memo - Magazine of European Medical Oncology

Hochleitner, M.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0294-z

Fiegl, M.; Thöni, C.; Hochleitner, M.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0305-0

In this article, different aspects of gender (used here both in the sense of sex, reflecting somatic differences between men and women, and gender, reflecting psychosocial differences) are reviewed. In preclinical research, are there gender aspects taken into consideration, e.g. in cell culture assays or animal models? What about gender aspects in cancer prevention, epidemiology and tumourigenesis, including gender-related susceptibilities towards environmental carcinogens? To offer some results from our own research in this field, original data on gender-related differences of symptoms and comorbidities in lung cancer at initial diagnosis are presented. Of importance, but still widely neglected in the haemato-oncologic literature is the influence of gender on the accessibility to diagnostic procedures and treatment. Gender-specific pharmacodynamic peculiarities and differences in treatment outcome and prognosis of various tumour entities are presented. Since gender aspects are often not put in focus of cancer research, relevant literature on this topic is rather sparse and difficult to search. In this regard, the authors make no claim to provide a comprehensive review.

Thöni, C.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0295-y

Gender differences are described for different kind of diseases, also for oncological diseases. Epidemiological and sociological aspects were clearly described, but the molecular basis has not been well investigated. At the moment, there are three mouse models existing in which precisely gender differences in carcinogenesis are investigated. In mouse models for lung adenocarcinoma, hepatocellular carcinoma and non-melanoma skin cancer, biological aspects of gender differences were studied in vivo.

Marosi, C.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0300-5

In recent years, new developments appeared in the treatment of malignant tumours of the nervous system, and prognosis improved to a certain degree with the advent of new systemic therapies. Of note, there are marked gender differences in both incidence and prognosis, the knowledge of which may influence therapeutic decisions. In this article, the latest findings in brain tumour treatment with a focus on gender aspects are reviewed.

Sztankay, M.; Giesinger, J.; Holzner, B.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0299-7

Advances in the treatment of haematological malignancies have greatly contributed to increased survival rates and improved prognosis. Patients, however, generally experience a great number of debilitating symptoms (e.g. fatigue, nausea, pain and depression) and impaired function affecting their quality of life (QOL). Besides sex differences in survival, there is evidence that disease affects facets of life differently in men and women. Literature indicates significantly better physical, emotional as well as role functioning in male haemato-oncological patients and suggests female gender to be a predictor of impaired overall QOL. Possible explanations comprise differences in biological features, gender-specific behaviour and measurement bias. Clinical implications point toward increased awareness for disease- and treatment-related aspects especially relevant in either male or female patients. Already evident gender patterns found in the perception of pain, communication styles and role limitations should be considered in the development and application of medical as well as psychosocial interventions.

Mader, R. M.; Fiegl, M.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0298-8

In the era of personalised medicine, it sounds surprising that gender aspects of tumour pharmacology have been seriously considered since the mid 1990s only. In parallel, cancer therapies have been the subject to several new treatment paradigms and novel therapeutic strategies which are all fuelled by the pipeline of new compounds necessary to realise tailored therapies. This plethora of novel options contrasts with the evidence about pharmacokinetic (PK) and pharmacodynamic (PD) differences in male and female subjects. To refine the term "difference" further, we should consider a distinction between gender disparities observed in experimental systems and the application to the clinical setting requiring a much higher level of evidence. Although there are convincing examples of PK (e.g. 5-fluorouracil) or PD differences (e.g. response in lung cancer treatment), gender disparities overlap with a variety of other confounding variables, most notably individual fitness, age, organ function, concurrent diseases, genetic/epigenetic background and others. Nowadays, gender per se is generally not a factor influencing dosing of anti-cancer drugs. Thus, the limited evidence on gender specific tumour pharmacology requires prospectively randomised clinical trials with gender oriented PK/PD endpoints in the form of PK/PD modelling to establish gender as a determinant in cancer pharmacology.

Geiger-Gritsch, S.; Mühlböck, H.; Harrasser, L.; Oberaigner, W.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0297-9

PURPOSE: The role of gender and age is currently the subject of research in oncology. Therefore, the proportion of elderly cancer patients in Tyrol by cancer site and gender was estimated and the results were compared to recent literature. In addition, to better highlight the public health aspects of the problem, we present age-specific incidence rates. METHODS: Based on the Cancer Registry of Tyrol including incidence data with years of diagnosis from 1999 to 2008 for the population of Tyrol, the proportions of patients for the age groups 70+ and 80+ by gender were analysed separately and age-specific incidence rates were calculated. RESULTS: 40% of all cancers are diagnosed in the age group 70+ and 15% in the age group 80+. In general, for all cancer sites combined the proportion of women in the age groups 70+ and 80+ is higher than compared to men: 42% versus 38% of incidence cases are of age 70+ and 19% versus 11% are of age 80+. Especially for the age group 80+, there are four cancer sites with the largest proportion: colorectal, stomach, pancreatic and bladder cancer. In addition, the analysis of the dataset by gender showed that remarkable differences in incident cases for several cancer sites can be observed for females compared to males in both age groups, especially for liver, pancreatic and bladder cancer. Age-specific incidence rates (per 100,000 persons) in age-group 80+ as compared to 50-69 and 70+ showed a threefold increase in both, men and women, for all cancer sites combined as well as for colorectal cancer. With regard to other frequent cancer sites, only minor increases were observed for lung, prostate and breast cancer. CONCLUSION: The analysis based on the Cancer Registry of Tyrol shows that there are considerable proportions of cancer cases in the elderly (age 70+ and age 80+) and that gender differences in incidence can be observed in these age groups as well. In addition, age-specific incidence rates underline the importance of cancer in the elderly. Since age- and gender-related effects on cancer survival are of increasing interest, the results provide a basis for further research.

