Gene Tests May Boost Lung Cancer Care

SATURDAY, June 2 (HealthDay News) -- U.S. researchers say they've developed new tests that can determine the precise genetic pathways that lead to lung cancer.

Being able to examine these genomic "signatures" may provide patients with alternatives to chemotherapy. For example, patients may be able to be treated with drugs that target the specific faulty pathway that caused their cancer, the researchers said.

"Traditional chemotherapy is not always effective. Even when we are able to match the right chemotherapy with the right patient, 70 percent of patients with lung cancer may not respond to therapy. We need to take a different approach to those patients, and that is where these targeted therapies come in," lead investigator Dr. Anil Potti, an assistant professor of medicine at the Duke Institute for Genome Sciences & Policy, said in a prepared statement.

The tests developed by the Duke team work by scanning thousands of genes taken from the tumors of cancer patients. The cells are kept alive in laboratory cultures to produce a genomic profile of the tumor's molecular makeup, which helps identify the faulty pathways that caused the malignancy.

In this study, the researchers treated laboratory lung cancer tumors with drugs that blocked one of three different pathways. In all cases, the tumors responded to the targeted therapy.

The findings were to be presented Saturday at the annual meeting of the American Society of Clinical Oncology, in Chicago.

The Duke researchers said they plan to begin a clinical trial of the genomic tests in lung cancer patients this year.

Herceptin Still Improves Odds Against Breast Cancer

MONDAY, June 4 (HealthDay News) -- After almost a decade of use, Herceptin continues to prolong the lives of women with a particularly aggressive form of breast cancer.

An analysis of two clinical trials showed that breast cancer patients receiving Herceptin along with chemotherapy have better survival and fewer recurrences after four years, compared to patients receiving chemotherapy alone. Previous data had shown improved outcomes only over two years.

"When we presented the original data in 2005, people wondered if the benefits were going to be maintained or were we just seeing acute, short-term benefits in this aggressive type of breast cancer," said Dr. Edith Perez, director of the Multidisciplinary Breast Clinic at the Mayo Clinic in Jacksonville, Fla., and the primary investigator of one of the trials. "The data now states that the benefit is completely maintained over time, maybe even increasing, without any increase in toxicity."

Perez presented the results of the joint analysis Monday at the American Society of Clinical Oncology's annual meeting in Chicago.

"The prediction that women would continue to do well appears to be accurate," added Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "This seems to confirm another substantial advance in treating cancer with molecular therapies. There's a lasting benefit, and that's important."

"This is great news for women," added Dr. Ramona Swaby, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. "It's reassuring because we're so used to using Herceptin in a non-curative [ie preventive] setting."

Herceptin, which was approved to treat advanced breast cancer in 1998, is effective in the 20 percent to 25 percent of breast cancer cases that test positive for the HER2/neu receptor.

This paper was an analysis of two trials that had already shown a benefit with Herceptin. Participants in both trials underwent chemotherapy and were then randomized to receive Herceptin or a placebo.

After four years, 85.9 percent of the women in the Herceptin arm remain cancer-free and 92.6 percent are still alive, compared with 73.1 percent and 89.4 percent respectively, of those not treated with Herceptin.

Overall, 397 patients in the chemotherapy-alone group have developed a recurrence or died, compared to only 222 in the Herceptin group.

The addition of Herceptin to therapy decreased the chances of the cancer returning by 52 percent and the risk of death by 35 percent.

"The benefit is not short-term, it's long-lasting, which impacts many, many lives," Perez said.

The first joint analysis of these two trials appeared in the Oct. 20., 2005, issue of the New England Journal of Medicine and found that disease-free survival and overall survival were improved by 52 percent and 33 percent, respectively, after two years of follow-up.

The good news follows another longer-term study of the drug, released Sunday at the cancer meeting, which showed that the risk of heart failure in women taking Herceptin was not any higher at five years than it was at two years.

Among the other findings of the joint analysis: the highest risk of relapse for HER2-positive breast cancer occurs within the first two years, although additional recurrences occur later and the cancer is more likely to recur in patients who initially had larger tumors, who had lymph node involvement or whose tumors were also estrogen-receptor-negative.

"The peak of relapse is still within the first three years, but relapses still continue occurring," Perez said.

Interestingly, Perez also found that estrogen-receptor-positive tumors experienced a 15 percent improvement, even though many physicians had believed these tumors did not respond well to Herceptin.

Disparities Persist in Cancer Care

Disparities Persist in Cancer Care
SUNDAY, June 3 (HealthDay News) -- Not every cancer patient is reaping the benefits of advances in medical care, new research shows.

