Author Interviews, Cancer Research, Omega-3 Fatty Acids / 13.11.2014

James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute MedicalResearch.com Interview with: James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. DiNicolantonio: Daily low-dose aspirin has been shown to decrease the risk for cancer in a meta-analysis of randomized controlled trials, which is likely attributable to its ability to modestly decrease the activity of cyclooxygenase-2 (cox-2), an enzyme which contributes importantly to the genesis and progression of adenocarcinomas. Adenocarcinomas are cancer of the glands, the most common type of breast cancer (invasive ductal carcinoma) is an adenocarcinoma, additionally many cancers of the lung, intestine, esophagus, colon are adenocarcinomas. We show that an ample dietary intake of long-chain omega-3 fats—the type prominent in fatty fish—would oppose cox-2 activity. Additionally, we cite numerous evidence that a higher intake of long-chain omega-3 fats has been found to reduce the risk for numerous types of cancer - especially when looking at trials that excluded fried or preserved fish (or fish high in omega-6), excluded trials with a high background intake of omega-6, and included trials where the "high" intake group - actually ate 2 servings of fish or more per week. Additionally, basic science as well as randomized data showing that long-chain omega-3s can reduce the number and size of colon polyps supports this argument. (more…)
Author Interviews, Cancer Research, End of Life Care, JAMA / 12.11.2014

Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical School MedicalResearch.com Interview with: Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Obermeyer: More patients with cancer use hospice today than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. We examined how hospice affects health care utilization and costs and found that, in a sample of elderly Medicare patients with advanced cancer, hospice care was associated with significantly lower rates of both health care utilization and total costs during the last year of life. Patients who did not enroll in hospice had considerably more aggressive care in their last year of life—most of it related to acute complications like infections and organ failure, and not directly related to cancer-directed treatment. Hospice and non-hospice patients had similar patterns of health care utilization until the week of hospice enrollment, when care began to diverge. Ultimately, non-hospice patients were five times more likely to die in hospitals and nursing homes. These differences in care contributed to a statistically-significant difference in total costs of $8,697 over the last year of life ($71,517 for non-hospice and $62,819 for hospice). (more…)
Author Interviews, Breast Cancer, Case Western, Chemotherapy / 10.11.2014

Ruth Keri, PhD, Professor and Vice Chair Department of Pharmacology Case Western Reserve University School of Medicine, and Associate Director for Basic Research in the Case Comprehensive Cancer Center Case Western Reserve University MedicalResearch.com Interview with: Ruth Keri, PhD, Professor and Vice Chair Department of Pharmacology Case Western Reserve University School of Medicine, and Associate Director for Basic Research in the Case Comprehensive Cancer Center Case Western Reserve University Medical Research: What is the background for this study? Dr. Keri: Over the last several decades, the discovery of targeted therapies for certain types of breast cancer, and their use in the clinic, have greatly improved the long-term outcome of patients. Yet some breast cancers don’t respond to these therapies, and ones that do often become resistant over time, resulting in patient relapse and metastatic disease. Why does resistance occur? There are many tricks a tumor employs to evade death. When a drug targets a certain protein or pathway the cancer cell relies on for survival, one potential route of resistance is the cancer cell’s ability to adapt and find another pathway to maintain growth. We reasoned that targeting two separate proteins or pathways important for cancer cell growth may be more effective at preventing or delaying this adaptation. (more…)
Author Interviews, Dartmouth, Lung Cancer, NEJM / 07.11.2014

William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 MedicalResearch.com Interview with: William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014. (more…)
Author Interviews, Cancer Research, Case Western, Dental Research, JAMA / 07.11.2014

MedicalResearch.com Interview with: Brendan J. Perry, BSc, MBBS Princess Alexandra Hospital Brisbane, Queensland, Australia MedicalResearch: What is the background for this study? What are the main findings? Dr. Brendan J. Perry: Oral cavity cancer is usually attributed to the “Five S’s” - smoking, spirits (alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice. This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth. In recent years, dentists have been recommending clients to get removable denture nyc to tackle down on discomfort. We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor. (more…)
Author Interviews, Breast Cancer / 06.11.2014

Antoine E. Karnoub, Ph.D. Assistant Professor of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Center for Life Science 0634 Boston, MA 02215 MedicalResearch.com Interview with: Antoine E. Karnoub, Ph.D. Assistant Professor of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Center for Life Science 0634 Boston, MA 02215 Medical Research: What are the main findings of the study? Dr. Karnoub: The main findings of the study are: (1) that the metastatic propensities of cancer cells can be remarkably modulated by otherwise ‘normal’ mesenchymal stem/stromal cells found in their vicinity; (2) that generation of highly malignant tumor-initiating cells can be significantly triggered by microenvironmental cues; (3) that repression of the gene FOXP2 by a miR-199a-led microRNA network enables the propagation of cancer stem cell and metastatic traits in otherwise weakly metastatic cancer cells; and (4) that such a signaling axis appears to forecast poor patient outcome. (more…)
Author Interviews, Chemotherapy, Dermatology / 04.11.2014

