Author Interviews, Case Western, Chemotherapy, Genetic Research, Lung Cancer, UT Southwestern / 22.03.2014

Dr. Azi Gazdar, MD UT Southwestern Medical Center W. Ray Wallace Distinguished Chair in Molecular Oncology Research Hamon Center for Therapeutic Oncology, PathologyMedicalResearch.com Interview with: Dr. Azi  Gazdar, MD UT Southwestern Medical Center W. Ray Wallace Distinguished Chair in Molecular Oncology Research Hamon Center for Therapeutic Oncology, Pathology MedicalResearch.com: What are the main findings of the study? Dr. Gazdar: We describe the characteristics of lung cancers arising in subjects who inherited a germline mutation that predisposes to lung cancer.  The mutation is rare in the general populations, and is inherited equally by both sexes.  However it is a potent predisposing gene, and one third of the never smoking carriers will develop lung cancer.  Thus, about 1% of patients who develop lung cancer carry the germline mutation.  This figure may rise as awareness of the condition and its link to lung cancer is raised among doctors diagnosing lung cancer. However, lung cancers mainly develop in women who are lifetime never smokers.  Lung cancer development is much less common among smokers and men, although accurate figures are not yet available. So the risk among carriers is somewhat similar to the BRCA genes predisposing to breast cancer, where a female carrier has about a 50% lifetime chance of developing breast cancer. The specific germline mutation (known as T790M) occurs in a gene known as epidermal growth factor receptor (EGFR) gene.  Sporadic mutations in this gene usually predict for effective responses to a class of drugs known as tyrosine kinase inhibitors (TKIs), which are widely used in the treatment of lung cancer.  However, the T790M mutation, when it occurs in sporadic tumors not associated with germline inheritance are resistant to TKI therapy.  Thus the prediction is that lung cancers arising in carriers with the germline mutation would also be resistant to TKI therapy. (more…)
Author Interviews, BMJ, Cancer Research, Chemotherapy, End of Life Care / 05.03.2014

Holly G. Prigerson, Ph.D. Irving Sherwood Wright Professor in Geriatrics Professor of Sociology in Medicine Co-Director, Center for End-of-Life Research Weill Cornell Medical College New York Presbyterian Hospital New York City, New York 10065MedicalResearch.com Interview with: Holly G. Prigerson, Ph.D. Irving Sherwood Wright Professor in Geriatrics Professor of Sociology in Medicine Co-Director, Center for End-of-Life Research Weill Cornell Medical College New York Presbyterian Hospital New York City, New York 10065 MedicalResearch.com: What are the main findings of the study? Dr. Prigerson: The main outcome of the research was end-of-life treatment and location of death with secondary outcomes being length of survival, late hospice referrals and attainment of preferred place of death. We found that 56 percent of patients receiving palliative chemotherapy in their final months.  Patients treated with palliative chemotherapy were five to 10 times more likely to receive intensive medical care and to die in an intensive care unit (ICU). Fewer than half died at home as compared with two-thirds of patients with metastatic cancer not treated with palliative chemotherapy. More specifically, we found that palliative chemotherapy was associated with:
  • Increased use of CPR and mechanical ventilation: 14% versus 2%
  • Late hospice referral: 54% versus 37%
  • Death in an ICU: 11% versus 2%
  • Death away from home: 47% versus 66%
  • Death away from their preferred place: 65% versus 80%
Survival did not differ significantly between patients who received palliative chemotherapy and those who did not (hazard ratio 1.11, 95% CI 0.90-1.38). Additionally, patients receiving palliative chemotherapy were less likely to acknowledge their illness as terminal (35% versus 49%, P=0.04), to have discussed end-of-life wishes with a physician (37% versus 48%, P=0.03), and to have completed a do-not-resuscitate order (36% versus 49%, P<0.05). (more…)
Author Interviews, Cancer Research, Chemotherapy, NEJM / 20.02.2014

