Cancer therapy articles within Nature Reviews Clinical Oncology

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  • Review Article |

    Imaging ovarian cancer and its metastases is important for diagnosis, staging and follow-up. The authors of this Review describe functional imaging techniques that are currently used in the experimental and clinical setting, including their advantages and limitations compared with conventional imaging. In the future, these imaging modalities will provide noninvasive biomarkers of therapeutic response and patient prognosis, which will allow improved patient management and outcome.

    • Stavroula Kyriazi
    • , Stan B. Kaye
    •  & Nandita M. deSouza

  • Review Article |

    Elevations in CA125 measurements often antedate any signs, symptoms or radiographic evidence of disease. Unfortunately, data favoring early therapeutic intervention for recurrent ovarian cancer are lacking. The results of a clinical trial suggest that withholding treatment in the event of isolated rising CA125 levels will not negatively impact overall survival. Women with no clinical evidence of disease should be informed about the usefulness and drawbacks of CA125 measurements, and offered the choice to pursue periodic measurements as well as other surveillance.

    • Amer K. Karam
    •  & Beth Y. Karlan

  • News & Views |

    The results of a randomized, controlled trial investigating the neurocognitive effects of stereotactic radiosurgery (SRS), with or without whole-brain radiation therapy (WBRT), to treat brain metastases demonstrated a significant reduction in learning and memory, associated with the addition of WBRT to SRS. The results indicate that SRS monotherapy is an effective and safe initial management strategy for brain metastases.

    • Nicholas F. Marko
    •  & Robert J. Weil

  • News & Views |

    Patients who undergo hepatic surgery for initially resectable liver metastases from colorectal cancer have a 70% risk of relapse. A recent phase III randomized trial has failed to demonstrate an improvement in disease-free survival with the addition of irinotecan to 5-fluorouracil and folinic acid as adjuvant treatment for patients with radically resected colorectal cancer with liver metastases.

    • Fotios Loupakis
    •  & Alfredo Falcone

  • News & Views |

    The effect of PSA level on distant metastases and cause-specific mortality was assessed in a recent study, and showed a nadir PSA level 1.5 ng/ml within 2 years of radiotherapy treatment predicts distant metastases and death from prostate cancer.

    • Mark K. Buyyounouski

  • News & Views |

    EGFR inhibitors provide benefit in patients with advanced and metastatic head and neck squamous cell carcinoma (HNSCC). Mass spectrometry profiling has been used to predict outcome in patients with HNSCC after EGFR inhibitor treatment, and may enable prior identification of patients most likely to benefit from these therapies. However, further validation in prospective studies is needed.

    • Mei-Kim Ang
    •  & D. Neil Hayes

  • News & Views |

    Dose-dense administration of paclitaxel as well as intraperitoneal administration of platinum and paclitaxel as first-line treatments provide similar advantages compared with standard treatment in advanced ovarian cancer. Both approaches, however, need to be confirmed by additional studies. A low dose of pegylated liposomal doxorubicin combined with carboplatin is superior to standard paclitaxel and carboplatin in relapsed platinum-sensitive ovarian cancer.

    • Thomas Hogberg

  • Case Study |

    This Case Study describes a patient with multiple myeloma and renal impairment who developed acute renal failure after three cycles of bortezomib-based primary therapy. Second-line lenalidomide and dexamethasone, with lenalidomide dose adjustment according to the patient's renal function, was well tolerated. This therapy elicited a rapid, durable partial tumor response and prompt improvement in the patient's kidney function.

    • Heinz Ludwig
    •  & Niklas Zojer

  • Review Article |

    The first generation of anti-cancer agents using novel nanomaterials has successfully entered widespread use and newer nanomaterials are gaining increasing interest as potential multifunctional therapeutic agents. The authors of this Review discuss how the new features of these agents could potentially allow increased cancer selectivity, changes in pharmacokinetics, amplification of cytotoxic effects, and simultaneous imaging capabilities.

    • David A. Scheinberg
    • , Carlos H. Villa
    •  & Michael R. McDevitt

  • Review Article |

    Mammalian target of rapamycin (mTOR) has a key role in several pathways that are involved in cell growth and cancer. In this Review, Dr. Dancey outlines the mechanisms of action and performance of current mTOR inhibitors in clinical trials. Second-generation inhibitors are also discussed along with strategies that should be used to improve outcomes achieved with mTOR inhibitors.

