Annals of Oncology 2007 18(6):967; doi:10.1093/annonc/mdm286
© 2007 European Society for Medical Oncology
in this issue
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Breast cancer in elderly women
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The incidence of breast cancer increases with age, and the disease
affects many older women; however, older women have less access
to clinical trials and fewer opportunities for treatment with
innovative therapies. In this issue
Mustacchi et al. report
on a study that aimed to describe the patient characteristics,
disease status, and local and systemic adjuvant treatments provided
to the subgroup of breast cancer patients aged 65 years or above.
These authors present data on some 1085 breast cancer patients
aged 65 years or above who were recruited to the National Oncological
Research observatory on Adjuvant therapy in breast cancer (NORA)
study, a study designed to collect information regarding adjuvant
treatment strategies after surgery, patterns of recurrence,
and possible correlations between cancer-related events and
biological factors. They found that age was significantly related
to later diagnosis and different patterns of treatment. Choice
of adjuvant systemic treatment was primarily related to hormone
receptor status and tumor stage but was strongly influenced
by patient age, with a proportional relationship between endocrine
treatment and increasing age.
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VEGF gene polymorphisms and gastric cancer prognosis
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Angiogenesis is a prerequisite for the growth and progression
of solid malignancies, and the vascular endothelial growth factor
(VEGF) superfamily of endothelial growth factors has been identified
to critically influence tumor-related angiogenesis. In gastric
cancer, the expression of VEGF or VEGF-C has been reported to
be correlated with poor prognosis, and VEGF-D and its receptor
vascular endothelial growth factor receptor-3 (VEGFR-3) have
been found to be associated with lymphatic metastasis, reduced
patient survival, and poor prognosis after the curative resection
of gastric adenocarcinomas. In clinical studies, VEGF gene polymorphisms
have been reported to be involved in the development of a number
of solid tumors. In this issue,
Kim et al. report the results
of a study that aimed to analyze VEGF gene polymorphisms and
their impact on the prognosis of patients with gastric cancer.
These authors found that VEGF gene polymorphisms were an independent
prognostic marker for patients with surgically resected gastric
adenocarcinoma and conclude that they may help identify patient
subgroups at high risk for a poor disease outcome.
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GVD for relapsed Hodgkin lymphoma
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Approximately 15-20% of patients with stage I-II Hodgkin lymphoma
and 35-40% of patients with stage III-IV Hodgkin lymphoma relapse
after first-line therapy. For patients with chemo-refractory
disease at relapse and those failing autologous stem cell transplantation,
the long-term prognosis is poor. Based on good single agent
response rates and limited toxicity, the Cancer and Leukemia
Group B (CALGB) initiated a phase I/II trial to evaluate the
combination of gemcitabine, vinorelbine, and pegylated liposomal
doxorubicin (GVD) for relapsed Hodgkin lymphoma. In this issue,
Bartlett et al., on behalf of the CALGB, report the results
of that trial. These authors report that the dose limiting toxicity
in phase I was mucositis for the transplant-naïve patients
and febrile neutropenia for the post-transplant patients. The
overall response rate (RR) for all patients was 70% (95% CI
59.8-79.7), with 19% complete remissions. They conclude that
GVD is a well-tolerated, active regimen for relapsed Hodgkin
lymphoma, with high response rates in patients failing prior
transplant confirming this regimens activity even in heavily
pretreated patients.
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Sequential chemotherapy for advanced NSCLC
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In the 1990s, taxanes emerged as important drugs for the management
of non-small-cell lung cancer (NSCLC). Studies with docetaxel
have reported consistent activity as salvage chemotherapy after
cisplatin-based treatment, and data also suggest that paclitaxel
might have similar activity as second-line chemotherapy. In
this issue,
Sculier et al. report the results of a randomized
phase III study that aimed to determine if, in advanced NSCLC,
the sequential administration of cisplatin-based chemotherapy
and paclitaxel is superior to a cisplatin-based chemotherapy,
followed by paclitaxel as salvage treatment. 485 chemotherapy-naïve
patients with advanced NSCLC were treated with 3 courses of
GIP (cisplatin 50 mg/m
2 on day 1, ifosfamide 3 g/m
2 on day 1
and gemcitabine 1 g/m
2 on days 1 and 8). Patients with nonprogressive
disease were then randomized to further similar courses of GIP
or courses of paclitaxel (225 mg/m
2 over 3 hours every 3 weeks).
These authors report no statistically significant difference
(
P= 0.17) between the two arms. They conclude that sequential
chemotherapy using a cisplatin-based regimen followed by paclitaxel
does not result in better outcome than cisplatin-based chemotherapy
using a taxane as salvage treatment.
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Quote
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"In the hands of the physician, narcotics are a great blessing.
In some cases, by relieving pain, they give the system the rest
necessary for overcoming the cause of the pain. Only those who
know of the suffering endured in former times can fully appreciate
the decrease in pain brought about by the proper use of narcotics."
The right use of narcotics from General Science by Bertha M. Clark.
CiteULike 
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Related articles in Ann Oncol:
- Breast cancer in elderly women: a different reality? Results from the NORA study
- G Mustacchi, ME Cazzaniga, P Pronzato, A De Matteis, F Di Costanzo, I Floriani, and On behalf of the NORA Study Group
Ann Oncol 2007 18: 991-996.
[Abstract]
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- Vascular endothelial growth factor gene polymorphisms associated with prognosis for patients with gastric cancer
- JG Kim, SK Sohn, YS Chae, YY Cho, H-I Bae, G Yan, JY Park, M-H Lee, HY Chung, and W Yu
Ann Oncol 2007 18: 1030-1036.
[Abstract]
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- Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin's lymphoma: CALGB 59804
- NL Bartlett, D Niedzwiecki, JL Johnson, JW Friedberg, KB Johnson, K van Besien, AD Zelenetz, BD Cheson, GP Canellos, and For the Cancer Leukemia Group B
Ann Oncol 2007 18: 1071-1079.
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- A phase III randomised trial comparing sequential chemotherapy using cisplatin-based regimen and paclitaxel to cisplatin-based chemotherapy alone in advanced non-small-cell lung cancer
- JP Sculier, JJ Lafitte, J Lecomte, CG Alexopoulos, O Van Cutsem, V Giner, A Efremidis, MC Berchier, T Collon, AP Meert, A Scherpereel, V Ninane, M Paesmans, T Berghmans, and On behalf of European Lung Cancer Working Party
Ann Oncol 2007 18: 1037-1042.
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