News breaks in the cancer arena all the time. Sometimes it’s big — like word that a breakthrough drug has increased survival for a hard-to-treat cancer. Sometimes it’s smaller. Any of it may matter to you and your family as you navigate your cancer journey. We do our best to keep you up-to-date with a weekly roundup of some of the most significant recent cancer news.
Zejula Can Extend Life for Some Patients With Ovarian Cancer
What’s New Zejula (niraparib) can help women newly diagnosed with ovarian cancer who respond to platinum-based chemotherapy, according to a study published November 25th, 2019, in the New England Journal of Medicine.
In the phase III trial, researchers randomly assigned 733 women newly diagnosed with ovarian cancer who’d already had a positive response to platinum-based chemotherapy to receive either Zejula or a placebo. About half of the patients had tumors with homologous recombination deficiency (HRD), which is defined as the presence of a BRCA gene mutation or high scores on tests indicating a number of genetic abnormalities. Among the patients who had tumors with HRD, the median time in which the cancer did not grow larger was longer in the Zejula group — 21.9 months — compared with 10.4 months in the placebo group. Overall, women taking Zejula had longer progression-free survival (the time during which the tumor did not advance): 13.8 months compared with 8.2 months.
Why It Matters Zejula is a PARP inhibitor, a class of medication that has been shown to benefit some women with recurrent ovarian cancer after platinum-based chemotherapy. Traditionally, first-line ovarian cancer treatment consists of surgery and chemotherapy. However, up to 85 percent of patients with advanced ovarian cancer relapse after the initial treatment. The study shows the value of Zejula for women with BRCA mutations or high gene mutation scores. Ovarian cancer patients should undergo testing to determine an HRD score. The authors noted that the financial costs of PARP inhibitors are substantial, however, and should be weighed against potential benefit.
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Acupuncture, Acupressure Can Ease Cancer Pain
What’s New A meta-analysis of studies on the effect of using acupuncture or acupressure for cancer pain shows the modality does lower pain intensity. The report was published December 19, 2019, in JAMA Oncology.
Researchers reviewed 14 randomized clinical trials investigating whether acupuncture or acupressure improved pain management in people with cancer. The treatments were compared to sham interventions or the use of analgesic pain medication. The study showed a significant association between real acupuncture and reduced pain. What’s more, acupuncture combined with an analgesic was linked to decreased analgesic use.
Why It Matters A growing number of patients are interested in alternative pain relief approaches, but research on the effectiveness of acupuncture or acupressure for cancer pain has produced mixed findings. The researchers called for more rigorous studies to identify the effects of acupuncture and acupressure on specific types of cancer pain and whether pain reductions can reduce opioid use.
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Opdivo Effective in Tumors With MMR Deficiencies
What’s New The immunotherapy drug Opdivo (nivolumab) appears to be effective in patients with tumors that have DNA mismatch repair (MMR) deficiencies, i.e., deficiencies in genes that regulate DNA repair, according to a study published December 19, 2019, in the Journal of Clinical Oncology.
Scientists looked at the response in 42 patients with an MMR deficiency treated with Opdivo. The study showed a 36 percent response rate with the median overall survival time of 17.3 months. All of the patients had received other treatments previously for their cancers. The most promising activity was in patients with MMR-deficient tumors that had lost tumor suppressor proteins called MLH1 or MSH2.
Why It Matters Previous studies showed Opdivo was effective in MMR-deficient colon cancer. The new study reflects an effort to look at various tumor subtypes, the authors said.
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Thyroid Cancer Rates Stabilizing
What’s New After several decades of rising rates, thyroid cancer incidence appears to be leveling off, according to a study published December 20, 2019, in the Journal of the American Medical Association.
Researchers looked at cancer databases to analyze changes in the number of cases of thyroid cancer diagnosed between 1992 and 2016. The rates rose from 1992 to 2009, including a 6.6 percent increase from 1998 to 2009. The rate of increase slowed from 2009 to 2014, however — from 13.8 to 14.7 per 100,000 people.
Why It Matters The increase in the number of cases of thyroid cancer, while concerning, is largely attributed to more screening and improved imaging. The plateauing of cases in recent years may reflect a greater understanding about overdiagnosis of thyroid cancer and practice guidelines that recommend a less intensive evaluation of thyroid nodules, the authors said.
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Dense Breast Notifications Not Helping to Catch Cancers Early
What’s New State laws mandating written notification to women who have dense breast tissue do not appear to be prompting behaviors or actions that could alter breast cancer risk, according to research published December 16, 2019, in the Journal of General Internal Medicine.
Researchers at the Boston University School of Medicine conducted a nationwide survey of women, asking about their reactions to dense breast notification letters (DBNs). The study showed few differences in responses between women who live in states mandating DBNs and those who do not. There were no differences in the awareness that breast density increased the risk of breast cancer and no differences in the number of women who discussed breast density with their doctors.
Why It Matters Women with dense breast tissue are at higher risk of breast cancer. DNBs are now mandated by more than 35 states to alert women their mammography exams have produced evidence of dense breasts. Women who received these letters are advised to speak with their personal physicians about the need for more frequent breast cancer screening or other measures to reduce the risk of being diagnosed with an advanced breast cancer. The fact that DNBs have had little effect may reflect the fact that DBNs are often written in language reflecting a higher literacy level than many women possess and, as such, women may not understand what the notification means, said the authors. The authors also found white women with higher incomes had more knowledge when it came to breast density while black women experienced greater anxiety and confusion. The FDA is currently developing standardized language for a federal DBN.
