Ovarian cancer has the highest mortality rate of all gynecologic cancers. It is the fifth leading cause of cancer death among U.S. women, with roughly 22,000 new cases and 15,000 deaths predicted for 2012. Outcomes for women diagnosed with advanced disease remain poor, and researchers continue to evaluate new approaches to treatment.

In two consecutive trials, researchers evaluated a novel immunotherapeutic strategy with two steps — dendritic cell vaccination and adoptive T-cell therapy. The first step of the immunotherapy approach is to preserve the patient’s tumor at the time of surgery so it can be used to manufacture a personalized vaccine that teaches the patient’s own immune system to attack the tumor. Next, researchers isolated immune cells called dendritic cells from the blood of 31 patients with recurrent, progressive, stage 3 and 4 ovarian cancer. They then prepared the vaccine by exposing each patient’s dendritic cells to her own tumor tissue. The first six patients were assigned to the first version of a vaccine while the other 25 were assigned to an enhanced vaccine.

After vaccine treatment, 19 patients showed clinical benefit and developed an antitumor immune response. Of these 19 patients, 8 had no measurable disease at the end of the study and remained on maintenance therapy and one of these eight remained disease-free for 42 months after vaccine treatment.

Eleven patients who responded to the vaccine treatment but still had residual disease moved to the second step of the immunotherapy: adoptive T-cell therapy. At this point, the researchers removed immune cells called T cells from patients’ blood, stimulated and expanded the cells in the laboratory, and then reinjected them into the patients. The researchers found that because the T-cells had already been “educated” by the dendritic cell vaccine to attack the tumor cells, the adoptive T-cell transfer amplified the antitumor immune response. Of these 11 patients, seven had stable disease and one had a complete response.

Both treatments were given in conjunction with Avastin® (bevacizumab), a targeted therapy that blocks a protein known as VEGF, which plays a key role in the development of new blood vessels. By blocking VEGF, Avastin deprives the cancer of nutrients and oxygen and inhibits its growth. The researchers noted that Avastin and immunotherapy was a powerful combination.

The vaccination therapy alone showed about a 61 percent clinical benefit and the combination of therapies showed about a 75 percent benefit. The researchers concluded that the therapy was effective and offered potential for good quality of life and minor side effects. They note that the approach warrants further investigation.

Reference:

Kandalaft LE, Tanyi J, Chiang C, et al. Autologous whole-tumor antigen vaccination in combination with adoptive T cell therapy for patients with recurrent ovarian cancer. Presented at the AACR Annual Meeting 2013, held in Washington, D.C., April 6-10. Abstract LB-335.

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In 2007, the WCRF and the AICR issued recommendations on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence. The 10 recommendations are as follows:

• Be as lean as possible within the normal range of body weight.
• Be physically active as part of everyday life.
• Limit consumption of energy-dense foods. Avoid sugary drinks.
• Eat mostly foods of plant origin.
• Limit intake of red meat and avoid processed meat.
• Limit alcoholic drinks.
• Limit consumption of salt. Avoid moldy grains or legumes.
• Aim to meet nutritional needs through diet alone (by avoiding supplements).
• Mothers to breastfeed; children to be breastfed.
• Follow the recommendations for cancer prevention. 

In order to determine whether these recommendations were associated with a reduced risk of death, researchers conducted a study to investigate 378,864 people in nine European countries enrolled in the European Prospective Investigation into Cancer and Nutrition study. Over a period of 12 years, researchers examined the subjects’ diet and lifestyle to see how closely they complied with six or seven (for women) of the ten recommendations: body fat, physical activity, consumption of foods and drinks that promote weight gain, consumption of plant foods, meat, alcoholic drinks and breastfeeding. Participants were given a score from 0 to 6 (or 7 for women); higher scores indicated greater compliance with the recommendations.

They then compared the group of participants with the strongest adherence to the guidelines to those with the weakest adherence to calculate the level of risk reduction that would come from compliance with the recommendations. When compared to the group with the lowest level of compliance, those who most closely followed the WCRF/AICR recommendations had a 34 percent reduced risk of death overall—and specifically, a 50 percent reduced risk of dying from respiratory disease, 44 percent reduced risk of dying from circulatory disease, and a 20 percent reduced risk of dying from cancer.

Being lean and eating foods mostly of plant origin appeared to have the greatest impact on reducing the risk of death from disease. Limiting alcohol consumption and eating mostly plant foods had the greatest impact on reducing the risk of cancer death. Women who breastfed for at least six months had a reduced risk of death from cancer and circulatory disease.

The researchers concluded that following the WCRF/AICR lifestyle recommendations could reduce the risk of cancer death and death from other diseases.

