European Journal of Cancer: Highlights of Issue 39:05

Battling with infection

Infections complicating chemotherapy - an Update

Despite all of the recent advances in anti-microbial therapy, bone marrow stem cell growth factors (G-CSF) and other kinds of supportive care, infection is still the most feared complication in oncology wards. Children are usually more at risk than adults because their treatments tend to be more intensive, but those treating adults with leukaemia and some other solid tumours have the same apprehensions. The Paediatric Update in this issue provides comprehensive coverage of the contemporary approach to the common kinds of “opportunistic” infection and also some rarer ones. A contrasting view of the same problems is provided in the Commentary by Dr. Anne Reilly from the “opposite side of the Atlantic”.

Incidence and mortality rates for prostate cancer in Southern Europe

The trends in incidence and mortality in France, Italy and Spain were examined in subjects from 1958-1997. The rates were also assessed in two age groups (40-69 years and 70 years and over) to see if there were any differences according to age. Data were obtained from the European Cancer Incidence and Mortality Database and the databank of the European Network of Cancer Registries. Incidence rates increased in most regions and the lowest rates were seen in Spain. Mortality- on the other hand- increased initially, then, more recently, decreased in France and Italy, but not in Spain. The authors suggest that “ the PSA test may have had a positive effect on mortality” although they acknowledge that other clinical factors have also probably contributed to the trends observed.

Properties of an ideal SERM?

The properties of an ideal SERM in the preventive setting for women with a high risk of breast cancer are outlined in this issue by Professor Powles. He examines the evidence for the chemopreventive effects of tamoxifen from previous trials. The risk factors of the patient will determine the benefit they will gain from endocrine preventive treatment. Professor Powles states that it should be possible with an ideal selective oestrogen receptor modulator (SERM) “to achieve multiple benefits on normal tissues and an enhanced anti-cancer effect compared with tamoxifen”. Indeed, other SERMs such as raloxifene are currently being compared with tamoxifen to see if they have a comparable efficacy without the side-effects of tamoxifen. Evidence for the use of anti-oestrogens- such as the aromatase inhibitors, anastrozole (Arimidex) and letrozole- in the treatment of women with breast cancer is also now available, but Professor Powles points out that this data is still immature and that long-term toxicity results are not yet available for these agents. They are also only effective for prevention in post-menopausal women. He suggests that a SERM with a better risk reduction than tamoxifen and reduced toxic side-effects -such as on the uterus- is likely to be a more promising agent than anti-oestrogenic drugs that may require “add-on” preventive treatments for their anti-oestrogenic complications. Dr. Powles concludes that future trials will need to be designed in a way to answer the fundamental question of whether “prevention is better than cure”.

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