memo - Magazine of European Medical Oncology

Marosi, Christine

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0178-0

Cancer is still the second cause of death in Europe and with the aging of populations, the number of cancer patients will further increase. For Austria, the gender-specific analysis of epidemiology and survival rates of cancer in the past 10 years show that there are significant differences between men and women that could at least partly been used for the implementation of future preventive and/or therapeutic actions. Gender-specific pharmacokinetic differences for medications with narrow therapeutic index as most of the drugs used in cancer therapy have been documented for more than a decade. It would be very helpful to develop instruments allowing individualized treatment planning taking into account the age, function of relevant organs, and gender of the patient than to adhere indefinitely to body surface area.

Willenbacher, Wolfgang; Willenbacher, Ella

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0185-1

Achieving a first complete remission in myeloma has become feasible with novel agent-based combination therapies followed by autologous stem cell transplantation (ASCT), leading to CR rates of 40%. But continuously occurring relapses in these patients have lead to the revival of maintenance (MT) concepts aiming to eliminate or control minimal residual disease when myeloma burden is low and not too many clonal tidings have been induced. On the other side, the clinical effectiveness of MT has to be balanced against its considerable cost, toxicity and effects on quality of life. Owing to low effectiveness and side effects of chemotherapy, steroids as monotherapy and α-interferon are obsolete options for maintenance concepts, while low-dose thalidomide should be considered in low-risk patients that do not achieve at least very good partial remission after ASCT, when other MT options are not available. There is limited data on the effectiveness of Bortezomib (BTZ) MT in high-risk patients with respect to both progression-free survival (PFS) and overall survival (OS). Lenalidomide (LEN) MT after ASCT shows a clear PFS benefit, but data on OS and the influence on the outcome of subsequent therapies are conflicting. Toxicity includes haematotoxicity, venous thromboembolism and the induction of secondary primary malignancies. LEN-MT cannot be considered a standard approach after ASCT yet, but should be discussed on a case by case basis with every patient, as well as BTZ-MT in t(4;14) positive myelomas. In non-transplant eligible patients keeping patients on prolonged therapies has been shown to be beneficial and the distinction to MT is often purely semantic.

Weiss, Lukas; Melchardt, Thomas; Egle, Alexander

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0186-0

B-cell receptor (BCR) inhibitors represent an exciting new treatment modality in chronic lymphocytic leukemia (CLL). Currently, ibrutinib monotherapy as well as idelalisib in combination with rituximab are approved by the European Medical Agency for the treatment of all patients with relapsed/refractory CLL and for first-line treatment of patients with deletion 17p or TP53 mutation unsuitable for chemoimmunotherapy. The results of ongoing trials with these and other BCR inhibitors are expected to lay the basis for approval in further indications, but have to be awaited. Above all, BCR inhibitors have shown to be able to fill the gap of urgently needed therapies for the elderly and comorbid CLL patient as well as the CLL patient with deletion 17p. BCR inhibitors might also challenge the role of allogeneic stem cell transplantation in CLL in the future.

Uprimny, Christian

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0175-3

For optimal therapy management in patients with lymphoma, sensitive and specific imaging modalities for accurate initial staging and evaluation of response to therapy are crucial. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) that combines metabolic information of 18F-FDG PET with morphological information of diagnostic CT has proven to be a very useful tool in the work-up of lymphomas. Especially in 18F-FDG-avid tumours like Hodgkin lymphoma and high-grade, aggressive non-Hodgkin lymphoma, 18F-FDG PET/CT is widely used for pre-treatment staging and response evaluation after completion of therapy with convincing evidence that it is more accurate than conventional imaging modalities. Although 18F-FDG PET/CT is also applied in other subtypes of lymphoma and in other clinical indications such as early response assessment, its benefit in these settings remains controversial. This review is intended to highlight the accepted clinical applications for 18F-FDG PET/CT in lymphoma, delivering a short clinical guideline when it is recommended to perform 18F-FDG PET/CT in a patient with lymphoma.

Ghanim, Bahil; Hoda, Mir Alireza; Klikovits, Thomas; Dome, Balazs; Grusch, Michael; Filipits, Martin; Klepetko, Walter; Berger, Walter; Hegedus, Balazs

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0166-4

Malignant pleural mesothelioma (MPM) is a devastating and treatment-resistant disease. Currently, well-established prognostic and predictive biomarkers are rare in clinical practice, whereas there is a whole body of various MPM biomarker studies published in medical literature in the past decades. Besides well-established pathological parameters, including histological subtype, disease stage, or level of lymph node involvement, blood parameters and circulating proteins related to a proinflammatory phenotype are emerging as prognostic biomarkers. Here we provide an overview about the current status of prognostic and predictive biomarkers in MPM, with a strong emphasis on their applicability in clinical practice.

Vrdoljak, Eduard; Miše, Branka Petrić; Jelavić, Tihana Boraska; Tomić, Snježana; Šundov, Dinka; Strikić, Ante

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0188-y

Gynecological malignancies account for roughly 10 % of all cancers in women with ovarian cancer as leading cause of death due to gynecological tumors. Surveillance programs of ovarian cancer are primarily based on recurrence rates, timing of recurrence, salvage options, and chances for cure of patient with recurrence. Since there is no prospective, high evidence data on optimal surveillance program after primary treatment of patients with ovarian cancer recommendations are based on review of retrospective data sets. From all the diagnostic tools available, history taking and clinical examination, including gynecological examination, still contribute to the greatest number of recurrence detections. Radiologic and laboratory tests are usually employed when a suspicion of recurrence is raised. Follow-up plan should be tailored according to the estimated risk of relapse for individual patient.

Zach, Leor; Talianski, Alisa; Lawrence, Yaakov Richard

2014 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-014-0181-5

Brain metastases are the most common malignant adult CNS tumor. The blood brain barrier (BBB) prevents many drugs from achieving therapeutic concentrations in the central nervous system (CNS), leaving the brain as a potential sanctuary site of disease and underscoring the importance of radiotherapy. Neurons, glial cells and vascular endothelium are prone to radiation-induced damage. Efforts have been made to reduce radiation-induced toxicity and increase efficacy (Stereotactic radio-surgery - SRS, advanced radiation-techniques that allow decreasing the dose to the hippocampi, while intensifying the radiation dose to large brain metastases or administering neuroprotective or radiation sensitizing agents during whole brain radiotherapy -WBRT in order to increase the therapeutic ratio). Surgery, radiotherapy and new pharmacological agents may become advantages for specific patient subgroups or in specific disease stages. Choosing how to treat brain metastases, must take into consideration patients and disease parameters (the primary tumor, age and performance status, systemic and brain tumor burden), and the potential risks and benefits of a treatment tool emphasising QOL considerations. Which modality to apply and when, is often a matter of local practice and treatment availability since level I evidence is lacking. The technology behind WBRT, FSR and SRS has substantially advanced over the previous decade, however only formal clinical trials will allow a definite answer to the question - are we getting better?