FDA Approves Axitinib for Advanced Renal Cell Cancer

The FDA has approved axitinib for patients with advanced disease that has progressed after receiving first-line therapy.
FDA Approvals

New Lung Cancer Assay Ready for Prime Time

The assay outperformed clinical criteria in identifying patients with early-stage nonsmall-cell lung cancer who were at high risk and who could benefit from additional treatment.
Medscape Medical News

2012 Multidisciplinary Head and Neck Cancer Symposium (MHNCS)

Read clinically focused news coverage of key developments from the meeting.
Medscape Hematology-Oncology

US Cancer Screenings Not Meeting Goals, Says CDC

Testing for cancer of the breast, cervix, and colon/rectum is recommended.
Medscape Medical News

Healthcare Gone Missing: The State of the Union Address

Henry R. Black, MD, and Roxana Mehran, MD, talked with Medscape after the 2012 State of the Union address about why healthcare was missing and what that portends.
Medscape Cardiology

[Errata] Erratum

Schiffman M, Wacholder S. Success of HPV vaccination is now a matter of coverage. Lancet Oncol 2012;13: 10–12—In this Comment (published online Nov 9, 2011), the last sentence of the sixth paragraph incorrectly lists HPV-35 as one of the oncogenic HPV types covered by the new nine-type Gardasil vaccine; the list should include HPV-45 instead. This correction has been made to the online version as of Jan 3, 2012.

[Comment] Drivers of the cost of cancer care

The Lancet Oncology Commission provides some excellent insights into the different drivers that shape cancer care, including imaging, radiography, surgery and hospital services, and drugs. However, the cost of drugs has dominated the subsequent press response and much of the commentary. This focus has arisen despite the Commission stating that the cost of drugs accounted for only about 13% of total US health-care expenditure in 2009. A similar percentage has been calculated for the cost of cancer care in New Zealand, where in a 6-year review the cost of drugs accounted for 10% of the total cost of cancer care per patient.

[Editorial] Budget cuts in the USA: a short-term win?

On Nov 18, 2011, President Barack Obama signed a bill into law that will affect the funding for several science agencies. The White House Office of Science and Technology Policy, which advices the executive office about the effects of science and technology on domestic and international affairs, has had its funding cut by more than 30%, leaving just $4·5 million. The USA's budget cuts to quell the national deficit of $1·2 trillion by 2021 mean that several key agencies such as the National Institutes of Health (NIH) and National Science Foundation had below-inflation increases to their funding.

[Correspondence] Chemotherapy for colorectal cancer – Authors' reply

Meyers and colleagues suggest that we compared upfront with deferred combination therapy, rather than with true sequential therapy. In fact, true sequential therapy concerns only irinotecan, since single-agent oxaliplatin is poorly active. In the CAIRO trial, first-line capecitabine followed by irinotecan alone then capecitabine–oxaliplatin (ie, deferred third-line combination therapy) was not inferior to upfront combination therapy in terms of overall survival.

[Comment] Further progress in HER2-directed therapy

Outcomes for women with early stage HER2-positive breast cancer have improved markedly since the introduction of the HER2-targeted monoclonal antibody trastuzumab. Women with node-positive disease can expect relapse-free survival to exceed 80% when treated with multi-agent chemotherapy and trastuzumab. However, there is still room for improvement, both by further reducing recurrence rates and by decreasing the toxicities of treatment. For some patients, the option may ultimately exist to eliminate chemotherapy entirely.

Phase I trial to investigate the safety, pharmacokinetics and efficacy of sorafenib combined with docetaxel in patients with advanced refractory solid tumours

