Impact of cetuximab in current treatment of metastatic colorectal cancer.

Introduction: Cetuximab is a chimeric monoclonal antibody targeting the EGFR, which has proven effective in patients with metastatic colorectal cancer (mCRC), wild-type Kirsten rat sarcoma viral oncogene homolog (KRAS).

Areas Covered: The aim of this manuscript is to discuss the current impact of cetuximab in the most important scenarios of mCRC. We review the currently available data regarding the role of other biomarkers, such as the mutational status of neuroblastoma RAS viral (v-ras) oncogene homolog in identifying patients who could benefit most from anti-EGFR.

Venous International Assessment, VIA scale, validated classification procedure for the peripheral venous system.

Purpose: VIA scale is a dynamic performance status tool of the peripheral venous system that is divided into five different grades, composed of three parameters: number of observable puncture points; optimal catheter size for cannulation and ease of performing venipuncture and risk of extravasation.

Methods: Prospective single-center, observational, open, non-randomized study divided into two phases. In the first longitudinal phase, we studied the clinical characteristics and the changes in their peripheral venous systems during intravenous chemotherapy for 16 patients (n=16) for an average period of 24 months.

Study of KRAS new predictive marker in a clinical laboratory.

Background: The presence of somatic mutations in the KRAS gene has been identified as a reliable strong negative predictor for the response to targeting the epidermal growth factor receptor (EGFR), in patients with metastatic colorectal cancer and the use of anti-EGFR monoclonal antibodies such as Cetuximab and Panitumumab is now restricted to patients with no detectable KRAS mutations. Between 30 and 40 % of colorectal cancers contain a mutated KRAS oncogene. The aim of this study was to evaluate concordance between three methods to analyze KRAS mutational status in regard to clinical testing.

[Personalized medicine in oncology: one drug, one biomarker].

Sir Williams Osler, the father of Modern Medicine, recognized more than one century ago, that "If it were not for the great variability among individuals, medicine might as well be a science and not an art". Nevertheless today, in our opinion this paradigm is presently in crisis. Clinical medicine starts to be a science thanks to this variability that is generating a personalized medicine based on the concepts of pharmacogenetic and pharmacogenomic.

[Circulating tumor cells: a new efficacy marker in the treatment of metastatic colorectal cancer].

Colorectal cancer metastasis is the result of several interacting processes at the end of which cancer cells survive in distant organs. Penetration of primary tumor cells into blood is central to the whole phenomenon of metastasis and is a common step in all cancer types. The detection of circulating tumor cells (CTC) in peripheral blood of patients with colorectal cancer could have clinical usefulness in three aspects: 1) as evidence of early dissemination, and then as a risk factor of clinical recurrence, 2) as a relevant risk factor for metastatic progression and worse prognosis, and 3) as predictive marker of response to treatment.

[The challenge of cancer survival in adults: therapeutic progress from the perspective of the clinican].

It is estimated than one out of 3 people in Spain will suffer of cancer along the life. In fact cancer is responsible for the 25% of deaths in our country. The good news is that the overall survival at five years is around 66%.

Biomarkers and anti-EGFR therapies for KRAS wild-type metastatic colorectal cancer.

Therapy for metastatic colorectal cancer has been improved in terms of response rate, time to progression and overall survival by the emergence of anti-EGFR monoclonal antibodies (cetuximab and panitumumab) in combination with standard cytotoxic chemotherapy (oxaliplatin or CPT-11-based combinations). However, the benefits of cetuximab and panitumumab are confined to KRAS wild-type (KRAS-wt) colorectal tumours; KRAS-mutated tumours rarely respond to these drugs. Of all colorectal tumours, 65% are KRAS-wt tumours, but anti-EGFR therapies are effective for only 60-70% of these.

Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients.

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs.

Spanish Society of Medical Oncology consensus for the use of haematopoietic colony-stimulating factors in cancer patients.

Neutropenia is a common complication of cancer chemotherapy. Colony-stimulating factors (CSF) may be used to avoid neutropenia-associated complications. The Spanish Society of Medical Oncology (SEOM) recently constituted a working group to review the main issues concerning the use of CSF and carried out a consensus process about the use of CSF in cancer patients, held in Madrid on 26 May 2006.

[Biomarkers and anti-EGFR therapies for KRAS wild-type tumors in metastatic colorectal cancer patients].

The natural history of metastasic colorectal cancer has being clearly modified in terms of response rate, time to progression and overall survival, once the antiEGFR monoclonal antibodies (cetuximab and panitumumab) have emerged in combination with the standard cytotoxic chemotherapy (FOLFOX and FOLFIRI). However, the benefit from cetuximab and panitumumab is only confined to KRAS-wild type (KRAS-wt) colorectal tumors, while KRAS-mutated tumors do not respond to these drugs. The 65% of colorectal tumors are KRAS-wt tumors, but efficacy of antiEGFR therapies is detected only in 60-70% of these KRAS-wt tumors.

Adjuvant chemotherapy for early-stage non-small-cell lung cancer. Single-centre experience and literature review.

Background: In recent years platinum-based chemotherapy has become the standard of care for patients with good performance status after complete resection in stages IB-IIIA non-small-cell lung cancer (NSCLC), although the benefit is mainly in stages II and IIIA.

Patients And Methods: In a retrospective trial we evaluate the clinical efficacy and toxicity profile of a platinum- and taxanes-based adjuvant chemotherapy in completely resected IB-IIIA NSCLC. The primary end point was relapse- free survival (RFS); principal secondary end points were overall survival (OS) and safety of the regimen.

[Translational research in clinical oncology: challenges and opportunities].

The principal objective of the translational research in Oncology is to translate the knowledge derived from the basic research to the clinical practice as soon as possible. The goal is to develop and maximize the concepts of oncopharmacogenomic and oncopharmacogenetic. In tis context it will be absolutely necessary that hospitals integrate the basic and clinical research in translational research units with the appropriate resources.

[Targeted therapy for cancer: anti-tyrosine kinase receptor agents].

The use of drugs to treat cancer based on molecular targets is common fact, especially those targeting kinases that are involved in the cellular signalling pathways. The anti-tyrosine receptor drugs are among the most developed, some of them having already been approved by the FDA and the EMEA for breast cancer, colorectal, lung GIST and renal cancer treatment. Although these drugs are currently focused on a single target, the future challenge is to hit several targets simultaneously, along with combined chemotherapy.

Oncologists' perceptions of cancer pain management in Spain: the real and the ideal.

Aim: Studies in some countries suggest that cancer pain is often not adequately controlled, but little is known about the situation in Spain. The objective of this study was to identify medical oncologists' perceptions about pain management in their patients.

Methods: Two-round Delphi survey of 24 medical oncologists from 22 large, geographically diverse hospitals in Spain.

Breast metastases as the first sign of recurrence of a cutaneous melanoma.

Malignant melanoma is the most rapidly increasing cancer in the world. Metastatic disease occurs in 20% of patients, and prognosis in these cases is poor. We report the case of a woman who presented breast metastasis as the first sign of recurrence of a melanoma.

Clinical 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.

A panel discussion of controversies and challenges in the adjuvant treatment of colon cancer.

Current issues of adjuvant therapy for colon cancer concern the introduction of drugs other than fluorouracil-5/leucovorin (5-FU/LV), the benefits for stage II patients, the use of new primary endpoints and the influence of age on treatment benefits. These issues were addressed in a panel discussion and the conclusions were the following: FOLFOX4 is the first regimen that shows superiority over 5-FU/LV. The use of 3-year disease-free survival as primary endpoint could encourage the quicker adoption of improved therapeutic strategies into clinical practice.