Minnesota

Melanoma More Common in Cancer Survivors

Mon, 02 Jan 2012 00:01:29 +0000

People with a history of certain types of cancer may be at increased risk of melanoma—an aggressive form of skin cancer. These results were published in the Archives of Dermatology.

Of the more than one million new diagnoses of skin cancer each year, roughly 68,000 involve melanoma. More than 8,000 people die of melanoma each year in the United States. What makes melanoma so dangerous is that it is more likely than other types of skin cancer to spread (metastasize) to other parts of the body.

Factors that increase the likelihood of developing melanoma include sun exposure and fair skin. To explore whether people with a history of cancer are more likely to develop melanoma, researchers collected information from a large US cancer database (the Surveillance, Epidemiology, and End Results database).

Having an initial diagnosis of melanoma before the age of 45 increased the risk of a subsequent diagnosis of melanoma by almost 12 times. Certain other cancer diagnoses before the age of 45 were linked with a smaller increase in melanoma risk. These other cancers were nonepithelial skin cancer, Kaposi sarcoma, female breast cancer, and lymphoma.
Having an initial diagnosis of melanoma after the age of 45 increased the risk of a subsequent diagnosis of melanoma by more than 8 times. Other cancers that were linked with a smaller increase in melanoma risk were nonepithelial skin cancer, ocular melanoma, female breast cancer, prostate cancer, thyroid cancer, lymphoma, and leukemia.

These results suggest that certain groups of cancer survivors may be at increased risk of melanoma. Risk of melanoma is particularly high for people who have already had a first diagnosis of melanoma, highlighting the importance of ongoing skin surveillance in this group.

Reference: Yang GB, Barnholtz-Sloan JS, Chen Y, Bordeaux JS. Risk and survival of cutaneous melanoma diagnosed subsequent to a previous cancer. Archives of Dermatology. 2011;147:1395-1402.

Still No Clear Evidence That Vitamin D Reduces Cancer Risk

Thu, 22 Dec 2011 00:01:36 +0000

According to a combined analysis of previous studies, there is still no clear evidence that vitamin D supplements reduce the risk of cancer. The combination of vitamin D and calcium, however, does appear to reduce the risk of bone fractures in older people. These results were published in the Annals of Internal Medicine.

Vitamin D is important for bone health, and some research suggests that it may also reduce the risk of certain types of cancer. A role for vitamin D in cancer prevention has not yet been firmly established, however, and research on this topic continues. Vitamin D can be produced in the skin in response to ultraviolet B (UVB) radiation from the sun or obtained from dietary sources. Few foods naturally contain large amount of vitamin D, but vitamin D can be obtained from fatty fish such as salmon, fortified foods such as milk, and dietary supplements.

To summarize what is currently known about the effects of vitamin D on bone fractures and cancer, researchers analyzed information from 19 randomized clinical trials and 28 observational studies. In an observational study, scientists do not control what the study participants do. Instead, the scientists observe what happens after the study participants make their own decisions about health behaviors such as supplement use. Results from observational studies are generally not as definitive as results from randomized clinical trials, but they are worth considering as part of the overall body of evidence on a topic.

Combined calcium and vitamin D reduced the risk of bone fractures in older people, but the optimal dosage remains uncertain. There was some evidence that the fracture benefit may be greater for institutionalized older adults than for community-dwelling older adults.
The effects of vitamin D on cancer risk are still uncertain.
Vitamin D supplementation may increase the risk of kidney and urinary tract stones.

These results suggest that vitamin D—in combination with calcium—can play a role in fracture prevention in older adults. There is still no clear evidence that vitamin D reduces the risk of cancer. People who are considering the use of vitamin D or any other dietary supplement are advised to discuss the risks and benefits with their physician.

Reference: Chung M, Lee J, Terasawa T et al. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2011;155:827-838.

