Hypofractionated Radiation for Low Risk Prostate Cancer Saves Time and Money

MedicalResearch.com Interview with:

Deborah Watkins Bruner RN, PhD, FAAN Senior Vice President of Research Emory University Professor and Robert W. Woodruff Chair in Nursing Nell Hodgson Woodruff School of Nursing Professor, Department of Radiation Oncology Emory University School of Medicine

Dr. Bruner

Deborah Watkins Bruner RN, PhD, FAAN
Senior Vice President of Research
Emory University
Professor and Robert W. Woodruff Chair in Nursing
Nell Hodgson Woodruff School of Nursing
Professor, Department of Radiation Oncology
Emory University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: In a randomized clinical trial entitled, “Quality of Life in Patients With Low-Risk Prostate Cancer Treated With Hypofractionated vs Conventional Radiotherapy” the NRG Oncology Group previously demonstrated that men with low risk prostate cancer had  similar 5-year disease- free survival of about 85%  when treated with either conventional radiotherapy  (C-RT) of 73.8 Gy in 41 fractions over 8.2 weeks, or with  hypofractionated radiotherapy (H-RT) of 70 Gy in 28 fractions over 5.6  weeks. However, late physician reported side effects of mild bowel and bladder symptoms were increased in patients treated  with H-RT and raised questions if the H-RT arm is acceptable to patients.

The current study asked the patient’s directly about their bowel, bladder, sexual function, anxiety, depression and general quality of life using valid patient reported questionnaires. These questionnaires have been found to be more accurate for reporting patient symptoms than physician report alone.

Continue reading

Hepatitis C: Study finds Direct Acting Antivirals Reduce Mortality and Liver Cancer

MedicalResearch.com Interview with:

Prof-Fabrice Carrat

Prof. Carrat,

Prof. Fabrice Carrat, MD, PhD
Institut Pierre Louis d’Épidémiologie et de Santé Publique,
Paris, France

MedicalResearch.com: What is the background for this study?  

Response: Most studies on direct acting antivirals were focused on sustained vriological response (SVR) rates, but few studies addressed the issue of clinical outcomes.

 

MedicalResearch.com: What are the main findings?

Response: Treatment of hepatitis C with direct acting antivirals (DAA) is associated with reduced risk of mortality and liver cancer. 

MedicalResearch.com: What should readers take away from your report?

Response: This suggests that direct acting antivirals should be considered for all patients with chronic hepatitis C infection.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Follow-up of cohort participants will continue to assess the long term impact of DAA on clinical outcomes, namely: decompensated cirrhosis (in patients with cirrhosis); residual risk of hepatocellular carcinoma, regression of  liver fibrosis and morbidity not related to the liver (particulary cardiovascular events). 

Disclosures: The study was sponsored by ANRS_INSERM  

Citation:

Fabrice Carrat, Hélène Fontaine, Céline Dorival, Mélanie Simony, Alpha Diallo, Christophe Hezode, Victor De Ledinghen, Dominique Larrey, Georges Haour, Jean-Pierre Bronowicki, Fabien Zoulim, Tarik Asselah, Patrick Marcellin, Dominique Thabut, Vincent Leroy, Albert Tran, François Habersetzer, Didier Samuel, Dominique Guyader, Olivier Chazouilleres, Philippe Mathurin, Sophie Metivier, Laurent Alric, Ghassan Riachi, Jérôme Gournay, Armand Abergel, Paul Cales, Nathalie Ganne, Véronique Loustaud-Ratti, Louis D’Alteroche, Xavier Causse, Claire Geist, Anne Minello, Isabelle Rosa, Moana Gelu-Simeon, Isabelle Portal, François Raffi, Marc Bourliere, Stanislas Pol. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. The Lancet, 2019; DOI: 10.1016/S0140-6736(18)32111-1

 

 

 

 

Feb 14, 2019 @ 1:02 pm

 

 

 

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HPV Testing for Primary Cervical Cancer Screening

MedicalResearch.com Interview with:

Matejka Rebolj, PhD King’s College London, London, UK

Dr. Rebolj

Matejka Rebolj, PhD
King’s College London, London, UK

Henry Kitchener, MD FRCOG FRCS University of Manchester, Manchester, UK

Dr. Kitchener

 

Professor Henry Kitchener, MD FRCOG FRCS
University of Manchester, Manchester, UK

 

MedicalResearch.com: What is the background for this study?

