Children Undergoing Bone Marrow Transplant Remain At Risk For Premature Death

MedicalResearch.com Interview with:

Smita Bhatia, MD, MPH Gay and Bew White Endowed Chair in Pediatric Oncology Professor, Pediatric Oncology Vice Chair for Outcomes Research, Dept of Pediatrics Director, Institute for Cancer Outcomes and Survivorship School of Medicine University of Alabama at Birmingham Associate Director for Outcomes Research UAB Comprehensive Cancer Center 

Dr. Bhatia

Smita Bhatia, MD, MPH
Gay and Bew White Endowed Chair in Pediatric Oncology
Professor, Pediatric Oncology
Vice Chair for Outcomes Research, Dept of Pediatrics
Director, Institute for Cancer Outcomes and Survivorship
School of Medicine
University of Alabama at Birmingham
Associate Director for Outcomes Research
UAB Comprehensive Cancer Center 

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

Response: Allogeneic bone marrow transplantation BMT is used with a curative intent for life-threatening malignant and non-malignant diseases of childhood.

In this observational study, we describe the late mortality experienced by children undergoing BMT over the past 3 decades. Our cohort included 1388 BMT recipients who had undergone allogeneic BMT between 1974 and 2010 and survived 2 or more years.

We found that, conditional on surviving the first 2 years after bone marrow transplantation, the probability of surviving an additional 20 years approached 80%. Risk of dying from non-relapse-related causes exceeded the risk of dying from relapse-related causes.

The leading non-relapse-related causes of death were infection (with or without graft vs. host disease) and new cancers. Overall, the cohort was at a 14-fold greater risk of dying as compared with the general population (of similar age and sex). Further, this excess risk remained elevated even among those who had survived 25 years.

On a positive note, the risk of late mortality has continued to decline over the past 3 decades. 

Continue reading

Lay Health Workers Reduce Costs and Improve Cancer Patients’ Satisfaction

MedicalResearch.com Interview with:

Manali Patel MD MPH Assistant Professor of Medicine, Oncology Stanford Palo Alto Veterans Affairs Health Care System 

Dr. Patel

Manali Patel MD MPH
Assistant Professor of Medicine, Oncology
Stanford
Palo Alto Veterans Affairs Health Care System  

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

Response: In prior work, many patients with advanced stages of cancer report a lack of understanding of their prognosis and receipt of care that differs from their preferences.

These gaps in care delivery along with the unsustainable rise in healthcare spending at the end-of-life and professional healthcare provider shortages led our team to consider new ways to deliver cancer care for patients.  Based on input from focus groups with patients, caregivers, oncology care providers and healthcare payers, we designed a novel model of cancer care to address these gaps in care delivery.  The intervention consisted of a well-trained lay health worker to assist patients with understanding and communicating their goals of care with their oncology providers and caregivers.

We found that patients who received the six-month intervention reported greater satisfaction with the care they received and their decision-making, had higher rates of hospice use, lower acute care use, and 95% lower total healthcare expenditures in the last month of life.  The intervention resulted in nearly $3 million dollars in healthcare savings.

Continue reading

Gene Biomarker Can Predict Brain Tumor Patients Who Have Better Outcomes

MedicalResearch.com Interview with:

Arnab Chakravarti MD Professor and Chair of Radiation Oncology Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The Ohio State University Comprehensive Cancer Center

Dr. Chakravarti

Arnab Chakravarti MD
Professor and Chair of Radiation Oncology
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
The Ohio State University Comprehensive Cancer Center

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

Response: Historically, the treatment for grade two gliomas has been a black box without really a standard-of-care therapy. In the past, it was really dealer’s choice, where it was based upon physician and patient preference. Either radiation alone, radiation plus chemotherapy, or chemotherapy alone, there wasn’t really any data to guide therapeutic decision-making. Then about three years ago the landmark study RTOG 9802 was published, which demonstrated a survival benefit with the addition of chemotherapy to radiation versus radiation alone. That became the standard of care for the treatment of grade two gliomas.

One of the tricky issues with regards to these tumors is that there’s a wide range of outcomes.

There are patients that succumb to disease within months, others that live decades. It’s very
important to personalize care for the individual patient and that’s why biomarkers, prognostic and predictive biomarkers are so important. The 9802 study showed us for the general population of patients that the addition of chemotherapy to radiation improved outcomes versus radiation alone.