N. T. Georgopoulos, PhD Senior Lecturer in Biological Sciences Department of Biological Sciences School of Applied Sciences University of Huddersfield MedicalResearch.com Interview with: N. T. Georgopoulos, PhD Senior Lecturer in Biological Sciences Department of Biological Sciences School of Applied Sciences University of Huddersfield Medical Research: What is the background for this study? What are the main findings? Dr. Georgopoulos: Chemotherapy-induced alopecia (CIA) is one of the most distressing side effect of chemotherapy and the anxiety caused by the prospect of Chemotherapy-induced alopecia can cause some cancer patients to even refuse treatment. Various classes of chemotherapeutic drugs such as taxanes (e.g. docetaxel), alkylating agents (e.g. cyclophosphamide) and anthracyclines/DNA intercalating agents (e.g. doxorubicin) target tumour cells due to their rapid division rate; however, these drugs also target the hair matrix keratinocytes, the most rapidly dividing cell subset in the hair follicle, thus resulting in follicle damage and ultimately hair loss. The only currently available preventative treatment for Chemotherapy-induced alopecia is head (scalp) cooling; scalp cooling during chemotherapy drug administration can substantially reduce hair loss and has been used since the 1970s. However, until recently there was inadequate biological data to support the cyto-protective capacity of cooling; yet such experimental evidence would be important to convince clinicians and patients of the efficacy of cooling. Moreover, it is not clear why in some patients scalp cooling fully protects from Chemotherapy-induced alopecia whereas in other patients it is less efficient. Finally, although scalp cooling can substantially reduce the incidence of hair loss in response to individual drugs, for some combined treatment regimens scalp cooling has much lower (and often quite limited) reported efficacy. Collectively, the need to answer these questions, and to provide ‘real’ experimental data that will support the ability of cooling to ‘rescue’ cells from the cytotoxic effects of chemotherapy drugs, led us to carry out the study. Using several cell culture models (including human hair follicular keratinocytes), we showed for the first time that cooling dramatically reduces or completely prevents the cytotoxic capacity of drugs such as docetaxel, doxorubicin and the active metabolite of cyclophosphamide (4-OH-CP), whilst combinatorial treatment showed relatively poor response to cooling. Our experimental, in vitro findings are in close agreement with clinical observations. Moreover, we have provided evidence that the minimum temperature achieved may be critical in determining the efficacy of cooling; as the lowest temperature achieved by scalp cooling can differ between patients (our unpublished observations), our findings may also explain why cooling protects from Chemotherapy-induced alopecia better in some patients but not others. (more…)
Author Interviews, Cancer, Cancer Research, Psychological Science / 04.11.2014

Linda E. Carlson, Ph.D., R.Psych. Enbridge Research Chair in Psychosocial Oncology Alberta Innovates-Health Solutions Health Scholar Professor, Department of Oncology, Faculty of Medicine Adjunct Professor, Department of Psychology, Faculty of Arts University of Calgary Clinical Psychologist, Director of Research Department of Psychosocial Resources MedicalResearch.com Interview with: Linda E. Carlson, Ph.D., R.Psych. Enbridge Research Chair in Psychosocial Oncology Alberta Innovates-Health Solutions Health Scholar Professor, Department of Oncology, Faculty of Medicine Adjunct Professor, Department of Psychology, Faculty of Arts University of Calgary Clinical Psychologist, Director of Research Department of Psychosocial Resources Medical Research: What is the background for this study? What are the main findings? Dr. Carlson: We have been investigating the effects of cancer support programs including the two in this study, Mindfulness-based cancer recovery, an 8-week group program in which patients learn mindfulness meditation and gentle yoga, and supportive-expressive therapy, a 12-week program where patients share difficult emotions in a supportive group environment. We know there is psychological benefit of these programs, but what about effects in the body? Telomeres are the protective caps on the end of chromosomes (like the tips on shoelaces) that protect them from damage and degredation. They are longest when we are young and naturally get shorter as we age. Shorter telomere's are associated with higher risk for many diseases, including cancer, and people with higher stress levels tend to have shorter telomeres. This is the first study to investigate whether short psychosocial interventions can affect telomere length in cancer pateints. We randomly assigned breast cancer survivors with cancer-related distress, feelings such as anxiety, fear, worry, and depression, to either mindfulness-based cancer recovery, supportive expressive therapy or a control group that just had a minimal intervention. We took blood samples before and after the groups (or at equal time points for those in the control condition) and measured the length of the telomeres. Women in both of the active support groups maintained the length of their telomeres over time, but the telomere length of women in the control group became shorter. This is the first controlled study to show that short-term interventions can actually have some effect on cellular aging in the telomeres. (more…)
Author Interviews, General Medicine, Leukemia, NEJM, Transplantation / 03.11.2014

