When evaluating the toxicity of a therapy, patients and their physicians may have different views on the severity of adverse effects. Patient-reported outcomes are becoming an increasingly important component of the assessment of new therapies. Montemurro and colleagues conducted a study of 604 women, across 11 sites, comparing patient vs physician estimation of chemotherapy-related adverse effects. The frequency and severity of toxic effects were consistently greater in the patient reports as compared with the physicians’ reports. This study underscores the need for patient-reported outcomes to be incorporated in drug development. Basch provides an Editorial.
Editorial
Hershman and colleagues reported long-term adverse effects of intermittent vs continuous androgen deprivation therapy for 1134 elderly men with metastatic prostate cancer enrolled in SWOG9346. The most common adverse effects were osteoporosis and hypercholesterolemia. Men receiving intermittent therapy had significantly more ischemic and thromboembolic events than those receiving continuous therapy. Although many assume that intermittent androgen derivation therapy may have fewer toxic effects than continuous treatment, this study suggests that there may be a higher incidence of cardiovascular events. Niraula and Tannock provide an Invited Commentary.
Invited Commentary
The risk of developing cancer after a solid-organ transplant may be related to many factors including, but not limited to, immune suppression. Acuna and colleagues evaluated the incidence of cancer development in 11 061 kidney, lung, or heart transplant recipients. In these patients, 20% of deaths were cancer related. Transplant recipients were also more likely to die of their cancer than patients with cancer who had not received transplants. The authors call for a different paradigm for cancer screening and prevention in transplant recipients. Schmid et al provide an Invited Commentary.
Invited Commentary
BRCA1 and BRCA2 are the most well-studied germline mutations associated with breast and ovarian cancer risk, but recent studies suggest that other inherited mutations also play a role. Norquist et al studied germline DNA from 1915 women with ovarian cancer. While 15% had evidence of BRCA1 and/or BRCA2 mutations, 0.4% had mutations in DNA mismatch repair genes. Mutations in 5 additional genes were more common in patients with ovarian cancer than controls. In this study, 18% of patients with ovarian cancer had a germline mutation that predicted disease risk. Stoffel and Fearon provide an Invited Commentary.
Invited Commentary
Clinical Review & Education
In this systematic review, Jean et al evaluate the observation that more toxic effects are associated with the use of sorafenib in patients with thyroid cancer than in other populations treated—patients with renal or hepatocellular cancer. A detailed analysis of the specific toxic effects of sorafenib is presented, and potential mechanisms of the tissue-based differences noted in development of adverse effects are reviewed.
Continuing Medical Education