Two studies presented Sunday at the American Society of Clinical Oncology meeting in Chicago show that race and socioeconomic status affect cancer prognosis, at least when it comes to breast cancer and some childhood cancers.

One report found that, although overall survival among women with metastatic breast cancer has improved over the past two decades, the survival gap between black and white women is widening. And children stricken with cancer in developing countries have a dramatically poorer prognosis than children in more developed nations, although a new program may narrow that difference.

About 180,000 women are diagnosed with breast cancer each year, and 5 percent to 10 percent of those already have metastatic disease, which has spread to other parts of the body. Median survival for these patients is 18 to 24 months.

A previous study found improving survival rates. This latest study extended that effort with a nationally representative sample of women.

The researchers looked at 15,438 women newly diagnosed with advanced breast cancer between 1988 and 2003. Information on the women was obtained from the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. Patients were divided into three groups based on their time of diagnosis: 1988-1993, 1994-1998 and 1999-2003.

Overall, one-year survival increased from 62.9 percent to between 64.4 percent and 66.6 percent, for an absolute improvement of 3.7 percent, said senior study author Dr. Sharon Giordano, an assistant professor of breast medical oncology at the University of Texas M. D. Anderson Cancer Center in Houston. Median survival also increased, from 20 to 25 months.

However, for white women, survival improved from 20 months to between 22 and 27 months. For black women, survival remained essentially unchanged -- hovering close to 17 months during the entire study period.

Meanwhile, the survival gap between black and white women simply grew.

From 1988-93, one-year survival was 63.2 percent for white women and 60.4 percent for black women. In the second time period, it was 64.9 percent and 58.1 percent, respectively. In the last time period, it was 67.6 percent and 58.8 percent, respectively.

"The absolute difference in one-year survival between black and white women increased across the three time periods, from 2.8 percent to 6.8 percent to an 8.8 percent difference," Giordano said.

"The study showed moderate improvements in breast cancer survival over time for women with metastatic disease, but the disparity in survival is worsening over time," she continued. "Survival of non-Hispanic white women has improved, while survival of black women has remained unchanged."

Giordano did not know the reasons for the trend, but speculated that it could be access to care or earlier diagnosis in white women.

"The data suggests that the gap is widening, which I think is unique information and certainly very concerning," said Dr. Ramona Swaby, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. "That definitely warrants attention. The progression from scientific discovery to fixing the problem is, first, attention."

"We've known about the disparities, but it was interesting that the disparities have just gotten wider over time when breast cancer treatment and earlier diagnostic modalities are more and more available," added Dr. Melanie Palomares, assistant professor of medical oncology and population sciences at City of Hope Cancer Center in Duarte, Calif. "Much more study needs to be done."

Another study found that a high proportion of black women with stage III breast cancer refused chemotherapy. "Everyone was given access and they found a lot of refusals," Palomares said. Although no reasons for the refusals were given, this may also play a part in differing outcomes.

Disparity in care was even greater with childhood cancers, according to other research presented at the meeting. A study showed that 80 percent of patients in developed countries were surviving their disease but only 20 percent of their peers in developing countries beat the odds. The good news: Initial results of a program in low-income and middle-income nations showed that a relatively modest monetary investment and external mentoring helped improve things.

The program, "My Child Matters," was created by the Geneva-based International Union Against Cancer and Sanofi-Aventis, with additional funding from the U.S. National Cancer Institute.

Another study presented at the meeting added insult to injury; using less intensive chemotherapy pushed the three-year overall survival rate for neuroblastomas in children to 96 percent. The survival rate for this same tumor is a dismal 10 percent in poorer nations.

During 2006, "My Child Matters" oversaw 14 pilot projects in Bangladesh, Egypt, Honduras, Morocco, Philippines, Senegal, Tanzania, Ukraine, Venezuela and Vietnam. After one year, the programs saw earlier detection, improved access to care , the introduction of psychosocial support, less abandonment and better follow-up. Each project received up to $67,000 annually.

As a result of these outcomes, 12 additional projects have been funded in Bolivia, Indonesia, Kenya, Mali, Peru and Romania.

"It's an issue of medical responsibility that we transfer care for kids with cancer. because we know how to treat cancer and we can transfer that knowledge," said study author Dr. Raul C. Ribeiro, of St. Jude Children's Research Hospital in Memphis, who is a member of the "My Child Matters" steering committee.

But the pain of childhood cancer does not end with treatment.

Another study presented at the meeting looked at long-term health-care utilization among childhood cancer survivors, and found that many are not receiving specialized health care after they beat their cancer.

Some two-thirds of childhood cancer survivors report some kind of chronic physical condition; in 28 percent, that condition is severe or life-threatening.

