Oncology NEWS International Vol 6 No 11

November 01, 1997

HAMBURG-The challenge in the treatment of pancreatic cancer “is to take systemic therapy one step further, whether it’s with new drugs or with novel approaches based on new biologic information,” Margaret Tempero, MD, of the University of Nebraska Medical Center, Omaha, said at the Ninth European Cancer Conference (ECCO 9), sponsored by the Federation of European Cancer Societies.

November 01, 1997

HAMBURG-Tumor cell detection (TCD) in bone marrow should supplant axillary lymph node status as a prognostic indicator for women with early breast cancer, Ingo J. Diel, MD, of the University of Heidelberg, said at the Ninth European Cancer Conference (ECCO 9).

November 01, 1997

CHICAGO-October’s National Breast Cancer Awareness Month (NBCAM) had a special focus on women in America’s agricultural communities. Zeneca, a founding co-sponsor of NBCAM, said that its breast cancer education program will target rural women to raise awareness of the need for mam-mography and other early detection methods in this population.

November 01, 1997

CHICAGO-Health care professionals who provide care to cancer patients need to help managers of employee benefits programs determine the cost and quality of the oncology services they purchase, said Dale Orred, corporate benefits manager for United Parcel Service, Atlanta.

November 01, 1997

CHICAGO-As the health care system in this country shifts from fee for service to managed care, private and public payers are being forced to make decisions about the oncology services they purchase. As payers struggle to define the scope of their coverage of oncology services, however, they may be ignoring the aspects of care that are most important to patients, speakers said at a conference on purchasing oncology services, sponsored by the American Cancer Society.

November 01, 1997

HAMBURG-Although BCG is extremely effective in high-risk bladder cancer and carcinoma in situ, many physicians hesitate to use it because of the intense inflammation and systemic side effects it produces. Moreover, no consensus has yet been reached about whether BCG is actually superior to chemotherapy.

November 01, 1997

HAMBURG-A 10-center phase III trial from the Netherlands has revealed that adjuvant vaccine therapy not only reduces the risk of recurrence but also prolongs relapse-free survival in patients with Duke’s B2, B3, or C colon cancer, Dr. J.B. Vermorken reported at the Ninth European Cancer Conference (ECCO 9).

November 01, 1997

HAMBURG-In women with operable breast cancer of small size, sentinel node biopsy can be used to predict the status of the axillary lymph nodes and thereby avoid unnecessary axillary dissection, according to a report from the European Institute of Oncology in Milan presented at the Ninth European Cancer Conference (ECCO 9).

November 01, 1997

TORONTO-Cancer patients with febrile neutropenia have routinely been hospitalized and treated with intravenous antibiotics. A pilot study presented at the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) suggests that low-risk patients can be treated just as well at home.

November 01, 1997

BROOKVILLE, NY-“Most of us wait until it’s too late to make decisions on end-of-life care,” Robert C. Cassidy, PhD, said at a conference on that subject. “But somewhere out there is an abyss, and we better start knitting a parachute before we get pushed out of the plane.”

November 01, 1997

ATLANTA-With dose-escalation studies of adjuvant chemotherapy in node-positive breast cancer producing mixed results, many researchers are moving to the dose-density approach, Clifford A. Hudis, MD, said at the Third Annual Perspectives in Breast Cancer meeting.

November 01, 1997

HAMBURG-More than 6,000 cancer researchers, clinical oncologists, and specialist cancer nurses from all over the world attended the Ninth European Cancer Conference (ECCO 9), considered Europe’s foremost multidisciplinary oncology event. (See reports on pages 1, 2, 3, 8, 13, 15, 24, 27, and 40.)

November 01, 1997

WASHINGTON-The House and Senate have each passed bills revising the process by which the Food and Drug Administration approves new drugs and medical devices. But what happens in the conference committee that resolves a significant difference between the two measures may well decide whether President Clinton signs or vetoes the final bill.

November 01, 1997

n PRINCETON, NJ-A single dose of Quadramet (Samarium Sm 153 Lexidronam injection) significantly relieved bone pain in patients with metastatic breast, prostate, and other primary cancers in a dose-dependent manner, a multicenter European study has shown.

November 01, 1997

CHICAGO-“Is the private practice oncologist at risk? I think we are,” said Bruce Feinberg, DO, at the first national conference on purchasing oncology services, sponsored by the American Cancer Society and the Kerr L. White Institute for Health Services Research, Decatur, Ga.

November 01, 1997

PHILADELPHIA-The growing use of pulmonary cytology, and consequent increasing experience of cytopath-ologists, has raised the diagnostic accuracy of the five basic pulmonary cytology techniques, Nadia Al-Kaisi, MD, told Oncology News International in an interview after her workshop on the subject at the annual fall meeting of the American Society of Clinical Pathologists (ASCP) and College of American Pathologists (CAP).

