Expert review of anticancer therapy
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Expert Rev Anticancer Ther · Oct 2010
ReviewPrimary and secondary therapeutic strategies for EGF receptor pathway inhibition in non-small-cell lung cancer.
As diagnostic and therapeutic options increase, strategies for the treatment of non-small-cell lung cancer (NSCLC) are becoming more tailored for specific patient subpopulations and individual patients. The introduction of therapy targeted against the EGF receptor (EGFR) pathway has provided new treatment options for select patients with NSCLC. ⋯ Efforts are underway to identify clinical and molecular predictors in patients who may benefit from treatment with EGFR TKIs. Recent strategies for targeting the EGFR pathway include combining EGFR TKIs with newer agents and developing second-generation irreversible EGFR TKIs, which may be used in patients who have failed treatment with first-generation EGFR TKIs.
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Non-small-cell lung cancer (NSCLC) is a heterogeneous illness associated with a high mortality rate. Personalized therapy may improve treatment outcomes by identification of a specific genotypic anomaly and target-specific therapy. ⋯ Multiple randomized studies, including the Iressa Pan-Asia Study and WJTOG3405, have confirmed the role of EGFR tyrosine kinase inhibitors as standard first-line therapy for patients with the EGFR mutation. In this article, we summarize the current nonpersonalized therapies and examine the available and investigational personalized therapies for patients with resectable early-stage, unresectable locally advanced, or metastatic disease.
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Expert Rev Anticancer Ther · Sep 2010
ReviewControversies and challenges in the current management of nasopharyngeal cancer.
Nasopharyngeal carcinoma is uncommon worldwide, but poses a significant public health burden in endemic regions. Primary treatment for nonmetastatic disease is by radiation therapy, which has evolved from simple 2D-planning techniques to intensity-modulated radiation therapy. The role of systemic therapy has also become more prominent, with concurrent cisplatin-based chemoradiation the current standard of care for locally advanced disease based on multiple Phase III studies. ⋯ Recent studies have focused on this challenge of treating micrometastases while keeping toxicities manageable. Radiation therapy techniques continue to be refined to maintain consistently high locoregional tumor control while decreasing the probability of acute and late toxicities. This article discusses some of the current issues confronting the multidisciplinary team managing this disease.
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Expert Rev Anticancer Ther · Jul 2010
ReviewPoly(ADP-ribosyl)ation polymerases: mechanism and new target of anticancer therapy.
Poly(ADP-ribose)polymerase (PARP) is a ubiquitously present nuclear enzyme that is not only involved in many important cellular pathways but also contributes to chromosomal structure and genomic stability. The development of highly selective and potent PARP inhibitors has become of increasing clinical interest because of their promising efficacy in patients with breast or ovarian cancer. ⋯ In particular patients with either deficiency or dysfunction of BRCA, which is involved in DNA double strand break repair, appear to benefit from PARP inhibition. This article summarizes the present knowledge regarding the physiological function of PARP and ([poly]ADP-ribose) PAR, the functional product of PARP, the development of PARP inhibitors, the recent clinical data of PARP inhibitors in cancer treatment and the selection of patients who may benefit from PARP inhibition.
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Expert Rev Anticancer Ther · Jul 2010
ReviewIntranasal fentanyl: from pharmacokinetics and bioavailability to current treatment applications.
Fentanyl, a short-acting synthetic pure opiate, offers an excellent option for the treatment of cancer and chronic pain. While oral administration is not an option, its high potency and lipophilicity have made intranasal administration feasible. Intranasal fentanyl has a bioavailability of 89%, with a short onset of action ( approximately 7 min) and duration times ( approximately 1 h). ⋯ Intranasal fentanyl has been investigated to assess its potential as a well-tolerated acute postoperative breakthrough pain relief medication. It has been shown to be superior to oral transmucosal fentanyl for the treatment of cancer breakthrough pain. Similar analgesic effects to fentanyl or morphine intravenously and orally, with a similar safety profile, have been reported for postoperative or acute pain treatment of children and adults in the prehospital and hospital settings.