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Cancer Advances: News from the 2005 ASCO Annual Meeting
A Word from the President
May 2005
This newsletter is designed to provide you with cancer research news from the 41st Annual Meeting of the American Society of Clinical Oncology, held May 13 - 17, 2005 in Orlando, Fl.
Dear Friends,
Doctors who treat people with cancer have an opportunity to improve their patients' care with the collective knowledge gained month by month, year by year, through the study and practice of clinical oncology. The 2005 ASCO Annual Meeting theme, Advancing the Science of Clinical Oncology, reflects the importance of a scientific, evidence-based approach to preventing and treating cancer.
To help inform the public about the latest advances in cancer research, ASCO publishes Cancer Advances, a series of consumer information resources. Cancer Advances: News from the 2005 ASCO Annual Meeting is designed to provide people living with cancer and their families with the latest information about cancer research, prevention, care, and treatment as presented each year at ASCO's Annual Meeting. The information contained in this issue was presented at the 41st Annual Meeting of the American Society of Clinical Oncology held in Orlando, Florida, from May 13 to 17.
I am pleased to be able to share the advances that have been made in the science of oncology this past year, especially in several areas that are so important to people living with cancer, such as access to quality care, cancer prevention, and survivorship. For more information about cancer, please visit ASCO's People Living With Cancer website (www.PLWC.org).
Sincerely,
David H. Johnson, MD
ASCO President
Last Updated: May 16, 2005
Too Few Lymph Nodes Are Being Removed During Stomach Cancer Surgery in the United States
A new study shows that one quarter of people undergoing surgery for stomach cancer have the recommended number of lymph nodes removed, that this number varies widely by geographic region, and that adequate lymph node removal is related to people surviving this cancer.
Lymph nodes are tiny, bean-shaped glands that help fight infection. When cancer cells start to spread to other parts of the body, they first go to the lymph nodes. During stomach cancer surgery, doctors remove a number of these lymph nodes and examine them for evidence of cancer. The more lymph nodes that are removed and examined, the more certain a doctor can be about how far the cancer has spread. This information helps determine the stage (description) of the cancer and guides treatment decisions. In 1997, the American Joint Committee on Cancer (AJCC) determined that 15 lymph nodes should be removed and assessed in people having stomach cancer surgery.
In this study, investigators analyzed 11,602 records in the Surveillance, Epidemiology, and End Results (SEER) database of people who had surgery to remove their stomach cancer from 1988 to 2001. They found that 15 or more lymph nodes were removed in only 27.6% of the people. In addition, this percentage varied among geographic regions. For example, enough lymph nodes were removed in 52.5% of people in Hawaii, but only 17.5% of people in Utah had the correct number of lymph nodes removed.
Furthermore, survival of these patients five years after diagnosis strongly related to the number of lymph nodes removed during surgery. More than twice as many patients (33.4%) in Hawaii, where the average number of lymph nodes removed was 15, were alive five years after their cancer diagnosis compared with Utah (16.2%), where the average number of lymph nodes removed was six.
The researchers cautioned that survival is probably not directly related to the number of lymph nodes removed during surgery. Instead, this measurement is probably a marker of the overall quality of care a patient receives.
"Our study showed that three-quarters of patients undergoing gastric cancer surgery are not having the recommended number of lymph nodes removed, said Natalie G. Coburn, MD, MPH, Surgical Oncology Fellow at the University of Toronto, and lead author of the study. "Patients need to be aware that this may lead to an inaccurate prognosis (estimate of a patient's chance of recovery) and less aggressive treatment after surgery."
What This Means for Patients
Patients having stomach cancer surgery should talk to their doctors in advance about the details of their surgeries that may affect their treatment and recovery, including the number of lymph nodes that will be removed.
Last Updated: May 16, 2005
Care Delayed for Black Women with Breast Cancer
A new study reports that black women are more likely to experience delays in the diagnosis and treatment of breast cancer. These delays are significant because other studies have found that postponing treatment for three months or more can lower the five-year survival rate by 12%.
"While this study confirms results of other smaller studies, we were very surprised by the degree of clinical delay experienced by black women with breast cancer when compared with other women," said Sherri N. Sheinfeld Gorin, PhD, Associate Professor at Columbia University in New York City and the study's lead author.
