New Test May Help Predict Survival From Ovarian Cancer

Method was used to count special type of immune cells in tumors from 30 women in study

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Chronic diseases hinder good cancer survival rates

Nov. 15, 2013 — There are many people in this position and the number is increasing; cancer patients who not only have to fight against cancer, but also suffer from other diseases. So-called comorbidity is a large and growing problem, not least because we are becoming older and age increases the risk of contracting cancer as well as other diseases.

How much diseases such as diabetes, COPD (chronic obstructive pulmonary disease), arthritis, depression and cardiovascular disease mean for cancer survival depends on the type of cancer; but the overall picture is the same. Other diseases have a strong negative impact on both the one and five-year survival rate. For example, for breast cancer the five-year survival rate for patients without other diseases is 83 percent. For patients with one or two other chronic diseases the survival rate is 64 percent, while it is 50 percent for those with three or more diseases. This is shown by new figures from the Central Denmark Region that have just been published in a special edition of the scientific journal Clinical Epidemiology. This edition focuses on cancer and comorbidity and is based on research from Aarhus University and Aarhus University Hospital.

Poorer survival to be expected -- but not so poor

According to Henrik Toft Sorensen, professor of clinical epidemiology at Aarhus University and Aarhus University Hospital, it is to be expected that survival rates are worse if you have a poorer state of health. But it is problematic that a similar improvement in the survival rate of this group of cancer patients has not happened.

"Our studies show that other diseases have a very significant importance for survival, and we can see that these patients have not experienced the same progress in survival rates as other cancer patients have experienced during the last 15 years," says professor Henrik Toft Sorensen, who has written the editorial in the journal.

The problem has previously been overlooked, though there has been greater awareness following the publication of specific figures on the problem 10 years ago.

"It has long been the case that cancer doctors are concerned with cancer, arthritis doctors with arthritis and so on. But increasing attention is being paid to the significance of the patients having other diseases," he says.

Many patients have other diseases

It is estimated that around 40 percent of all Danish cancer patients have one or more other diseases with which they have been hospitalised. 30 percent have one or two other diseases, while 10 percent have three or more diseases. This appears from a systematic literature review (SLR) of all of the studies of comorbidity and breast, lung and colon cancer that have been carried out in Denmark and abroad over the past decade. The study is financed by the Danish Cancer Society and has just been published in the journal Clinical Epidemiology, along with the new figures.

That so many also have other diseases is due not only to age but also unhealthy lifestyles. According to Henrik Toft Sorensen, part of the explanation of the poor survival rate can also be found here. Smoking, alcohol and being overweight simply give a poorer rate of survival. After these factors, what means something here is the treatment. Among other things because patients with other diseases have a greatly increased risk of complications, but also because there is a risk of them receiving either too much or too little treatment.

Lack of knowledge about the proper treatment

Whether it is the cancer that the patients die of is unclear, explains PhDMette Sogaard, Clinical Epidemiological Department, Aarhus University and Aarhus University Hospital, who are behind the literature review.

"It is not clear what the patients die of -- whether it is the cancer or the other diseases. However, we can see that it is neither due to the fact that they have a more aggressive cancer, that the disease is more advanced when detected, or that the patients are older," she says.

What can be seen, however, is that cancer patients with other diseases do not receive the same treatment as other cancer patients. This is probably because they cannot tolerate the treatment quite as well and because they experience complications more often than other cancer patients. According to Mette Sogaard, it could nonetheless be interesting to investigate whether we use the right treatment.

"There are still a lot of unanswered questions -- not least whether some of these patients are receiving too little treatment," she says.

Frede Olesen, chairman of the Danish Cancer Society shares this assessment:

"It is obvious that the treatment must often be individually adapted when there are several concurrent diseases. But basically, the poor results are unsatisfactory and we must focus our research on the reasons for this lack of progress. We have to carefully examine whether the quality of the simultaneous treatment of several diseases is good enough," says Frede Olesen.

This journal can be accessed at: http://www.dovepress.com/clinical-epidemiology-journal

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Hyperfractionated radiotherapy improves survival in head and neck cancer patients

Sep. 27, 2013 — The use of an intensified form of radiotherapy in patients with locally advanced head and neck cancers can improve overall survival rates compared with standard radiation therapy, according to results from a large study to be presented at the 2013 European Cancer Congress (ECC2013) [1].

A comparison of altered fractionation radiotherapy (AFRT) with standard fractionation radiotherapy (SFRT) in a meta-analysis of more than 11,000 patients showed an eight percent reduction in the risk of death in the AFRT group, as well as a nine percent reduction in the risk of progression or death.

