New Guidelines for Surgical Margins After DCIS Breast Cancer Interview with:

Monica Morrow, MD, FACS Chief, Breast Service, Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology

Dr. Monica Morrow

Monica Morrow, MD, FACS
Chief, Breast Service
Department of Surgery
Anne Burnett Windfohr Chair of Clinical Oncology
Memorial Sloan-Kettering Cancer Center What is the background for this study?

Response: DCIS, ductal carcinoma in situ, intraductal cancer or Stage 0 cancer refers to what some people call the earliest form of cancer we can find and others term “precancerous”. This difference in terms is due to the fact that DCIS lacks the ability to spread to other parts of the body, a fundamental characteristic of cancer. The goal of treatment in DCIS is to prevent progression to invasive cancer which has the ability to spread. DCIS accounted for only 2-3 % of breast cancers seen in the pre-screening mammography era, but it comprises 25-30% of the malignancies detected in screening mammography programs.

For this reason it is uncommon in women under age 40, and more commonly seen in women over 50 years of age. Approximately 70% of the women in the US diagnosed with DCIS are treated with lumpectomy (removal of the DCIS and a margin of surrounding normal breast tissue), and additional surgeries to obtain clear, or more widely clear, margins are done in approximately 30% of women.

For this reason, the Society of Surgical Oncology, the American Society for Therapeutic Radiation Oncology, and the American Society of Clinical Oncology undertook the development of an evidence based guideline to determine the optimal clear margin for women with DCIS treated with lumpectomy and whole breast radiotherapy.

Continue reading

Pre-op Venous Thromboembolism Prophylaxis Safely Reduced Clots and Pulmonary Emboli Interview with:
Luke V. Selby, MD
Research Fellow, Department of Surgery
Vivian E. Strong, MD FACS
Associate Attending Surgeon, Department of Surgery
Memorial Sloan Kettering Cancer Center

Medical Research: What is the background for this study? What are the main findings?

Response: There was strong concern at our institution about the safety of providing pre-operative Venous Thromboembolism (VTE) chemoprophylaxis (in addition to our standard peri and post-operative prophylaxis) was unsafe.  To answer this question we administered a single dose of either low molecular weight heparin or unfractionated heparin to all eligible surgical patients at our institution over a six month period. When compared to identically selected patients operated on during the preceding 18 months, patients who received the pre-operative VTE chemoprophylaxis did not have higher rates of bleeding complications and had lower rates of DVT and pulmonary embolism (PE).

Continue reading

Marked Increase in Prescription Drugs and Polypharmacy in US Adults Interview with:
Dr. Elizabeth D. Kantor PhD MPH
Assistant Attending Epidemiologist
Memorial Sloan Kettering Cancer Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Kantor: We know that use of prescription drugs represents a major expenditure in the United States and research suggests that use of prescriptions has increased. However, much of what we know is derived from information on expenditures, is outdated, or is limited to certain populations, such as older adults or those with a given clinical condition. For example, a number of studies have looked at things like use of drugs used to control condition x among persons with condition x, but that doesn’t tell us about use of that class of drugs in the population.

It’s important that we continue to monitor use of prescription drugs in the population, as practice patterns are continually evolving as the population ages, the health needs of the population change, drugs enter/exit the market, scientific knowledge advances, and policies change. We therefore sought to create an updated comprehensive reference on prescription drug use among US adults using nationally representative data from the National Health And Nutrition Examination Survey, a continuous survey conducted by the Centers for Disease Control and Prevention. We examined trends in use of prescription drugs over 7 cycles, ranging from 1999-2000 to 2011-2012 (the sample size per cycle ranged from 4,861 to 6,212).Participants were asked about use of prescription medications over the prior 30 days, from which we were able to estimate the prevalence of use within each survey cycle. We then looked at trends in prescription drug use, both overall and within drug classes.