John E. Wagner, M.D. Principal Investigator Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children's Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455 MedicalResearch.com Interview with: John E. Wagner, M.D. Principal Investigator Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children's Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455 Medical Research: What is the background for this study? What are the main findings? Dr. Wagner: Earlier studies of umbilical cord blood transplantation (UCB) in children with hematological malignancies demonstrated a survival rate of approximately 50%. While single UCB transplant was very effective despite HLA mismatch, few adults had access to umbilical cord blood as a treatment option due to the cell dose requirement of 2. 5 x 10^6 nucleated cells per kilogram recipient body weight. For this reason, at the University of Minnesota we explored the co-transplantation of two partially HLA matched umbilical cord blood units in adults as a straightforward strategy to achieving the cell dose requirement. Early results were remarkable with survival rates higher than that observed in children. This in turn led to the design of the BMT CTN 0501 study, a randomized trial comparing single versus double umbilical cord blood transplantation in children aged 2-21 years with hematological malignancies. All patients received a uniform conditioning regimen of fludarabine, cyclophosphamide and total body irradiation and GVHD prophylaxis of cyclosporine A and mycophenylate mofetil. 224 patients were randomized. There were four major findings:
  • 1) survival results overall, regardless of treatment arm, have improved,
  • 2) for children, an adequately dosed single umbilical cord blood unit is sufficient, giving a survival result of 72% at one year,
  • 3) double umbilical cord blood transplant is associated with more GVHD and poorer platelet recovery but survival is comparable to an adequately dosed single unit, and
  • 4) HLA mismatch is well tolerated with potentially better disease free survival in patients transplanted with HLA mismatched umbilical cord blood , a provocative finding that requires further investigation.
(more…)
Author Interviews, Biomarkers, BMJ, Ovarian Cancer / 03.11.2014

Ben Van Calster PhD Department of Development and Regeneration KU Leuven, Herestraat Leuven, Belgium MedicalResearch.com Interview with: Ben Van Calster PhD Department of Development and Regeneration KU Leuven, Herestraat Leuven, Belgium MedicalResearch: What is the background for this study? What are the main findings? Dr. Van Calster: Ovarian cancer is a very common type of cancer among women, with over 200,000 new cases per year worldwide. It is the most lethal of gynecological malignancies. Research has shown that the referral of patients with ovarian cancer to specialized gynecological oncologists in high volume centers improves survival. However, audits in Europe and the United States also show that only a minority of women with ovarian cancer are appropriately triaged to receive specialist care. In addition, different types of malignancies are not treated in the same way. Hence optimal personalized management of an ovarian tumor hinges on the detailed preoperative diagnosis of its nature. Unfortunately, current prediction models focused on the discrimination between benign and malignant tumors without further specification of the likely type of malignancy. Various prediction models and rules have been developed to help predict whether an ovarian mass is benign or malignant. A recent systematic review meta-analysis has shown that the IOTA model LR2 and simple rules perform better than any other previous test. However none of these tests give anything other than a dichotomous outcome – i.e. cancer or non-cancer. In practice the position is more nuanced. The ADNEX model estimates the likelihood that a tumor is benign, borderline malignant, stage I cancer, stage II-IV cancer, or secondary metastatic cancer. This model is the first that is able to differentiate between benign and these four subtypes of malignancy. To do so, ADNEX uses three clinical predictors (age, serum CA-125 level, and type of center), and six ultrasound characteristics of the tumor (maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites). The model is based on data from almost 6,000 women recruited at 24 centers in 10 countries. (more…)
Author Interviews, Biomarkers, Nature, Pancreatic / 03.11.2014

