bluuebunny/crossref_metadata_2025 huggingface dataset:
Can an Oncology Information System Improve Radiation Therapy Safety and Patient Confidence?
Authors: Francis Laura ,   Business Marketing Manager, Business Software Systems, Elekta Ltd
Published: October 2015

Radiation therapy has become one of the safest and most effective methods for treating cancer. Over half of all cancer patients undergo radiotherapy, either as the sole treatment technique or combined with other therapies. As technologies evolve and improve, radiotherapy techniques become increasingly sophisticated, requiring more time and skill to ensure delivery as prescribed. Such is the increasing complexity of treatments that technology providers are trying to keep up with demand for more and more advanced computing power to manage the need for immensely precise and powerful tools. Today the need for oncology information systems and electronic medical records is paramount in providing the tools for image management, data and workflow control supporting individual patient demographics, treatment planning, delivery and follow-up.
What’s New in Gynaecological Oncology?
Authors: Vagno Giovanni Di ,   Senior Registrar, Department of Obstetrics and Gynaecology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo
Published: October 2015

Is para-aortic lymph node dissection beneficial in the treatment of endometrial cancer? Para-aortic lymph node dissection is associated with a survival benefit in women with intermediate or high-risk endometrial cancer: a retrospective cohort study of women with endometrial cancer reported that eight-year, disease-specific survival rates were significantly higher for women with intermediate or high-risk disease who underwent combined pelvic and para-aortic lymph node dissection compared with pelvic lymph node dissection alone; there was, however, no significant difference in women with low-risk disease. What is the best, cutting-edge management for clear cell and papillary serous cancers of the endometrium? There is increasing evidence of the efficacy of an integrated and modified approach for these special histotypes compared with standard treatment for endometrial cancer: platinum/taxane-based chemotherapy is effective in determining relapse/survival benefits of both early- and advanced-stage patients. Is it possible to predict optimal cytoreduction in ovarian cancer? A high preoperative serum CA-125 level is associated with a lower likelihood of optimal cytoreduction: a meta-analysis of 14 studies found that serum CA-125 ≥500 U/ml has sensitivity and specificity for optimal cytoreduction of 69 and 63 %, respectively. Can multiple conisation procedures increase the risk of preterm delivery? The risk of preterm delivery increases in women with cervical intraepithelial neoplasia who undergo more than one cervical conisation. A population-based retrospective study reported that, compared with women who have undergone one prior conisation, the risk of preterm delivery increases threefold in women with two prior conisations. How often do the human papillomavirus (HPV) genotypes 16 and 18 cause invasive cervical cancer? In recent decades, the rate at which the major HPV genotypes (contained within HPV vaccines) caused invasive cervical cancers remained stable. This observation is crucial, given the large amount of public money invested in prophylactic HPV vaccine campaigns.
Bronchial Carcinoid Tumours in Children — A Review
Authors: Rizzardi Giovanna , Bertolaccini Luca , Terzi Alberto ,   Thoracic Surgery Unit, S Croce Hospital, Cuneo,   Thoracic Surgery Unit, S Croce Hospital, Cuneo,   Thoracic Surgery Unit, S Croce Hospital, Cuneo
Published: October 2015

Bronchial carcinoids (BCs) are rare, well-differentiated malignant neuroendocrine tumours that account for 25 % of all lung neoplasms in adults. In paediatric patients, carcinoids represent the most frequent primary lung cancer. Although BCs in childhood often have an endobronchial location causing airway obstruction, they are frequently misdiagnosed as benign conditions, resulting in a delay in definitive diagnosis and treatment. Surgery represents the treatment of choice for BCs, and lung-sparing resections (sleeve or bronchoplastic procedures) are recommended in central carcinoid tumours; pneumonectomy should be avoided, particularly in childhood. If promptly diagnosed and radically treated, BCs in children have an excellent prognosis. Relapses can occur many years after a radical resection, highlighting the necessity for long-term follow-up.
Treatment Options for Myelodysplastic Syndromes
Authors: Prescott Hillary , Jabbour Elias , Bryan Jeffrey , Kantarjian Hagop ,   Clinical Pharmacy Specialist,   Assistant Professor,   Clinical Pharmacy Specialist,   Chair, Department of Leukemia, The University of Texas MD Anderson Cancer Center
Published: October 2015

Myelodysplastic syndromes (MDS) are a group of heterogeneous haematopoietic stem cell disorders characterised by peripheral blood cytopenias and a risk of transformation to acute myeloid leukaemia. Until recently, treatment of MDS predominately consisted of supportive care measures. However, three agents for the treatment of MDS have recently been approved: lenalidomide, decitabine and azacitidine. These agents have dramatically improved the outcomes for patients with MDS. To date, azacitidine is the only agent that has demonstrated a survival advantage when compared with conventional care. Novel agents and combination regimens including lenalidomide, decitabine and azacitidine are being explored in an effort to further improve patient outcomes.
The Role of Imaging in Suspected Prostate Cancer
Authors: Ouzzane Adil , Villers Arnauld ,   Assistant Specialist,   Professor and Chairman, Department of Urology, Lille University Hospital, Lille Nord de France University
Published: October 2015

