Annals of Oncology 2007 18(7):1127; doi:10.1093/annonc/mdm396
© 2007 European Society for Medical Oncology
In this issue
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Oral ibandronate versus intravenous zoledronic acid
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Bisphosphonates such as clodronate, ibandronate, pamidronate
and zoledronic acid are the standard of care for patients with
metastatic bone disease. Biochemical markers of bone resorption
show potential in the initial evaluation of bone metastases,
as surrogates of disease progression, as fracture predictors,
and as prognostic factors of survival. In addition, serum levels
of biochemical markers of bone cell activity are increasingly
recognized as useful determinants for assessing the clinical
response to antineoplastic and antiresorptive therapy in metastatic
bone disease. In this issue
Body et al. report the results of
an open phase III study that aimed to compare directly the effect
of treatment with oral ibandronate and intravenous zoledronic
acid on markers of bone resorption and formation in breast cancer
patients with bone metastases. These authors report that oral
ibandronate was well tolerated and statistically non-inferior
to zoledronic acid for the primary study endpoint, the percentage
change in the bone resorption marker, S-CTX.
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FOLFOX, bevacizumab and erlotinib for metastastic colorectal cancer
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The epidermal growth factor receptor (EGFR) has emerged as an
important therapeutic target in a variety of human cancers.
In colorectal cancer, between 25-77% of tumors overexpress EGFR
and this overexpression has been associated with poorer prognosis.
While the oral inhibitors of the EGFR intracellular domain,
such as erlotinib and gefitinib, do not appear to have measurable
activity against metastatic colorectal cancer as single agents,
they may enhance the activity of combination chemotherapy. In
this issue,
Meyerhardt et al. report the results of a multi-center
phase II study that aimed to assess the efficacy and toxicity
of a combination of infusional 5-fluorouracil (5-FU), leucovorin,
oxaliplatin, bevacizumab and erlotinib for the first-line treatment
of patients with metastatic colorectal cancer. These authors
report that of the 35 patients enrolled all came off trial for
reasons other than progression; 18 (51%) had protocol-defined
adverse events requiring removal, 9 (26%) withdrew consent due
to toxicity, 6 pursued surgery or localized therapies, and 2
requested a treatment holiday. The authors suggest that these
findings raise concerns about the tolerability of adding more
agents to already complex combination regimens for metastatic
colorectal cancer.
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Phase I/II Study of galiximab with rituximab
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Treatment of follicular non-Hodgkin's lymphoma (NHL) is characteristically
associated with a high rate of initial response, followed by
relapse. Despite improvements in response rates with more aggressive
combination regimens, the increased toxicity and/or logistics
of administration with these regimens limit their use in a significant
number of patients. Single-agent rituximab (anti-CD20 antibody)
has demonstrated response rates of approximately 50% with a
favorable safety profile in relapsed or refractory, low-grade
or follicular B-cell NHL. Studies investigating maintenance/extended
treatment with rituximab have shown prolonged progression-free
survival and event-free survival in indolent NHL. Galiximab,
a monoclonal antibody that targets CD80, has shown modest single-agent
clinical activity and tolerability in a phase I study in relapsed
or refractory, follicular NHL. In this issue,
Leonard et al.
report on a phase I/II study that aimed to evaluate galiximab
in combination with a standard course of rituximab. These authors
conclude that galiximab can be safely combined with a standard
course of rituximab.
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Effects of chemotherapy on reactivation of tuberculosis
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Various malignancies and cytotoxic chemotherapy have been proposed
to increase the risk of reactivation of tuberculosis, but the
available literature on this topic is conflicting. In India
tuberculosis continues to be a common infection in with reported
prevalence of cases in Chengulpet in Tamil Nadu as high as 10.8/1000
person. In this issue,
Nair et al. present a retrospective analysis
of patients with high grade non- Hodgkin's lymphoma (NHL) with
a past history of tuberculosis and who had had adequate antitubercular
therapy. These patients were followed up during cytotoxic chemotherapy
and later to assess the risk of reactivation of tuberculosis.
These authors report that in cohort of 8 patients with past
history of tuberculosis, selected from 141 patients of high
grade NHL, all patients received cyclical cytotoxic chemotherapy.
The median duration of follow up after completion of chemotherapy
was 5 years (range- 10 months- 5 years), during which none of
the patients developed reactivation of tuberculosis.
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Quote
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"Yet – when the dreadful steel was plunged into the breast
– cutting through veins – arteries – flesh
– nerves – I needed no injunctions not to restrain
my cries. I began a scream that lasted unintermittingly during
the whole of the incision - & I almost marvel that it rings
not in my Ears still! so excruciating was the agony."
Fanny Burney recalls her mastectomy, 1811, from The Journal and Letters of Fanny Burney (Madame D'Arblay) 1791-1840.
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- Oral ibandronate is as active as intravenous zoledronic acid for reducing bone turnover markers in women with breast cancer and bone metastases
- J-J Body, M Lichinitser, S Tjulandin, P Garnero, and B Bergström
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- Phase II study of FOLFOX, bevacizumab and erlotinib as first-line therapy for patients with metastastic colorectal cancer
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