European Journal of Cancer: Highlights of Issue 39:07

Calculating the risks of treating the elderly with cancer

Despite an increasingly ageing population, older patients with cancer are often not offered participation in clinical trials. This may be because the cellular and molecular mechanisms regulating the “process of ageing” are still far from understood. The relationship between ageing and the risk of cancer is also difficult to determine and inter-individual variations are difficult to quantify. In this issue, Repetto and colleagues review these problems and some of the recent advances such as the stratification of older patients that might require different clinical approaches through the use of the Comprehensive Geriatric Assessment. “Treatment guidelines are clearly needed”, they state, but the difficulty at present is the lack of available data from clinical trials to help in guiding the management and treatment of these older patients.

Chromosomal imbalances and resistance to fluoropyrimidines

As the underlying mechanisms for acquired resistance to fluoropyrimidines in colorectal cells have not yet been identified, Hidaka and colleagues have investigated the genomic changes that occur when comparing a parental human colorectal cancer cell line with cell lines resistant to 5-fluorouracil (5-FU) and 5-fluoro-2’-deoxyuridine (FdUrd). Using a Comparative Genomic Hybridisation analysis, losses of 3p and 3q were observed in both resistant cell lines, but not in the parental cell line. Both resistant cell lines also showed a reduced expression of OPRT, an enzyme involved in the activities of the bifunctional enzyme, uridine monophosphate (UMP) synthase, that is located on 3q13. An amplification of 18p11.2-p11.3 containing the thymidine synthase (TS) gene was also observed in the FdUrd-resistant cell line, but not in the other resistant or parental cell lines. They suggest that the chromosomal changes identified provide some indication of the potential mechanisms involved in acquired fluoropyrimidine resistance.

Increase in kidney cancer incidence and mortality in Northern England

Although kidney cancer is rare, its incidence and mortality are rising world-wide. Tate and colleagues examined the incidence and mortality rates for 8741 cases derived from data extracted from the population-based Northern and Yorkshire Cancer Registry. The cases were diagnosed between 1978 and 1997. The age-standardised incidence rate for renal parenchymal carcinoma increased by 86% over the time period studied. This increase was observed for all age groups. The authors speculate that although some of the increase may be due to improved diagnostics, aetiological causes- such as hypertension and obesity- are likely to be involved.

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