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Research Advances

Research Advances is your one-stop shop for the latest information in cutting edge cancer research. The New England Journal of Medicine, Journal of Clinical Oncology, and Lancet Oncology are recognized both nationally and internationally as among the world’s authoritative resources for significant advances in clinical cancer research and editorial opinions on a wide variety of cancer-related topics. Audiences of these publications include medical professionals from all oncology disciplines and sub-specialties, researchers, students, and related health care professionals throughout the world.

The Lancet Oncology

[Editorial] Clinical decision making: more than just an algorithm
November, 2017, has seen two seemingly contradictory stories in the headlines: in the UK, the Government has unveiled plans to accelerate access to medicines under a new Accelerated Access pathway; while a recent study published in the Journal of the American Medical Informatics Association (JAMIA) has shown that more than 70% of clinicians override e-prescribing alerts when being warned of potential drug–drug interactions. This somewhat ironic paradox—in which more drugs are being pushed through to the market, only to be bottlenecked through a system that relies on an automated system of prescription—has potentially conflicting consequences.

[Comment] Reducing the global cancer burden among young adults
In The Lancet Oncology, Miranda M Fidler and colleagues1 provide estimates for cancer incidence and mortality among young adults (aged 20–39) worldwide. These estimates were categorised by country income and development level (Human Development Index, HDI), thus affording investigators the opportunity to compare across cancer types. This important study establishes a contemporary global burden of cancer in young adults—975 396 new cancer cases and 358 392 cancer-related deaths in 2012. The authors provide the foundation necessary for a call to action for clinicians, policy makers, and researchers focused on reducing the substantial burden that cancer afflicts upon young adults.

[Comment] ALK and ROS1 rearrangement in NSCLC: rapidly evolving standards
Approximately 5% of patients with non-small-cell lung cancer (NSCLC) have a rearrangement in the gene for anaplastic lymphoma kinase (ALK), an oncogenic fusion protein.1 Crizotinib, alectinib, and ceritinib are tyrosine kinase inhibitors (TKIs) used for untreated, ALK-positive patients. Crizotinib was approved as frontline therapy based on results showing longer progression-free survival (10·9 months [95% CI 8·3–13·9]) than that seen with platinum-based chemotherapy (7·0 months [95% CI 6·8–8·2]; hazard ratio [HR] for progression or death 0·45, 95% CI 0·35–0·60; p<0·001).

[Comment] Quality of life: an important element of treatment value
In the era of platinum-based chemotherapy, attempts to improve the quality of life (QOL) of patients with advanced non-small-cell lung cancer (NSCLC) using a less toxic treatment than the existing standard therapy were often disappointing. In a randomised trial1 comparing cisplatin-based treatment to a so-called platinum-free combination chemotherapy, the goal of improving QOL was not met. The lesson learned was that in patients with a disease often associated with serious symptoms, reduction of treatment-related toxicity is not enough to improve global QOL, and more effective control of disease is needed to achieve a positive QOL balance.

[Comment] Bevacizumab in adjuvant treatment of non-small-cell lung cancer
Outcomes in early-stage non-small-cell lung cancer (NSCLC) are infamously poor. In the ANITA trial of patients with stage IB–IIIA disease,1 median overall survival for after surgical resection was 43·7 months. Use of adjuvant chemotherapy improved outcome but median overall survival was still only 65·7 months, and meta-analyses2 of NSCLC adjuvant chemotherapy trials suggest a relative survival benefit of just 5% at 5 years.2 When Heather Wakelee and colleagues designed the E1505 trial in 2007, the results of which are reported in The Lancet Oncology, there was a massive unmet need for better therapeutics.

[Comment] Grant, deny, or reassess the role of yttrium-90 in hepatocellular carcinoma?
Transarterial chemoembolisation and selective internal radiotherapy (SIRT) with yttrium-90 (90Y) are viable treatment options for patients with unresectable, localised hepatocellular carcinoma, including selected patients with major vascular invasion. However, frontline sorafenib and second-line regorafenib are the only US Food and Drug Administration (FDA)-approved systemic therapy options available for patients with locally advanced (ie, with major vascular invasion) or metastatic hepatocellular carcinoma.

[Comment] Missing a GOLDen opportunity in gastric cancer
Advanced gastric cancer has a poor prognosis; currently available palliative treatments result in survival of less than 18 months for most patients. Although immune checkpoint blockade has shown promise in chemorefractory gastric cancer, the modest benefit associated with anti-PD-1 therapy means that alternative gastric cancer vulnerabilities should continue to be explored.1 Defective homologous recombination, classically found in BRCA-mutated tumours, has been successfully exploited by poly-ADP-ribose polymerase (PARP) inhibitors in ovarian, breast, and prostate cancer.

[Comment] Towards personalised medicine in lung and thymus neuroendocrine tumours
A personalised treatment approach is increasingly the aim of oncology care. In the gastrointestinal tract, an effective grading system has been devised for neuroendocrine tumours to guide treatment strategies and help malignancy stratification, but for lung and thymus carcinoids this information has remained less reliable, especially in metastatic tumours where diagnostic material is limited and for cases with similar histology.1

Journal of Clinical Oncology

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New England Journal of Medicine