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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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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Study of Bone Cancer in Dogs May Improve Treatment in Kids

MONDAY, Aug. 8 (HealthDay News) -- The discovery of a gene pattern that distinguishes highly aggressive bone cancer in dogs from a less aggressive form may help improve treatment of bone cancer in children, according to researchers.

Other than humans, dogs are the only species that develops bone cancer spontaneously with any frequency. Dogs are more likely than humans to develop bone cancer, but human and dog forms of bone cancer are very similar, explained study team leader Dr. Jaime Modiano, a comparative medicine expert at the College of Veterinary Medicine and Masonic Cancer Center at the University of Minnesota.

The newly discovered gene pattern in dogs is an exact match with humans and may assist in treatment planning for children with bone cancer, according to the report in the September issue of the journal Bone.

"Our findings pave the way to develop laboratory tests that can predict the behavior of this tumor in dogs and children at the time of diagnosis," Modiano said in a university news release. "This allows us to tailor individualized therapy to meet the patient's needs. Patients with less aggressive disease could be treated conservatively, reducing the side effects and the risks associated with treatment, while patients with more aggressive disease could be treated with more intense therapy."

The course and aggressiveness of bone cancer can vary from patient to patient and is difficult to predict. Some patients respond well to conventional treatment and live for decades without recurrence, while others have a poor response and experience a rapid return of bone cancer, the release noted.

More information

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

SOURCE: University of Minnesota, news release, July 28, 2011

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For Many, Risks of Lung Biopsy May Outweigh Benefits: Study

MONDAY, Aug. 1 (HealthDay News) -- For many patients, biopsies of lung nodules found during CT scans may be unnecessary and even dangerous, a new study finds.

"As we have been doing more CT scans, we are finding more of these nodules or spots in the lungs, which have unclear clinical significance," said lead researcher Dr. Renda Soylemez Wiener, an assistant professor of medicine at Boston University School of Medicine.

Nodules are spotted in as many as 25 percent of patients undergoing a chest CT scan, the study said. "When nodules show up, doctors and patients need to decide whether to biopsy that spot in the lung," she said. "There are risks to that [surgical] procedure, which may be more common than most people realize."

Lung collapse and bleeding are complications of the procedure, which involves removing and examining a sample of tissue.

Wiener, noting that 98 percent of the nodules turn out to be benign, said physicians perform too many unnecessary lung biopsies.

Too many CT scans are also done, Wiener said. "We find information we don't know what to do with. Like we find a spot in the lung and have to decide whether or not to expose a patient to the risk of biopsy," she said.

One factor driving lung biopsies is physician fear of being sued for not finding a cancer, Wiener said. Also, a recent U.S. National Cancer Institute report, which found that CT screening reduced lung cancer deaths compared with use of traditional chest X-rays, is expected to boost the use of scans for smokers and others at risk of lung cancer. But doctors need to tell patients about the risks, the study authors said.

"There are situations where it might not be worth it to do a biopsy," Wiener said. These include "people with either very low risk of cancer or people who have such a high risk of cancer that they are probably going to go to surgery no matter what a biopsy shows," she said.

Also, people so frail that they couldn't withstand lung cancer treatment should not have a biopsy, Wiener said.

For the study, published in the Aug. 2 issue of the Annals of Internal Medicine, Wiener's team reviewed data on 15,865 adults who underwent a lung biopsy.

Of the 1 percent who experienced bleeding as a result of the procedure, 17.8 percent needed a blood transfusion, they found.

Lung collapse, a condition called a pneumothorax, occurred in 15 percent of the patients.

Of that group, 6.6 percent needed a chest tube to expand the lung and a longer hospital stay. These patients were also more likely to develop respiratory failure that required mechanical ventilation, the researchers found.

Complications during biopsy were more common among older patients, smokers and people with chronic obstructive pulmonary disease, the researchers said.

Dr. Norman H. Edelman, a professor of preventive medicine, internal medicine, physiology and biophysics at Stony Brook University in New York and chief medical officer for the American Lung Association, said the "the findings are especially relevant" in light of the National Cancer Institute lung cancer screening trial.

"In all likelihood, the Institute's findings will result in the identification of many more pulmonary nodules, which physicians will have to evaluate," he said.

Typically, doctors must choose between careful watching with subsequent CT scans and early biopsy. "The current report should be helpful to physicians in making a 'real world' risk-versus-benefit analysis between the two approaches," Edelman said.

