Volume 10 Issue 6, June 2013

A recent study has highlighted the risks and benefits associated with the administration of intermittent androgen deprivation therapy in patients with metastatic prostate cancer. Although there are improvements in many quality-of-life domains, these improvements must be carefully weighed against the potential harms of intermittent androgen deprivation therapy in this patient population.

Nomograms have been constructed to provide patient-specific predictions for overall survival and disease-free survival after resection for patients with primary localized retroperitoneal soft tissue sarcoma, by combining data registered across three institutional databases. However, whether overall survival, or disease-free survival, is a more useful predictor is disputable.

Radiotherapy is known to cause heart disease. A recent analysis challenges several long-held tenets, indicating that radiation-induced cardiotoxicity might occur at lower doses, and earlier, than generally believed. We must be mindful of this toxicity and limit cardiac radiation dose as much as possible.

The addition of lapatinib to paclitaxel improves survival in patients with newly diagnosed HER2-positive metastatic breast cancer, further validating the importance of HER2 signalling as a target in this cancer subtype. However, the availability of other more-effective and less-toxic HER2-targeted therapies limits the clinical usefulness of the regimen.

For patients in low and middle-income countries (LMICs), many of the advances in medical oncology enjoyed in the developed world are nothing but an aspiration for the future. However, as Gilberto Lopes Jr and colleagues describe, LMICS are using generic and biosimilar drugs, expanding participation in clinical trials, implementing universal health-care schemes, using compulsory licensing schemes and increasing public–private partnerships to increase access to cancer medications for their citizens.

Although surgery is a requirement for a potential cure from pancreatic cancer, it is usually diagnosed at a late stage, when surgical intervention is not straightforward. This Review article outlines the controversies surrounding the treatment options for patients with advanced-stage pancreatic cancer, from surgery through to chemotherapy, radiotherapy, targeted agents and palliative care.

Lung cancer is the leading cause of cancer death in the world. Although smoking cessation will have the greatest impact on lung cancer development, chemoprevention could prove to be very effective. The authors discuss the principles of chemoprevention, including data from preclinical models, completed clinical trials and observational studies, and describe new treatments for novel targeted pathways and future chemopreventive efforts.

In selected patients with early stage breast cancer, accelerated partial breast irradiation (APBI) has emerged as an alternative treatment option to whole breast irradiation. The authors of this article review the available modalities, patient selection criteria and consensus guideline recommendations, and current controversies in APBI, and discuss why it has become an accepted therapy for suitably selected patients outside of clinical trials.

In this Perspectives article, the authors propose that lower histological grade in breast cancer might be a hallmark of relative chromosomal stability, which in turn might be predictive of additional benefit from taxane-based chemotherapy in women with oestrogen-receptor-positive cancer. They interpret published data to on the relationships between tumour grade, chromosomal instability and intratumour heterogeneity and discuss the potential use of chromosomal instability to tailor therapy.