The Latest Developments in Cancer Research and Treatment for May 2020

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.

Drug Combo Prolongs Survival for People With Liver Cancer

What’s New Combining the drugs Tecentriq (atezolizumab) and Avastin (bevacizumab) improves survival time and significantly reduces the risk of death in people with hepatocellular cancer, the most common type of liver cancer, according to research published May 14, 2020, in The New England Journal of Medicine.

Research Details The international study, led by UCLA researchers, involved 501 people who had advanced or inoperable hepatocellular cancer. One group of study participants received Tecentriq and Avastin and the other group received the drug Nexavar (sorafenib), which is a standard treatment for liver cancer. After 12 months, the rate of survival with the combination of drugs was 67.2 percent compared with 54.6 percent for the group on Nexavar. The percentage of patients whose cancer shrank or disappeared more than doubled in the combination therapy group.

Why It Matters The findings mark the first new first-line therapy to improve liver cancer survival in more than a decade. Typically, the prognosis for advanced liver cancer is poor. “The therapy is a real game changer for people diagnosed with this aggressive disease," said the study's principal investigator and lead author, Richard S. Finn, MD, a professor of medicine at the David Geffen School of Medicine and director of the signal transduction and therapeutics program at the UCLA Jonsson Comprehensive Cancer Center in Los Angeles. "We now have a new therapy that … improves survival for people with the disease … while maintaining a high quality of life."

RELATED: New Cancer Statistics Show Largest Drop in Cancer Mortality in a Single Year

Even One Negative Colonoscopy Test Result Is Good News

What’s New Having a single negative, high-quality colonoscopy is linked to a significant reduction in the risk of developing and dying from colorectal cancer, according to a study published May 25, 2020, in the Annals of Internal Medicine.

Research Details The study, from researchers in Poland, analyzed data from a colorectal cancer screening registry of more than 165,000 people. They found a single negative screening colonoscopy that was considered of high quality was linked to an 84 percent reduced risk of colorectal cancer incidence and a 90 percent reduced risk of colorectal cancer death over a 17-year follow-up period.

Why It Matters The study suggests that high-quality colonoscopies produce data that is reassuring and long-lasting, the authors said. A high-quality colonoscopy is defined as a complete examination of the entire colon by a colonoscopist with an adequate adenoma detection rate and the complete removal of polyps. The data could be used to help determine optimal screening intervals for average-risk people following a colonoscopy, the authors said.

RELATED: Never Too Young: A 30-Something Battles Hereditary Colon Cancer

Many Women With Breast Cancer Don’t Follow Guidelines to Fight Fatigue

What’s New Women with breast cancer who suffer from fatigue may not be adhering to supportive care recommendations, according to research presented May 22 at the European Society for Medical Oncology (ESMO) Breast Cancer Virtual Meeting 2020.

Research Details French researchers followed more than 7,000 women with breast cancer from 26 French cancer centers for at least five years after their diagnosis. They found that more than one-third of the patients reported severe fatigue between three to six months after treatment. While 64 percent of the women complied with physical activity recommendations to facilitate recovery, 36 percent did not. Those patients who did not follow physical activity recommendations were more likely to have lingering fatigue.

Why It Matters Cancer-related fatigue is common and can be long-lasting among breast cancer survivors, the authors said. Severe fatigue can prevent survivors from returning to normal activities even well after they become cancer-free. While more research is needed into the cause of cancer-related fatigue, supportive care recommendations, such as recommendations for physical activity and cognitive behavioral therapy, are available to guide patients to recovery. "The message here is that we need to work harder to encourage patients to stay active, and to make them understand that even if it seems counterintuitive, it is exercise, not rest, that will help them to overcome fatigue," said study author Antonio Di Meglio, MD, of Gustave Roussy in Villejuif, France.

RELATED: San Antonio Breast Cancer Symposium: New Therapies for Women With HER2-Positive Breast Cancer Highlighted on Day 1

Drug May Curb Nausea and Vomiting in Some Patients

What’s New The medication olanzapine, a generic drug used to treat various mental disorders, may help patients with advanced cancer who suffer from nausea and vomiting unrelated to chemotherapy, according to a study published May 7, 2020, in JAMA Oncology.