In this study, investigators analyzed the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (an extensive source of information about the health care of older women) for women age 64 and older who were diagnosed with primary breast cancer between 1992 and 1999. They identified 49,865 women with breast cancer, of whom 2,982 were black.
Results show that 20.9% of black women had a diagnosis delay (delay between screening and diagnosis) of one to two months compared with 14.3% of white women, and 23.5% of black women had a diagnosis delay of more than two months compared with 14.3% of white women. In addition, 29.6% of the black women had a treatment delay (delay between diagnosis and treatment) of more than one month.
Even after considering other factors that could contribute to these delays, black women were 89% more likely than other women to have a diagnostic delay of more than one month, 58% more likely to have a treatment delay of more than one month, and 81% more likely to have total clinical delay (diagnosis plus treatment), regardless of the stage of their cancers. Researchers attributed these differences to biological and genetic factors, cultural differences, and health care access issues.
"While we need to encourage women to make doctor's appointments right away and follow up with necessary care, health care providers also need to be more involved in helping women make arrangements for such care," said Dr. Gorin.
What this means for patients
Women who find a suspicious lump, receive suspicious findings on a mammogram, or receive positive biopsy results for breast cancer are encouraged to follow up with a cancer doctor as soon as possible. Breast cancer is treatable, and the five-year survival outlook is positive for most women, especially if treatment is started soon after diagnosis.
Last Updated: May 16, 2005
Chemotherapy Dose Does Not Differ Between Black Women and White Women with Breast Cancer
A new study from the National Surgical Adjuvant Breast and Bowel Project (NSABP) shows that higher rates of breast cancer deaths for black women are not due to lower doses of chemotherapy. Black women are more likely to die from breast cancer than white women, but the reasons are unknown.
Previous research shows that black people tend to have lower numbers of white blood cells (WBCs) than white people. Some chemotherapy drugs further reduce the number of WBCs, which increases the chance of developing a serious infection while receiving chemotherapy. The researchers thought that doctors may be giving black women lower doses of chemotherapy to avoid dangerous drops in white blood cell counts, and this difference might explain why black women are more likely to die from breast cancer than white women.
In this study, doctors compared the WBC count and dose of the chemotherapy drugs doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan, Neosar) given to 1,041 black women and 9,639 white women. Although the initial WBC counts were slightly lower in blacks compared with whites, the total dose of chemotherapy was similar.
"Our study shows that chemotherapy dosing is equal for white and black women, and that chemotherapy dose is not the likely cause of the difference in survival between black and white women with breast cancer," said Charles R. Thomas, Jr., MD, Professor and Vice Chairman, Department of Radiation Oncology and Professor of Medical Oncology, University of Texas Health Science Center, speaking on behalf of the NSABP.
What this means for patients
Although black women may have fewer WBCs before starting chemotherapy treatment, this condition does not have to affect overall chemotherapy dose. Differences in breast cancer mortality cannot be attributed to chemotherapy dose, and more research is needed to learn why more black women die from breast cancer.
Last Updated: May 16, 2005
Two Studies Assess Benefit of Two Different Drugs Used to Lower the Risk of Colorectal Cancer Returning
People with stage III, and often stage II, colorectal cancer are given adjuvant chemotherapy (chemotherapy after surgery), to lower the risk that the cancer will return. Two reports from large phase III clinical trials evaluate the benefit of adjuvant chemotherapy in colon cancer.
The first study found that adding oxaliplatin (Eloxatin) to standard chemotherapy of leucovorin (Wellcovorin) and fluorouracil (Efudex) lowers the risk that the cancer will return by 21% for people with stage II or III colorectal cancer. Oxaliplatin is already approved by the U.S. Food and Drug Administration (FDA) for use in combination with fluorouracil and leucovorin to treat people with stage III and IV colorectal cancer.
"Our results suggest that the addition of oxaliplatin to standard therapy is an important option for patients with stage II or III colorectal cancer who need chemotherapy after surgery," said Norman Wolmark, MD, Chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP) and lead author of the study.
In this phase III study, 2,407 patients with either stage II or stage III colorectal cancer received adjuvant chemotherapy with a combination of fluorouracil and leucovorin, with or without oxaliplatin. After almost three years, 76.5% of the patients who received oxaliplatin remained cancer-free, compared with 71.6% of the patients who had not received oxaliplatin.