Publication year: 2012
Source: European Journal of Cancer, Available online 27 January 2012
Ahmad Awada, Alain Hendlisz, Olaf Christensen, Chetan D. Lathia, Sylvie Bartholomeus, ...
AimThe safety, pharmacokinetics and efficacy of sorafenib plus docetaxel in patients with advanced refractory cancer were investigated in a Phase I, dose-escalation trial.MethodsTwenty-seven patients in four Cohorts received docetaxel on Day 1 (Cohorts 1 and 4: 75 mg/m; Cohorts 2 and 3: 100 mg/m) plus sorafenib on Days 2–19 (Cohorts 1 and 2: 200 mg twice-daily (bid); Cohorts 3 and 4: 400 mg bid) in 21-day cycles.ResultsMost common adverse events (AEs) (Grade 3–5) included neutropenia (89%), leucopaenia (81%), hand–foot skin reaction (30%) and fatigue (30%). The most common drug-related AEs leading to dose reduction/interruption or permanent discontinuation were dermatologic (41%), gastrointestinal (26%) and constitutional (22%). Coadministration of sorafenib altered the pharmacokinetics of docetaxel. On average, docetaxel area under the concentration–time curve (AUC)0–24increased by 5% (Cohort 1), 54% (Cohort 2), 36% (Cohort 3) and 80% (Cohort 4) with docetaxel plus sorafenib, whileCmaxincreased by 16–32%, independent of sorafenib/docetaxel doses. Three of 25 evaluable patients (11%) had partial responses; 14 (52%) had stable disease.ConclusionDose-limiting dermatologic AEs were more common than expected for either therapy alone. A starting dose of docetaxel 75 mg/mplus sorafenib 400 mg bid (with dose reductions for dermatological toxicities) is proposed for Phase II.

Adaptive designs at European Organisation for Research and Treatment of Cancer (EORTC) with a focus on adaptive sample size re-estimation based on interim-effect size

Publication year: 2012
Source: European Journal of Cancer, Available online 24 January 2012
M. Mauer, L. Collette, J. BogaertsEuropean Organisation for Research and Treatment of Cancer (EORTC) Statistics Department
Given the high failure rates and the increased costs of Phase III trials in oncology and the recent explosion of targeted agents, researchers are looking for better design strategies to try and optimise the use of available patients and financial resources. In this context, adaptive designs are seen as promising tools.We reviewed the different possible adaptations in the design of a clinical trial on the basis of the FDA guidance and summarized these. The pro and cons of adaptive designs are highlighted with a focus on one of the more ‘controversial’ adaptive designs, the sample size reassessment based on interim-effect size as proposed by Mehta and Pocock.While group sequential designs are preferable to such adaptive designs, both are difficult to implement in the case of rapid accrual and long time to event. Adaptive designs may have some potential in less favourable situations. However, the increase in overall power should be carefully weighted as well as the risk of a large negative trial.Adaptive designs need good, sometimes extensive, logistics. Some adaptive designs (e.g. group sequential designs) proved to be very useful and are already a part of the standard repertoire of trial designs used at European Organisation for Research and Treatment of Cancer (EORTC). Adaptive designs need strong measures to prevent bias that could otherwise become uncontrollable, particularly if interim results are leaked. This includes a prospective planning of adaptations.Finally, these studies currently have the potential to induce a heavy workload and cost linked to their regulatory management.

Inhibition of human hepatocellular carcinoma HepG2 by phthalocyanine photosensitiser ZnPcS2P2: ROS production, apoptosis, cell cycle arrest

Publication year: 2012
Source: European Journal of Cancer, Available online 19 January 2012
Jingwei Shao, Jinping Xue, Yongchao Dai, Hong Liu, Lee Jia, ...
Photodynamic therapy (PDT) has been accepted as an alternative treatment for cancer. The rationale for the development of PDT for cancer is that target specificity can be achieved by controlling the location at which light activates the drug, i.e. photosensitiser. Metal phthalocyanines represent a new class of photosensitisers developed for cancer treatment. In the present study, we focused on exploring molecular mechanisms of the lead photosensitiser ZnPcS2P2on hepatocellular carcinoma (HCC) HepG2 cells to guide our future development of ZnPcS2P2. Growth inhibition potency of ZnPcS2P2and its analogues was tested in vitro with and without irradiation at wavelength 670 nm. Irradiation shifted the concentration-growth inhibition curves of ZnPcS2P2to the left and decreased the IC50s of ZnPcS2P2required to produce equivalent inhibition by 200-fold on various cell lines. The amphipathic ZnPcS2P2permeated through HepG2 cell membrane and predominately distributed to lysosome and mitochondria, where it significantly reduced mitochondrial membrane potential (ΔΨm) and increased caspase-3 activity in a concentration-dependent manner after irradiation. Early apoptosis of HepG2 occurred followed by necrosis when concentrations of ZnPcS2P2were increased in the presence of irradiation. Reactive oxygen species (ROS) production was significant following ZnPcS2P2plus irradiation treatment and cell cycle was mainly arrested at G2/M stage. In conclusion, ZnPcS2P2, once irradiated, induces HepG2 cells into apoptosis via reducing ΔΨm, producing ROS, activating caspase-3, and causing cell arrest at G2/M stage. This study provides important insights into molecular mechanisms of the anti-cancer ZnPcS2P2, which now is in the clinical trials II in China.

