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

New Guidelines Aim to Protect Patients During the COVID-19 Pandemic

What’s New The National Comprehensive Cancer Network (NCCN) has released guidelines for the care of people with cancer during the COVID-19 pandemic. The guidelines were published online April 9 in the Journal of the National Comprehensive Cancer Network.

Research Details The authors say the recommendations are intended to keep people with cancer and healthcare professionals as safe as possible during the pandemic. Safety measures for patients include the use of telemedicine visits when possible, screening for COVID-19 symptoms before visits, limited surgeries and procedures, switching infusion therapies to oral therapies when possible, and transitioning outpatient care to home care when possible. For healthcare workers, the safety recommendations include daily temperature checks, telecommuting when possible, and the use of personal protective equipment per government guidelines.

Why It Matters The NCCN is an alliance of leading cancer centers. The guidelines were written by the organization’s best practices committee. The document stresses the need to provide effective and compassionate care for people with cancer without sacrificing the health and safety of medical professionals and their families and colleagues. The authors note that the changing nature of the pandemic may mean additional updated guidelines later.

"The unprecedented challenges we are all facing from the COVID-19 pandemic heighten NCCN's commitment to sharing evidence-based consensus from leading medical experts as rapidly as possible, free of charge, to everyone around the world," says Robert W. Carlson, MD, chief executive officer of the NCCN. "We are doing everything we can to review and share reliable information that will help keep oncology patients, providers, and staff safe under the new reality of increased risk."

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Disruptions in Health Insurance Coverage Impact Cancer Outcomes

What’s New Disruptions in health insurance coverage — that is to say a lapse in coverage — occur with surprising frequency among U.S. residents and can impact cancer care and survival, according to a study published April 27 in the Journal of the National Cancer Institute.

Research Details The study, from the American Cancer Society, reviewed studies focusing on health insurance coverage disruptions and cancer care that were published between 1980 and 2019. Data from the 29 studies showed that from 4 percent to almost 33 percent of adults experienced coverage disruptions. People who experienced coverage disruptions were less likely to receive cancer prevention or screening and, if they were diagnosed with cancer, were more likely to have advanced disease and have worse outcomes compared with people with cancer without coverage disruptions.

Why It Matters The findings highlight the fragmented nature of health insurance coverage in the United States and the severe consequences that can occur when coverage is lost, even temporarily. “Our findings were consistent across multiple cancer [treatment] sites, with several studies finding a ‘dose-response’ relationship, meaning the longer the disruption, the worse the care,” says Robin Yabroff, PhD, lead author of the study. “The consistency of these findings across the cancer control continuum in our review highlights how important it is to minimize breaks in health insurance coverage to address cancer disparities and promote health equity.”

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Immunotherapy Before Surgery May Extend Survival for People With Merkel Cell Carcinoma

What’s New People with an aggressive type of skin cancer called Merkel cell carcinoma appear to benefit from immunotherapy drug treatment before surgery, according to a study published online April 23 in the Journal of Clinical Oncology.

Research Details The early-phase trial involved people with the disease who received the anti-PD-L1 immunotherapy drug Opdivo (nivolumab). Among 36 participants who then underwent surgery, almost half had no live tumor cells in the surgical tissue. Recurrence-free survival rates were 77.5 percent after one year and 68.5 percent after 24 months.

Why It Matters The study is the first to show that people with Merkel cell carcinoma tumors who receive immunotherapy before surgery may need less-extensive surgery and may also have a reduced risk of cancer recurrence, the authors say. The study is small, and more research is needed, says lead author Suzanne Topalian, MD, associate director of the Bloomberg Kimmel Institute for Cancer Immunotherapy at Johns Hopkins Medicine in Baltimore.

"Historically, many of these patients would subsequently relapse after standard surgical and postoperative treatments,” says Dr. Topalian.

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Immunotherapy Drug Keytruda Extends Survival in People With Lung Cancer and Brain Metastases

What’s New People with non-small cell lung cancer (NSCLC) that has spread to the brain had longer survival times when taking the immunotherapy drug Keytruda (pembrolizumab), according to research published April 3 in The Lancet Oncology.