The patient population that was selected for our study were the high-risk low-grade glioma
patients. Patients who are generally over the age of 40, tumor sizes that exceeded 6 cm in terms of maximum dimension, tumors that invaded the corpus callosum, astrocytic histology of patients with neurological symptoms. These are typically the patients that were included in the study. Really the main objective of this study was to determine the efficacy of treatment compared to historical controls. Continue reading

Early Dinner May Lower Cancer Risk

MedicalResearch.com Interview with:
“Christmas Roast and Ham Dinner. Had Tamales for Christmas Eve and Christmas morning. #Roast #Ham #ChristmasDinner #Christmas #Champagne #Dinner #Foodstagram” by Yvonne Esperanza is licensed under CC BY 2.0Manolis Kogevinas, MD, PhD

Research Professor
NCDs & Environment Group
Barcelona Institute for Global Health (ISGlobal) – Campus MAR
Barcelona Biomedical Research Park (PRBB) (office 194)
Barcelona, Spain

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

Response: We did the study for two main reasons.

(i) breast and to a less extent prostate cancer are the cancers that have been associated with night shift work and resulting circadian disruption (disruption of the natural day-light cycle);

(ii) experimental studies in animals indicate that timing of diet is important. For example, giving an hypercaloric diet to mice during the day results in obesity, while giving the same diet during the night does not. Mice are nocturnal animals and this means that there normal eating time is the night when they can metabolise what they eat. So, would something similar affect humans? When we eat in late hours at a time when “normally” (normally in the sense of evolution) we would be resting.

In this study we show that adherence to a more diurnal eating pattern and specifically an early supper and a long interval between last meal and sleep are associated with a lower breast and prostate cancer risk. Specifically having super before 9pm and having an interval of 2 hours between the last big meal and sleep, were both associated with an approximately 20% prevention of breast and prostate cancer) compared to those who have supper after 10pm or those who eat and then sleep very close after supper.

Also, the strongest protection was found in “morning types” as compared to “evening types”. Morning types are expected to function worse than evening types in late evening so late suppers may have more adverse effects on them.

Continue reading

TARDOX Study: Targeting liver tumours with focused ultrasound for triggered drug delivery of thermosensitve liposomes is safe, feasible and enhances delivered dose

MedicalResearch.com Interview with:

Paul Lyon DPhil, MRCS Academic Clinical Fellow in Radiology Oxford University Hospitals NHS Foundation Trust Oxford, UK

Dr. Lyon

Paul Lyon DPhil, MRCS
Academic Clinical Fellow in Radiology
Oxford University Hospitals NHS Foundation Trust
Oxford, UK

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

Response: Delivering therapeutic doses of systemic chemotherapy to solid tumours, whilst ensuring side effects remain tolerable, has a presented a long-standing and unsolved challenge in oncology. With the advent of smart nanomedicines for clinical use, such as Lyso-Thermosensitive Liposomal Doxorubicin (LTLD, ThermoDox®, Celsion, USA), which has been formulated to release its doxorubicin content at 2.5°C above body temperature, there is now opportunity for targeted tumour therapy in combination with therapeutic devices.

Much like a magnifying glass can focus energy from the sun to burn a hole in paper, ultrasound can be focused deep within the body to induce therapeutic effects in tumours, including ablation, hyperthermia and other bioeffects. Since its inception in the 1940s, focused (or therapeutic) ultrasound has evolved and is now FDA-approved for a variety of indications including ablation of several tumour types, virtue of being safe, non-invasive and non-ionising.

Building on decades of preclinical research efforts worldwide, the TARDOX study is the first clinical trial to attempt triggered drug delivery to a target tumour non-invasively using an external focused ultrasound device. This phase 1 study which ran between March 2015-March 2017 in Oxford, UK, treated 10 patients with inoperable primary or secondary liver tumours which were either stable or refractory to previous chemotherapies. In each patient, a single intervention under general anaesthetic was performed during which a selected liver tumour was targeted and gently heated with focused ultrasound following an intravenous infusion of LTLD. Biopsies were used to determine the quantity of intratumoral doxorubicin before and after the ultrasound exposure.  Continue reading

Vitamin D and Colorectal Cancer Risk – What is the Correlation?

MedicalResearch.com Interview with:

Stephanie J. Weinstein, M.S., Ph.D.  Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH 

Dr. Weinstein

Stephanie J. Weinstein, M.S., Ph.D. 
Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics
National Cancer Institute, NIH  

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

Response: Vitamin D, known for its role in maintaining bone health, is hypothesized to lower colorectal cancer risk via several pathways related to cell growth and regulation. Previous prospective studies have reported inconsistent results for whether higher concentrations of circulating 25-hydroxyvitamin D, the accepted measure of vitamin D status, are linked to lower risk of colorectal cancer. The few randomized clinical trials of vitamin D supplementation and colorectal cancer completed thus far have not shown an effect; but study size, relatively short supplementation duration, and only moderate compliance may have contributed to their null findings.

