ONCOLOGY Vol 24 No 13

The effectiveness of RT in the palliative setting is sometimes overlooked; however, RT can provide excellent palliation for patients whose disease becomes refractory to other modalities.

Radiation therapy has an essential role for certain patients with DLBCL. It is hoped that ongoing and future trials will identify the patients who will benefit from this treatment and those for whom it is unnecessary.

The BHGI is working to collaborate with colleagues in LMCs to develop practical strategies to improve outcome, applying implementation research methodology to promote early detection strategies in settings where appropriate care can be administered.

Anderson et al highlight the Breast Health Global Initiative for guideline development and discuss how developments in low and middle income countries have parallels in the delivery of health care to underserved populations in industrialized countries. Guidelines for appropriate breast cancer treatment must address early detection, accurate diagnosis, and the delivery of timely and appropriate treatment modalities.

Breast cancer is a significant global health issue: An updated analysis by the International Agency for Research on Cancer estimated that there were 1.38 million new breast cancer cases diagnosed in 2008 and confirmed that it remains the most frequent cause of cancer death in women worldwide.

This effort has already brought important contributions to countries of low and middle incomes: the basic guidelines, which not only indicate how patients with breast cancer can be treated even with modest resources, but also provide a minimum level of care below which countries, governments and health care systems cannot even pretend that they provide care for women with breast cancer.

Though there are no data yet on their efficacy, oleander extracts are promoted to treat cancer, AIDS, and congestive heart failure, and are being investigated in clinical trials.

With the new direction in research and clinical trials, treating patients who most benefit from treatment with minimal toxicity will continue to be the mainstay of personalized cancer therapy.

Bevacizumab has become a standard of care for first line therapy in a subgroup of advanced NSCLC patients. With the advent of other effective therapies in bevacizumab-eligible patients and the ongoing development and testing of biomarkers for cytotoxic agents, it remains to be seen whether continued use of bevacizumab will be justified in the absence of predictive biomarkers.

Despite the fact that bevacizumab and cetuximab are both in an advanced stage of clinical development for use in treatment for unresectable NSCLC (with bevacizumab already licensed for the use in clinical practice), several unanswered questions regarding these drugs remain. A number of ongoing trials have been specifically addressed to answer them, however, the first priority should be to personalize treatment, through clinical or biological markers, in order to better select patients who could benefit from targeted therapy with decreased toxicity.

Moreover, today’s new economic reality has forced policymakers to scrutinize every branch of medicine to cut costs. Not surprisingly, oncology has taken center stage in this debate.