Breast Cancer Drug Raises Risk of Heart Problems in Older Women: Study

WEDNESDAY, Aug. 10 (HealthDay News) -- The breast cancer drug Herceptin increases the risk of heart problems in elderly patients, especially those with a history of heart disease and/or diabetes, a new study says.

Researchers analyzed the medical records of 45 women, ages 70 to 92, who were treated with Herceptin (trastuzumab) since 2005 and found that 12 (26.7 percent) of them developed heart problems caused by the drug.

That rate is slightly higher than what was noted in earlier clinical trials of younger, healthier women.

In this new study, 33 percent of the women with a history of heart disease developed either asymptomatic or symptomatic heart problems as a result of taking Herceptin, compared with 9.1 percent of women without a history of heart disease.

The researchers also found that about 33 percent of women with diabetes developed heart problems, compared with 6 percent of diabetes-free women.

When the women with heart problems stopped taking Herceptin, all but one recovered fully and five were able to re-start treatment with the drug.

The study appears in the journal Annals of Oncology.

"This is the first study specifically to assess trastuzumab-related cardiac toxicity and the cardiovascular factors that are associated with an increased risk in a selected population of elderly breast cancer patients," study author Dr. Cesar Serrano, who conducted the research while working as a clinical fellow at the Department of Medical Oncology Breast Cancer Centre at the Vall d'Hebron University Hospital in Barcelona, Spain, said in a journal news release.

"Trastuzumab is generally well-tolerated and, although there are some concerns about it causing heart problems, until now few risk factors have been identified among patients in clinical trials, most of whom are usually younger than 70 years and have good general health. Our study has demonstrated a significantly increased incidence of cardiac events among patients aged 70 and over with cardiovascular risk factors such as a history of cardiac disease and diabetes," said Serrano, who is now a postdoctoral research fellow at Brigham and Women's Hospital in Boston.

Serrano said the findings suggest that elderly women with one or more heart risk factors who are being treated with trastuzumab should be referred to a cardiologist. He also recommended closer monitoring of such patients for possible heart problems.

More information

The U.S. National Cancer Institute has more about breast cancer treatment.

SOURCE: Annals of Oncology, news release, Aug. 9, 2011

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Counseling May Help Women at Risk for Breast Cancer Gene

FRIDAY, Aug. 5 (HealthDay News) -- Although women whose mothers had breast cancer may worry about developing cancer themselves, many do not fully understand when and why they should be screened or their options to reduce their risk for the disease, a new study suggests.

"Young, high-risk women have little knowledge about the probabilities and options for managing the cancers for which their risks are remarkably increased. Further, many report intense anxiety related to their potential cancer development," principal investigator Andrea Farkas Patenaude, of the Dana-Farber Cancer Institute, said in an institute news release.

The daughters of women with BRCA1 or BRCA2 genes have a 50 percent chance of having this mutation themselves, which will increase their risk of breast cancer by 85 percent and raise their risk of ovarian cancer by up to 60 percent. The researchers pointed out that these women will be unable to make informed health decisions until they know about these risks as well as the genetic testing, other types of screening and risk-reducing surgery available to them.

In conducting the study, the investigators questioned the 18- to 24-year-old daughters of mothers who are BRCA1 or BRCA2 mutation carriers, about their attitudes, health behaviors, life plans and how much they knew about hereditary breast or ovarian cancer genetics.

The researchers found that the women surveyed worried a lot about hereditary breast or ovarian cancer. In fact, 40 percent of the daughters revealed they worried a great deal or to an extreme about hereditary cancer.

The study also revealed that the women were not well-informed about the genetics of breast or ovarian cancers, compared to those who had genetic counseling. The participants also did not fully understand their cancer screening and risk-reduction options, including when they should begin this screening process.

"These data support the need and can provide the foundation for the development of targeted educational materials to reduce that anxiety and ultimately improve participation in effective screening and risk-reducing interventions that can improve survival and quality of life for these young women," Farkas Patenaude said.

The findings were slated for presentation on Thursday in Orlando at the Era of Hope conference hosted by the Department of Defense Breast Cancer Research Program. Because this study was presented at a meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute provides more information on how to assess breast cancer risk.