Krishnansu S. Tewari, MD, FACOG, FACS| Professor & Director of Research Principal Investigator - The Gynecologic Oncology Group at UC Irvine The Division of Gynecologic Oncology University of California, Irvine Medical Center Orange, CA 92868MedicalResearch.com Interview with: Krishnansu S. Tewari, MD, FACOG, FACS| Professor & Director of Research Principal Investigator - The Gynecologic Oncology Group at UC Irvine, Division of Gynecologic Oncology University of California, Irvine Medical Center Orange, CA 92868 MedicalResearch.com: What are the main findings of the study? Dr. Tewari: The main findings of this study were that the addition of bevacizumab to chemotherapy resulted in a significantly improved survival of 3.7 months in a population of patients that have very limited options. This improvement in overall survival was not accompanied by any significant deterioration in quality of life and serious side effects were limited to 3% to 8% of the study population. (more…)
Author Interviews, Breast Cancer, Chemotherapy / 20.12.2013

MedicalResearch.com Interview with: Prof. Dr. med. Sibylle Loibl MD Unit Head of Medicine & Research Member of Management Board Associate Professor University Frankfurt GBG Forschungs GmbH
 Neu-Isenburg MedicalResearch.com: What are the main findings of the study? Dr. Loibl: We could demonstrate that patients with a HER2+ primary breast cancer harbouring a PIK3CA mutation are less likely to achieve a pathological complete response after treatment with an anthracycline/taxane containing therapy in combination with trastuzumab and lapatinib, than patients whose tumours does not harbour the mutation (so called wild type). This difference was largest in the group with HER2+, HR + tumours. The pCR rate in this cohort was as low as 6.3%. Looking at the differences in another study with either trastuzumab or lapatinib anti-HER2 treatment is seems as patients with a PIK3CA mutated tumour have a low pCR rate irrespective of the antiHER2 treatment, whereas the patients with a wild type tumour benefit from trastuzumab and the double blockade. (more…)
Author Interviews, Chemotherapy, Compliance / 16.12.2013

Dawn L. Hershman, MD MS Associate Professor of Medicine and MedicalResearch.com Interview with: Dawn L. Hershman, MD MS Associate Professor of Medicine and Epidemiology Leader, Breast Cancer Program Herbert Irving Comprehensive Cancer Center Columbia University Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Hershman: We have found in the past that compliance to 5 years of hormone therapy for the adjuvant treatment of breast cancer is low. While toxicity is a main reason, other factors are also important. Recent studies suggest out of pocket costs are high among cancer patients. We evaluated the change in adherence to hormone therapy after the introduction of generic Aromatase inhibitors. We found that discontinuation decreased and adherence increased with generic aromatase inhibitors compared to brand name. we found that higher co-payments were associated with decreased adherence and increased discontinuation. We also found that patients in the highest income group were more likely to be adherent to hormone therapy. (more…)
Author Interviews, Chemotherapy, Gastrointestinal Disease, Hepatitis - Liver Disease, MD Anderson / 10.12.2013

Harrys A. Torres, MD, FACP Assistant Professor Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer CenterMedicalResearch.com Interview with: Harrys A. Torres, MD, FACP Assistant Professor, Director of Hepatitis C Clinic Department of Infectious Diseases, Infection Control and Employee Health The University of Texas MD Anderson Cancer Center MedicalResearch.com: What are the main findings of the study? Dr. Torres: The main findings of the study were that patients with hepatitis C virus (HCV) infection who were successfully treated with antivirals and attained sustained virologic response (SVR) did not have a relapse of HCV infection after receiving immunosuppressive chemotherapy for cancer. Patients in the study received different chemotherapeutic agents, including rituximab and systemic corticosteroids. Durability of SVR was maintained up to 14 years after chemotherapy in cancer patients. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Lancet, MD Anderson / 24.11.2013