Side effects were similar in the two groups, although 8% of the patients who received oxaliplatin experienced nervous system problems. In addition, diarrhea and dehydration that required hospitalization were more common in the oxaliplatin group (4.7% vs. 2.8%).
In the second study, doctors found that irinotecan (Camptosar) slightly improved the effectiveness of the standard chemotherapy drugs used to treat colorectal cancer after surgery for stage II or III cancer, but offered little benefit for stage III cancer alone. Irinotecan is approved by the FDA for use in combination with fluorouracil and leucovorin as initial treatment for people with advanced colorectal cancer and as second-line treatment in people whose colorectal cancer continued to spread after treatment with fluorouracil and surgery.
This study evaluated 3,278 people with stage II or III colorectal cancer who received fluorouracil and leucovorin with or without irinotecan for six months. Irinotecan reduced the risk of the cancer returning for people with stage III cancer by 11%, which was not statistically different from the other treatment. When people with stage II or III colorectal cancer were analyzed together, irinotecan lowered the risk of cancer returning by 13%.
What this means for patients
Both studies assess the value of adjuvant chemotherapy in people with early stage colorectal cancer. That is, can chemotherapy after surgery help lower the chance that the cancer returns? These two studies are different in the choice of chemotherapy: oxaliplatin (in the first study) or irinotecan (the second study), and each are given in combination with fluorouracil and leucovorin.
The first study confirms the results of an earlier European study that showed that adjuvant chemotherapy with oxaliplatin lowers the risk of the cancer returning for people with stage II or III colorectal cancer by 21%. The second study showed that adjuvant chemotherapy with irinotecan lowered the risk of the cancer returning by 13%, and confirms an earlier study in the United States that showed little benefit with irinotecan. The method of how the drugs were given was also slightly different. The first study used a two-hour infusion of fluorouracil given weekly, rather than a 48-hour prolonged infusion.
In conclusion, two large studies have now shown that oxaliplatin lowers the risk of the cancer returning, and two other large studies have shown that irinotecan does not appear to lower this risk. However, many people taking oxaliplatin experience serious side effects to the nervous system, which may not go away after treatment. Patients are encouraged to talk to their doctors about the risks and benefits of adjuvant chemotherapy for early stage colorectal cancer.
Last Updated: May 16, 2005
New Drug Helps People with Non-Small Cell Lung Cancer Live Longer
Results of a new study show that adding bevacizumab (Avastin) to chemotherapy helps people with non-small cell lung cancer (NSCLC) live longer. Bevacizumab stops angiogenesis, the process of forming new blood vessels, which helps tumors grow and spread.
In this phase II/III study, 444 people with untreated stage IIIb or IV NSCLC received the standard treatment of paclitaxel (Taxol) and carboplatin (Paraplatin), and 434 people received bevacizumab in addition to these two drugs. The people who received bevacizumab lived longer (an average of 12.5 months) than those who received the standard treatment (an average of 10.2 months). In addition, the cancer did not grow or spread for 6.4 months for the bevacizumab group, compared with 4.5 months for the standard treatment group, and tumors in 27% of the bevacizumab group shrank, compared with 10% of those for the standard treatment group.
"This is the first time a study has shown that adding a targeted therapy to standard chemotherapy can help these patients live longer," said lead investigator Alan B. Sandler, MD, Associate Professor of Medicine at Vanderbilt University Medical Center in Nashville, Tennessee. "The findings show that drugs like bevacizumab that stop angiogenesis may have a place in the treatment of lung cancer."
The most common side effects of these drugs included low white blood cell counts, blood clots, and bleeding. An uncommon but noted side effect of bevacizumab was life-threatening bleeding from the lungs.
What this means for patients
Bevacizumab is approved to treat people with advanced colorectal cancer, but this is the first study to suggest that this drug can also help people with lung cancer. Patients should talk to their doctors about the risks and benefits of this new treatment.
Last Updated: May 16, 2005
Chemotherapy Helps People with Cancer of the Stomach and Lower Esophagus Live Longer
Results of the MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial show that perioperative chemotherapy (the use of chemotherapy before and after surgery) improved overall survival and delayed cancer growth for people with operable cancer of the stomach and lower esophagus.
The chemotherapy drugs used in this study were epirubicin (Ellence), cisplatin (Platinol), and fluorouracil (Efudex).
