Volume 2 Issue 9, September 2005

Differences in cancer survival rates throughout Europe are difficult to interpret, but declines in cancer mortality rates from breast cancer and colorectal cancer occurring in many developed countries reflect the great advances in cancer control that have been made in recent years.

In this provocative Viewpoint the authors challenge the concept that patients in clinical trials have a better survival and quality of life than those managed routinely. For instance, phase III trials of breast cancer that restrict access to post-study salvage chemotherapy have yielded 'superior' survival data for investigational drug combinations compared with single-agent therapy, despite poor survival in all cohorts. Should such studies set new standards of care for our patients?

Most modern medical centers worldwide now offer sentinel lymph node (SLN) biopsy for treating melanoma and breast cancer, yet debate continues regarding whether SLN biopsy should be routinely used in clinical practice. The authors assert that SLN biopsy is an accurate, safe and minimally invasive staging technique that is an extremely powerful prognostic tool, and should be considered a staging procedure, not a therapeutic one. This review provides a concise overview of the current literature on SLN biopsy and discusses the controversies associated with technical and patient management issues.

Some molecular targeted therapies can confer radiation response and minimize toxicity compared with chemoradiation regimens. Many of these molecular targeted drugs are being tested in clinical trials in combination with radiotherapy; however, for the optimal translation of these drugs in the clinical setting, their safety must be demonstrated in phase I clinical trials. The combination of new molecular targeted therapies and radiation might not necessarily be equivalent to the toxicity of the targeted drug plus the usual toxicity of radiation. Deutschet al. discuss the need for specific and long-term clinical evaluation and the necessity to reassess phase I strategies, toxicity endpoints, and trial concepts in order to fully optimize these regimens.

In oncology, hundreds of prognostic marker studies are published each year, yet few markers have been demonstrated to be clinically useful. Altman and Riley discuss the pitfalls associated with publication bias, inadequate reporting and retrospective studies, and advocate that an evidence-based approach should be adopted. The authors comment on the advantages of making individual patient data available and improving the reporting of the results of prognostic marker studies.