Annals of Oncology 2008 19(5):827; doi:10.1093/annonc/mdn184
© 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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Pemetrexed as second-line treatment for locally advanced or metastatic NSCLC
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Thirty to forty percent of patients with advanced non-small
cell lung cancer (NSCLC) receive second-line treatment after
standard first-line platinum-based chemotherapy. Consequently,
optimizing second-line treatment has become a major research
focus. A randomized phase III trial comparing docetaxel with
pemetrexed as second-line therapy for advanced NSCLC has shown
that pemetrexed (500 mg/m
2, i.v., day 1, q3week) has comparable
efficacy to docetaxel, but less toxicity. In this issue,
Cullen et al.
[pp. 939–945] report the results of a randomized phase
III trial comparing pemetrexed 500 mg/m
2 with 900 mg/m
2 that
aimed to determine if higher dosing benefits NSCLC patients
as second-line therapy. These authors report that accrual was
terminated with 588/600 patients enrolled because an interim
analysis indicated a low probability of improved survival and
numerically greater toxicity on the P900 arm. These authors
conclude that pemetrexed 500 mg/m
2 i.v. q3week remains the standard
pemetrexed dose for second-line treatment of platinum-pretreated
advanced NSCLC.
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BMI and survival in patients with ovarian cancer
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The incidence of obesity is increasing in the developed world
and is associated with an increased risk of malignancy, contributing
to 14–20% of cancer-related mortality. However, an association
between obesity and cancer survival is less clear. Although
obese women are more likely to develop endometrial cancer, there
is evidence that they have improved survival and, in ovarian
cancer, one study identified increased BMI as an independent
negative prognostic factor for disease-free and overall survival
while a second reported an association between BMI >25 kg/m
2 and reduced survival. These studies are, however, relatively
small and non-homogeneous. In this issue,
Barrett et al. [pp.
898–902] report the results of a retrospective investigation
of the association between BMI and progression-free and overall
survival in women with ovarian cancer or peritoneal cancer treated
on the Scottish Randomised Trial in Ovarian Cancer (SCOTROC)-1
study. These authors report that obese patients with epithelial
ovarian cancer do not have a poorer prognosis, provided that
they receive optimal doses of chemotherapy based on measured
glomerular filtration rate and actual body weight.
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Determinations of LDH in the follow up of myelodysplastic syndromes
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Myelodysplastic syndromes (MDS) represent a heterogeneous group
of myeloid neoplasms characterized by disturbed maturation of
myeloid cells, bone marrow failure, and enhanced risk to transform
to secondary acute myeloid leukaemia (AML). In recent decades,
a number of attempts have been made to establish useful MDS
scoring systems that can indicate the prognosis concerning survival
and AML evolution. A number of previous and more recent studies
have shown that an elevated serum lactate dehydrogenase (LDH)
is associated with a poor prognosis in MDS. In this issue,
Wimazal et al.
[pp. 970–976] report the results of a study in which LDH
levels were serially determined in 221 patients with
de novo MDS (median age 70 years, range 24–94) and the increase
in LDH was then correlated with survival and AML evolution.
These authors report that LDH levels were significantly higher
in the two 3 month periods preceding progression compared with
the previous 3 month periods (
P < 0.005).
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Cigarette smoking and site-specific cancer mortality
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In addition to lung cancer, cigarette smoking has been shown
to be related to an elevated risk of some less common but nonetheless
important malignancies, including carcinoma of the stomach,
pancreas, bladder, esophagus and kidney. Despite apparent biological
plausibility, uncertainty still exists as to the influence,
if any, of smoking on other malignancies, including prostate,
colon, rectum, brain, skin, and lymphoma. For many of these
outcomes, this inconsistency of evidence may be at least partially
ascribed to a paucity of sufficiently powered cohort studies.
In this issue,
Batty et al. [pp. 996–1002] report the
results of a study that aimed to examine the association of
cigarette smoking with death attributed to 15 cancer sites,
seven of which are regarded as having an uncertain relation
with tobacco using data from the original Whitehall study, a
prospective cohort of 17 363 London-based male government employees
(age 40–69 years) who were examined in the late 1960s
and then followed up for a maximum of 38 years. These authors
report that following adjustment for demographic characteristics,
risk factors, and prevalent disease, established positive cigarette
smoking—cancer gradients were confirmed for carcinoma
of the lung, stomach, pancreas, bladder, upper aero-digestive
(including esophagus), and liver, and for myeloid leukemia.
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Quote
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‘"I don't suppose, for instance, Einar," he said, "that you ever had a bill from Finsen for all the medicine your poor mother had a few years ago."
Einar could not deny that it was still owing the doctor – there were about two hundred bottles of it.
"Yes, it doesn't take much medicine to add up to the price of a cow," observed the Fell King.’
Drug costs considered, again, in Independent People by Halldór Laxness.
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