New Adjuvant Treatments For Breast Cancer Prove Cost-effective
Science Daily — New adjuvant treatments for breast cancer are cost-effective at improving survival, according to two new studies. Published inthe journal CANCER, the two studies looked at the cost-effectiveness of different drugs for the management of adjuvant therapies for early breast cancer.
In a Canadian economic study of estrogen receptor positive breast cancers, switching from tamoxifen to the oral steroidal aromatase inhibitor exemestane (trade name: Aromasin) extended disease free survival at a minimal cost per person. In another of study of human epidermal growth factor receptor 2 (HER2)-positive breast cancer, the addition of the anti-HER2 receptor monoclonal antibody, trastuzumab (trade name: Herceptin), is projected to improve life expectancy at a relatively low cost.
Breast cancer is a major cause of cancer mortality, second only to lung cancer as a cause of cancer death in women. The five-year survival rate for localized breast cancer has increased from 80 percent in the 1950s to 98 percent today. Mammography has led to cancers being detected earlier, when early treatments may be more effective. A greater understanding of the molecular biology of breast cancer has led to new post-surgical treatments, including hormone modulators and monoclonal antibodies. Many of these agents have led to decreased mortality and disease recurrence. As the therapeutic effectiveness of these drugs has been verified and is included in professional treatment guidelines, their cost-effectiveness is being investigated.
Cost-effectiveness is measured not just in life years (LY) gained but is adjusted also for the quality of life gained. This combination is expressed as a quality-adjusted life year (QALY). The ratio of cost to QALY is calculated to provide a quantitative estimate of the cost-effectiveness of a therapy.
A recent study showed that switching from tamoxifen to exemestane after two to three years of tamoxifen significantly improves disease-free survival compared to tamoxifen alone. Ms. Nancy Risebrough from the HOPE Research Centre, Sunnybrook Health Sciences Centre in Toronto and Dr. Nicole Mittmann from the HOPE Research Centre at Sunnybrook Health Sciences Centre in Toronto and the University of Toronto and colleagues evaluated the cost-effectiveness of switching from tamoxifen to exemestane after two to three years.
The authors found that over 7.5 years, a tamoxifen-exemestane adjuvant protocol improved disease free survival (LY and QALY) at an additional cost of Can$2,889 per patient. The incremental cost-effectiveness ratio was calculated to be Can$24,185/QALY gained, well below a recognized threshold of Can$50,000/QALY gained.
Based on three-year follow-up of a recent clinical trial, the addition of trastuzumab to adjuvant chemotherapy treatment has been projected to improve significantly the long-term survival of early HER2-positive breast cancers. Dr. Louis Garrison, Jr of the University of Washington in Seattle and co-investigators evaluated the cost-effectiveness of adding trastuzumab to standard chemotherapy.
Dr. Garrison and co-authors estimated that life expectancy would improve by three years on average with the addition of this drug due to reduced disease recurrence. Over a lifetime, the cost-effectiveness ratio was estimated to be US$26,417/QALY and over 20 years was estimated at US $34,201.
The two economic studies agree with previous cost-effectiveness studies of the similar regimens and support their clinical use. The cost-effectiveness ratios calculated for both exemestane and trastuzumab were below those of many widely used oncology treatments.
source : www.sciencedaily.com
Tuesday, June 26, 2007
Family tree may miss breast cancer gene
Family tree may miss breast cancer gene
CHICAGO, June 20 (UPI) -- A U.S. study says doctors may be underestimating a woman's breast cancer risk if there are few women on her father's side of the family.
Doctors generally look at family history to determine if a woman might carry the BRCA1 or BRCA2 gene mutations that would predispose her to the disease, HealthDay said Wednesday.
The study, published in the June 20 issue of the Journal of the American Medical Association, said family history data isn't always available to women.
Dr. Jeffrey Weitzel, lead researcher and director of the department of clinical cancer genetics at City of Hope Comprehensive Cancer Center in Duarte, Calif., said insurance companies need to broaden the coverage for BRCA testing.
"Half of all heredity for breast cancer comes from dad," he said. "Most clinicians don't realize that BRCA can be inherited through dad."
source : www.sciencedaily.com
CHICAGO, June 20 (UPI) -- A U.S. study says doctors may be underestimating a woman's breast cancer risk if there are few women on her father's side of the family.
