Chemotherapy articles within Nature Reviews Clinical Oncology

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  • Review Article |

    Adjuvant treatment with anthracycline–taxane combination therapy in high-risk early-stage breast cancer has raised the important question of how to manage patients who relapse. In the metastatic setting, one option is rechallenging with the same agent, or class of agent, that has been used in the adjuvant setting. This Review comprehensively examines the evidence from clinical trials for rechallenging with both anthracyclines and taxanes, and highlights issues to be examined in the context of future clinical trials.

    • Carlo Palmieri
    • , Jonathan Krell
    •  & David Miles

  • Review Article |

    This Review discusses the advantages and disadvantages of weekly paclitaxel for the treatment of relapsed ovarian cancer. When compared with the 3 weekly schedule, weekly paclitaxel is better tolerated, with a reduced frequency of toxic effects; however, response duration can be short. Importantly, patients with tumors that are resistant to 3-weekly paclitaxel have responded to treatment with weekly paclitaxel. Current research focuses to increase response duration include the combination of weekly paclitaxel with molecular-targeted agents and the use of molecular profiling to better select patients for treatment.

    • Richard D. Baird
    • , David S. P. Tan
    •  & Stan B. Kaye

  • News & Views |

    The optimum approach for the treatment of rare anaplastic gliomas following surgical resection is uncertain. A recent study has now provided a greater understanding of the heterogeneous tumor biology of these tumors and has emphasized the prognostic importance of chromosome 1p19q deletion, IDH mutation and MGMT promoter methylation. The importance of radiotherapy and chemotherapy for treating these heterogeneous tumors is being elucidated for subgroups of patients.

    • Patrick G. Morris
    •  & Andrew B. Lassman

  • News & Views |

    Investigators found that denileukin diftitox, which targets the interleukin-2 receptor, achieves objective response rates in 44% of patients with cutaneous T-cell lymphoma, with a median duration of response of 7.8 months and 2% incidence of severe vascular leak syndrome. The inclusion of a placebo arm in the study revealed several additional interesting observations.

    • Marshall E. Kadin
    •  & Eric C. Vonderheid

  • News & Views |

    A phase III trial investigated the efficacy of carboplatin and a taxane with and without cetuximab, a monoclonal antibody against EGFR, in patients with advanced non-small-cell lung cancer. This trial did not reveal an improvement in the primary end point of progression-free survival (according to an independent radiological review committee) with the addition of cetuximab to the carboplatin and taxane regimen. A retrospective investigation of potential biomarkers did not reveal any significant association between these biomarkers and cetuximab efficacy.

    • Thomas E. Stinchcombe
    •  & Mark A. Socinski

  • Review Article |

    Chronic lymphocytic leukemia has long been regarded as an incurable disease of the elderly. Consolidation strategies using non-cross resistant agents have improved the success rates of patients with residual disease at the end of induction treatment. This Review discusses chemoimmunotherapy regimens that contain purine analogs and rituximab and considers new developments in induction and consolidation strategies that are leading the path towards cure.

    • Constantine S. Tam
    •  & Michael J. Keating

  • News & Views |

    In the NOAH clinical trial, trastuzumab treatment for locally advanced breast cancer was associated with increased complete and overall response rate and improved event-free survival. The ability to identify this advantage in a relatively smaller number of patients (compared with adjuvant therapy trials) suggests that the neoadjuvant setting might serve to inform the design of adjuvant trials and indicate appropriate off-study adjuvant therapy.

    • Heather L. McArthur
    •  & Clifford A. Hudis

  • Review Article |

    Metronomic chemotherapy is the chronic administration of chemotherapeutic agents at relatively low, minimally toxic doses, and with no prolonged drug-free breaks. This type of chemotherapy inhibits tumor growth primarily through anti-angiogenic mechanisms. The latest clinical trials of metronomic chemotherapy in adult and pediatric cancer patients are discussed and the authors highlight the research efforts that need to be made to facilitate the optimal development of metronomic chemotherapy in the clinic.

    • Eddy Pasquier
    • , Maria Kavallaris
    •  & Nicolas André

  • News & Views |

    Management of high-risk non-muscle-invasive bladder cancer represents a difficult challenge in clinical practice. The dilemma is to decide between an organ-sparing approach or radical cystectomy with the risk of undertreatment or overtreatment for this group of patients. This issue is especially important for patients who have failed previous intravesical therapy.

    • Christian Weiss
    •  & Claus Rödel

  • Review Article |

    Prognostic and predictive markers in colon cancer might help define which patients with stage II disease are likely to benefit from adjuvant therapy. In this Review, Tara Gangadhar and Richard Schilsky discuss the recent clinical development of such markers, including microsatellite instability and 18q loss of heterozygosity. Further validation of these markers could potentially lead to the individualization of adjuvant therapy in colon cancer.

    • Tara Gangadhar
    •  & Richard L. Schilsky

  • 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 |

    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 |

    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 |

    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 |

    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

  • 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

  • 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 |

    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 |

    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

  • 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

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