Dr. Murray Korc MD, Professor Department of Medicine, Division of Endocrinology, Biochemistry and Molecular Biology, and the Pancreatic Cancer Signature Center IU Simon Cancer Center, Indiana University School of Medicine Indianapolis, Indiana MedicalResearch.com Interview with Dr. Murray Korc MD, Professor Department of Medicine, Division of Endocrinology, Biochemistry and Molecular Biology, and the Pancreatic Cancer Signature Center IU Simon Cancer Center, Indiana University School of Medicine Indianapolis, Indiana Medical Research: What is the background for this study? What are the main findings? Dr. Korc: Pancreatic ductal adenocarcinoma (PDAC) is a deadly cancer with an overall 5-year survival rate of 6%. Currently, there are no highly specific and sensitive biomarkers in the blood that can be used for definitively diagnosing the presence of this cancer. In addition, in spite of the usefulness of CA19-9 in differentiating between patients with pancreatic cancer and chronic pancreatitis, this test may yield a significant number of false positive and false negative results, and it may be influenced by the presence of jaundice. These difficulties are compounded by the fact that patients with pancreatitis are at-risk for developing Pancreatic ductal adenocarcinoma. We decided to carry out a study of microRNAs using plasma from treatment-naïve PDAC patients, chronic pancreatitis patients, and controls without pancreatic disease. We focused on microRNAs because they are known to be present in the blood and to be very stable. We chose to conduct these assays in plasma because we reasoned that there would be fewer confounding factors by comparison with either whole blood or serum. We determined that five microRNAs were elevated in plasma from PDAC patients by comparison with either chronic pancreatitis or controls. Importantly, among these five microRNAs, high levels of miR-10b, miR-155, and miR-106b in the plasma were highly accurate in diagnosing Pancreatic ductal adenocarcinoma with ~95% sensitivity and ~100% specificity. (more…)
Author Interviews, Colon Cancer / 02.11.2014

Enrique Quintero MD, PhD President, Asociación Española de Gastroenterología (AEG) Chief of Gastroenterology, Hospital Universitario de Canarias Professor of Medicine, Universidad de La Laguna La Laguna. Tenerife Spain MedicalResearch.com Interview with: Enrique Quintero MD, PhD President, Asociación Española de Gastroenterología (AEG) Chief of Gastroenterology, Hospital Universitario de Canarias Professor of Medicine, Universidad de La Laguna La Laguna. Tenerife Spain Medical Research: What is the background for this study? What are the main findings? Dr. Quintero: First degree relatives (FDRs) of patients with colorectal cancer (CRC) are at increased risk of developing the disease compared with the general population. For that reason, clinical practice guidelines recommend colonoscopy every five years starting at the age of 40 years or ten years less than the youngest case in the family. However, this approach has some drawbacks:
  • first, several studies have shown that the benefit of colonoscopy is limited by a low uptake (less than 40%);
  • second, it represents an important colonoscopy burden, as about 70-80% of explorations are normal or without relevant lesions, which implies a high resource consumption; and
  • third, this recommendation is not based on evidence, as no randomized controlled trials have compared the efficacy of screening colonoscopy with that of other strategies.On the other hand, pilot studies have shown that one-time fecal immunochemical tests (FIT) have acceptable capacity to detect advanced neoplasia (defined as cancer or advanced adenoma) in family members of patients with CRC. For these reasons we conducted a prospective randomized trial to compare the efficacy of repeated fecal immunochemical tests versus one-time colonoscopy for detecting advanced colorectal neoplasia in asymptomatic FDRs of patients with colorectal cancer.
The main finding of our study was that cumulative fecal immunochemical tests screening (1 per year, during 3 years), yielded an equivalent detection rate to one-time colonoscopy for cancer, advanced adenoma and advanced neoplasia both by intention-to-screen and per-protocol analysis, after controlling for confounders such as age, gender, index-case age, and number of affected relatives. In fact, FIT detected all cancers and 61% of advanced adenomas. In addition, the study confirmed that the number of subjects requiring colonoscopy to detect one advanced neoplasm was 4 times less in individuals screened by FIT than in those screened by colonoscopy. Therefore, FIT may save a substantial number of unnecessary colonoscopies, preventing harms and lowering costs. (more…)
Author Interviews, Hormone Therapy, Prostate Cancer / 30.10.2014

David R. Ziehr B.S., MD Candidate Harvard Medical School MedicalResearch.com Interview with: David R. Ziehr B.S., MD Candidate Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Response: Androgen deprivation therapy (ADT), commonly achieved with gonadotropin-releasing hormone agonists or antagonists, is a mainstay of prostate cancer therapy. While randomized controlled trials demonstrate that ADT improves survival among men with unfavorable risk prostate cancer, retrospective studies have suggested that some men with comorbid illnesses such as heart disease may not derive a benefit from—or may even be harmed by—ADT. However, the nature of this harm has not been characterized. We studied over 5000 men with prostate cancer who were treated with brachytherapy (implanted radioactive seeds) with or without ADT. We analyzed the men based on pre-treatment cardiac comorbidity and examined the association between ADT and death from cardiac causes. We found that among men with congestive heart failure or a past myocardial infarction (MI), Androgen deprivation therapy was associated with a three-times greater risk of death from heart disease. However, Androgen deprivation therapy was not associated with greater risk of cardiac mortality in men without heart disease or with a risk factor for heart disease, such as diabetes, hypertension or hyperlipidemia. (more…)
Author Interviews, Breast Cancer, Chemotherapy / 30.10.2014

