A review of oncology literature compiled by Giuseppe Curigliano, Division of Medical Oncology, IEO, Milan, Italy

A neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: EORTC randomized trial 40954

Christoph Schuhmacher et al. JCO, Early Release

Patients with locally advanced adenocarcinoma of the stomach or esophagogastric junction (AEG II and III) were randomly assigned to preoperative chemotherapy followed by surgery or to surgery alone.

144 patients. The R0 resection rate was 81.9% after neoadjuvant chemotherapy as compared with 66.7% with surgery alone (P = .036). The surgery-only group had more lymph node metastases than the neoadjuvant group (76.5% v 61.4%; P = .018). Postoperative complications were more frequent in the neoadjuvant arm (27.1% v 16.2%; P = .09). After a median follow-up of 4.4 years and 67 deaths, a survival benefit could not be shown

Abstract

Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study

Martin Kocher et al. JCO, Early Release

Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2.

Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT.

Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P < .001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm

Abstract

Monoclonal antibody targeting of N-cadherin inhibits prostate cancer growth, metastasis and castration resistance

Hiroschi Tanaka et al. Nature Medicine, Early Release

Comparing gene expression in isogenic androgen-dependent and castration-resistant prostate cancer  xenografts, we found a reproducible increase in N-cadherin expression, which was also elevated in primary and metastatic tumors of individuals with CRPC.

Monoclonal antibodies against the ectodomain of N-cadherin reduced proliferation, adhesion and invasion of prostate cancer cells in vitro. In vivo, these antibodies slowed the growth of multiple established CRPC xenografts, blocked local invasion and metastasis and, at higher doses, led to complete regression.

Abstract

The promise and pitfalls of a cancer breakthrough

Eliot Marshall, Science, November 12

Screening for small tumors with advanced x-ray imaging led to a significant drop in lung cancer deaths (20% fewer) among smokers and ex-smokers, compared with screening with standard chest x-rays. Such positive results are unheard of, particularly for lung cancer, which kills 157,000 people in the United States each year. Until now, no randomized study has shown that screening for lung cancer can save lives. 

The National Lung Screening Trial (NLST), enrolled 53,454 smokers and ex-smokers between ages 55 and 74; 354 died of lung cancer in the CT screening arm compared with 442 in the chest x-ray group ($250 million study of a 3D imaging method known as low-dose helical computed tomography).

Disadvantages of CT screening. One is cost. The price of a scan, estimated at about $300 to $500 per screening, is the least of it. High ratio of people who get positive test results but do not have lung cancer. In NLST, about 25% of those screened with CT got a positive result requiring follow-up. According to NCI study, about 96% to 98% are false positives.

One negative consequence of CT screening is that it triggers follow-up scans, each of which increases radiation exposure. Even low-dose CT scans deliver a significantly greater exposure than conventional chest x-rays it remains to be determined how, or if, the radiation doses from screening ... may have increased the risks for cancer during the remaining lifetime of those screened

Abstract