Doctors generally look at family history to determine if a woman might carry the BRCA1 or BRCA2 gene mutations that would predispose her to the disease, HealthDay said Wednesday.
The study, published in the June 20 issue of the Journal of the American Medical Association, said family history data isn't always available to women.
Dr. Jeffrey Weitzel, lead researcher and director of the department of clinical cancer genetics at City of Hope Comprehensive Cancer Center in Duarte, Calif., said insurance companies need to broaden the coverage for BRCA testing.
"Half of all heredity for breast cancer comes from dad," he said. "Most clinicians don't realize that BRCA can be inherited through dad."
source : www.sciencedaily.com
Black Women Are Prone To Aggressive Type Of Cancer
Lorie Williams thought for months that she might have a lump in her breast. But when the doctor said it was cancer, she was still stunned. After all, she was just 29 years old, no one in her family had ever had breast cancer, and she had never heard of anyone getting the disease so young.
"I was just numb," said Williams, who lives in Holly Springs, N.C. "I couldn't believe it was really happening. Then I just became hysterical."
Women such as Williams have become the focus of an intense effort to solve one of the most pressing mysteries about breast cancer: Why are black women, who are less likely to get the disease than white women, more likely to get it when they are young - and much more likely to die from it?
Now, researchers have uncovered a crucial clue: Black women, particularly young ones, get hit much more often by an aggressive form of breast cancer that is invulnerable to many of the latest treatments.
That discovery, however, has raised a thicket of questions and an intense debate. Are black women prone to the deadlier cancer for genetic reasons? The same deadly form of breast cancer turns out to be extremely common in parts of Africa where the slave trade was centered, indicating that genes play a role. Researchers also have found evidence that other factors, such as breast-feeding patterns, may be key.
The emerging picture of breast cancer marks a transforming development in the battle against the disease, some experts say, particularly for black women.
"It's a sea change for how we think about the problem of breast cancer in African-American women," said Rowan T. Chlebowski, who studies breast cancer at Harbor-UCLA Medical Center. "It's really changing the debate."
'Triple-Negative' Cancer Traced
Researchers have long thought that the reason black breast cancer patients were more likely to die was the stubborn inequities in the quality of care that minorities receive. Black women tend to get fewer mammograms, to get their diagnosis after their cancer has spread and to receive less aggressive treatment once diagnosed, many studies have shown.
Those factors do play a significant role. But recent research has found that even when everything is equal, black women are less likely to survive.
At the same time, researchers using the latest molecular tools have discovered that breast cancer comes in at least five variations. One, called "triple-negative" because it lacks three key markers that distinguish tumors, grows quickly, recurs more often and kills more frequently. It is much harder to prevent and treat because it does not respond to the newest drugs, including those that block estrogen and targeted therapies such as Herceptin.
A key insight came last year when a detailed genetic analysis of 496 breast tumors showed that a "basal-like" form of triple-negative cancer was startlingly more common among young black women, accounting for 39 percent of their cancers, compared with 16 percent of white women's.
"We found an important piece of the puzzle," said Lisa A. Carey of the University of North Carolina, who led the study. "This indicates that biology is important."
Other studies subsequently confirmed the findings, including one published last month that found triple-negative tumors about twice as often among black women as among white women. It also found that triple-negative is also more frequent in Hispanics than in whites, though still less common than in blacks.
Some researchers, suspecting that the higher rate among African-Americans might stem from a genetic predisposition, have begun studying women in parts of Africa. They discovered that triple-negative is extremely common, accounting for some 70 percent of breast cancers in women tested in Nigeria and Senegal, for example.
"This suggests that there may be a genetic contribution," said Olufunmilayo Olopade of the University of Chicago, who is leading the research. "Is it because of genes common to African ancestry? Maybe there's a genetic contribution that we didn't appreciate."
Breast-Feeding Is A Variable
But other research suggests that social factors may be more crucial. One study published online this week, for example, found that women who did not breast-feed their children are especially prone to triple-negative cancer.
"Our data show that is has nothing to do with genetics but really has to do with environmental factors," said Robert Millikan of the University of North Carolina, noting that black women are less likely than white women to breast-feed.
source : www.tbo.com
"I was just numb," said Williams, who lives in Holly Springs, N.C. "I couldn't believe it was really happening. Then I just became hysterical."