Response: We now have reliable and affordable technologies to detect human papillomavirus (HPV), a virus which is universally accepted as the cause of cervical cancer. Various large trials confirmed that cervical screening could be improved by replacing the smear (cytology) test that has been in use for decades, with HPV testing. Many countries are now making the switch. In England, this is planned for the end of 2019. To test how to run HPV testing within the English National Health Service, a pilot was initiated in 2013 in six screening laboratories. We also wanted to determine whether the encouraging findings from the trials could be translated to everyday practice. This is important not only because we will be using different HPV tests, but also because women undergoing screening in trials are much more selected than those who are invited to population-based screening.  Continue reading

Stereotactic Radiation Can Condense Treatment Times For Prostate Cancer

MedicalResearch.com Interview with:

Amar U. Kishan, MD Assistant Professor Department of Radiation Oncology University of California, Los Angeles

Dr. Kishan

Amar U. Kishan, MD
Assistant Professor
Department of Radiation Oncology
University of California, Los Angeles

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Typical external beam radiation courses range up to 8-9 weeks in length (39-45 treatments). There are data that shorter courses, delivering a higher dose per day, may be just as effective.

Stereotactic body radiotherapy (SBRT) really pushes this concept by condensing the treatment to just four to five treatments, with a high dose per day.

Here, we present the pooled results of the outcomes of 2142 men with low and intermediate risk prostate cancer and a median of 6.9 years of followup.

We demonstrate a very favorable efficacy and safety profile. Specifically, the rates of recurrences were 4.5% and 10.2% for low and intermediate risk disease at 7 years, and rates of late severe toxicity were 2.4% for urinary toxicity and 0.4% for gastrointestinal toxicity.

Continue reading

Radiomics Plus Machine Learning Can Optimize Prostate Cancer Classification

MedicalResearch.com Interview with:

Gaurav Pandey, Ph.D. Assistant Professor Department of Genetics and Genomic Sciences Icahn Institute of Data Science and Genomic Technology Icahn School of Medicine at Mount Sinai, New York 

Dr. Pandey

Gaurav Pandey, Ph.D.
Assistant Professor
Department of Genetics and Genomic Sciences
Icahn Institute of Data Science and Genomic Technology
Icahn School of Medicine at Mount Sinai, New York 

MedicalResearch.com: What is the background for this study?

 Response: Multiparametric magnetic resonance imaging (mpMRI) has become increasingly important for the clinical assessment of prostate cancer (PCa), most routinely through PI-RADS v2, but its interpretation is generally variable due to its relatively subjective nature.

Radiomics, a methodology that can analyze a large number of features of images that are difficult to study solely by visual assessment, combined with machine learning methods have shown potential for improving the accuracy and objectivity of mpMRI-based prostate cancer assessment. However, previous studies in this direction are generally limited to a small number of classification methods, evaluation using the AUC score only, and a non-rigorous assessment of all possible combinations of radiomics and machine learning methods. Continue reading

Veyonda Enhanced Benefit of Radiation Therapy in Metastatic Prostate Cancer Trial

MedicalResearch.com Interview with:

Graham Kelly, BSc (Vet) (Hons, BVSc (Hons), PhD Managing Director and Chief Executive Officer Noxopharm 

Dr. Kelly

Graham Kelly, BSc (Vet) (Hons, BVSc (Hons), PhD
Managing Director and Chief Executive Officer
Noxopharm 

MedicalResearch.com: What is the background for this announcement? What are the main findings?