Between 1994 and 2002, 250 patients received perioperative chemotherapy, and 253 received only surgery. Five years after diagnosis, 36% of the patients who received perioperative chemotherapy were still alive, compared with 23% of those who did not receive chemotherapy. In addition, the cancer continued to grow in 70% of the patients who received chemotherapy, compared with 83% who did not receive chemotherapy.
"Perioperative chemotherapy should be considered one of the treatment options for patients with these cancers," said Professor David Cunningham, MD, of the Royal Marsden Hospital in Surrey, United Kingdom, and lead author of the study. He noted that research has shown that the combination of chemotherapy and radiation therapy given after surgery can also help people with this cancer.
What this means for patients
People with these types of cancer are encouraged to talk to their doctors about the risks and benefits of this treatment. Early results of the MAGIC study were presented at the 2003 ASCO Annual Meeting, where it was reported that the reason chemotherapy before surgery is helpful is because it shrinks tumors, making them easier to remove.
Last Updated: May 16, 2005
About Risk
Many studies summarized in this publication talk about the risk of developing cancer, and these numbers may be confusing. To help understand risk, the following information may help:
Risk factors: Individual circumstances that increase a person's chance of developing a disease, including cancer
Absolute risk: The chance that a person will develop a disease during a given time. Absolute risk is helpful for determining how many people, or what percentage of the population (such as "one in 100"), is at risk for a disease.
Relative risk: A comparison between a group of people who have a particular risk factor and a group of people who do not, in order to determine the difference in risk level between the two groups.
Both relative and absolute risk provide important information when making decisions about lifestyle or cancer treatment. Knowing that a risk factor increases the risk of developing cancer by 100% (relative risk) might sound very frightening. But looking at the absolute risk (one person in 100 versus two people in 100) may provide a more complete picture. The best way to understand your own risk is to talk with your doctor.
For more information, please read the feature article Understanding Risk on People Living With Cancer (www.PLWC.org).
Last Updated: May 16, 2005
Drugs that Lower Cholesterol May Also Help Lower Breast Cancer Risk
A study of more than 40,000 female veterans in the United States shows that the cholesterol-lowering drugs known as statins help reduce the risk of breast cancer by more than half.
Between October 1998 and June 2004, doctors collected health information from female veterans in the South Central Veterans Affairs Health Care Network. They compared the use of statins between 556 women with a history of breast cancer and 39,865 women with no history of breast cancer. After accounting for other factors known to influence the risk of breast cancer, such as age, smoking, alcohol use, and diabetes, the risk of breast cancer was 51% lower for women who used statins than for women who did not.
"This is a significant study for people with breast cancer and women at high risk for this disease," said Vikas Khurana, MD, Assistant Professor of Medicine at Louisiana State University Health Science Center at Shreveport and senior author of the study. "The findings indicate that statins may have a role in breast cancer prevention."
Examples of statins include lovastatin (Altoprev, Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), and atorvastatin (Lipitor).
What this means for patients
Although this study is promising, more studies are needed to look at the possible protective role of statins in breast cancer. At this time, it is not recommended that women take statins to lower their risk of breast cancer.
Last Updated: May 16, 2005
Drug May Lower Risk of Developing Prostate Cancer
Results of a large phase II clinical trial show that a hormone drug called toremifene (Acopodene) lowers the risk of prostate cancer by nearly half for men with prostatic intraepithelial neoplasia (PIN).
PIN is a precancerous condition of the prostate that is diagnosed with a biopsy (removal and examination of tissue samples from the prostate). PIN can develop into prostate cancer in some, but not all, men. Toremifene, a hormonal therapy that is used to treat women with advanced breast cancer, may work by blocking a specific estrogen receptor that helps prostate cancer develop.
Between July 2001 and May 2004, 514 men with PIN received 20 mg, 40 mg, or 60 mg of toremifene or a placebo (an inactive drug) for a year. Tissue samples were taken from the men after six months and 12 months of receiving the drug.
After one year, nearly one-third of the men who took the placebo developed prostate cancer. Men treated with 20 mg of toremifene for six months had a 22% lower risk of developing prostate cancer than men who took the placebo, while men who completed a year of treatment nearly halved their risk of developing prostate cancer. Men taking toremifene had few side effects.
