Health sciences articles within Nature Reviews Clinical Oncology

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  • News & Views |

    A recent landmark study reported the long-term results that compared a standard course of whole-breast irradiation (25 treatments over 5 weeks) with a hypofractionated course of radiation (16 treatments over 3.5 weeks) in patients with early-stage, node-negative breast cancer. The trial demonstrated equivalence of results with respect to overall survival, local control, toxicity and cosmetic outcomes.

    • Bruce G. Haffty

  • News & Views |

    Prognostic models for patients with Hodgkin lymphoma are imperfect and do not allow a precise individualized therapy. A recent gene-expression profiling study, translated into a routine immunohistological test, identified genes of tumor-associated macrophages as being responsible for treatment outcome in patients with Hodgkin lymphoma. If this finding is confirmed by other investigators, it could be a major step towards personalized therapy for patients with Hodgkin lymphoma.

    • Volker Diehl

  • 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

  • News & Views |

    Although high-dose methotrexate is widely accepted as the most effective chemotherapeutic agent for primary CNS lymphoma, no optimal dose or dosing strategy has been established. Researchers from the International Extranodal Lymphoma Study Group used clinical trial data to explore whether or not an area under the curve model might be useful to optimize methotrexate dosing. The results strongly suggest that effective methotrexate dose is an important variable in patient outcome.

    • Lauren E. Abrey

  • News & Views |

    Imatinib 400 mg has been the first-line therapy for chronic myeloid leukemia (CML) since 2001 but may have been licensed at too low a dose. A recent study compared the standard dose with higher doses in patients with newly diagnosed CML and found no difference in response rates at 12 months. But, is the devil in the detail?

    • Jane F. Apperley

  • Review Article |

    The number of young cancer survivors is increasing owing to advances in cancer therapeutics, but many face infertility as a result of their treatment. Teresa Woodruff highlights the obstacles to fertility preservation in young cancer patients and describes how the Oncofertility Consortium is addressing these issues by integrating a multidisciplinary network of specialists to assess the impact of treatment, allows research advances in fertility-saving options, and provides patients with the best possible care.

    • Teresa K. Woodruff

  • Case Study |

    A 63-year-old male patient under chronic treatment with sorafenib for an unresectable multifocal hepatocellular carcinoma (HCC) presented with suspected variant angina. Spontaneous spasm occurred during cardiac catheterization and was revealed during coronary angiogram with the unusual feature of a retrograde transient filling of a contralateral branch. Italo Porto and colleagues contend that the effects of sorafenib treatment were primarily responsible for the major cardiovascular event observed in this case, and suggest that clinicians should be aware of this possible severe complication of sorafenib therapy.

    • Italo Porto
    • , Andrea Leo
    •  & Filippo Crea

  • 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

  • Review Article |

    Two gene-expression-based reference laboratory tests, MammaPrint® and Oncotype Dx®, are available for prognostication of patients diagnosed with breast cancer. This Review provides a conceptual and practical overview of these two tests and describes the clinical contexts for which these assays were developed so oncologists can select the most appropriate assay based on specific clinical contexts.

    • Chungyeul Kim
    •  & Soonmyung Paik

  • Review Article |

    Many men diagnosed with prostate cancer as a consequence of PSA testing have clinically insignificant disease. In this Review, Peter Albertsen discusses risk assessment in prostate cancer and strategies to identify these patients at low-risk of disease progression. The benefits of active surveillance are considered as an option for these men, as opposed to either surgery or radiation that are recommended for men who have a significant risk of disease progression.

    • Peter C. Albertsen

  • News & Views |

    The 5-year follow up data from a study on localized prostate cancer has shown high rates of bladder, lung, and rectal cancers in men treated with external beam radiotherapy compared with radical prostatectomy. At 10 years of follow-up, only excess lung cancer risk was significant, and the authors conclude that increased secondary malignancy risk with radiation should be included in initial treatment decisions and counseling. In my opinion, younger men subjected to radiation might suffer more in the long-term than if they had undergone surgery.

    • Judd W. Moul

  • News & Views |

    The optimal age-specific treatment approach for adolescents with Hodgkin lymphoma (HL) is controversial. Here we discuss the results of a recent retrospective analysis that compared the outcomes for adolescents with those of young adults with HL treated with regimens normally recommended for adults. The investigators conclude that adult treatment protocols are a safe and effective treatment option for adolescents with HL, but the results do not consider late treatment toxicity that may impact quality of life and survival.

    • John T. Sandlund
    •  & Melissa M. Hudson

  • News & Views |

    A recent trial concluded that preoperative biliary drainage (PBD) in patients with pancreatic head cancer increases complications but is unlikely to change clinical practice. The difference in the outcomes reported was because of excessive complications in the PBD group using plastic stents. We argue that these patients need treatment in regional pancreatic cancer centers using low-occlusion metal stents.

    • John P. Neoptolemos
    •  & Christopher M. Halloran

  • News & Views |

    The role of preoperative biliary drainage (PBD) before surgery for tumors of the pancreatic head causing biliary obstruction has been controversial. A recent randomized trial revealed a higher complication rate with PBD in comparison to early surgery (within one week). Based on this trial, early surgery should be considered the preferred approach; however, the role of PBD when early surgery is not possible remains unclear.

    • Daniel J. Renouf
    •  & Malcolm J. Moore

  • News & Views |

    A recent study analyzed the timing of non-platinum chemotherapy in combination with radiotherapy in patients with head-and-neck cancer and showed that only those who had not undergone surgery benefited from the chemoradiation therapy. However, inconsistencies between some results of this study and those of previous studies, along with the advent of novel, less toxic combinations of radiotherapy, are likely to limit the development of the chemotherapy regimens used in their study.

    • Jacques Bernier
    •  & Lisa Licitra

  • Review Article |

    Well-developed and validated genomic signatures can lead to personalized treatment decisions resulting in improved patient management. However, the pace of acceptance of these signatures in clinical practice has been slow because many of the signatures have been developed without clear focus on the intended clinical use, and proper independent validation studies establishing their medical utility have rarely been performed. The authors of this Review focus on guidelines that physicians could refer to when evaluating studies on prognostic gene-expression signatures.

    • Jyothi Subramanian
    •  & Richard Simon

  • Case Study |

    This Case Study describes a patient with multiple relapses of atypical HLH that became refractory to treatment with numerous immunosuppressive agents. As HLH is driven by CD52+T cells and histiocytes, alemtuzumab was used as targeted therapy to induce stable remission and enable allogeneic stem-cell transplantation to be successfully performed.

    • Matthew P. Strout
    • , Stuart Seropian
    •  & Nancy Berliner

  • 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

  • Review Article |

    Mutations inVHL cause von Hippel–Lindau (VHL) disease, and are common in sporadic clear-cell renal-cell carcinoma (ccRCC). Drugs that modulate the downstream targets of the pVHL/HIF pathway have proven benefit in treating ccRCC. This Review, therefore, discusses the potential role of VHLalterations as prognostic and predictive markers in ccRCC.

    • Lucy Gossage
    •  & Tim Eisen

  • Review Article |

    The validation of predictive and prognostic biomarkers and surrogate end points requires robust statistical analysis of data gathered from multiple, large, independent studies. In this Review, Marc Buyse and coauthors discuss this validation process and the nature of biomarkers and surrogate end points. Furthermore, they consider strategies for the pragmatic evaluation of biomarkers and surrogate end points in the absence of statistical validation.

    • Marc Buyse
    • , Daniel J. Sargent
    •  & Aimery de Gramont

  • 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

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