To address inconsistencies in prior studies on vitamin D, and to investigate associations in population subgroups, we harmonized and analyzed participant-level data from over 5,700 colorectal cancer cases who had blood collected before colorectal cancer diagnosis, and 7,100 matched cancer-free controls. Study participants were drawn from 17 prospective cohorts from the United States, Europe, and Asia and were followed for an average of 5.5 years (range: 1 – 25 years). We used a single, widely accepted assay and laboratory for new vitamin D measurements and calibrated existing vitamin D measurements. In the past, substantial differences between assays made it difficult to integrate vitamin D data from different studies. Our novel calibration approach enabled us to explore risk systematically over the broad range of vitamin D levels seen internationally.  Continue reading

Ultrasound Therapy Found To Be Effective Option For Prostate Cancer

MedicalResearch.com Interview with:

Prof. Hashim Ahmed Professor and Chair of Urology Imperial College London

Prof. Ahmed

Prof. Hashim Ahmed
Professor and Chair of Urology
Imperial College London

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

Response: Men with localised clinically significant prostate cancer currently undergo radical (whole gland) surgery or radiotherapy. These treatments are effective but can cause urine leakage in 5-30% and erectile dysfunction in 30-60%. Radiotherapy can cause rectal problems in 5%.

So, although there is benefit in treating the cancer in these men, the side effects significantly affect the quality of life. 

Continue reading

HPV Testing Detects Cervical Pre-Cancer Earlier Than PAP Tests

MedicalResearch.com Interview with:

Gina Ogilvie | MD MSc FCFP DrPH Professor | Faculty of Medicine | University of British Columbia Canada Research Chair | Global control of HPV related disease and cancer Senior Public Health Scientist | BC Centre for Disease Control Senior Research Advisor | BC Women's Hospital and Health Centre BC Women's Hospital and Health Centre Vancouver, BC

Dr. Gina Ogilvie

Dr. Gina Ogilvie | MD MSc FCFP DrPH
Professor | Faculty of Medicine | University of British Columbia
Canada Research Chair | Global control of HPV related disease and cancer
Senior Public Health Scientist | BC Centre for Disease Control
Senior Research Advisor | BC Women’s Hospital and Health Centre
BC Women’s Hospital and Health Centre
Vancouver, BC

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

Response: HPV is known to be the cause of 99% of cervcial cancers.

In this study, we compared the routine screening test for cervical cancer, Pap test, to HPV testing.

We found that by using HPV testing, women were significantly more likely to have cervical pre-cancers detected earlier. In addition, women with negative HPV tests were significantly less likely to have pre-cancers 48 months later.

Continue reading

Enzalutamide (Xtandi) Provides Men with NonMetastatic Castration Resistant Prostate Cancer an Effective Treatment Option

MedicalResearch.com Interview with:

Maha Hussain, MD, FACP, FASCO Genevieve Teuton Professor of Medicine Division of Hematology/Oncology Deputy Director Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine

Dr. Hussain

Maha Hussain, MD, FACP, FASCO
Genevieve Teuton Professor of Medicine
Division of Hematology/Oncology
Deputy Director
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine

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

Response: Until recently patients with non metastatic castration resistant prostate cancer (nmcrpc) had no impactful systemic therapy options.  Progression to metastatic crpc; the deadly phase of the cancer, is a given in the vast majority of patients.

Enzalutamide significantly delayed the time to metastases development by almost 2 years compared to placebo with a 71% reduction in the risk of metastases or death and a median metastases free survival of 36.6 compared to 14.7 months respectively.  This was accomplished without negative impact on quality of life (qol).  Enzalutamide treated patients had a higher rate of PSA declines and delayed time to requiring other anticancer therapies.   

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

Response: Androgen receptor targeting continues to be clinically relevant in this disease and the therapeutic impact is greater in earlier disease settings with lower tumor burden. This data provides men with non metastatic castration resistant prostate cancer an effective treatment option.

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

Response: In this disease setting maximizing the antitumor effect with rational combinations to increase tumor kill with the goal of further reducing the risk of metastasis and prolonging overall survival and potentially hope for “cure”. 

