Burden of illness for metastatic melanoma in Canada, 2011-2013.

BACKGROUND: Detailed epidemiology for patients with advanced metastatic melanoma in Canada is not well characterized. We conducted an analysis of patients with this disease in the province of Ontario, with the aim being to study the presentation, disease characteristics and course, and treatment patterns for malignant melanoma. METHODS: In this Canadian observational prospective and retrospective study of patients with malignant melanoma, we used data collected in the Canadian Melanoma Research Network (cmrn) Patient Registry. We identified patients who were seen at 1 of 3 cancer treatment centres between April 2011 and 30 April 2013. Patient data from 2011 and 2012 were collected retrospectively using chart records and existing registry data. Starting January 2013, data were collected prospectively. Variables investigated included age, sex, initial stage, histology, mutation type, time to recurrence, sites of metastases, resectability, and previous therapies. RESULTS: A cohort of 810 patients with melanoma was identified from the cmrn registry. Mean age was 58.7 years, and most patients were men (60% vs. 40%). Factors affecting survival included unresectable or metastatic melanoma, initial stage at diagnosis, presence of brain metastasis, and BRAF mutation status. The proportion of surviving patients decreased with higher initial disease stages. CONCLUSIONS: Using registry data, we were able to determine the detailed epidemiology of patients with melanoma in the Canadian province of Ontario, validating the comprehensive and detailed information that can be obtained from registry data.

Angiogenesis as a target for breast cancer therapy.

Angiogenesis, the development of new blood vessels, is crucial for the growth of both primary tumors and metastases beyond a minimal size and the vasculature of tumors facilitates their metastatic spread. Inhibition of angiogenesis is thus seen as a potentially useful approach to anti-metastasis therapy, and is an area of active research and development. Here we discuss this therapeutic approach in the context of breast cancer. An overview of the contribution of angiogenesis to tumor development is provided and current treatment options for breast cancer are briefly summarized. Assessment of angiogenesis in primary breast tumors has been shown to provide independent prognostic information. There are opportunities for the application of anti-angiogenesis therapeutic strategies in the treatment of breast cancer. Clinical trial design must take into account the unique properties of anti-angiogenic agents to fully assess their potential clinical benefit.

Molecular biology of breast cancer metastasis. Clinical implications of experimental studies on metastatic inefficiency.

Recent technological advances have led to an increasing ability to detect isolated tumour cells and groups of tumour cells in patients' blood, lymph nodes or bone marrow. However, the clinical significance of these cells is unclear. Should they be considered as evidence of metastasis, necessitating aggressive treatment, or are they in some cases unrelated to clinical outcome? Quantitative experimental studies on the basic biology of metastatic inefficiency are providing clues that may help in understanding the significance of these cells. This understanding will be of use in guiding clinical studies to assess the significance of isolated tumour cells and micrometastases in cancer patients.