Women such as Williams have become the focus of an intense effort to solve one of the most pressing mysteries about breast cancer: Why are black women, who are less likely to get the disease than white women, more likely to get it when they are young - and much more likely to die from it?
Now, researchers have uncovered a crucial clue: Black women, particularly young ones, get hit much more often by an aggressive form of breast cancer that is invulnerable to many of the latest treatments.
That discovery, however, has raised a thicket of questions and an intense debate. Are black women prone to the deadlier cancer for genetic reasons? The same deadly form of breast cancer turns out to be extremely common in parts of Africa where the slave trade was centered, indicating that genes play a role. Researchers also have found evidence that other factors, such as breast-feeding patterns, may be key.
The emerging picture of breast cancer marks a transforming development in the battle against the disease, some experts say, particularly for black women.
"It's a sea change for how we think about the problem of breast cancer in African-American women," said Rowan T. Chlebowski, who studies breast cancer at Harbor-UCLA Medical Center. "It's really changing the debate."
'Triple-Negative' Cancer Traced
Researchers have long thought that the reason black breast cancer patients were more likely to die was the stubborn inequities in the quality of care that minorities receive. Black women tend to get fewer mammograms, to get their diagnosis after their cancer has spread and to receive less aggressive treatment once diagnosed, many studies have shown.
Those factors do play a significant role. But recent research has found that even when everything is equal, black women are less likely to survive.
At the same time, researchers using the latest molecular tools have discovered that breast cancer comes in at least five variations. One, called "triple-negative" because it lacks three key markers that distinguish tumors, grows quickly, recurs more often and kills more frequently. It is much harder to prevent and treat because it does not respond to the newest drugs, including those that block estrogen and targeted therapies such as Herceptin.
A key insight came last year when a detailed genetic analysis of 496 breast tumors showed that a "basal-like" form of triple-negative cancer was startlingly more common among young black women, accounting for 39 percent of their cancers, compared with 16 percent of white women's.
"We found an important piece of the puzzle," said Lisa A. Carey of the University of North Carolina, who led the study. "This indicates that biology is important."
Other studies subsequently confirmed the findings, including one published last month that found triple-negative tumors about twice as often among black women as among white women. It also found that triple-negative is also more frequent in Hispanics than in whites, though still less common than in blacks.
Some researchers, suspecting that the higher rate among African-Americans might stem from a genetic predisposition, have begun studying women in parts of Africa. They discovered that triple-negative is extremely common, accounting for some 70 percent of breast cancers in women tested in Nigeria and Senegal, for example.
"This suggests that there may be a genetic contribution," said Olufunmilayo Olopade of the University of Chicago, who is leading the research. "Is it because of genes common to African ancestry? Maybe there's a genetic contribution that we didn't appreciate."
Breast-Feeding Is A Variable
But other research suggests that social factors may be more crucial. One study published online this week, for example, found that women who did not breast-feed their children are especially prone to triple-negative cancer.
"Our data show that is has nothing to do with genetics but really has to do with environmental factors," said Robert Millikan of the University of North Carolina, noting that black women are less likely than white women to breast-feed.
source : www.tbo.com
$150 million pledged to UCSF cancer center
$150 million pledged to UCSF cancer center
SAN FRANCISCO, June 26 (UPI) -- The University of Southern California-San Francisco has received a $150 million pledge, the school's largest philanthropic donation from an individual.
University officials said the anonymous pledge to support clinical and research programs at the University of Southern California-San Francisco Comprehensive Cancer Center will be used to strengthen five major components of its programs: advancing experimental therapies, creating a world-class database to support future individualized therapies, enhancing the facility's ability to recruit scientific leaders, improving patient care and support services and strengthening the center's translation of basic research into clinical care.
"The donor's immense generosity will serve as a potent catalyst for programs and research that will benefit cancer patients throughout the world," said University of Southern California-San Francisco Chancellor J. Michael Bishop.
source : www.sciencedaily.com
SAN FRANCISCO, June 26 (UPI) -- The University of Southern California-San Francisco has received a $150 million pledge, the school's largest philanthropic donation from an individual.
