Expert review of anticancer therapy
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Expert Rev Anticancer Ther · Feb 2006
ReviewSignificance of gene expression analysis of renal cell carcinoma.
Renal cell carcinoma (RCC) describes a family of epithelial tumors arising from within the kidney. Each subtype of RCC presents a unique clinical picture with varied tumor biology, patient prognosis and response to treatment. Gene expression profiling offers the ability to analyze thousands of candidate genes in high-throughput arrays and has led to a greater knowledge of the molecular genetics of RCC. ⋯ Gene expression data also promise to advance current staging systems and improve prognostic information for patients and clinicians. Understanding the genetic signature of RCC tumors will allow for sophisticated application of systemic and targeted therapies, improving patient response and minimizing unnecessary exposure of patients to treatment toxicities. This article reviews the significance of gene expression analysis in the understanding of tumor biology and RCC treatment.
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Expert Rev Anticancer Ther · Feb 2006
ReviewBRCA1-associated complexes: new targets to overcome breast cancer radiation resistance.
Since BRCA1 was cloned a decade ago, significant progress has been made in defining its biochemical and biological functions, as well as its role in breast and ovarian cancers. BRCA1 has been implicated in many cellular processes, including DNA repair, cell cycle checkpoint control, protein ubiquitination and chromatin remodeling. ⋯ Finally, the possibility that BRCA1-associated proteins may serve as new targets for breast cancer radiation therapy is explored. The activation or inactivation of these BRCA1-associated proteins may modify both the risk of developing cancers in BRCA1 mutation carriers and the efficacy of breast cancer therapy, including radiation.
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Despite the limited efficacy of systemic chemotherapy in the treatment of metastatic melanoma, it remains the gold standard in the case of patients with a good performance status and no major comorbidities for whom radical surgery is unsuitable. Various drugs have been employed as monochemotherapy with response rates ranging from 0 to 20%. ⋯ However, the current scenario does not seem to be significantly different from the situation of 20 or 30 years ago. To date, no single drug, combination chemotherapy in addition to a hormonal or biotherapy compound, has demonstrated an overall survival benefit in a randomized clinical trial.
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Expert Rev Anticancer Ther · Jan 2006
ReviewLetrozole as adjuvant endocrine therapy in postmenopausal women with breast cancer.
The third-generation aromatase inhibitor letrozole offers a promising approach to treating hormone-sensitive breast cancer for postmenopausal women, through potent and specific inhibition of estrogen synthesis. In neoadjuvant and first-line treatment, letrozole demonstrated superior efficacy compared with tamoxifen in randomized Phase III trials. ⋯ For patients who have already completed 5 years of tamoxifen, extended endocrine therapy with letrozole is a new therapeutic option based on the results of the MA-17 trial. The optimal use of aromatase inhibitors remains an open question, at least until results from randomized trials (BIG 1-98, TEAM) investigating the sequential use of an aromatase inhibitor and tamoxifen in comparison with continuous monotherapy become available.
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Expert Rev Anticancer Ther · Dec 2005
ReviewClinical practice guidelines on antiemetics in oncology.
The tolerability of chemotherapy has been significantly improved by the advent of effective drugs and protocols for the amelioration of chemotherapy-induced nausea and vomiting. Variables such as the timing of nausea and vomiting (acute, delayed or anticipatory) and the emetogenicity of the chemotherapy must be taken into account in developing guidelines for antiemetic prophylaxis and treatment. Although there are a number of 5-hydroxytryptamine antagonists available, the clinical differences between them are small. ⋯ Alternatively, a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone can be used in the acute phase, followed by dexamethasone for prophylaxis in the delayed phase. For chemotherapy with a low emetogenicity, either dexamethasone, metoclopramide, prochlorperazine or triethyperazine alone is recommended. No prophylaxis is generally required during the delayed phase and indeed may not be necessary during the acute phase either.