Volume 11 Issue 7, July 2014

Over the past three decades, the interpretation of clinical trial outcomes in studies of advanced-stage non-small-cell lung cancer has changed. The robustness of findings from these trials has been called into question. We believe this change is a reflection of the improved understanding of molecular-based therapeutics and continued advances in this field.

The recent results of the Early Breast Cancer Trialists' Cooperative Group meta-analysis have demonstrated that post-mastectomy radiotherapy reduces breast cancer recurrence and mortality in women with positive axillary lymph nodes—independently from the number of the lymph nodes involved—with no significant effect in patients with node-negative axillary status.

MEK1 and MEK2 have key roles in tumorigenesis and, therefore, represent promising targets for cancer therapy; however, MEK1/2 inhibitors have been shown to have efficacy in only a narrow range of cancer types, mainly tumours that harbourBRAF or NRASmutations. In this article, the clinical experience with MEK inhibitors to date is reviewed, and potential approaches to overcoming therapeutic resistance and increasing the efficacy of treatment are discussed.

Circulating tumour cells (CTCs) might be representative of the tumour burden and might also provide information on tumour cell biology. As such, these cells hold promise in the prediction and monitoring of response to anticancer therapy. In this Review, the authors highlight the challenges of monitoring treatment response in metastatic castrate-resistance prostate cancer and discuss the developments in CTC analyses that have increased the value of these cells as potential biomarkers in this disease.

Metronomic chemotherapy has undergone major advances as an antiangiogenic therapy. The discovery of the pro-immune properties of chemotherapy has established the intrinsic multitargeted nature of this therapeutic approach. André et al. describe the complex mechanisms of action of metronomic chemotherapy, and discuss the latest clinical data in both adult and paediatric populations, highlighting its potential role in the era of personalized medicine.

A key challenge in oncology is obtaining drugs predicted to be beneficial based on the patient's tumour profile. One solution is creation of a national facilitated access programme and registry for off-label use of targeted anti-cancer drugs. Schilsky discusses several key elements of implementing personalized cancer care services in an oncology practice setting and offers solutions to some of the obstacles of making personalized medicine available to many patients.