No Increased Risk of Birth Defects in Offspring of Childhood Cancer Survivors

Wed, 21 Dec 2011 00:01:49 +0000

Children born to survivors of childhood cancer do not appear to have an increased risk of birth defects. These results were published in the Journal of Clinical Oncology.

Cancer treatment can have a range of reproductive effects. Treatment may result in a loss or reduction of fertility in men and women, and treatments that damage the uterus—such as radiation to the pelvis—may increase a woman’s risk of miscarriage or pre-term delivery. Studies of birth defects among children conceived after a parent’s cancer treatment have generally been reassuring, but not all of the studies considered the type and dose of treatment received by the parent.

To explore further the risk of birth defects among children born to cancer survivors, researchers evaluated information from the Childhood Cancer Survivor Study (CCSS). The childhood cancer survivors had been diagnosed with cancer before the age of 21. Information was available about almost 4,700 children born to these survivors. The children had been born at least five years after their parent’s cancer diagnosis.

129 children (2.7%) had at least one birth defect. Though the study did not have a comparison group of children born to cancer-free parents, this frequency of birth defects is similar to what has been reported for the overall US population.
Children born to a parent who had previously received DNA-damaging cancer treatment (alkylating chemotherapy or radiation to the ovaries or testes) were no more likely to have a birth defect than children born to a parent who had not received this type of treatment.
Increasing doses chemotherapy or radiation did not increase the risk of birth defects in the offspring.

These results provide reassuring evidence that children born to childhood cancer survivors do not have a significantly increased risk of birth defects.

Reference: Signorello LB, Mulvihill JJ, Green DM et al. Congenital anomalies in the children of cancer survivors: a report from the childhood cancer survivor study. Journal of Clinical Oncology. Early online publication December 12, 2011.

Nplate Produces Rapid Response in Adults with ITP

Tue, 20 Dec 2011 00:01:50 +0000

Among adults with low platelet counts or bleeding symptoms from primary immune thrombocytopenia (ITP), treatment with Nplate® (romiplostim) produces a rapid increase in platelet counts. These results were presented at the 53^rd Annual Meeting of the American Society of Hematology.

Thrombocytopenia occurs when platelet levels fall below normal. It can often occur as a direct result of cancer, from cancer treatment, or from other diseases such as ITP. Adult chronic ITP is an autoimmune disorder in which the patient’s immune system attacks mature platelets or attacks the cells in the body that produce platelets. This results in thrombocytopenia and puts the patient at risk of serious bleeding problems.

Nplate is an agent that stimulates the production of platelets in the bone marrow. Nplate has been approved for the treatment of thrombocytopenia in adult ITP patients who have not responded to standard therapies and is also being evaluated in the management of other patients with thrombocytopenia.

The current study involved more than 400 ITP patients, all of whom had received prior treatment for ITP. Study participants were treated with Nplate once per week.

The most common side effects of Nplate included headache, joint pain, and fatigue.
91 percent of patients had a doubling of their platelet count to at least 50,000 platelets per microliter.
The median time required to achieve a platelet response was one to two weeks

These results continue to support the use of Nplate for adults with ITP. Nplate produced a rapid platelet response in these patients.

Reference: Janssens A, Tarantino MD, Bird R et al. Final results from an international, multi-center, single-arm study evaluating the safety and efficacy of romiplostim in adults with primary immune thrombocytopenia. Presented at the 53^rd ASH Annual Meeting and Exposition. San Diego, CA, December 10-13, 2011. Abstract 3279.

Myotonic Muscular Dystrophy Linked with Increased Cancer Risk

Mon, 19 Dec 2011 00:01:32 +0000

People with myotonic muscular dystrophy may be more likely than people in the general population to develop certain types of cancer. These results were published in the Journal of the American Medical Association.

Myotonic muscular dystrophy (MMD) is the most common form of adult-onset muscular dystrophy. The condition is characterized by progressive muscle wasting and weakness.