Melissa Skala, Ph.D. Assistant Professor of Biomedical Engineering Assistant Professor of Cancer Biology Vanderbilt University Nashville, TN 372 MedicalResearch Interview with: Melissa Skala, Ph.D. Assistant Professor of Biomedical Engineering Assistant Professor of Cancer Biology Vanderbilt University Nashville, TN 37235 Medical Research: What is the background for this study? What are the main findings? Dr. Skala: We developed a new metabolic imaging technique that is highly sensitive to tumor cell response to anti-cancer drug treatment. We coupled this imaging technique with new, three-dimensional cultures that can be grown from breast tumor biopsies. Together, our data indicate that this approach could be used to perform rapid, low-cost, and accurate drug screens for individualized treatment of cancer patients. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy / 27.10.2014

MedicalResearch.com Interview with: Shidong Jiang Associate professor of Engineering Thayer School of Engineering at Dartmouth Medical Research: What is the background for this study? What are the main findings? Dr. Jiang: Breast cancer is the most common non-skin cancer in women worldwide, and the second leading cause of women’s cancer mortality in the United States. A common treatment strategy after diagnosis is to shrink breast cancer tumors larger than 3 centimeters with a 6 to 8 month course of Neoadjuvant Chemotherapy prior to surgery. Clinical studies have shown that patients who respond to Neoadjuvant Chemotherapy have longer disease-free survival rates, but only 20 to 30 percent of patients who receive Neoadjuvant Chemotherapy fit this profile. Our work represents the first clinical evidence that tumor total hemoglobin estimated from DOST images differentiates women with locally advanced breast cancer who have a complete pathological response with Neoadjuvant Chemotherapy from those who do not with predictive significance based on image data acquired before the initiation of therapy. The implication of this prognostic information is that certain tumors are pre-disposed to responding to Neoadjuvant Chemotherapy, and that this predisposition should be known prior to choosing the therapy. The study also demonstrates the potential of dramatically accelerating the validation of optimal Neoadjuvant Chemotherapy regimes through future randomized clinical trials by reducing the number of patients required and the length of time they need to be followed by using a validated imaging surrogate as an outcome measure. (more…)
Author Interviews, Colon Cancer, Cost of Health Care / 25.10.2014

Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann Arbor MedicalResearch.com Interview with: Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann Arbor Medical Research: What is the background for this study? Dr. Veenstra: Nearly 50,000 patients are diagnosed with stage III colorectal cancer each year. Chemotherapy is known to increase survival by up to 20% and is the standard recommendation for these patients after surgery. However, use of chemotherapy may be associated with financial strain. In order to better understand the financial burden and worry associated with colorectal cancer treatment, we surveyed 956 patients being treated for stage III colorectal cancer. We asked patients to answer questions about financial burden such as whether they had used savings, borrowed money, skipped credit card payments, or cut back on spending for food, clothing or recreational activities because of their cancer treatment. We also asked patients how much they worry about financial problems because of their cancer or its treatment. (more…)
Author Interviews, Cancer, Pancreatic / 24.10.2014

MedicalResearch.com Interview with: Jeremy L. Humphris MBBS The Kinghorn Cancer Center, Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia and Andrew V. Biankin Regius Professor of Surgery Director, Wolfson Wohl Cancer Research Centre, University of Glasgow Garscube Estate, Switchback Road, Bearsden, Glasgow Scotland United Kingdom Medical Research: What are the main findings of the study? Response: Familial pancreatic cancer (FPC) is a family with at least 2 first degree (parent-child or siblings) with pancreatic cancer. We found these patients represent nearly 9% of our cohort. In addition we found those with familial pancreatic cancer were more likely to have other first degree relatives with a history of extra-pancreatic cancer, in particular melanoma and endometrial cancer. Patients with familial pancreatic cancer had more high grade precursor lesions in the pancreas adjacent to the tumour but the outcome was similar. Smoking was more prevalent in sporadic pancreatic cancer and active smoking was associated with significantly younger age at diagnosis in both groups. Long-standing diabetes mellitus (> 2 years duration) was associated with poorer survival in both groups. (more…)
Author Interviews, Colon Cancer, NEJM / 22.10.2014