    • Janet Dancey

  • Review Article |

    Painful bone metastases can be treated with radiotherapy, and single-fraction radiotherapy with 1 × 8 Gy has been shown to be as effective for pain relief as multi-fraction regimens. The authors discuss why single-fraction radiotherapy is considered the standard regimen for uncomplicated painful bone metastases without pathological fractures or spinal cord compression, and highlight the reasons why long-course multi-fraction radiotherapy should be reserved for patients with a relatively favorable survival prognosis.

    • Dirk Rades
    • , Steven E. Schild
    •  & Janet L. Abrahm

  • Review Article |

    Surgery of esophageal cancer is associated with a poor prognosis, yet there is no international consensus on the optimal management of operable esophageal cancer. The authors of this Review discuss the role of perioperative chemotherapy and definitive chemoradiation, and the associated survival benefits.

    • Alicia Okines
    • , Bhupinder Sharma
    •  & David Cunningham

  • News & Views |

    Chemoradiotherapy and surgical resection are important elements of multimodality treatment for patients with locally advanced rectal cancer. The optimum sequence of these modalities has been addressed in several randomized trials and preoperative chemoradiotherapy has been shown to be superior to postoperative treatment for a variety of end points.

    • Claus Rödel

  • News & Views |

    The addition of hormonal therapy to radiation therapy improves survival in men with unfavorable risk prostate cancer. Yet, men with prostate cancer have higher rates of non-cancer death than the general population and most will die from causes other than their index malignancy. Co-morbid cardiovascular disease is strongly associated with cause of death and this raises the possibility that prostate cancer or its treatment increases cardiovascular disease risk and possibly mortality.

    • Jason A. Efstathiou
    • , William U. Shipley
    •  & Matthew R. Smith

  • News & Views |

    The success achieved in the management of children with acute lymphoblastic leukemia has now been extended to older adolescents and young adults, as demonstrated recently by Nachman and coauthors. The effectiveness of treatment with an intense multiagent chemotherapy protocol renders the use of allogeneic hematopoietic stem-cell transplantation in first remission questionable, and calls for careful evaluation of the use of this chemotherapy in this patient population.

    • Raymond Hutchinson

  • News & Views |

    A randomized phase III trial for advanced pancreatic cancer comparing gemcitabine with gemcitabine plus capecitabine has again demonstrated that combination chemotherapy provides no significant outcome advantage for patients. A marked change in treatment paradigm is essential if therapeutic interventions are to move beyond the persistently dismal outcome results for the majority of pancreatic cancer patients, as exemplified by the past decade of clinical research.

    • Jordan Berlin
    •  & Al B. Benson III

  • News & Views |

    A minority of patients with primary central nervous system lymphoma (PCNSL) achieve a complete response to therapy and most patients have a poor prognosis. A recent randomized phase II trial demonstrated that the addition of high-dose cytarabine to high-dose methotrexate increases the complete response rate and improves patient outcome.

    • Stephen M. Ansell
    •  & S. Vincent Rajkumar

  • News & Views |

    Disappointing phase III results for thalidomide combined with gemcitabine and carboplatin in patients with advanced non-small-cell lung cancer might be related to poor efficacy of targeted therapies in unselected patients. We argue that current trial designs are flawed because they expose large numbers of such patients to potentially harmful treatment, and suggest that future research strategies should prioritize identification of predictive markers.

    • Martin Reck
    •  & Ulrich Gatzemeier

  • News & Views |

    In Japan, it is quite rare for an investigator to submit an investigational new drug application to initiate a clinical trial and obtain approval of a drug on the basis of clinical trial results. This means that development of new therapies is currently driven almost entirely by pharmaceutical companies as opposed to independent investigators. Here, we provide our perspective on the reasons for this situation and advocate investigator-initiated cancer drug development as a means of increasing access to better therapies for Japanese cancer patients.

    • Chiyo K. Imamura
    • , Naoko Takebe
    •  & Naoto T. Ueno

  • Opinion |

    Defective DNA mismatch repair (MMR) occurs in approximately 15% of sporadic colorectal cancers. Studies have shown that patients with MMR-deficient colorectal cancers have a more favorable prognosis, but evidence indicates these patients do not benefit from adjuvant 5 fluorouracil-based chemotherapy. The importance of determining MMR status to inform clinical decision-making for adjuvant chemotherapy in patients with stage II colon cancer is discussed.

    • Frank A. Sinicrope

  • Review Article |

    Melanoma is an increasing problem, especially in the elderly population. In this article, the authors highlight key aspects of the epidemiology, presentation, staging and management of melanoma. They also emphasize the need for greater understanding and awareness of this cancer to optimize patient outcomes.