Among a multitude of tests available to evaluate patients with suspected prostate cancer, modern imaging techniques seem to be the most relevant and their use is growing fast. Magnetic resonance imaging (MRI) technology is the most important imaging tool for identifying early prostate cancers, characterising tumours, helping in patient risk stratification and enabling focused use of biopsy. In addition, recent advances in transrectal ultrasonography of the prostate, such as realtime tissue elastography and contrast-enhanced ultrasonography, allow better identification of cancer. The optimal prostate cancer diagnostic strategy has to be validated. However, one way of improving identification in patients referred for screening might be pre-biopsy MRI, which would provide guidance for targeting biopsies. A targeted biopsies only strategy (that is, without systematic biopsies) may reduce the number of biopsies (indicated only in patients with positive imaging), therefore avoiding the potentially unnecessary diagnosis of insignificant cancer. Any prospective, randomised trial testing MRI as an adjunct or replacement for biopsies will need to be carefully designed to include costutility and cost-effectiveness analysis of imaging.
Cabazitaxel in the Management of Metastatic Castration-resistant Prostate Cancer Progressing After Docetaxel-based Chemotherapy
Authors: Heidenreich Axel , Pfister David ,   Chairman and Director,   Head Urologist, Conservative Uro-oncology, Department of Urology, RWTH Aachen University
Published: October 2015

Docetaxel is the guideline-recommended first-line chemotherapy in men with castration-resistant prostate cancer (CRPC). Despite its proven survival benefit, however, all patients will progress after a mean interval of six to eight months. Recently, the FDA approved cabazitaxel and abiraterone acetate as effective second-line treatment options in this clinical scenario. By comparison with mitoxantrone, cabazitaxel improves progression-free survival, overall survival, time to prostate surface antigen (PSA) progression and time to metastatic progression. On the other hand, cabazitaxel (Sanofi) is asscociated with a significantly higher frequency of grade 3 and 4 haematotoxic and gastrointestinal side effects than mitoxantrone. In experienced hands, and with the use of proactive therapeutic measures  such as weekly monitoring, adequate patient counselling and appropriate application of the guidelines on management and prophylaxis of neutropenia and diarrhoea — all side effects can be handled easily without harming the patient, as has been shown recently by the analysis of the results of the German and European compassionate use programmes. Cabazitaxel is one of the key components in the management of disease progression after docetaxel, and might be of benefit in men with high metastatic burden, rapid PSA doubling time and minimal side effects during first-line docetaxel therapy.
Bevacizumab Therapy for Choroidal Melanoma
Authors: Lima Breno R , Singh Arun D ,   Senior Resident in Ophthalmology,   Director, Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, US
Published: October 2015

Bevacizumab, an anti-angiogenic agent, has gained widespread use in ophthalmology for the treatment of neovascular conditions, such as age-related macular degeneration. Targeting angiogenesis has been proposed as a potential therapy for different kinds of malignancies, by limiting supply of oxygen and nutrients, and consequently tumour growth and metastasis. Bevacizumab has been approved by the US Food and Drug Administration, along with chemotherapy, for the treatment of metastatic colorectal carcinoma and non-small cell lung cancer. Nevertheless, a beneficial effect in the treatment of choroidal melanoma has yet to be demonstrated, despite elevated levels of vascular endothelial growth factor (VEGF). However, bevacizumab might have a role in the management of complications of radiation therapy.
Management Strategies for Elderly Patients with Diffuse Large B-Cell Lymphoma
Authors: Nastoupil Loretta J , Sinha Rajni , Flowers Christopher R ,   Fellow,   Assistant Professor,   Director, Lymphoma Program and Associate Professor, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, US
Published: October 2015

Diffuse large B-cell lymphoma (DLBCL) is the most commonly occurring form of lymphoma and most commonly presents in the sixth decade. Given the dramatic rise of the incidence of lymphoma since the late 1990s in patients who present over the age of 65, and the expected increase in the prevalence of DLBCL with the ageing population, defining appropriately tailored modern therapy for elderly DLBCL patients is an increasingly important clinical concern. Moreover, age has been one of the most important adverse prognostic features, with numerous studies associating older age with inferior outcomes. Although it has been well established that B-cell diversity decreases with age, and that the loss of diversity can be associated with clonal expansion of B-cells, it remains unknown how this or other factors contribute to the pathogenesis and poor prognosis in elderly patients with DLBCL. Furthermore, elderly patients often have more co-morbid illnesses, worse performance status, less haematologic reserve and altered pharmacokinetics related to decreased metabolism and clearance of drugs. We examine the impact of these factors on therapeutic decision-making in patients with DLBCL and explore treatment alternatives for elderly individuals. Future research is needed not only to address treatment strategies but also to define the biologic heterogeneity between younger and older patients with DLBCL, so that more rational therapeutic approaches can be investigated.
Serious Hazards of Transfusion Haemovigilance — The UK Experience
Authors: Bolton-Maggs Paula HB , Cohen Hannah ,   Consultant Haematologist and Honorary Senior Lecturer, University of Manchester,   Consultant Haematologist and Honorary Senior Lecturer, Department of Haematology, University College London Hospitals NHS Foundation Trust and University College London, UK
Published: October 2015

