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Two meta-analyses of the Non Small Cell Lung Cancer Meta-analyses Collaborative Group (NSCLC MACG) on the effects of adjuvant chemotherapy on early stage NSCLC after complete or curative resection have demonstrated that adjuvant cisplatin-based regimens are a valid and recommendable option following curative surgery. We discuss these results in the light of current interdisciplinary guidelines and existing meta-analyses of randomized clinical trials.
Whether a 70-gene signature could help individualize therapy in breast cancer patients with small tumors is the subject of a recently reported study. The authors of the article raise important issues about how to validate the clinical utility of the new molecular classifiers for risk prediction.
The IAEA-ACC study compared accelerated radiotherapy with standard radiotherapy in a multicenter trial conducted in developing countries. Advantages were most notable in patients with early-stage disease, which may limit the utility of this therapy. In countries where resources are limited, however, this strategy may be a cost-effective approach to improving outcomes in patients with head and neck cancer.
A clinical trial of patients with pharmacogenomically selected non-small-cell lung cancer clearly demonstrated an improvement in progression-free survival after gefitinib treatment compared with standard chemotherapy. This report is the first to suggest that personalized therapy based on pharmacogenomics could be standardized in the treatment of lung cancer.
Adding lomustine to the standard combination of idarubicin and cytarabine for the treatment of old patients with acute myeloid leukemia improves complete response rates and overall survival. These findings emphasize the importance of dose intensity and raise the question of a unique role for nitrosoureas in the treatment of this disease.
The ZODIAC trial reported that the addition of vandetanib to docetaxel in second-line treatment of unselected patients with metastatic non-small-cell lung cancer resulted in a statistically significant improvement in progression-free survival compared with docetaxel alone. Identification of biomarkers to assist in molecular selection of patients for targeted therapy is a tool for 'smart' clinical trial design.
Image-guided core biopsy (IGCB) of the peritoneum and omentum is a minimally invasive, safe and accurate diagnostic tool for patients with suspected malignancy. With the use of either ultrasound or CT guidance, this technique provides sufficient material to enable assessment of specific cancer subtypes, distinguish recurrence from a new disease process, and inform prognosis. In this Review, the authors discuss IGCB and its clinical applications, and critically examine available alternatives.
Brain metastases are a frequent complication in patients with advanced breast cancer. Whole-brain radiation therapy (WBRT) is the standard treatment for these patients, but it can cause neurocognitive damage, and results are suboptimal. Therapies that reduce toxic effects, improve local control, and prevent recurrences are needed. The authors of this Review outline the current strategies and novel developments in WBRT, and discuss new irradiation modalities that are improving outcomes in breast cancer patients with brain metastases.
Bone is the most common site of breast cancer metastasis, resulting in substantial morbidity and mortality. A number of therapies are being developed, including bisphosphonates, which target factors that promote tumor growth in bone. The authors of this Review outline the underlying mechanisms that drive this pathological process, and highlight potential molecular targets that will improve therapeutic interventions for metastatic breast cancer. Tools that assess response in individual patients and guide appropriate treatment are also discussed.
Nanotechnology offers great promise for the detection, prevention and treatment of cancer. Current limitations of this technology include the heterogeneous distribution of nanoparticles to tumors, caused in part by the physiological barriers presented by the abnormal tumor vasculature and interstitial matrix. This Review discusses these barriers and summarizes strategies that have been developed to overcome them. It additionally examines design considerations for the optimization of delivery of nanoparticles to tumors.
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.
