ONCOLOGY Vol 26 No 4

Oncologists and their patients are facing disruptive changes in healthcare, research, and communication. This dramatic increase in the quantity and quality has changed our lives forever. However, many of us remain frustrated with our inability to control this information overload.

Radium-223 is a promising agent that represents a new class of alpha pharmaceuticals that gets down to the site of bony metastases. The limited side-effect profile potentially allows for repeat administration to increase durability of pain control, and for its use in combination with novel biologic and chemotherapeutic agents.

One would hope that survival data from at least one more phase III or phase IV clinical trial will convincingly show a prolongation of survival due to treatment with Alpharadin. This will not be inexpensive therapy.

In their review of multi-gene assays of breast cancer, Drs. Gökmen-Polar and Badve highlight the overall similarity of “first-generation” molecular assays that have been developed, using different strategies, to understand the relationship between gene expression within tumor samples and the outcomes of patients with breast cancer.

Future randomized studies should focus on determining which patients benefit most from the inclusion of molecular diagnostics in treatment decision making and on the development of treatment algorithms that incorporate patient factors, histologic and biologic findings, and molecular markers.

In rare diseases, the “magic” lies in close collaboration between individual investigators at academic institutions, the pharmaceutical industry, and funding institutions such as the National Cancer Institute.

Like Burnison and Lim, we conclude conveying our sense of optimism that progress is being made-and that important clinical questions are being asked related to the care of patients afflicted with ATC. We believe, however, that in the final analysis, important progress will remain highly dependant upon collaborations conducted across specialties, across institutions, and across nations.

In this article, we endeavor to clarify the role of radiation therapy and chemotherapy in the treatment of ATC; we note important contributions of the historical literature, and we review more contemporary strategies adopted by several renowned institutions.

In this review, we will present the current data on commercially available molecular profiling assays in breast cancer and discuss the challenges surrounding their incorporation into routine clinical practice as prognostic and predictive tools.

This article will present current information about alpha-pharmaceuticals, a new class of targeted cancer therapy for the treatment of patients with CRPC and bone metastases. It will review preclinical and clinical studies of the experimental radiopharmaceutical radium-223 chloride (Alpharadin).

Of all the sad pronouncements that oncologists deliver, this may be the one that stings the most. If you were expecting hope from your doctor, how would you react to these words? Would you sit with quiet disbelief, or storm out of the office?

All those who walk through your doorway become your responsibility, at least until you either cure them, satisfy them, or in the rare case of incorrigibles, banish them. Opening our office to all comers is part of every doctor's commitment to the sick, and the faster we accept this, the smoother our day will proceed. Sometimes, though, it ain’t easy.