Haemovigilance is an important method for the surveillance of adverse events. The UK Serious Hazards of Transfusion (SHOT) scheme was set up in 1996 and collects adverse events resulting from the transfusion of blood and its components. The information collected is presented at an annual symposium and published in report form, and has resulted in several changes in blood transfusion practices  in the blood services at donor collection, within hospital laboratories and at the patients bedside — resulting in improved safety and a reduction in serious events and deaths. SHOT reporting has stimulated many other initiatives, such as national transfusion audit and education strategies, endorsed by the government in order to reduce harm and increase transfusion safety.
Ability of the Comprehensive Geriatric Assessment to Predict Frailty in Older People Diagnosed with Cancer in a General Hospital
Authors: Molina-Garrido Maria José , Guillén-Ponce Carmen ,   Head, Senior Adult Oncology Consultation, Medical Oncology Department, Virgen de la Luz General Hospital, Cuenca,   Medical Oncologist, Oncology Department, Ramón y Cajal General Hospital, Madrid, Spain
Published: October 2015

The field of oncogeriatrics considers the comprehensive geriatric assessment (CGA) as the main tool for distinguishing between patients who are frail and those who are not frail. The aim of our study was to determine the role of the CGA in predicting the risk of frailty in elderly patients. This prospective study was conducted at the Cancer in the Elderly Unit of the Medical Oncology Department at the Virgen de la Luz General Hospital in Cuenca, Spain. Demographic data and information about the CGA were collected. Using a bivariate logistic regression analysis, these factors were analysed and the factors that are associated with the risk of frailty were determined, as measured by the Barber questionnaire (BQ). We included 262 patients in the study with a mean age of 79 years (range 7093 years). Seventy-four percent of the patients (n=194) had a risk of frailty as measured by the BQ. In the bivariate analysis, only age (odds ratio [OR] 1.064, 95 % confidence interval [CI] 1.0001.133, p=0.051), being divorced, widowed or single (OR 0.450, 95 % CI 0.2160.937, p=0.033) and being dependent in instrumental activities of daily living (IADL) (OR 3.003, 95 % CI 1.1817.638, p=0.021) were associated with a higher risk of frailty. The risk of being frail in an elderly patient with cancer is higher in patients dependent in IADL and in patients who are not married. Age is another risk factor for frailty.
Antitumour Effects of Somatostatin Analogues in the Treatment of Neuroendocrine Tumours
Authors: Bastos Diogo Assed , Gumz Brenda , Costa Frederico ,   Hematologist,   Physician,   Medical Oncologist, Oncology Center, Hospital Sírio-Libanês, São Paulo, Brazil
Published: October 2015

Neuroendocrine tumours (NETs) are rare and heterogeneous neoplasms that can present with functional syndromes due to the hypersecretion of peptides. Somatostatin analogues (SSAs) have been used since the 1980s for the treatment of neuroendocrine tumours, with the aim of controlling the symptoms of functioning tumours and improving patients’ quality of life. Data from preclinical studies offer evidence of both direct and indirect mechanisms by which SSAs can exert antitumour effects. The activation of somatostatin receptors by SSAs leads to the activation of phosphotyrosine phosphatases, which control downstream apoptotic and antiproliferation signalling pathways. Also, the suppression of secretion of several growth factors and inhibition of antiangiogenic activity by SSAs indirectly inhibits tumour cell proliferationin vitro. Previous uncontrolled studies had shown tumour shrinkage and disappearance in response to the SSA octreotide. Recent results from the randomised and placebo-controlled PROMID trial have demonstrated that octreotide has antitumour activity in patients with metastatic mid-gut NETs. This article examines recent data providing evidence of the antitumour activity of somatostatin analogues.
Symptomatic Spinal Metastases from Intracranial High-grade Glioma – Report of Four Cases and Review of the Literature
Authors: Powell James ,   Specialist Registrar, Velindre Cancer Centre, Velindre NHS Trust, Wales
Published: October 2015