MedicalResearch.com: Is there anything else you would like to add? Any disclosures:

Response: On behalf of all my coauthors and study investigators I wish to thank the patients and their caregivers for participating in this trial.  Their partnership is critical to defeat prostate cancer.

Research funding to our institutions for clinical trials from Pfizer.

Citation:

Enzalutamide in Men with Nonmetastatic, Castration-Resistant Prostate Cancer

Maha Hussain, M.D., Karim Fizazi, M.D., Ph.D., Fred Saad, M.D., Per Rathenborg, M.D., Neal Shore, M.D., Ubirajara Ferreira, M.D., Ph.D., Petro Ivashchenko, M.D., Eren Demirhan, Ph.D., Katharina Modelska, M.D., Ph.D., De Phung, B.S., Andrew Krivoshik, M.D., Ph.D., and Cora N. Sternberg, M.D.
June 28, 2018
N Engl J Med 2018; 378:2465-2474
DOI: 10.1056/NEJMoa1800536

 

 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Recombinant Polio Vaccine Improved Survival Rate Among Some With Aggressive Recurrent Brain Tumor

MedicalResearch.com Interview with:

Dr. Annick Desjardins, Assistant Professor of Medicine, photographed on October 2, 2013.

Dr. Desjardins

Annick Desjardins, M.D., F.R.C.P.C.
Associate Professor of Neurology
Associate Professor of Neurosurgery
Director of Clinical Research
The Preston Robert Tisch Brain Tumor Center at Duke
Duke University School of Medicine
Durham, NC 27710

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

Response: The poliovirus receptor (CD155) is an onco-fetal cell adhesion molecule with widespread expression in all solid tumors and particularly in primary CNS tumors (adult and pediatric).

Recombinant nonpathogenic polio–rhinovirus chimera (PVSRIPO) was generated by replacing a critical piece of the genetic information from the Sabin type 1 polio vaccine, making PVSRIPO incapable of harming or killing normal brain cells, but toxic/lethal in cancer cells. In preclinical models, it has been demonstrated that the infection of tumor cells, leads to the release of danger signals, which triggers a recruitment of dendritic/CD4/CD8 T cells and a destruction of tumor cells by anti-tumor T cells.

The manuscript reports the results of the phase 1 trial of PVSRSIPO in recurrent WHO grade IV malignant glioma patients. Adult patients with recurrence of a single glioblastoma lesion, 1-5.5cm in dimension, in a non-eloquent area of the brain, were enrolled on study. PVSRIPO is injected slowly over 6.5 hours directly into the tumor via a small catheter inserted via a small bur hole. Once intratumoral injection is completed, the catheter is removed and patients are observed for localized tumor inflammation, followed by tumor contraction. A total of 61 patients were treated on study, 9 patients in a dose escalation phase and 52 in a dose expansion phase. Side effects observed were in relation to the localized inflammation of the tumor and depending on the cerebral functions in close proximity to the tumor: headaches, visual field changes, hemiparesis, etc.

One patient experienced a brain hemorrhage at the time of catheter removal, which triggered right sided weakness and aphasia. The patient remained alive 57.5 months after PVSRIPO infusion at data cutoff of March 20th, 2018. Two on-study death were observed, a patient died from cerebral edema and seizures, which was later found to be due to tumor progression, and one patient died from the complications of an intracranial hemorrhage while receiving anticoagulation and bevacizumab.

The median overall survival among all 61 patients who received PVSRIPO was 12.5 months (95% CI, 9.9 to 15.2), comparatively to 11.3 months (95% CI, 9.8 to 12.5) in a historical control group of patients treated at Duke and who would have met eligibility on trial, would have the trial been available to them.

At 24 months, the survival plateaued in patients treated with PVSRIPO with an overall survival rate of 21% (95% CI, 11 to 33) at 24 months and 36 months in PVSRIPO treated patients, while overall survival in the historical control group continued to decline, with an overall survival rates of 14% (95% CI, 8 to 21) at 24 months and 4% (95% CI, 1 to 9) at 36 months in the historical control group.  Continue reading

PD-1 Inhibitors Appear to Improve Overall Survival More than Progression-Free Cancer

MedicalResearch.com Interview with:

Bishal Gyawali, MD, PhD Department of Medicine Brigham and Women's Hospital

Dr. Bishal Gyawali

Bishal Gyawali, MD, PhD
Department of Medicine
Brigham and Women’s Hospital

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

Response: PD-1 inhibitors are an interesting class of cancer drugs with atypical response patterns in clinical trials. There is a lot of debate over cancer drugs that improve progression-free survival (PFS) – a surrogate measure of clinical benefit– without affecting patients’ overall survival (OS), but in some studies, PD-1 inhibitors appears to improve overall survival (OS) without affecting PFS.