November 01, 1997

CHICAGO-When the US Supreme Court decided recently that patients have no inherent right to physician-assisted suicide, it neglected to help physicians decide how to respond to those “exceptional cases involving real patients with real suffering,” said Timothy E. Quill, MD, at the American Academy of Family Physicians annual meeting.

November 01, 1997

CHICAGO-The purchasers that make critical health care decisions for approximately 75% of the American population who have insurance readily acknowledge they have little understanding of the cost of oncology care or the types of services that cancer patients need.

November 01, 1997

BARCELONA, Spain-Intrathecal administration of the selective neuronal channel blocker SNX-111 via an external pump proved safe and feasible in 11 patients with chronic intractable pain. More than half of the group saw an improvement in pain control, William Brose, MD, reported at a meeting of the International Association for the Study of Pain.

November 01, 1997

SAN DIEGO-Just as a glacier may advance and retreat simultaneously, managed oncology care appears to be experiencing both integration and disintegration, said James L. Wade III, MD, president of the Association of Community Cancer Centers (ACCC).

November 01, 1997

PITTSBURGH-A special microscope capable of “seeing” some 40 different wavelengths of the visible color spectrum is being used to add dramatic new colors to stained tissues, which may enhance the pathologist’s ability to detect malignancies.

November 01, 1997

WASHINGTON-A consensus conference convened to assess the treatment of estrogen deficiency symptoms in breast cancer survivors has recommended that physicians treat these women with “tailored treatment strategies” that avoid the use of estrogen but provide its short-term and long-term benefits.

November 01, 1997

HAMBURG-Patients with poor-prognosis M1 prostate cancer who undergo orchidectomy have little to gain and much to lose from adjuvant mitomycin (Mutamycin) therapy, according to the findings of a phase III study from the EORTC’s Genitourinary Tract Cancer Cooperative Group.

November 01, 1997

LOS ANGELES-The West Los Angeles VA Medical Center is seeking 21 patients with relapsed or refractory multiple myeloma to participate in a phase II clinical trial of pamidronate disodium for injection (Aredia).

November 01, 1997

In Session I of the First Sonoma Conference on Prostate Cancer, a critical concern in prostate cancer management was addressed: improving the pretreatment prediction of patients’ outcomes in localized prostate cancer.

November 01, 1997

SOUTHAMPTON, Bermuda-Shortly after the publication of trial results showing similar efficacy of antiestrogens toremifene (Fareston) and tamoxifen (Nolvadex) in metastatic breast cancer, the Finnish Breast Cancer Group started to plan a comparison study of the two agents as adjuvant breast cancer therapy, said Kaija Holli, MD, of Tampere University Central Hospital, Tampere, Finland.

November 01, 1997

BALTIMORE-The $368.5 billion settlement worked out between 40 state attorneys general and the tobacco industry now faces the lengthy congressional process. Congress must enact and the President must sign into law a number of provisions to finalize the agreement.

November 01, 1997

SAN DIEGO-Many oncologists attending a session on capitation at the Association of Community Cancer Centers’ 14th National Oncology Economics Conference may have hoped the speaker would reveal the “ideal rate” to charge for capitated oncology care, but, unfortunately, “there is no such thing,” Philip L. Beard told the gathering.

November 01, 1997

PHILADELPHIA-“Litigation is killing the Pap test. You have to allow patients to sue, but suing because the test is imperfect, we can’t allow,” Richard M. DeMay, MD, told Oncology News International. The solution, he believes, is “some sort of legislation.”

November 01, 1997

PHILADELPHIA-The American Association for Cancer Research (AACR) is seeking applications for its sixth annual Gertrude B. Elion Cancer Research Award, as well as Research Fellowships for young scientists.

November 01, 1997

PHILADELPHIA-The FDA has approved testing for HPV (human papillomavirus) directly from Cytyc’s ThinPrep Pap Test collection vial. HPV testing is performed using Digene Corporation’s Hybrid Capture HPV DNA Assay, the only HPV test currently approved for marketing by the FDA.

November 01, 1997

TORONTO-Potent new anti-HIV three-drug “cocktails” are far more likely to fail in the real world of primary care than in carefully controlled clinical trials, researchers reported at the American Society for Microbiology’s 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). However, it appears that such failures are much less likely if patients are started on the three agents concurrently rather than sequentially.

