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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Tamoxifen Wards Off Breast Cancer's Return for More Than a Decade

THURSDAY, July 28 (HealthDay News) -- Women who took the cancer-suppressing drug tamoxifen for five years after a breast cancer diagnosis were nearly 40 percent less likely to have the cancer return, and that protection lasted for more than a decade after they stopped taking the drug, a new study finds.

Researchers analyzed the results of about 20 randomized controlled trials on a five-year course of tamoxifen vs. not taking the drug. The trials involved 21,000 women from a dozen countries around the world, including the United States, Europe, China and Japan.

Some 15 years after their diagnosis -- and 10 years after they stopped taking the drug -- women who took tamoxifen still had one-third lower risk of dying than women who didn't take it.

"It's a remarkable drug," said study author Dr. Christina Davies, a lead investigator with the Early Breast Cancer Trialists Collaborative Group, which was established some 25 years ago to conduct periodic reviews of research on breast cancer from around the world. "It has probably saved more lives than any other oncological drug ever."

Of 10,645 women who took tamoxifen, about 26 percent had a relapse at the 10-year-mark, compared to 40 percent who didn't take the medication. By 15 years, 33 percent of women who took the drug had their cancer return, compared to 46 percent who didn't.

The statistics were similar when it came to death rates. After a decade, about 25 percent of women who didn't take the drug had died compared to 18 percent of those who did take it; at 15 years, 33 percent who didn't take the drug died compared to 24 percent of those who took tamoxifen.

"They not only gained the benefits while they were taking the drug, but for many years afterward," Davies said.

The study is published in the July 28 online issue of The Lancet.

Tamoxifen has been widely used for more than 30 years to treat the most common type of breast cancer, estrogen-receptor positive tumors.

The drug works by inhibiting the activity of estrogen, a female hormone that can drive the growth of breast cancer tumors. The drug is most often prescribed as a once-a-day pill for younger women with breast cancer.

Older, postmenopausal women are now often prescribed a newer class of drugs called aromatase inhibitors, which block estrogen released in body fat, experts said. Aromatase inhibitors are most easily used in women who no longer have ovaries that are producing estrogen, Davies said.

One reason for the switch to aromatase inhibitors: Prior research, as well as the current study, found that tamoxifen raises the risk of cancer of the lining of the uterus (endometrial cancer) and life-threatening blood clots in the lungs. The analysis found the added risk from tamoxifen to older women was small, and in younger women it was "almost non-existent," Davies said.

"The benefits greatly outweigh the risks," Davies said.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said studies such as this that look at death rates over the long-term are valuable.

"The study shows that tamoxifen as an adjuvant [additional] therapy for breast cancer has had a very successful track record that has been sustained over 30 years of use in the clinic, even though it's used less now," he said.

The analysis found tamoxifen worked equally well in women who underwent chemotherapy and radiation in addition to surgery, Davies noted. Another benefit: tamoxifen is inexpensive. Davies estimated a five-year course of the drug costs about $150, of particular importance in developing nations where breast cancer rates have risen dramatically, she said.

Many of the women in the analysis, she noted, failed to take the full five-year course of the drug, so it's possible the protective effect from fully taking the medication as prescribed might be even greater. The findings raise the question of whether, say, a 10-year course of tamoxifen might be even more beneficial than five years.

About half of the women worldwide diagnosed with breast cancer are pre-menopausal, she said. "For those women, tamoxifen is the main treatment option," she said.

About two-thirds of breast cancers in the United States are estrogen-positive. The drug worked even on those whose tumors are "weakly positive," she noted.

More information

The U.S. National Cancer Institute has more on tamoxifen.

SOURCES: Christina Davies, M.D., senior research scientist, Clinical Trial Service Unit, University of Oxford, Oxford, England; Len Lichtenfeld, deputy chief medical officer, American Cancer Society, Atlanta; July 28, 2011, The Lancet, online

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High-Fiber Diet Might Lower Risk for Colon Polyps

TUESDAY, Aug. 9 (HealthDay News) -- People who regularly eat legumes, brown rice, cooked green vegetables and dried fruit have a reduced risk of colon polyps, a precursor to colon cancer.

That's the finding of California researchers who analyzed data from 2,818 people who were followed for 26 years. During that time, 441 cases of rectal/colon polyps were detected among the participants.