Reference:

Vergnaud AC, Romaquera D, Peeters PH, et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study. The American Journal of Clinical Nutrition. Published early online April 3, 2013. doi: 10.3945/ajcn.11

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Each year in the United States, more than 240,000 men are diagnosed with prostate cancer and more than 27,000 die of the disease. Prostate cancer is typically a disease of aging. It may persist undetected for many years without causing symptoms. In fact, most men die with prostate cancer not from prostate cancer. Approximately 20% of men will develop prostate cancer during their lifetime, yet only 3% will actually die of the disease.

The treatment of early-stage prostate cancer is controversial because thus far there is no clear proof that aggressive treatment prolongs survival compared with deferred treatment. Furthermore, treatment can cause lasting side effects, such as impotence and incontinence. Some men opt for a more conservative approach, called active surveillance or watchful waiting—which defers treatment until symptoms appear and/or there is evidence of progression. This approach can help some men avoid unnecessary treatment and potentially long-lasting side effects; however, until now, it wasn’t possible to predict which cancers were aggressive and required treatment and which were slow-growing and could be watched until treatment was necessary.

The Oncotype DX prostate cancer test measures the level of expression of 17 genes across four biological pathways to predict prostate cancer aggressiveness. The test results are reported as a Genomic Prostate Score (GPS) that ranges from 0 to 100 and is combined with other clinical factors to further clarify a man’s risk prior to treatment intervention.

The validation study led by researchers at the University of California, San Francisco (UCSF) included 395 patients whose GPS was assessed using tissue from a single needle biopsy. The results indicated that the information provided by the GPS significantly increased—tripled, in fact—the number of patients identified as having low-risk disease who were thus eligible for active surveillance rather than treatment. What’s more, approximately 10 percent of patients originally classified as very low or low risk by clinical factors were identified by GPS as having more aggressive disease, which would be considered for immediate treatment.

The researchers concluded that the Oncotype DX GPS strongly predicted disease aggressiveness, offering information beyond currently available clinical factors, such as PSA and biopsy Gleason Score, to help physicians and their prostate cancer patients confidently choose the most appropriate treatment based on an individualized risk assessment. What’s more, the test has been validated to guide treatment decisions with the prostate needle biopsy sample—meaning low-risk patients could avoid invasive treatments such as surgery or radiation. The test is now available to patients and the researchers speculate that it could increase the use of active surveillance and help avoid overtreatment.

Reference:

Cooperberg M, Simko J, Falzarano S, et al. Development and validation of the biopsy-based genomic prostate score (GPS) as a predictor of high grade or extracapsular prostate cancer to improve patient selection for active surveillance. Presented at the 2013 annual meeting of the American Urological Association. May 4-8, 2010. San Diego, CA. Abstract 2131.

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The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins, and fats; the production of bile; the processing of hemoglobin; and detoxification of numerous substances. Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Hepatitis C is an infection of the liver and one of the leading causes of liver cancer.

Statins are cholesterol-lowering drugs and are the most commonly prescribed class of prescription drugs in the United States. Some studies have suggested that in addition to their cardiovascular effects, statins may help to reduce the risk of certain cancers, including prostate cancer and colorectal cancer.[2][3] However, other studies have demonstrated little evidence that statins reduce risk.[4][5]

To examine the relationship between statins and liver cancer among individuals with hepatitis C (HCV), researchers conducted a population-based cohort study of 260,864 HCV-infected patients enrolled in the Taiwan National Health Insurance Research Database. Patients were followed from 1999 to 2010, during which time about 13 percent of patients (35,023) filled a prescription for statins.

During the course of follow-up, there were 27,883 cases of liver cancer in the cohort. Among the 35,023 patients using statins, 1,378 had liver cancer. Among the 225,841 patients not using statins, 26,505 developed liver cancer. After the researchers accounted for patients’ age, gender and other diseases, they found those who took statins were about half as likely to get cancer as non-statin users. Higher doses of statins, as well as longer-term use, were linked to a further drop in cancer risk.

The researchers concluded that among people with hepatitis C, statin use was associated with a reduced risk of liver cancer; however, they are quick to point out that this doesn’t prove that statins prevent cancer. The data isn’t strong enough to warrant prescribing statins for liver cancer prevention; however, the researchers did not find a link between statins and any complications in this population—meaning that doctors do not need to avoid prescribing statins in people with hepatitis C.

References:

Copyright © 2013 CancerConsultants. All Rights Reserved.

Anal cancer is an uncommon type of cancer that occurs in the anal canal, the opening at the end of the rectum. The rate of anal cancer in the United States has been rising since 1940. The most common type of anal cancer is squamous cell carcinoma of the anal canal (SCCA), which accounts for about 85 percent of cases.