November 01, 1997

HAMBURG-“I can see at least three new directions that carry the potential for significant improvements in the care of breast cancer patients in the coming years,” said Dr. Martine Piccart, winner of the 1997 Hamilton Fairley Award of the European Society of Medical Oncology (ESMO) in her address at the Ninth European Cancer Conference (ECCO 9).

November 01, 1997

NEW YORK-The North American Brain Tumor Coalition (NABTC) kicked off the first Brain Tumor Awareness Week, October 19 to 25, 1997. The national event is designed to educate the public about the impact of brain tumors, as well as highlight the need for increased research funding.

November 01, 1997

BETHESDA, Md-A major re-evaluation of the nation’s cancer surveillance system is in the offing. National Cancer Institute director Richard D. Klausner, MD, told the President’s Cancer Panel that he has asked for such a review by NCI staff, working with other relevant agencies such as the National Center for Health Statistics.

November 01, 1997

ATLANTA-Gazing up at a canopy of red fall foliage or a placid blue lake, the cancer patient is able to relax and momentarily forget the large radiation machine looming over her. She remains still and calm for her radiation treatment, and leaves the facility in good spirits. This is the goal of “visual therapy,” the use of nature photography throughout treatment centers but especially in high-stress areas such as radiation oncology.

November 01, 1997

HAMBURG-Pathologists may soon be able to obtain expert second opinions on specimens through microscope teleconferencing on the Internet, thanks to an oncologic pathology network now under development by a consortium of European Union pathologists and companies. In addition to allowing long-distance consultations, the EURO-PATH project-European Pathology Assisted by Telematics for Health-will provide pathologists with access to a multimedia European database.

November 01, 1997

Using a series of 421 patients with localized prostate cancer who were treated with radiation, six predictive models were analyzed to determine which model correlates most closely to actual clinical outcome data in regard to biochemical freedom from failure. Multivariate analysis was performed using the following covariates: prostate specific antigen; Gleason score; stage; dose; PSA density; and perineural invasion. Initially, the Pisansky model appeared to be the most predictive.

November 01, 1997

A Scandinavian study challenges the efficacy of endocrine treatment alone, compared to endocrine treatment plus radiotherapy for the treatment of locally advanced prostate cancer. All patients in the study receive neoadjuvant total androgen blockade for 3 months and then continue with antiandrogens alone. After 3 months, radiotherapy will be started in one arm of the study. The primary end point of the study is survival, with secondary end points of prostate-specific antigen (PSA) progression, clinical progression, and quality of life. [Oncol News Int 6(Suppl 3):18-19, 1997]

November 01, 1997

To investigate the potential use of adjuvant hormonal therapy, a randomized, prospective trial was conducted among patients with locally advanced prostate cancer, comparing irradiation alone, with irradiation plus hormonal treatment with goserelin, an agonist anologue of gonadotropin-releasing hormone that reduces testosterone secretion. A total of 415 men under 80 years old with locally advanced disease and no previous treatment for prostate cancer were initially recruited, with data available for analysis on 401 of these patients. Preliminary results at 33-months’ follow-up suggested that goserelin started at the onset of external irradiation improved both local control and 5-year survival. Updated results at 45 months confirm these data. The overall 5-year survival rate for those treated with goserelin in addition to radiotherapy was 79%, compared to 62% in the radiotherapy only group. The localized control rate was 97% in the combined treatment group compared to 77% in the radiotherapy only group. [Oncol News Int 6(Suppl 3):21-22, 1997]

November 01, 1997

Over the past 10 years, the Radiation Therapy Oncology Group has evaluated, by Phase III trials, the value of using a combination regimen, including androgen suppression (goserelin [Zoladex] and flutamide [Eulexin]) and radiation therapy, in locally advanced prostate cancer. Androgen suppression prior to or during radiation has not been shown to increase overall survival, but it has been shown to increase progression-free survival and freedom from distant metastases. In addition, a subset of men with poorly differentiated tumors who received goserelin following external beam radiation have had a significant overall survival benefit at 5 years’ follow-up. [Oncol News Int 6(Suppl 3):19-20, 1997]

November 01, 1997

Androgen deprivation has been used prior to radical prostatectomy in an attempt to improve local control of prostate cancer and delay time to cancer progression. Thirty men (mean age of 65) with clinical stage T3 adenocarcinoma of the prostate were entered into a phase II trial at the University of California, San Francisco, examining the effects of neoadjuvant androgen deprivation (luteinizing hormone-releasing agonist and an antiandrogen) before radical prostatectomy. Twenty-six of these patients subsequently underwent radical prostatectomy. Despite impressive physiological changes in prostate and tumor volume, stage reduction was noted in only 4 patients (15%). Overall, with a mean follow-up of 32.7 months, 72% of patients had evidence of disease recurrence, including detectable PSA. Several series suggest that in patients with stage T1 and T2 disease, the likelihood of a positive surgical margin after radical prostatectomy is decreased substantially by neoadjuvant deprivation. The effect on long-term disease-free survival, however, is still unknown. [Oncol News Int 6(Suppl 3):16-17, 1997