In our study, we observed that use of any prescription medications increased over the study period, with 51% of adults reporting any prescription medication use in 1999-2000 and 59% reporting any use in 2011-2012. We also observed an increase in polypharmacy (or use of 5 or more prescription drugs) over the study period, with approximately 8% of adults reporting use of 5 or more drugs in 1999-2000, as compared to 15% in 2011-2012. Polypharmacy was much more common among older adults: 24% of adults ages 65 and older reported use of 5 or more drugs in 1999-2000 and 39% reported use of 5 or more drugs in 2011-2012. At first glance, one might take a look at these results and think that this is probably because the US population is aging and people tend to take more drugs as they age. But we found that the increase in overall prescription drug use and polypharmacy persisted even after accounting for the aging of the US population. This means that something else is driving the observed increase in use of prescription drugs.

We also found that use of the majority of drug classes increased over the study period. For example, among commonly used drug classes, we observed marked increases in use of drugs taken to control high cholesterol, high blood pressure, and diabetes. We also observed marked increases in some less commonly used drug classes, such as muscle relaxants. Interestingly, if we look at the ten most commonly used drugs in 2011-2012, we can see that most are taken for conditions associated with cardiometabolic disease This raises the question of how much of this increase in prescription drug use may be attributable to overweight/obesity, as we know that the prevalence of obesity has increased among US adults.
Continue reading

More Children With SCID Are Now Transplant Candidates Interview with:
Richard J. O’Reilly, MD
Memorial Sloan Kettering Cancer Center

Medical Research: What are the main findings of the study?
Dr. O’Reilly:

1.       In a comparison of the results of HLA-matched sibling transplants with other established transplant approaches, including T-cell depleted half-matched parental marrow grafts, unmodified transplants from matched unrelated donors and cord blood transplants in the current era (2000-2009), transplants from donors other than HLA-matched siblings had 5 year survival outcomes similar to those of matched siblings when applied to young infants (≤ 3.5 months of age) or infants of any age that were not infected at the time of transplants. Thus any child born with SCID can now be successfully transplanted.

2.       Active infection at the time of transplant significantly reduced chances of long-term survival for all infants except those who received transplants from HLA-matched siblings. Thus, infection is a dominant determinant of transplant outcome.  Control of treatable infections prior to transplant should be a major clinical objective.

3.       Treatment with chemotherapy containing busulfan significantly enhances the likelihood of recovering a normal ability to make antibodies and fosters better recovery of T-cells that provide cell mediated immunity, and may be an acceptable risk in uninfected infants. However, use of any chemotherapy prior to transplant in an infant who is infected, greatly decreases chances of survival. In infected patients who lack a matched sibling, T-cell depleted transplants from half matched related donors had the best outcomes.
Continue reading

Central Venous Catheters Raise Infection Risk in Cancer Patients

Allison Lipitz-Snyderman, PhD Assistant Attending Outcomes Research Scientist Center for Health Policy and Outcomes Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York, NY Interview with:
Allison Lipitz-Snyderman, PhD
Assistant Attending Outcomes Research Scientist
Center for Health Policy and Outcomes
Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center New York, NY  10065

Medical Research: What are the main findings of the study?

Dr. Lipitz-Snyderman: Long-term central venous catheters are used to administer intravenous fluids and treatments such as chemotherapy.  These catheters can also be a source of bloodstream infections which can be harmful to cancer patients.  However, this risk is not well understood.  In our study, we found that the use of these catheters was associated with an increased risk of infections for patients with cancer.  We used a population-based dataset, SEER-Medicare, to study this issue in older adult cancer patients.  This dataset allowed us to study patients treated in different institutions and follow them over time.
Continue reading

Uveal Melanoma: MEK Inhibition with Selumetinib Provided Clinical Benefit

Dr. Richard D. Carvajal MD Director, Developmental Therapeutics; Elizabeth and Felix Rohatyn Chair for Junior Faculty Memorial Sloan Kettering Cancer Interview with:
Dr. Richard D. Carvajal MD
Director, Developmental Therapeutics; Elizabeth and Felix Rohatyn Chair for Junior Faculty
Memorial Sloan Kettering Cancer Center

MedicalResearch: What are the main findings of the study?