Intraspinal (leptomeningeal or intramedullary) metastases from primary intracranial gliomas have been well documented in several clinical and pathological series; however, symptomatic intraspinal metastases remain rare. We conducted a retrospective search of cases of intraspinal metastases treated at our centre and report four cases of symptomatic intraspinal leptomeningeal and intramedullary metastases from an intracranial glioma. The mean age of the four cases was 43 years (range 28–55 years). The intraspinal metastases were detected after a median time of 18.5 months after onset of the disease and the median survival time of the four patients from detection of spinal metastases was one month. Median overall survival of the four patients was 19 months. One patient was treated with surgery and all received radiotherapy treatment. Radiotherapy provided good initial palliation of pain but improvement in neurological deficits was limited.Overall, prognosis in cases of leptomeningeal and intramedullary metastases from primary intracranial glioma is very poor; however, this diagnosis should be considered in patients with malignant glioma presenting with new back pain and/or associated spinal neurological signs or symptoms. Radiotherapy provided relief of pain and some improvement in neurological function but no survival advantage. Clinical awareness and recognition of this entity will become increasingly important as local control of primary malignant glioma improves and corresponding improvements in outcome and prognosis of this disease are observed.
Preoperative Treatment of Locally Advanced Rectal Cancer
Authors: Sohal Davendra P S , Sun Weijing ,   Attending Physician and Assistant Professor, Cleveland Clinic, Cleveland, US,   Professor and Director of GI Cancer of Hematology-Oncology Division, Co-Director, UPMC Gastrointestinal Cancer Center of Excellence, UPMC Cancer Pavilion, Pittsburgh, US
Published: October 2015

The preoperative management of locally advanced rectal cancer has evolved over the years to establish fluoropyrimidine-based chemoradiation as the usual standard of care. With the advent of newer agents – chemotherapeutic and biologic – for treatment of colorectal cancer, their role in this setting is being evaluated as well. This review is focusing on up-to-date data and studies regarding preoperative treatment of locally advanced rectal cancer.
Combination Therapy of Cancer – Escalating the Effect of Dendritic Cell-based Cancer Vaccine in the Tumour Micro-environment
Authors: Lee Hyunah ,   Office of the Biomedical Professors, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Published: October 2015

A key factor in initiating and operating the immune system against tumour cells, the dendritic cell (DC) has been regarded as the next possible breakthrough in new cancer therapy. However, the results of more than 15 years of clinical studies with DC vaccine revealed the difficulties fulfilling this expectation. Evidence has disclosed that the DC activation required for proper tumour-specific effector CD4+ and CD8+ T cell stimulation is inhibited in the micro-environment of tumour. Studies have further reported that DC phenotypes in tumour tissue and draining lymph nodes are mostly immature, which results in regulatory immune responses. Also, the existence of MDSCs and TAMs adversely affect both DC function and immune suppression in the cancer-environment. In this review, efforts to overcome the tumour or host-dependent hindering which inhibit the effect of cancer vaccine will be discussed. The combination therapy of cancer with DC vaccine and other immune modulators may improve the clinical efficacy.
Squamous Cell Carcinoma Arising in a Mature Cystic Teratoma of the Ovary: A Case Series and Review of the Literature
Authors: Powell James R , Haldar Krishnayan ,   Specialist Registrar, Velindre Cancer Centre, Carfiff, Wales, UK,   Sub-specialty Fellow, Llandough Hospital, Cardiff, Wales, UK
Published: October 2015

Mature cystic teratomas account for 30–45 % of all ovarian tumours. Malignant transformation of these tumours is rare with squamous cell carcinoma (SCC) being the commonest histological type. During a 24-year period (1986–2010) we identified six women treated for SCC arising in a mature cystic teratoma at our institution. Each case was reviewed retrospectively recording presenting symptoms, tumour markers, preoperative imaging, tumour stage, management and outcome. Durable responses are difficult to achieve but best treatment response was seen in a woman who had partial response to chemo-radiotherapy. Concurrent chemo-radiation may be considered for disease confined to the pelvis.
Current Status and New Developments in Breast Cancer Diagnosis and Detection
Authors: Tzias Demitrios , AM O’Flynn Elizabeth , Allen Steven D , M Wilson A Robin ,   Specialist Registrar, The Royal Marsden Hospital NHS Foundation Trust,   Senior Research Fellow and Consultant Radiologist, The Institute for Cancer Research, Sutton and & The Royal Marsden NHS Foundation Trust, London,   Consultant Radiologist, The Royal Marsden Hospital NHS Foundation Trust, London, UK,   Consultant Radiologist, The Royal Marsden Hospital NHS Foundation Trust, London, UK
Published: October 2015

Despite extensive research into new ways of imaging the breast x-ray mammography and breast ultrasound, supplemented where necessary by magnetic resonance imaging, remain the techniques used for the vast majority of breast imaging for screening and the assessment of symptomatic breast problems. Recent advances in these technologies mean that these three techniques are highly effective for both detecting disease and for confirming normality. X-ray based imaging of the breast has been around now for 100 years but it is only in the last 10 years or so that digital technology developments have allowed for major advances in the efficacy of this technique. Digital breast tomosynthesis is currently the most promising technology as it has the potential to both improve detection of breast cancer and greatly reduce the numbers of false positive events. Technological advances in grey scale high frequency ultrasound imaging mean that it is now universally used in both symptomatic diagnosis and breast screening. Newer ultrasound techniques such as 3D imaging, Doppler analyses and elastography add some additional value but so far none of these has achieved their hoped for additional potential. Magnetic resonance imaging is currently the most sensitive imaging technique for the detection and characterisation of breast disease, but its cost remains a barrier to its more widespread use. Nuclear medicine techniques have a role is special circumstances but are yet to show that they should be used in routine practice. There are a large number of potential alternative new imaging techniques for the breast, but, as yet, none of these have shown any significant benefits over the current techniques. Dedicated breast computed tomography has perhaps the best promise but clinically effective breast imaging at present remains in the application and refinement of recent developments in digital mammography, ultrasound and magnetic resonance imaging.
Octreotide – A Review of its Use in Treating Neuroendocrine Tumours
Authors: Costa Frederico , Gumz Brenda ,   Medical Oncologist,   Physician, Oncology Centre, Hospital Sírio-Libanês, São Paulo, Brazil
Published: October 2015

