Viewpoint in 2007

Patients rely on health-care professionals to provide them with relevant and clear information about their disease and its treatment. Recent research has shown that physicians are viewed as the most important source of information for patients with breast cancer; however, physicians do not necessarily provide patients with the information they need to be able to make an informed decision, as discussed in this Viewpoint.

Breast cancer screening requires a high level of compliance in order to be effective. The author of this Viewpoint discusses the socio-economic and cultural factors associated with screening in developing countries.

The incidence of the skin malignancy, melanoma, is increasing and it often becomes refractory to common therapies after metastasis. In this Viewpoint the author discusses different therapeutic approaches for metastatic melanoma.

The immunosuppressive impact of melanoma upon the human body is now beginning to be understood and interferon α2b at high dosage is critical to the reversal of signaling defects in the T cells of melanoma patients. The authors of this Viewpoint discuss the use of high dose interferon α2b in patients with high risk melanoma.

Women who carry a germline mismatch-repair mutation causal to Lynch syndrome have increased risks of developing endometrial carcinoma and ovarian cancer, as well as colorectal carcinoma. This Viewpoint outlines the rationale for the use of lifesaving prophylactic gynecologic surgery in these women following childbearing, with testing and surveillance unless and until such surgery is performed.

Hypothyroidism seems to be a risk of sunitinib therapy for cancer. The authors of this Viewpoint review the evidence for the occurrence of hypothyroidism in this setting and discuss possible actions of thyroid hormone replacement in the cancer patient.

Should patients with stage I non-small-cell lung cancer who are unsuitable for surgery receive hypofractionated stereotactic radiotherapy? In the rush to implement new technology, there could be a danger of overlooking refinements important to ensure safety, according to the author of this Viewpoint.

Angiogenesis is one of the fundamental processes during tumor growth and disease progression, and is regulated by numerous molecular pathways, including, but not limited to, VEGF, matrix metalloproteinases (MMPs), endoglin (CD105), integrin α_vβ₃and E-selectin. All these pathways could serve as targets for molecular imaging, as outlined in this Viewpoint.

The issues of appropriate tumor marker assessment and the technical challenges of imaging tools are discussed in this Viewpoint by Usha Menon.

There are a number of factors that make cancer screening more difficult in the lungs than in other organs. These factors include the characteristics of the patient group being screened, the heterogeneous nature of lung cancer and issues with the screening process itself, as discussed in this Viewpoint.

The evidence for use of spiral CT for lung cancer screening and the results and implications of the International Early Lung Cancer Action Program study are discussed in this Viewpoint.

This Viewpoint compares targeted intraoperative radiotherapy with other forms of partial breast irradiation. Advantages of targeted intraoperative radiotherapy include reduced risk of the target area being untreated, the potential to add external-beam whole-breast radiotherapy, cost-effectiveness of this technique and relatively straightforward technical requirements.

This Viewpoint compares external-beam-based partial breast irradiation with other forms of partial breast irradiation. With appropriate patient selection, delivery of partial breast irradiation through an external-beam approach presents many advantages, including patient acceptability, ease of use and cost effectiveness. Silvia Formenti discusses the relative merits of prone and supine patient positioning during external-beam radiotherapy and the important challenges that remain.

This Viewpoint compares MammoSite^® brachytherapy with other forms of partial breast irradiation. Although very few reports on clinical efficacy have been published, indications so far are that the MammoSite^®catheter is technically simple, adequately spares normal tissues, and is associated with a favorable cosmetic outcome and toxicity profile. The choice of the optimal irradiation method remains complex and requires input from both treating physicians and their patients.

This Viewpoint compares multicatheter brachytherapy with other forms of partial breast irradiation. As the forerunner of other ABPI techniques, interstitial brachytherapy has to its credit the best intermediate-term to long-term oncological and cosmetic results, and to its discredit some of the highest recurrence and complication rates. Enhancements to quality assurance and patient selection criteria could hold the key to best practice.

The authors of this Viewpoint argue there are no facile solutions to replace the painstaking, empirical effort required to identify the targets within 'addicted' tumors. Redundant pathways and our incomplete understanding of drug targets cast doubt on biomarker evidence unless reinforced by biological observations. Further integration of academia, industry and the regulatory organizations is required.

ERα and ERβ are structurally and functionally distinct, but currently only ERα is used to guide clinicians. The authors of this Viewpoint discuss whether this strategy is sufficiently informative, and how outcome and tumor response to adjuvant hormonal therapy can be followed more effectively.

In this Viewpoint, Richard Kaplan asserts that phase II oncology trials could be improved using strategies such as adding a 'real-world' cohort, validating biomarkers across trials, utilizing factorial designs to answer several clinical questions simultaneously, and coordinating academic trial design on an international basis.

Legal barriers, restricted resources, lack of physician training, and physician and patient worries about potential opioid addiction can be barriers to effective and rational pain management in patients with cancer pain. Sebastiano Mercadante discusses these issues, as well as suggesting interventions for improving care.

Observations that CTLA4 has a key role in regulating immune responses mediated via T cells have led to therapeutic approaches targeting this inhibitory pathway for tumor immunotherapy. It is possible that combining anti-CTLA4 antibodies with a vaccine may help to direct immune responses toward target antigens, enhancing clinical efficacy and perhaps reducing treatment-related adverse effects. These theories have been tested in clinical trials in patients with advanced prostate cancer, as discussed in this Viewpoint.