Some reports have suggested that people with MMD may have an increased risk of benign and malignant tumors. To further explore this issue, researchers conducted a study among more than 1,600 people who were diagnosed with MMD in Sweden or Denmark between 1977 and 2008. The cancer risk in the study participants was compared with the cancer risk in the general population of those countries.

104 MMD patients were diagnosed with cancer during follow-up. In a similar group of people from the general population, only 52 cases of cancer would be expected.
Types of cancer that were significantly more common among the MMD patients than among the general population were endometrial cancer (cancer of the lining of the uterus), brain cancer, ovarian cancer, and colon cancer. Other types of cancer that may be more common among MMD patients include eye cancer, female genital cancer, thyroid cancer, and pancreatic cancer.

These results suggest that people with MMD may have an increased risk of several types of cancer. People with MMD may wish to talk with their doctor about recommended cancer screening tests and other ways to manage their cancer risk.

Reference: Gadalla SM, Lund M, Pfeiffer RM et al. Cancer risk among patients with myotonic muscular dystrophy. JAMA. 2011;306(22):2480-2486.

Velcade Improves Survival with Multiple Myeloma

Fri, 16 Dec 2011 00:01:30 +0000

Final results from the VISTA trial demonstrate that the addition of Velcade® (bortezomib) to melphalan and prednisone substantially improves overall survival among patients with previously untreated multiple myeloma. These results were presented at the 53^rd Annual Meeting of the American Society of Hematology.

Multiple myeloma is a cancer of plasma cells. Plasma cells are a special type of white blood cell that are part of the body’s immune system. Plasma cells normally live in the bone marrow and make proteins, called antibodies, which circulate in the blood and help fight certain types of infections. Plasma cells also play a role in the maintenance of bone by secretion of a hormone called osteoclast activating factor, which causes the breakdown of bone. Patients with multiple myeloma have increased numbers of abnormal plasma cells that may produce increased quantities of dysfunctional antibodies detectable in the blood and/or urine. These abnormal antibodies are referred to as paraproteins or monoclonal proteins in the blood (M proteins) or urine (Bence Jones protein).

Velcade is the first in a new class of anticancer agents known as proteasome inhibitors. It’s been shown to provide benefits in the treatment of multiple myeloma and mantle cell lymphoma.

The VISTA study is an international Phase III clinical trial. The study involved 655 previously untreated multiple myeloma patients who were ineligible for stem cell transplantation. Patients were assigned to receive treatment with melphalan and prednisone alone (MP) or in combination with Velcade (VMP). Patients have now been followed for five years.

The addition of Velcade improved overall survival by more than 13 months: overall survival was 56.4 months among patients treated with VMP and 43.1 months among patients treated with MP.
Neither treatment group had an increased risk of second cancers compared with the general population.

These results suggest that the addition of Velcade to melphalan and prednisone improves overall survival among patients with previously untreated multiple myeloma who are not eligible for stem cell transplantation.

Reference: San Miguel JF, Schlag R, Khuageva NK et al. Continued overall survival benefit after 5 years’ follow-up with bortezomib-melphalan-prednisone (VMP) versus melphalan-prednisone (MP) in patients with previously untreated multiple myeloma, and no increased risk of second primary malignancies: final results of the phase 3 VISTA trial. Presented at the 53^rd ASH Annual Meeting and Exposition. San Diego, CA, December 10-13, 2011. Abstract 476.

Combined HER2 Treatment Improves Outcome of Advanced Breast Cancer

Thu, 15 Dec 2011 00:01:43 +0000

Among women with metastatic, HER2-positive breast cancer, treatment with a combination of HER2-targeted therapies may produce better outcomes than treatment with only a single HER2-targeted therapy. These results were published in the New England Journal of Medicine and were also presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

Approximately 20-25% of breast cancers overexpress (make too much of) a protein known as HER2. Fortunately, the development of drugs that specifically target HER2-positive breast cancer has improved outcomes. These drugs include Herceptin® (trastuzumab), Tykerb® (lapatinib), and the investigational drug pertuzumab.