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New Molecular Tests for Bladder Cancer No Better Than Standard Pathology
What’s New Standard pathology tests to determine characteristics of bladder cancer outperform the new molecular tests, according to a study published in the January 2020 issue of The Journal of Urology.
Researchers conducted a series of studies comparing standard pathology tests and newer molecular subtyping tests on cancer specimens from patients with muscle invasive bladder cancer. The study found that standard pathology tests outperformed molecular subtyping in characterizing cancer as low or high grade and determining the extent of its invasion into the bladder wall and surrounding tissue.
Why It Matters Newer molecular cancer tests are emerging to help healthcare providers choose treatments and gauge patient outcomes. Many studies show the value of these tests for several types of cancers. However, the new study does not show a benefit for molecular subtyping tests for bladder cancer at this time. "Muscle invasive bladder cancer is aggressive," said Vinata B. Lokeshwar, MD, chair of the department of biochemistry and molecular biology at the Medical College of Georgia at Augusta University. "Everyone is trying to find out how to improve diagnosis, treatment, and survival." While genetic profiling of a tumor has some value in helping to identify new treatment targets, “using this information to subtype tumors does not appear to add diagnostic or prognostic value for patients," she said.
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Exercise Can Ease Side Effects From Prostate Cancer Therapy
What’s New Short-term exercise can reduce the side effects of hormone therapy in men with advanced prostate cancer, according to a study published recently in the British Journal of Urology International.
The study involved 50 patients on hormone therapy, also known as androgen deprivation therapy, half of whom participated in supervised exercise sessions twice a week for three months. The study showed fewer undesirable side effects, such as poor cardiovascular fitness and fatigue, in the men who were exercising.
Why It Matters Hormone therapy can cause weight gain and can also increase the risk of heart problems, the authors said. The study showed a way to prevent some of these adverse events. "This research shows that some of the harmful side effects of hormone therapy are reduced in men who begin to exercise regularly around the same time that these drugs are prescribed,” said author John Saxton, PhD, from the University of East Anglia Norwich Medical School. “Our findings have important implications for the quality of prostate cancer survival."
RELATED: Prostate Cancer Treatments Have Varying Side Effects, Study Shows
New Guidelines for Skin Cancer Radiation Therapy
What’s New The American Society for Radiation Oncology (ASTRO) has issued new recommendations on the use of radiation therapy for skin cancer patients. The paper was published online recently in Practical Radiation Oncology.
The report represents a consensus review of a multidisciplinary group of experts and a review of scientific evidence showing when radiation is most likely to benefit patients. The recommendations describe when radiation treatment is appropriate as a stand-alone therapy or after surgery.
Why It Matters Skin cancer is the most common type of cancer. Basal and squamous cell cancers are typically highly treatable, but melanoma can be challenging to treat if detected at an advanced stage. Most basal and squamous cell cancers are surgically removed. Radiation therapy sometimes follows surgery. The new guidelines are meant to reduce the variation in treatment approaches. "There is significant variation in practice about when and how radiation should be used for nonmelanoma skin cancers, largely because few randomized studies have compared modern treatment options head-to-head," explained Phillip Devlin, MD, chair of the guideline task force and a radiation oncologist at Brigham and Women's Hospital in Boston.
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Experimental Immunotherapy Has Effect on Multiple Myeloma
What’s New An experimental immunotherapy led to lasting benefits in multiple myeloma patients whose disease had relapsed or become resistant to standard therapies, according to research published December 16, 2019, in Lancet Oncology.
The phase II multicenter international trial featured the experimental drug belantamab mafodotin given in either a high dose or low dose to 196 patients. Among patients receiving the low dose, 31 percent had a response, meaning the amount of cancer in their bodies was reduced.
Why It Matters Multiple myeloma is a cancer that occurs in the bone marrow. When standard treatments don’t work, the prognosis is poor. Belantamab mafodotin has a potentially serious side effect involving vision that requires management by eye specialists, said the senior author, Adam D. Cohen, MD, an assistant professor of hematology-oncology in the Perelman School of Medicine at the University of Pennsylvania and a member of Penn’s Abramson Cancer Center. “Overall, the side effects are manageable with appropriate supportive care, and the fact that this treatment can be given once every three weeks as an outpatient infusion means this could be a convenient and beneficial therapy for multiple myeloma patients.” More studies are planned to evaluate belantamab mafodotin in combination with other treatments.
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Maintenance Chemotherapy Beneficial for Advanced Colorectal Cancer
What’s New A less aggressive form of maintenance chemotherapy may be more helpful to patients with metastatic colorectal cancer than more aggressive chemotherapy, according to research published December 19, 2019, in JAMA Oncology.
Researchers from the Mayo Clinic conducted a meta-analysis of 12 clinical trials to compare different strategies following initial treatment for people whose cancer had spread. The study compared continuing aggressive chemotherapy, less-intensive maintenance chemotherapy, and observation with no chemotherapy. The analysis showed no benefit to continuing full chemotherapy compared with the other strategies. People who had maintenance chemotherapy had the most significant improvement in disease control.
Why It Matters About 1 in 4 colorectal cancer patients has disease that has spread to other organs. Typically, maintenance chemotherapy is recommended after initial treatment, but some patients opt for a break from chemotherapy, the authors said.
"Many chemotherapies that are used are initially beneficial in both shrinking and controlling the cancer," said senior author Tanios Bekaii-Saab, MD, a gastrointestinal oncologist at the Mayo Clinic. "However, after a few months of therapy, the maximum benefit is usually achieved and the main focus should be on how to continue that benefit while minimizing side effects. This study confirms that switching to maintenance treatment is appropriate and beneficial, with introduction of full chemotherapy later upon progression of the disease."
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