European Journal of Cancer: Highlights of Issue 40:07

Predicting toxicity or response - no longer a roll of the dice?

Can DPD be used to predict toxicity or response?

Dr. van Kuilenburg asks this question in a Review published in this issue. He proposes that although the role of tumoral levels of dihydropyrimidine dehydrogenase (DPD) in predicting response is still unclear, there is ample evidence that a deficiency in DPD is associated with severe toxicity to 5-fluorouracil (5FU)-based chemotherapy. Data from the literature suggests that patients with a partial DPD deficiency have an increased risk of developing Grade IV neutropenia when compared with patients with a normal DPD activity, he said. Of the 39 mutations or polymorphisms identified in the DPD gene, the IVS14+1G>A mutation appears to be the most common and has been detected in approximately a quarter of all patients experiencing severe 5FU toxicity.

HER-2 receptor unlikely to be a target in osteosarcoma

The HER-2 receptor is an unlikely target in human osteosarcoma (OS) authors conclude in this issue. Anninga and colleagues examined HER-2 protein and mRNA expression in 15 biopsy and 18 resection samples from human OS. HER-2 mRNA expression was similar in all the samples to that of the negative control and only one sample had a moderately positive immunostain. "The monoclonal antibody trastuzumab (Herceptin), directed against the HER-2-receptor, is not likely to be an effective therapeutic agent in OS, they said. An accompanying Editorial by Dr. Ian Judson discusses this and other studies and comments "It is notable that there have still been no reports of positive clinical trials of trastuzumab in this disease".

Current best practice in the management of children with oral complications-an Update

Belfield and Dwyer provide an Update in this issue on the oral complications that can occur in children with cancer and the preventive interventions that are available. They conclude that there are few new treatments for children and that most newer interventions have not been widely used or studied in the paediatric population. Prevention remains the best treatment, they said. Dental evaluation at diagnosis and meticulous oral hygiene during oncotherapy will minimise complications and improve the quality of life of survivors. This area is further discussed in an accompanying Commentary by Drs. Lucas and Roberts.

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