Volume 10 Issue 10, October 2013

Two phase III trials have shown that prolonging chemotherapy duration improves outcome in patients with nonsquamous non-small-cell lung cancer. Pemetrexed versus placebo, and pemetrexed–bevacizumab versus bevacizumab was tested in patients without disease progression after pemetrexed–cisplatin treatment. Biomarker-directed chemotherapy and/or targeted therapy could further improve treatment outcomes for patients with lung cancer.

On 15 July 2013, the FDA approved afatinib as a first-line treatment for patients with metastatic non-small-cell lung cancer whose tumours harbour exon 19 deletions or exon 21 (L858R) EGFR substitution mutations. We discuss three recent studies investigating afatinib in this molecular subset of patients.

The tumour board has outlived its intended function—it delays care, provides minimal patient benefit, is costly, does not account for patient psychosocial issues, is not evidence-based and has numerous potential legal issues. Instead, multidisciplinary oncology teams using real-time social media and networking that integrates patient input is a better approach.

In a recent randomized trial, lenalidomide plus low-dose dexamethasone prolonged overall survival in patients with high-risk smoldering multiple myeloma. Although the results are impressive, the generalizability is limited to a small subset of patients. Additional studies are needed to identify specific patient populations who can benefit from early intervention.

Advances in the arena of whole-genome sequencing have revealed biomarkers of drug sensitivity and resistance in both renal cell carcinoma and urothelial tumours. This Review article highlights those markers of particular interest and discusses the preclinical and clinical evidence supporting their utility.

There are many circumstances where patients respond to reintroduction of the same therapy (drug rechallenge) following relapse or disease progression during therapy, and in a few cases, when a therapy is continued beyond disease progression. The authors comprehensively describe the available data on rechallenge and continuation beyond progression treatment strategies, discuss the potential mechanisms explaining tumour re-sensitization with reintroduced or continued therapy, and make the case for why drug resistance definitions need to be re-evaluated.

Immunotherapy is associated with durable clinical benefit in patients with melanoma, and this consensus statement outlines recommendations for its use. The panel has based their guidance on the available evidence and outlines a treatment paradigm using drugs that are FDA approved.

In this Science & Society article, the authors provide their personal experience of treating children in low and middle-income countries in sub-Saharan Africa. The authors discuss how conducting clinical trials in this environment can be used for the benefit of all paediatric patients, and outline the measures that need to be put in place to ensure that the outcomes in improved care are met.