ONCOLOGY Vol 23 No 4

Annually, about 8,000 patients are found to have metastatic melanoma presenting as recurrence of an earlier primary melanoma, and this number closely approximates the annual number of deaths from the disease. This statistic illustrates the lack of progress that has been made in the treatment of stage IV melanoma over the past several decades.

The US Food and Drug Administration (FDA) has approved everolimus (Afinitor) oral tablets for the treatment of patients with advanced kidney cancer whose disease has progressed after treatment with other cancer therapies. Everolimus is intended for patients with advanced renal cell cancer who have already tried another kinase inhibitor (sunitinib [Sutent] or sorafenib [Nexavar]).

Responding to President Obama’s call for “a cure for cancer in our time,” the Pharmaceutical Research and Manufacturers of America recently delivered a new report on drugs in the research pipeline for cancer.

A phase III clinical trial of sunitinib (Sutent) has been stopped early after the drug showed significant benefit in patients with advanced pancreatic neuroendocrine tumors. An independent data monitoring committee recommended halting the trial after concluding that sunitinib demonstrated greater progression-free survival compared with placebo plus best supportive care in these patients.

Despite the widespread perception that herbal products are safe because they are “natural,” few products have been subjected to rigorous research.

At the very start of their clinical training, radiation oncologists tend to embrace technology. The specialty draws a preponderance of technophiles to it, and those few who are not at first passionate about technology quickly become so.

The ultimate goal of radiation therapy (RT) is to deliver enough radiation to eradicate all tumor clonogens within the irradiated field while also minimizing dose to adjacent normal structures so as to cause no (or minimal) normal tissue injury. With few exceptions, the dose of radiation currently delivered to most anatomic sites is limited by the tolerance of these adjacent normal organs, thereby restricting the dose of radiation deposited in tumors to an amount that may or may not be ideal to realize an optimal cure. The goal of many advanced technologies introduced into RT are aimed at addressing this problem.

On November 30–December 2, 2006, the Radiation Research Program of the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) hosted a workshop entitled “Advanced Technologies in Radiation Oncology: Evaluating the Current Status and Future Potential of Proton and Other Heavy Charged-Particle Radiation Therapy, Intensity Modulated Radiation Therapy and Stereotactic Radiation Therapy.”

The review of health literacy and its impact on older adults by Amalraj and colleagues in this issue of ONCOLOGY brings much-needed attention to this very critical issue. The impact of limited health literacy is made even more critical given the increasing number of older adults in the United States, estimated to be 20% of the US population by the year 2030, and the fact that limited health literacy disproportionately affects them.

The authors review the current trends in health literacy, patient-physician communication, and the medical treatment decision process, focusing attention on the older cancer patient population.

Endometrial cancer is the most common gynecologic malignancy, with an estimated 40,100 cases and 7,470 deaths in 2008. This malignancy represents 6% of all cancers, and 3% of cancer deaths in women. Endometrial cancer is more prevalent in older women, with an incidence of 1 in 142 for women 40 to 59 years old, increasing to 1 in 81 women over 70 years old.[1] Median age at diagnosis is 62.[2] The mortality of endometrial cancer has decreased from 4.18 to 4.12 per 100,000 from 1991 to 2004.

Published analyses combining groups of patients with different risk profiles have created confusion surrounding patient selection for adjuvant treatment after surgery for endometrial cancer. As a result, no randomized trial has demonstrated a survival benefit with the addition of adjuvant radiation

In this issue of ONCOLOGY, Diavolitsis et al have provided an excellent overview of the literature and state of our understanding of the role of adjuvant therapy in the treatment of endometrial cancer.

Results from an 8-year trial involving more than 130,000 women published in The New England Journal of Medicine (360:1385-1394, 2009) demonstrate that in low-resource settings, a single round of human papillomavirus (HPV) testing significantly reduces the numbers of advanced cervical cancers and deaths, compared with Pap testing or visual inspection with acetic acid (VIA). This was the first randomized controlled trial to measure incidence of cervical cancer and associated rates of death as the primary outcomes, using different tools for screening.

Maintenance rituximab (Rituxan) following CVP therapy (cyclophosphamide, vincristine, prednisone) improves progression-free survival in patients with stage III/IV indolent lymphoma, according to a phase III study published online ahead of print in the Journal of Clinical Oncology (March 2, 2009).

Based on preclinical data, antiangiogeneic therapy for cancer is both logical and rational. Tumors secrete proangiogenic factors, and the design of agents that target these factors has great potential to add to and in some cases replace cytotoxic chemotherapy.

Numerous preclinical and clinical studies have demonstrated a role for angiogenesis in the growth and progression of breast cancer. Elevated vascular endothelial growth factor (VEGF) levels have been demonstrated in association with poor outcomes, and thus, this finding is an attractive target for therapeutic intervention.

Tumor angiogenesis, an important step in breast cancer development, invasion, progression, and metastasis, is regulated by the expression of proangiogenic factors such as vascular endothelial growth factor (VEGF).[1-6] Higher levels of VEGF expression are associated with poor clinical outcomes and decreased survival in patients with breast cancer.