The risk of polyps was 40 percent lower among those who ate brown rice at least once a week and 33 percent lower among those who eat legumes (a class of vegetables that includes beans, peas and lentils) at least three times a week, the Loma Linda University team found.

Eating dried fruit three times or more a week, compared to less than once a week, was associated with a 26 percent reduced risk. Eating cooked green vegetables once a day or more, vs. less than five times a week, was associated with a 24 percent reduced risk, according to the report published online in the journal Nutrition and Cancer.

"Eating these foods is likely to decrease your risk for colon polyps, which would in turn decrease your risk for colorectal cancer," study author Dr. Yessenia Tantamango, a postdoctoral research fellow, said in a university news release.

"While a majority of past research has focused on broad food groups, such as fruits and vegetables, in relation to colon cancer, our study focused on specific foods, as well as more narrowed food groups, in relation to colon polyps, a precursor to colon cancer. Our study confirms the results of past studies that have been done in different populations analyzing risks for colon cancer," Tantamango said.

"Legumes, dried fruits and brown rice all have a high content of fiber, known to dilute potential carcinogens," Tantamango noted. "Additionally, cruciferous vegetables, such as broccoli, contain detoxifying compounds, which would improve their protective function."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about colon polyps.

SOURCE: Loma Linda University, news release, Aug. 2, 2011

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Scientists ID Gene Linked to Syndrome Behind Elephant Man Disease

WEDNESDAY, July 27 (HealthDay News) -- Researchers say they've identified the gene mutation that causes the same condition that Joseph Merrick, the 19th century Englishman famously known as "The Elephant Man," was thought to have had.

Proteus syndrome causes different parts of the body to grow faster and larger than other parts. Only about 500 cases are known in the developed world.

The new findings, published in the July 27 edition of the New England Journal of Medicine, could help in the tricky diagnosis of this disorder (many of these patients are born normal), as well as eventually lead to treatments.

"This gives us a therapeutic target," said study senior author Dr. Leslie Biesecker, chief of the genetic disease research branch at the U.S. National Human Genome Research Institute (NHGRI).

For people whose lives have been affected by Proteus syndrome, there is a deeper, more personal meaning in the new research.

"Understanding what we have here is huge for families," said Kim Hoag, founder of the Proteus Syndrome Foundation, whose son, Alex, died from a pulmonary embolism, one complication of the disorder, at 9 years of age. "When you have a kid with Proteus syndrome, there's no rhyme or reason to what he has. It's so scary."

Added Tracey Whitewood-Neal, chairwoman of the Proteus Syndrome Foundation UK and the mother of Jordan, a child with Proteus syndrome who is now 16 and preparing to enter college: "For me and other families, this is so much more than a scientific breakthrough. This is personal and this is real. This is the light at the end of the tunnel and the glimmer of hope we've been waiting for all these years."

Proteus syndrome is what's known as a mosaic disorder, meaning that some cells in the body have the hallmark genetic mutation and some don't.

The mutation, which is genetic yet not inherited, occurs spontaneously some time after an embryo has already formed. This accounts for the great degree of variability in the condition, because the earlier the mutation occurs in embryonic development, the more widespread the overgrowth in tissue and bone.

According to the University of Kansas Medical Center, some of the common signs of Proteus syndrome include: partial enlargement of the hands and/or feet; overgrowth of one side of the face, body, or limbs; an enlarged head; discolored skin that can be rough; and tumors.

Although research on Proteus syndrome at NHGRI started in 1996, geneticists had to wait for the advent of next-generation gene sequencing to start testing tissue they had been banking over the years.

The researchers eventually were able to compare tissue samples from affected parts of the body in 29 Proteus syndrome patients with tissue from unaffected parts of the body.

Twenty-six of the patients had the exact same point mutation in the AKT1 gene. A point mutation is a single "misspelling" in the billions of letters that make up the human genome. The researchers hypothesized that the three patients who tested negative may have had low levels of the gene or had the gene in tissues that weren't biopsied.

The good news is that the mutation also creates an oncogene, which can drive the uncontrolled cell division normally associated with cancer. Research is already under way to find drugs to battle that mutation as it occurs in tumors.

Treatments for Proteus syndrome may be able to piggy-back on these advances.

"It may become possible to treat those with Proteus syndrome with a drug originally developed for cancer," Biesecker said at a Wednesday teleconference. "This allows us to leapfrog a number of steps. But, Proteus syndrome is not an overgrowth syndrome so we would have to adapt cancer treatments."

