Review Articles in 2012

Palliative care is a crucial part of the treatment spectrum for patients with cancer because these patients frequently undergo aggressive therapy, sometimes in discordance with their wishes. This Review article outlines the different elements of palliative care, including communication, quality of life, symptom control, patient satisfaction and resource utilization, and shows how it can benefit patients.

Cancer cachexia is a metabolic syndrome that is defined by loss of muscle mass. This syndrome can cause a great deal of distress to patients with cancer and their families. This Review article outlines the symptoms, mechanisms and treatment options for cachexia with the aim of improving the quality of life of patients.

Tumour dormancy is when cancer sleeps undetected for periods that can last up to decades. The therapeutic potential of inducing or maintaining this dormant period is clear. This Review describes the mechanisms of dormancy and uses genitourinary cancers as models to demonstrate how dormancy principles could be exploited clinically.

Glioblastomas are difficult to treat, and patients have a poor prognosis. Knowledge of the molecular pathogenesis of glioma has launched an era of targeted-therapies, which are discussed in this Review article. Biomarkers, novel trial design, and the identification of molecular subgroups are other advances that are explored here.

Technological innovations have made possible the integration of imaging technology into the radiation treatment devices to increase the precision and accuracy of radiation delivery. But, this is just the beginning. In this Review, David A. Jaffray discusses the different exciting advances in image-guided radiotherapy to achieve patient-specific radiotherapy treatment courses in the ever evolving field of radiation oncology.

The emergence of individualized medicine has spurred the need for the development of clinical decision-support systems (CDSSs) based on prediction models of treatment outcome. In radiation oncology, CDSSs combine clinical, imaging and molecular factors to achieve the highest accuracy to predict tumour response. Here, the authors provide an overview of these factors—including survival, recurrence patterns and toxicity—and discuss the methodology behind the multistage development of CDSSs.

Hypoxia can affect clinical outcome after radiotherapy, resulting in reduced local tumour control and increased malignant progression. Hence, its detection is of utmost importance, but how can we detect hypoxia? Horsman et al. assess the potential use of imaging to identify hypoxic tumours that would lead to treatment modifications with the aim of improving clinical outcome after radiotherapy.

Are there any methods beyond MRI for brain tumours imaging? This Review by Andrew C. Peet and colleagues discusses the additional information that can be obtained by using functional imaging methods—such as diffusion imaging, perfusion imaging and magnetic resonance spectroscopy—and the challenges in determining the best way to incorporate these techniques into routine clinical practice.

The administration of high-precision radiotherapy, termed stereotactic body radiotherapy (SBRT), delivers high doses of radiation to tumours without greatly affecting adjacent normal tissues. SBRT can affect the disease course for properly selected patients with metastatic cancer with improved palliation, disease response, and long-term disease control. In this Review, the biology, practical aspects of delivery and emerging clinical opportunities for SBRT in limited metastatic cancer patients are discussed.

The question “are we learning anything new?” keeps being asked when related to comprehensive gene analysis of tumours. This Review attempts to answer that question, and describes how new targets are being identified and how that knowledge is being translated into the clinic.

Improvements in the pathological classification of lymphoma have had little impact on advancing drug development or improving the cure rate. The authors discuss the current status of biomarker development in lymphoma, and how novel biomarker-directed clinical trial designs using rationally designed combination strategies will help to improve outcomes in patients with lymphoma.

The development of treatment for rare diseases presents unique challenges. This Review article outlines the discovery process for a number of oncology paradigms in rare tumours, including those that are a subset of more-common cancers. The authors discuss drug-class examples of targeted therapies for orphan diseases, as well as potential therapeutic strategies that can be adopted to treat these orphan conditions.

Allogeneic haematopoietic stem-cell transplantation (HSCT) is frequently applied as part of treatment in patients with acute myeloid leukaemia in their first or subsequent remission. In this Review, the authors propose risk assessment as a dynamic process during treatment, incorporating both disease-related and transplant-related factors for the decision to proceed either to allogeneic HSCT or to apply a nontransplant strategy.

Aspirin has been widely reported to be associated with cancer prevention, and now its use as a cancer therapy option is being explored. In this Review, the authors discuss evidence from trials that suggest that aspirin initiation after the diagnosis of colorectal cancer improves survival. The issues of dosage, duration, toxicity and patient selection are also described.

The association between cancer and angiogenesis has been established for decades, but it is only in the past 10 years that the concept of cancer prevention using antiangiogenic agents has emerged. This Review outlines the mechanisms of action of these preventative agents and proposes that there should be four levels of angioprevention, depending on the cancer risk.

Most studies for identifying biomarkers for oestrogen receptor-α (ERα)-positive breast cancer have been performed using material from consecutive series of patients treated with tamoxifen. Consequently, the predictive value of any biomarker identified is confounded by its prognostic value. In this Review, the authors discuss how different biomarkers might enable the prediction of broad endocrine or agent-specific resistance.

The identification ofBRCA1 and BRCA2 mutations has affected multiple aspects of breast cancer care, including screening and prevention. The authors discuss therapies that have quickly entered clinical practice and highlight some of the challenges in the development of targeted therapies in BRCA1 and BRCA2mutation carriers, as well as specific issues in the area of diagnostic testing related to these targeted therapies.

The needs and treatment requirements of older patients with cancer are different to their younger counterparts. However, few data are available on which to base important clinical decisions for the treatment of this patient population. This Review article outlines the issues and some of the solutions associated with treating cancer in older patients and uses three case studies to illustrate the practical problems that clinicians face.

This Review describes current strategies and future approaches to improve T cell-based therapies to treat post-transplant lymphoproliferative disease, a serious and often life-threatening complication that is associated with Epstein-Barr virus and can occur after haematopoietic stem-cell or solid organ transplantation.

Venous thromboembolism (VTE) is a potentially life-threatening condition that can be associated with significant morbidity and is linked to cancer by numerous pathophysiological mechanisms. Here, the risk factors, mechanisms, prevention, and optimal treatment of VTE in patients with cancer are discussed.