Articles in 2014

Although large, population-based studies are a powerful tool for elucidating real-world outcomes and uncommon events, confounding factors must be tightly controlled. A recent report from Nam and coauthors has neglected such a confounding factor and, therefore, stands in need of further study to clarify the findings.

A recent population-based analysis from Nam and coauthors found high complication rates occurring within 5 years of prostatectomy or radiation therapy interventions for prostate cancer. These findings emphasize that treatments should be reserved for men at significant risk of disease progression, and perhaps further concentrated into higher-volume centres of excellence.

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.

Identification of the optimal dose remains a key challenge in drug development. The standard approach that is based on identifying the maximum tolerated dose does not take into account important aspects of clinical pharmacology for newer targeted agents. The authors discuss adaptations to dose-finding trials for molecularly-targeted agents that enable more-efficient trials in the future in terms of costs and, most importantly, optimal patient benefit.

Idelalisib, the first PI3Kδ inhibitor in clinical use, has excellent activity in patients with chronic lymphocytic leukaemia and indolent B-cell lymphomas, heralding a new era of targeted therapy for these types of cancer. Idelalisib intercepts critical communications between B cells and the microenvironment, including B-cell receptor signalling and chemokine networks.

Several clinical trials have addressed the role of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery for rectal cancer. The recently published EORTC 22921 study adds further debate to the merits of adjuvant chemotherapy in this setting.

Soft-tissue sarcomas (STS) are a rare and heterogeneous group of tumours, with a wide range of differing behaviours and underlying molecular pathologies. Recent advances in molecular pathogenesis, novel targeted therapies, changes in clinical trial design and increased international collaboration have led to the development of histology-driven therapy. The authors of this Review describe the current gold standard treatment for specific STS subtypes and outline the future promising therapies in the pipeline.

Individuals with Li-Fraumeni syndrome, who carry germline mutations in theTP53 gene that encodes the tumour-suppressor protein p53, are at high risk of developing cancers in multiple organs. In this Review, considerations for cancer screening and management in carriers of TP53mutations are discussed, and an evidence-based approach to cancer surveillance in such individuals is proposed.

Patients infected with HIV seem to develop certain types of cancer more frequently than uninfected people. Specifically, lymphomas represent the most frequent malignancy affecting patients with HIV. This Review focuses on the different type of lymphomas that generally occur in patients infected with HIV, as well as other cancers. The authors provide an update of epidemiological data and diagnostic issues, and discuss the most-appropriate strategies for the management of patients with both HIV and lymphomas.

In September 2012, over 100 experts in cancer research in Africa met in London to discuss the challenges in carrying out high-quality research in this continent. This Review summarizes the discussions and recommendations of this meeting and many examples of successful programmes that have enhanced the development of research in Africa. It also discusses the next steps required to create programmes that will enable evidenced-based cancer control approaches.