Edelman also said the regional variation in use of needle lung biopsy invites examination. (The data showed a rate of 14.7 per 100,000 adults in New York compared to 36.2 per 100,000 adults in Florida.)

"If we are to be rational about resource utilization, we must solve the question of whether some regions do too few procedures or other regions do too many," he said.

More information

For more information on lung cancer, visit the U.S. National Library of Medicine.

SOURCES: Renda Soylemez Wiener, M.D., M.P.H., assistant professor, medicine, Boston University School of Medicine; Norman H. Edelman, M.D., professor, preventive medicine, internal medicine, physiology and biophysics, Stony Brook University, N.Y., chief medical officer, American Lung Association; Aug. 2, 2011, Annals of Internal Medicine

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Cell Phones Don't Seem to Pose Cancer Risk to Kids: Study

WEDNESDAY, July 27 (HealthDay News) -- Children who use cell phones don't seem to face an increased risk of brain cancer, compared to children who don't use them, a new study contends.

But, the study authors and other experts cautioned that more research is needed.

With the increase in cell phone use among kids, some worry that radiation from the devices can increase the risk for brain tumors. Children's brains are still developing, and because their heads are smaller radiofrequency electromagnetic fields may penetrate areas deeper in the brain, some researchers say.

"The [study] results are reassuring, given the widespread use of mobile phones by children and adolescents," said lead author Martin Roosli, an assistant professor at the Swiss Tropical and Public Health Institute in Basel, Switzerland.

"However," he added, "uncertainties remain regarding long-term use. Thus, further careful monitoring whether brain tumor incidence is increasing in this age group is important."

The findings were published July 27 in the Journal of the National Cancer Institute.

For the study, Roosli's team collected data on 352 children and adolescents aged 7-19 with brain cancer, and compared them to 646 similar children who did not have brain cancer. The children came from Denmark, Norway, Sweden and Switzerland. The researchers also interviewed the children and asked them about their cell phone use.

The researchers found that children with brain tumors didn't use cell phone more than those without tumors. Specifically, 75.3 percent of the children with brain tumors said they had used a cell phone more than 20 times before being diagnosed with their tumor. Among those children without cancer, 72.1 percent reported similar cell phone use.

Among children with tumors, 55 percent said they used a cell phone regularly, compared to 51 percent of children without tumors.

Also, there was no increase in the risk for tumors in the area of the brain receiving the most radiation from cell phones, the researchers said.

"However, people who are concerned might consider using cell phones with low radiation emissions or they might consider using an ear piece or using the phone's speaker," Roosli said.

These findings probably won't quell the debate about the potential risk of brain cancer from cell phones.

In May, a panel of experts at the World Health Organization (WHO) said cell phones may cause brain cancer. After reviewing dozens of studies on the subject, the experts classified cell phones as "possibly carcinogenic to humans" and placed them in the same category as the pesticide DDT and gasoline engine exhaust.

Commenting on the new study, John D. Boice Jr., of the International Epidemiology Institute and co-author of an accompanying editorial in the journal, said that "the occurrence of a brain tumor in a child is a devastating diagnosis. Research into the causes of brain tumor and improved treatment regimens should continue. However, there should not be a concern that using a cell phone has caused brain cancer."

There's been no evidence from population data on brain tumor occurrence over the past 20 years to indicate that rates are increasing among children or adults, which would be expected if cell phone use caused brain tumors, Boice said.

"The recent announcement by the WHO has caused widespread confusion and unnecessary alarm, in large part due to a misunderstanding of the category 'possibly carcinogenic,' which is for agents for which there is 'limited evidence for carcinogenicity,'" he explained.

Elizabeth Ward, national vice president of intramural research at the American Cancer Society, called the new research "a very important study that has a great number of strengths, including a population-based contemporary sample and a high participation rate."

"But, as in most areas of epidemiology where complex risk factors are studied, additional studies are needed to develop conclusive evidence about potential risks of mobile phone use. It is important that additional studies be done in children, adolescents and young adults with early life exposure to mobile phones," she added.

More information

For more on brain cancer, visit the U.S. National Library of Medicine.

SOURCES: Martin Roosli, Ph.D., assistant professor, Swiss Tropical and Public Health Institute, Basel, Switzerland; John D. Boice Jr., Sc.D., International Epidemiology Institute, Rockville, Md.; Elizabeth Ward, Ph.D., national vice president, intramural research, American Cancer Society, Atlanta; July 27, 2011, Journal of the National Cancer Institute

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