STOCKHOLM-Published data overwhelmingly support the use of trastuzumab (Herceptin) concurrently with chemotherapy, according to John Crown, MD, a consultant oncologist at St. Vincent’s Hospital in Dublin, Ireland. On the other hand, there is no evidence that sequential delivery is less effective than concurrent therapy, and it is definitely less toxic, commented Ian E. Smith, MD, head of the Breast Unit at Royal Marsden Hospital in London.
The studies presented at SABCS 2008 regarding adjuvant taxane schedules are well designed and add to a growing body of data on how best to use these drugs, although they leave some questions unresolved. NSABP B-30 nicely controlled for number of cycles of treatment. All patients received four cycles of doxorubicin and four of docetaxel (Taxotere), and some got four cycles of cyclophosphamide, so there was some control over the duration of exposure and total number of doses for each drug.
The optimal use of taxanes in the adjuvant treatment of breast cancer continues to inspire debate. Questions remain regarding the relative efficacy of sequential vs concurrent treatment, the most effective doses and schedules, and the best combinations of agents. Key studies presented at SABCS 2008 offered insight into these issues, but no definitive resolutions. In fact, two studies designed to establish optimal scheduling reached conflicting conclusions.
Adult patients with low-grade glioma had better survival if they received chemotherapy in addition to radiotherapy, according to the results of a Radiation Th erapy Oncology Group (RTOG) study. The data were presented at the 2008 Society for Neuro-Oncology meeting in Lake Las Vegas, Nev.
Cancer patients in England will no longer have to pay prescription charges for medicines that treat their side effects, starting in April. Drugs that will be exempt include those that address pain, nausea, chronic diarrhea, fatigue, and mouth ulcers. Tamoxifen and other long-term hormone treatments are also currently subject to this charge.
There is strong rationale for both the octreotide LAR and everolimus studies in NET”, said Dr. Siu, associate professor of medicine at the University of Toronto and Princess Margaret Hospital. “And I applaud both sets of authors for conducting trials in rare tumors.”
This is one of a number of studies that show that adding novel drugs to conventional treatments can achieve higher response rates in multiple myeloma,” said Dr. Anderson, who is the Kraft Family Professor of Medicine at the Dana-Farber Cancer Institute in Boston.
CHICAGO-Serious and fatal drug reactions tripled between 1998 and 2005, according to a 2007 FDA analysis. In that time period, the total number of serious adverse drug events multiplied 4 times faster than the number of prescriptions written. The number of serious drug reactions for biotechnology agents rose nearly 18-fold (T Moore et al: Analysis of FDA reported post marketing ADR database, Arch Intern Med 167:1752-1759, 2007).
Jimmie C. Holland, MD, widely recognized as the founder of “psychooncology,” grew up in a rural part of Texas with fertile black soil, known as the Blackland Bible Belt. It was a time when cotton was king and little girls were named Bobbi and Jimmie. Back then, the gender line was clearly demarcated; girls became teachers and nurses and homemakers. Interested in medicine as a youngster, Jimmie thought about nursing, but decided instead to buck the old-boy tradition and become a doctor. Her family and teachers supported her dream, and she never looked back.
In the first of what will become an annual review process, the nation’s largest cancer-care payer has added three new formularies to its drug coverage policy, giving oncologists even greater ability to prescribe off -label cancer drugs.
Recent results from prospective, controlled trials, specifically evaluating strategies for preventing or reducing the severity of the dermatologic effects of EGFR inhibitors, represent the first step toward an evidence-based approach to the prevention and management of these important effects.
The review by LoRusso is a critical update to what could be considered the most significant dermatologic toxicity in modern oncology. This increased importance of dermatologic toxicities to epidermal growth factor receptor (EGFR) inhibitors can be attributed to several factors: 45% to 100% of patients will develop a papulopustular rash; the rash occurs in cosmetically sensitive areas (the face and upper trunk); it is associated with symptoms of pain and pruritus; and superinfections occur in approximately 30% of patients receiving these agents-all of which lead to dose modification by 76% and discontinuation by 32% of oncologists.
Epidermal growth factor receptor (EGFR) inhibitors have emerged as important drugs in cancer therapy, providing a proven survival advantage for some patients with non–small-cell lung cancer, colorectal cancer, head and neck cancer, and pancreas cancer.
States population will be over 65 years old, with 2% of the population over 84. The corresponding projections for 2050 are 21% and 5%, respectively.[1] These projections underscore the aging of the population, with most recent estimates of life expectancy hitting a record high of 78.1 years.[2] With Americans living longer than ever before, physicians are already seeing larger numbers of elderly patients with cancers whose incidence increases with age, including colon cancer.
The Hippocratic principle of not harming the patient has remained up to this day an undisputed dogma in medicine. It reminds the physician of the possible detrimental, if not lethal, outcome of the treatment he prescribes and implicitly enforces good medical practice, although the true impact will unlikely be known. Oncology is one subspecialty of Medicine where this dilemma-ie, the pros and cons of treatment-is continuously put to the test, as the physician must decide on treatment for an often life-threatening illness while taking into account individual factors such as the patient’s will, performance status, available standard treatment options, and possible experimental approaches.