Dr. Kelly K. Hunt, M.D., F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, TXMedicalResearch.com Interview with: Dr. Kelly K. Hunt, M.D., F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center, Houston, TX MedicalResearch.com: What are the main findings of the study? Dr. Hunt: The primary endpoint of the Z1041 trial was the proportion of patients who had pathological complete response in the breast, defined as the percentage of women who started the neoadjuvant treatment with no histological evidence of disease in the breast at surgery.  We found that high pathologic response rates were observed in both treatment groups with similar cardiac safety profiles in both arms of the trial.  Specifically, 56.5% of patients in the sequential group (fluorouracil, epirubicin and cyclophosphamide on day one of a 21-day cycle for four cycles followed by paclitaxel plus trastuzumab weekly for 12 weeks) had a complete pathological response versus 54.2% of the patients who received the concurrent regimen (paclitaxel and trastuzumab weekly for 12 weeks followed by fluorouracil, epirubicin and cyclophosphamide on day one of a 21-day cycle with trastuzumab on days one, eight and 15 of the 21-day cycle for four cycles).  The difference in pathologic complete response rates between the treatment arms was not statistically significant.  Cardiac safety was a secondary endpoint of the trial and we found that both regimens had acceptable cardiac safety profiles. (more…)
Author Interviews, Cancer Research, Chemotherapy / 06.11.2013

MedicalResearch.com Interview with: Dr. Shuichi Hironaka, MD Clinical Trial Promotion Department, Chiba Cancer Center 666-2 Nitona-cho Chuo-ku Chiba-shi Chiba, 260-8717 Japan MedicalResearch.com: What are the main findings of the study? Dr. Hironaka: This is the first randomized phase III trial comparing paclitaxel and irinotecan in second-line chemotherapy for advanced gastric cancer. This study showed that no statistically significant difference was observed between paclitaxel and irinotecan for overall survival. However, both are reasonable second-line treatment options for advanced gastric cancer. (more…)
Author Interviews, Breast Cancer, Chemotherapy, MD Anderson, Vanderbilt / 10.10.2013

MedicalResearch.com Interview with: Hiroko Masuda MD

Morgan Welch Inflammatory Breast Cancer Research Program and Clinic; Departments of 2Breast Medical Oncology, 3Bioinformatics and Computational Biology The University of Texas MD Anderson Cancer Center, Houston, Texas;

W. Fraser Symmans, MD Anderson Cancer Center, Department of Pathology, Unit 85, 1515 Holcombe Blvd., Houston, TX 77030-4009;

Naoto T. Ueno, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1354, Houston, TX 77030.

MedicalResearch.com: What are the main findings of the study?

Answer: Triple-negative breast cancer (TNBC) could be classified into 7 subtypes: basal-like 1 (BL1), basal-like 2 (BL2), immunomodulatory (IM), mesenchymal (M),mesenchymal stem-like (MSL), luminal androgen receptor (LAR), and unstable (UNS). Using cluster analysis, Lehmann and Bauer et al. identified these TNBC subtypes in 21 public mRNA gene expression profiles of breast cancer. However, the clinical relevancy of these novel molecular subtypes has not been established. To establish the clinical relevancy, we determined if the subtypes of TNBC have different rates of pathological complete response (pCR) to standard neoadjuvant chemotherapy regimens. In this study, we confirmed that TNBC is heterogeneous and that pCR differs by TNBC subtype using the algorithm proposed by Lehmann and Bauer et al. The BL1 subtype had the highest pCR rate (52%), and BL2 and LAR had the lowest pCR rates (0% and 10%, respectively). TNBC subtype was an independent predictor of pCR status (P=0.022) via a likelihood ratio test. To our knowledge, this was the first study to show that the TNBC subtype can serve as an independent predictor of pCR status in patients who received standard chemotherapy regimens. This confirms the possible clinical relevance of the 7 molecular subtypes, and these subtypes may lead to innovative clinical trials of personalized medicine for patients with TNBC. (more…)

Author Interviews, Cancer Research, Chemotherapy, Hormone Therapy / 23.04.2013

MedicalResearch.com eInterview with Andrew Weickhardt, MBBS, DMedSc, FRACP MedicalResearch.com: What are the main findings of the study? Dr. Weickhardt: The study was hoping to confirm our earlier published observation that crizotinib use led to low testosterone in male patients. The earlier study was based on our observation of symptoms of low testosterone in some patients treated with the drug, and had suggested strongly that crizotinib led to rapid decrease in testosterone levels, however this was based only on a single center's patients, and only 19 patients. We hoped to do this by surveying a larger population of crizotinib treated patients across multiple institutions. We serially measured several relevant hormones. (more…)