The lancet oncology
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The lancet oncology · May 2017
Randomized Controlled Trial Multicenter Study Comparative StudyTrastuzumab emtansine versus taxane use for previously treated HER2-positive locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma (GATSBY): an international randomised, open-label, adaptive, phase 2/3 study.
Although trastuzumab plus chemotherapy is the standard of care for first-line treatment of HER2-positive advanced gastric cancer, there is no established therapy in the second-line setting. In GATSBY, we examined the efficacy and tolerability of trastuzumab emtansine in patients previously treated for HER2-positive advanced gastric cancer (unresectable, locally advanced, or metastatic gastric cancer, including adenocarcinoma of the gastro-oesophageal junction). ⋯ F Hoffmann-La Roche.
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The lancet oncology · May 2017
Randomized Controlled Trial Multicenter Study Comparative StudyProphylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial.
Results from a previous phase 3 study suggested that prophylactic cranial irradiation reduces the incidence of symptomatic brain metastases and prolongs overall survival compared with no prophylactic cranial irradiation in patients with extensive-disease small-cell lung cancer. However, because of the absence of brain imaging before enrolment and variations in chemotherapeutic regimens and irradiation doses, concerns have been raised about these findings. We did a phase 3 trial to reassess the efficacy of prophylactic cranial irradiation in the treatment of extensive-disease small-cell lung cancer. ⋯ The Ministry of Health, Labour and Welfare of Japan.
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The lancet oncology · May 2017
ReviewThe future of personalised radiotherapy for head and neck cancer.
Radiotherapy has long been the mainstay of treatment for patients with head and neck cancer and has traditionally involved a stage-dependent strategy whereby all patients with the same TNM stage receive the same therapy. We believe there is a substantial opportunity to improve radiotherapy delivery beyond just technological and anatomical precision. ⋯ We propose a new treatment shift that moves away from an era of empirical dosing and fractionation to an era focused on the development of evidence to guide personalisation and biological adaptation of radiotherapy. We believe these approaches offer the potential to improve outcomes and reduce toxicity.
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The lancet oncology · May 2017
ReviewProton therapy for head and neck cancer: expanding the therapeutic window.
Use of proton beam therapy has expanded, with the number of proton centres rapidly increasing not only in the USA but also worldwide. The physical characteristics of the proton beam offer important advantages versus widely used photon techniques in terms of radiation precision. ⋯ Comparisons of radiation dose distributions between photon and proton techniques suggest considerable benefit in terms of toxicity sparing, but this has only recently been confirmed by substantial clinical data. In this Review, we attempt to define the role of this method in the contemporary multidisciplinary management of various types of head and neck cancer.
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The lancet oncology · May 2017
ReviewManagement of elderly patients with locoregionally confined head and neck cancer.
Head and neck cancer in elderly patients represents a major health burden because its management provides unique and complex challenges for multidisciplinary teams, such as reduced treatment tolerance, multiple comorbidities, and altered pharmacokinetics and pharmacodynamics. Despite the prominent challenges involved, high-level evidence for the management of this group of patients is scarce. ⋯ Evaluation of age-specific factors such as life expectancy, impaired functional status, and cognitive decline warrant consideration as part of the management decision process. In this Review, we provide an update of the available evidence on the management of locoregionally confined head and neck cancer in elderly patients and propose a practical treatment algorithm for clinicians to help manage this patient population.