This is a call to oncologists for action.

Cancer cases are growing in an exponential way, likewise the prices of new cancer drugs. Continuing in this way, in the near future, it will be impossible to provide optimum care for all cancer patients. Therefore, it is important to establish mechanisms that enable the National Health Systems to provide the best options of treatment, either through the elaboration of decision-binding frameworks or through other initiatives that guarantee the best quality care for all oncology patients to overcome, in the best possible way, this difficult illness. Here, we review current proposals that have been established by different cancer organizations worldwide, their similarities, their differences and whether they are helpful in a real clinical setting. Facing present reality and despite these organizations' huge efforts, these proposals are not being implemented at all and it does not seem feasible that they will in the short run. In the same way, we support and argue why oncologists should have a crucial and a preponderant role to establish the best way of guaranteeing an equal access to the latest oncology care.

Multicenter phase II study of oxaliplatin and sorafenib in advanced gastric adenocarcinoma after failure of cisplatin and fluoropyrimidine treatment. A GEMCAD study.

BACKGROUND: Cisplatin and fluoropyrimidine (CF) are standard first- line treatment in advanced gastric cancer, but no second-line treatment has yet been established. We present a phase II study in which we evaluated the efficacy and toxicity of the combination of Sorafenib (S), and Oxaliplatin as second-line therapy. METHODS: Patients with progressive gastric adenocarcinoma after CF- first-line, ECOG 0-2, and measurable disease were included. The primary objective was PFS. Treatment doses were Oxaliplatin 130 mg/m²/3 weeks and Sorafenib 800 mg/bid/d. RESULTS: We included 40 patients. CR was 2.5% and SD was 47.2%. Grade 3-4 toxic effects were neutropenia (9.8%), thrombocytopenia (7.3%), neurotoxicity (4.9%) and diarrhea (4.9%). Median PFS was 3 months (95%CI: 2.3-4.1) and median OS was 6.5 months (95% CI: 5.2-9.6). Time to progression (TTP) to first line therapy was a prognosis factor. Median OS was 9.7 months when time-to-progression during first-line chemotherapy was >6 months and 5.6 m when it was <6 months (p = 0.04). CONCLUSIONS: Time-to-progression under a CF-based first-line therapy determines subgroups of GC patients with different prognosis. The combination of Oxaliplatin-Sorafenib in advanced GC patients previously treated with CF appears safe, but our results do not support the implementation of a phase III trial.

Analysis of the elderly patient population in a tertiary-care university hospital.

A progressively ageing population and the high association between advanced age and cancer has resulted in an increased interest in the field of geriatric oncology with the objective being a more effective diagnosis and treatment of these patients. We performed an epidemiological analysis on an intent-to-treat of elderly population within our healthcare unit. This is a retrospective study of all patients attended in our Medical Oncology Department during the year 2002. A total 667 patients were assessed, 42% older than 70 years of age. The most frequent tumour sites were lung, colorectal and breast. The most frequent histology was adenocarcinoma. The diagnosis in advanced stages was significantly higher in older age group (76% vs. 59%). The use of symptom-control follow-up and palliative-care, compared with radio- and chemo-therapy, was higher in older age group. However, we observed no statistically significant differences with respect to inclusion in clinical trials. In conclusion, the elderly represents an important percentage of patients receiving cancer care. The distributions by sites and histology types are similar in both groups of age. Although the election of palliative treatment is more frequent in elderly population, the most frequently used treatments in both groups, were radiotherapy and chemotherapy. We didn't observe any significant differences about the inclusion in clinical trials.

Venous thromboembolic disease in cancer. Optimisation of the use of antithrombotic agents.

Venous thromoboembolism is one of the most common complications in cancer patients and may have serious consequences. At present, most clinical oncologists report using thromboprophylaxis in less than 5% of patients. One of the possible reasons for this limited use is the lack of oncology specific guidelines. In effect, while there are excellent guidelines for optimising the use of antithrombotic agents to prevent and treat thromboembolism, they must be adapted to the concrete context of cancer patients. The present review explores how different situations affect cancer patients and their risk of developing venous thromboembolism (VTE), and evaluates the situations in which antithrombotic agents should be administered to treat and prevent VTE.