Cancer care costs at "crisis" point

No abstract available

Cancer news from ISPOR

No abstract available

Radioembolization for the Treatment of Liver Tumors: General Principles

Radioembolization aims to selectively target radiation to all liver tumors while limiting the dose to normal liver parenchyma. The deposition of yttrium-90 (90Y) microspheres delivered through the hepatic artery are preferentially implanted within liver tumors in a 3:1 to 20:1 ratio compared with a normal liver. The principles and mode of action of radioembolization are fundamentally different from the conventional embolization of liver tumors through transarterial embolization or chemoembolization. A meticulous work-up, involving computed tomography scanning, contrast-enhanced magnetic resonance imaging, and transfemoral hepatic angiogram, is essential to assess the appropriateness of the patient for treatment. A simulation of the treatment, done with technetium-99m-labeled macroaggregated albumin particles, which approximate the size of microspheres, is used to identify the shunting of microparticles to the lungs or gastrointestinal tract, thus helping to determine patient selection. Whole-liver or unilobar treatment approaches are chosen according to the anatomic distribution of the tumors, concomitant factors affecting liver function, and institutional preferences. Optimal periprocedural care, discharge planning, and follow-up care are essential to assess treatment response and ensure that short-term side effects of radioembolization are adequately managed. The expanding literature on radioembolization shows that this is an effective treatment for the management of both primary and metastatic tumors.

Weekly Paclitaxel and Carboplatin Induction Chemotherapy Followed by Concurrent Chemoradiotherapy in Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Objective: To perform a phase II trial evaluating dose dense induction chemotherapy for locally advanced head and neck cancer. Patients and Methods: Thirty-five patients received 6 weekly doses of carboplatin (area under the curve=2) and paclitaxel (135 mg/m2) followed by concurrent weekly paclitaxel (40 mg/m2) and carboplatin (area under the curve=1) and daily radiation (66-72 Gy). Results: There was 1 induction death from neutropenic sepsis and 1 sudden death during chemoradiotherapy. The overall response rate with induction was 79%. With >40 months of follow-up, the 36-month overall survival was 67% and squamous cell carcinoma of the head and neck survival 84%. Patients undergoing biopsy of the primary tumor site after the therapies had 17/18 (94%) pathologic complete response rate. The locoregional relapse rate was 40% (24 mo 28%) and distant relapse rate was 8% with only 1 distant site. Conclusions: Therapy was active but patients must be carefully selected and monitored. Compared with the historical controls, dose dense and intense induction chemotherapy decreased distant failure rate without compromising the locoregional control.

Postoperative Low Pelvic Radiotherapy and Chemotherapy for Stage II and III Rectal Cancer

Objectives: To evaluate whether postoperative low pelvic radiotherapy (RT) combined with chemotherapy is an appropriate treatment for stage II and III rectal cancer. Methods: Between November 1997 and May 2006, 104 patients with stage II and III rectal cancer underwent surgery as the primary treatment followed by postoperative RT combined with chemotherapy in our institute and were reviewed retrospectively. Sixty-nine patients received low pelvic RT only (upper margin at 1 cm above the low end of the sacroiliac joint; median dose 54 Gy) (low pelvic RT group) and the other 35 patients received whole pelvic RT (upper margin at the mid L5; median dose 43.2 Gy) and subsequently received a boost to the low pelvis (total median dose 54 Gy) (whole pelvic RT group). Results: The 5-year overall survival rate, local control rate, and distant metastasis-free rate were 72% versus 63%, 86% versus 84%, and 66% versus 62% for low pelvic versus whole pelvic RT group. There were no statistical differences in these 2 groups. Two patients (2.9%) of the low pelvic RT group and 2 patients (5.7%) of the whole pelvic RT group developed upper pelvis relapse, which was out of the low pelvic field. The incidence of Grade 3 to 5 small bowel late complications of the low pelvic RT group was significantly less than that of the whole pelvic RT group (4.3% vs. 20%) (P=0.029). Conclusions: Low pelvic RT significantly reduces small bowel late complications and does not compromise the overall survival rate, local control rate, and distant metastasis-free rate.