Some groups are at a higher risk of developing anal cancer, including gay men, individuals with multiple sex partners over their lifetime, individuals with genital warts, and those who have had anal intercourse. Infection with the human papillomavirus (HPV) is one of the major risk factors for anal cancer and in fact, is estimated to cause about 85 percent of all anal cancer cases. Individuals with compromised immune systems—including those with HIV—are at a higher risk of developing HPV, and subsequently HPV-related cancers.

Using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, researchers found that the rate of anal cancers went from approximately one person per 100,000 between 1973 and 1996 to three per 100,000 between 1997 and 2009. They identified 11,231 cases of SCCA between 1973 and 2009 and analyzed the trends among these cases. They observed a large rise in incidence in 1997. In the 23 years prior to 1997, 4,224 people were diagnosed, whereas 7,007 people were diagnosed in the 13 years following 1997. Anal cancer rates rose for both genders, but more dramatically for men. Rates for both SCCA and anal carcinoma in situ (CIS) rose, whereas rates for adenocarcinoma remained stable.

The researchers concluded that the incidence of SCCA and CIS increased dramatically after 1997 for both men and women, although men were more likely to be diagnosed with CIS. They speculated that the increase could be the result of more available screening and an increased effort to identify high-risk individuals who may benefit from screening.

Reference:

Nelson RA, Levine AM, Bernstein L, et al. Changing patterns of anal canal carcinoma in the United States. Journal of Clinical Oncology. 2013; 31(12): 1569-1575.

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A mammogram is an X-ray of the breast. Screening mammography is performed in a woman without breast symptoms in order to detect breast cancer at an early stage when it is most easily treated. Different groups of experts have reached different conclusions about when mammographic screening should begin and how often it should be performed. The U.S. Preventive Services Task Force recommends that routine screening of average-risk women begin at age 50 and be performed every two years. The American Cancer Society recommends annual screening beginning at age 40.

Although screening mammography can reduce the risk of death from breast cancer (due to early detection), disease screening in healthy individuals can also lead to false-positive test results. A false-positive result suggests that cancer may be present even though the person is actually cancer-free. False-positive results can lead to anxiety and unnecessary additional testing.

To examine the impact of false-positive results, researchers conducted a cohort study with a 3-year follow-up. The study included 454 women ages 50 to 69 who had abnormal mammography results and 864 participants who had normal mammograms. The participants completed the Consequences of Screening in Breast Cancer—a validated questionnaire encompassing 12 psychosocial outcomes—at baseline, 1, 6, 18, and 36 months. The first component of the survey addresses eight types of psychosocial outcomes, such as self-image, anxiety, sexuality, dejection, and negative effects on behavior. The second component encompasses four scales: perceived changes resulting from the mammography, impact on social relationships, feeling less or more relaxed/calm, and anxiety.

The results indicated that three years after the false mammography results, women still exhibited greater psychosocial consequences compared with women who had normal mammograms. In fact, psychological testing at 6 months showed that women who received false-positive results remained as upset as women who had breast cancer—and reported changes in existential values and inner calmness as great as those reported by women with a diagnosis of breast cancer.

The researchers concluded that false-positive results on screening mammography cause long-term psychosocial harm that can last as long as three years. The frequency of false-positive mammography results ranges from 20 to 60 percent in the United States and Europe. Though screening for breast cancer may be beneficial, it can also result in psychological harm from false-positive results.

Reference:

Brodersen J, Siersma VD. Long-Term Psychosocial Consequences of False-Positive Screening Mammography. Annals of Family Medicine. 2013; 11(2): 106-115.

Copyright © 2013 CancerConsultants. All Rights Reserved.

Overview

Eligibility Requirements

Inclusion:
1. Must have a documented diagnosis of CLL/SLL
2. Have failed > 1 previous treatments for CLL/SLL, and have relapsed and/or refractory disease following last prior treatment
3. ECOG PS of < 2
4. LVEF > 50%

Exclusion:
1. Autologous stem cell transplant within 3 months

2. Ongoing or active infection requiring parenteral antibiotics
3. Uncontrolled diabetes mellitus, Chronic symptomatic clinically significant cardiac arrhythmia that is symptomatic or requires treatment, or asymptomatic sustained ventricular tachycardia. Subjects with controlled atrial fibrillation that is asymptomatic are eligible
4. Subjects who are at a high risk for a thromboembolic event and are not willing/able to take (VTE) prophylaxis
5. Chemotherapy, radiotherapy, investigational anticancer therapy or major surgery within 28 days of Day 1 dosing
6. Use of systemic corticosteroids in doses greater than prednisone equivalent to 20 mg/day within 3 weeks prior to study drug dosing
7. Prior treatment with Btk inhibitors
8. Patients with uncontrolled hyper or hypothyroidism.