We therefore conducted a systematic review and meta-analysis of randomized trials of PD-1 inhibitors (nivolumab and pembrolizumab) to assess the effect of these drugs on OS versus PFS. We showed that PD-1 inhibitors do appear to improve OS more than PFS.  Continue reading

How Does Alcohol Affect Risk of Cancer or Premature Death?

MedicalResearch.com Interview with:
“Alcohol” by zeevveez is licensed under CC BY 2.0Andrew Kunzmann
Research Fellow
Queen’s Universit
Belfast

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

Response: We decided to conduct this research because the messages about the health effects linked to light-moderate drinking are less consistent. Previous studies suggest that light-moderate drinking is linked to an increased risk of cancer but a lower risk of mortality than never drinking. The international guidelines around what constitutes drinking in moderation also differ, with UK guidelines now recommending intakes below 6 pints of beer or 175ml glasses of wine per week (equivalent to less than 1 per day) but other guidelines recommending intakes of 2 drinks or less per day. We wanted to see what the risk of getting either of these conditions (cancer or mortality) were to give a more comprehensive and less confusing message about the health effects of light-moderate drinking.

This was part of a well-established collaboration between Queen’s University Belfast and the National Cancer Institute in the US. We used data from a cancer screening trial in the US that contained data on over 100,000 people from the US, who were free from cancer at the start of the study and who completed a questionnaire asking how much alcohol they consumed at different periods of their adult life. This was then linked to data over an average of 9 years after they completed the questionnaire to see which individuals developed cancer or died from any cause. We then assessed whether risk of cancer and mortality differed based on lifetime alcohol intakes after accounting for a number of other factors such as age, educational attainment, smoking and dietary intakes.

Continue reading

Radionuclide 177Lu-Dotatate Improves QoL in Patients with Neuroendocrine Tumors

MedicalResearch.com Interview with:

Jonathan Strosberg MD Moffitt Cancer Center Tampa, FL

Dr. Strosberg

Jonathan Strosberg MD
Moffitt Cancer Center, Tampa, FL

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

Response: Neuroendocrine tumor (NET) progression is associated with deterioration in quality of life. We assessed the impact of 177Lu-Dotatate treatment on time to deterioration in health-related quality of life in patients with advanced midgut neuroendocrine tumors in the NETTER-1 study.

Continue reading

Long Term HIV Viral Suppression Reduces But Does Not Eliminate Elevated Cancer Risk

MedicalResearch.com Interview with:

Lesley S. Park, PhD, MPH Instructor, Medicine- Primary Care and Population Health BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

Dr. Lesley Park

Lesley S. Park, PhD, MPH
Instructor, Medicine- Primary Care and Population Health
BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship
Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

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

Response: As the population of persons living with HIV/AIDS is aging, the overall burden of cancer is substantial and increasing; however, we have much to learn about the potential cancer prevention benefits of antiretroviral treatment (ART).

Our study is the first to examine the effects of prolonged periods of viral suppression and potential cancer prevention benefits. While prior randomized clinical trials (RCTs) and observational studies have examined viral suppression and cancer risk, they mostly were limited to small numbers of cancer outcomes or were only focused on few specific cancer types.

Our study demonstrated a benefit of the prevention of cancer development in AIDS-defining cancers (non-Hodgkin lymphoma, Kaposi sarcoma), which was expected, but also in some non-AIDS-defining cancer types (lung, larynx, melanoma, leukemia).  Continue reading

bpMRI Can Be Used to Improve Prostate Cancer Risk

MedicalResearch.com Interview with:

Lars Boesen MD PhD Department of Urology Herlev Gentofte University Hospital Herlev

Dr. Boessen

Dr. Lars Boesen MD PhD
Department of Urology
Herlev Hospital

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

Response: The current standard of care in prostate cancer diagnosis includes untargeted transrectal ultrasound-guided biopsies for all biopsy-naïve men with clinically suspicion of prostate cancer. However, this strategy that practically has remained unchanged for decades has limited diagnostic accuracy as significant cancers are missed or under-graded and insignificant cancers are unintendedly detected by the random sampling leading to possible overtreatment.