Research Details The study was a randomized trial of 30 patients with advanced cancer who had not recently received chemotherapy or radiation but still had significant nausea and vomiting. The study participants were randomly assigned to receive a daily low dose of olanzapine or a placebo. The study showed that, prior to the start of therapy, the patients’ nausea severity scores ranged from 8 to 10. One week after therapy, the nausea scores of the placebo group remained at 8 to 10. However, the scores in the olanzapine group dropped to 2 to 3 after one day on the medication and 0 to 3 after one week of on it.

Why It Matters The treatment of cancer patients who have nausea and vomiting unrelated to chemotherapy has been overlooked, the authors said, noting that limited research has been performed to learn how to help these patients. The study suggests that olanzapine, which is inexpensive, may be an effective remedy for these patients.

New Type of Diabetes Can Be Early Sign of Pancreatic Cancer

What’s New A recently identified type of diabetes known as 3c (also called pancreatogenic diabetes) could be an early manifestation of pancreatic cancer, according to research published May 14, 2020, in the journal Gut.

Research Details Scientists from the genetic and molecular epidemiology group at the Spanish National Cancer Research Centre in Madrid studied 3,500 people from six European countries to analyze the relationship between several risk factors for pancreatic cancer, such as smoking and obesity. The study did not find a link between type 2 diabetes and an increased risk of pancreatic cancer, however type 3c diabetes was linked to pancreatic cancer.

Why It Matters New classifications of diabetes are emerging based on the genetic and molecular characteristics of the disease. Diabetes type 3c is an inflammation of the pancreas that interrupts insulin production. This type of diabetes may represent about 5 to 10 percent of all diabetes in Western countries. However, the authors said, it may be misdiagnosed as type 2 diabetes. More effort is needed to better identify type 3c, they said. Pancreatic cancer is often detected at a late stage when survival chances become poor. Identification of type 3c diabetes may allow closer monitoring of patients that can lead to earlier detection of pancreatic cancer.

Previous research has focused on whether diabetes could cause cancer. But, the senior author of the new study said: "Our team turned the equation around and, for the first time, we asked the question whether pancreatic cancer could cause diabetes. Using innovative epidemiological and statistical analysis strategies, we found that pancreatic cancer is the cause of the development of diabetes type 3c in 26 percent of cases."

RELATED: Should Everyone With Pancreatic Cancer Get BRCA Testing?

High Price of Cancer Drugs Not Always Warranted

What’s New The cost of many new cancer drugs in the United States is not justified, according to a study that reviewed drug costs in several countries. The paper was published April 30, 2020, in The Lancet Oncology.

Research Details Researchers from the University of Zurich and Harvard Medical School looked at the prices of 65 new cancer drugs for solid tumors and calculated the monthly cost of treatment for a standard patient. The study also examined whether there is a link between monthly treatment costs and the clinical benefit of the drugs using two established systems for evaluating the clinical benefit of cancer therapies. The study showed no correlation between cost and benefit in many countries. Only for patients in France was a correlation found between cost and benefit.

Why It Matters Many new cancer drugs come with extremely high price tags. In the United States, drug prices are dictated by an unregulated free market while many European countries negotiate drug prices with manufacturers. The authors suggest, based on their findings, that cancer drugs with low or uncertain clinical benefit could be prioritized for price negotiations that would establish more appropriate cost-effectiveness. "Our study clearly shows that, in general, for Switzerland, Germany, England, and the United States, there is no association between clinical benefit of a cancer drugs and their prices," explains lead author, Kerstin Vokinger, MD. "It's also clear that the prices of cancer drugs in the United States are significantly higher than in the four European countries, with Americans paying on average approximately twice as much for the same drug."

RELATED: Cancer News Digest: The Latest Developments in Cancer Research and Treatment for April 2020

Uninsured Patients and Those on Medicaid Don’t Fare as Well in Cancer Clinical Trials

What’s New Cancer patients with no health insurance or who are enrolled in Medicaid experience smaller benefits when participating in clinical trials, according to research published April 30, 2020, in JAMA Network Open.

