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ONCOLOGY Vol 28 No 4

With the progress in diagnostic methods that has made it possible to decipher the genetic code of DLBCL within a relatively short time, and with the increasing number of drugs that are entering clinical trials, our next big challenge is to enroll patients in trials in a timely manner.

Our heads hit the pillow later at night as the complexity of treating DLBCL increases, but we are well rested on account of the progress that is being made.

Rationally designed clinical trials investigating novel agents in patient populations enriched for those who are most likely to benefit will be instrumental for expediting progress. With respect to DLBCL, it has become clear that one treatment no longer fits all.

The classification of diffuse large B-cell lymphoma into three distinct molecular diseases--germinal center B-cell–like subtype, an activated B-cell–like subtype, and a primary mediastinal B-cell lymphoma subtype--has laid the foundation for the development of new agents and novel strategies that target individual subtypes.

We have yet to establish a standard practice for maintenance therapy in metastatic colorectal cancer. Of course, ideally we could find a biomarker of benefit for patients who should be managed this way, but thus far we have had no such luck.

A 60-year-old man was incidentally found to have a large right renal mass during a CT scan with and without intravenous and oral contrast ordered by his primary care physician to evaluate mild right side abdominal discomfort and hepatomegaly.

As new data and new treatment options emerge, palliative radiotherapy algorithms will need to undergo continuous modifications and updates to ensure that patients receive optimal symptom relief.

Moving forward, perhaps no recent development in the use of RT in metastatic prostate cancer has captured greater attention than the use of radium-223 in metastatic castration-resistant prostate cancer (mCRPC).

This review will include discussion of the role of radiation therapy for osseous metastases and metastatic spinal cord compression, as well as the use of radiopharmaceuticals for painful osseous metastases.

There is no question that radiopharmaceuticals have a role in the management of patients with metastatic bone disease. There is also no question that fractionated external beam radiotherapy (EBRT) is highly effective and generally well tolerated when delivered with large open or focal fields.

In order to achieve maximum survival of patients with metastatic castration-resistant prostate cancer, the judicious use of all available effective agents and modalities is required. Both EBRT and radium-223 are effective at relieving pain, but both may decrease bone marrow function.

Therapies targeting HER2 have revolutionized the treatment of breast cancer. Trastuzumab is the foundation of treatment for women with HER2-positive breast cancer. The challenge ahead is to develop predictors that can identify patients for whom trastuzumab alone will be sufficient.

It will be critically important to await the longer-term DFS and OS results from the neoadjuvant studies, as well as the adjuvant studies evaluating dual HER2 blockade, prior to these approaches truly becoming the standard of care.

This review discusses the treatment of primary, nonmetastatic HER2-positive breast cancer in the adjuvant and neoadjuvant settings—settings in which tremendous progress has been made.

It is important for all of us now and then to take a step back and recapture the wonder that we all felt at the onset of our careers, when treatments we now consider simple and routine held an aura of miracle. For me, a little bit of that wonder returns every time I treat a patient with a bony metastasis—in particular, from prostate cancer.

 
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