European Journal of Cancer: Highlights of Issue 37:17

The role of interferon-alpha in malignant melanoma - a current perspective

In this issue, Alexander Eggermont reviews the current evidence for the use of the pleiotropic cytokine interferon-alpha (IFN-a) in the treatment of malignant melanoma. He states that despite overall response rates of 10-15% when used for the treatment of stage IV metastatic melanoma patients, IFN-a has been widely used in the adjuvant setting for patients with stage II-III disease. He discusses the results from these trials that have been limited by their lack of statistical power, heterogenous patient populations and differing treatments and schedules. He concludes that 'the role for IFN-a remains to be defined' and that 'a change of paradigm such as exploring the anti-angiogenic activities in non-toxic long-term treatments' may be required.

Recent declines in mortality from cancer in Catalonia, Spain (1975-1998)

Fernandez and colleagues have examined the mortality rates from cancer in Catalonia, Spain between 1975 and 1998. Using data from the Mortality registry of Catalonia, both age-standardised mortality rates and joinpoint regression models were calculated. Both male and female overall mortality rates have declined since 1991, in agreement with the trends seen in Europe and the USA. The authors have suggested that this is predominantly due to decreases in tobacco-related cancer deaths in men and in the female breast cancer rates, as well as the recent levelling off of colorectal cancer rates in both sexes. The authors propose that these decreases are likely to be, at least partly, explained by the decreased number of male smokers, the earlier detection of breast cancers following the implementation of screening and increased public awareness and improved treatments. Thus, the time between diagnosis and death will be increased and more people will die from competing causes rather than from their cancer. Worryingly, women showed an upward trend in smoking-related cancers between 1981-1998 of 0.5% (annual percent change). Furthermore, lung cancers increased since 1988 by 2.1% (annual percent change) and are now the third leading cause of cancer in women (4.4/100 000) after breast (16.8/100 0000) and colorectal cancers (11.1/100 000). The authors states that this 'smoking epidemic (in women) and its impact on incidence and mortality will be a major health problem in our country in the near future'.

EGFR - a prognostic factor for unresectable pharyngeal cancer patients treated by chemoradiotherapy

The prognosis for patients with unresectable head and neck cancers is still relatively poor with approximately 35-55% 3-year survival rates reported for those treated by chemoradiotherapy. In this issue, Magne and colleagues examine the prognostic value of the level of the epidermal growth factor receptor (EGFR) in 77 tumours from unresectable pharyngeal cancer patients (median age 56 years). The study had the advantage of including a relatively homogenous population of patients since all had stage IV tumours and were treated with the same chemoradiotherapy regimen (twice daily radiotherapy with concomitant cisplatin-5-fluorouracil). Multivariate analysis determined Karnofsky index and the EGFR level as significant independent predictors of the length of the time to progression (TTP) and overall survival (OS). The EGFR level did not predict for response to treatment. However, all of the complete responders who had an EGFR expression in the lowest quartile (< 35 fmol/mg protein) were alive at 3 years, whereas only 13% were alive in the subgroup of complete responders with EGFR expression levels in the highest quartile (> 275fmol/mg protein). The authors propose that EGFR is a 'powerful prognostic parameter in unresectable pharyngeal cancer patients treated by concomitant chemo-radiotherapy'.

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