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    CNS metastases in HER2-positive breast cancer
 Top
 CNS metastases in HER2-positive...
 Imatinib in patients with...
 Prognostic significance of bone...
 Molecular staging of the...
 Quote
 
Trastuzumab, a humanized monoclonal antibody that recognizes the extracellular domain of HER2, has been studied in a variety of clinical settings, including a randomized trial of chemotherapy with or without trastuzumab as first-line treatment for HER2-positive metastatic breast cancer. That study showed that the addition of trastuzumab improved response rate, and progression-free and overall survival. Recently, HER2 overexpression and trastuzumab-based therapy has been suggested to be associated with increased rates of brain metastases. Retrospective analyses of women with HER2-overexpressing breast cancer receiving trastuzumab-based treatment indicated that approximately one-third had developed CNS metastases. In this issue, Burstein et al. report on a study that aimed to assess the clinical frequency and time course of isolated brain metastases among women receiving trastuzumab in combination with chemotherapy for advanced breast cancer. These authors conclude that patients with HER2-overexpressing metastatic breast cancer are at risk of CNS progression, reflecting improved peripheral tumor control and patient survival through use of trastuzumab.


    Imatinib in patients with c-Kit-expressing relapsed SCLC
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 CNS metastases in HER2-positive...
 Imatinib in patients with...
 Prognostic significance of bone...
 Molecular staging of the...
 Quote
 
Although standard combination cytotoxic chemotherapy of small-cell lung cancer (SCLC) has shown antitumor activity, long-term survival is low and most patients eventually develop progressive disease. Even patients achieving a complete response show a high rate of relapse. High level expression of c-Kit and its ligand, stem cell factor (SCF), has been found widely in SCLC, and the role of the c-Kit autocrine loop in SCLC has been well studied. This autocrine loop not only functions cooperatively with other SCLC autocrine loops, but also seems to confer a tumor survival advantage in SCLC. Imatinib mesylate is an orally bioavailable inhibitor of several tyrosine kinases including c-Kit. In a pivotal study, pretreatment of H526 cells with imatinib was shown to inhibit SCF-mediated Kit activation. In this issue, Dy et al. report the results of a phase II study that aimed to evaluate the clinical activity of imatinib mesylate in patients with recurrent and refractory c-Kit-expressing SCLC. These authors report that imatinib showed no clinical activity in spite of patient selection for c-Kit-expressing SCLC.


    Prognostic significance of bone marrow magnetic resonance imaging in previously untreated multiple myeloma
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 CNS metastases in HER2-positive...
 Imatinib in patients with...
 Prognostic significance of bone...
 Molecular staging of the...
 Quote
 
Conventional radiographs of the skeleton are routinely obtained during the work-up of patients with suspected myeloma, with abnormal radiographs being detected in more than 80% of patients. However, the prognostic value of radiographic findings is controversial and in some series, patients with normal appearing skeletal surveys actually had a worse prognosis than patients with minimal lytic changes. Recently, the International Myeloma Working Group proposed an International Staging System (ISS) based on serum albumin and ß2-microglobulin. However, magnetic resonance imaging (MRI) can sample a large volume of bone marrow and depicts bone marrow abnormalities in multiple myeloma with greater sensitivity than conventional radiographs. In this issue, Moulopoulos et al. report a study that aimed to correlate MRI patterns with the ISS and the outcome of patients with previously untreated, symptomatic multiple myeloma. These authors report that diffuse marrow replacement on MRI added to the evaluation and management of these patients.


    Molecular staging of the sentinel lymph node in melanoma patients
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 CNS metastases in HER2-positive...
 Imatinib in patients with...
 Prognostic significance of bone...
 Molecular staging of the...
 Quote
 
The number of metastatic nodes and tumor burden of nodal metastasis are the two major predictors of outcome in patients with melanoma of equivalent T classification. Therefore, accurate classification of the nodal status is of compelling prognostic value for patients with early stage melanoma. In this issue, Romanini et al. report a study that aimed to assess the prognostic value of using reverse transcriptase (RT)–PCR to determine positivity in melanoma patients'sentinel lymph node (SLN) previously shown to be negative by conventional histopathology. These authors report that RT–PCR was more sensitive than conventional histopathology for the detection of SLN positivity and that it was a reliable predictor of disease relapse in stage I–II melanoma patients.


    Quote
 Top
 CNS metastases in HER2-positive...
 Imatinib in patients with...
 Prognostic significance of bone...
 Molecular staging of the...
 Quote
 
‘Also, the high standard held up to the public mind by the College of Physicians, which gave its peculiar sanction to the expensive and highly rarefied medical instruction obtained by graduates of Oxford and Cambridge, did not hinder quackery from having an excellent time of it; for since professional practice chiefly consisted in giving a great many drugs, the public inferred that it might be better off with more drugs still, if they could only be got cheaply, and hence swallowed large cubic measures of physic prescribed by unscrupulous ignorance which had taken no degrees.’

Dr Lydgate considers the problems of his profession in George Eliot's Middlemarch.





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