Reviews & Analysis

Two novel agents targeting the androgen receptor signalling axis, even after chemotherapy treatment, have been demonstrated to be effective in patients with metastatic castration-resistant prostate cancer (CRPC). Enzalutamide is the newest approved treatment that improves survival in this lethal and morbid disease.

The observational registry CaPSURE study reported that men with prostate cancer who were taking aspirin were less likely to die of prostate cancer than nonusers. This favourable effect seems to be stronger than that observed in a pooled analysis of randomized clinical trials of aspirin, and in other observational studies.

The administration of high-precision radiotherapy, termed stereotactic body radiotherapy (SBRT), delivers high doses of radiation to tumours without greatly affecting adjacent normal tissues. SBRT can affect the disease course for properly selected patients with metastatic cancer with improved palliation, disease response, and long-term disease control. In this Review, the biology, practical aspects of delivery and emerging clinical opportunities for SBRT in limited metastatic cancer patients are discussed.

Convincing data have shown that human papillomavirus (HPV)-DNA testing predicts the development of high-grade cervical cancer better than cytology. However, for HPV-positive women, triage with cytology testing should be performed before colposcopy. The question on how to proceed if the cytology test in HPV-positive women is negative remains unclear.

The 8-year European Study Group for Pancreatic Cancer has determined that adjuvant chemotherapy for periampullary neoplasms prolongs survival compared with surgery alone. Is now the time to implement social networks or other web-based applications to assist investigators and clinicians to find the optimal treatment faster?

The question “are we learning anything new?” keeps being asked when related to comprehensive gene analysis of tumours. This Review attempts to answer that question, and describes how new targets are being identified and how that knowledge is being translated into the clinic.

Improvements in the pathological classification of lymphoma have had little impact on advancing drug development or improving the cure rate. The authors discuss the current status of biomarker development in lymphoma, and how novel biomarker-directed clinical trial designs using rationally designed combination strategies will help to improve outcomes in patients with lymphoma.

The development of treatment for rare diseases presents unique challenges. This Review article outlines the discovery process for a number of oncology paradigms in rare tumours, including those that are a subset of more-common cancers. The authors discuss drug-class examples of targeted therapies for orphan diseases, as well as potential therapeutic strategies that can be adopted to treat these orphan conditions.

Compared with anastrozole alone, the combination of fulvestrant and anastrozole significantly improved time without disease progression and extended the median overall survival of women with endocrine-responsive metastatic breast cancer; offering a new standard-of-care for these women. Unfortunately, information about the efficacy of the combination in the adjuvant setting is not available.

Allogeneic haematopoietic stem-cell transplantation (HSCT) is frequently applied as part of treatment in patients with acute myeloid leukaemia in their first or subsequent remission. In this Review, the authors propose risk assessment as a dynamic process during treatment, incorporating both disease-related and transplant-related factors for the decision to proceed either to allogeneic HSCT or to apply a nontransplant strategy.

Many patients who present with stage III NSCLC are in their 70s with multiple comorbidities who are generally unfit to receive the standard chemoradiotherapy regimen. In this Perspectives article, the author puts forth proposals to advance research within shorter timescales to improve outcomes for patients for whom standard treatment is unavailable.

Treatment of prostate cancer using high-intensity focused ultrasound (HIFU) focal therapy could be a reliable treatment option but, are we ready for it? This Perspectives article assesses whether our current methods for cancer diagnosis, tissue targeting, and treatment follow up are accurate enough to allow the design of HIFU focal therapy protocols.

Aspirin has been widely reported to be associated with cancer prevention, and now its use as a cancer therapy option is being explored. In this Review, the authors discuss evidence from trials that suggest that aspirin initiation after the diagnosis of colorectal cancer improves survival. The issues of dosage, duration, toxicity and patient selection are also described.

Dabrafenib is the second agent in the therapeutic class of selective BRAF inhibitors, and has proven efficacy in a phase III trial (BREAK-3) with impressive improvements in progression-free survival and response rates. Differences in the safety profile exist compared with vemurafenib, but the future lies in combinatorial strategies and improved patient selection.

The small EVEREST trial has shown that the concept of guiding cetuximab dose escalation using the clinical parameter of acneiform skin rash is safe. However, as no significant increase of cetuximab efficacy could be observed, data from the ongoing EVEREST II trial must be awaited before dose escalation can be considered for clinical use.

Nature Reviews Clinical Oncologypresents a new form of article, a Viewpoint, which provides a forum for a number of researchers to discuss important ongoing issues in oncology. In this Viewpoint article, experts from the field of breast cancer screening discuss and offer insight into the controversy regarding the efficacy and optimal methods of screening.

The Affordable Care Act—the Obama administration's signature legislation designed to insure over 30 million currently uninsured Americans—was recently declared constitutional by the US Supreme Court. Although not perfect, the law contains provisions that will benefit patients with cancer, those at risk of cancer and those in remission.

The current definition of multiple myeloma is outdated. The diagnosis requires evidence of overt end-organ damage, preventing initiation of early therapy when the malignancy is at its most susceptible stage. We propose an evidence-based approach using more-sensitive and highly specific biomarkers to update the definition of this disease.

The association between cancer and angiogenesis has been established for decades, but it is only in the past 10 years that the concept of cancer prevention using antiangiogenic agents has emerged. This Review outlines the mechanisms of action of these preventative agents and proposes that there should be four levels of angioprevention, depending on the cancer risk.

The goal of personalized therapy is to target tumours with the right drug for the right person at the right time. This is not an easy task, and in this Perspectives article, Funda Meric-Bernstam and Gordon B. Mills tell us about the challenges that need to be overcome and how we should temper the current excitement about targeted therapies with realistic expectations.