Annals of Oncology 2006 17(4):537; doi:10.1093/annonc/mdl067
© 2006 European Society for Medical Oncology
in this issue
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Vaginal oestradiol in postmenopausal women on adjuvant aromatase inhibitors
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Around a fifth of patients on adjuvant aromatase inhibitors
(AIs) suffer from atrophic vaginitis. Many ask if they can use
topical oestrogen to alleviate the symptoms as conventional
hormone-replacement therapy is not recommended. These topical
oestrogen preparations are generally perceived to result in
minimal systemic absorption of oestrogen. In this issue, however,
Kendall et al. report the results of a study in which serum
levels of oestradiol, follicle stimulating hormone and luteinising
hormone were measured in women on adjuvant AIs at baseline then
2, 4, 7–10 and 12 weeks after commencement of vaginal
oestradiol. These authors found that vaginal oestradiol significantly
raises systemic oestradiol levels at least in the short term
and they conclude that this reverses the oestradiol suppression
achieved by AIs in women with breast cancer.
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Irinotecan plus carboplatin in small-cell lung cancer
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Etoposide in combination with platinum-based chemotherapy has
been the standard treatment for extensive disease small-cell
lung cancer (SCLC). Recent trial data have, however, suggested
the superiority of irinotecan/cisplatin over etoposide/cisplatin
in SCLC. In this issue,
Schmittel et al. present the results
of a randomized phase II study, involving 70 patients with extensive
SCLC, that aimed to compare the irinotecan/carboplatin combination
with etoposide/carboplatin. These authors report that median
progression-free survival was 9 months (95% CI: 7.1–10.9)
in the irinotecan cisplatin arm and 6 months (95% CI: 4.1–7.9)
in the etoposide/cisplatin arm (
P=0.03). Based on these phase
II results they report that the trial has been extended to phase
III to assess the impact on overall survival.
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Nutrient intakes and risk of non-Hodgkin's lymphoma
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Incidence and mortality rates of non-Hodgkin's lymphoma (NHL)
have been increasing in Western populations over the last three
decades, but the factors that could have contributed to these
upwards trends are unclear. Most studies on micronutrients and
NHL risk are inconclusive: carotenoid intake has been inversely
related to NHL risk in two studies, and high intake of ß-carotene
was reported to have a significant protective effect in one
study; unlike vitamin intake from food sources, vitamin supplementation
has been related to an increased NHL risk. In this issue
Polesel et al. report a hospital-based case control study of 190 incident,
histologically-confirmed NHL cases aged 18–84 years and
484 subjects admitted to hospitals for acute, non-neoplastic
diseases unrelated to diet. These authors suggest that a diet
rich in polyunsaturated fatty acids and vitamin D is associated
with a reduced risk of NHL.
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Discuss expensive anti-cancer drugs with patients
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Patients generally wish to receive as much information as possible,
particularly in relation to treatment options, and wish to be
active participants in treatment decision making. Many of the
newest anti-cancer drugs, with proven efficacy in phase II and
III trials, face delays in approval or subsidization. Costs
can be considerable and for most people would represent a considerable
financial burden. Informing patients about unsubsidized expensive
anti-cancer drugs raises a number of ethical issues for the
individual clinician. In this issue,
Thomson et al. report the
results of a study that aimed to document the attitudes and
practices of Australian medical oncologists with regard to disclosure
of expensive anti-cancer treatment options to patients. Using
a postal survey these authors found that between 28% and 41%
(depending on the scenario) would not mention an expensive anti-cancer
drug if it were not subsidized.
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Quote
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"Love is the extremely difficult realization that something
other than oneself is real. Love, and so art and morals, is
the discovery of reality."
Iris Murdoch considers love in The sublime and the good
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