News & Views in 2013

The recently updated HER2 testing guidelines by ASCO and the College of American Pathologists (CAP) are a significant step towards personalized medicine. It is excellent news that such great effort has been put into standardizing biomarker assessment. Undoubtedly, these recommendations will improve the analytical validity of HER2 testing, its clinical utility and the communication among health-care providers.

The international phase III REGARD study demonstrated improved overall survival with ramucirumab as second-line therapy for patients with advanced-stage gastric and gastroesophageal junction adenocarcinoma. As a novel biological treatment, is ramucirumab also the harbinger of a new era of targeted therapies in this prevalent and highly morbid disease?

A landmark study has delineated and identified the genetic pathways that drive the natural course of chronic lymphocytic leukaemia (CLL) B cells into Richter's transformation. CLL-related Richter's transformation is a distinct lymphoma, and poses various questions about B-cell ontogeny and relevance of B cell receptor signalling inhibitors.

Colorectal cancer (CRC) screening strongly reduces CRC-related mortality, with the effects of screening persisting for 20–30 years. These observations support current CRC screening and surveillance guidelines. At the population level, screening contributes to longer, healthier living. Thus, it is one small step for mankind, yet one giant leap for man.

Controversy surrounds the use of mammography for breast cancer screening. This commentary explains why retrospective analyses of women who die from breast cancer do not add to the body of knowledge about the value of screening in young women. Mammographic screening alone cannot be expected to overcome aggressive biology.

Concerns still exist regarding the best use of low-dose CT screening for lung cancer and how to select high-risk individuals who will benefit most from participation in screening programmes. Two studies now indicate factors that may reduce the false-positive rate of lung cancer screening with low-dose CT.

A randomized phase III trial comparing pazopanib with sunitinib in patients with advanced clear cell renal cell carcinoma showed that although progression-free survival and overall survival were similar, pazopanib was better tolerated. Recent advances in genomics and metabolomics have provided novel insights that could be leveraged to improve therapy.

The survival of patients with multiple myeloma has improved tremendously over the years. However, patients with disease that has relapsed and is refractory to thalidomide, lenalidomide and bortezomib have poor long-term outcomes. The novel immunomodulatory drug pomalidomide now offers a new therapeutic option for these patients.

The treatment of urological cancers is becoming increasingly complex, and, as a result, multiple specialties are required to maximize outcomes. London Cancer is an organisation with the remit of improving outcomes for patients with cancer using multidisciplinary teamwork within a large urban population. Key performance indicators will be used to assess the quality of care, and will ultimately demonstrate improved outcomes.

Radium-223 dichloride was recently approved for the treatment of men with symptomatic castration-resistant prostate cancer without visceral disease. An understanding of when to use this first-in-class α-emitting agent in the context of the other new treatments is evolving.

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.

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.

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 standard treatment for patients with advanced-stage non-small-cell lung cancer with a performance status of 2 is unclear because of the heterogeneity of this population. Although a recent trial suggests that carboplatin plus pemetrexed improves survival as compared to single-agent pemetrexed, we should be cautious when defining new standards of treatment on the basis of single small trials.

Superficial basal cell carcinomas are a common challenge in clinical dermatology because they are frequent and surgical approaches tend to scar. A large randomized trial comparing three nonsurgical approaches has shown that all had similar clinical outcomes—so, you pay your money and take your choice.

Rearrangements of the ALK gene have been associated with sensitivity to crizotinib and other kinase inhibitors with activity against ALK. The phase III PROFILE 1007 randomized study of crizotinib versus chemotherapy has demonstrated that crizotinib is superior to standard second-line chemotherapy in ALK-positive non-small-cell lung cancer.

Well-documented biorepositories are essential for cancer research. Currently, major biobanks are located in the developed world, which represents the minority global population; however, countries with low-resource settings contribute more than 50% of the global cancer burden. Therefore, there is an urgent need to establish next-generation biorepositories in developing countries.

A randomized trial compared prophylactic platelet transfusion with transfusion given when bleeding occurred. Decreased platelet usage was noted in the therapeutic transfusion group with a very low incidence of significant bleeding in recipients of autologous transplants. This finding indicates that a 'no-prophylaxis' approach is acceptable in such patients. However, prophylactic platelet transfusion should continue to be the standard in leukaemia patients receiving induction chemotherapy.

As we learn more about the biology of cancer, we may be able to apply prognostic biomarkers to select patients at high risk or low risk of disease recurrence or progression. This will allow a priori stratification of patients in clinical trials and will help to tailor treatment to patients.