Multiparametric MRI in the diagnosis of prostate cancer has been studied extensively in recent years and has improved detection, localization, staging and risk stratification. It has been suggested that if multiparametric MRIs were used as a triage test prior to biopsies, a significant proportion of men might safely avoid prostate biopsies and the diagnostic ratio of significant vs. insignificant cancer could be improved compared to performing standard biopsies in all men. However, multiparametric MRIs are generally time-consuming (~40 min scan time), expensive and include intravenous contrast media. This reduces its feasibility for widespread clinical implementation in larger patient populations in the western community with its high PCa prevalence.

The development of a simpler and faster (~15 min) biparametric MRI protocol using less scan sequences and circumvents intravenous contrast-media seems to preserve adequate diagnostic accuracy in a detection setting and could facilitate dissemination of prostate MRI as a triage test before any biopsy.

Here we present a large prospective study that assesses the diagnostic accuracy of a novel biparametric MRI to rule out significant prostate cancer in N=1020 biopsy-naive men with clinically suspicion of prostate cancer.

We found that a low suspicion biparametric MRI had a very high negative predictive value (97%) for ruling out significant cancer on confirmatory biopsies. Furthermore, bpMRI suspicion scores were strongly associated with prostate cancer detection rates and restricting biopsies (targeted plus standard) to men with suspicious biparametric MRIs meant 30% could avoid prostate biopsies, improved significant prostate cancer diagnosis by 11%, and reduced insignificant prostate cancer diagnosis by 40% compared to our current diagnostic approach – standard biopsies for all men with clinically suspicion of prostate cancer.  Continue reading

How Long Should Cancer Survivors Be Followed by Oncology?

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Dr. Anil K. Sood M.D. Professor and Vice Chair for Translational Research in the Departments of Gynecologic Oncology and Cancer Biology and co-director of the Center for RNA Interference and Non-Coding RNA MD Anderson Cancer Center

Dr. Sood

Dr. Anil K. Sood M.D.
Professor and Vice Chair for Translational Research in the Departments of Gynecologic Oncology and Cancer Biology and co-director of the Center for RNA Interference and Non-Coding RNA
MD Anderson Cancer Center

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

Response: Cancer survivorship care involves coordinating between oncologists, surgeons, and primary care teams, yet there are no consistent or universal guidelines to dictate who will oversee which aspects of care, and when.

MedicalResearch.com: What are the main findings?

Response: Some cancer survivorship populations have a short high-risk period and exceedingly low cancer mortality, suggesting their survivorship care may best be overseen by their primary care physician. The highest-risk populations saw a majority of deaths from their primary cancer, and had high-risk periods longer than five-years, suggesting an extended period of survivorship care management by their oncologist.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Many patients may be undergoing excessively long survivorship care with their oncologist, while others may be receiving insufficient periods of oncologist-led survivorship care

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

Response: This study looked at broad, organ-based cancer types. The methods used in this study could be performed to further tailor personalized survivorship care based on cancer and patient-level specifics.

All authors have no pertinent disclosures.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community

Citation:

Dood RL, Zhao Y, Armbruster SD, et al. Defining Survivorship Trajectories Across Patients With Solid TumorsAn Evidence-Based Approach. JAMA Oncol. Published online June 02, 2018. doi:10.1001/jamaoncol.2018.2761

 

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

What Happened to Prostate Cancer Screening and Treatment After PSA Guidelines Changed?

MedicalResearch.com Interview with:

James T. Kearns, MD Clinical Fellow, Department of Urology University of Washington School of Medicine Seattle, WA 

Dr. Kearns

James T. Kearns, MD
Clinical Fellow, Department of Urology
University of Washington School of Medicine
Seattle, WA

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

Response: The effects of the USPSTF recommendation against prostate cancer screening had not been fully characterized among a younger population, particularly with respect to downstream effects such as prostate biopsy, prostate cancer diagnosis, and treatment for prostate cancer.

We found that PSA testing decreased in the years surrounding the USPSTF recommendation, but we also found a larger proportionate decrease in prostate biopsy, prostate cancer diagnosis, and use of surgery or radiation for the treatment of prostate cancer.

Continue reading

Combination Therapy Could Dramatically Alter CLL Treatment

MedicalResearch.com Interview with:

Dr. Danelle James,

Dr. James

Dr. Danelle James, M.D., M.A.S.
Head of Clinical Science
Pharmacyclics, an AbbVie Company

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

Response: CAPTIVATE is a Phase 2 study investigating IMBRUVICA (ibrutinib) plus VENCLEXTA (venetoclax) for the treatment of Chronic Lymphocytic Leukemia (CLL) in the first-line setting. It was designed to evaluate if remission with undetectable minimal residual disease (MRD) can provide treatment-naïve CLL/SLL patients with treatment holidays (a period of time when a patient is able to stop therapy). The study enrolled 164 patients with previously untreated CLL or SLL.