Research Details Scientists at the Yale Cancer Center in New Haven, Connecticut, enrolled 42 people with lung cancer and small brain tumors in the phase 2 study. Some of them had PD-L1 biomarkers, which indicate a good response to Keytruda, expressed by the tumors, while others did not. In those whose tumors expressed PD-L1, 40 percent were alive at one year and 34 percent at two years, compared with a typical two-year survival rate of 14 percent. None of the participants without PD-L1 expression benefited from Keytruda.

Why It Matters Typically, lung cancer that spreads to the brain is difficult to treat, and radiation has been the only option. “We have clearly shown, for the first time, that brain metastasis responds to a targeted immunotherapy treatment for lung cancer,” says the study’s lead investigator Sarah B. Goldberg, MD, associate professor of medicine at Yale Cancer Center. “In general, we found that the benefit offered by pembrolizumab to the lungs in patients with advanced lung cancer was mirrored in control of their brain tumors. The brain and body response were the same.”

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Immunotherapy After Chemotherapy Slows Growth of Metastatic Bladder Cancer

What’s New People with metastatic bladder cancer who received immunotherapy immediately following chemotherapy, a treatment strategy known as switch maintenance immunotherapy, had slower progression of cancer, according to research published online April 9 in the Journal of Clinical Oncology.

Research Details Researchers at Mount Sinai Health System in New York City conducted a randomized phase 2 trial in 108 people with urothelial cancer, a type of bladder cancer. One group received the drug Keytruda (pembrolizumab) after they received platinum-based chemotherapy. The other group received a placebo following chemotherapy. The time until the cancer progressed was about 60 percent longer in the people receiving Keytruda.

Why It Matters This is the first study to show promising results from switch maintenance immunotherapy. “This trial, along with another recent study testing a similar approach, bolsters the use of switch maintenance treatment, which will likely become a standard of care for metastatic urothelial cancer, a disease characterized by a paucity of advances in decades,” says lead author Matthew Galsky, MD, co-director of the Center of Excellence for Bladder Cancer at Mount Sinai.

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Breastfeeding Lowers Risk of Ovarian Cancer

What’s New The risk of developing ovarian cancer declines when women breastfeed their infants, with a longer duration of breastfeeding linked to the greatest decline in risk, according to research published online April 2 in JAMA Oncology.

Research Details The study featured 9,973 women with ovarian cancer and 13,843 women who did not have the disease. The data was culled from 13 case-control studies. The analysis showed that breastfeeding was linked to a 24 percent reduced risk of ovarian cancer. The risk reduction was 18 percent for women who breastfed less than three months and 34 percent for those who breastfed 12 months or longer.

Why It Matters Previous research has linked breastfeeding with a reduced risk of ovarian cancer. This study is the largest one to date to explore the association. It provides further evidence that breastfeeding can be a modifiable factor to lower the risk of ovarian cancer apart from pregnancy alone, which also lowers the risk of developing the disease.

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Juul E-Cigarette Sales on the Rise Again Despite Ban on Some Flavors

What’s New Juul e-cigarette sales initially dropped following the company’s withdrawal of some flavored products from U.S. stores but then recovered, according to a study published online May 6 in the American Journal of Public Health.

Research Details American Cancer Society researchers looked at data on e-cigarette sales from January 2015 through October 2019. Juul sales grew through October 2018, especially the sale of fruit-flavored products. In November 2018, however, Juul removed some of its flavored products from stores, including the mango, crème brûlée, fruit medley, and cucumber products. The action led to a 9.1 percent drop in all fruit-flavored e-cigarette product sales. However, during that period, menthol or mint-flavored product sales rose as did tobacco-flavored products. Juul's sales surpassed its previous sales high within 12 weeks of the removal of some of the flavored products. Sales of fruit-flavored e-cigarette products produced by other manufacturers, such as Njoy, increased substantially. According to the study, sales of e-cigarettes peaked in August 2019.