Impact of Postoperative Radiation on Survival for High-grade Soft Tissue Sarcoma of the Extremities After Limb Sparing Radical Resection

Objectives: To use the Surveillance, Epidemiology, and End Results (SEER) Database to analyze the impact of postoperative radiation after limb sparing surgery for high-grade extremity soft tissue sarcomas (STS). Methods: We identified patients, aged 20 to 79, who were diagnosed between 1988 and 2006 with high-grade STS of the extremities and underwent radical limb sparing surgery with or without postoperative external beam radiation. Kaplan-Meier and Cox regression analyses were performed to evaluate the effect of postoperative external beam radiation therapy on overall survival (OS) and disease-specific survival (DSS). Results: A total of 983 patients met the selection criteria: 788 (80.2%) received postoperative radiation and 195 (19.8%) underwent surgery alone. For the whole cohort, there were no differences between the groups in OS (P=0.06) or DSS (P=0.20). On subgroup analysis, for tumors ≤5 cm there remained no significant differences in OS (P=0.8) or DSS (P=0.93). However, for tumors >5 cm the 3-year OS improved with the addition of postoperative radiation from 55.6% to 73.4% (P<0.001). Similarly, the 3-year DSS improved from 68.1% to 80.6% (P=0.005). Conclusions: Because of the retrospective nature of this study and inherent limitations of the SEER database, a large prospective study is needed to further elucidate the relationship between postoperative radiation and survival. However, these data do support the use of adjuvant radiation for patients with high-grade extremity STS measuring >5 cm.

Randomized Phase II Study of Carboplatin-Paclitaxel or Gemcitabine-Vinorelbine in Patients With Advanced Nonsmall Cell Lung Cancer and a Performance Status of 2: West Japan Thoracic Oncology Group 0004

Objectives: The aim of the present study was to evaluate the efficacy and safety of carboplatin plus paclitaxel versus gemcitabine plus vinorelbine in patients with advanced nonsmall cell lung cancer (NSCLC) and an Eastern Cooperative Oncology Group performance status (PS) of 2. Methods: Chemotherapy-naive patients with NSCLC of stage IIIB or IV and a PS of 2 were eligible. The patients received 3-week cycles of carboplatin (area under the curve of 6) plus paclitaxel (200 mg/m2) on day 1 (CP) or gemcitabine (1000 mg/m2) plus vinorelbine (25 mg/m2) on days 1 and 8 (GV). The primary end point was 1-year survival rate for selection of the better treatment arm for further study. Results: Of the 89 patients enrolled, 84 were assessable (41 in the CP arm, 43 in the GV arm). The overall response rate, median survival time, and 1-year survival rate were 29.3%, 5.9 months, and 22.0%, respectively, for the CP arm and 20.9%, 6.0 months, and 27.9% for the GV arm. Common toxicities of grade 3 or 4 included neutropenia (67.5% for the CP arm vs. 65.1% for the GV arm), febrile neutropenia (20% vs. 14%), and infection (25.0% vs. 23.2%). The frequency of nausea of grade 3 was greater for the CP arm (17.5% vs. 2.3%), whereas that of anemia of grade 3 or 4 (30.2% vs. 12.5%) or treatment-related death (7.0% vs. 2.4%) was greater for the GV arm. Conclusions: The 1-year survival rate did not exceed 30% for either doublet chemotherapy. Furthermore, each treatment was associated with a substantial degree of toxicity.

Major Response to Everolimus in Melanoma With Acquired Imatinib Resistance [DIAGNOSIS IN ONCOLOGY]

Sudden Death Related to Toxicity in a Patient on Capecitabine and Irinotecan Plus Bevacizumab Intake: Pharmacogenetic Implications [DIAGNOSIS IN ONCOLOGY]

Prioritizing Phase I Treatment Options Through Preclinical Testing on Personalized Tumorgraft [DIAGNOSIS IN ONCOLOGY]

Randomized, Double-Blind, Placebo-Controlled Phase II Study of AMG 386 Combined With Weekly Paclitaxel in Patients With Recurrent Ovarian Cancer [Gynecologic Cancer]

Purpose

To estimate the efficacy and toxicity of AMG 386, an investigational peptide-Fc fusion protein that neutralizes the interaction between the Tie2 receptor and angiopoietin-1/2, plus weekly paclitaxel in patients with recurrent ovarian cancer.