Alfredo Falcone MD Chiara Cremolini Fotios Loupakis University of Pisa and Azienda-Ospedaliero Universitaria Pisana Italy MedicalResearch.com Interview with: Alfredo Falcone MD Chiara Cremolini Fotios Loupakis University of Pisa and Azienda-Ospedaliero Universitaria Pisana Italy Medical Research: What are the main findings of the study? Dr. Falcone: In the TRIBE study the main findings are that the use of an initial more intensive therapy with a triplet of cytotoxics (FOLFOXIRI) plus bevacizumab vs a doublet (FOLFIRI) + bevacizumab improves the outcome of metastatic colorectal cancer patients with unresectable metastases. In particular FOLFOXIRI + bevacizumab vs FOLFIRI+bevacizumab improved RECIST response-rate (65% vs 53%, p=0.006), progression-free survival which was the primary endpoint (median 12,1 vs 9,7 months, HR=0,75, p=0.003) and overall survival (median 31,0 vs 25,8 months, HR=0.79, p=0.054). These results, also compared to those reported in previous phase III studies in molecularly unselected patients, represent an important advance in the treatment of this disease. (more…)
CHEST, Lung Cancer / 21.10.2014

Peter J. Mazzone, MD, FCCP MPH Director of the Lung Cancer Program for the Respiratory Institute Cleveland Clinic MedicalResearch.com Interview with: Peter J. Mazzone, MD, FCCP MPH Director of the Lung Cancer Program for the Respiratory Institute Cleveland Clinic Medical Research: What are the main findings of this study? Dr. Mazzone: There were 2 parts to this study. In the first part we looked at how the breath collection instrument and sensor were performing and made adjustments to both in order to optimize its performance. In the second part we used the improved device and sensor to see if we could accurately separate a sensor signal of our patients with lung cancer from those without lung cancer. We found good separation of lung cancer from non-cancer breath signals, and very good separation of signals of one type of lung cancer from another. We have concluded that a colorimetric sensor array based breath test is capable of separating those with lung cancer from those without. (more…)
Author Interviews, Cancer Research / 21.10.2014

Dr. Iris L. Romero MD MS Associate Professor of Obstetrics & Gynecology, Section of General Gynecology The University of Chicago Medicine Chicago, IL MedicalResearch.com Interview with: Dr. Iris L. Romero MD MS Associate Professor of Obstetrics & Gynecology, Section of General Gynecology The University of Chicago Medicine Chicago, IL Medical Research: What are the main findings of the study? Dr. Romero: There is increasing epidemiologic and preclinical data indicating that the commonly used diabetic drug, metformin, may have anticancer effects. In ovarian cancer, in 2011 in Obstetrics & Gynecology we reported that in a retrospective cohort ovarian cancer patients that were using metformin had increased survival compared to those not using mefomrin. In this study, we expand on those findings by testing whether metformin can prevent ovarian cancer or improve response to chemotherapy in mouse models. In a prevention study, we found that mice treated with metformin before cancer was initiated developed less tumor than those treated with placebo. In a treatment study, in vitro, metformin increased the cytotoxic effect of paclitaxel. In addition, using a genetic mouse model we show that the combination of paclitaxel plus metformin results in a greater tumor reduction than either drug used alone. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Journal Clinical Oncology, Mayo Clinic / 21.10.2014

dr_edith_perez MedicalResearch.com Interview with: Edith A. Perez, MD Mayo Clinic Jacksonville, FL 32224 Medical Research: What are the main findings of the study? Dr. Perez: Our joint analysis of two large prospective trials showed that adding one year of Trastuzumab to otherwise standard adjuvant chemotherapy significantly improved long term survival in women with resected HER2+ breast cancer. (more…)
Author Interviews, Dermatology, Melanoma / 21.10.2014

Prof. David Whiteman Group leader, Cancer Control Group QIMR Berghofer Herston, Queensland MedicalResearch.com Interview with: Prof. David Whiteman Group leader, Cancer Control Group QIMR Berghofer Herston, Queensland   Medical Research: What are the main findings of the study? Dr. Whiteman: Mortality from melanoma has continued to rise in Queensland, Australia, the jurisdiction with the world’s highest incidence of this disease. We analysed more than 4000 deaths from melanoma over the last 2 decades, and calculated mortality rates according the thickness of the primary lesion. (more…)
Author Interviews, Cancer Research, Journal Clinical Oncology, MD Anderson / 21.10.2014

MedicalResearch.com Interview with: Joanna-Grace M. Manzano, MD Assistant Professor Department of General Internal Medicine Maria E. Suarez-Almazor, MD, PhD Barnts Family Distinguished Professor Chief, Section of Rheumatology & Deputy Chair, Dept. of General Internal Medicine UT MD Anderson Cancer Center Houston, TX Medical Research: What are the main findings of the study? Response: Our study established that unplanned hospitalization among elderly patients with GI cancer are very common – 93 events per 100-person years. Certain characteristics were found to have an increased risk for an unplanned hospitalization in our cohort, namely: older age, black race, advanced disease, higher comorbidity score, residing in poor neighborhoods and dual eligibility for Medicare and Medicaid. Esophageal and gastric cancer had the highest risk for unplanned hospitalization among all GI cancer types. Some of the observed reasons for unplanned hospitalization were potentially preventable and related to the patient’s comorbid illness. (more…)
Author Interviews, Melanoma, Ophthalmology / 17.10.2014