Neuroendocrine tumours (NETs) are a heterogeneous group of neoplasms whose incidence has dramatically increased in recent years. Octreotide is a somatostatin analogue used in the treatment of NETs, and its use in clinical trials has been associated with substantially increased survival. Although traditionally used for the relief of symptoms that result from release of peptides and neuroamines, there has been a growing body of evidence that suggest octreotide has antiproliferative effects. A phase III clinical study has demonstrated that the long-acting formulation (LAR), octreotide LAR, lengthens time to tumour progression in patients with well-differentiated metastatic midgut NETs, and that octreotide LAR is a treatment option for patients with metastatic midgut NETs, regardless of functional status. Furthermore, octreotide LAR has demonstrated clinical efficacy in different types of NETs. These data, along with emerging data on somatostatin analogs, may change the way doctors approach this patient population and reinforce the use of these drugs as a treatment option for patients with non-functioning tumours.
New Developments in Chronic Lymphocytic Leukaemia Diagnosis
Authors: Delgado Julio , Santacruz Rodrigo , Baumann Tycho , Montserrat Emili ,   Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain,   Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain,   Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain,   Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Published: October 2015

Chronic lymphocytic leukaemia (CLL) is the most prevalent leukaemia in the developed world, with a remarkable racial and sex diversity. The diagnosis of CLL is based on the presence in blood of more than 5,000 monoclonal B cells/μl, with a distinctive immunophenotype (CD5+, SmIgdim, CD20dim, CD19, CD23), which persists for more than 3 months. Newer monoclonal antibodies, such as anti-CD43, anti-CD200 or anti-ROR1, may provide further information in differentiating CLL from other chronic lymphoproliferative disorders. CLL lacks a specific genetic signature regarding chromosomic aberrations, but in cases of uncertain diagnosis molecular genetics including fluorescentin situhybridisation may be useful. Next-generation sequencing techniques are unfolding the molecular heterogeneity of CLL.
Introduction
Authors: Bellmunt Joaquim ,   Hospital del Mar, Barcelona, Spain
Published: October 2015

Vinflunine is the only agent that has been developed and registered in the treatment of metastatic urothelial carcinoma after the failure of a platinum-containing regimen. It was registered in 2009 as single agent on the basis of a phase III pivotal trial that followed two phase II trials. The results of the phase III trial were confirmed in a long-term analysis and in subgroup analyses. Vinflunine is now recommended in European guidelines. Its usage can be adapted to special populations that are not rare in this disease, such as elderly patients or patients with renal or hepatic impairment. However, there remain some unmet medical needs that further development with vinflunine could theoritically meet in order to further improve the care of patients with urothelial carcinoma. Several tracks are being explored, which include first-line or maintenance chemotherapy regimens for patients who are not fit for cisplatin.
How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?
Authors: Glynne-Jones Rob , Tan David , Moran Brendan J , Goh Vicky ,   Consultant Radiation Oncologist, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK,   Oncologist, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK,   National Clinical Lead for Low Rectal Cancer and Consultant Colorectal Surgeon, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK,   Professor, Division of Imaging Sciences and Biomedical Engineering, Kings College London, Department of Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
Published: October 2015

The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases?
Neoadjuvant Chemotherapeutic and Targeted Therapies for Early-stage, High-risk Breast Cancer
Authors: Chung Clement , Lee Rosetta ,   Oncology Clinical Pharmacist, Lyndon B Johnson General Hospital, Houston, Texas, US,   PGY1 Pharmacy Practice Resident, Ben Taub General Hospital, Houston, Texas, US
Published: October 2015

Neoadjuvant or preoperative chemotherapy is the preferred treatment for locally advanced, inflammatory and early-stage high-risk breast cancers. Patients with locally advanced breast cancers are candidates for neoadjuvant therapy because their tumours are often not amenable to resection. On the other hand, patients are candidates for neoadjuvant chemotherapy if the breast-conserving surgery is not possible. At present, anthracycline- and taxane-based chemotherapy regimens remain as the cornerstone for neoadjuvant therapy in early breast cancer, but there is a clear need for effective therapies in high-risk, early-stage patients. A number of chemotherapeutic and targeted therapies have been evaluated in clinical trials with varying results. The US Food and Drug Administration (FDA) has recently approved pertuzumab in combination with trastuzumab and cytotoxic chemotherapy as a neoadjuvant therapy option for HER2-positive breast cancer. This article reviews the neoadjuvant chemotherapeutic and targeted therapies options for early-stage, high-risk breast cancer. Possible role of molecular subtyping in triple-negative breast cancer is also described.
Oncoplasty as the Standard of Care in Breast Cancer Surgery
Authors: Urban Cicero , Anselmi Karina Furlan , Kuroda Flavia , Schwartz Jean-Claude ,   Breast Surgeon and Professor of Medicine, Pontifical Catholic University of Paraná and Positivo University and Chair of the Department of Surgery, Hospital Nossa Senhora das Graças, Curitiba, Brazil,   Breast Surgeon, Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil,   Breast Surgeon, Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil,   Breast Surgeon, Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
Published: October 2015

