Annals of Oncology 2006 17(2):181; doi:10.1093/annonc/mdj144
© 2006 European Society for Medical Oncology
in this issue
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Cost – utility of aromatase inhibitors
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Several studies have shown aromatase inhibitors administered
as monotherapy or sequentially to tamoxifen to improve relapse-free
survival in postmenopausal women with early breast cancer. However,
we lack information on whether there could be any differences
with respect to efficacy and toxicity between the different
drugs or related to regimen of administration. In this setting,
any difference regarding cost/utility may be an important issue
when selecting regimen. In this issue,
Lønning presents
a cost/utility study that compared different regimens based
on the theoretical assumption that costs, benefits and side
effects were similar for each drug and independent of whether
it was administered as monotherapy or sequentially. He reports
that using these assumptions tamoxifen for 2 years followed
by an aromatase inhibitor provided the lowest cost/quality-adjusted
life year (QALY) estimates. However, a further improvement of
relapse-free survival of 1% if the aromatase inhibitor is given
upfront provides an acceptable cost/QALY.
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Early versus delayed chemotherapy in mesothelioma
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Over the next decade we can expect to see a continuing rise
in the incidence of malignant mesothelioma occurring in many
parts of Europe, Australia and other industrialized nations.
Mesothelioma remains a disease with limited therapeutic options
with palliation of symptoms as the mainstay of management for
most patients, and currently there are no data regarding the
relative benefit of any chemotherapy regimen over best supportive
care (BSC) but one trial is ongoing in the first line setting.
In this issue,
O'Brien et al. report on a prospective randomized
study that aimed to assess the use of early versus delayed cytotoxic
therapy in patient with malignant mesothelioma. These authors
report that in this trial with patients presenting with stable
symptoms after control of pleural effusion, the early use of
chemotherapy provided an extended period of symptom control
and a survival advantage.
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AML in elderly patients not eligible for intensive chemotherapy
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The incidence of acute myelogenous leukemia (AML) increases
with the aging of the general population. However, while the
best management of AML in younger patients is mainly based on
intensive chemotherapy, it still remains a matter of controversy
in elderly patients. Indeed, less than 50% of newly diagnosed
AML patients aged over 60 are included in intensive chemotherapy
trials. In this issue,
Latagliata et al. report a study that
aimed to retrospectively examine 244 consecutive elderly AML
patients diagnosed over a 10-year period and not eligible for
intensive chemotherapy, with a view to the possible identification
of patients with different disease outcome and survival. These
authors highlight the great heterogeneity of elderly AML patients
not eligible for intensive chemotherapy. Further, they propose
a simple scoring system including easily evaluable parameters,
which could distinguish subjects with different prognoses.
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Effects of smoking regulations in Italy
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From 10 January 2005 the Italian government banned smoking in
all indoor public places. In addition to reducing passive smoking,
smoke-free policies increase smoking cessation and reduce tobacco
consumption. In this issue
Gallus et al. report the results
of a survey on a representative sample of the Italian adult
population that aimed to provide information on attitudes towards
smoking regulation in Italy following the ban. In addition,
by comparing smoking consumption from subsequent nationally
representative population-based surveys, and from official legal
sales over time, they attempt to disentangle the impact of the
smoking ban on tobacco consumption. These authors report that
following the ban support for smoke-free policies increased,
smoke-free policies accounted for around an 8% decrease in cigarette
consumption in the short run. Moreover, smoke-free legislations
do not seem to unfavorably affect the business of restaurants
or cafes.
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Quote
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"‘Stop!’ He looked at the horse, then at me, then
dropped the reins, and without saying a bad word, ‘Where
are you going?’ says he. And he showed his teeth in a
grin, and his eyes were spiteful-looking.
‘Ah,’ thought I, ‘you are a queer customer!’ ‘I am going to vaccinate for the smallpox,’ said I. ‘And what is that to you?’ ‘Well, if that's so,’ says he, ‘vaccinate me.’ He bared his arm and thrust it under my nose. Of course, I did not bandy words with him; I just vaccinated him to get rid of him. Afterwards I looked at my lancet and it had gone rusty."
Yergunov vaccinates the Devil in The Horse-Stealers by Anton Chekhov.
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