Research Details Researchers from the SWOG Cancer Research Network examined data from more than 10,000 patients in SWOG phase 3 clinical trials from 1984 through 2012. The trials were all “positive,” meaning the patients who received the experimental therapy had better survival than patients who received the standard treatment. The study found that patients of all ages, genders, and racial-ethnic groups, as well as those with private insurance who received experimental trial drugs, all on average lived longer compared with patients who took the standard treatments. Only uninsured patients or those enrolled in Medicaid did not experience a similar strong survival benefit when receiving an effective experimental therapy.

Why It Matters Medicaid is the federal health insurance program for low-income individuals. Almost 20 percent of Americans receive their health insurance through Medicaid, the authors noted. The study is the first to look at how treatment effects from clinical trials with positive findings vary by demographics or among subgroups of people. The findings suggest that insurance status reflects overall socioeconomic status and that people with lower socioeconomic states have fewer healthcare resources that may impact their survival.

"Patients in trials having no or limited insurance may not have the financial means to pay for the extra supportive treatments or post-trial cancer treatments that help people live longer,” said the study’s lead author, Joseph Unger, PhD, a SWOG health services researcher and biostatistician based at Fred Hutchinson Cancer Research Center in Seattle. “This could be especially meaningful for understanding treatment benefits if experimental therapy requires more supportive care or is more difficult to adhere to than standard treatment."

Platinum-Based Chemotherapy Benefits Some Pancreatic Cancer Patients

What’s New People with metastatic pancreatic cancer who have specific gene mutations in DNA repair genes had better outcomes after receiving platinum-based chemotherapy compared with patients who did not have those mutations, according to a study published May 22, 2020, in Clinical Cancer Research.

Research Detail The study, from researchers at Memorial Sloan Kettering Cancer Center, looked at the association between mutations in of DNA repair genes known as homologous recombination (HR) genes and clinical outcomes in 262 patients with metastatic pancreatic cancer. Overall, the median survival for all patients was 15.5 months. But further analysis showed that patients with mutations in HR genes who were treated with first-line platinum-based chemotherapy had longer survival compared with those without mutations who received first-line platinum-based chemotherapy — 25.1 months compared with 15.3 months.

Why It Matters Approximately 5 to 9 percent of pancreatic cancer patients have HR gene mutations. These genes are valuable biomarkers that can help predict the patient’s response to treatment, the authors said. "Our data support the use of platinum-based chemotherapy as first-line treatment for patients with defects in various HR genes," said senior author Eileen O'Reilly, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center. "The results underscore the importance of genetic testing in newly diagnosed patients to help refine treatment decisions."

Racial Disparities Emerge in Liver Cancer Deaths

What’s New The launch of new drugs to treat hepatitis C lowered the risk of liver cancer in many people but led to a disproportionate number of liver cancer deaths in groups of people who could not afford the drugs, said the authors of a study published April 30, 2020, in the journal EClinical Medicine.

Research Details Researchers from Florida Atlantic University's Schmidt College of Medicine and Baylor College of Medicine looked at liver cancer deaths in racial groups from 1979 to 2016. They found that from 1979 to 1998, racial inequalities in liver cancer deaths in the United States were shrinking. But after the launch of drugs to treat hepatitis C infection, the gap in deaths between whites and blacks increased again.

Why It Matters Hepatitis C is a major cause of liver cancer. Antiretroviral drugs to treat the infection are highly effective and have had a significant impact on preventing liver cancer. However, these drugs are expensive. The authors of the study noted that, other types of antiretroviral drugs, such as those used to treat human immunodeficiency virus HIV, have also led to an increase in racial inequalities in death rates in the United States. "A major clinical and public health priority should be to decrease racial inequalities in mortality following the introduction of lifesaving drugs in the United States and worldwide," said study senior author Charles H. Hennekens, MD, the Sir Richard Doll Professor and senior academic advisor in FAU's Schmidt College of Medicine in Boca Raton, Florida.

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