University officials said the anonymous pledge to support clinical and research programs at the University of Southern California-San Francisco Comprehensive Cancer Center will be used to strengthen five major components of its programs: advancing experimental therapies, creating a world-class database to support future individualized therapies, enhancing the facility's ability to recruit scientific leaders, improving patient care and support services and strengthening the center's translation of basic research into clinical care.
"The donor's immense generosity will serve as a potent catalyst for programs and research that will benefit cancer patients throughout the world," said University of Southern California-San Francisco Chancellor J. Michael Bishop.
source : www.sciencedaily.com
Sharing Stronach's struggle with cancer
The news about Belinda Stronach's cancer diagnosis certainly puts perspective on life and stretches our understanding of what it is to support someone. Belinda ended up supporting me in ways I can only hope to reciprocate.
Nearly a year ago, an ultrasound and CT scan revealed an eight-centimetre mass on my right ovary. I was informed by the oncologist that it was either a twisted cyst or ovarian cancer. I was 27 years old at the time and it's an uncommon cancer to appear in young women. Since then, I strongly advise doctors and "patients" to begin by eliminating ovarian cancer as a possibility, as I'm living proof of the contrary. Given my biological grandmother's history with breast cancer, I was as likely a candidate for ovarian cancer as I was for breast cancer. It's vital to have both ovaries and breasts checked if there's a family history of either cancer. Even though the doctor tried to reassure me – she had never diagnosed a "patient" under the age of 35 with ovarian cancer – I knew. This wasn't the first time I was hit by cancer.
I trust Belinda Stronach with my life and with my secrets.
She's one of very few people I confided in with the results of initial tests. I didn't inform my family as I didn't want them to worry needlessly. My father passed away from small-cell lung cancer and, unfortunately, cancer reminds my family of our loss. I knew Belinda wouldn't overreact; she would remain strong and extremely discreet. You simply have to observe the way she conducts herself in public through intense media scrutiny – always with great poise, integrity and sincerity.
I worked with Belinda while she considered running for the Liberal leadership last year, and neither of us realized what awaited us. Instead of me supporting her for the leadership – as she decided not to run – she supported me through my treatments. I can only offer her my support in hopes she will be just as successful as I have been.
I still remember receiving a beautiful bouquet following my first surgery. I asked my nurse to read the card to me when she brought the flowers into my room. She exclaimed: "You know Belinda!"
I do know Belinda and one thing's certain, she definitely doesn't want you to feel sorry for her. In fact, she wants you to challenge her more than ever before.
Allow me to offer some advice to people who are supporting family members or friends through treatments. There's nothing more infuriating than being treated differently because you have cancer. We are the same people we were prior to our diagnosis. Cancer simply magnifies our personality, dreams and aspirations. Stronach is a generous person; she wants to make a difference, an impact on the world. She wants to save lives in Africa, help educate women in impoverished countries, help champion the rights of women and to make a difference in the lives of Canadians. She wants to have great fun while working hard. Her cancer intensifies those goals and traits, making them more evident and real.
It's also more difficult to watch someone go through cancer treatments than it is to go through treatments. Your friends and family feel powerless. I can't possibly imagine how incredibly worried Stronach is for her own children, wanting to protect them from it all, just as my parents tried to protect me when my father was going through his own battle.
Finally, I resent when people treat cancer as the most horrific experience possible in their life. Cancer is simply this: another part of life. It has certainly changed my life, but for the better, not for the worse.
source : www.thestar.com
Nearly a year ago, an ultrasound and CT scan revealed an eight-centimetre mass on my right ovary. I was informed by the oncologist that it was either a twisted cyst or ovarian cancer. I was 27 years old at the time and it's an uncommon cancer to appear in young women. Since then, I strongly advise doctors and "patients" to begin by eliminating ovarian cancer as a possibility, as I'm living proof of the contrary. Given my biological grandmother's history with breast cancer, I was as likely a candidate for ovarian cancer as I was for breast cancer. It's vital to have both ovaries and breasts checked if there's a family history of either cancer. Even though the doctor tried to reassure me – she had never diagnosed a "patient" under the age of 35 with ovarian cancer – I knew. This wasn't the first time I was hit by cancer.
I trust Belinda Stronach with my life and with my secrets.
