Annals of Oncology 2006 17(6):881; doi:10.1093/annonc/mdl125
© 2006 European Society for Medical Oncology
in this issue
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breast cancer and risk of CNS metastases
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In women with breast cancer, a population-based estimate of
the incidence proportion of brain metastases is 5.1%. In case
series, the incidence of central nervous system (CNS) metastases
among women with metastatic breast cancer is estimated to be
10–16%, while in autopsy series, brain metastases are
found in 20% to 30% of patients. In this issue,
Pestalozzi et al. present the results of a study on a large cohort of patients
with long-term follow-up (median 13 years) from the diagnosis
of early-stage breast cancer, which aimed to analyze factors
associated with CNS recurrence. These authors report factors
predictive of CNS as first recurrence included node-positive
disease, estrogen receptor-negative, tumor size > 2 cm, tumor
grade 3, age below 35 years, HER2-positive. They further report
that risk of subsequent CNS recurrence was elevated in patients
experiencing lung metastases.
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EGFR in colorectal cancer
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One of the most promising targets for the therapy of colorectal
cancer is the epidermal growth factor receptor (EGFR). However,
clinical trials using irinotecan in combination with the anti-EGFR
monoclonal antibody cetuximab failed to establish a significant
link between EGFR tumor expression based on immunohistochemistry
and response to treatment in patients with colorectal cancer.
It has, therefore, been hypothesised that tumors with a low
overall level of EGFRs, below the threshold detection, may have
high affinity receptors that are responsive to EGFR-targeted
therapy. In this issue,
Francoual et al. present a report of
a retrospective study that considered the presence and distribution
of high-affinity and low-affinity EGFR in a large series of
colorectal cancer samples using a specific ligand binding assay.
These authors report that a large majority of tumor samples
did indeed exhibit one class of high–affinity binding
sites.
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HAART-use in HIV-associated Hodgkin's disease
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Hodgkin's disease has been shown to be the most common non-AIDS-defining
malignancy in patients infected with HIV. Prior to the introduction
of highly active antiretroviral therapy (HAART) the median survival
of patients with HIV-associated Hodgkin's disease was less than
20 months, with poor tolerance of and low response rates to
chemotherapy contributing to the poor outcomes. Recent studies,
with limited numbers of patients, have, however, suggested improved
survival in patients with HIV-associated Hodgkin's disease treated
with HAART. In this issue,
Hentrich et al. present the results
of a study that aimed to evaluate further the outcome of Hodgkin's
disease in patients infected with HIV with respect to the use
of HAART. These authors report that patients receiving HAART
had a significantly better 2-year overall survival than those
not receiving HAART (74% versus 30%,
P < 0.001).
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aprepitant versus ondansetron in delayed emesis
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Despite treatment with a 5-hydroxytriptamine-3 receptor antagonist
(5-HT
3 RA) plus a corticosteroid, according to published guidelines,
more than 50% of patients still vomit in response to highly
emetogenic chemotherapy, such as high-dose cisplatin. The 5-HT
3 RAs prevent vomiting in the first 24 hours after chemotherapy,
but they appear to lack efficacy in the delayed phase, i.e.
24–120 hours after the start of chemotherapy. Aprepitant
is a selective, high-affinity neurokinin-1 (NK1) receptor antagonist;
NK1 receptors being found in brain regions critical to regulating
the vomiting reflex. In this issue,
Schmoll et al. report the
results of a study that aimed to compare an aprepitant regimen
with a multiple-day ondansetron-plus-dexamethasone regimen in
patients receiving their first cycle of cisplatin chemotherapy.
These authors report that the aprepitant regimen was superior
in the acute, delayed, and overall phases of chemotherapy-induced
nausea and vomiting, and they suggest that the aprepitant regimen
should be considered a new standard of antiemetic therapy for
cisplatin-treated patients.
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quote
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‘The science of life is a superb and dazzlingly lighted
hall which may be reached only by passing through a long and
ghastly kitchen.’
Claude Bernard exhibits his gift for telling metaphor in Introduction à l'Étude de la Médecine Expérimentale.
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