To explore whether treatment with both Herceptin and pertuzumab can improve outcomes among women with metastatic, HER2-positive breast cancer, researchers conducted a study among 808 patients. All patients received Herceptin and chemotherapy, and some patients also received pertuzumab.

The addition of pertuzumab delayed cancer progression. Survival without cancer progression was 12.4 months among patients treated with only Herceptin and chemotherapy, and 18.5 months among patients treated with Herceptin, chemotherapy, and pertuzumab.
The addition of pertuzumab was generally well tolerated by patients, although patients in the pertuzumab group were more likely to experience febrile neutropenia (low-white blood cell count accompanied by fever) and diarrhea.

These results suggest adding pertuzumab to Herceptin and chemotherapy may improve outcomes among women with metastatic, HER2-positive breast cancer.

Studies are also exploring the use of pertuzumab in early-stage breast cancer.

Reference: Baselga J, Cortes J, Kim S-B. Pertuzumab plus trastuzumab plus doxetaxel for metastatic breast cancer. New England Journal of Medicine. Early online publication December 7, 2011.

Afinitor Delays Breast Cancer Progression

Wed, 14 Dec 2011 00:01:50 +0000

Among postmenopausal women with advanced breast cancer that had become resistant to hormonal therapy, the combination of Afinitor® (everolimus) and Aromasin® (exemestane) delayed cancer progression to a greater extent than Aromasin alone. The results of this Phase III clinical trial were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

Each year roughly 200,000 U.S. women are diagnosed with breast cancer. Many of these breast cancers are hormone receptor-positive, meaning that exposure to estrogen and/or progesterone can cause them to grow.

Treatment of hormone receptor-positive breast cancer often includes hormonal therapies such as tamoxifen or an aromatase inhibitor. Tamoxifen acts by blocking estrogen receptors, and aromatase inhibitors suppress the production of estrogen in postmenopausal women. Aromatase inhibitors include Femara® (letrozole), Arimidex® (anastrozole), and Aromasin® (exemestane). Many women with advanced breast cancer become resistant to hormonal therapy, and treatment options for these women remain limited.

Afinitor is an oral medication that works by inhibiting a protein known as mTOR. The mTOR protein plays an important role in regulating cancer cell division and blood vessel growth. Currently, Afinitor is used for the treatment of selected patients with kidney cancer, pancreatic neuroendocrine tumors, and subependymal giant cell astrocytoma (SEGA).

To explore the use of Afinitor among women with advanced, estrogen receptor-positive, HER2-negative breast cancer, researchers conducted a Phase III clinical trial (BOLERO-2) among 724 women. All of the women had experienced cancer recurrence or progression in spite of treatment with Femara or Arimidex. Study participants were treated with Aromasin alone or in combination with Afinitor.

Survival without cancer progression was 7.4 months among women treated with both Afinitor and Aromasin, compared with 3.2 months among women treated with Aromasin alone.
The most common side effects in the Afinitor group were oral mucositis, fatigue, lung inflammation, and high blood sugar.

These results suggest that the addition of Afinitor to Aromasin improved outcomes among women with advanced breast cancer that had previously been treated with hormonal therapy. Afinitor has not yet been approved for use in breast cancer.

Reference: Hortobagyi GN, Piccart M, Rugo H et al. Everolimus for postmenopausal women with advanced breast cancer: updated results of the BOLERO-2 phase III trial. Presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. December 6-10, 2011. Abstract S3-7.

Longer Follow-Up Continues to Suggest That Zometa May Provide Breast Cancer Benefit

Tue, 13 Dec 2011 00:01:20 +0000

Longer-term follow-of of the ABCSG-12 study continues to suggest that the bisphosphonate drug Zometa® (zoledronic acid) may improve outcomes among women with early-stage, hormone receptor-positive breast cancer. These results were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

The majority of breast cancers are hormone receptor-positive. These cancers are stimulated to grow by the circulating female hormones estrogen and/or progesterone. Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen as well as drugs known as aromatase inhibitors.

