IN THIS ISSUE

Extract

Breast Cancer Survival and Aromatase Inhibitors

It is unclear whether treating breast cancer patients with aromatase inhibitors and inactivators offers a survival benefit compared with more traditional hormone therapies such as tamoxifen. Mauri et al. (p. 1285 ) performed a meta-analysis of randomized controlled trials that compared several generations of aromatase inhibitors and inactivators with standard hormone therapy in advanced breast cancer patients. They found statistically significant survival benefits with third-generation aromatase inhibitors and inactivators but not with earlier agents. The authors conclude that aromatase inhibition, particularly with third-generation drugs, may be associated with improved survival over hormonal treatments.

In an editorial, Van Poznak and Hayes (p. 1261 ) note that aromatase inhibitors may be the choice for endocrine-responsive metastatic breast cancer. Depleting estrogen in postmenopausal patients by aromatase inhibition is a step forward, they write, but there is much to learn.

Idiotype Vaccination in Follicular Lymphoma

Idiotype vaccination—injecting patients with a tumor-specific antigen to elicit an immune response against their tumor—has promise as a possible way to control lymphoma. To evaluate its clinical benefit, Inogès et al. (p. 1292 ) studied patients with follicular lymphoma whose disease had gone into remission after a first course of chemotherapy and then relapsed. The patients received chemotherapy a second time and, after achieving a second remission, were vaccinated periodically over more than 2 years with autologous lymphoma-derived idiotype protein vaccine. Of the 25 vaccinated patients, 20 showed an immune response to their vaccine. In the 18 patients with available data, the second remission was longer than the first. By contrast, all five nonresponding patients had a shorter second remission, as is typical in follicular lymphoma.