SOURCE: Dana-Farber Cancer Institute, news release, Aug. 4, 2011

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Elderly Lung Cancer Patients Can Gain From Two-Drug Chemo: Study

MONDAY, Aug. 8 (HealthDay News) -- Countering conventional wisdom, researchers in France say that elderly lung cancer patients can gain significant benefit from an aggressive, double-barreled chemotherapy that's often used in younger patients.

The finding raises questions about standard public health recommendations, such as those issued the American Society of Clinical Oncology in 2004, which advised physicians not to expose elderly patients with non-small cell lung cancer (NSCLC) to the undesirable side effects of combination chemotherapy.

Instead, older patients have typically been offered less harsh -- but also less effective -- chemotherapies containing a single agent. That's because, until now, it's been assumed that the benefits to elderly patients of dual-chemo ("doublet") regimens simply weren't worth their onerous side effects and risks.

But, "our study demonstrates clearly that [the doublet] scheme is feasible in elderly patients," study author Dr. Elisabeth Quoix, from the department of chest diseases at Hopitaux Universitaires de Strasbourg at the University of Strasbourg. She noted that survival rates among elderly patients, even among those over the age of 80, appeared comparable to those of younger patients on the dual-drug regimen.

The findings are reported online Aug. 9 in The Lancet.

As life expectancy increases, so does the risk for lung cancer, the leading cancer killer worldwide. As a result, studies show that lung cancer rates have been ramping up among the elderly, with patients in the developed world now averaging between 63 and 70 years of age at diagnosis.

According to Quoix, that means that "elderly patients represent around 50 percent of all patients with lung cancer." She also believes that "there has been for quite a long time such a nihilism toward this disease, especially for elderly patients, that unfortunately most of these patients are under-treated."

In fact, prior research indicates that, in recent years, as little as one-quarter of NSCLC patients over the age of 66 have gotten the same first-line standard of care as younger patients.

To learn more, between 2006 and 2009 Quoix' team recruited just over 450 NSCLC patients between the ages of 70 and 89. All of these patients were undergoing treatment at one of 61 different medical centers across France.

Half were placed on a dual-chemotherapy regimen involving the agents carboplatin and paclitaxel, which together comprise what doctors call "platinum-based doublet chemotherapy." The other half were placed on a single drug ("monotherapy") regimen involving either vinorelbine or gemcitabine.

Dual-regimens were spread across four weeks, while the single regimens were spaced over three weeks.

The researchers found that toxic side effects were indeed more common among those exposed to two chemotherapy agents at once. Yet over the course of 2.5 years of follow-up (on average), the team also found that survival rates were much higher among the dual-chemo group.

For example, elderly patients who were placed on the two-drug therapy survived more than 10 months on average, compared with just over 6 months for those getting the single therapy group.

What's more, nearly 45 percent of doublet patients survived to the one-year mark post-treatment, compared with about 25 percent of those in the single-chemo group.

The authors concluded that -- harsher toxic side-effects notwithstanding -- double-chemo treatment appears to afford elderly lung cancer appreciable and worthwhile benefits. They therefore called for a reconsideration of current protocols for lung cancer treatment among the elderly.

However, in an editorial, Dr. Karen L Reckamp, from the City of Hope Comprehensive Cancer Center in Duarte, Calif., said that there have been too few clinical trials involving older men and women with lung cancer. That means that the "optimum chemotherapy regimen remains unknown" for elderly lung cancer patients, she wrote.

"Clinical trials that examine therapy for lung cancer usually include a minority of patients over 70, so that results do not provide guidance on the best treatment for this group," Reckamp explained.

But she agreed that the new French study "moves the field forward" by highlighting the apparent "dramatic improvement in survival" among elderly afforded dual-chemo treatment.

"This strongly supports doublet chemotherapy in carefully selected older individuals with NSCLC," Reckamp said. However, "the results must be balanced by a look at the increased toxicities and deaths in the combination arm. We are still in need of addition studies that evaluate older individuals with NSCLC and perform an assessment so that we might predict those who may have greater benefit or who might be at greater risk for toxicity."

More information

For more on non-small cell lung cancer, visit the American Cancer Society.

SOURCES: Elisabeth Quoix, M.D., department of chest diseases, Hopitaux Universitaires de Strasbourg, University of Strasbourg, France; Karen L Reckamp, M.D., City of Hope Comprehensive Cancer Center, Duarte, Calif; Aug. 9, 2011, Lancet, online

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