Acai demonstrated antioxidant and apoptotic effects in in vitro and in vivo studies, but no human studies have been conducted. Despite the lack of supportive data, acai, like many herbal products, is promoted to cancer patients on the Internet, often with false claims of cure.
In their informative article, Richard O’Hara and Diane Blum touch on several key challenges of cancer survivorship. Looking at cancer through the lens of social concerns and developmental issues, they have brought important psychosocial aspects of survivorship to the forefront of our attention, with a particular focus on the domain of social well-being within the parameters of interpersonal relationships, and financial, employment, insurance, and legal issues.
When my doctor told me that I would have to put my life on hold at age 25 because tests confirmed that I had Hodgkin’s disease-cancer!-my life changed totally. I had to quit my job, move back in with my parents, and wonder about the quantity and quality of the rest of my life.
Bill, 53 years old and a 3-year survivor of non-Hodgkin’s lymphoma, reflects on his ongoing journey as a cancer survivor: “I was very sick and treatment was very rough, complete with a severe allergic reaction that was difficult to diagnose for a long time. But I made it through to the other shore…remission. Since then, I’ve been trying to rebuild a new life…Living with an 18-year-old [son], I can see how in some ways I’m in a parallel universe…Both of us are looking out at the world before us, at all the many possible options...trying to figure out what we want tomorrow to look like.
On January 20th, all eyes were on the inauguration in Washington, and most of us felt not only a sense of renewed hope but also some uncertainty about what the future will hold. In many ways, cancer patients also face these dual feelings of hope and uncertainty when treatment ends and they confront the task of finding a “new normal.” Re-establishing routines, relationships, and one’s connection to the world is eagerly wanted, but for some it can be daunting. The impact of cancer on one’s health, daily function, and body image, as well as financial and other concerns, also may present challenges.
As difficult as treatments are for many cancer patients, another difficult time awaits them at the conclusion of therapy. Until that point, patients have become accustomed to the fleeting comfort of regularly scheduled appointments for diagnostic testing, chemotherapy and/or radiation treatments, and ongoing contact with health care professionals. Conclusion of treatment can seem abrupt and the absence of attention can be unsettling for many. It is at this point that patients often ask, “What can I do now to help myself?”
In 2008, roughly 1.44 million Americans were diagnosed with cancer,[1] and accordingly were labeled as “cancer survivors.” Fortunately, for roughly 65% of those who were newly diagnosed, this label will expand to encompass issues of long-term survivorship and health maintenance.[2] Extended cancer survivorship is a relatively new concept. In the past, most people who were diagnosed with the disease did not survive it. While longer survival times are a measure of success, the dark side of this victory is that a substantial proportion of these survivors will experience recurrence or second cancers. In addition, many more will go on to develop comorbid conditions such as cardiovascular disease (CVD), diabetes, or osteoporosis, which often kill or debilitate survivors at much higher rates than the cancer itself.[3,4]
CMHB Jonathan Test Article Chapter One
In metastatic breast cancer (MBC), lapatinib (Tykerb) + letrozole (Femara) delayed disease progression in HER2+, HR+ patients, according to initial results from a phase III trial (EGF30008) presented by Stephen Johnston, MD (abstract 46).
Based on 2 meta-analyses of nearly 20,000 HR+ early breast cancer patients, AIs are superior to tamoxifen in reducing recurrences, whether as initial monotherapy or given in a “switching” strategy (abstract 12).
There is evidence that higher doses of fulvestrant (Faslodex) may have greater activity than the approved dose of 250 mg/mo. The FIRST trial (Fulvestrant First-Line Study) compared 500 mg vs anastrozole 1 mg/d in the first-line advanced disease setting, finding that a dose of 500 mg/mo achieved response rates and clinical benefit rates similar to those obtained with anastrozole 1 mg/d but gave a significantly longer time to progression (abstract 6126).
EXPERT’S CORNER-Nearly three quarters of breast cancer patients have tumors that express estrogen receptors (ERs) or progesterone receptors (PRs); approximately half of these patients are postmenopausal. We look to endocrine therapy, therefore, to prevent recurrences and save lives in the majority of early breast cancer patients and to prolong survival in the advanced disease setting.
ABCSG Trial: Survival Benefit for Tamoxifen. Anastrozole Updated results from Austrian Breast and Colorectal Cancer Study Group Trial 8 confirmed a survival difference for the sequencing strategy of tamoxifen followed by anastrozole (Arimidex), compared to 5 years of tamoxifen (abstract 14). Preliminary results (median follow-up 55 mo) had previously revealed a 24% reduction in recurrence in favor of the sequencing strategy, although the difference was not statistically significant.
The largest numbers of trial terminations occur at phase II, especially if the trial is for a marketed therapy compared with a novel drug, according to an expert analysis in the Good Clinical Practice Journal.
CHICAGO-Using imaging to monitor drug response is becoming an increasingly important fi eld of research, and radiologists who are not involved in clinical trials should at least become aware of it, said presenters at an RSNA 2008 refresher course (RC730A).