"This is the first time that a drug has shown promise for lowering the incidence of prostate cancer in men with PIN," said lead author David Price, MD, Director of Urologic Oncology and Clinical Research at Regional Urology LLC in Shreveport, Louisiana.
What this means for patients
Although this study shows promise, more studies are needed to determine whether toremifene can prevent prostate cancer. Men with PIN are encouraged to talk to their doctors about participating in the ongoing phase III clinical trial.
Last Updated: May 16, 2005
Raloxifene May Protect Against Uterine Cancer
Results of a new study show that raloxifene (Evista) is associated with lowering the risk of developing uterine (endometrial) cancer by 50%. Raloxifene is a selective estrogen receptor modulator (SERM) used to treat osteoporosis (thinning of the bones) and may lower the risk of breast cancer.
It is in the same class of drugs as tamoxifen (Nolvadex), a hormone treatment that is used to reduce the risk of breast cancer for some women. However, studies have shown that tamoxifen increases the risk of uterine cancer.
In this study, doctors compared the use of raloxifene and tamoxifen in 547 women with uterine cancer and 1,412 women without this cancer. The women with cancer were part of the Women's Insights and Shared Experiences (WISE) study project at the University of Pennsylvania School of Medicine. The women without cancer were contacted by random telephone dialing in the Philadelphia area.
The results show that women taking tamoxifen had a 50% increased risk of developing uterine cancer, but the women taking raloxifene lowered their risk of uterine cancer by 50%. These women took raloxifene for less than three years.
"Uterine cancer is becoming more common, so it's important to start thinking about ways to reduce the risk," said Angela DeMichele, MD, MSCE, Assistant Professor of Medicine at the Abramson Cancer Center and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. "If raloxifene helps prevent both breast cancer and uterine cancer, that information could help a woman decide which drug to choose."
What this means for patients
This study shows that raloxifene, unlike tamoxifen, may protect against uterine cancer. However, it is not yet known how raloxifene compares with tamoxifen for lowering the risk of breast cancer. This comparison is being studied in the STAR (Study of Tamoxifen and Raloxifene) trial, and the results from this trial are not expected until 2006. In the meantime, women at high risk of developing breast cancer should talk to their doctors about ways to lower this risk. Finally, only black and white women were included in this study, so the findings could be different for women of other ethnic backgrounds.
Last Updated: May 16, 2005
Eating Less Fat Can Lower the Risk that Breast Cancer Will Return
A phase III clinical trial from the Women's Intervention Nutrition Study (WINS) found for the first time that eating a lower-fat diet lowers the risk of recurrence (return of the cancer) in postmenopausal women with early stage breast cancer.
"This study may well represent the first lifestyle change—namely, lowering dietary fat—that can improve breast cancer outcome," said Rowan T. Chlebowski, MD, PhD, a medical oncologist at the Los Angeles Research Institute at Harbor-UCLA Medical Center and the study's lead author.
In this study, doctors compared how often breast cancer returned (either near the original tumor, in the other breast, or in another part of the body) in 2,437 women with early stage breast cancer. All women received standard treatment for their breast cancer, depending on the stage and type of cancer.
Of the women in the study, 1,462 ate a standard diet (containing an average of 51.3 grams of fat daily), and 975 women ate a low-fat diet (33.3 grams of fat daily) and received eight nutrition counseling sessions over 16 weeks, as well as ongoing counseling with a nutritionist every three months. After five years, 9.8% of the women on the low-fat diet had a recurrence of their breast cancer, compared with 12.4% of those eating the standard diet. In addition, women with breast cancer that does not respond to hormones on the low-fat diet had a 42% lower risk of recurrence than those on the standard diet.
What this means for survivors
While more trials are needed to confirm these results, this study suggests that eating a low-fat diet can help postmenopausal women with early stage breast cancer reduce their risk of recurrence.
Last Updated: May 16, 2005
Taking Aspirin Regularly Lowers the Risk of Colorectal Cancer Returning and Improves Survival
In a new study of people with stage III colon cancer, doctors from the Cancer and Leukemia Group B (CALGB) research group found that taking aspirin regularly lowered the risk of recurrence (return of the cancer) and death by approximately 50%.
Although this study was primarily designed for another purpose, it also showed that aspirin helps people who have already been diagnosed with colon cancer.
