With each passing year, chemotherapy is less and less a focus of interest. Instead, the focus is on the abundance of exciting new biologic and targeted agents that are bulldozing the therapeutic landscape in the lymphomas and chronic lymphocytic leukemia.
Chemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of thrombocytopenia in the cancer setting. In patients receiving chemotherapy, thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles.
Clinical trials of the new thrombopoietin receptor agonists in the management of chemotherapy-induced thrombocytopenia are needed to address concerns about the safety and practical efficacy new agents before we accept them as standard therapies.
Some targeted systemic therapies have demonstrated evidence of activity in the brain—specifically in melanoma, lung cancers, and breast cancers—and these agents warrant further study in clinical trials.
Conventional methods for treating brain metastasis, such as surgery, WBRT, and SRS, each compete with and complement one another. A plethora of recent studies have helped define and expand the utility of these tools.
We may find that in the case of recurrence surveillance, doing less than we now do is better. Conversely, for persistent symptoms, adoption of lifestyle behaviors by survivors, and the meeting of family needs, doing more than we do now is better.
In this review, we discuss the established guidelines and current evidence regarding post-treatment surveillance, and we propose general management strategies in prostate, colorectal, and breast cancers.