In preclinical and ongoing clinical studies, we’ve seen complementary activities with this combination. The combination has also previously shown potential for deeper remissions, as well as potential for lower risk of tumor lysis syndrome with ibrutinib as the lead-in therapy.

Early data from CAPTIVATE show promising activity for the combination in this patient population, with 77 percent of the first 30 patients achieving responses with no detectable MRD in the blood after only six cycles of the combination therapy. Approximately nine out of 10 of the first patients achieved undetectable MRD after 12 cycles of combination therapy (which were preceded by three cycles of single agent ibrutinib, for a total of 15 cycles of therapy). Specifically, 86 percent of the first 14 patients achieved undetectable MRD in the marrow and 93 percent in the peripheral blood.

Continue reading

Smokers At Increased Risk of Prostate Cancer Recurrence

MedicalResearch.com Interview with:
“Stop smoking!” by Emil_95 is licensed under CC BY 2.0Shahrokh F. Shariat, M.D.
Professor and Chairman
Department of Urology,
Comprehensive Cancer Center
Medical University Vienna
Adjunct Professor of Urology and Medical Oncology
Weill Medical College of Cornell University, New York, NY, USA
Adjunct Professor of Urology
UT Southwestern, Dallas, TX

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

Response: We know that tobacco smoking produces more than 70 carcinogens and is associated with worse prognosis in many solid cancers.

Although the association between cigarette smoking and prostate cancer death has been demonstrated, such association regarding other end points is still unclear. We evaluated different disease endpoints, such as recurrence, occurrence of metastasis and cancer-specific mortality at an earlier stage of disease. We found that smokers who underwent primary treatment for localized prostate cancer – such as radical prostatectomy and radiotherapy – are at increased risk of recurrence, metastasis and cancer-specific mortality.  Continue reading

More Young Women Than Men Now Get Lung Cancer

MedicalResearch.com Interview with:
“Woman smoking” by Pedro Ribeiro Simões is licensed under CC BY 2.0Ahmedin Jemal, DVM, PHD
Scientific Vice President, Surveillance & Health Services Rsch
American Cancer Society, Inc.
Atlanta, GA 30303

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

Response: Historically, lung cancer rates have been higher in men than women at all ages because of the substantially higher cigarette smoking prevalence in men.

However, cigarette smoking prevalences over the past few decades have become similar between young men and women. Consistent with this pattern, we previously reported the convergence of lung cancer rates between young men and young women. In this paper, we examined the lung cancer incidence rates in young women versus young men in the contemporary cohorts.

We found that the historically higher lung cancer incidence rates in young men than in young women have reversed in whites and Hispanics born since the mid-1960s. However, this emerging incidence patterns were not fully explained by sex difference in smoking prevalence as cigarette smoking prevalences among whites and Hispanics were not higher in young women than young men.

Continue reading

Checkpoint Inhibitors Rapidly Being Incorporated Into Routine Cancer Care

MedicalResearch.com Interview with:

Jeremy O'Connor, MD Section of General Internal Medicine Department of Internal Medicine Postdoctoral Fellow, National Clinician Scholars Program Yale University

Dr. O’Connor

Jeremy O’Connor, MD
Section of General Internal Medicine
Department of Internal Medicine
Postdoctoral Fellow, National Clinician Scholars Program
Yale University

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

Response: There has been a lot of enthusiasm for the use of novel therapies in cancer care, and in particular for novel anticancer agents known as immune checkpoint inhibitors. But very little is known about how quickly providers have adopted immune checkpoint inhibitors into clinical practice. Existing studies suggest, in fact, that the process of clinical adoption is slow, with conventional wisdom holding that it takes an average of 17 years for new evidence to change practice.

Our study evaluated whether the adoption of novel therapies might be much faster in certain contexts with the early use of immune checkpoint inhibitors as a notable example.

Continue reading

Men Receive Triple Amount of Cancer Research Funding

MedicalResearch.com Interview with:
“Faecal Coliforms analysis” by SuSanA Secretariat is licensed under CC BY 2.0Dr. Mahiben Maruthappu

Public Health Registrar

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

Response: Gender disparities in the fields of science and technology have been documented, and  it becomes increasingly apparent at higher levels of seniority. In this analysis, we found a quantifiable difference in cancer research funding awarded to female principle investigators compared to male principle investigators (PIs).