Dr Pierre Blanchard, a radiation oncologist from the Institut Gustave Roussy, Villejuif, France, will tell the congress that, although concomitant chemoradiation (CRT), where radiotherapy and chemotherapy are delivered together, remains the standard of care for patients with locally advanced head and neck squamous cell carcinomas, AFRT should be considered when treatment intensification is sought-after and CRT is not feasible because of other pre-existing conditions such as cardiac and renal disease.

AFRT is an intensified radiotherapy treatment that can be given in various schedules. The first is hyperfractionation, where radiotherapy is given twice daily ten times per week, resulting in a higher total dose of around 80 Grays (Gy) [2] compared with the dose of 70 Gy given using SFRT in the same overall time (around seven weeks). The second way uses an accelerated schedule, where the overall treatment time is reduced but the dose is kept at the same level or at a lower dose. AFRT is associated with increased acute side effects but not late side effects, compared to SFRT.

"After than more than seven years patient follow-up, our research has shown that the higher dose intensity of AFRT works to improve outcomes," says Dr Blanchard. "The hyperfractionated regime is the most effective in terms of overall survival. Indeed, in this group of trials the risk of death is reduced by 18% by the use of hyperfractionated RT, with 41% of patients alive at five years compared to 33% in the SFRT group. While the acute side effects of AFRT are increased compared to those experienced by patients on SFRT, the late side effects are comparable and, overall, side effects are more than compensated for by the significant increase in survival in the AFRT group."

The meta-analysis was carried out by an international collaboration known as MARCH, including many countries in Europe, the USA, Canada, and Brazil, Egypt and developing countries through the International Atomic Energy Authority. The researchers say that the survival benefits are mostly related to improvements in loco-regional control, the area located close to the primary tumour being by far the most common first site of relapse in this disease.

"These data are a major advance for the understanding of the role in AFRT in head and neck squamous cell carcinoma," says Dr Blanchard. "By carrying out a large-scale analysis such as this one, we believe that we have provided enough evidence to indicate that doctors should recommend AFRT as a validated treatment option for head and neck cancer patients."

Professor Cornelis van de Velde, President of ECCO, said: "This large-scale analysis of patients with head and neck cancer shows that hyperfractionation increases survival, and local control is also improved by the use of this technique. This is an important step forward in the treatment of this devastating disease."

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Treating chest lymph nodes in early breast cancer improves survival without increasing side effects

Sep. 27, 2013 — Giving radiation therapy to the lymph nodes located behind the breast bone and above the collar bone to patients with early breast cancer improves overall survival without increasing side effects. This new finding ends the uncertainty about whether the beneficial effect of radiation therapy in such patients was simply the result of irradiation of the breast area, or whether it treated cancer cells in the local lymph nodes as well, the 2013 European Cancer Congress (ECC2013) [1] heard.

Dr Philip Poortmans, a radiation oncologist from the Institute Verbeeten, Tilburg, The Netherlands, and a member of the EORTC Radiation Oncology and Breast Cancer Groups, said that results from the international randomised trial, which involved 4004 patients from 43 centres, were convincing. "Our results make it clear that irradiating these lymph nodes give a better patient outcome than giving radiation therapy to the breast/thoracic wall alone. Not only have we shown that such treatment has a beneficial effect on locoregional disease control, but it also improves distant metastasis-free survival and overall survival," he said.

Lymphatic drainage from breast cancer means that the cancer is more likely to spread to other parts of the body. It normally follows two pathways. The best known is to the axilla (armpit), and these lymph nodes are usually treated by surgery and/or radiation therapy. The second pathway drains to the internal mammary (IM) lymph nodes behind the breast bone, and also to those just above the collar bone, the medial supraclavicular (MS) nodes. Because of uncertainty about the effects of treatment in this area, and particularly concerns about the increased toxicity that might be due to the irradiation of a larger area, many centres do not currently treat the IM-MS lymph nodes.

After an average follow-up of 10.9 years, the researchers found that patients in the IM-MS treatment group had better overall survival independent of the number of lymph nodes involved. A total of 382 patients in the IM-MS group died during that period, compared with 429 in the non IM-MS group, and there was no increase in non-breast cancer related mortality in the first group. To date, there have been no serious complications related to the treatment.

The researchers believe that the beneficial effect of IM-MS radiation can be explained by the ability of the treatment to eradicate microscopic tumour deposits in the lymph nodes. "With this treatment, we can stop the development of metastases at their source," said Dr Poortmans. "Interestingly, this effect is irrespective of the stage of the tumour. We believe that this is likely to be related to the positive interaction of the IM-MS treatment with systemic treatment -- chemotherapy, hormonal therapy and targeted treatment."