In this study, 830 people being treated with chemotherapy after surgery for stage III colon cancer completed surveys about their use of aspirin midway through treatment and six months after treatment. Regular aspirin use was reported by 8.7% of the patients. After nearly two and a half years, the risk of recurrence was 55% lower and the risk of death was 48% lower in people who took aspirin.
In addition, 4.3% of the patients were taking cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex) and rofecoxib (Vioxx). Taking either drug lowered the risk of recurrence by 44%. There was no benefit seen with acetaminophen (Tylenol), another anti-inflammatory drug.
What this means for survivors
"While aspirin appears to reduce the risk of cardiovascular disease, it is too early to tell people with colorectal cancer to start taking aspirin regularly for the purpose of reducing the risk of their cancer returning," said Charles Fuchs, MD, Associate Professor of Medicine at the Dana-Farber Cancer Institute in Boston, and the study's lead author. "More studies are clearly needed to confirm our findings." Regular aspirin use can have serious side effects, so people with colorectal cancer should talk to their doctors about the risks and benefits of taking aspirin or COX-2 medications to reduce their risk of cancer recurrence.
Last Updated: May 16, 2005
Most Survivors of Childhood Cancer Have Significant Health Problems by Age 45
A report from the Childhood Cancer Survivor Study (CCSS) shows that adult survivors of childhood cancer have five times the risk of developing moderate to severe health problems compared with their healthy siblings.
Severe health problems include second cancers, heart disease, kidney transplant or the need for dialysis, mental retardation, and paralysis of an arm or leg. Moderate health problems due to the long-term effects of radiation therapy or chemotherapy include lung scarring requiring oxygen therapy, congestive heart failure, a blood clot in the head or lungs, cirrhosis of the liver, ovarian or testicular failure, and becoming legally blind or losing an eye.
In this study, doctors looked at how often moderate and severe chronic health problems happened in two groups: 10,397 adults who were diagnosed with a childhood cancer between 1970 and 1986, and 3,034 of their siblings. The average age of the survivors when they were diagnosed was nearly 10 years. At the time of the study, the survivors were ages 18 to 48.
By age 45, 57.1% of the survivors and 18.2% of the siblings had a moderate health problem, and 37.4% of the survivors and 4.6% of the siblings had a severe health problem. The risk of having either a moderate or severe health problem was five times greater for the survivors.
"This study provides the first estimate of how often physical health problems occur in childhood cancer survivors as they become adults," said Kevin C. Oeffinger, MD, Professor of Family Medicine, University of Texas Southwestern Medical Center, Dallas, and lead author of the study. "Most survivors will have future health problems related to their previous cancer therapy, which are likely to increase as they reach their 30s and 40s."
What this means for survivors
Survivors of childhood cancer are encouraged to talk to their doctors about making plans to screen for future health problems and to discuss ways to reduce potential risks to their health. In addition, keeping detailed information about their personal and family medical histories, the doses and types of cancer treatments they received, other health conditions, and lifestyle habits (such as smoking) can help doctors assess the possibility of future health problems.
Last Updated: May 16, 2005
Many Cancer Survivors Say Their Nonmedical Needs Are Not Met
A new survey from the Lance Armstrong Foundation (LAF) of 1,020 cancer survivors (ages 18 to 75) shows that nearly half feel their nonmedical needs, such as emotional distress, financial issues, and sexual side effects, are not being met.
More than half feel that their emotional needs are more difficult to cope with than their physical needs.
In addition, 70% of the group say they have suffered depression at some point due to cancer, 32% said they talk about cancer a few times every month (including 10% who said they talk about it every day), and 40% said their lives are still affected by cancer.
"These findings show that cancer is a burden that never leaves a person, even after therapy is over," said Steven N. Wolff, MD, Professor of Medicine at Meharry Medical College, the study's lead author, and member of the Board of Directors of the LAF.
This survey was conducted online from October 1 – 6, 2004, and 73% of the people who participated were diagnosed more than two years before the survey.
What this means for survivors
Cancer survivors who are experiencing emotional, social, or other nonmedical problems are encouraged to discuss these problems with their doctors and to ask for referrals to appropriate resources.
Last Updated: May 16, 2005
New Drug Shows Promise in Advanced Kidney Cancer
A new drug, called AG-013736, is designed to treat metastatic renal cell cancer (a type of kidney cancer) that no longer responds to immunotherapy.