    • Susan Tsai
    • , Charles Balch
    •  & Julie Lange

  • Review Article |

    Microsatellite instability (MSI) is a frequent molecular phenomenon of colorectal cancer and is associated with deficient DNA mismatch repair. This Review presents an overview of MSI, including its clinical features and applications. The authors discuss the prognostic and predictive value of MSI and how it can be used to improve our knowledge of other cancer subtypes.

    • Eduardo Vilar
    •  & Stephen B. Gruber

  • Review Article |

    Breast cancer is a heterogeneous disease with different molecular drivers regulating its growth, survival and treatment response. Drug development efforts have resulted in agents against new molecular targets that are active against only those tumors with the targeted molecular alteration or phenotype. The authors critically discuss the recently established and investigational strategies for the treatment of the main breast cancer subtypes.

    • Serena Di Cosimo
    •  & José Baselga

  • News & Views |

    Chemotherapy options for patients with extensive-stage small-cell lung cancer (SCLC) are limited. A recent phase III trial assessed the combination of carboplatin and pemetrexed but this regimen produced inferior survival results compared with the standard carboplatin and etoposide regimen. The combination of carboplatin and etoposide remains the standard first-line chemotherapy option for the treatment of patients with extensive-stage SCLC.

    • Janakiraman Subramanian
    •  & Ramaswamy Govindan

  • News & Views |

    Activating mutations in EGFR are characteristic of patients with lung cancer who have high sensitivity to EGFR tyrosine kinase inhibitors, such as gefitinib and erlotinib. The randomized IPASS study by Mok and colleagues confirmed that patients with EGFR mutations have a higher response rate, longer progression-free survival and improved quality of life when treated with first-line gefinitib instead of chemotherapy.

    • Joel W. Neal
    •  & Lecia V. Sequist

  • News & Views |

    Dose-dense chemotherapy has been proposed to improve breast cancer outcome due to its ability to prevent cancer cell repopulation; however, little is known about which patients benefit most from such scheduling. A pooled analysis of studies assessing dose-dense adjuvant chemotherapy has shown that most of the therapeutic benefit derived from dose-dense scheduling arises in patients with node-positive, triple-negative disease.

    • Eitan Amir
    • , Alberto Ocana
    •  & Bostjan Seruga

  • News & Views |

    First-line platinum and taxane chemotherapy improves the prognosis of patients with epithelial ovarian cancer (EOC), however, about 80% of patients relapse and long-term survival is poor. The development of drug resistance is the main cause of treatment failure; therefore, the identification of new compounds that interfere with tumor growth and survival is a priority.

    • Cristiana Sessa
    •  & Gianluca Del Conte

  • News & Views |

    We reviewed the results of the Gynecological Oncology Group 204 (GOG-204) randomized phase III trial, which investigated four cisplatin combination chemotherapy regimens for the treatment of patients with recurrent or metastatic cervical carcinoma. As the overall survival was similar between all arms, treatment recommendations need to be tailored based on toxic effects.

    • David O. Holtz
    •  & Charles J. Dunton

  • News & Views |

    The considerable progress made in the field of clinical neuro-oncology and the understanding of brain tumor biology is generating cautious optimism. Treatment options for patients with glioblastoma multiforme (GBM), the most common form of malignant gliomas, now include anti-angiogenic therapy after failure of standard multi-modality treatments. Furthermore, scientific advancements are providing new insights into disease pathogenesis and point to novel therapeutic approaches for a disease that traditionally lacked treatment options.

    • Deric M. Park
    • , Sith Sathornsumetee
    •  & Jeremy N. Rich

  • Review Article |

    Pancreatic adenocarcinoma is the most lethal of the solid tumors and most patients present with locally advanced or metastatic disease that precludes curative resection. Considerable efforts have been made during the past decade to identify better systemic treatments. The authors of this Review discuss the current standards of care for patients with locally advanced and metastatic pancreatic carcinoma, and outline future directions for the development of new treatment strategies.

    • Anastasios Stathis
    •  & Malcolm J. Moore

  • News & Views |

    Motzer and colleagues present updated results from a multicenter, phase III trial of sunitinib versus interferon-α as first-line treatment for patients with metastatic renal-cell carcinoma. The observed improvement in overall survival for patients treated with sunitinib further establishes this agent as the reference standard for first-line treatment of good-risk and intermediate-risk patients with metastatic renal cancer.

    • Jason E. Faris
    •  & M. Dror Michaelson

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