Annals of Oncology 2008 19(10):1663; doi:10.1093/annonc/mdn660
© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org
In this issue
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Prognosis and therapy of breast carcinomas according to HER2 score
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The standardization of the HER2 score and recent changes in
therapeutic modalities in both the surgical and pharmaceutical
adjuvant arenas suggest the need for a reevaluation of the role
of HER2 in recently diagnosed breast carcinomas. Such analyses
are possible even with a relatively short follow-up period since
the prognostic impact of HER2 positivity is related to the first
3–4 years after surgery. In this issue, Ménard
et al. [pp. 1706–1712] present the results of a multicenter,
retrospective study of 1794 primary breast carcinomas diagnosed
in Italy in 2000–2001 and which were scored in four HER2
categories according to immunohistochemistry. The authors conclude
that the present prognostic significance of HER2 is correlated
to receptor expression level and they suggest the need to consider
HER2 2+ and HER2 3+ tumors as distinct diseases with different
outcomes and specific features.
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Testing standard vs. daily radiosensitisation by cisplatin for limited small-cell lung cancer
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Chemotherapy has been a major advance in the treatment of small-cell
lung cancer (SCLC). However, if survival is significantly prolonged,
5-year overall survival (OS) is approximately 5% and there are
10 times more long-term survivors in patients with limited disease
than in those with extensive disease. Radiotherapy, in combination
with chemotherapy, can improve survival as established by various
meta-analyses. In this issue, Sculier et al. [pp.1691–1697]
present the results of a randomized phase III study that aimed
to determine in limited small-cell lung cancer if locoregional
irradiation concurrently with induction chemotherapy with cisplatin
and etoposide prolongs survival when cisplatin is given daily
as a radiosensitiser. These authors report the trial did not
show that daily radiosensitisation by small doses of cisplatin
can improve survival in comparison to the standard administration
of the full dose of cisplatin on the first day of induction
chemoradiotherapy. Nevertheless, both arms were associated with
quite good long-term survival: 18% and 21% 5-year survival rates,
respectively.
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XELOX vs. FOLFOX-4 as second-line therapy in metastatic colorectal cancer
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Capecitabine is an oral fluoropyrimidine with similar efficacy
to bolus 5-FU/folinic acid in both the first-line treatment
of metastatic colorectal cancer and as adjuvant therapy for
stage III colon cancer. XELOX, a regimen combining capecitabine
and oxaliplatin has emerged as a viable treatment option in
both the first-line and second-line settings. Noninferiority
of XELOX versus FOLFOX has recently been demonstrated in two
phase III studies in the first-line treatment of metastatic
colorectal cancer. In this issue, Rothenberg et al. [pp. 1720–1726]
present the results of a randomized phase III trial that aimed
to demonstrate the noninferiority of capecitabine plus oxaliplatin
(XELOX) versus 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX-4)
as second-line therapy in patients with metastatic colorectal
cancer after prior irinotecan-based chemotherapy. These authors
found that XELOX was noninferior to FOLFOX-4 with respect to
progression-free survival in these patients. Moreover, although
the study was not powered for an analysis of overall survival,
the overall survival data were supportive of the primary analysis.
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Pulmonary function in Hodgkin's lymphoma patients
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Pulmonary toxicity and lung function impairment are well documented
as acute and late complications after radiation therapy alone
for Hodgkin's lymphoma (HL). Combined modality therapy has replaced
radiation therapy alone as standard therapy for patients with
HL, but with the known pulmonary toxicity associated with bleomycin,
studies have shown that the combination of adriamycin, bleomycin,
vinblastine, and dacarbazine (ABVD) with mediastinal irradiation
further potentiates lung toxicity. While there are ample data
describing the relationship between radiation and the risk of
pulmonary toxicity in patients receiving radiation therapy for
lung cancer, less information is available on HL patients. In
this issue, Ng et al. [pp. 1754–1758] report on a study
that aimed to prospectively study changes in lung function in
Hodgkin's lymphoma (HL) patients and to explore predictors for
these changes over time. These authors report that several factors
contribute to decline in %DLCO in HL patients who received bleomycin-based
computed tomography. They suggest that the identification of
threshold radiation dosimetric parameters for reduced lung function
may provide guidance in the radiation planning of these patients.
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Quote
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"Life is a rainbow that also includes black."
Poet Yevgeny Yevtushenko in interview in 1987.
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