She's one of very few people I confided in with the results of initial tests. I didn't inform my family as I didn't want them to worry needlessly. My father passed away from small-cell lung cancer and, unfortunately, cancer reminds my family of our loss. I knew Belinda wouldn't overreact; she would remain strong and extremely discreet. You simply have to observe the way she conducts herself in public through intense media scrutiny – always with great poise, integrity and sincerity.
I worked with Belinda while she considered running for the Liberal leadership last year, and neither of us realized what awaited us. Instead of me supporting her for the leadership – as she decided not to run – she supported me through my treatments. I can only offer her my support in hopes she will be just as successful as I have been.
I still remember receiving a beautiful bouquet following my first surgery. I asked my nurse to read the card to me when she brought the flowers into my room. She exclaimed: "You know Belinda!"
I do know Belinda and one thing's certain, she definitely doesn't want you to feel sorry for her. In fact, she wants you to challenge her more than ever before.
Allow me to offer some advice to people who are supporting family members or friends through treatments. There's nothing more infuriating than being treated differently because you have cancer. We are the same people we were prior to our diagnosis. Cancer simply magnifies our personality, dreams and aspirations. Stronach is a generous person; she wants to make a difference, an impact on the world. She wants to save lives in Africa, help educate women in impoverished countries, help champion the rights of women and to make a difference in the lives of Canadians. She wants to have great fun while working hard. Her cancer intensifies those goals and traits, making them more evident and real.
It's also more difficult to watch someone go through cancer treatments than it is to go through treatments. Your friends and family feel powerless. I can't possibly imagine how incredibly worried Stronach is for her own children, wanting to protect them from it all, just as my parents tried to protect me when my father was going through his own battle.
Finally, I resent when people treat cancer as the most horrific experience possible in their life. Cancer is simply this: another part of life. It has certainly changed my life, but for the better, not for the worse.
source : www.thestar.com
Two Adjuvant Treatments for Breast Cancer Earn Their Keep
TORONTO, June 26 -- Two well-accepted adjuvant therapies for early breast cancer proved cost-effective for improving survival, according to a pair of studies.
Both exemestane (Aromasin) and trastuzumab (Herceptin) have been proven effective in adjuvant breast cancer therapy, and the drugs are included in professional treatment guidelines.
But given their cost, one set of researchers in Canada and another in the U.S. evaluated the cost-effectiveness of the drugs, and reported their findings online in Cancer, with publication in the Aug. 1 issue of the journal.
Each study, one for each drug, found a low projected lifetime cost under $30,000 per life-year gained, adjusted for quality of life.
In the Canadian study of postmenopausal women with estrogen-receptor-positive breast cancer, switching to adjuvant exemestane, an aromatase inhibitor, after two or three years of tamoxifen (Nolvadex) extended disease-free survival at a minimal cost of under $3,000 per patient per year over 7.5 years, Nicole Mittmann, M.Sc., Ph.D., of the University of Toronto, and colleagues found.
Their analysis used a hypothetical cohort of postmenopausal women from the recent Intergroup Exemestane Study (IES), which found a survival benefit for switching to exemestane.
Disease progression and hazard ratios for recurrence and survival were determined from IES datasets, the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, and from published literature.
Cost-effectiveness, from a government-payer perspective, was measured not only in life years gained but was adjusted for gain in quality of life. The combination was expressed as quality-adjusted life years gained.
Five years after completing adjuvant therapy (a total of 7.5 years) a tamoxifen-exemestane adjuvant protocol improved absolute disease-free survival by 2.6% (80.9% versus 78% for tamoxifen alone).
Compared with continued tamoxifen, sequential therapy with tamoxifen and exemestane increased the total discounted medical costs in Canadian dollars by $2,889 per patient over 7.5 years.
Cost savings in the exemestane group for reduced cancer recurrence were $1,680 per person and for other cancers, $221 per person.
The incremental cost-effectiveness ratio for exemestane was $28,119 per life year gained.
Calculated as the quality-adjusted life year gained, the incremental cost-utility ratio was $24,185.
source : www.medpagetoday.com
Both exemestane (Aromasin) and trastuzumab (Herceptin) have been proven effective in adjuvant breast cancer therapy, and the drugs are included in professional treatment guidelines.
