Annals of Oncology 2007 18(5):811; doi:10.1093/annonc/mdm131
© 2007 European Society for Medical Oncology
in this issue
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Predicting early relapse in postmenopausal women with hormone receptor-positive breast cancer
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A total of five trials have shown that aromatase inhibitors
improve disease-free survival compared with tamoxifen alone.
ATAC (anastrozole) and BIG 1-98 (letrozole) compared up-front
aromatase inhibitors for 5 years to tamoxifen for 5 years. While
awaiting results from ongoing randomized trials,
Mauriac et al.
have examined prognostic factors of an early relapse among patients
in the BIG 1-98 trial to aid in treatment choices. The analyses
included all 7707 eligible patients treated on BIG 1-98, with
median follow-up of 2.0 years, and a primary end point of breast
cancer relapse. These authors report that predictive factors
for early relapse were node positivity (
P < 0.001), absence
of both receptors being positive (
P < 0.001), high tumor
grade (
P < 0.001), HER-2 overexpression/amplification (
P < 0.001), large tumor size (
P = 0.001), treatment with tamoxifen
(
P = 0.002) and vascular invasion (
P = 0.02).
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Optimal chemotherapy for good-risk metastatic nonseminomatous germ-cell tumors
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The use of cisplatin-based combination chemotherapy has led
to a dramatic improvement in the cure rates of patients with
metastatic nonseminomatous germ-cell tumors (NSGCT). Over the
last 20 years, a series of clinical trials have been conducted
to refine the optimal chemotherapy regimen by reducing short-
and long-term toxic effects without compromising cure rates.
In 1993, the Genito-Urinary Group of the French Federation of
Cancer Centers designed a randomized trial to compare the efficacy
and toxicity of three cycles of bleomycin, etoposide and cisplatin
(BE500P) with four cycles of etoposide and cisplatin (E500P)
in patients with good-risk NSGCT. In this issue,
Culine et al.
report the mature results of that trial. These authors report
that among 257 assessable patients, with median follow-up of
53 months, 124 and 122 patients achieved a favorable response
in the 3BE500P and 4E500P arms, respectively (
P = 0.34). These
authors conclude that in the absence of further data 3BE500P
is the treatment of choice for metastatic NSGCT patients.
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Prognostic factors for diffuse large B-cell lymphoma
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Anthracycline-based polychemotherapy represents the standard
of care for diffuse large B-cell lymphoma (DLBCL), curing 40%–50%
of patients with DLBCL, and with the International Prognostic
Index (IPI) defining prognostic subgroups with long-term disease-free
survival ranging from 15% to 65%. While intensification of chemotherapy
with autologous stem-cell transplantation improves the prognosis
for intermediate/high and high-risk patients with chemosensitive
disease, these approaches are associated with increased toxicity.
Consequently, a more accurate risk assessment would be desirable
for the large intermediate-risk group to identify patients who
might benefit from dose intensification, while avoiding overtreatment
of the remaining group. In this issue,
Veelken et al. present
the results of a study that aimed to assess biological subclassification
of DLBCL by immunohistochemistry in clinical practice, by analyzing
outcome of DLBCL patients in relationship to the IPI and tumor
immunophenotype. These authors conclude that in DLBCL treated
with risk-adapted therapy, immunohistochemical subcategorization
of DLBCL into germinal center (GC) and non-GC type has little
clinical value and that the IPI-associated risk appears to be
mitigated by intensified upfront therapy.
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Monitoring of renal function in cancer patients
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While renal impairment (RI) has been shown to be a major risk
factor in a number of diseases, the influence of milder degrees
of renal disease is less well defined, particularly in patients
with malignant diseases. In this issue,
Kleber et al. report
the results of a study that aimed to determine whether and to
what extent cancer patients show RI and milder degrees of RI
and which parameter of creatinine, cystatin C or estimated glomerular
filtration rate (eGFR) is most suitable to determine risks for
secondary end points, such as concurrent diagnoses, hypertension,
diabetes, myocardial infarction and stroke. These authors report
that those cancer patients with decreased eGFR (<60 ml/min/1.73m
2)
had increased odds ratios (OR) to have more concurrent diagnoses
(OR 3.4; 95% confidence interval 1.5–8.1).
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Quote
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"Yes, he had died, chilled and starved, with none to speak a
kindly word, or do a kindly deed for him, in that last dread
of hour of need!"
The death of Bomefree from The Narrative of Sojourner Truth dictated by Sojourner Truth (
1797–1883).
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Related articles in Ann Oncol:
- Predictors of early relapse in postmenopausal women with hormone receptor-positive breast cancer in the BIG 1-98 trial
- L Mauriac, A Keshaviah, M Debled, H Mouridsen, JF Forbes, B Thürlimann, R Paridaens, A Monnier, I Láng, A Wardley, J-M Nogaret, RD Gelber, M Castiglione-Gertsch, KN Price, AS Coates, I Smith, G Viale, M Rabaglio, N Zabaznyi, A Goldhirsch, and On the behalf of BIG 1-98 Collaborative Group and International Breast Cancer Study Group, Berne, Switzerland
Ann Oncol 2007 18: 859-867.
[Abstract]
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- Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumors: a randomized trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP)
- S Culine, P Kerbrat, A Kramar, C Théodore, C Chevreau, L Geoffrois, NB Bui, J Pény, A Caty, R Delva, P Biron, K Fizazi, J Bouzy, and JP Droz
Ann Oncol 2007 18: 917-924.
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- Immunophenotype as prognostic factor for diffuse large B-cell lymphoma in patients undergoing clinical risk-adapted therapy
- H Veelken, S Vik Dannheim, J Schulte Moenting, UM Martens, J Finke, and A Schmitt-Graeff
Ann Oncol 2007 18: 931-939.
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- Monitoring of renal function in cancer patients: an ongoing challenge for clinical practice
- M Kleber, M Cybulla, K Bauchmüller, G Ihorst, B Koch, and M Engelhardt
Ann Oncol 2007 18: 950-958.
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