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      How I treat cancer special issue

      editorial
      1 , 2 ,
      ESMO Open
      BMJ Publishing Group
      cancer

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Within the 3 years of its existence, ESMO Open – Cancer Horizons has so far published a total of 330 articles dealing with all possible aspects of cancer and cancer care. These have included papers in the following areas: epidemiological studies1 2; access to cancer care3–7; the advent of biologicals and their broad use in the clinic8 9; various aspects of magnitude of clinical benefit achieved by the use of certain drugs10 11; biological considerations on the regulation of tumour growth12 13 and propagation14–16; clinical cutting-edge papers on the treatment of cancer in selected unfamiliar situations1 17–21; new treatment options either registered by the European Medicines Agency (which ESMO Open regularly publishes in its ‘EMA Corner’22) or a broader understanding of existing compounds23–28 in an abundance of various cancers29–35 and quality of life issues of cancer patients.3 36–42 These patient-oriented publications were complemented by aspects concerning the oncological profession.4 43 Further, a more profound understanding of challenging side effects was addressed in several articles.44–50 Thus, ESMO Open – Cancer Horizons has established itself as a reliable source of information on the very many aspects of cancer and cancer care published within it. This is corroborated by the high levels of engagement with the journal’s content. Since launch there have been 581 000 page views from 325 000 users around the world. In 2018, usage from the Americas exceeded that from Europe for the first time (125 000 views vs 108 000 views). The European Society for Medical Oncology (ESMO) importantly and regularly publishes and updates guidelines on the treatment of cancers.51–54 This series of guidelines has become very much rightly truly iconic in the oncological community. The current special issue of ESMO Open – Cancer Horizons is the result of a request we have sent out to key opinion leaders in various fields of cancer in which we have asked them to give a very succinct opinion on how they would treat cancer in a very special and circumscript situation related to predefined diagnosis. Thus, we have intended to present the oncological community with an endeavour which would encompass a series of ESMO’s attempts including the generation of guidelines,51 the results of the Magnitude of Clinical Benefit10 11 36 and personal considerations of key opinion leaders.55–58 We hope that these very short and succinct summaries will help you in your everyday care of patients with cancer who give the true meaning to all of our endeavours.

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          Most cited references53

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          Cardiotoxicity of immune checkpoint inhibitors

          Cardiac toxicity after conventional antineoplastic drugs (eg, anthracyclines) has historically been a relevant issue. In addition, targeted therapies and biological molecules can also induce cardiotoxicity. Immune checkpoint inhibitors are a novel class of anticancer drugs, distinct from targeted or tumour type-specific therapies. Cancer immunotherapy with immune checkpoint blockers (ie, monoclonal antibodies targeting cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed cell death 1 (PD-1) and its ligand (PD-L1)) has revolutionised the management of a wide variety of malignancies endowed with poor prognosis. These inhibitors unleash antitumour immunity, mediate cancer regression and improve the survival in a percentage of patients with different types of malignancies, but can also produce a wide spectrum of immune-related adverse events. Interestingly, PD-1 and PD-L1 are expressed in rodent and human cardiomyocytes, and early animal studies have demonstrated that CTLA-4 and PD-1 deletion can cause autoimmune myocarditis. Cardiac toxicity has largely been underestimated in recent reviews of toxicity of checkpoint inhibitors, but during the last years several cases of myocarditis and fatal heart failure have been reported in patients treated with checkpoint inhibitors alone and in combination. Here we describe the mechanisms of the most prominent checkpoint inhibitors, specifically ipilimumab (anti-CTLA-4, the godfather of checkpoint inhibitors) patient and monoclonal antibodies targeting PD-1 (eg, nivolumab, pembrolizumab) and PD-L1 (eg, atezolizumab). We also discuss what is known and what needs to be done about cardiotoxicity of checkpoint inhibitors in patients with cancer. Severe cardiovascular effects associated with checkpoint blockade introduce important issues for oncologists, cardiologists and immunologists.
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            Global cancer control: responding to the growing burden, rising costs and inequalities in access

            The cancer burden is rising globally, exerting significant strain on populations and health systems at all income levels. In May 2017, world governments made a commitment to further invest in cancer control as a public health priority, passing the World Health Assembly Resolution 70.12 on cancer prevention and control within an integrated approach. In this manuscript, the 2016 European Society for Medical Oncology Leadership Generation Programme participants propose a strategic framework that is in line with the 2017 WHO Cancer Resolution and consistent with the principle of universal health coverage, which ensures access to optimal cancer care for all people because health is a basic human right. The time for action is now to reduce barriers and provide the highest possible quality cancer care to everyone regardless of circumstance, precondition or geographic location. The national actions and the policy recommendations in this paper set forth the vision of its authors for the future of global cancer control at the national level, where the WHO Cancer Resolution must be implemented if we are to reduce the cancer burden, avoid unnecessary suffering and save as many lives as possible.
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              Targeting immune checkpoints in breast cancer: an update of early results

              The immune tumour microenvironment has been shown to play a crucial role in the development and progression of cancer. Expression of gene signatures, reflecting immune activation, and the presence of tumour-infiltrating lymphocytes were associated with favourable outcomes in HER2-positive and triple-negative breast cancer. Recently, immunotherapy with immune checkpoint blockade induced long-lasting responses and improved survival in hard-to-treat malignancies (ie, melanoma and non-small cell lung cancer) and are changing treatment paradigms in a variety of neoplastic diseases. Immune checkpoint blockade has been evaluated in breast cancer, particularly in the triple-negative subtype, with promising results observed in monotherapy or in combination with chemotherapy in the metastatic and neoadjuvant settings. However, identification of patients who are most likely to benefit from immune checkpoint blockade remains challenging, with many patients not responding to treatments and a significant financial cost. The combination of immune checkpoint blockade with conventional cancer treatments such as chemotherapy, radiotherapy, targeted therapies or with other immunotherapies is a promising strategy to potentiate its efficacy in breast cancer although further research is required to effectively identify who will respond to these immunotherapies. In this review we report the most recent results that emerged from trials testing immune checkpoint blockade and potential predictive biomarkers and emphasise the new strategies that are under clinical development in breast cancer.
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                Author and article information

                Journal
                ESMO Open
                ESMO Open
                esmoopen
                esmoopen
                ESMO Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7029
                2019
                1 May 2019
                : 4
                : Suppl 2
                : e000514
                Affiliations
                [1 ]departmentComprehensive Cancer Center , Medical University of Vienna , Vienna, Austria
                [2 ]Central European Cancer Center , Vienna, Austria
                Author notes
                [Correspondence to ] Professor Christoph C Zielinski; christoph.zielinski@ 123456meduniwien.ac.at
                Article
                esmoopen-2019-000514
                10.1136/esmoopen-2019-000514
                6555613
                fc774593-cbbe-4a07-9bec-15c4c044e2df
                © Author (s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, any changes made are indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 13 March 2019
                : 14 March 2019
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                Editorial
                1506
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                cancer
                cancer

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