But given their cost, one set of researchers in Canada and another in the U.S. evaluated the cost-effectiveness of the drugs, and reported their findings online in Cancer, with publication in the Aug. 1 issue of the journal.
Each study, one for each drug, found a low projected lifetime cost under $30,000 per life-year gained, adjusted for quality of life.
In the Canadian study of postmenopausal women with estrogen-receptor-positive breast cancer, switching to adjuvant exemestane, an aromatase inhibitor, after two or three years of tamoxifen (Nolvadex) extended disease-free survival at a minimal cost of under $3,000 per patient per year over 7.5 years, Nicole Mittmann, M.Sc., Ph.D., of the University of Toronto, and colleagues found.
Their analysis used a hypothetical cohort of postmenopausal women from the recent Intergroup Exemestane Study (IES), which found a survival benefit for switching to exemestane.
Disease progression and hazard ratios for recurrence and survival were determined from IES datasets, the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, and from published literature.
Cost-effectiveness, from a government-payer perspective, was measured not only in life years gained but was adjusted for gain in quality of life. The combination was expressed as quality-adjusted life years gained.
Five years after completing adjuvant therapy (a total of 7.5 years) a tamoxifen-exemestane adjuvant protocol improved absolute disease-free survival by 2.6% (80.9% versus 78% for tamoxifen alone).
Compared with continued tamoxifen, sequential therapy with tamoxifen and exemestane increased the total discounted medical costs in Canadian dollars by $2,889 per patient over 7.5 years.
Cost savings in the exemestane group for reduced cancer recurrence were $1,680 per person and for other cancers, $221 per person.
The incremental cost-effectiveness ratio for exemestane was $28,119 per life year gained.
Calculated as the quality-adjusted life year gained, the incremental cost-utility ratio was $24,185.
source : www.medpagetoday.com
Breast Cancer and Green Tea-Mushroom
Green Tea-Mushroom Combination May Suppress Breast Cancer: Pairing of natural compounds appears to work in cells – without toxicity by Jeni Baker
A link between green tea consumption and protection from different types of cancer has been well documented. The same holds true for the medicinal mushroom Ganoderma lucidum; evidence suggests that consuming it can help prevent some cancers.
Scientists from Methodist Research Institute’s Cancer Research Laboratory wanted to know what would happen when extracts of these two compounds were combined and introduced to highly invasive breast cancer cells.
Their research* yielded some compelling new findings.
Synergy and signaling
The study was fairly straightforward – and for periods of 24 and 48 hours, the team exposed the metastatic breast cancer cells to green tea extract (GTE) and extract of G. ludicum extract (GLE), an oriental medicinal mushroom – and the findings can be summed up just as succinctly:
The GTE-GLE combination significantly slowed both individual cell growth and colony formation among the breast cancer cells. Additionally, the effects of the pairing were greater than the sum of the individual effects of each compound. In other words, each compound appears to boost the cancer-inhibiting effects of the other.
Who knew that something so important could be going on behind the molecular scenes of simple green tea and mushrooms?
It’s all about disrupting the “communication” among cancer cells – the sooner, the better – and that’s what the active ingredients in these compounds appear to do, says lead author Daniel Sliva, PhD.
“Abnormal signaling is directly responsible for the invasiveness of cancer cells, so we look for signaling in cells that shouldn’t be there,” he says. “The goal is to stop the growth and invasive behavior of cancer cells by preventing abnormal signaling proteins from being produced. When we can do that, we can stop cancer metastasis.”
“Define your future by what you’re doing now”
Metastasis, the spreading of cancer throughout the body, “is, of course, the larger problem with all types of cancer,” says Sliva. “Because this study focused on specific cell-signaling mechanisms, our findings are applicable to other types of cancers, as well.”
Although much additional research is needed, Sliva recommends that people with breast cancer or who are at risk for the disease speak with their doctors if they’re thinking about integrating green tea or G. ludicum into their diets.
Both are generally harmless to most people, he says, which underscores the growing body of evidence that toxicity and side effects don’t have to be part of effective cancer treatment.
Sliva’s overall advice about cancer prevention and management?
“Don’t smoke, get plenty of exercise, eat a lot of fruits and vegetables, and try to use natural products whenever you can,” he says. “Define your future by what you’re doing now.”
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