Reviews & Analysis

For patients with metastatic colorectal cancer, various treatment options exist; however, all are associated with adverse events. Although the majority of these adverse events are minor, some adverse effects might be severe. This Review describes the toxic effects reported in key clinical trials of biologic and cytotoxic agents. The author discusses the strategies that can be implemented to manage toxicity and to minimize treatment interruption or discontinuation, and enhance quality of life.

The use of MRI for the management of prostate cancer is controversial; however, technological advances in the past few years indicate that this diagnostic approach should be utilized. The authors propose MRI could improve risk stratification not only for those diagnosed with prostate cancer but in men prior to a biopsy. They explain how MRI evaluation could help select those men who require intervention and avoid biopsy and unnecessary treatment in others.

Targeted therapies such as tyrosine kinase inhibitors (TKI) have been shown to induce hypothyroidism and thyroid dysfunction. The management of thyroid dysfunction and possible related symptoms, such as fatigue, represents a challenge to oncologists. The authors review the available data of TKI-related thyroid dysfunction and propose a diagnostic and therapeutic algorithm for the management of TKI-related hypothyroidism.

Well-differentiated neuroendocrine tumors (NET) are usually slow-growing cancers even when they exhibit local invasion or metastases. Surgery is curative in a minority of patients and systemic chemotherapy is minimally effective. Important cellular processes involved in the pathogenesis of NET have now been identified. In this Review, Reidy et al. discuss the data regarding therapies currently used for treating well-differentiated NETs and the strategies being used in clinical trials.

Bone is the most common organ for tumor metastasis, especially in patients with cancers of the breast or prostate. Bone metastases disrupt skeletal metabolism, resulting in considerable skeletal morbidity and chronic pain. This Review summarizes the clinical trial data of bisphosphonates for the prevention of skeletal-related events and the palliation of bone pain. The authors discuss how nitrogen-containing bisphosphonates have demonstrated great promise in patients with advanced malignancies.

Women with cancer treated with radiotherapy who become pregnant have an increased risk of poor fetal outcome. The case of a 27-year-old woman who became pregnant while receiving radiotherapy for Hodgkin lymphoma and gave birth to a healthy infant is described. The authors suggest that careful evaluation of fetal exposure to radiation should be performed in each individual case to allow pregnant patients to decide on the fate of their pregnancy.

Balloon-based brachytherapy was developed to simplify the bracytherapy technique to make it more accessible to breast cancer patients. Balloon-based brachytherapy is associated with a more-convenient delivery of radiotherapy, improved quality of life and patient compliance. This Review discusses a new device called Xoft Axxent^®electronic brachytherapy, which uses a disposable electronic radiation source and avoids the need of a high-dose-rate afterloader unit, thereby enhancing the convenience for patients.

Determining the correct dosage for the majority of chemotherapeutic agents presents a challenge for clinicians because there is a fine balance between doses that cause significant drug toxicity and loss of efficacy. This Review discusses the current limitations of body surface area-based dosing, provides examples of successful pharmacogenomics investigations that have used drug-metabolizing enzymes to decrease drug toxicity or improve efficacy, and highlights promising advances in pharmacogenomic-directed pharmacotherapy.