MedicalResearch.com Interview with: Prof I. Jolanda M. de Vries Professor, Dept of Tumor Immunology Radboud University Nijmegen Medical Research: What are the main findings of the study? Prof. de Vries: Dendritic cells are antigen-presenting cells with the unique capacity to activate naive antigen-specific T cells, and by this means are very suitable to induce immunologic antitumor responses. Dendritic cells cultured from monocytes can be matured and loaded with tumor antigen ex vivo and administered back into the patient. Within the lymph node, dendritic cells present antigens to T cells to initiate an immune response. Metastatic uveal melanoma patients were vaccinated with autologous DCs loaded with tumor antigens (gp100 and tyrosinase), obtained by leukapheresis, according to a schedule of 3 biweekly vaccinations. One to 2 weeks after the last vaccination, a skin test was performed to analyse the induction of immunologic responses. We can conclude that dendritic cell vaccination is feasible and safe in metastatic uveal melanoma. Dendritic cell-based immunotherapy is potent to enhance the host’s antitumor immunity against uveal melanoma in approximately one third of patients. (more…)
Author Interviews, Cancer Research, MD Anderson / 17.10.2014

Steven J. Frank, M.D. Associate Professor of Radiation Oncology Medical Director of the Proton Therapy Center The University of Texas MD Anderson Cancer Center MedicalResearch.com Interview with: Steven J. Frank, M.D. Associate Professor of Radiation Oncology Medical Director of the Proton Therapy Center The University of Texas MD Anderson Cancer Center MedicalResearch.com Editor’s Note: A recent research published in Oncology Payers, discusses the quality of life benefits and cost-savings of intensity modulated proton therapy (IMPT or proton therapy) with traditional x-ray therapy for advanced stage head and neck cancer. The senior author of the paper, Dr. Steven Frank, highlights two oropharyngeal cancer patients, one of whom received proton therapy and the other x-ray treatments. Both patients received chemotherapy. The study showed that although the upfront costs of proton therapy were three times that of standard x-ray treatments, the proton therapy patient was spared the necessity of a feeding tube, nutritional and supportive care and weight loss that accompanied the x-ray treatments. By the end of the treatment period, the total care costs for the proton therapy patient were 20% lower than the x-ray treatment plan. To evaluate the costs, Dr. Frank has been employing a costing tool used elsewhere at MD Anderson called Time-driven Activity-based Costing that places the emphasis on the value of medical care, both monetary and in terms of quality of life. Dr. Frank plans to enroll 360 patients over the next five years as well as to open the study to other cancer centers. He notes that the results will be especially valuable as health insurance companies look to further bundled insurance payments. Dr. Frank was kind enough to answer several questions regarding his work for the MedicalResearch.com audience. Medical Research: From a patient's perspective, what are the main differences between traditional x-ray therapy and proton therapy for cancer treatment? Dr. Frank: In proton therapy, the radiation hits the cancer, while with traditional x-ray the radiation hits the cancer and the normal tissues in the head and neck, causing more side effects during and after treatment. The main advantage is that proton therapy eliminates unnecessary radiation. As radiation oncologists, our primary goal is to effectively kill cancer while sparing the patient the side effects of excessive radiation. Proton therapy achieves this for many patients with a variety of cancers, including lymphoma, lung, head and neck, prostate, esophageal and pediatric cancers. (more…)
Author Interviews, Melanoma, UCSF / 17.10.2014

Martina Sanlorenzo, MD Department of Dermatology Mt. Zion Cancer Research Bldg. San Francisco, CA 94143-0808 MedicalResearch.com Interview with: Martina Sanlorenzo, MD Department of Dermatology Mt. Zion Cancer Research Bldg. San Francisco, CA 94143-0808 Medical Research: What are the main findings of the study? Dr. Sanlorenzo: In the treatment of BRAF mutant melanoma, the combination of BRAF inhibitor and MEK inhibitor has a better cutaneous safety profile compared with BRAF inhibitor monotherapy. Combination regimen shows fewer cutaneous adverse events and longer cutaneous adverse event-free interval. In particular, the development of squamous cell carcinoma or keratoacanthoma was significantly less frequent. (more…)
Author Interviews, Melanoma, PLoS / 16.10.2014

