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Malignant pleural effusion complicates the care of approximately 150,000 people in the United States each year. The pleural effusion is usually caused by a disturbance of the normal Starling forces regulating reabsorption of fluid in the pleural space, secondary to obstruction of mediastinal lymph nodes draining the parietal pleura.

Carcinoma of an unknown primary site is a common clinical syndrome, accounting for approximately 3% of all oncologic diagnoses. Patients in this group are heterogeneous, having a wide variety of clinical presentations and pathologic findings. A patient should be considered to have carcinoma of an unknown primary site when a tumor is detected at one or more metastatic sites, and routine evaluation (see below) fails to define a primary tumor site.

Magnets have been thought for centuries to have healing power. Scientists at Georgia Institute of Technology and the Ovarian Cancer Institute hope to take this possibility a quantum leap further. They are grooming magnetic nanoparticles as the mainstay of a technique aimed at filtering out free-circulating ovarian cancer cells from the body. Their goal is to slow or stop the metastatic spread of cancer.

Pharmacologic strategies targeting the DNA of tumor cells have been in use for much of the past century for many different cancer types. Radiation has also been a long-employed strategy to cause DNA damage and subsequent tumor cell death. However, the class of agents designed to inhibit the enzyme poly-(ADP-ribose) polymerase (PARP) have taken this a step further-these agents do not damage DNA themselves, but rather, inhibit the repair of DNA via inhibition of the base excision single-strand repair pathway. PARP inhibitors have been shown preclinically and clinically to enhance the affects of chemotherapies known to damage DNA or interefere with DNA replication. However, the most exciting use of PARP inhibitors may be in exploiting the concept of synthetic lethality. In this setting, the concept is based on two factors: (1) BRCA1/2-positive malignancies cannot use one of the major pathways to repair double-strand DNA breaks (ie, homologous recombination), and (2) making the base excision repair pathway nonfunctional via inhibition of PARP leads to tumor cell death, as unrepaired single-strand breaks are converted into double-strand breaks.

While they represent a minority of patients with lung cancer, more than 20,000 people in the United States who never smoked cigarettes are diagnosed with lung cancer each year.[1] This makes lung cancer in “never-smokers” one of the 10 most common cancers-more common than ovarian cancer. In this issue of ONCOLOGY, Subramanian and Govindan give an overview of emerging data about lung cancer in never-smokers.[2] The data outlined in this review provide support for the hypothesis that we can define this collection of diseases affecting never-smokers not by the absence of a common risk factor (smoking) but by each tumor’s molecular features.

As knowledge increases about the processes underlying cancer, it is becoming feasible to design “targeted therapies” directed toward specific pathways that are critical to the genesis or maintenance of the malignant phenotype. Poly(ADP-ribose) polymerase (PARP) inhibitors are an example of this new framework. DNA damage repair is a complex and multifaceted process that is critical to cell survival. Members of the PARP family are central to specific DNA damage repair pathways, particularly the base excision repair (BER) pathway. PARP inhibition, with subsequent impairment of the BER mechanism, may enhance the cytotoxicity of agents that generate single-strand breaks in DNA, such as radiation and certain chemotherapy drugs. In addition, PARP inhibitors may induce death through “synthetic lethality” if the DNA repair mechanisms that rescue BER-deficient cells are themselves impaired. This mechanism is thought to underlie the impressive results of PARP inhibition in BRCA-associated breast and ovarian cancer, and may also account for the reported benefit of this approach in “triple-negative” breast cancer. This review will examine the current understanding of PARP inhibition as a treatment for breast cancer, ongoing clinical trials, and future directions for this new approach.

The American Society of Clinical Oncology (ASCO) released its report, Clinical Cancer Advances 2009: Major Research Advances in Cancer Treatment, Prevention and Screening, an independent assessment of the most significant clinical cancer research studies of the past year, including 15 major advances.

BELGRADE-Endocyte presented phase IIa data from its trial using EC145 (pegylated liposomal doxorubicin) in women with advanced-stage ovarian cancer at the 2009 European Society of Gynaecological Oncology.

Industry Watch

The following company announcements were made at ECCO/ESMO 2009 in Berlin: Pfizer drugs prolong overall survival Pfizer Oncology released data from a phase III trial for sunitinib (Sutent) for the treatment of progressive,

The US Food and Drug Administration (FDA) recently cleared the OVA1 Test, the first blood test that, prior to surgery, can help physicians determine if a woman is at risk for a malignant pelvic mass. OVA1 is the first FDA-cleared laboratory test that can indicate the likelihood of ovarian cancer with high sensitivity prior to biopsy or exploratory surgery, even if radiologic test results fail to indicate malignancy.

October marks National Breast Cancer Awareness month, now in its 25th year, a time to contemplate important advances and milestones as well as future research needs.

M.D. Anderson Cancer Center scientists have targeted a protein that is overexpressed in ovarian cancer cells and used it as a molecular homing mechanism to deliver chemotherapy in preclinical models. The protein, EphA2, is attractive for molecularly targeted therapy because its overexpression is associated with poor prognosis, according to Anil K. Sood, MD, and colleagues.

Robyn was 63 years old when she was diagnosed with Stage III ovarian cancer. After recovering from a total abdominal hysterectomy and oopherectomy, she traveled to a comprehensive cancer center to consult with a physician specializing in ovarian cancer. She took her entire collection of pathology slides and reports, laboratory and imaging study reports, and the summary of her surgical procedure.

ORLANDO-For the majority of women who undergo ovarian cancer treatment, disease relapse is a matter of when rather than if. These women could spend the rest of their lives undergoing regular CA125 serum marker testing. A recent study that compares the quality of life in early- and advanced-stage ovarian cancer survivors found that CA125 marker measurements for recurrence were, understandably, a source of anxiety for both groups.

Researchers from the Centers for Disease Control and Prevention (CDC) have found that survival among women with ovarian cancer is influenced by age of menarche and total number of lifetime ovulatory cycles.Previous studies have indicated that the factors associated with a decreased risk of developing ovarian cancer include fewer lifetime ovulatory cycles, higher parity, oral contraceptive use, hysterectomy and tubal ligation, according to the researchers.

The National Functional Genomics Center has launched a consortium that will undertake two projects: A biologically-driven analysis of ovarian cancer cell lines and a trial that uses molecular profiling to target chemotherapy.