European Journal of Cancer: Highlights of Issue 37:12

Adolescents - the 'lost tribe'!

Laura, a 14 year-old girl (or is she a young woman?) with a painful swelling in her femur - probably an osteosarcoma - is referred to a large teaching hospital with both Paediatric and Medical Oncology wards, but no Adolescent Unit, although there is such a Unit in Citytown - 50 miles away from her home. Her GP's letter describes her as "post-pubertal, but immature." Laura has apparently said "if it's cancer, I want to die". Where should she be admitted, investigated and treated?

This kind of dilemma is common all over the world. Generally, nurses, doctors and managers are only just becoming aware of the special needs of this age group, to the extent that Adolescents are a ' Lost Tribe'. The Update and Commentary in this issue highlight the problem in greater detail and suggest some solutions. Specialised Adolescent Units also treating patients with diseases other than cancer may be the answer, in larger centres at least, but political will and extra funds would be needed. The challenge for Europe, with its public and vocal commitment to Human Rights, is to lead the way by providing Laura and young people like her with the 'Homeland' they so evidently need.

Hepatocyte growth factor, a survival factor for c-met-expressing Burkitt's lymphomas?

Depending on the cellular context, HGF has mitogenic, morphogenic and motogenic effects. Its receptor, encoded by c-met, has properties of a tyrosine kinase receptor and there is substantial evidence that the HGF/c-met pathway is involved in tumour growth, invasion and metastasis. In this issue, Skibinski and colleagues show that pretreating Burkitt's lymphoma (BL) cell lines with HGF, prior to exposure to DNA damaging drugs, such as doxorubicin, results in a cytoprotective effect. They suggest that the c-met pathway may be involved as only BL cells that expressed c-met were protected from apoptosis. Moreover, an agonistic monoclonal antibody recognising the extracellular portion of c-met was also able to mimic the protective effect of HGF in these cells. Western blotting and flow cytometric analysis suggested that HGF exerts this effect by abrogating the doxorubicin-induced decrease in anti-apoptotic proteins Bcl-XL and Bcl-2. Since many cells undergo apoptosis in response to chemotherapy, the development of chemotherapy-resistant tumours, a common problem in cancer therapy, may occur, at least in some cases, through modulation of the apoptotic pathway. Thus, the authors conclude that, if these results translated to the in vivo situation, HGF /c-met status may influence the disease outcome of patients on chemotherapy. However, they also state that other markers of apoptosis, such as caspase activation, will need to be measured to confirm their in vitro conclusions.

Is follow-up of patients with thin melanomas worthwhile?

The frequency of recurrence for patients with thin melanomas is low, around 4-11% and this raises the question of whether follow-up of these patients is worthwhile. In this issue, Kittler and colleagues have investigated the prognosis of patients that recur according to the time between last follow-up and recurrence. They studied 513 patients with thin melanomas. Only 20 patients recurred and these could be divided into two groups; those that had a follow-up visit within a year of recurrence (n=14) and those that did not (n=6). There were differences in survival between the two groups (median survival of 22.3+ months compared with 12.5 months, respectively) and the site of recurrences also differed with metastatic disease in the former group confined to the lymph nodes in the majority of cases. As expected given the rarity of recurrences, their study is based on small numbers, but this was also partly due to the high number of cases lost to follow-up (n=197) and that were non-compliant (n=132, 50.2% of those not lost to follow-up). The authors state that this drop-out rate did not depend on the patients' age, sex or tumour thickness and that this 'should be a subject for future research'. This will be of particular interest given the authors' conclusion that 'regular follow-up examinations are essential'.

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