Patients at low risk of their cancer spreading outside the breast will often be given less intensive systemic therapy in order to spare them side effects. In these cases, using IM-MS radiation therapy can improve their outcome by eradicating residual tumour cells in the breast/thoracic wall. For patients at high risk of metastases, who receive systemic therapy, the prospect of cure is also related to the chance of leaving residual tumour cells behind throughout the body. In these cases too, the ultimate outcome can be improved by using effective locoregional treatment to eradicate disease at the site where it is most likely to be present, the researchers say.

"The results of our trial, in which the patients received appropriate systemic treatments, contradict the existence of a 'competition' between locoregional and systemic treatments," said Dr Poortmans. "Because there is an interaction between these treatments, in many patients their combination will result in an enhancement of the combined benefits; in other words, one plus one can equal more than two."

The researchers intend to follow up these patients in the long term and are planning an average follow-up of 20 years, with the next analysis at 15 years.

"It is of the utmost importance that we record all possible events, including recurrence and toxicity, and such follow-up will also give us the opportunity to continue evaluating our patients in other areas, for example quality of life and wellbeing," said Dr Poortmans. "But we believe that our trial has already given solid evidence of the benefits of radiation treatment of the IM-MS lymph nodes, and we hope that such treatment will become standard clinical practice for patients with early breast cancer."

Professor Cornelis van de Velde, President of ECCO, said: "In past studies, radiotherapy as an adjunct to surgery has shown important improvements in loco-regional control as well as survival, and these further survival benefits without an increase in short and long term toxicities are a valuable development. The results of this study will help us on the road to the development of yet more personalised treatments, in which we have to find the delicate balance between under-treatment resulting in an increased risk of disease recurrence, and over-treatment accompanied by unnecessary toxicity, in order to provide optimal care for breast cancer patients."

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Hyperfractionated radiotherapy improves survival in head and neck cancer patients

Sep. 27, 2013 — The use of an intensified form of radiotherapy in patients with locally advanced head and neck cancers can improve overall survival rates compared with standard radiation therapy, according to results from a large study to be presented at the 2013 European Cancer Congress (ECC2013) [1].

A comparison of altered fractionation radiotherapy (AFRT) with standard fractionation radiotherapy (SFRT) in a meta-analysis of more than 11,000 patients showed an eight percent reduction in the risk of death in the AFRT group, as well as a nine percent reduction in the risk of progression or death.

Dr Pierre Blanchard, a radiation oncologist from the Institut Gustave Roussy, Villejuif, France, will tell the congress that, although concomitant chemoradiation (CRT), where radiotherapy and chemotherapy are delivered together, remains the standard of care for patients with locally advanced head and neck squamous cell carcinomas, AFRT should be considered when treatment intensification is sought-after and CRT is not feasible because of other pre-existing conditions such as cardiac and renal disease.

AFRT is an intensified radiotherapy treatment that can be given in various schedules. The first is hyperfractionation, where radiotherapy is given twice daily ten times per week, resulting in a higher total dose of around 80 Grays (Gy) [2] compared with the dose of 70 Gy given using SFRT in the same overall time (around seven weeks). The second way uses an accelerated schedule, where the overall treatment time is reduced but the dose is kept at the same level or at a lower dose. AFRT is associated with increased acute side effects but not late side effects, compared to SFRT.

"After than more than seven years patient follow-up, our research has shown that the higher dose intensity of AFRT works to improve outcomes," says Dr Blanchard. "The hyperfractionated regime is the most effective in terms of overall survival. Indeed, in this group of trials the risk of death is reduced by 18% by the use of hyperfractionated RT, with 41% of patients alive at five years compared to 33% in the SFRT group. While the acute side effects of AFRT are increased compared to those experienced by patients on SFRT, the late side effects are comparable and, overall, side effects are more than compensated for by the significant increase in survival in the AFRT group."

The meta-analysis was carried out by an international collaboration known as MARCH, including many countries in Europe, the USA, Canada, and Brazil, Egypt and developing countries through the International Atomic Energy Authority. The researchers say that the survival benefits are mostly related to improvements in loco-regional control, the area located close to the primary tumour being by far the most common first site of relapse in this disease.

"These data are a major advance for the understanding of the role in AFRT in head and neck squamous cell carcinoma," says Dr Blanchard. "By carrying out a large-scale analysis such as this one, we believe that we have provided enough evidence to indicate that doctors should recommend AFRT as a validated treatment option for head and neck cancer patients."