Response: Veyonda is an experimental drug being developed as a means of enhancing the anti-cancer effect of radiotherapy. The Phase 1b DARRT-1 study is assessing the ability of Veyonda to boost a palliative dose of external beam radiotherapy (EBRT) applied to a single lesion, to result in a systemic response in non-irradiated lesions (known as an abscopal response) in men with metastatic, end-stage prostate cancer. The aim is to provide at the least better palliation, and at best a survival advantage. The reported data concerns the study’s initial dose-finding arm involving three different dosages of Veyonda. This arm involves 12 subjects and the report concerns their clinical status at 12-weeks post-irradiation. The data provide clinical evidence of an abscopal effect in at least half of the eight subjects receiving the two highest Veyonda dosages and demonstrate that the combination of Veyonda and palliative radiotherapy was well-tolerated. The 1200 mg dosage was confirmed as the therapeutic dose.

Continue reading

Kidney Transplant Patients at Increased Risk of Skin Cancer, Even After Graft Stops Working

MedicalResearch.com Interview with
"Kidney Model 9" by GreenFlames09 is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Donal JSextonMD, PhD
Department of Nephrology and Kidney Transplantation
Beaumont Hospital
Royal College of Surgeons in Ireland
Dublin, Ireland

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Patients who receive a kidney transplant as treatment for end stage kidney disease are at risk of malignancy due to immunosuppression. In contrast to

other solid organ transplant types, when kidney transplants fail it is possible for recipients to return to dialysis. Immunosuppression is usually reduced or completely stopped when  the allograft fails due to the risk of infection on dialysis.

We decided to investigate what the trajectory of risk for non-melanoma skin cancer and invasive cancers overall (composite group) looked like for patients who have received multiple consecutive kidney transplants with intervening periods of graft failure. We compared cancer risk during periods of allograft failure and periods of functioning kidney transplants.   Continue reading

Melanoma Rates Stable in Australia but Rising in US

MedicalResearch.com Interview with:

Melanoma CDC/ Carl Washington, M.D., Emory Univ. School of Medicine; Mona Saraiya, MD, MPH

Example of one type of melanoma

Dr. Catherine M. Olsen
Associate Professor
Cancer Control Group
QIMR Berghofer Medical Research Institute

MedicalResearch.com: What is the background for this study?

Response: Melanoma incidence and mortality rates are increasing globally. Public health campaigns aiming to reduce sun exposure and use of sunbed have been implemented in many parts of the world, but there is significant variability in terms of the history and reach of these campaigns across countries. We examined melanoma incidence rates in eight different countries with different patterns of sun exposure and varying approaches to melanoma control.

Continue reading

Transparency and Technology Reduced Racial Disparities in Early Lung Cancer Treatment

MedicalResearch.com Interview with:

Samuel Cykert, MD Professor of Medicine and Director of the Program on Health and Clinical Informatics UNC School of Medicine, and Associate Director for Medical Education, NC AHEC Program Chapel Hill, NC

Dr. Cykert

Samuel Cykert, MD
Professor of Medicine and Director of the Program on Health and Clinical Informatics
UNC School of Medicine, and
Associate Director for Medical Education, NC AHEC Program
Chapel Hill, NC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Reports going as far back as the early 1990’s through reports published very recently show that Black patients with early stage, curable lung cancer are not treated with aggressive, curative treatments as often as White patients. These type of results have been shown in other cancers also. It’s particularly important for lung cancer because over 90% of these patients are  dead within 4 years if left untreated. In 2010, our group published a study in the Journal of the American Medical Association that showed that Black patients who had poor perceptions of communication (with their provider), who did not understand their prognosis with vs. without treatment, and who did not have a regular source of care ( a primary care doctor) were much less likely to get curative surgery. Also our results suggested that physicians who treated lung cancer seemed less willing to take the risk of aggressive treatments in treating Black patients (who they did not identify with as well) who had other significant illnesses.