Oncoplastic surgery is redefining breast cancer surgery today. Despite the lack of randomised clinical trials, current evidence suggests at least equivalent oncological outcomes, reduced re-excision rates and superior aesthetic results. This review outlines the arguments for the superiority of this new approach over the current standard of care and discusses some of the difficulties with regards to training and mentoring the next generation of surgeons.
Immunosuppressed Microenvironment – An Emerging Target in Prostate Cancer Management
Authors: Bellmunt Joaquim , Fizazi Karim , Srikrishna Geetha ,   Associate Professor of Medicine, Dana Farber Cancer Center and Director, Harvard Medical School, Boston, Massachusetts, US,   Chair, Department of Cancer Medicine, Institut Gustave Roussy and Professor of Medicine, University of Paris Sud, Villejuif, France,   Research Assistant Professor, Cancer Center, Sanford-Burnham Medical Research Institute, La Jolla, California, US
Published: October 2015

Although the prognosis of metastatic castrate-resistant prostate cancer (mCRPC) has dramatically changed in the last decade, with median survivals improving from about a year to almost 3 years, current hormonal and chemotherapeutic approaches ultimately result in resistance. An enhanced understanding of the microenvironment of prostate cancer may explain the mechanisms underlying this resistance and provide novel therapeutic targets. The tumour microenvironment promotes the growth and spread of prostate cancer through suppression of immune responses. Many cellular and molecular components of the immunosuppressed tumour microenvironment have been identified as potential targets for therapeutic intervention, including myeloid-derived suppressor cells (MDSCs), tumour-associated macrophages (TAMs), toll-like receptors (TLRs) and the pro-inflammatory protein S100A9. Several agents have demonstrated an ability to modulate the tumour cell microenvironment, including immunotherapies such as sipuleucel T and ipilimumab. In preclinical models, tasquinimod has been shown to bind to S100A9 and therefore has the potential to affect accumulation and function of MDSCs as well as enhancing anti-tumour immune responses. It is now in phase III development. The bone microenvironment also represents a valuable therapeutic target: in clinical studies, denosumab, a rank-L inhibitor, delays time to first skeletal event, despite showing no improvement in overall survival (OS). Radium-223, an alpha-emitter with high bone affinity, delays bone metastasis as well as significantly improving OS.
Personalised Cancer Care – A Global Perspective
Authors: Cazap Eduardo ,   Past-President, Union for International Cancer Control (UICC), Geneva; Founding President, Latin-American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires; Executive Committee, National Cancer Institute, Ministry of Health, Buenos Aires, Argentina
Published: October 2015

Much debate surrounds the matter of personalised medicine. The problem of new treatments at high costs is usually mentioned in relation with inequalities and problems of access to care. But there is also an urgent need to discuss the impossibility for many healthcare systems in the world to provide myriad new diagnostic procedures and treatments to all populations. In this editorial, the current situation from a global perspective will be analysed and the position of some of the leading cancer organisations will be presented. We also discuss some possible actions to be developed to overcome this urgent and contradictory situation.
Demonstration of Clinical Comparability of the Biosimilar Filgrastim to Neupogen, in Terms of Safety and Efficacy, in Healthy Volunteers and Patients Receiving Myelosuppressive Chemotherapy
Authors: Jilma Bernd , Jagiełło-Gruszfeld Agnieszka , Tomczak Piotr , Gadgil Himanshu , Orlik Grzegorz , Desai Kalpna , Catalano Tina , Dowd Jason ,   Professor, Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria,   Oncologist, The Institute of Maria Skłodowska-Curie Cancer Center and Institute, Warsaw, Poland,   Head of Chemotherapy Department, Clinic of Oncology, Poznan University of Medical Sciences, Poznan, Poland,   Intas Pharmaceuticals Limited, Gujarat, India,   Accord Healthcare, Warsaw, Poland,   Apotex Inc., Toronto, Ontario, Canada,   Apotex Inc., Toronto, Ontario, Canada,   Apotex Inc., Toronto, Ontario, Canada
Published: October 2015