Patients and Methods

Patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer were randomly assigned 1:1:1 to receive paclitaxel (80 mg/m² once weekly [QW], 3 weeks on/1 week off) plus intravenous AMG 386 10 mg/kg QW (arm A), AMG 386 3 mg/kg QW (arm B), or placebo QW (arm C). The primary end point was progression-free survival (PFS). Secondary end points included overall survival, objective response, CA-125 response, safety, and pharmacokinetics.

Results

One hundred sixty-one patients were randomly assigned. Median PFS was 7.2 months (95% CI, 5.3 to 8.1 months) in arm A, 5.7 months (95% CI, 4.6 to 8.0 months) in arm B, and 4.6 months (95% CI, 1.9 to 6.7 months) in arm C. The hazard ratio for arms A and B combined versus arm C was 0.76 (95% CI, 0.52 to 1.12; P = .165). Further analyses suggested an exploratory dose-response effect for PFS across arms (Tarone's test, P = .037). Objective response rates for arms A, B, and C were 37%, 19%, and 27%, respectively. The incidence of grade ≥ 3 adverse events (AEs) in arms A, B, and C was 65%, 55%, and 64%, respectively. Frequent AEs included hypertension (8%, 6%, and 5% in arms A, B, and C, respectively), peripheral edema (71%, 51%, and 22% in arms A, B, and C, respectively), and hypokalemia (21%, 15%, and 5% in arms A, B, and C, respectively). AMG 386 exhibited linear pharmacokinetic properties at the tested doses.

Conclusion

AMG 386 combined with weekly paclitaxel was tolerable, with a manageable and distinct toxicity profile. The data suggest evidence of antitumor activity and a dose-response effect, warranting further studies in ovarian cancer.

Distribution of Coronary Artery Stenosis After Radiation for Breast Cancer [Breast Cancer]

Purpose

To study distribution of coronary artery stenosis among patients with breast cancer (BC) and to assess correlation between radiotherapy (RT) and location of stenosis.

Patients and Methods

A Swedish BC cohort diagnosed from 1970 to 2003 was linked to registers of coronary angiography from 1990 to 2004, which yielded 199 patients. Stenoses of the coronary arteries were graded from 0 to 5, where 0 indicated a normal vessel and 5 indicated occlusion. Two hotspot areas for radiation were defined: proximal right coronary artery (prox RCA), mid and distal left anterior descending artery and distal diagonal (mdLAD + dD). RT regimens were categorized as high or low risk of irradiating the hotspot areas. Left breast/chest wall was considered high risk for mdLAD + dD; left internal mammary chain (IMC), high risk for prox RCA and mdLAD + dD from 1970 to 1995 and thereafter solely for mdLAD + dD; and right IMC, high risk for prox RCA. Other RT targets and no RT were considered low risk. Results were expressed in odds ratios (ORs) and 95% CIs.

Results

For irradiated left- versus right-sided BC, the OR for grade 3 to 5 stenosis in mdLAD + dD was 4.38 (95% CI, 1.64 to 11.7), and for grade 4 to 5 stenosis, the OR was 7.22 (95% CI, 1.64 to 31.8). For high-risk RT versus low-risk or no RT, the OR for grade 3 to 5 stenosis in hotspot areas was 1.90 (95% CI, 1.11 to 3.24).

Conclusion

An increase of stenosis in mdLAD + dD in irradiated left-sided BC and an association between high-risk RT and stenosis in hotspot areas for radiation indicate a direct link between radiation and location of coronary stenoses.

Intensive Radiographic and Biomarker Surveillance in Stage II and III Colorectal Cancer

Oncology 2012;82:41–47 (DOI:10.1159/000333855)

Family History Record and Hereditary Cancer Risk Perception according to National Cancer Institute Criteria in a Spanish Medical Oncology Service: A Retrospective Study

Oncology 2012;82:30–34 (DOI:10.1159/000335960)

Polymorphism of the TLR4 Gene Reduces the Risk of Hepatitis C Virus-Induced Hepatocellular Carcinoma

Oncology 2012;82:35–40 (DOI:10.1159/000335606)

Transforming Growth Factor Beta 1 Overexpression Is Closely Related to Invasiveness of Hepatocellular Carcinoma

Oncology 2012;82:11–18 (DOI:10.1159/000335605)

A Phase II Randomized Study of Cisplatin-Pemetrexed plus either Enzastaurin or Placebo in Chemonaive Patients with Advanced Non-Small Cell Lung Cancer

Oncology 2012;82:25–29 (DOI:10.1159/000335268)