Because of the persisting disparities and our 2010 findings, we worked with a community group, the Greensboro Health Disparities Collaborative to consider potential solutions.  As these omissions were not overt or intentional because of race on the part of the patients or doctors, we came up with the idea that we needed transparency to shine light on treatment that wasn’t progressing and better communication to ensure that patients were deciding on good information and not acting on mistrust or false beliefs.  We also felt the need for accountability – the care teams needed to know how things were going with patients and they needed to know this according to race. To meet these specifications, we designed a system that received data from electronic health records about patients’ scheduled appointments and procedures. If a patient missed an appointment this umbrella system triggered a warning. When a warning was triggered, a nurse navigator trained specially on communication issues, re-engaged the patient to bring him/her back into care. In the system, we also programmed the timing of expected milestones in care, and if these treatment milestones were not reached in the designated time frame, a physician leader would re-engage the clinical team to consider the care options.

Using this system that combined transparency through technology, essentially our real time warning registry, and humans who were accountable for the triggered warnings, care improved for both Black and White patients and the treatment disparity for Black patients was dramatically reduced. In terms of the numbers, at baseline, before the intervention, 79% of White patients completed treatment compared to 69% of Black patients. For the group who received the intervention, the rate of completed treatment for White patients was 95% and for Black patients 96.5%.  Continue reading

Study Evaluates Thyroid Hormone Suppression For High Risk Thyroid Cancer

MedicalResearch.com Interview with:

Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc. Assistant Clinical Investigator/Assistant Professor Metabolic Disease Branch/NIDDK/NIH Bethesda, MD

Dr. Klubo-Gwiezdzinska

Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc.
Assistant Clinical Investigator/Assistant Professor
Metabolic Disease Branch/NIDDK/NIH
Bethesda, MD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: People with intermediate- and high-risk differentiated thyroid cancer (DTC) are treated with surgical removal of the thyroid gland and radioactive iodine therapy.  After surgery and initial treatment, the thyroid hormone levothyroxine is used for long-term management not only to replace appropriate physiologic thyroid hormones post-surgery, but also to suppress thyrotropin (TSH) release from the pituitary gland at supraphysiologic doses.

The current recommended American Thyroid Association TSH suppression goal in patients with a high-risk differentiated thyroid cancer presenting with distant metastases is less than 0.1mIU/ml, and between 0.1-0.5 mIU/ml for patients with intermediate-risk DTC presenting with local metastases to the neck lymph nodes. This TSH goal is much lower than physiologic TSH level, which ranges between 0.4-4.1 mIU/ml, depending on the measurement method and person’s age.

TSH suppression is used because some preclinical evidence suggests that TSH can stimulate growth of cancer cells.  However, several preclinical studies show that thyroid hormones may also stimulate cancer growth. In addition, too much levothyroxine, leading to TSH suppression, may cause side effects such as abnormal heart rhythms and decreased bone mass.

In this study, based on a large multicenter database analysis, we found that continuous TSH suppression with levothyroxine was not associated with better progression-free survival and overall survival in patients with either intermediate- and high-risk differentiated thyroid cancer. The patients were followed for an average of 7 years after surgical thyroid cancer removal and radioactive iodine therapy.  Continue reading

Younger Generations at Much Higher Risk of Obesity Related Cancers

MedicalResearch.com Interview with:

Hyuna Sung, PHD Principal Scientist, Surveillance Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 

Dr. Sung

Hyuna Sung, PHD
Principal Scientist, Surveillance Research
American Cancer Society, Inc.
250 Williams St.
Atlanta, GA 30303 

MedicalResearch.com: What is the background for this study?

Response: This project was motivated by our previous finding on the rise of colorectal cancer among young adults before age 55. Changes in cancer trends among young age group have significant implications because the newly introduced carcinogenic agents are likely to affect trends among young people before they affect those among older people. Owing to this relationship, cancer trends among young people can be often considered as a bellwether for future disease burden. Given the dramatic increase of the obesity prevalence during 3-4 decades in the US, we wanted to expand the colorectal cancer finding to the more comprehensive list of cancers and explain them in the context of obesity epidemic.