The Childhood Cancer Survivor Study found that 12 percent of childhood cancer survivors had not had any contact with the health-care system in the previous two years. Most of these people were uninsured, males or lower income. Fourteen percent reported receiving cancer-related care and 18 percent risk-based care.

Among patients at increased risk for cardiac problems or breast cancer, just 28 percent and 49 percent, respectively, reported having received an echocardiogram or mammogram, respectively.

"Our study probably overestimates the care being received, because this is a select group of patients who are probably more aware of their long-term risks," said study leader Dr. Paul Nathan, a staff oncologist at the Hospital for Sick Children in Toronto. "Overall, health-care utilization is below what we would have hoped."

Gene Therapy Reverses Erectile Dysfunction in Rats

SUNDAY, June 3 (HealthDay News) -- Gene therapy using nerve growth factors reversed erectile dysfunction in rats within four weeks, say University of Pittsburgh School of Medicine researchers.

Erectile dysfunction (ED) affects between 15 million and 30 million men in the United States. Many men suffer nerve damage-related ED after surgery for prostate cancer.

The Pittsburgh team found that the genes for the "glial cell line derived neurotrophic factor" (GDNF) and the GDNF family ligand, called neurturin, were both effective in treating erectile dysfunction in the rats. The genes were placed in a genetically engineered herpes simplex virus, which was then injected into the rats' damaged cavernous nerve.

The finding suggests a potential new treatment for ED in men.

"Because the herpes virus persists in the nerve cell for as long as it is alive and nerve cells typically do not reproduce, this represents the first-ever demonstration of a long-term treatment for ED that does not rely on the chronic administration of drugs that can have potentially harmful side effects," study co-leader Joseph C. Glorioso, chairman of the department of biochemistry and molecular genetics, said in a prepared statement.

The study was to be presented over the weekend at the annual meeting of the American Society of Gene Therapy, in Seattle.

source : health.yahoo.com

Hair Relaxers Won't Boost Black Women's Breast Cancer Risk

WEDNESDAY, May 30 (HealthDay News) -- Black women who routinely use hair relaxers can relax: The products will not increase their risk of breast cancer, a new study finds.

According to researchers reporting in the May issue of Cancer Epidemiology Biomarkers and Prevention, millions of women use hair relaxers. However, no research had yet been done as to whether the products may boost cancer risk. This is the first such study to examine the issue.

In the study, a team led by Lynn Rosenberg, of Boston University's Slone Epidemiology Center, analyzed 1997-2003 data from the Black Women's Health Study. That trial included 59,000 black women across the United States.

"In the present study of African-American women, increases in breast cancer risk were not associated with any categories of duration of hair relaxer use, frequency of use, age at first us, number of burns experienced during use, or type of relaxer used," Rosenberg noted.

"The findings provide empirical evidence that hair relaxers are not carcinogenic to the breast and do not contribute to the higher incidence of breast cancer in young African-American women than in young white women," she said.

source : health.yahoo.com

Vitamin D, Calcium Might Lower Breast Cancer Risk

TUESDAY, May 29 (HealthDay News) -- Premenopausal women who get a lot of vitamin D and calcium may cut their risk of breast cancer by almost a third, Harvard Medical School researchers report.

"Adequate intakes of calcium and vitamin D are necessary for women in keeping up their health, and additionally, these two nutrients may help prevent breast cancer development, especially among premenopausal women," said lead author Jennifer Lin, an assistant professor of medicine.

Her team's report appears in the May 28 issue of the Archives of Internal Medicine.

In the study, Lin's team collected data on more than 10,500 premenopausal and almost 21,000 postmenopausal women age 45 and older who were part of the Women's Health Study. The data included information on what they ate and the dietary supplements they took.

Over an average of 10 years, 276 premenopausal women and 743 postmenopausal women went on to develop breast cancer.

The researchers found that premenopausal women whose intake of vitamin D and calcium was high had about a 30 percent lower risk of developing breast cancer. However, they didn't find this association for postmenopausal women.

Animal studies have also found an association between calcium and vitamin D intake and breast cancer prevention, Lin's group noted.

"Calcium and vitamin D may confer protection against breast tumorigenesis," Lin said. "However, more studies are necessary to investigate the potential utility of these two nutrients in breast cancer development," she added.

One expert stressed that the evidence for a protective effect of vitamin D and calcium is still not clear.

"I really don't think that one can say from this study that the effect is only in premenopausal women, because there are a number of factors in the study that may have limited the ability to see the effect," said Victoria Stevens, an epidemiologist at the American Cancer Society. "This is particularly true for vitamin D, because most vitamin D comes from exposure to sunlight, which they did not take into account."