Immunotherapy, a treatment for advanced kidney cancer, is the use of substances (made by the body or created in a laboratory) to support or stimulate the body's own immune system in fighting cancer. Interleukin-2 (IL-2) and interferon-alpha are well-known immunotherapies for kidney cancer.
This study was a phase II trial, in which researchers wanted to determine whether AG-013736 could slow tumor growth in kidney cancer. AG-013736 is taken as a pill and is designed to shut down various pathways that help tumors grow and form new blood vessels.
In this study, 52 patients received AG-013736. The tumors shrank by 30% in 21 patients (40%). After one year, tumors in only 13 (25%) of the patients grew or spread. The most common side effect of AG-013736 was high blood pressure, which is easily treated with medication.
"The response of this drug in patients with advanced renal cancer is better than any other drug that has been approved for this disease," said Brian Rini, MD, Assistant Professor of Medicine at the University of California, San Francisco, and lead author of the study.
What this means for patients
The study provides evidence that this drug works in people with this type of kidney cancer. However, a large phase III trial comparing this drug with the current standard treatment must be done in order for the drug to become widely available. Patients are encouraged to talk to their doctors to learn more.
Last Updated: May 16, 2005
Letrozole Better than Tamoxifen at Keeping Breast Cancer from Returning
A phase III study led by the International Breast Cancer Study Group (IBCSG) shows that letrozole (Femara) is more effective than tamoxifen (Nolvadex) in preventing breast cancer recurrence (return of the cancer).
Currently, tamoxifen is widely used to prevent breast cancer recurrence for women whose breast cancer responds to hormones. Letrozole is a different type of drug called an aromatase inhibitor, which slows or stops the growth of breast cancers that are controlled by estrogen.
Doctors studied breast cancer recurrence in 8,028 postmenopausal women. These women received either tamoxifen for five years, letrozole for five years, tamoxifen for two years followed by letrozole for three years, or letrozole for two years followed by tamoxifen for five years. At this time, results are only available for the first two groups (tamoxifen only and letrozole only); follow-up is ongoing to determine if switching drugs mid-course affects breast cancer recurrence.
The results showed that women who took letrozole had fewer recurrences (351) than women who took tamoxifen (428), which was a 19% reduction in risk. Additionally, the risk of cancer spreading to other areas of the body was lowered by 27% for the women taking letrozole.
However, the two drugs had different side effects. Women who took tamoxifen were more likely to have blood clots, vaginal bleeding, and uterine cancer than the women who took letrozole. Those on letrozole were more likely to experience joint pain, bone fractures, and slightly increased cholesterol levels. Deadly strokes and heart attacks were more common in the letrozole group, although these conditions were rare.
"Our results suggest that using an aromatase inhibitor for the treatment of hormonally responsive breast cancer lowers the rate of recurrence," said Beat J. Thürlimann, MD, senior lecturer in Medical Oncology at the University of Basel in Switzerland, and Study Chairman of the trial. "The role of tamoxifen in breast cancer treatment is likely to become limited as studies continue to show that aromatase inhibitors are more effective for many patients with this disease." However, doctors noted that the side effects of each drug should be considered when determining which one is better.
What this means for patients
This study shows that letrozole, an aromatase inhibitor, is better at preventing breast cancer recurrence than tamoxifen. This study confirms other studies showing that aromatase inhibitors (such as anastrozole [Arimidex] and exemestane [Aromasin]) can reduce the risk of recurrence. However, because of the possibility of an increased risk of heart attack and stroke, more research is needed to study the long-term effects of letrozole. Given that each drug has a different set of side effects, women should discuss with their doctors which drug is best for them in preventing breast cancer recurrence based on their personal circumstances.
Last Updated: May 16, 2005
Clinical Trials
Cancer clinical trials: Research studies involving people that compare new treatment and prevention methods with the best-known treatment to determine whether they are safe, effective, and offer a better treatment option.
Phase I trial: Determines the best, safe dose and schedule of a drug. These trials are generally available to patients with any type of cancer.
Phase II trial: Determines whether a drug is effective in treating a specific type of cancer.
Phase III trial: Defines the role of a drug in cancer treatment. The drug is usually compared with the best known treatment (known as "standard therapy").
Phase IV trial: Tests performed in a larger population once the drug has been approved to study its cost-effectiveness.
Last Updated: May 16, 2005
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