Continue reading

Antioxidants May Enhance Efficacy of Chemotherapy on Glioblastoma

MedicalResearch.com Interview with:

Dr. Scott Litofsky, MD  Division of Neurological Surgery University of Missouri-Columbia School of Medicine Columbia, MO 65212 

Dr. Litofsky

Dr. Scott Litofsky, MD
Division of Neurological Surgery
University of Missouri-Columbia School of Medicine
Columbia, MO 65212 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many patients take over-the-counter medications to held their cancers. Some of these remedies may be helpful; others are potentially harmful. Anti-oxidant medications are frequently selected by patients as they are inexpensive and available.

We were approached by a high school student, Macy Williams (one of the authors) to do some research in our laboratory when she won a research scholarship (the 2016 Emperor Science Award) from Stand Up to Cancer. She worked with us several times per week doing experiments during her senior year of high school. When she graduated, we continued the work that she started.

We studied effects of Vitamin D3, Melatonin, and alpha-Lipoic Acid on glioblastoma cells, a highly malignant brain tumor. We included experiments of these agents alone and in combination with Temozolomide, a chemotherapy agent used as standard of care in glioblastoma. The work was done in cultured cells, measuring growth and survival of cells. We used concentrations that could be achieved by oral intake of the drugs.

We found that antioxidant medications, particularly alpha Lipoic Acid, had synergistic effects with Temozolomide – that is Temozolomide impair glioblastoma cell growth and survival better when combined with an antioxidant. The mechanism of action may be through reactive oxygen species.  Continue reading

Female Radiation Oncologists Less Likely to Receive Industry Payments

MedicalResearch.com Interview with:

Dr. Ann Raldow MD MPH Assistant Professor Department of Radiation Oncology David Geffen School of Medicine UCLA

Dr. Raldow

Dr. Ann Raldow MD MPH
Assistant Professor
Department of Radiation Oncology
David Geffen School of Medicine
UCLA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Similar to women in other historically male-dominated fields, female radiation oncologists face unique obstacles in achieving many metrics of career success, including equal salary, research funding, and academic promotion. Our study of industry payments found that female radiation oncologists were less likely than their male colleagues to receive payments from industry and that these payments tended to be of smaller monetary value.

Continue reading

Self Sampling for Cervical HPV: Useful Screening Tool

MedicalResearch.com Interview with:

Prof. J. (Hans) Berkhof PhD Vrije Universiteit Amsterdam 

Prof. Berkhof

Prof. J. (Hans) Berkhof PhD
Vrije Universiteit
Amsterdam 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In most countries, the Pap test is used for cervical cancer screening but recently several countries have switched from Pap testing to HPV testing.

Like the Pap test, the HPV test requires a cervical sample to be taken by a clinician. Vaginal self-sampling is also used, but only in underscreened women. We know that self-sampling increases screening participation in underscreened women and it is likely that many women that attend screening also prefer self-sampling if it had been offered to them.

We studied whether an HPV self-sampling test is an accurate alternative to a regular HPV test in women invited for routine screening. We randomized about 14,000 women, invited for screening, to self-sampling or clinician-sampling. Women with a positive HPV test result also received the other HPV test.

We found that the HPV self-sampling test yielded similar performance as the regular HPV test for detection of cervical pre-cancerous lesions (CIN3 and CIN2).  Continue reading

Risk Factors for Kidney Cancer Identified

MedicalResearch.com Interview with:

Brian R. Lane MD PhD Division of Urology Spectrum Health Grand Rapids, Michigan

Dr. Lane

Brian R. Lane MD PhD
Division of Urology
Spectrum Health
Grand Rapids, Michigan

MedicalResearch.com: Can you explain how you conducted your study, and what the main findings were?

