Annals of Oncology 2008 19(8):1365; doi:10.1093/annonc/mdn534
© 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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Extracapsular spread and the risk of recurrence in node-positive, premenopausal breast cancer
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Extracapsular tumor spread in axillary lymph node metastases
is often associated with locoregional failure in breast cancer.
There is, however, controversy about the necessity of regional
irradiation in general, as well as in the presence of extracapsular
tumor spread as few studies have evaluated the prognostic role
of extracapsular tumor spread, and even fewer reports have dealt
with the different sites of relapse in these patients. In this
issue, Gruber et al. (pp. 1393–1401) report on a retrospective
analysis that aimed to evaluate the prognostic impact of extracapsular
tumor spread on the risk of local, axillary, and supraclavicular
recurrence in node-positive premenopausal breast cancer patients
treated within one large randomized trial. These authors report
that following adjustment for the number of lymph node metastases
and other baseline prognostic factors, extracapsular tumor spread
is not significantly associated with any of the three recurrence
types studied.
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Cetuximab with FUFOX in untreated patients with advanced colorectal cancer
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Several studies are exploring the use of the epidermal growth
factor receptor-targeting mAb cetuximab combined with irinotecan
and 5-fluorouracil (5-FU)/FA or oxaliplatin and 5-FU/FA in the
first-line setting in patients with colorectal cancer. FUFOX
is a once-weekly oxaliplatin (50 mg/m
2) plus infusional 5-FU/FA
regimen that has been shown to have superior efficacy and less
toxicity than the bolus 5-FU/FA Mayo Clinic regimen in patients
with advanced colorectal cancer. In this issue, Arnold et al.
(pp. 1442–1449) report a study that aimed to assess the
feasibility of administering cetuximab in combination with FUFOX
at their recommended doses. These authors report that cetuximab
combined with FUFOX was generally well tolerated with the most
common grade 3/4 adverse events being diarrhea (27%) and paresthesia
(16%). Median progression-free and overall survival times including
all 49 patients were 8.1 (95% confidence interval 6.0–9.7)
and 28.2 months, respectively. Cetuximab pharmacokinetics seemed
not to be different for combination with FUFOX compared with
cetuximab/irinotecan combinations.
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Quality of life and comorbidity as prognostic determinants in non-small-cell lung cancer
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In many different human malignancies including lung cancer,
the negative survival impact of comorbidities has been shown
to be a prognostic determinant that is distinct from main disease
characteristics. Lung cancer symptoms and psychological distress
are a major burden for lung cancer patients and greatly contribute
to quality of life (QoL) impairment. Several instruments have
been developed and validated to assess QoL in lung cancer patients,
yet their use is mainly limited to the clinical research setting.
Performance status (PS) remains the key factor in therapeutic
decision making and QoL is often considered as a less-potent
clinical parameter and less easy to measure. Nevertheless, an
exhaustive evaluation of factors contributing to non-small-cell
lung cancer (NSCLC) prognosis will need the simultaneous appraisal
of PS, comorbidities, and QoL. In this issue, Jacot et al. (pp.
1458–1464) report the results of a study that aimed at
validating a lung cancer disease-specific simplified comorbidity
score (SCS) in a prospective bicentric NSCLC population by measuring
its relative prognostic determinant impact while also considering
variables such as QoL, PS, Charlson comorbidity index (CCI),
and disease stage. These authors suggest that the SCS is more
informative than the CCI in predicting NSCLC patient outcome
as the former is also more disease specific.
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An exercise program for persistent cancer-related fatigue after treatment
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While several studies have evaluated different therapies for
the treatment of cancer-related fatigue, therapeutic options
remain limited. Cognitive behavior therapies and psychotherapy
may reduce fatigue in cancer patients, but these interventions
do not correct the impairment of physical performance frequently
observed in this patient group. Exercise has been proposed as
a nonpharmacologic intervention for the treatment of cancer-related
fatigue, and when carried out during chemo- or radiotherapy,
exercise reduces the impairment of PS related to treatment.
Moreover, it has been shown that exercise programs improve the
QoL in women treated for breast cancer. In this issue, Dimeo
et al. (pp. 1495–1499) report the results of a study that
aimed to assess the effects of a 3-week endurance and resistance
exercise program on persistent cancer-related fatigue after
treatment. These authors report that the program led to a substantial
improvement of physical performance and reduction of mental
and physical fatigue in cancer patients after treatment. However,
it did not affect depression, anxiety, or cognitive fatigue.
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Quote
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‘I will put my faith in science, even if this means that
the dumb old body is about to be transmogrified into an evil
clown—puking, trembling, swelling, surrendering significant
parts, and oozing postsurgical fluids. The surgeon—a more
genial and forthcoming one this time—can fit me in; the
oncologist will see me. Welcome to Cancerland.’
Barbara Ehrenreich faces up to therapy in Welcome to Cancerland.
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Extracapsular spread and the...
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