The research team is now working with the Royal London Hospital, where Merrick died in 1890 at the age of 27, to test his skeleton for the mutation.

"We will answer the more than century-old question of the cause of his condition," said Biesecker at the news conference. "It's not an easy study because of the way the skeleton was degraded and prepared. We hope to be able to announce an answer in the coming months."

More information

To learn more visit the Proteus Syndrome Foundation.

SOURCES: Leslie Biesecker, M.D., chief, genetic disease research branch, U.S. National Human Genome Research Institute, Bethesda, Md.; Kim Hoag, founder, Proteus Syndrome Foundation, Colorado Springs, Colo.; July 27, 2011, news conference with Biesecker and Tracey Whitewood-Neal, chairwoman, Proteus Syndrome Foundation UK; July 27, 2011, New England Journal of Medicine

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Smart Food Choices Key to a Healthy Barbeque

SATURDAY, Aug. 6 (HealthDay News) -- Choosing healthy foods to barbeque -- and even barbequing with marinades instead of high-fat sauces -- can help reduce your risk of heart disease as well as stroke, experts say.

Many common barbeque favorites, such as pork, ribs and even corn on the cob, are often slathered with rich sauces that are high in calories, fats and salt. There are, however, healthier ways to barbeque that are also delicious, according to Dr. Vivienne Halpern, a member of the Society for Vascular Surgery.

"Grilling lean meats and vegetables without heavy sauces are wonderful for the barbeque," explained Halpern in a society news release. "These can become your family's new favorites." A fresh salad and watermelon for dessert will make the meal complete, she suggested.

When firing up the grill, instead of barbequing hot dogs and hamburgers, Halpern suggested choosing lean proteins that are lower in fat, calories and cholesterol, such as chicken, fish, turkey, sirloin, turkey, buffalo or veggie burgers. Halpern also pointed out that olive oil-based marinades and lemon juice are healthier ways to add flavor to grilled meats and vegetables.

"It's true that we are what we eat," added Halpern. "Our food choices affect our caloric intake, cholesterol and sodium."

Halpern's recommendations underscore the 2010 Dietary Guidelines for Americans, created by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. The guidelines urge Americans to eat more of the following:

Fruits and vegetablesWhole grainsLow-fat milk productsLean meats, beans, eggs, nutsFishFoods low in saturated fats, trans fats, cholesterol, salt, and added sugar

Americans can also control their blood pressure and cholesterol, Halpern added, with moderate exercise (such as walking 30 minutes each day), not smoking and maintaining a healthy body weight.

More information

The U.S. National Heart, Lung and Blood Institute has more about heart and vascular diseases.

SOURCE: Society for Vascular Surgery, news release, Aug. 1, 2011

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Stomach Cancer Tumors Have Genetic Differences: Researchers

WEDNESDAY, Aug. 3 (HealthDay News) -- Stomach cancer tumors have genetic differences, which determine how they respond to treatment, researchers have found.

In identifying two distinct versions of the disease, scientists found that a certain regimen of chemotherapy is more effective on one tumor type, while another drug works best on the other. The study authors said their findings would help doctors more effectively treat gastric cancer patients.

"Our study is the first to show that a proposed molecular classification of gastric cancer can identify genomic subtypes that respond differently to therapies, which is crucial in efforts to customize treatments for patients," study senior author Dr. Patrick Tan, associate professor in the Cancer and Stem Cell Biology Program at the Duke-National University of Singapore (NUS) Graduate Medical School, said in a university news release.

A microscopic pathology test developed in the 1960s, known as the Lauren classification, is a general description (either intestinal or diffuse) of how well the tumor cells clump together. The Singapore-based team at the Duke-NUS Graduate Medical School, however, was able to distinguish gastric cancer tumors where the Lauren test could not.

"There is a general assumption in the field that intestinal and diffuse gastric cancers [as classified by Lauren] represent two very different versions of gastric cancer, and now genomic data confirms this by demonstrating that the two genomic subtypes have very different molecular patterns," said Tan.

In profiling 37 stomach cancer cell lines, the researchers found two distinct patterns. Moreover, in accurately defining these tumor subtypes, they were also able to observe differences in how well each responded to chemotherapy.

"The exact mechanistic reasons for this difference are currently unclear, and this is an area that we are actively working on," noted Tan, adding that the researchers are working to find more specific vulnerabilities to drugs.