Response:  We used large-scale genome-wide association studies (GWAS) to identify genetic variants associated with obesity measures, blood pressure, lipids, type 2 diabetes, insulin, and glucose. these genetic variants were used as proxies for the above-mentioned risk factors and evaluated in relation to renal cell carcinoma risk (kidney cancer) using GWAS data from 10,000 RCC patients and 20,000 control participants.

–          Based on these genetic data, we found that multiple measures of obesity, as well as diastolic blood pressure (DBP) and fasting insulin, are associated with renal cell carcinoma risk. In contrast, we found little evidence for an association with RCC risk for systolic blood pressure (SBP), circulating lipids, overall diabetes, or fasting glucose.  Continue reading

Breast Cancer Survivors More Likely To Develop Subsequent Blood Cancers

MedicalResearch.com Interview with:
medicalresearch.comDr. Marie Joelle Jabagi, PharmD, MPH

University of Paris Sud, Paris-Saclay University, Paris
Health Product Epidemiology Department
French National Agency for Medicines and Health Products Safety
Saint-Denis, France

MedicalResearch.com: What is the background for this study?

Response: Secondary hematologic malignant neoplasms that develop months or years after the diagnosis of breast cancer may be a consequence of genetic predisposition, environmental factors, previous cancer treatments or a combination of all those factors. These secondary malignant neoplasms are increasingly becoming a concern given that the population of breast cancer survivors is growing substantially. However, their frequency in real life has been poorly investigated to date.

The aims of our research were to estimate the frequency of various types of hematologic malignant neoplasm following a diagnosis of primary breast cancer among women aged 20 to 85 years in France during the past decade, and to compare it to the corresponding frequency in women of the French general population.

Continue reading

Younger Cancer Survivors Face Greater Financial Burdens

MedicalResearch.com Interview with:

Zhiyuan "Jason" Zheng PhD Director, Economics and Healthcare Delivery Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Zheng

Zhiyuan “Jason” Zheng PhD
Director, Economics and Healthcare Delivery Research
American Cancer Society, Inc.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Historically, the cost of healthcare can be a substantial burden for cancer survivors and their families in the US. Even with health insurance, a cancer diagnosis can impose significant out-of-pocket costs for medical care.  These are partially due to the rising costs of cancer treatments in recent years, moreover, the increasing levels of coinsurance, copayments, and deductibles also shift a significant portion of the burden to cancer patients.

We found that younger cancer survivors, those aged 18-49 years, bear a higher burden than their older counterparts. We also found that two-thirds of cancer survivors enrolled in high-deductible health plans did not have health savings accounts, and they are more vulnerable to financial hardship than those in high-deductible health plans with health savings accounts and those covered by low-deductible plans.

These findings are important to patients because although cancer patents have benefited from newer and more advanced treatments, financial hardship may lead to emotional distress, cause changes in health behaviors, and jeopardize treatment adherence and health outcomes. 

Continue reading

First Patient Dosed in Phase 3 AGENT Study for Metastatic Colorectal Cancer

MedicalResearch.com interview with:

Anders Rabbe CEO of Isofol Medical

Anders Rabbe

Anders Rabbe
CEO of Isofol Medical

MedicalResearch.com: What is the background for this study? How common is colorectal cancer? 

Response: Colorectal cancer (CRC) is one of the most common forms of cancer with more than 1.8 million new cases identified globally every year. Due to a lack of new therapeutic options and a high mortality rate, colorectal cancer is a disease with a significant unmet need for effective new treatments.

Isofol is developing arfolitixorin (Modufolin®) to improve the efficacy of standard of care chemotherapy for advanced colorectal cancer. Arfolitixorin is the company’s proprietary drug candidate currently being studied in a global Phase 3 AGENT study (ISO-CC-007) as a first-line treatment for patients with metastatic colorectal cancer (mCRC), which just enrolled its first patient in December of 2018. Continue reading

Esophageal Cancer: HMIE Procedure Reduces Morbidity Without Sacrificing Efficacy

MedicalResearch.com Interview with:

Guillaume Piessen, MD, PhD University Hospital Centre Lille, France

Prof. Piessen

Guillaume Piessen, MD, PhD
University Hospital Centre
Lille, Franc

MedicalResearch.com: What is the background for this study?