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Overview

Eligibility Requirements

Inclusion:
1. Invasive adenocarcinoma of breast; HLA-A2 or HLA-A3 haplotype per central lab
2. Node-positive (pN1 or pN2); T1-3 at the time of dx
3. Her2 status per central lab; ER/PR status per qualified lab
4. Mastectomy or lumpectomy; Received radiation
5. Must receive neoadjuvant or adjuvant chemo or both consisting of 4 cycles (chemo regimen per NCCN guidelines)
6. Must not be more than 2 months and no sooner than 1 month from completion of chemo or radiation at the time of first study tx
7. If ER/PR + must receive adjuvant endocrine tx after chemo unless contraindicated

Exclusion:
1. Bilateral breast ca; Inflammatory breast ca; Hx prior breast ca
2. Prior Herceptin
3. Ongoing endocrine tx except for adjuvant hormone tx
4. NYHA stage 3 or 4 cardiac disease
5. Allergy to tetanus antibody

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Cancer survivors represent a growing population—and one in need of medical care, psychosocial support, and practical assistance. The aging of the population will result in a higher number of cancer survivors, which could present new healthcare challenges.

Researchers used data from the Surveillance, Epidemiology and End Results Program and population projections from the U.S. Census Bureau to determine cancer prevalence and survival. They found that as of January 2012, there were approximately 13.7 million cancer survivors living in the United States and that population was projected to reach 18 million by 2022. The data indicates that 64 percent of this survivor population has survived five years or more; 40 percent have survived 10 years or more; and 15 percent have survived 20 years or more after diagnosis. Over the next decade, the number of people who have lived five years or more after their cancer diagnosis is projected to increase approximately 37% to 11.9 million.

Survival trends vary across cancer subtypes. Currently, women with breast cancer account for 22 percent of survivors, while men with prostate cancer account for 20 percent of survivors. In contrast, people with lung cancer, the second most commonly diagnosed cancer, only represent 3 percent of survivors.

The increase in the survivor population is due in most part to the aging of the population. By 2020, the researchers predict that two-thirds of cancer survivors will be over the age of 65. The researchers say that the growing survivor population will present new healthcare challenges, as survivors will have long-term medical, psychosocial, and practical needs that will need to be met.

Reference:

de Moor JS, Mariotto AB, Parry C, et al. Cancer Survivors in the United States: Prevalence across the Survivorship Trajectory and Implications for Care. Cancer Epidemiolog,y Biomarkers & Prevention. 2013; 22(4): 561–70.

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Cancer screening refers to the use of tests to detect cancer in individuals who do not have any symptoms of the disease. In general, the primary goal of screening is to reduce cancer deaths by detecting cancer at an earlier and more treatable stage. For some types of cancer—including cervical cancer—screening can also play a role in cancer prevention. Screening for cervical cancer can identify precancerous changes to the cervix. Treatment of these precancers can then prevent the development of invasive cancer.

The Pap test is a screening test that has had a tremendous impact on cervical cancer incidence and mortality. During a Pap test, a sample of cells is removed from the cervix and evaluated under a microscope. The results of the Pap test are generally classified into one of several categories ranging from normal to cancerous. Two of these categories—atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intra-epithelial lesions (LSIL)—are considered indeterminate and may require further testing.

More recently, tests for high-risk types of human papillomavirus (HPV) have also been incorporated into cervical cancer screening programs. Persistent HPV infection causes most cases of cervical cancer. Researchers continue to evaluate the best way to triage women with ASCUS or LSIL—a repeated Pap test or an HPV test.

Researchers compared the accuracy of HPV testing with the Hybrid Capture 2 (HC2) assay against that of repeat Pap test for detection of underlying cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) or grade 3 or worse (CIN3+) in women with ASCUS or LSIL. They performed a comprehensive review of 39 studies that included women with ASCUS or LSIL who had undergone HPV testing and repeat Pap test or HPV testing alone, with verification by colposcopy and colposcopy-directed biopsies. There were two groups of meta-analyses: 13,196 women with ASCUS and 9,983 women with LSIL.

The results indicated that the HPV test had 27% better sensitivity and equal specificity in detecting high-grade cervical precancers in women with an initial finding of ASCUS. In women with LSIL, the HPV test also missed fewer high-grade lesions, with 23% better sensitivity than repeat Pap test.

The researchers concluded that the HPV test can be recommended for triaging women with ASCUS because it has a higher accuracy than repeat Pap test. However, when triaging women with LSIL, an HPV test yields a significantly higher sensitivity, but significantly lower specificity than a repeat Pap test. Therefore, they recommend that the management of LSIL should be balanced and take individual circumstances into account.

Reference:

Arbyn M, Roelens J, Simoens C, et al. Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD008054. DOI: 10.1002/14651858.CD008054.pub2

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