Zometa is a bisphosphonate drug that is used for the treatment of cancer-related hypercalcemia (high levels of calcium in the blood) and of bone metastases in patients with advanced cancers. Recent research has focused on the potential anticancer effects of Zometa and the ability of Zometa to prevent treatment-related bone loss among women with early-stage breast cancer. Study results regarding the potential anticancer effects of Zometa have been mixed.

The current Phase III clinical trial evaluated Zometa among 1,803 premenopausal women with Stages I-II, hormone receptor-positive breast cancer. The study was conducted by the Austrian Breast and Colorectal Cancer Study Group (ABCSG).

Following surgery all patients were treated with hormonal therapy consisting of goserelin (for ovarian suppression) and either Arimidex® (anastrozole) or tamoxifen. Some patients also received Zometa. Treatment was given for three years.

A previous analysis after four years of follow-up found that women given Zometa had a lower risk of cancer recurrence than women who did not receive Zometa.[1] Women have now been followed for roughly seven years.[2]

Women treated with Zometa had a 28% reduction in risk of recurrence and a 36% reduction in risk of death.
No women experienced osteonecrosis of the jaw (death of bone tissue in the jaw: a rare side effect of some bone drugs).

These results continue to suggest that Zometa may improve outcomes among selected women with early-stage breast cancer. Not all studies have found a benefit of Zometa in early-stage breast cancer, however, and the role of Zometa for this purpose remains uncertain.

References:

[1] Gnant M, Mlineritsch B, Schippinger W, et al. Endocrine therapy plus zoledronic acid in premenopausal breast cancer. New England Journal of Medicine. 2009;360:679-691

[2] Gnant M, Mlineritsch B, Luschin-Ebengreuth G et al. Long-term follow-up in ABCSG-12: significantly improved overall survival with adjuvant zoledronic acid in premenopausal patients with endocrine-receptor-positive early breast cancer. Presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. December 6-10, 2011. Abstract S1-2.

Many Women Not Getting Breast Reconstruction After Mastectomy

Tue, 13 Dec 2011 00:01:07 +0000

Less than one-quarter of women who have a mastectomy undergo immediate breast reconstruction. These results were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

For some women with breast cancer, treatment will include a single or double mastectomy (removal of one or both breasts). In order to restore the appearance of a breast, women may choose to undergo breast reconstruction after their mastectomy. Research suggests that immediate breast reconstruction can improve psychological well-being.

Breast reconstruction surgery has become increasingly refined and can be successfully accomplished in almost all women treated with mastectomy. The goal of breast reconstruction surgery is to create a breast that matches the opposite breast. This can be accomplished by using a breast implant alone, by actually reconstructing the breast with the patient’s own tissue, or by utilizing a combination of these two techniques.

To explore the frequency and predictors of immediate breast reconstruction, researchers collected information about more than 106,000 breast cancer patients who had undergone mastectomy between 2000 and 2010.

Overall, 23% of women underwent immediate breast reconstruction.
Rates of immediate reconstruction increased over time, from 15% in 2000 to 33% in 2010.
Compared with women without health insurance, women with commercial health insurance were three times more likely to undergo breast reconstruction.
Women were less likely to undergo immediate reconstruction if they were older, black, treated at a rural or non-teaching hospital, or had multiple other health problems.

These results suggest that although rates of post-mastectomy breast reconstruction have increased over time, they remain low. Of the factors evaluated, insurance status was one of the strongest predictors of who received breast reconstruction. The researchers encourage public policy that ensures access to reconstructive surgery for all women.

Reference: Hershman DL, Neugut A, Richards CA et al. Influence of hospital factors, physician factors and type of health insurance of receipt of immediate postmastectomy reconstruction in young women with breast cancer. Presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium. December 6-10, 2011. Abstract S6-3.