Reviews & Analysis

Quality-of-life improvements and nutritional status are important in the management of cancer patients, but are often overlooked. Treatments for anorexia and cachexia are often attempted during the advanced stages of the disease. Cytokines and tumor-derived factors appear have a significant role in the pathogenesis of anorexia and cachexia. Laviano et al. discuss the pathogenesis and diagnosis of cachexia and anorexia, focusing on the dietary and drug interventions, which can prolong survival and positively influence quality of life for cancer patients.

Epstein–Barr virus (EBV)-associated malignancies are a heterogenous group of tumors that are generally relatively radiosensitive and chemosensitive in their early stages, but less amenable to conventional modality therapy in late stage or relapse. New and emerging strategies to manipulate the immune response are discussed. These strategies are used either alone or as an adjuvant therapy in combination with chemotherapy with or without monoclonal antibodies.

Diagnostic improvements and earlier detection of tumors have resulted in the emergence of a shift from Halsted paradigm, which has encouraged the use of systemic adjuvant therapy. With these changes in tumor paradigm, the rationale for local treatment as a curative treatment strategy has been challenged. This Viewpoint emphasizes the importance of local control in this scenario.

While the potential for therapeutic cancer vaccines has been recognized, based on modest clinical trials in the metastatic setting, a gap exists between the limited clinical activity of cancer vaccines and promising preclinical findings. Morseet al. discuss the relevance of appropriate platforms for cancer vaccine testing, identification of the most important biologic endpoints, and reiterate the need to improve our understanding of how to manipulate the immune system beyond the initial vaccine-induced stimulation. The authors focus on the areas of cancer vaccine development that will translate into clinical application.

The function ofHelicobacter pyloriin inflammation-induced gastric cancers is one of the best studied infectious etiologies. A better understanding of the molecular mechanisms underpinning this process, and the role of inflammation in malignancies seen in other organs where inflammation is common, will lead to novel cancer prevention and treatment strategies for gastric cancers and other malignancies.

Statins are commonly prescribed to treat dyslipidemia and to prevent coronary artery disease, but studies also indicate their potential for cancer prevention. Preclinical data suggest pleiotropic antineoplastic effects of statins, but clinical data assessing cancer risk associated with statin use are conflicting. This review critically discusses the existing evidence highlighting the role of statins for cancer chemoprevention.

Survival rates for patients with gastric cancer in Japan are considerably higher than reported for US patients. Surgery for gastric cancer is the mainstay of treatment, but the extent of regional lymphadenectomy is under considerable debate. Roukos and Kappas provide insights explaining the reasons for differences in treatment decisions between the US and Japan. The latest data from recent trials are discussed together with neoadjuvant treatment options, which could improve clinical outcomes.

Hodgkin's lymphoma has become a curable disease successfully treated using dose-escalated BEACOPP chemotherapy regimens pioneered by the German Hodgkin's Lymphoma Study Group. However, the unacceptable side effects of chemotherapy have propagated new therapeutic concepts based on biological characteristics of the disease to be explored. This viewpoint discusses the promises and pitfalls of targeted therapy.

The combination of transurethral resection of the bladder tumor (TURBT), chemotherapy, and radiotherapy in selected patients with bladder cancer may result in survival rates comparable to the best cystectomy series, while preserving bladder function. This Viewpoint article discusses the role radiotherapy plays in this approach.

The use of prognostic and predictive factors for the treatment of breast cancer patients has both advantages and limitations when applied to the interpretation of microarray data in the clinical setting. This review focuses on the critical aspects of genomic parameters and how the information gleaned from microarray analysis can be used to enhance clinical therapy.

Radical surgical treatment for breast cancer has become superseded by breast conserving surgery with protracted whole breast irradiation. The last decade has seen the emergence of a new treatment paradigm for early breast cancer in the form of partial breast treatment with conservative surgery and accelerated partial breast irradiation. Survival, cosmetic, and cost implications are comprehensively discussed.

Intensity-modulated radiation therapy (IMRT) is a new technical advance in radiotherapy that delivers high dose of radiation to the tumor, while reducing the dose to adjacent non-target tissue, thereby sparing critical organs. This technique is especially attractive for treating head and neck cancers, and this review critically discusses the advantages of this targeted therapy.

Treating cancer patients who have type II diabetes is a challenge, especially as cardiac, renal, and neurologic complications need to be considered. This review discusses the evidence from population-based studies and clinical trials, and suggests how improvements in cancer outcomes can be achieved by improved diabetes control.

In the treatment of rectal cancer, the additional use of radiotherapy has changed treatment policy dramatically. Compelling data showed that preoperative radiotherapy, in addition to surgery for resectable rectal cancer, is superior to postoperative treatment. Considering evidence-based data, it is hard to understand why preoperative radiotherapy has not been accepted in the US.

In 1990, an NIH Consensus Conference recommended postoperative chemoradiotherapy as standard treatment for stage II and III rectal cancer. Many European centers and even some countries have adopted the US recommendations as standard care. In other parts of Europe, however, the jury is still out, as discussed in this Viewpoint.

Advances in imaging and computing technology have improved the targeting of tumor tissue using conventional X-ray therapy, especially for the treatment of childhood brain tumors. Proton radiotherapy allows better sparing of normal tissues than the most conformal photon radiation. The characteristics of this technology and examples of who would benefit most from this treatment are discussed.

Untangling the complex pathways underlying the major cancer phenotypes remains a significant challenge, but deregulated expression of a single multi-component enzyme, telomerase, is implicated as a causative factor for immortalization in the vast majority of human tumors. This review highlights the potential of telomerase as a target for novel cancer gene therapies.

High-throughput technologies have been developed in hopes of increasing the pace of biomedical research, accelerating the rate of translation from bench to bedside. Using such technology in target discovery has necessitated validation of the targets in an equally rapid manner. This review looks at the role of tissue microarrays in validating potential tumor biomarkers, now and in the future.

Among the most intensely studied new agents are the epidermal growth factor receptor (EGFR) inhibitors. This review focuses on how radiosensitization of tumors by EGFR inhibitors may be mediated, with reference to cell proliferation, survival, angiogenesis, and DNA repair. Defining the signals involved in radiosensitization could potentially predicting response and guide approaches to combine further novel regimens.