Why It Matters “There are two lessons to take away from this study,” says lead author Alex Liber, senior scientist with the economic and health policy research program at the American Cancer Society. “First, companies’ attempts to self-impose their own restrictions are unlikely to improve public health. Juul’s withdrawal of fruit-flavored products was quickly offset by a combination of increased fruit-flavored sales by Juul’s competitors and increased sales of other flavors. It is highly unlikely that overall youth use declined given the short-lived impact on sales trends.” The other lesson, the authors say, illustrates what happens if exceptions are made to regulatory policies. Other companies will likely step in to fill the void.

RELATED: My Juul Breakup: 8 Steps That Helped Me Finally Quit Vaping

Common Infections More Frequent in Years Preceding Cancer Diagnosis

What’s New People who develop cancer tend to experience more infections in the years prior to the cancer diagnosis compared with individuals who don’t have cancer, according to research published online April 17 in the journal Cancer Immunology Research.

Research Details Scientists at Kyoto University in Japan examined a database to determine the annual infection rates in adults from 2005 to 2012. Infections consisted of such ailments as influenza, gastroenteritis, hepatitis, and pneumonia. The data included 2,354 people who were diagnosed with any type of cancer between June 2010 and June 2011 and more than 48,000 people who were not diagnosed with cancer between 2005 and 2012. The analysis showed that people who had cancer had more infections in the six years prior to the diagnosis. In the year prior to diagnosis, infection rates for the people with cancer were higher than the noncancer group by 18 percent for influenza, 46.1 percent for gastroenteritis, 232.1 percent for hepatitis, and 135.9 percent for pneumonia. (One potential explanation for the particularly high rate of pneumonia may be people misdiagnosed with pneumonia when lung cancer is causing their symptoms.)

Why It Matters It’s not clear why a higher infection rate may be linked to cancer. "Cancer can develop in an inflammatory environment caused by infections, immunity disruption, exposure to chemical carcinogens, or chronic or genetic conditions," says lead author Shinako Inaida, PhD, a visiting researcher at the Graduate School of Medicine at Kyoto University. "An individual's immunity is thought to be a factor in the development of cancer, but additional research is needed to understand the relationship among precancerous immunity, infections, and cancer development."

RELATED: Cold and Flu Complications: How Dangerous Are These Illnesses?

Medicaid Not Helpful to People With Small Cell Lung Cancer

What’s New People with small cell lung cancer (SCLC) on Medicaid fare no better in survival compared with people who have no insurance all, according to a study published April 22 in JAMA Network Open.

Research Details Researchers led by the University of Texas MD Anderson Cancer Center in Houston analyzed data from more than 181,000 people with SCLC. They found no difference between the survival of those with SCLC on Medicaid compared with those with no insurance. Patients with private insurance, managed care plans, and Medicare had better SCLC survival rates than Medicaid and uninsured patients.

Why It Matters Medicaid was expanded under the Affordable Care Act to allow more people to obtain insurance, costing billions of dollars. However, the authors note, care under Medicaid coverage, though it can vary from state to state, can be substandard to care under other types of insurance. Access to specialized care may be a particular problem for those under Medicaid. “These findings suggest that there are substantial outcome inequalities for SCLC relevant to the policy debate on the Medicaid expansion under the Affordable Care Act,” the authors state.

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Knowing About a Cancer Diagnosis Improves Survival

What’s New People with cancer who were told about their diagnosis survived longer than people who were not told, according to a study published online April 7 in Psycho-Oncology.

Research Details Chinese researchers studied the level of knowledge almost 30,000 adults with lung cancer had about their illness. They found that those who knew about their diagnosis survived an average of 18 months, compared with 8.7 months for those who were not told.

Why It Matters In some countries and cultures, families prefer to keep bad news from patients. In China, for example, doctors typically explain the patient’s condition to family members, who then decide whether to tell the patient. The study provides evidence that patients should be informed of their condition, the authors say. "Although the complete disclosure of cancer diagnoses may cause emotional disturbance in patients immediately after being told of their diagnosis, it benefits them in the long term," says senior author Yunxiang Tang, MD, PhD, of the Second Military Medical University in China. "Communication skills training for doctors, and psychological support and education for patients and their families, should be given more attention in clinical practice."

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