Current opinion in oncology
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The purpose of this review is to assess recent evidence that demonstrates that aspirin has the potential to be an effective preventive and therapeutic agent in gastrointestinal malignancy. ⋯ These findings have re-awakened interest in the role of aspirin in the primary prevention of cancer and in the treatment of cancer. Randomized controlled trials are underway to assess the role of aspirin within the treatment algorithms of several solid common cancers.
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The purpose of this review is to provide an update on palliative sedation in palliative and end-of-life care. Palliative sedation is the medical procedure used to deal with refractory symptoms in advanced cancer patients when all other specific approaches have failed. ⋯ To maintain palliative sedation as a legitimate clinical procedure from any ethical or clinical point of view, it must be limited to the restricted area for which it was conceived, that is, relief from refractory suffering as deemed necessary by a patient and by an experienced palliative care team. In this way, there is no risk of associating palliative sedation with other end-of-life decisions. Close collaboration is needed between oncologists and palliative care physicians for this clinical procedure.
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Next generation sequencing (NGS) allows the rapid analysis of genomes and has brought invaluable information on cancer biology and drug targets. Laboratories have started to provide NGS data to physicians to aid in the prescription of targeted drugs. The review presents the recent clinical experience with NGS. ⋯ NGS and other molecular technologies are transforming the practice of medical oncology and clinical research. Sequencing of primary tumors, metastases, or blood-derived circulating tumor DNA has great potential to guide individualized cancer treatment. However, the integration of NGS as a breakthrough technology is associated with operational challenges such as information processing, medical education and interpretation, and reimbursement.
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BRAF and NRAS mutations can exert an oncogenic effect and are a target for novel therapeutic strategies. Selective MEK inhibitors inhibit growth and induce cell death in BRAF and NRAS mutated melanoma cell lines. The first MEK inhibitor (trametinib) has recently been approved for the treatment of BRAF-mutated metastatic melanoma not previously treated with BRAF inhibitors and several more are in clinical development. ⋯ MEK inhibitors represent a new treatment option in BRAF and NRAS mutated melanoma. As monotherapy, MEK inhibitors appear to provide minimal benefit in patients previously treated with a BRAF inhibitor, so they should be reserved for BRAF-inhibitor-naïve patients. Combined BRAF and MEK inhibition seems to provide a greater benefit than BRAF inhibitor monotherapy. MEK inhibition has also shown efficacy in NRAS-mutated patients, for whom there is no specific targeted therapy.
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The purpose of this review is to provide an update on the current data about low-dose computed tomography (LD-CT) lung cancer screening. ⋯ Currently, the NLST is the only sufficiently powered trial to report a lower mortality rate with LD-CT screening. Long-term follow-up data are still anticipated on the European screening trials. Furthermore, data on the extent of the potential dangers of LD-CT screening, such as overdiagnosis, false-positive results, and the effect of cumulative radiation dose, have yet to be investigated thoroughly.