At this point in time, a recommendation that women take vitamin D or calcium to decrease their breast cancer risk is not warranted, she said.

"I don't think we should go that far," Stevens said. "The society doesn't recommend the use of any vitamin supplements" to prevent breast cancer.

"I don't think this study says that we should change that," Stevens said. "At this point, the evidence doesn't support anything more than getting a good diet and maintaining good levels of physical activity," she said.

source : health.yahoo.com

Healthy Diet, Exercise Might Lower Chances of Cancer's Return

SUNDAY, June 3 (HealthDay News) -- In an era of highly complex medications with highly complex mechanisms and even more complicated names, take comfort that some basic (and pronounceable) lifestyle changes can have an impact on cancer outcomes.

Diet and exercise still matter, according to two studies that were presented Saturday at the American Society of Clinical Oncology annual meeting in Chicago.

One study found that individuals with stage III colon cancer who had undergone surgery and chemotherapy had higher odds of relapsing or dying if they followed a predominantly "Western" diet of red meat, fat, refined grains and dessert.

"This is the first large amount of data to look at whether diet affects colon cancer survivors, and the suggestion is that dietary factors may have an effect," said study author Dr. Jeffrey Meyerhardt, an assistant professor of medicine at Dana-Farber Cancer Institute and Harvard Medical School, both in Boston. "Certainly we need more studies to understand the patterns. We also need to emphasize that diet is not a substitute for standard treatment."

Dr. Neal Meropol, director of the Gastrointestinal Cancer Program at Fox Chase Cancer Center in Philadelphia, added: "This suggests that diet can influence not only the development of cancer, but the chance that your colon cancer will come back. This is a very important result because it suggests that one can make a behavioral adjustment that could reduce their risk of dying from colon cancer."

Meropol emphasized, however, that the issue of diet and cancer development or recurrence is an extremely complex one.

People with stage III colon cancers have positive lymph nodes, although the cancer does not indicate any evidence of spreading outside of the local colon area. Standard treatment is surgery followed by chemotherapy.

More than 1,000 patients with stage III colon cancer who were participating in a trial of adjuvant chemotherapy were asked to complete questionnaires on their diet for six months after the chemotherapy ended. Researchers then tracked the participants to see if their cancer recurred or if they died.

Dietary patterns fell into two categories: "Western," which involved a high intake of red meat, fat and dessert, and "prudent," meaning high fruit, vegetable, poultry and fish consumption.

The two dietary patterns did not necessarily preclude each other. "Everyone has some score for each of those patterns," Meyerhardt stated. "Someone might eat a lot of hamburger and a lot of vegetables."

People who consumed the highest levels of the Western diet had almost quadruple the risk of recurrence or death compared with those who consumed the least in this category.

"Those who had a higher intake of a Western-pattern diet characteristic of more red meat and dessert had a significantly higher risk of recurrence and mortality, about four times as high," Meyerhardt said.

What's interesting is that the dietary pattern seemed to have an effect in a relatively short period of time -- years, as opposed to a lifetime. Why? One hypothesis is that this type of diet stimulates some growth factors that allow the growth of microscopic disease, Meyerhardt said.

But it also raises the question of whether the study participants had modified their diet after their diagnosis or whether this was a continuation of past patterns. "Future research should be geared toward answering that very question, whether changing a diet from Western to prudent would in fact reduce the risk of dying from colon cancer," Meropol said.

A second study, also from Dana-Farber, found that previously sedentary breast cancer survivors who exercised reduced the amount of insulin in their blood. It was unclear, however, what effect this might have on cancer recurrence, but the suggestion is that insulin levels may explain why physical activity has been associated with better outcomes.

Previous studies have shown that women who shed extra pounds and became more physically active had a lower risk of breast cancer recurrence. Women who are obese at the time of diagnosis, by contrast, have a higher level of recurrence.

For this study, researchers assigned 101 women with breast cancer to a 16-week program of cardiovascular exercise and strength training or to "normal" care. All women had their insulin and blood glucose levels measured, as well as their weight, body composition, and waist and hip circumference. Participants had already completed chemotherapy and/or radiation but had not started on any hormonal therapies, said study author Dr. Jennifer Ligibel, an instructor of medicine at Dana-Farber and Harvard.

Women in the exercise group lowered their insulin levels by about 20 percent, Ligibel said, an amount that approached statistical significance. These women also had a trend toward improved insulin sensitivity, meaning how their body responds to the hormone insulin.

"The ultimate goal is to look at exercise vs. not exercising and see what happens to women's breast cancer," Ligibel said.

source : health.yahoo.com