EUROPEAN ONCOLOGY – VOLUME 4 ISSUE 2 – WINTER 2008

Chemotherapy-induced NeutropeniaFebrile neutropenia and its complications continue to be associated with substantial morbidity, mortality and cost.1,2 Haematological toxicity associated with cancer chemotherapy occurs most frequently during the initial cycles, but varies across patient populations and treatment programmes (see Figure 1).3–5 A number of studies have also indicated that chemotherapy-induced neutropenia is associated with improved treatment […]

A multimodal approach to the treatment of cancer pain that deploys both pharmacological and non-pharmacological methods may be beneficial, particularly in more challenging cases. However, pharmacological management is usually the first-line therapeutic approach. Non-steroidal anti-inflammatory agents (NSAIDs) have long been part of the analgesic pharmacopoeia for cancer patients in mild to moderate pain.3 The World […]

Oesophageal and junctional adenocarcinoma may be advanced at presentation, and overall five-year survival remains dismal at between 10 and 20%.1 For patients presenting with localised disease, several advances in standards of care have emerged in recent years that have improved management. First, comprehensive staging with computed tomography (CT), endoscopic ultrasound (EUS) and fluorodeoxyglucose positron emission […]

While ATC is characterised by an almost fatal outcome, with survival that rarely exceeds one year regardless of the available therapy,1 unselected patients suffering from MTC have an overall 10-year survival of approximately 70% following primary surgery.3,4 However, little effective therapy has existed until recently for patients with unresectable MTC.4 Because of the rarity of […]

Chemotherapy versus Best Supportive Care Chemotherapy became a serious entity for NSCLC only in the mid-1990s, particularly after a meta-analysis by the NSCLC Collaborative Group that looked at all randomised controlled trials (RCTs) of chemotherapy or BSC in all treatment situations, i.e. surgery, radiotherapy or BSC.1 In trials of chemotherapy versus BSC in advanced disease, […]

Further understanding of cancer biology has allowed the development of several potential molecular targets for cancer treatment. Numerous targeted agents have been evaluated in clinical trials of cancer treatment, and a number of phase III trials have generated definite results. In particular, several agents that target the epidermal growth factor receptor (EGFR) and the angiogenesis […]

The introduction of new cytotoxic and biological agents in metastatic breast cancer (MBC) has resulted in slightly improved survival. Nevertheless, the prognosis of MBC remains poor, median survival rates from the development of metastases are in the range of two to three years and a cure remains elusive.4 The most frequently used agents in MBC […]

Nevertheless, if epothilones have some similarities to taxanes in targeting and stabilising microtubules, they also have important differences.2,3 These two families target at or near the same binding site on the β-tubulin subunit, but the structural characteristics of epothilones with a 16-member ring and a flexible structure allow binding in a manner that is unique […]

Epothilones are microtubule-stabilising cytotoxic chemotherapeutic agents (see Figure 2).8–11 Their mode of action includes induction of apoptosis and promotion of cell death.7,12,13 These agents represent a novel class of microtubule inhibitors with efficacy and lower susceptibility to drug resistance in taxane-resistant tumours. Epothilones, including ixabepilone, patupilone, KOS-862, KOS-1584 and sagopilone, are under investigation for the […]

EGFR and HER-2 in Breast Cancer The EGFR/HER family of tyrosine kinases plays an important role in the development and progression of breast cancer.1 It includes four known members: EGFR (HER-1 or erbB1), HER-2 (neu or erbB2), HER-3 (erbB3) and HER-4 (erbB4). Signalling from these receptor tyrosine kinases is triggered by binding of specific ligands, […]

The original Memorial Sloan-Kettering Cancer Center (MSKCC) risk group categorisation identified five high-risk factors in cytokine-treated patients: Karnofsky performance status (KPS) <80; serum calcium >10 (corrected for albumin); haemoglobin below normal; absence of prior nephrectomy; and lactate dehydrogenase (LDH) >1.5 x upper limit of normal.1 The median survivals were 20, 10 and four months for […]

Second-line Therapy Development of resistance to one kind of hormonal therapy does not preclude a second or even third line of hormonal manipulation. The androgen receptor often remains active despite low serum testosterone levels.3 Several classes of therapeutic options are available, including: adrenal androgen inhibitors;4 antiandrogens, e.g. flutamide, nilutamide and bicalutamide;5 oestrogens and progestins;6 and […]

The majority of patients with MDS are anaemic. Up to 90% of patients will require regular transfusions. In 50–60% of patients, anaemia is severe (haemoglobin level below 10g/dl)1 and is associated with a decreased physical performance and poor quality of life,2 along with increased cardiac morbidity and mortality.3–5 The aim of blood transfusion therapy is […]

Theoretical Considerations The liver parenchyma is relatively sensitive to radiation, with a tolerance to external irradiation of approximately 30Gy.13,14 In contrast, HCCs are relatively resistant to radiation, requiring doses of 120Gy for tumoricidal effect. The liver is unable to tolerate the radiation doses required to achieve tumoricidal effects by standard external-beam radiation; therefore, whole-liver external-beam […]

The liver provides fertile ground for the formation of metastases, not only because of its dual blood supply but also because of humoral factors that promote cell growth required for constant cell-line function and regeneration. The blood supply of the liver is exceeded only by that of the lung in terms of blood flow per […]

The liver may be the only metastatic site in patients with colorectal carcinoma. Liver metastases can be found in up to 80% of these patients; up to 50% of these cases are identified at primary presentation.1,2 Surgical resection is the standard curative treatment, but fewer than 20% of patients are candidates for this surgery. Recent […]

After the acceptance of irinotecan- and oxaliplatin-based combination therapies as a standard of care, treatment options now extend beyond conventional chemotherapy and routinely include biological agents targeting angiogenesis and the epidermal growth factor receptor (EGFR) system (bevacizumab [BEV] and cetuximab [CET]). The addition of BEV and CET to chemotherapy in the treatment of metastatic colorectal […]

Early-stage Pancreatic Cancer Surgery For the few patients who present with potentially resectable disease, accurate diagnosis and staging are vital to avoid the unnecessary morbidity associated with aggressive surgical management. Initial radiological staging usually employs contrast-enhanced computed tomography. Endoscopic ultrasound (EUS) in experienced hands is emerging as an important pre-operative assessment tool. EUS allows more […]

The treatment of adult sarcomas stands in sharp contrast to childhood sarcomas. In the 1970s, the introduction of chemotherapy made a big difference in the prognosis of rhabdomyosarcoma, Ewing’s sarcoma and osteosarcoma, raising their cure rate from less than 20% to more than 60%.2 The chemosensitivity of adult STS is too low to have a […]

Image-guided RF thermal ablation (RFTA) is a branch of interventional oncology that uses direct application of RF-generated heat to coagulate and destroy tumour tissue.6 The term covers coagulation induction from all electromagnetic energy sources with frequencies less than 30MHz; most currently available devices function in the 375–500kHz range.7 It is the most commonly used technology […]