAF and MEK inhibitors with BRAF inhibition alone showed increased progression-free survival and reduced incidence of secondary malignancies in patients with mutant BRAF V600 melanoma. This trial provides strong support for developing combinations hitting the same pathway in melanoma.

Cancer cachexia is a metabolic syndrome that is defined by loss of muscle mass. This syndrome can cause a great deal of distress to patients with cancer and their families. This Review article outlines the symptoms, mechanisms and treatment options for cachexia with the aim of improving the quality of life of patients.

Radiotherapy has been driven by constant technological advances since the discovery of X rays in 1895. This Timeline article covers the history of radiotherapy and focuses on the advances of major importance in the past two decades. These changes have provided clinical benefit for patients with cancer.

Tumour dormancy is when cancer sleeps undetected for periods that can last up to decades. The therapeutic potential of inducing or maintaining this dormant period is clear. This Review describes the mechanisms of dormancy and uses genitourinary cancers as models to demonstrate how dormancy principles could be exploited clinically.

Glioblastomas are difficult to treat, and patients have a poor prognosis. Knowledge of the molecular pathogenesis of glioma has launched an era of targeted-therapies, which are discussed in this Review article. Biomarkers, novel trial design, and the identification of molecular subgroups are other advances that are explored here.

The large randomized study by Crook et al. demonstrated that intermittent administration of androgen deprivation therapy should be considered the standard of care when patients with moderate and well-differentiated localized prostate cancer are treated for rising PSA levels after definitive radiotherapy.

Technological innovations have made possible the integration of imaging technology into the radiation treatment devices to increase the precision and accuracy of radiation delivery. But, this is just the beginning. In this Review, David A. Jaffray discusses the different exciting advances in image-guided radiotherapy to achieve patient-specific radiotherapy treatment courses in the ever evolving field of radiation oncology.

The emergence of individualized medicine has spurred the need for the development of clinical decision-support systems (CDSSs) based on prediction models of treatment outcome. In radiation oncology, CDSSs combine clinical, imaging and molecular factors to achieve the highest accuracy to predict tumour response. Here, the authors provide an overview of these factors—including survival, recurrence patterns and toxicity—and discuss the methodology behind the multistage development of CDSSs.

The VELOUR and VITAL studies recently demonstrated ziv-aflibercept improved overall survival in patients with metastatic colorectal cancer (mCRC), including those previously treated with bevacizumab, but did not improve overall survival in non-small-cell lung cancer. Thus, VEGF-directed agents might be useful throughout the continuum of care in mCRC, but biomarkers are needed to identify patients likely to benefit.

An update of the COU-AA-301 study confirms a survival advantage with abiraterone–prednisone compared to prednisone in post-docetaxel patients with metastatic castration-resistant prostate cancer. We place these data in the context of earlier disease states and other novel agents and explore practical issues concerning the future use of abiraterone.

The National Cancer Institute (NCI) has invested a great deal of resources into examining imaging modalities and agents to improve image-guided interventions and disease monitoring in cancer. In this Perspectives article, the author describes the efforts of the NCI has made to facilitate clinical trials in imaging.

PET or SPECT, is that the question? Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are both tomographic techniques that enable 3D-localization of the tumour and can be combined with CT for hybrid imaging; but is one better that the other? In oncology imaging nothing is black or white, and Rod Hicks and Michael Hofman provide us with an in-depth analysis of the advantages and disadvantages of each technique.

Hypoxia can affect clinical outcome after radiotherapy, resulting in reduced local tumour control and increased malignant progression. Hence, its detection is of utmost importance, but how can we detect hypoxia? Horsman et al. assess the potential use of imaging to identify hypoxic tumours that would lead to treatment modifications with the aim of improving clinical outcome after radiotherapy.

Are there any methods beyond MRI for brain tumours imaging? This Review by Andrew C. Peet and colleagues discusses the additional information that can be obtained by using functional imaging methods—such as diffusion imaging, perfusion imaging and magnetic resonance spectroscopy—and the challenges in determining the best way to incorporate these techniques into routine clinical practice.

Once upon a time, around 100 years ago, there was an X ray image of a sarcoma. From then on, increasingly complex functional imaging techniques were developed and are now applicable in both clinical and research platforms. This Timeline article revisits the achievements of the pioneer techniques in cancer imaging, discussing how they have changed over time and envisioning how imaging will remodel the future of modern oncology.

Addition of aprepitant, an NK-1 receptor antagonist, to dexamethasone and a 5-HT3 receptor antagonist contributes substantially to emetic control in patients receiving 5-day cisplatin-containing chemotherapy, a new trial shows. Some needs in antiemetic therapy remain unmet, including control of emesis with multiple-day chemotherapy and control of nausea.

A retrospective cohort study has shown that pancreatic radiation is a risk factor for diabetes in survivors of paediatric cancer. This validates and refines prior epidemiological observations of diabetes after radiation to the abdomen and total-body irradiation, and will result in modification of surveillance recommendations in national survivor guidelines.