November 01, 1997

The outcome of 500 patients treated solely with irradiation for clinical stages T1-T4, N0, M0 prostatic carcinoma was used to develop an enhanced prognostic system for patients with clinically localized prostatic cancer. Clinical tumor stage, Gleason score, and pretherapy prostate-specific antigen (PSA) were independently associated with clinical or biochemical relapse and included in a risk score equation that defined patient groups with distinctly different outcomes. [Oncol News Int 6(Suppl 3):8-9, 1997]

November 01, 1997

Outcomes beyond tumor response and patient survival have increasingly gained in importance over the past two decades. Quality of life (QOL) and cost-effectiveness of therapy have emerged as additional end points of interest. Conflicting results can and have been reported, however, depending on the measures used to report QOL and cost-effectiveness. Examples of QOL and cost-effectiveness issues and measures related to androgen deprivation therapy (ADT) for prostate cancer follow. [Oncol News Int 6(Suppl 3):22-24, 1997]

November 01, 1997

The single most significant predictor of the inability of radiotherapy to prevent biochemical failure is the pretreatment PSA level. Palpable stage and Gleason score are also important pretreatment prognostic factors and have been combined with PSA to construct a model to predict treatment outcome.

November 01, 1997

Three equations have been formulated to estimate the risk that men treated for clinically localized prostate cancer have extracapsular extension, lymph node involvement, and non-organ confined disease. The equation for extracapsular extension risk is based on pretreatment prostate-specific antigen (PSA) and Gleason scores.

November 01, 1997

Reverse-transcriptase polymerase chain reaction (PCR) technology can detect small numbers of cells expressing prostate-specific antigen (PSA), even when these cells are extensively diluted in a population of non-PSA expressing cells. The assay was applied to a cohort of more than 200 patients who were candidates for radical prostatectomy based on diagnostic tests that predicted that the prostate cancer was localized to the prostate gland. In this group, a positive RT-PCR test correlated significantly with early metastatic spread of prostate cancer. [Oncol News Int 6(Suppl 3):11-12, 1997]

November 01, 1997

A total of 186 randomly selected needle biopsies were evaluated and radical prostatectomy samples were matched with preoperative PSA concentration and patient demographics. Gleason score and optimized microvessel density were determined from the needle biopsy samples; pathologic stage was verified by independent review of the prostatectomy samples. An automated digital image analysis system measured microvessel morphology and calculated the optimized microvessel density in biopsies. Using this system in combination with the Gleason score and serum PSA significantly increases the ability to predict extraprostatic extension of cancer preoperatively. [Oncol News Int 6(Suppl 3):13-14, 1997]

November 01, 1997

Information from pathologic stage and pretreatment clinical parameters-prostate-specific antigen (PSA), Gleason score, and clinical stage-can be incorporated into a single construct-calculated prostate cancer volume. It is represented by the quotient of the cancer-specific PSA and the PSA measured in serum per cm3 of prostate cancer of a given Gleason score, where cancer-specific PSA is defined as PSA corrected for the PSA contributed by benign prostatic epithelial cells.

November 01, 1997

Data from three academic institutions were used to develop a model to predict pathologic stage in a group of men with clinically localized prostate cancer. The model combined serum prostate-specific antigen (PSA) level, clinical stage, and Gleason score. The data were used to generate nomograms that present the probability of a patient having organ-confined cancer, isolated capsular penetration, seminal vesicle involvement, or pelvic lymph node involvement. [Oncol News Int 6(Suppl 3):14-15, 1997]

November 01, 1997

HAMBURG-In previously un-treated women with advanced breast cancer, doxorubicin (Adriamycin) yields a higher response rate and longer progression-free survival than does paclitaxel (Taxol), according to the results of a randomized crossover trial conducted by the EORTC and presented at the Ninth European Cancer Conference (ECCO 9).

November 01, 1997

CHICAGO-A recurring theme voiced by members of the oncology community throughout a two-day conference on purchasing oncology services was the need for payers to financially support the participation of cancer patients in NCI-sanctioned clinical trials.

November 01, 1997

PHILADELPHIA-Fine needle aspiration (FNA) for breast cytology has a false-positive incidence “very close to zero,” Nadia Al-Kaisi, MD, said in an interview with Oncology News International. “For the past several years,” she said, “the accuracy has increased because of increased recognition of the cytologic features of the various benign and malignant lesions.”