Dr. Carvajal: This is the first study to show that a systemic therapy provides significant clinical benefit in a randomized fashion to patients with advanced uveal melanoma, a population of patients who have very limited treatment options.   This clinical benefit has never previously been demonstrated with other agents, both conventional or investigational.
Continue reading

Colon Cancer Screening May Be Worthwhile In Previously Unscreened Elderly Interview with:
Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands and
Ann G. Zauber PhD
Memorial Sloan Kettering Cancer Center, New York

MedicalResearch: What are the main findings of the study?

Answer: The main finding of our study is that colorectal cancer screening of individuals without previous screening is worthwhile well beyond age 75, which is the recommended age to stop screening in individuals with an adequate screening history. The exact age up to which screening should be considered in unscreened elderly depends on an individual’s health status: in healthy individuals screening remains worthwhile up to age 86, whereas in individuals with a severe illness, such as heart failure, screening remains worthwhile up to age 80. Continue reading

Breast Cancer: Guidelines on Margins for Breast-Conserving Surgery

dr_monica_morrow Interview Invitation with:

Monica Morrow MD
Anne Burnett Windfohr Chair of Clinical Oncology
Chief Breast Service memorial Sloan Kettering Cancer Center What are the main findings of the study?

Dr. Morrow: The study is the report of a Consensus panel examining the question of whether more widely clear lumpectomy margins than no ink on tumor decrease local recurrence.  A metaanalysis of published literature was used as the primary evidence base for the conclusion.
Continue reading

Advanced Prostate Cancer: Abiraterone (Zytiga) Improved Quality of Life

Dr. Ethan Basch MD Memorial Sloan-Kettering Cancer Interview with
Dr. Ethan Basch MD
Memorial Sloan-Kettering Cancer Center What are the main findings of the study?

Dr. Basch: The primary clinical finding of this study is that treatment with abiraterone acetate delays the time until pain develops or worsens in men with advanced prostate cancer.  Furthermore, abiraterone delays the time until quality of life and functioning deteriorate, compared to placebo.  There is also a broader research finding of this study, which is that it is feasible to rigorously study the time until symptom progression in cancer clinical trials, which paves the way for future studies to use a similar approach.
Continue reading

Lung Cancer: Micropapillary Morphology To Guide Resection vs Lobectomy Choice

Prasad Adusumilli MD, FACS Associate Member, Thoracic Surgery Memorial Sloan-Kettering Cancer Center New Interview with: Prasad Adusumilli MD, FACS
Associate Member, Thoracic Surgery
Memorial Sloan-Kettering Cancer Center
New York What are the main findings of the study?

Answer: The current standard of care of for early-stage lung adenocarcinoma, the common form of lung cancer is curative-intent surgery either by limited resection, LR (removal of tumor with clear margins) or lobectomy, LO (removal of one-third to one-half of the lung harboring the tumor). Although lung-sparing LR is preferable, there is a reported incidence of 30-40% of recurrences within the same lung. The causative factor/s for these local recurrences is not known.

In our study, we analyzed recurrence patterns and pathological features in patients who underwent 476 LO and 258 LR performed at the Memorial Sloan-Kettering Cancer Center, New York. We investigated the morphological patterns in pathology specimens utilizing the recently proposed International Association for the Study of Lung Cancer / European Respiratory Society / American Thoracic Society (IASLC/ERS/ATS) classification. We noticed that presence of micropapillary morphology was associated with three times higher recurrences in patients undergoing LR compared to LO, these recurrences were lower when there is an adequate margin (2 cm) resected beyond the tumor. In patients undergoing LO, the recurrences were 75% less.
Continue reading

2 genetic variations predict second cancers after radiation for children with Hodgkin lymphoma

A genome-wide association study published in the August issue of Nature Medicine has found two tiny genetic variations that can predict which patients with Hodgkin’s lymphoma are most likely to develop radiation-induced second cancers years after treatment. Knowing in advance who is at risk could help physicians tailor treatment to reduce the risks for patients who are most susceptible to long-term damage.