Professor Cornelis van de Velde, President of ECCO, said: "This large-scale analysis of patients with head and neck cancer shows that hyperfractionation increases survival, and local control is also improved by the use of this technique. This is an important step forward in the treatment of this devastating disease."

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Limited brain Mets with 50 more young adult cancer patients alone, has improved the survival of Stereotactic radiation therapy.

According to the study published in the 55 annual general meeting of the society for radiation oncology (ASTRO)-American whole brain irradiation (Stereotactic ）, adult brain cancer patients 50 years following when dealing with Stereotactic radiosurgery (SRS), and found that there is improvement in survival rates cannot be used. Young patients (50 years old) was found despite the omission of new brain metastasis localization development of big risk with or without. University of Texas MD Anderson Cancer Center, University of Southern California （ USC Norris Comprehensive Cancer Center home ） from the authors of the study are included.

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Agenus brain cancer vaccine improves survival in mid-stage study

(Reuters) - Biotechnology company Agenus Inc said its experimental brain cancer vaccine increased the survival of patients without their cancer worsening in a mid-stage trial, compared with the standard treatment.

Agenus shares jumped as much as 34 percent on the Nasdaq on Monday morning.

The vaccine, codenamed HSPPC-96, showed an almost 18 month median progression-free survival — a 160 percent increase versus current standard treatment of radiation combined with chemotherapy drug temozolomide.

The vaccine was being used in combination with the standard treatment to treat patients with newly diagnosed glioblastoma multiforme, an aggressive type of tumor which affects the brain.

Agenus plans to discuss a late-stage trial with the U.S. Food and Drug Administration, based on the trial data.

A preliminary analysis of the study in May had showed that the vaccine had a 146 percent increase in progression-free survival when compared with the standard-of-care.

"We are impressed by the data and look forward to feedback from the FDA regarding next steps," Roth Capital Partners analyst Joseph Pantginis wrote in a note, raising the price target on the stock to $15.

It was up 22 percent at $3.34 at midday after touching a high of $3.68.

(Reporting By Adithya Venkatesan; Editing by Joyjeet Das)

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Gene Mutation May Help Predict Lung Cancer Survival in Nonsmokers

THURSDAY, Sept. 12 (HealthDay News) -- Researchers say they've identified a gene mutation that's associated with a higher risk of lung cancer in women who do not smoke, but a better chance of survival in female and male lung cancer patients.

The mutation, which occurs in a gene that protects cells from oxidative stress, is found four times more often in women than in men, according to the study published Sept. 11 in the journal PLoS One.

The researchers analyzed the DNA of lung cancer patients in Japan and found that nonsmoking women with two copies of the -617A mutation in the NFR2 gene had a much higher incidence of lung cancer than nonsmoking men.

The investigators also found that both female and male lung cancer patients with this mutation had better survival rates than other patients.

This is the first study to provide clinical evidence that this mutation is associated with lung cancer patient survival, said researcher Dr. Toshihisa Ishikawa and colleagues at the RIKEN Center for Life Science Technologies in Japan.

The study strongly suggests that the presence of this mutation "is a good prognostic biomarker for the assessment of the overall survival chances of patients with adenocarcinoma, as well as a practical tool for personalized cancer therapy," Ishikawa said in a RIKEN news release.

Although the study found an association between the gene mutation and lung cancer survival, it did not prove a cause-and-effect relationship.

Lung cancer is the leading cause of cancer-related deaths in many industrialized countries, according to background information in the news release. Smoking is the main cause of lung cancer, but 10 percent to 15 percent of cases occur in nonsmokers.

More information

The U.S. National Cancer Institute has more about lung cancer.

SOURCE: PLoS One, news release, Sept. 11, 2013

Copyright c 2013 HealthDay. All rights reserved.

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New mutation identified, associated with better survival in lung cancer patients

Sep. 12, 2013 — Japanese researchers have identified a mutation associated with a higher incidence of lung cancer in Japanese women who do not smoke, but better survival in lung cancer patients. In a study published today in the journal PLOS ONE, the team from the RIKEN Center for Life Science Technologies shows that the mutation, a single nucleotide polymorphism (SNP) in a gene that protects cells from oxidative stress, is found four times more frequently in women than in men.

Lung cancer is the leading cause of cancer-related deaths in many industrialized countries. Most deaths are due to long-term exposure to cigarette smoke, but non-smokers account for 10 -- 15% of cases.

