ONCOLOGY Vol 22 No 7

In this issue of ONCOLOGY, Drs. Patel, Puthillath, Yang, and Fakih discuss the evolution of adjuvant therapy for locally advanced rectal cancer from postoperative to preoperative radiation and provide a fairly comprehensive review of the data on adjuvant/neoadjuvant chemoradiation for rectal cancer. The authors then attempt to critically evaluate the use of combination chemotherapy regimens in the neoadjuvant setting, asking the question, “Is more better?”

Neoadjuvant chemoradiation has become the favored adjuvant treatment for stages II and III rectal cancer. Compared to postoperative chemoradiation, this modality of treatment has been shown to be superior in terms of toxicity, local relapse, and sphincter-saving.[1] This article will focus on the evolution of neoadjuvant chemotherapy over the past 2 decades, current acceptable neoadjuvant standards, and current investigational regimens.

This practical review on the use of serum markers and circulating tumor cells (CTCs) focuses on the role of these assays in the management of patients with breast cancer and contains important information and perspectives for the practicing oncologist. The varying roles of these markers in early-stage and advanced disease are presented, and the implications in management are quite different in each setting.

Important therapeutic innovations within the past several years have resulted in only modest survival benefits for women with metastatic breast cancer. In this setting, cancer remains incurable and treatment is mainly palliative, involving judiciously applied multiple endocrine, chemotherapeutic, or biologic therapies in an attempt to induce a series of remissions and, ultimately, adequate palliation. At present, we lack both a consensus management algorithm and an ideal treatment model of specific subsets of women.

The authors address the “theoretical” advantages of protons vs photons as well as what they consider to be key issues and uncertainties in proton therapy. Essentially, the paper concedes certain advantages of proton therapy, such as its high degree of conformability with the use of fewer beams and its reduced-volume integral dose with respect to intensity-modulated x-ray therapy (IMXT), and notes some future directions in proton therapy in terms of partial prostate boosting, intensity-modulated proton therapy (IMPT), and in vivo dosimetry verification with positron-emission tomography (PET).

The authors review the main evidence from the literature on neoadjuvant approaches in locally advanced rectal cancer, starting with the use of radiotherapy only in the pre–total mesorectal excision (TME) era, through fluorouracil (5-FU)–based chemoradiation in the TME era, to the most modern administration of “targeted therapy” in association with radiotherapy and traditional chemotherapy.

A large phase III study has found that the targeted therapy cetuximab (Erbitux), combined with platinum-based chemotherapy, is effective as a first-line treatment for patients with advanced non–small-cell lung cancer (NSCLC). This is the first time a targeted drug has shown a survival benefit as a first-line treatment for patients with NSCLC, including all subtypes of the disease, reported lead author Robert Pirker, md, associate professor of medicine at Medical University of Vienna in Austria at the ASCO meeting (abstract 3).

Along with various imaging modalities, serologic tumor markers such as CA 15-3 and CA 27.29 have been used for decades to monitor treatment response in patients with metastatic breast cancer (MBC). Despite the frequent use of these markers, they lack high sensitivity and specificity for breast cancer progression. The prognostic significance of these markers remains indeterminate because of the conflicting outcome of many clinical trials. The circulating tumor cell (CTC) test has recently been studied in clinical trials in patients with MBC. Some of the studies showed that high levels of CTCs are correlated with poor survival in MBC. An intergroup trial is underway to determine the implication of changing treatment based on the CTC level. This article will discuss the current data on these markers, with special emphasis on the CTC test. The potential clinical utility of these markers will also be discussed.

External-beam radiation is a highly effective curative treatment option for men with localized prostate cancer.[1,2] Over the past several decades, efforts have been made to improve the “therapeutic ratio” of radiation by increasing dose to improve cure rates without causing a substantial increase in side effects. Due to its potential to create superior dose distributions, proton therapy is considered by many to be the best available form of external radiation therapy. Here we will critically examine the evidence supporting the use of protons in the treatment of prostate cancer.

Bone metastases are a common feature of many solid cancers, especially those originating from the prostate, breast, lung, kidney, melanoma, and other sites. Up to 80% of patients with these cancers will develop painful bony disease during the course of their disease.