Hodgkin’s lymphoma is one of the most treatable cancers, with more than 90 percent of patients surviving after a combination of radiation and chemotherapy. But nearly 20 percent of patients treated as children develop a second cancer within 30 years. The younger the patients are when treated and the higher the radiation dose, the greater the risk. This late side effect of treatment is the second leading cause of death for long-term Hodgkin’s survivors.

“This finding means we can better identify children who are most susceptible to radiation-induced cancers before treatment begins and modify their care to prevent this serious long-term complication,” said Kenan Onel, MD, PhD, associate professor of pediatrics and senior author of the study. “Luckily our options for Hodgkin’s are broad enough that we can find ways to control the initial disease without relying on radiation therapy.”

“This is also a triumph for genome-wide association studies,” he added. “Many previous GWAS studies found multiple genetic differences, with each of them playing only a modest role, with minimal impact on clinical management. In this study, which focused on the interaction between genes and a very specific environmental factor—cancer long after radiation therapy—a small number of genetic differences produced a very big impact.”

Onel and colleagues analyzed the genomes of 178 Hodgkin’s patients who had been treated between the ages of 8 and 20 with chemotherapy and radiation therapy. Within 30 years after treatment, 96 of them had developed second cancers and 82 had not.

When they scanned each patient’s genome, focusing on 665,313 tiny genetic variations known as single nucleotide polymorphisms, they found three variations that appeared far more often in patients with second cancers. When they repeated the study using a different set of patients—62 cases with second cancers and 71 without—two of the three markers were significant.

Those two markers were both from a small region known as 21q on chromosome 6. Both are positioned near a gene known as PRDM1.

The genetic variations closely associated with increased cancer risk, and with each other, appeared to decrease activation of the PRMD1 gene. They had no detectable effect any other genes. Cells with the protective version of both markers expressed PRDM1 after being exposed to radiation. Cells with the variants linked to subsequent cancers did not produce any PRDM1.

Previous studies have found that PRDM1 is involved in a variety of fundamental cellular processes, including proliferation, differentiation and apoptosis—which can all go awry in cancer. The gene’s activity is lost in many cancer types.

In Onel’s small samples, only three percent of patients with both of the protective variants developed second cancers within 30 years; nearly 33 percent of those with both of the high-risk variations did.

“Taken together,” the authors note, “our findings support a novel role for PRDM1 as a radiation-responsive tumor suppressor.” PRMD1 may be important for understanding the causes of second cancers in survivors of pediatric Hodgkin’s lymphoma as well as in other cancer patients treated with radiation therapy.”

This study should also “bring some optimism” back to genome-wide association studies, Onel added. Most previous cancer-related markers found through GWAS have been “of little clinical value for predicting risk, response to therapy or survival.” But by incorporating environmental exposure, such as radiation therapy, into genomic investigations, “much of the missing heritability can be revealed,” he said. “By folding in the environmental component, we were able to ask a more targeted question. This approach could improve our ability to integrate genomics into routine cancer care.”


The National Institutes of Health, the American Cancer Society, American Lebanese Syrian Associated Charities, the Leukemia Lymphoma Society, the Breast Cancer Research Foundation, the Cancer Research Foundation, and the University of Chicago Comprehensive Cancer Center supported this research.

Additional authors include Timothy Best, Andrew Skol, Sarah Jackson, Olufunmilayo Olopade and Stephanie Huang of the University of Chicago; Dalin Li, Thomas Mack, Wendy Cozen and David Conti of University of Southern California; Kenneth Offit and Thomas Kirchhoff of Memorial Sloan Kettering Cancer Center; Yutaka Yasui of the University of Alberta; Smita Bhatia of City of Hope; Louise Strong of the MD Anderson Cancer Center; Susan Domchek and Katherine Nathanson of the University of Pennsylvania; and Leslie Robison of St Jude Children’s Research Hospital.