Dr. Toshihisa Ishikawa and his team analyzed the DNA of patients with primary lung cancer and found that non-smoking Japanese women with two copies of the SNP (-617A) in the NFR2 gene had a markedly higher incidence of adenocarcinoma of the lung, as compared with non-smoking, homozygous males.

Furthermore, they find that both male and female lung cancer patients homozygous for the same SNP in the NRF2 gene survive lung cancer much better.

Nuclear factor erythroid-derived 2 (NF-E2)-related factor (NRF2) controls cellular adaptation to oxidants and electrophiles by inducing antioxidation and detoxification genes, and protects normal cells from external toxic challenges and oxidative stress.

Their study also suggests that lung cancer patients harboring a SNP (-617A) allele in the NRF2 gene in combination with the wild-type allele of the MDM2 gene have better prognosis.

"This is the first report providing clinical evidence that homozygous alleles for the SNP (-617A), one of the intrinsic genetic polymorphisms in the NRF2 gene, are associated with the overall survival of lung cancer patients," explains Dr. Ishikawa.

"The study strongly suggests that the presence of homozygous alleles for this SNP is a good prognostic biomarker for the assessment of the overall survival chances of patients with adenocarcinoma, as well as a practical tool for personalized cancer therapy," he concludes.

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Story Source:

The above story is based on materials provided by RIKEN.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. Yasuko Okano, Uru Nezu, Yasuaki Enokida, Ming Ta Michael Lee, Hiroko Kinoshita, Alexander Lezhava, Yoshihide Hayashizaki, Satoshi Morita, Masataka Taguri, Yasushi Ichikawa, Takeshi Kaneko, Yutaka Natsumeda, Tomoyuki Yokose, Haruhiko Nakayama, Yohei Miyagi, Toshihisa Ishikawa. SNP (–617C>A) in ARE-Like Loci of the NRF2 Gene: A New Biomarker for Prognosis of Lung Adenocarcinoma in Japanese Non-Smoking Women. PLoS ONE, 2013; 8 (9): e73794 DOI: 10.1371/journal.pone.0073794

Note: If no author is given, the source is cited instead.

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Despite higher survival, brachytherapy to treat cervical cancer declines in US

Sep. 11, 2013 — A study by researchers at Brigham and Women's Hospital (BWH) found that brachytherapy treatment was associated with better cause-specific survival and overall survival in women with cervical cancer. The population-based analysis also revealed geographic disparities and decline in brachytherapy treatment in the United States. Brachytherapy is a type of cancer treatment in which radioactive implants are inserted directly into the tissue near the tumor site.

The study is published in the September 2013 issue of The International Journal of Radiation Oncology.

The researchers used the Surveillance, Epidemiology, and End Results (SEER) Database to identify 7,359 patients with advanced stage cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. (The 18 SEER population-based registries cover approximately 28 percent of the US population and include Connecticut, New Jersey, Metropolitan Detroit, Iowa, New Mexico, Hawaii, Seattle, Utah, Alaska, San Francisco-Oakland, San Jose-Monterey, Los Angeles, Greater California, Kentucky, Louisiana, Metropolitan Atlanta, Rural Georgia, and Greater Georgia. The registries collect information about patient and tumor characteristics and first course of cancer-directed treatment.)

Of the 7,359 patients identified, the researchers found that 63 percent of these women received brachytherapy in combination with EBRT, and 37 percent received EBRT alone. Factors associated with higher odds of brachytherapy use included younger age, being married, earlier years of diagnosis, earlier stage and certain SEER regions.

Moreover, brachytherapy usage rate decreased from 83 percent in 1988 to 58 percent in 2009. There was a sharp decline from 43 percent to 23 percent in 2003. The researchers noted that the decline may be related to the decreasing incidence of cervical cancer and increased adoption of alternative treatment techniques, such as intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT).

In terms of patient survival, brachytherapy was associated with a higher four-year cause-specific survival (64.3 percent vs. 51.5 percent) and overall survival (58.2 percent vs. 46.2 percent) compared to EBRT alone. Brachytherapy treatment was also independently associated with better cause-specific survival and overall survival.

"The shift away from brachytherapy is concerning, and has directly lowered the survival rates of cervical cancer patients," said Akila Viswanathan, MD, MPH, director of BWH Gynecologic Radiation Oncology, senior study author. "High-quality brachytherapy must continue to be used, ideally with image-guidance, to maximize survival and minimize toxicity."

Brachytherapy is an important component of treatment that escalates the dose of radiation to the primary tumor while minimizing the dose to critical organs at risk. The standard treatment of locally advanced cervical cancer is EBRT with concurrent chemotherapy, followed by brachytherapy.

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