Annals of Oncology 2006 17(3):355; doi:10.1093/annonc/mdl040
© 2006 European Society for Medical Oncology
in this issue
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Survival in BRCA1-associated breast cancer
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Studies comparing survival in BRCA1-associated and sporadic
breast cancer report inconsistent results and frequently concern
small sample sizes. Moreover, the impact on survival of the
classical prognostic factors, e.g. tumor size and nodal status,
has not been investigated separately in BRCA1-associated tumors.
However, there are indications that this impact might differ
from that seen with sporadic cases. In this issue,
Brekelmans et al. report a study that aimed to assess the survival of patients
with BRCA1-related breast cancer while taking account patient
and tumor characteristics and treatment factors that might influence
this survival. These authors report that tumor size and nodal
status are also prognostic factors for BRCA1-associated breast
cancer. Further BRCA1-associated breast cancer is characterized
by a high incidence of contralateral breast cancer and a trend
towards worse survival for the ductal tumor type.
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5-FU/leucovorin and 3H1 in colorectal cancer
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According to the anti-idiotype network theory it should be possible
to immunize a patient against a particular antigen by exposing
that patient to an antibody which mimics the target antigen.
The monoclonal antibody 3H1 mimics the external structure of
the carcinoembryonic antigen (CEA) and, therefore, has the potential
to stimulate immune responses to CEA that may benefit colorectal
cancer patients. In this issue,
Chong et al. report the results
of a randomized phase III study of some 630 patients that aimed
to compare the clinical efficacy, in previously untreated patients
with metastatic colorectal cancer, of 5-fluorouracil (5-FU)/leucovorin
(LV) plus 3H1 to that of 5FU/LV plus placebo. These authors
report that 3H1 is safe and does effectively induce immune responses
to CEA. Patients with a negative CEA response had a median survival
of 8.3 months (95% CI: 7.5-11.0) compared with patients with
a strong response: median survival not reached (
P < 0.001).
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Chlamydia eradication in orbital lymphoma
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Chronic inflammation due to various persistent infections may
play a crucial role in the development of malignancies. Recent
results have implicated
Chlamydia, especially
Chlamydia psittaci,
in the development of ocular adnexal lymphoma. It has been speculated
that a high percentage of patients could benefit from antibiotic
therapy without exhaustive testing for chlamydial infection.
In this issue,
Grünberger et al. present a report of their
experience with ex-juvantibus antibiotic treatment in patients
diagnosed with MALT lymphoma of the ocular adnexa. These authors
report finding no effect of "blind" antibiotic treatment with
doxycyclin in these patients. They suggest a potential geographic
difference in the role of
Chlamydia in ocular adnexal lymphoma,
and they conclude that antibiotic therapy without prior testing
for
Chlamydia should be discouraged.
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Three-weekly vs. weekly docetaxel in advanced NSCLC
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The vast majority of patients with advanced non-small-cell lung
cancer (NSCLC) will progress after first-line chemotherapy;
however, patients with a good performance status who had responded
to first-line treatment are candidates for second-line chemotherapy.
In this setting, docetaxel has demonstrated superiority in 1-year
survival and quality of life compared to ifosfamide, vinorelbine,
or best supportive care alone. However, using the recommended
dose of 75 mg/m
2 every 3 weeks febrile neutropenia is observed
in 12-16% of patients, prompting a search for new dose schedules.
In this issue,
Camps et al. report the results of a second-line
randomized phase III study in advanced NSCLC patients, comparing
docetaxel 75 mg/m
2 every 3 weeks to docetaxel 36 mg/m
2 weekly
for 6 consecutive weeks followed by two weeks of rest. These
authors report that both weekly and 3-weekly docetaxel are effective
and well-tolerated, with different toxicity profiles, but they
conclude that in general, there is no indication to recommend
the weekly schedule.
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Quote
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"‘And I think I may say with reasonable certainty that,
in order to cure him complete, all that we need to do is a simple
and easy surgical operation – namely, to remove these
irritant bodies.’
‘And then he will be sane?’
‘Then he will be perfectly sane, and a quite admirable citizen.’
‘Thank Heaven for science!’ said old Yacob, and went forth at once to tell Nunez of his happy hopes."
The doctor proposes a blinding in The Country of the blind by H. G. Wells.
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