Sterlacci, W.; Stockinger, R.; Fiegl, M.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0296-x

Sex differences concerning incidence, risk factors, morphology and prognosis have been encountered in a variety of non-sex specific neoplasms. However, the reason for such disparities is usually not apparent. Therefore, gender aspects should be actively identified and analyzed in future studies to gain further insight and achieve potential practical benefits. This review briefly presents tumour entities commonly associated with apparent differences between women and men. Possible causes for this phenomenon are outlined and discussed.

Berger, W.; Pircher, A.; Sibilia, M.; Bubendorf, L.; Filipits, M.; Fiegl, M.; Früh, M.; Manegold, C.; Popper, H.; Hilbe, W.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0281-4

Due to the growing relevance of anti-EGFR therapeutic strategies, knowledge of the modes of action of these strategies and also their modes of resistance has gained growing attention in the oncology field. In this context, the Ras–Raf–MEK–ERK pathway is of major interest, and is leading to new therapeutic strategies and biomarker evaluation. This central pathway is also involved in the complex field of angiogenesis. The present review summarises the most relevant developments that were presented at a scientific symposium in January 2011 in Austria.

Popper, H.; Wrba, F.; Gruber-Mösenbacher, U.; Hulla, W.; Pirker, R.; Hilbe, W.; Studnicka, M.; Mohn-Staudner, A.; Ploner, F.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0319-7

Patients with stage IIIB and IV non-small-cell lung carcinoma (NSCLC) harbouring activating mutations of the epidermal growth factor receptor (EGFR) gene should be treated first-line with gefitinib or erlotinib, EGFR tyrosine kinase inhibitors (TKI). EGF receptor mutations are most common in adenocarcinomas, especially in the non-mucinous type, while they are rare in squamous-cell carcinomas and sarcomatoid carcinomas, and they do not occur in neuroendocrine carcinomas. Therefore, following intense discussion and in consensus with oncologists and pulmonologists, the Pulmonary Pathology Working Group of the Austrian Society of Pathology recommends a-priori EGFR mutation analysis for all adenocarcinoma cases, and for all other NSCLC cases upon clinical request. This will markedly reduce the waiting time for those patients who will most likely gain the greatest benefit from EGFR TKI therapy.

Augustin, F.; Bodner, J.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0301-4

Surgical topics of particular interest presented at the 14th World Conference on Lung Cancer in Amsterdam included minimally invasive surgery for NSCLC, prognosis of patients with unexpected pathological N2 disease, risk evaluation of surgery in the elderly and surgical approaches for malignant pleural mesothelioma.

Bauernhofer, T.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0302-3

The combination of gemcitabine with erlotinib is viewed as one standard in the treatment of patients with advanced pancreatic cancer. However, the magnitude of the survival benefit of the combination therapy compared to single agent gemcitabine is relatively small. Whether this statistically significant survival benefit translates to a relevant clinical benefit of the combined treatment in view of increased toxicity and costs is still a matter of debate. Consequently, there has been great interest in identifying molecular biomarkers predictive for response and survival benefit from EGFR-targeted agents in advanced pancreatic cancer. No data have been published up to now concerning the value of K-RAS mutations in pancreatic cancer as a predictive marker for lack of response to EGFR targeted agents. Nevertheless, the first prospective evaluation of K-RAS status and response to erlotinib in combination with either gemcitabine or capecitabine suggest a significant improvement of overall survival only for patients with K-RAS wild type tumors suggesting a possible role of K-RAS mutational status as predictive marker in pancreatic cancer.

Jäger, R.; de Vries, A.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0303-2

Pancreatic carcinoma is one of the leading causes of cancer-related mortality and has an extremely poor prognosis. The management of locally advanced pancreatic cancer remains controversially discussed. Radiochemotherapy has been employed in different treatment protocols to improve local control and survival with patients suffering from local advanced but non-metastatic disease. The objective of this short review is to give a recent overview about the experiences with radiochemotherapy in the treatment of pancreatic cancer. Even if neoadjuvant, postoperative and definitive radiochemotherapy protocols offer a promising and feasible treatment option, the question about treatment indication and which patients benefit the most cannot yet be answered.

Auberger, J.; Russ, G.; Greil, R.; Egle, A.

2012 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-011-0304-1

Invasive fungal infections (IFI) remain a leading cause of morbidity and mortality in immunocompromised patients. Despite major improvements, it often remains difficult to obtain accurate diagnosis in neutropenic patients. Timely initiation of antifungal treatment in this high-risk population is mandatory to improve survival. Today, clinicians have a choice among a growing armamentarium of novel antifungal agents. Agents such as "veteran" amphotericin B deoxycholate (d-AMB) have been replaced with lipid formulations, and new generation triazoles as well as novel class echinocandins finally offer opportunities to improve prognosis with less systemic toxicity. Clinical decision-making depends on several guidelines, published studies and not least on economic considerations. The current review summarises up-to-date treatment recommendations of the DGHO/AGIHO, and ECIL-3, as well as the recently published 2010 Clinical Practice Guidelines of the IDSA.