Detection of Asymptomatic Cardiac Metastasis and Successful Salvage Chemotherapy Comprising a Prednisone, Etoposide, Procarbazine, and Cyclophosphamide Regimen in an Elderly Japanese Patient Suffering from a Delayed Recurrence of Diffuse Large B-Cell Lymphoma

Case Rep Oncol 2012;5:62–68 (DOI:10.1159/000336447)

Reduction in Circulating Tumor Cell Count following Therapy with <i>nab</i>®-Paclitaxel plus Carboplatin in a Patient with Leptomeningeal Carcinomatosis from Breast Cancer

Case Rep Oncol 2012;5:56–61 (DOI:10.1159/000336247)

Hypotension due to Chemotherapy in a Patient with Small Cell Lung Cancer and Lambert-Eaton Myasthenic Syndrome Undergoing Hemodialysis: A First Case Report

Case Rep Oncol 2012;5:52–55 (DOI:10.1159/000336220)

Unusual Presentation of a Left Testicular Carcinoid

Case Rep Oncol 2012;5:43–46 (DOI:10.1159/000336160)

Irinotecan-Induced Dysarthria

Case Rep Oncol 2012;5:47–51 (DOI:10.1159/000336156)

Editorial Board

Table of Contents

Time trends in testicular cancer in Croatia 1983–2007: Rapid increases in incidence, no declines in mortality

Abstract: Testicular cancer, although a rare malignancy, represents the most common cancer in young male populations of Western origin. While increasing incidence trends of testicular cancer have been reported, mortality is declining in many high-resource settings. Using national data from the Croatian National Cancer Registry for the period 1983–2007, time trends were analysed by joinpoint regression and Age–Period–Cohort models. The present study is the first to analyse the testicular cancer trends in the Croatian population. Over the 25-year period, a mean number of 89 incident cases and 13 deaths were reported annually. The observed mean annual increases in age-standardised rates were 7.0% for incidence and 1.6% for mortality, with no abrupt linear changes (joinpoints) identified. The incidence rates of testicular cancer incidence have been steeply increasing in successive cohorts born since the mid-1930s. The rapid rise in testicular cancer incidence in the Croatian population appears to be one of the highest rates of increase recorded in Europe and worldwide. The lack of decline in the mortality rates over time, while based on relatively few deaths, highlights a need for improvements in diagnostics and management of therapy in Croatia in order to improve the survival and quality-of-life of testicular cancer patients.

Revisiting the association between alcohol drinking and oral cancer in nonsmoking and betel quid non-chewing individuals

Abstract: Background: Alcohol drinking is an oral cancer (OC) risk factor; tobacco smoking (TS) and betel quid chewing (BQC) are oral carcinogens and effect modifiers of drinking. Although the assessment of the independent effect of drinking on OC must necessarily account for effect modifiers, no observational study has included interaction terms between drinking, TS, BQC in regression analyses. In order to assess the independent association between drinking and OC, this pooled analysis focused on subjects who were not exposed to such effect modifiers. Methods: Case-control studies on OC, which discriminated non TS/non BQC drinkers from multiexposed drinkers were searched. Exposed subjects (≥1 drink daily, ≥10 years) were compared to unexposed subjects (non/occasional drinkers). Unadjusted odds ratios (ORs) were extracted/calculated. Pooled ORs were assessed with the random-effect method, which assumed high between-study heterogeneity (assessed with Cochran's Q). Robustness of estimates was investigated through use of adjusted ORs, correction for publication bias, sensitivity analysis to inclusion criteria. The drinking–TS interaction was assessed with the Interaction Contrast Ratio (ICR) and the Attributable Proportion due to Interaction (AP). Results: Sixteen studies were used, with substantially high heterogeneity. The pooled OR was 0.787 (95CI, 0.677–0.914). Use of adjusted ORs, correction for publication bias, sensitivity analysis corroborated these results. ICR and AP were 2.444 and 54.6%. Conclusions: Consistent with stratified analyses reporting non significant/negative associations between alcohol drinking and OC in non multiexposed subjects, an OC preventive activity of drinking is inferable. However, given the high prevalence and the oral carcinogenicity of concomitant drinking and smoking, drinking control policies remain essential.