Aim: To demonstrate biosimilarity as evidenced by the pharmacokinetic (PK), pharmacodynamics (PD), efficacy and safety comparability of AccofilR/GrastofilR (filgrastim), a recombinant human granulocyte colony-stimulating factor, and the reference product, NeupogenR. Patients and methods: Four phase I studies were conducted to demonstrate the comparative efficacy of Accofil/Grastofil and Neupogen. PD and PK parameters of Accofil/Grastofil (filgrastim) at and around the main clinical dose (5 μg/kg), using both the intravenous (IV) and subcutaneous (SC) routes of administration, were compared with Neupogen (EU) in healthy volunteers in three phase I clinical studies in a single-dose setting and following multiple-dose administration. An additional phase I PK/PD study was performed to compare Accofil/ Grastofil (filgrastim) to both EU-approved Neupogen and US-licensed Neupogen following the administration of a fixed SC dose of 300 μg. The efficacy and safety of Accofil/Grastofil was also evaluated in chemotherapy-naive women with stage IIA, IIB and IIIA breast cancer receiving docetaxel, doxorubicin, cyclophosphamide (TAC) chemotherapy. No comparator arm was included in this study so the efficacy and safety comparison was made with published data for the reference product, Neupogen. Results: A total of 235 healthy subjects were enrolled in the phase I studies and 120 patients in the phase III study. The PK and PD data demonstrated high comparability of the Accofil/ Grastofil and Neupogen products, with the 90 % confidence interval (CI) for primary PK parameters and 95 % CI for primary PD parameters falling within the pre-defined equivalence limits. In the phase III study, Accofil/Grastofil (filgrastim) demonstrated a safety and efficacy profile that was similar to the published data for the reference product Neupogen for the reduction of the duration of neutropenia in patients with breast cancer who were undergoing chemotherapy. Conclusion: Lack of clinically meaningful differences was convincingly demonstrated between Accofil/Grastofil (filgrastim) and the reference product, Neupogen.
A Comprehensive Overview of the Role of Azacitidine in the Management of Myelodysplastic Syndromes and Acute Myeloid Leukaemia
Authors: Barkate Hanmant V , Sejpal Jaykumar J , Belagali Yogesh R ,   Associate Vice President (Researcher),   Senior Medical Advisor (Researcher),   Medical Advisor (Researcher), Department of Medical Affairs & Clinical Research, Intas Pharmaceuticals Limited, Ahmedabad, India
Published: October 2015

Myelodysplastic syndromes (MDS) are a heterogeneous group of haematological disorders marked by progressive cytopenias and risk of transformation to acute myeloid leukaemia (AML). Best supportive care (BSC) remains the mainstay of therapy. The pyrimidine analogue azacitidine was the first drug to demonstrate that a change in the natural history of MDS is possible and was the first chemotherapeutic agent approved by the US Food and Drug Administration for the treatment of MDS. Azacitidine, a hypomethylating agent, has shown to reduce proliferation and induce apoptosis of dysplastic cells. The Cancer and Leukemia Group B (CALGB) 9221 and AZA-001 trials demonstrated superiority of azacitidine over BSC and conventional care regimen, respectively. Various studies have demonstrated that azacitidine has better tolerability with comparable efficacy in terms of conventional therapy in older AML patients. Azacitidine is well tolerated even in the elderly patients. Cytopenias were the most commonly occurring haematological adverse events. Gastrointestinal adverse events (AEs) (e.g. nausea, vomiting and diarrhoea) and injection-site reactions were the most commonly occurring nonhaematological AEs. The review summarises the current role of azacitidine in the management of MDS and AML.
Head and Neck Cancer Highlights of ESMO Congress 2014
Authors: Economopoulou Panagiota , Kotsantis Giannis , Kavourakis George , Psyrri Amanda ,   Medical Oncology Fellow,   Medical Oncology Fellow,   Medical Oncology Fellow,   Assistant Professor, Division of Oncology, Second Department of Internal Medicine, Attikon University Hospital, Chaidari, Athens, Greece
Published: October 2015

Head and neck squamous cell carcinoma (HNSCC) is a challenging cancer to treat and cure. A great proportion of patients present with advanced disease and appropriate treatment options include surgical resection with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT), radical concurrent CRT or RT with monoclonal antibody cetuximab. Despite improved outcomes with CRT, overall prognosis is still unsatisfactory and treatment-related toxicity is a matter of major importance. To obtain improved outcomes and mitigate disease recurrence, current research is focused on novel molecular targeted agents, immunotherapy and discovery of predictive markers. Herein, we summarise recent advances in treatment of head and neck cancer, as presented in European Society for Medical Oncology (ESMO) Congress 2014.
Ethnic Differences in the Association Between Human Leukocyte Antigen and Stevens-Johnson Syndrome
Authors: Ueta Mayumi ,   Department of Ophthalmology, Kyoto Prefectural University of Medicine, and Research Centre for Inflammation and Regenerative Medicine, Faculty of Life and Medical Sciences, Doshisha University, Kyoto
Published: October 2015

