Annals of Oncology 2005 16(12):1851; doi:10.1093/annonc/mdi412
© 2005 European Society for Medical Oncology
In this issue
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Lung adenocarcinoma biomarkers—differences between smokers and never-smokers
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Non-small-cell lung cancer (NSCLC) arising in never-smokers
is usually of adenocarcinoma subtype, but the oncogenesis of
such tumors is poorly understood. Tumors from never-smokers
often arise in a focal manner and are less frequently associated
with gene mutations, loss of heterozygosity, chromosomal abnormalities
and DNA methylation than tobacco-related lung tumors. Despite
these differences that could signify specific genetic alterations,
the treatment of NSCLC has not generally taken the tobacco status
of patients into consideration. One major change might, however,
arise from the use of epidermal growth factor receptor (EGFR)
tyrosine-kinase inhibitors, which have higher response rates
in NSCLC from never-smokers. In this issue, Dutu et al. present
the results of a study that aimed to better define the biological
characteristics of lung adenocarcinomas by comparing the expression
of a panel of EGFR-related biomarkers in lung adenocarcinomas
from smokers and never-smokers. These authors report that lung
adenocarcinomas from smokers express high levels of EGFR and
Ki-67, while those from never-smokers are characterized by high
levels of pAKT and p27.
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Effects of trastuzumab on ovarian cancer
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Although first-line chemotherapy induces complete clinical remission
in many patients with this cancer, relapse usually occurs 18–28
months from diagnosis. Several radiotherapeutic and chemotherapeutic
techniques have been developed to treat the micrometastatic
disease remaining after chemotherapy, but their unfavorable
therapeutic indices make them incompatible with long-term use.
Trastuzumab targets the HER2 receptor and has shown efficacy
in clinical studies of HER2-positive breast cancer and activity
in HER2-positive preclinical models of ovarian carcinoma. However,
as a cytostatic rather than cytotoxic agent it may have only
modest effects in advanced metastatic disease. Potentially greater
efficacy might be achieved in micrometastatic disease. In this
issue, Delord et al. report a study that aimed to evaluate the
effect of trastuzumab on disease-free and overall survival in
a specially designed murine model of ovarian cancer (OVCAR-3),
which mimics the natural history of human micrometastatic disease.
These authors report that trastuzumab cured the mice if started
soon after induction chemotherapy, and it modestly inhibited
proliferation through mitogen-activated protein kinase signal
transduction and inhibited AKT phosphorylation, involved in
the survival pathway.
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Darbepoetin-alfa in myelodysplatic syndromes
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In patients with myelodysplastic syndromes (MDS) the generally
advanced age of patients and attendant non-hematological comorbidities
often limit therapeutic options, with many patients receiving
supportive care only irrespective of their International Prognostic
Scoring System risk group. In low- and intermediate-1-risk MDS,
anemia is often the major or only clinical problem. Recombinant
human erythropoietin (rhEPO) has been consistently used to relieve
anemia and reduce transfusion requirements in these patients.
Darbepoetin-alfa is a novel erythropoietic agent with greater
sialic acid content, an approximately three-fold longer terminal
half-life and greater biological activity than rhEPO, allowing
less frequent administration with a similar efficacy and safety
profile and increased biological activity. In this issue, Stasi
et al. report the results of a phase II study that aimed to
evaluate the impact of darbepoetin-alfa therapy on hemoglobin
levels, transfusion requirements and changes in quality of life
in anemic patients with previously untreated low- and intermediate-1-risk
MDS. These authors report that in this patient group darbepoetin-alfa
is active, safe and well tolerated in a substantial proportion
of patients, and has a positive impact on the patients' quality
of life.
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Parent–adolescent communication in the case of parental cancer
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Little is known about the effect of a stressful event such as
cancer on communication patterns in families. Moreover, results
of studies among families confronted with parental cancer are
mainly based on small samples, qualitative data and have a descriptive
nature. Although open communication between parents and children
is often advocated, in particular when a parent has cancer,
there is little evidence that adolescents who perceive more
open communication with ill and healthy parents actually function
better. In this issue, Huizinga et al. report a study of 212
adolescent children from 139 families in which a parent had
received a diagnosis of cancer with the aims of assessing (i)
parent–adolescent communication (PAC) in families of cancer
patients, (ii) relationships between PAC and posttraumatic stress
symptoms in adolescent children and (iii) associations between
parents' illness characteristics and PAC. These authors report
that PAC in families of cancer patients differs little from
that in families not confronted with parental cancer. However,
problems with communication outweighed lack of openness with
respect to the development of posttraumatic stress symptoms.
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Quote
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"I knew a very clever physician, of large dispensary and hospital
practice, who invariably began his examination of each patient
with ‘Put your finger where you be bad.’ That man
would never waste his time with collecting inaccurate information
from nurse or patient. Leading questions always collect inaccurate
information."
Florence Nightingale considers the obtaining of inaccurate information in Notes On Nursing: What It Is, And What It Is Not.
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