Africa's growing cancer burden: Environmental and occupational contributions

Highlights: ► Africa's cancer burden will at least double between 2008 and 2030. ► High levels of environmental/occupational carcinogenic exposures arise from difficulties to enforce health standards, use of out-dated machinery, lack of personal protective measures and of hazard knowledge. ► Exposure sources/settings include mining, pesticide-intensive agriculture, chemical industries, chrysotile asbestos use, hazardous wastes, air pollution. ► Unique exposure patterns provide research opportunities to clarify the role of possibly-carcinogenic agents. ► Regulation and surveillance of exposure levels and of cancer are needed for locally-tailored cancer control plans.Abstract: Background: Primary prevention measures are needed for Africa's cancer burden (715,000 new cases and 542,000 deaths in 2008), a burden projected to double by 2030 due to demographic changes alone. Control of cancer-causing infections and lifestyle-related carcinogens will play a significant role in prevention, but less often addressed are environmental and occupational contributions. Methods: We review environmental issues that contribute to Africa's Cancer burden. Results: We demonstrate evidence of the impact of environmental carcinogens on the cancer burden as of now and that circumstances present today may increase their contribution further. Suboptimal implementation and monitoring of environmental protection and of occupational health standards, including in the informal sector, use of outdated technologies in industry and lack of awareness of potential hazards in the specific employment structure give rise to high levels of exposures. Carcinogens of concern include (i) those that have been long present (e.g. indoor air pollution) whose contribution may increase as life-expectancy increases and long latency periods for cancer are realised, (ii) exposures in mining and agricultural sectors and (iii) modern environmental hazards, including urban air pollution and agents arising from the mis-management of hazardous waste from local, industrial and trans-boundary sources. Conclusions: Actions taken to reduce exposures and research to fill gaps in knowledge, adapted to local settings, could help mitigate the cancer burden.

Influence of age on the pharmacokinetics of i.v. vinflunine: Results of a phase I trial in elderly cancer patients

Abstract: Objective: Vinflunine (VFL) is a novel microtubule inhibitor indicated in the treatment of advanced or metastatic urothelial transitional cell cancer after failure of a prior platinum-containing regimen at the recommended dose of 320mg/m² q3 weeks. This trial was designed to assess the pharmacokinetic (PK) behavior and tolerance of VFL in elderly patients (pts), and to propose dose-adjustments if necessary.Material and methods: Three groups of cancer pts over 70years old (y) were open to recruitment: 70–75y, 75–80y and ≥80y. Each group of pts received intravenous VFL, respectively at 320, 280 and 250mg/m² on cycle 1. Pharmacokinetics and safety data were collected at cycle 1 and were compared to reference values from younger pts <70y.Results: 46 pts were treated. For pts 70–75y and 75–80y, there was no statistically age-related change for VFL PK. For pts ≥80y, VFL blood total clearance (Cltot) was significantly decreased by 18%. The most common adverse events observed in this elderly population were not different from those seen in younger pts. No toxic death was recorded. Main toxicities were neutropenia (Grade 3/4: 73% of pts), constipation (all grade: 63%) and asthenia (all grade: 56%), without any relationship between the observed incidence and the ageing of pts.Conclusion: Based on PK and safety data, a dose reduction at 280mg/m² and 250mg/m² is recommended in pts 75–80y and ≥80y respectively.

First Asian Congress on Cancer in Older Patients Kuching, Malaysia 22–23rd January 2011

Abstract: SIOG 2011-First Asian Congress on Cancer in Older Patients organized by Sarawak Hospice Society, was held in Kuching, Sarawak, Malaysia from 22 to 23rd January 2011 under the chair of Riccardo A. Audisio and Matti A. Aapro. The meeting was accredited by ACOE and ESMO and endorsed by UICC and ESSO and first to be held in Asia.The congress was well attended with 500 participants from 16 countries. The participants included doctors, nurses, pharmacists and X-ray technologists. The topics included the global and South East Asian perspective on older patients, under treatment, clinical assessment tools, surgical treatment of breast, lung and esophageal cancers, supportive care for breast cancer, cultural barriers in Malaysia, newer radiotherapy techniques that can be used in older patients, targeted treatment of lung, colorectal cancers and hematology. Preliminary findings of using the Groningen Frailty Index in an Asian oncology patient population were presented. An interesting topic on the cultural barriers to cancer care in the elderly from the three ethnic groups in Sarawak was presented. The findings revealed the challenges faced by the public as well as the healthcare professionals. The topics discussed were relevant to the local needs of the participants so that they could apply the knowledge when they returned home.The Meeting Highlights collect the views of the panelists: to update on the cutting edge of present knowledge, in order to improve our understanding of the malignant disease affecting the senior patients and its implication in the Asian setting and to optimize the management.

