An increasing elderly population, the spread of western-style diets, and increasing tobacco consumption means that the incidence of cancer continues to rise around the globe. Despite decades of intensive research and the huge expenditure of financial resources, a diagnosis of advanced disease in the vast majority of cancer types means shortened life expectancy. Improvements in treatment are still largely measured in terms of relatively small (in absolute terms) increments in median survival. Consequently the search continues for the elusive ‘cure for cancer’. Nonetheless the current outlook for cancer therapy is optimistic. A new era appears to have dawned in cancer management, with the aim of rendering it a chronic but ultimately manageable condition like diabetes or heart disease. Significant new ‘targeted’ cancer therapeutics have been added to the clinical armamentarium in recent years. These represent the successful translation of the rapidly increasing knowledge of the molecular biology of tumourigenesis, into drugs which make a meaningful difference to patients living with cancer. However, big challenges remain in this highly complex area of medicine.The failure of epidermal growth factor receptor inhibitors in the front-line treatment of non-small cell lung cancer raised questions on the optimal use of these agents. The identification of patients most likely to benefit from targeted therapy is critical: this ranges from the use of biomarkers to guide the clinical development process, through to the commercial availability of robust diagnostic and prognostic tools to select patients for optimal therapeutic benefit. A related challenge is the integration of a multiple-targeting approach into clinical practice. Solid tumours usually have a handful of key molecular abnormalities underlying the disease. Optimal treatment may therefore depend on tailoring targeted therapy to the specific molecular abnormalities present in individual patients, as well as learning how best to combine new agents with existing cytotoxics. In this supplement we have asked leading experts to review and comment on six areas of interest to the oncology community. Multiple myeloma (MM) is the second most prevalent haematological malignancy after non-Hodgkin’s lymphoma, accounting for approximately 10–15% of all haematological malignancies. Recent statistics indicate increasing incidence and earlier age of onset, and despite advances in treatment the disease is incurable. New insights into the biology of MM have produced drugs that target not only specific intracellular pathways but also the myeloma-bone marrow microenvironment. The regulatory approvals for Thalidomid® and Velcade® are important advances which broaden the options available to patients. Noopur Raje, Paul Richardson and Kenneth Andersen will discuss the latest status of available therapies in this area.

This Supplement Also Contains:

Foreword
Foreword - BTG Supplement
Russell Hagan
Senior Vice President and Head, Research and Development, BTG

Multiple Myeloma
Multiple Myeloma: A New Paradigm in Cancer Therapy
Noopur Raje
The Division of Hematology and Oncology, Massachusetts General Hospital Paul Richardson
The Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
Kenneth C Anderson
The Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA

Chronic Lymphocytic Leukaemia
Treatment Strategies for Chronic Lymphocytic Leukaemia
Tapan Kadia
Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston,Texas
Elias Jabbour
Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston,Texas
Susan O’Brien
Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston,Texas

Oncology Biomarkers
Evaluating Biomarkers as Surrogates for Cytostatics: The Clinical Reality
Bill Gullick
Professor of Cancer Biology, University of Kent

Ovarian Cancer
Ovarian Cancer in Relapse: Medical Management Approaches
Eric Pujade-Lauraine
Département d’Hématologie et d’Oncologie Médicale, Hôpital Hôtel-Dieu, Paris, France and Centre Léon Bérard, Lyon, France
Jean-Paul Guastalla
Département d’Hématologie et d’Oncologie Médicale, Hôpital Hôtel-Dieu, Paris, France and Centre Léon Bérard, Lyon, France

Gastric Cancer
New Treatments for Advanced Gastric Cancer
Naureen Starling
1.Clinical Research Fellow
David Cunningham
Head of the Gastrointestinal and Lymphoma Units, Royal Marsden Hospital

Prostate Cancer
Prostate Cancer Therapy: Progress and Future Trends
Karol Sikora
Professor of Cancer Medicine, Imperial College and Scientific Director, Medical Solutions Plc

Chronic lymphocytic leukaemia (CLL) is the most common type of leukaemia in the Western world. It accounts for approximately 30% of all leukaemias, and mainly affects elderly people. It follows a highly variable clinical course: patients may succumb within a short time after diagnosis, or remain asymptomatic for many years. Prognostic factors summarised in the well established Binet and Rai clinical staging systems have, in recent years, been supplemented with important new biological parameters. Mutation status in the IgVH (immunoglobulin variable heavy chain) gene is a predictor of clinical outcome. Surrogate markers for VH status have been identified (e.g. ZAP-70), to enable routine laboratory assessment. Assessment of a patient’s individual risk is very important when determining the best treatment option.A number of drugs are effective (though not curative) in CLL, either as single agents or in combination regimens, and they are reviewed by Susan O’Brien and her colleagues from the MD Anderson Cancer Center in the US.