The HLA-B12 antigen is significantly increased in Caucasian patients with Stevens-Johnson syndrome (SJS) with ocular complications, whileHLA-A*0206is strongly associated with Japanese patients with SJS/toxic epidermal necrolysis (TEN) with ocular complications. There are strong ethnic differences in the association between HLA and SJS/TEN. Regarding the association between HLA and drug-induced severe cutaneous adverse reactions (SCAR), including SJS and TEN, the strong allopurinol-specific association betweenHLA-B*5801and allopurinol-induced SCAR may be a universal phenomenon, since it has been identified in all Han Chinese, Caucasian and Japanese patients. In contrast, the carbamazepine-specific association betweenHLA-B*1502and carbamazepine-induced SJS may be specific to certain ethnic groups, as it has been identified in Han Chinese but not in Caucasian and Japanese patients. Dermatologists have reported that allopurinol and anticonvulsant drugs such as carbamazepine are commonly associated with SJS/TEN, while many of the author’s patients developed SJS after receiving treatment for the common cold with antibiotics, cold remedies and/or non-steroidal antiinflammatory drugs (NSAIDs). This article posits that the SJS/TEN patients seen by dermatologists are not always the same as the SJS/TEN patients consulting opthalmologists.
Managing Primary Open-angle Glaucoma – Ocular Tolerability, Compliance, Persistence and Patient Outcomes
Authors: Hommer Anton ,   Department of Ophthalmology, Hera Hospital, Vienna, and Department of Clinical Pharmacology, Medical University of Vienna
Published: October 2015

Primary open-angle glaucoma (POAG) is a progressive optic neuropathy that, left untreated, can lead to irreversible damage to the optic nerve and permanent vision loss. To date, intraocular pressure (IOP) is the only modifiable risk factor for disease progression, and topical eye-drops are currently used as the leading non-surgical glaucoma therapy. Despite the efficacy of pharmacotherapy in lowering IOP, success is ultimately defined by patient compliance and patient persistence. Ocular tolerability is a crucial factor in patient compliance and persistence; non-adherence owing to adverse effects can lead to poor control of IOP and treatment failure. Prostaglandin analogues are currently the first-line antiglaucoma agents, with a good tolerability profile and a better IOP-lowering effect compared with β-blockers. Combination therapies have also shown greater efficacy in lowering IOP compared with the individual constituents, with fewer adverse effects. Treatment should be tailored to the individual patient, with a focus on ocular tolerability and its role in adherence, compliance and vision preservation.
Use of Thermoreversible Hydrogels in Corneal Wound Repair
Authors: Tint Naing L , Rose Felicity RAJ ,   Wolfson Centre for Stem Cells, Tissue Engineering and Modelling (STEM), School of Pharmacy, Centre for Biomolecular Sciences, University of Nottingham,   Division of Ophthalmology and Visual Sciences, Eye, ENT Centre, Queens Medical Centre, University of Nottingham
Published: October 2015

Corneal infection, inflammation and injury can result in scarring and loss of transparency of the cornea, which accounts for one to two million cases of monocular blindness worldwide. Modulating and promoting wound healing of the cornea has proved to be a major challenge. The amniotic membrane is currently used as a biological bandage to achieve this; however, many limitations have been shown to exist with this technique. Hydrogels are large polymeric networks that have a high fluid content. Such polymers can be manipulated to switch between liquid and solid states depending on light, temperature and ionic changes and can be either biodegradable or nonbiodegradable. Thermosensitive hydrogels can be manipulated to form gels at body temperature and may hold potential as synthetic scaffolds for ocular surface reconstruction, wound healing and ophthalmic drug delivery.
Integrity of Foveal Cones in Early Age-related Macular Degeneration
Authors: Norren Dirk van , Kanis Martijn ,   Professor of Ophthalmic Physics,   Intern, Department of Ophthalmology, University Medical Centre Utrecht
Published: October 2015

In this article, we highlight a method that probes the directional sensitivity of cones, in particular those in the fovea. Directional sensitivity is a unique property of cones, i.e. it is not shared by any other retinal element, and can be taken as a measure of the health of cones. In a group of healthy subjects, the directional reflection was 1.78%. In early age-related macular degeneration (AMD), despite a healthy-looking fovea, the mean directional reflection was 0.92%; in late AMD, the figure decreased further to 0.86%. These findings point to a malfunctioning of the outer segments. In addition, the method yields an estimate of the optical density of macular pigment. In early AMD, the macular pigment did not differ from normal; this finding did not point to a protecting role of macular pigment in AMD.
Imaging Technologies for the Diagnosis of Glaucoma
Authors: Bochmann Frank , Azuara-Blanco Augusto ,   Department of Ophthalmology, Cantonal Hospital of Lucerne,   Consultant Ophthalmic Surgeon, Department of Ophthalmology, Aberdeen Royal Infirmary
Published: October 2015

In this article we describe recent advances in imaging technologies that quantify the topography of the optic nerve head and retinal nerve fibre layer and their role in diagnosing glaucoma. These technologies include optical coherence tomography (OCT), scanning laser polarimetry (SLP, GDx) and confocal scanning laser ophthalmoscopy (CSLO, HRT). A review of recently published literature was carried out. The diagnostic performance of the different imaging devices is comparable and appears to be acceptable for the diagnosis of manifest glaucoma. The benefits of recent technological improvements need to be fully assessed. At the moment it is not clear which of the currently used imaging technologies is the most useful for diagnosis and management of glaucoma.