Response: Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagectomy (HMIE) with a combined laparoscopy+thoracotomy procedure compared to an open esophagectomy (OE), according to results of the MIRO trial published in the last issue of the New England Journal Of Medicine (link article).

This French prospective multi-center randomized controlled study was funded by the French National Cancer Institute (Grant n° 1907). The study was conducted by Pr Mariette who sadely passed away in 2017 and Pr Piessen (Department of Digestive and Oncological Surgery, CHU Lille), under the hauspice of FRENCH (Fédération de Recherche EN Chirurgie) and FREGAT (French Eso-Gastric Tumors) working group (https://www.fregat-database.org/fr/).

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer.

Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].

Continue reading

WHO: Profits Outweigh R&D Costs of New Cancer Drugs

MedicalResearch.com Interview with:

Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland

Dr. Kiu Tay-Teo

Kiu Tay-Teo, PhD
World Health Organization
Geneva, Switzerland

MedicalResearch.com: What are the main findings?

Response: High costs and high risks of R&D for drugs have been presented to justify high drug prices, especially for cancer drugs. However, it is unclear whether prices are in fact justifiable compared to the overall return on R&D investment.

In this paper, we systematically compared incomes from the sales of cancer drugs with the R&D costs. We quantified the incomes generated from the sales of 99 cancer drugs approved by FDA from 1989–2017. This was based on sales figures reported in the originator companies’ annual financial reports, and where necessary, estimates deduced from the reported figures. The sales incomes were net of rebates and discounts, but without accounting for expenses and taxes. For the R&D costs of bringing one new cancer drug to the market, the literature reported a typical costs of between $219 million and $2.9 billion, after accounting for the costs of failed products that were investigated but not marketed and the opportunity costs. For the main analysis, we used a median cost of $794 million, as reported in the literature. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs.

Continue reading

What Causes ‘Chemo Brain’ in Women?

MedicalResearch.com Interview with:

Nicole J. Gervais, Ph.D. Postdoctoral fellow | Einstein lab University of Toronto, Department of Psychology Toronto, ON

Dr. Gervais

Nicole J. Gervais, Ph.D.
Postdoctoral fellow | Einstein lab
University of Toronto, Department of Psychology
Toronto, ON 

MedicalResearch.com: What is the background for this study?  

Response: Aromatase inhibitors (AIs) including letrozole are given as an adjuvant therapy for postmenopausal women with hormone receptor positive breast cancer. Women taking this drug have reported a number of symptoms including hot flashes, memory complaints and mood changes. However, not all studies report memory issues. This might be due to the fact that studies in this population are hampered by confounds, such as chemotherapy/radiotherapy, stress and disease stage, all of which can also adversely impact memory. These confounds make it challenging to observe the independent effects of AIs on memory. By using a non-human primate model, we were able to examine the effects of aromatase inhibition on these symptoms as well as brain function without these confounding effects.

Continue reading

Cancers Attributable to Obesity Vary by State

MedicalResearch.com Interview with:

Farhad Islami, MD PhD Scientific Director, Surveillance Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Islami

Farhad Islami, MD PhD
Scientific Director, Surveillance Research
American Cancer Society, Inc.
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?

Response: Despite variations in excess body weight (EBW) prevalence among states in the United States, there was little information on the proportion of incident cancers attributable to EBW (or population attributable fraction, PAF) by state. This information would be useful to help states set priorities for cancer control initiatives.