Editorial Board

Determination of an adequate screening tool for identification of vulnerable elderly head and neck cancer patients treated with radio(chemo)therapy

Abstract: Objectives: We evaluated two proposed screening tools, the Vulnerable Elders Survey-13 (VES-13) and the G8, to identify patients who could benefit from a comprehensive geriatric assessment (CGA).Materials and Methods: All consecutive patients aged ≥65years with primary head and neck cancer were assessed with VES-13, G8 and CGA. Receiver operating characteristics (ROC)-analysis was used to determine diagnostic performance of both screening instruments.Results: Fifty-one patients were recruited, of which 39.2%, 66.7% and 68.6%, were defined vulnerable when evaluated with VES-13, G8 and CGA, respectively. The area under the ROC-curves (AUC±SE) of VES-13 (0.889±0.045) and G8 (0.909±0.040) did not significantly differ (P=0.7083). A sensitivity and specificity of respectively 57.1% and 100% for VES-13 (cut-off ≥3) and 85.7% and 75.0% for G8 (cut-off ≤14) was obtained. The combined score “VES-13+(maximum-G8)” (AUC=0.971±0.019) showed a superior AUC to G8 (P=0.0242) and VES-13 (P=0.0237). The most optimal cut-off score of 5 for the combined test resulted in a sensitivity of 91.4% and a specificity of 93.8%. Positive and negative predictive values were 100% and 51.6%, 88.2% and 70.6%, and 97.0% and 83.3% for the VES-13, G8 and combined test respectively.Conclusion: Both tools were found to have good diagnostic performance. However, at the proposed cut-off scores, our data suggest the G8 as the most optimal screening tool. Moreover, the combined tool could represent an interesting alternative.

Understanding the link between cancer and neurodegeneration

Abstract: There is growing evidence that cancer shares a number of biological pathways with common neurodegenerative diseases of aging. In epidemiologic studies, Parkinson's and Alzheimer's disease seem to be associated with a decreased cancer risk. Genes associated with neurodegeneration have important functions in protein folding and processing, but often play a role in the cell cycle. Activation and deregulation of the cell cycle is a core feature of both diseases; in the neuron, the end result is apoptosis, while in the malignant cell, it is uncontrolled proliferation. Successful aging requires a careful balance between the forces that promote tissue renewal and those that suppress the cell cycle. Proteins such as p53 and Pin1 might explain why some individuals are relatively protected from cancer but at increased risk of neurodegeneration. This article reviews the available epidemiologic evidence linking neurodegenerative disease and cancer, discusses the cellular pathways and genes which might account for this unexpected relationship, and explores the potential therapeutic implications of this area of research.

Expert Video Viewpoints on Castration-Resistant Prostate Cancer: Care Across the Continuum - Section 3

Section 3 Emerging Treatment Options

For CME-certification information and other resources, visit www.IMERonline.com/CRPCvide...
Target Audience
Medical oncologists, urologists, radiation oncologi...

Author: imeronline
Added: 01/25/2012

Expert Video Viewpoints on Castration-Resistant Prostate Cancer: Care Across the Continuum - Section 2

Section 2 mCRPC Progression

For CME-certification information and other resources, visit www.IMERonline.com/CRPCvide...
Target Audience
Medical oncologists, urologists, radiation oncologists, and ...

Author: imeronline
Added: 01/25/2012

Expert Video Viewpoints on Castration-Resistant Prostate Cancer: Care Across the Continuum - Section 1

Section 1: Identification and Initial Treatment of CRPC Test

For CME-certification information and other resources, visit www.IMERonline.com/CRPCvide...
Target Audience
Medical oncologists, urolog...

Author: imeronline
Added: 01/25/2012

The Need For More Metastatic Breast Cancer Specific Clinical Trials

Vital Options International presents Advocacy in Action, bringing together the influential leaders of the cancer advocacy community to address core issues that impact metastatic breast cancer patients...

Author: vitaloptions
Added: 01/23/2012

Living With Metastatic Breast Cancer: Maria Wetzel

Vital Options International presents Advocacy in Action, bringing together the influential leaders of the cancer advocacy community to address core issues that impact metastatic breast cancer patients...

Author: vitaloptions
Added: 01/23/2012