Current opinion in oncology
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Given the burden of suffering associated with the development of ovarian cancer and the clear survival gradient related to the stage of disease at diagnosis, there is much enthusiasm for the development of effective screening strategies aimed at early detection. To date, no evidence exists to justify mass population screening; however, emphasis on subpopulation screening, identification of novel serologic markers, and multimodality screening designs have provided hope that these refinements may eventually translate into a reduction in ovarian cancer mortality.
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Epstein-Barr virus (EBV), a human herpes virus, is associated with a variety of malignancies. In vitro, it is able to transform B cells, which will grow as lymphoblastoid cell lines in the absence of T cells. Patients with a variety of immunodeficiency diseases are subject to the development of B-cell lymphomas that express viral antigens on their cell surface. ⋯ Transfer of mature T cells from EBV-immune marrow donors has been demonstrated to be effective in controlling these EBV-associated B-cell tumors. Recently the demonstration that EBV transcripts are found in other lymphomas (including Hodgkin disease cells) has led to the suggestion that transfer of EBV-specific T cells may also be effective in managing these tumors. Current research involves optimizing methods to expand cells that recognize the EBV antigens expressed in the lymphoma cells.
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There is increasing molecular and epidemiologic evidence that human papillomavirus (HPV) is associated with a distinct subset of head and neck squamous cell carcinomas. The strength and consistency of HPV DNA presence in oropharyngeal cancers bolster the argument that this association is likely causal. HPV-positive tonsillar cancer in particular is emerging as a specific disease entity with distinct molecular, pathologic, and clinical characteristics. ⋯ This review focuses on the recent literature (since 1998) investigating the relationship between HPV and head and neck cancer development, using the current paradigm for causal inference in epidemiologic research attributed to Sir A. Bradford Hill. Data examining the association of HPV with pathogenesis of head and neck squamous cell carcinoma before 1999 were previously reviewed in this journal.
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In the past decade, the discovery of tumor antigens recognized by T cells has revolutionized the tumor vaccine field. The appreciation that peptides are bound to and restricted by major histocompatibility class I and II molecules for immune recognition has encouraged a number of early-phase clinical trials of peptide vaccines. I summarize herein the rationale for and the results of a number of clinical trials of peptide vaccines for melanoma, suggesting that immune and clinical responses can be seen in those with metastatic and resected disease using a variety of surrogate assays. The challenge for the future is to correlate the results of immunologic assays with clinical benefit in patients with advanced cancer.
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The bcr-abl fusion protein is present in the vast majority of cases of chronic myelogenous leukemia, and the deregulated tyrosine kinase activity of this protein is essential for leukemic transformation. Thus, bcr-abl is an ideal target for pharmacologic inhibition. In preclinical studies, ST1571 (formerly CGP57148B), an abl-specific, tyrosine kinase inhibitor, selectively killed bcr-abl-expressing cells both in vitro and in vivo. In early clinical trials of ST1571, encouraging results have been obtained, and there is already a suggestion that ST1571 may soon need to be incorporated into treatment algorithms for chronic myelogenous leukemia.