In this paper, we estimated the PAF and number of incident cancer cases attributable to EBW by sex in all 50 states and the District of Columbia using representative exposure and cancer occurrence data. To provide more accurate estimates, we adjusted state-level data on body mass index (BMI) based on self-reported weight and height from the Behavioral Risk Factor Surveillance System by sex, age group, race/ethnicity, and education level (162 strata) using BMI values from the National Health and Nutrition Examination Survey, a nationally representative survey with objectively-measured height and weight.

Continue reading

Breast Cancer Risk Remains Elevated 20-30 years After Childbirth

MedicalResearch.com Interview with:

Dale P. Sandler, Ph.D.  Chief, Epidemiology Branch National Institute of Environmental Health Sciences NIH

Dr. Sandler

Dale P. Sandler, Ph.D.
Chief, Epidemiology Branch
National Institute of Environmental Health Sciences
NIH

MedicalResearch.com: What is the background for this study?

Response: Not having children is a well-established risk factor for breast cancer, but most of this evidence comes from studies of postmenopausal women since breast cancer before menopause is relatively uncommon. There is growing evidence that some risk factors differ for premenopausal and postmenopausal breast cancer – for example obesity which increases risk for breast cancer after menopause but appears to be protective before menopause.

There was some evidence that breast cancer risk increased shortly after pregnancy. It was thought that this risk lasted for 5 to ten years. Studies were unable to fully characterize the duration of this increase in risk or evaluate factors such as breast feeding, age at birth, or family history of breast cancer that could modify the relationship between recent pregnancy and breast cancer risk. Breast cancer before menopause or age 55 is relatively rare, and few individual studies are large enough to answer these questions.

To answer these questions, we formed the Breast Cancer Collaborative Group, a pooling project involving 20 prospective cohort studies. We included 890,000 women from 15 of these long-term studies across three continents, including over 18,000 incident breast cancer cases.  Continue reading

Pancreatic Cancer: mFOLFIRINOX After Surgery Improves Survival

MedicalResearch.com Interview with:

Pr Thierry Conroy | Director

Prof. Conroy

Prof. Thierry Conroy MD, Director
Department of Medical Oncology
Institut de Cancérologie de Lorraine
Vandoeuvre-lès-Nancy CEDEX

MedicalResearch.com: What is the background for this study?

Response:  Surgery of pancreatic cancer offers the only chance of cure. Despite the low response rate (5% – 9%) of gemcitabine in metastatic disease, a 6-month regimen of adjuvant therapy with gemcitabine increases 5-year survival from 10% to 20% and is recognized as standard of care. However, recurrence rate remain high despite adjuvant treatment with 69-75% of patients relapsing within 2 years.

–       The combination of bolus and continuous infusion Fluorouracil, Folinic Acid, Irinotecan and Oxaliplatin (Folfirinox) was shown to increase response rate (31.6% versus 9.4%) in metastatic disease as compared to Gemcitabine and increase survival (11.1 versus 6.8 months).

–       Deletion of bolus Fluorouracil in the Folfirinox regimen (mFOLFIRINOX) decreased toxicity and do not reduce efficacy in advanced disease.

–       We performed a randomized trial in patients with good performance status, ECOG 0-1 CA 19.9 ≤ 180 U/L and no cardiac contraindication to fluorouracil.

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Chemo and Some Cancers Raise Risk of Shingles

MedicalResearch.com Interview with:

Herpes Zoster - Shingles on chest Wikipedia image

Herpes Zoster – Shingles
on chest
Wikipedia image

Jiahui Qian, MPH
School of Public Health and Community Medicine
University of New South Wales
Sydney Australia

 

 

MedicalResearch.com: What is the background for this study?

Response: Herpes zoster is a neurocutaneous disease caused by the reactivation of latent varicella zoster virus and its risk is related to the cell-mediated immunity. Previous studies have reported a higher zoster risk among patients with haematological cancer and cancer patients receiving chemotherapy. However, the role of the cancer itself and the receipt of cancer treatment is not clearly separated, we therefore started this study and tried to separate the risk of zoster associated with the cancer itself from cancer treatment.  Continue reading