Professor Robert Insall CR-UK Beatson Institute for Cancer Research Glasgow UK MedicalResearch.com Interview with: Professor Robert Insall CR-UK Beatson Institute for Cancer Research Glasgow UK Medical Research: What are the main findings of the study? Prof. Insall: The principal message is that melanoma cells make their own steering signals, and thus drive themselves out of the tumour and into the bloodstream. This comes in two parts: (a) The principal steering signal when we assay melanoma spread in vitro is lysophosphatidic acid, LPA. LPA steers cells with really remarkable accuracy; blocking LPA receptors stops them from spreading without hurting their health or ability to move. (b) Where does the LPA gradient come from? They make it themselves. There seems to be lots of LPA around; they break down the LPA near them, leading to a gradient that's low near the cells and high further away. This is the gradient that steers the tumour cells. (more…)
Author Interviews, JCEM, Lipids, Prostate Cancer / 13.10.2014

Emma H. Allott PhD Division of Urology, Department of Surgery, Duke University School of Medicine Cancer Prevention, Detection, and Control Program, Duke Cancer Institute Division of Urology, Veterans Affairs Medical Center Durham Durham, North Carolina. MedicalResearch.com Interview with: Emma H. Allott PhD Division of Urology, Department of Surgery, Duke University School of Medicine Cancer Prevention, Detection, and Control Program, Duke Cancer Institute Division of Urology Veterans Affairs Medical Center Durham Durham, North Carolina. Medical Research: What are the main findings of the study? Dr. Allott: Relative to normal triglyceride levels, high triglycerides (≥150 mg/dl) were associated with 35% increased risk of prostate cancer recurrence. In addition, we found that each 10 mg/dl increase in total serum cholesterol above the abnormal cut-off value of 200 mg/dl was associated with a 9% increased risk of prostate cancer recurrence, while each 10 mg/dl increase in HDL (high density lipoprotein; “good” cholesterol) below the abnormal cut-off value of 40 mg/dl was associated with a 39% increased risk of prostate cancer recurrence. These findings suggest that normalization, or even partial normalization, of serum lipid levels among men with dyslipidemia may reduce the risk of prostate cancer recurrence. (more…)
Author Interviews, Cancer Research, Lancet, Thromboembolism / 08.10.2014

MedicalResearch.com Interview with: Prof Martin H Prins MD Maastricht University Medical Centre, Maastricht, Netherlands Medical Research: What are the main findings of the study? Dr. Prins: Patients with active cancer, i.e. a cancer that was diagnosed or treated within 6 months before the episode, that was recurrent or metastatic, or that was diagnosed during treatment, who had a symptomatic episode of venous thromboembolism, were included in this pooled subgroup analysis of the Einstein DVT and PE studies. The incidence of recurrent venous thromboembolism was similar between groups. It occurred in 16 (5%) of 354 patients allocated to rivaroxaban and 20 (7%) of 301 patients allocated to enoxaparin and vitamin K antagonist (hazard ratio [HR] 0•67, 95% CI 0•35 to 1•30). Clinically relevant bleeding was also similar and occurred in 48 (14%) of 353 patients receiving rivaroxaban and in 49 (16%) of 298 patients receiving standard therapy (HR 0•80, 95% CI 0•54 to1•20). However, major bleeding was less frequent among rivaroxaban recipients and occurred in eight (2%) of 353 patients receiving rivaroxaban and in 15 (5%) of 298 patients receiving standard therapy (HR 0•42, 95% CI 0•18 to 0•99). Mortality was also similar. (more…)
Author Interviews, Breast Cancer / 07.10.2014

Professor Xiaodong Zhang Professor of Macromolecular Structure and Function Department of Medicine Imperial College, London, UK MedicalResearch.com Interview with: Professor Xiaodong Zhang Professor of Macromolecular Structure and Function Department of Medicine Imperial College, London, UK Medical Research: What are the main findings of the study? Prof. Zhang: Since its discovery 20 years ago, the BRCA2 gene and its protein product, BRCA2, have been under intensive investigations. The importance of the BRCA2 protein lies in the central roles it plays in the most faithful DNA damage repair pathway. Mutations in BRCA2 thus can cause defects in this repair pathway, making the repair inefficient or forcing cells to use alternative repair methods that are prone to mistakes, all of which contribute to mutations in the genomic DNA, thus increase the risk of cancer development. Our study aims to understand how BRCA2 works through studying its 3-dimensional structures and its interactions with other key partners in the repair pathway. Our study provides first 3-dimensional views of BRCA2 and BRCA2-RAD51 and reveals that BRCA2 molecules exist as pairs and a BRCA2 pair recruit two sets of RAD51 molecules arranged in opposite orientations. Our study also shows a single stranded DNA binds across the BRCA2 dimer and that BRCA2 increases the frequency of RAD51 filament formation events, presumably to increase the efficiency of establishing a longer filament required for searching for matching strands of DNA in intact sister chromatin. Our results thus not only define the precise roles of BRCA2 in helping RAD51 filament formation, but how it helps RAD51 loading onto single stranded DNA. (more…)