Annals of Oncology 2007 18(10):1589; doi:10.1093/annonc/mdm473
© 2007 European Society for Medical Oncology
in this issue
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Prognostic role of peritumoral vascular invasion in operable breast cancer
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For breast cancer patients with peritumoral vascular invasion
(PVI), treatment choice follows an algorithm similar to that
for node-positive disease. Nevertheless, controversies remain
about the role of PVI in the risk assessment of patients with
operable breast cancer, with several previous studies failing
to confirm any prognostic role for vascular invasion. In this
issue, Colleoni et al. [
1632–1640] report the results
of a study that aimed to prospectively analyze the prognostic
role of PVI extent in terms of both disease-free and overall
survival in a large group of patients with surgery, pathological
evaluation and treatment recommendations performed by the same
team of physicians. These authors found that in patients with
node-negative disease a statistically significant difference
in disease-free survival, risk of distant metastases and overall
survival was observed at the multivariate analysis for extensive
PVI versus no PVI.
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Gemcitabine plus platinum in pancreatic cancer
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Systemic chemotherapy with single-agent gemcitabine is regarded
as a standard of care for treatment of locally advanced and
metastatic pancreatic cancer. Several randomised trials are
now available which consistently report the favourable impact
of gemcitabine/platinum-analog combinations on the survival
of patients with advanced pancreatic cancer, but none of these
studies has had a sufficient statistical power to demonstrate
a significant survival advantage. In this issue, Heinemann et
al. [
1652–1659] report a pooled analysis of the GERCOR/GISCAD
intergroup study comparing gemcitabine plus oxaliplatin to gemcitabine
and a German multicenter trial comparing gemcitabine plus cisplatin
versus gemcitabine. These authors conclude that the combination
of gemcitabine with a platinum analog such as oxaliplatin or
cisplatin significantly improves progression-free and overall
survival compared with single-agent gemcitabine in advanced
pancreatic cancer.
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Disease progression in Hodgkin's lymphoma
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In the NCIC CTG/ECOG trial HD.6 patients with limited stage
Hodgkin's lymphoma were randomized to receive treatment that
included radiation or to chemotherapy, as a single modality,
consisting of doxorubicin, bleomycin, vinblastine and dacarbazine
(ABVD). With a median follow up of 4.2 years, this study showed
progression-free survival (PFS) was superior in patients allocated
to radiation therapy, but no difference in overall survival
was seen. In this issue, Macdonald et al. [
1680–1684]
report on the patterns of progression and subsequent outcomes
of patients with progression in the HD.6 trial. After a median
of 4.2 years, 33 patients had progressed. Two radiation oncologists
determined whether sites of progression were confined within
radiation fields and compared freedom from second progression
(FF2P) with freedom from second progression or death (FF2P/D).
These authors conclude that treatment that includes radiation
reduces the risk of progressive Hodgkin's lymphoma in sites
receiving this therapy, but they were unable to detect differences
in FF2P or FF2P/D.
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Immunotherapy versus DTIC in melanoma
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Currently, two agents are approved for use in stage IV melanoma
patients; dacarbazine (DTIC) in Europe and the US, and high-dose
intravenous interleukin-2 (IL-2) in the US. Single-agent interferon-alpha
(IFN
) therapy, as well as single-agent IL-2 treatment, yields
response rates of approximately 15% in metastatic melanoma with
infrequent long-term responders and occasional long-term survivors.
The combination of IFN
and IL-2 has been reported to increase
response rates, but this has not been confirmed in a randomized
phase III trial. Moreover, the use of histamine dihydrochloride
(HDC) as a counter-suppressive agent in combination with IL-2
and/or IFN
has been under investigation in several clinical
trials. In this issue, Middleton et al. [
1691–1697] report
on a study that aimed to evaluate the safety and efficacy of
immunotherapy with HDC, IL-2 and IFN compared with DTIC in adults
with stage IV melanoma. These authors report that while treatment
with HDC/IL-2/IFN was safe on an outpatient basis, this regimen
did not improve upon the response rate and overall survival
seen with DTIC.
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Quote
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"I sat thinking, alone in the upstairs flat. I thought about
Gloria taking the vitamin C and remembered her being sick the
next day. She was only sick for a day! Vitamin C couldn't cause
cancer, could it? I couldn't be to blame, could I? All because
I kissed her when I had a cold."
Peter Turner considers the causes of Gloria Grahame's cancer in his memoir Film stars don't die in Liverpool.
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Related articles in Ann Oncol:
- Prognostic role of the extent of peritumoral vascular invasion in operable breast cancer
- M. Colleoni, N. Rotmensz, P. Maisonneuve, A. Sonzogni, G. Pruneri, C. Casadio, A. Luini, P. Veronesi, M. Intra, V. Galimberti, R. Torrisi, S. Andrighetto, R. Ghisini, A. Goldhirsch, and G. Viale
Ann Oncol 2007 18: 1632-1640.
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- Increased survival using platinum analog combined with gemcitabine as compared to single-agent gemcitabine in advanced pancreatic cancer: pooled analysis of two randomized trials, the GERCOR/GISCAD intergroup study and a German multicenter study
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- Patterns of disease progression and outcomes in a randomized trial testing ABVD alone for patients with limited-stage Hodgkin lymphoma
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Prognostic role of peritumoral...
Gemcitabine plus platinum in...