The researchers said they plan further research in which gastric cancer tumors will be genetically profiled to determine the most effective treatment.

The study findings were published in the Aug. 1 edition of Gastroenterology.

More information

The American Cancer Society has more about stomach cancer.

SOURCE: Duke-National University of Singapore Graduate Medical School, news release, Aug. 1, 2011

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Urine Test Might Help Predict Prostate Cancer Risk

WEDNESDAY, Aug. 3 (HealthDay News) -- A new urine test might help doctors detect prostate cancer and better evaluate a patient's treatment options, researchers say.

"This is a tool that men and their physician can use to help them decide whether it's appropriate to get a biopsy now or delay that decision," said lead researcher Dr. Scott Tomlins, a pathology resident at the University of Michigan Health System.

The test looks for two genetic markers associated with prostate cancer. The first, called TMPRSS2:ERG, is caused by two genes changing places and fusing together; it is thought to cause prostate cancer. Since the gene fusion is only seen in about half of cancer patients, the test also looks for another marker, called PCA3.

"We are exploiting some new bio-markers to try to refine the PSA [prostate-specific antigen] test," Tomlins said.

The PSA test can indicate prostate cancer, but it is unreliable, often producing false positives and false negatives, Tomlins said. "You can have low PSA and have cancer, or high PSA and not have cancer," he said.

The two genetic markers may be more reliable indicators of prostate cancer, he said. One of them, TMPRSS2:ERG, is only seen in cancer, he added.

Together, they can be used "to stratify men into saying, 'You have a high chance of having cancer, and you should get a biopsy now, or if you are in a lower risk group you have a much lower risk of cancer and perhaps you could delay the biopsy,'" Tomlins said.

However, Tomlins cautioned that the test is not perfect. "It's hard to recommend that someone not get a biopsy, because there is always a chance you are going to miss a cancer that doesn't have either of these two markers," he said.

For the study, published in the Aug. 3 issue of Science Translational Medicine, Tomlins' team studied urine samples from 1,312 men who had high PSA levels and had had a prostate biopsy or surgery to remove the prostate.

The researchers specifically looked for the two markers and used them to slot the men into high-, intermediate- or low-risk groups for prostate cancer. They then compared their results with the results from biopsies, which are done with a needle in a physician's office for detection of any cancer cells.

Based on the biopsies, cancer was found in 21 percent of the men in the low-risk group, in 43 percent of the intermediate-risk group and in 69 percent of the high-risk group.

The researchers said the findings of the urine tests correlated with tumor size and the cancer's aggressiveness. In the low-risk group, only 7 percent had aggressive cancer, compared with 40 percent of the men classified as high-risk, they found.

One limitation of the study is that most patients were Caucasian, so further studies are needed to see whether the findings extend to all men, the researchers noted.

Although not yet available to the public, the test soon will be offered at the University of Michigan, Tomlins said.

The test is licensed to Gen-Probe, a San Diego maker of genetically based diagnostic tests. Mike Watt, a company spokesman, said the test is still in the early stages of development and has not been submitted to the U.S. Food and Drug Administration for approval. The company has no firm idea of the test's cost should it be approved, Watt added.

Study funding was supported in part by Gen Probe, and the University of Michigan and Brigham and Womens Hospital have obtained a patent on the detection of ETS gene fusion in prostate cancer, in which four co-authors are listed as co-inventors.

A prostate cancer expert, Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said the test is "a step forward, but we still have a ways to go."

"On average the risk is higher in people with both markers and lowest in people who have neither, but that's on average," D'Amico said.

If a patient has indications of an aggressive prostate cancer, the test can add more to that diagnosis, D'Amico said. But for men who potentially have cancer, a low-risk determination based on this test shouldn't preclude biopsy, he said.

"It adds fuel to the fire when you suspect something bad, but I don't think it takes you out of the woods when these markers are not present," D'Amico said.

More information

For more information on prostate cancer, visit the American Cancer Society.

SOURCES: Scott Tomlins, M.D., Ph.D., pathology resident, University of Michigan Health System, Ann Arbor; Anthony D'Amico, M.D., Ph.D., chief, radiation oncology, Brigham and Women's Hospital, Boston; Mike Watt, spokesman, Gen-Probe, San Diego, Calif.; Aug. 3, 2011, Science Translational Medicine

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