Annals of Oncology 2006 17(9):1339; doi:10.1093/annonc/mdl326
© 2006 European Society for Medical Oncology
in this issue
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Improving capecitabine/docetaxel tolerability
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Because the combination of capecitabine and docetaxel improves
survival compared with docetaxel monotherapy in anthracycline-pretreated
patients with metastatic breast cancer, it represents a standard
of care for anthracycline-pretreated patients. However, in a
phase III trial the capecitabine/docetaxel combination therapy
was associated with toxicities that were consistent with the
known side effects of the individual agents. There was a higher
incidence of gastrointestinal adverse events and hand-foot syndrome
in the combination arm compared with the single-agent docetaxel
arm, but a lower incidence of neutropenic fever, myalgia, arthralgia
and pyrexia. In this issue,
Leonard et al. present a detailed
review of the safety profile of the capecitabine/docetaxel combination
analyzing the effect of dose reduction on tolerability and efficacy.
These authors conclude that capecitabine/docetaxel dosing flexibility
does allow management of side effects without compromising efficacy.
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Temozolomide/cisplatin for patients with NSCLC and brain metastases
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Brain metastases occur in 20–30% of patients with non-small-cell
lung cancer (NSCLC) and their presence considerably worsen the
prognosis. Chemotherapy is considered as the main treatment
of disseminated NSCLC but remains controversial in patients
with brain metastases since they are excluded from most clinical
trials, as the blood-brain barrier is considered to prevent
the passage of chemotherapy into the brain. Nevertheless, data
suggest that the blood-brain barrier is disrupted when brain
metastases are present, and some reports show that the concentration
of chemotherapy drugs is similar in cerebral and extracerebral
sites of the disease. In this issue,
Cortot et al. report the
results of a phase II trial that aimed to determine the efficacy
and tolerability of chemotherapy with temozolomide and cisplatin
in NSCLC patients with brain metastases. The authors report
a lack of efficacy of up-front chemotherapy with temozolomide
and cisplatin in these patients, but they conclude that their
results support the feasibility of chemotherapy before brain
radiotherapy in NSCLC patients with bone metastases.
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Maintnence rituximab for mantle cell lymphoma
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Mantle Cell lymphoma accounts for approximately 6–8% of
newly diagnosed non- Hodgkin's lymphomas and is a particularly
challenging lymphoma subtype to manage. It had the poorest 5-year
survival of all the non-Hodgkin's lymphoma subtypes in the NHL
classification project and is considered incurable with standard
therapies. High response rates are seen with CHOP plus rituximab
(R), but the progression-free survival (PFS) is short (median
16–20 months). Since the median age for newly diagnosed
mantle cell ymphoma patients is 64, approaches that do not include
stem cell transplantation or involve highly aggressive chemotherapy
regimens need to be developed. In this issue,
Kahl et al. report
the results of a multi-center phase II pilot study of rituximab
and modified hyper-fractionated cyclophosphamide, vincristine
doxorubicin, dexamethasone (modified R-hyperCVAD) administered
every 28 days for 4–6 cycles followed by rituximab maintenance
therapy. These authors report that modified R-hyperCVAD was
a tolerable and effective induction therapy for untreated mantle
cell lymphoma, and that maintenance rituximab appeared to prolong
PFS without increasing toxicity.
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Body size and laryngeal cancer
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While tobacco smoking, together with alcohol drinking, is the
major risk factor for laryngeal cancer, a role for diet and
nutrition has also been suggested, including a favorable effect
of fruit and vegetables. A number of studies have considered
the relationship of body mass index with laryngeal cancer risk,
but none of these studies, however, assessed lifetime weight
history. In this issue,
Garavello et al. report the results
of an analysis of data from a large case-control study on laryngeal
cancer conducted in Italy, including detailed information on
several anthropometric measures and weight at various ages.
These authors report that this study supports the existence
of a relation between leanness and laryngeal cancer risk. In
particular, men with less abdominal fat (characterized by a
lower waist-to-hip ratio) had an increased risk of laryngeal
cancer.
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Quote
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"On and on they walked, and it seemed that the great carpet of deadly flowers that surrounded them would never end. They followed the bend of the river, and at last came upon their friend the Lion, lying fast asleep among the poppies. The flowers had been too strong for the huge beast and he had given up at last, and fallen only a short distance from the end of the poppy bed, where the sweet grass spread in beautiful green fields before them."
The Scarecrow and the Tin Woodman learn of the narcotic power of poppies in The Wonderful Wizard of Oz by L. Frank Baum.
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