Across all cancer research funding grants that we identified, male PIs received 3.6 times the total investment value, and 1.6 times the average award value compared with their female counterparts.  Continue reading

New Biomarker Could Change Lung Cancer Treatment Paradigm

MedicalResearch.com Interview with:
Ryo Nagashio, Ph.D.

Department of Molecular Diagnostics
School of Allied Health Sciences, Kitasato University
Japan.

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

Response: Lung cancer is the leading cause of cancer deaths in both men and women in the United States and worldwide. The disease is associated with a poor prognosis because most lung cancers are only diagnosed at an advanced stage. The identification of patients at an early stage of cancer when it can be treated surgically is extremely important to improve prognosis.

Current biomarkers for lung cancer include carcinoma embryonic antigen (CEA), sialyl Lewis X antigen (SLX), SCC antigen, and cytokeratin fragment (CYFRA) 21-1, but these are not sensitive enough to detect tumors early.

The results of our study provide evidence that the CKAP4 protein may be a novel early sero-diagnostic marker for lung cancer. Across disease stages I-IV, the sensitivities of serum CEA, CYFRA, and SCCa are reported with 30-52, 17-82, and 24-39 percent, respectively. In this study, the sensitivity of serum CKAP4 was 81 percent in the training set and 69 percent in the validation set. These rates are higher than those of the current sero-diagnostic markers. Furthermore, the sensitivity of serum CKAP4 was also high even in stage I non-small cell lung cancer.

Continue reading

Which Cancers Cost The Most To Treat?

MedicalResearch.com Interview with:

Matthew P. Banegas, PhD, MPH Center for Health Research Kaiser Permanente

Dr. Banegas

Matthew P. Banegas, PhD, MPH
Center for Health Research
Kaiser Permanente

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

Response: Despite a large body of research on cancer care costs, we observed a significant evidence gap. Namely, while about one-half of cancer diagnoses in the U.S. occur among people under age 65, it can be difficult to find good data on the costs of care for this population. That’s because most of the current literature on cancer care costs is based on SEER Medicare data, which are limited to Medicare fee-for-service beneficiaries.

At a time of rising costs and an ever-increasing number of new therapies, we felt it was important to improve our understanding of cancer costs for U.S. adults of all ages. We examined medical care costs for the four most common types of cancer in the United States: breast, colorectal, lung, and prostate cancer.

Continue reading

Chemotherapy Choice Can Be Aided By Assessing TDP Profile

MedicalResearch.com Interview with:

Ed Liu, M.D President and CEO The Jackson Laboratory (JAX)

Dr. Ed Liu

Ed Liu, M.D
President and CEO
The Jackson Laboratory (JAX)

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

Response: A few years ago we and others identified a complex genomic instability profile commonly found in the genomes of breast, ovarian and endometrial carcinomas, which is characterized by hundreds of isolated head-to-tail duplications of DNA segments, called tandem duplications. We refer to this configuration as the tandem duplicator phenotype, or TDP.

In this study, we perform a meta-analysis of over 2,700 cancer genomes from over 30 different tumor types and provide a detailed description of six different types of TDP, distinguished by the presence of tandem duplications of different sizes. Collectively, these profiles are found in ~50% of breast, ovarian and endometrial carcinomas as well as 10-30% of adrenocortical, esophageal, stomach and lung adeno-carcinomas. We show that distinct genetic abnormalities associate with the distinct TDPs, clearly suggesting that distinct molecular mechanisms are driving TDP formation. In particular, we provide strong evidence of a casual relationship between joint abrogation of the BRCA1 and TP53 tumor suppressor genes and the emergence of a short-span (~11 Kb) TDP profile. We also observe a significant association between hyper-activation of the CCNE1 pathway and TDP with medium-span (~230 Kb) tandem duplications, and between mutation of the CDK12 gene and medium- and large-span TDP (coexisting 230 Kb and 1.7 Kb tandem duplications).

Importantly, we find that different forms of TDP result in the perturbation of alternative sets of cancer genes, with short-span TDP profiles leading to the loss of tumor suppressor genes via double transections, and larger-span TDP profiles resulting in the duplication (i.e. copy number gain) of oncogenes and gene regulatory elements, such as super-enhancers and disease-associated SNPs.  Continue reading