Phase II Study Suggests Benefit of Adding Rituximab to Chlorambucil in First-Line Treatment for Chronic Lymphocytic Leukemia

“In a UK phase II study reported in the Journal of Clinical Oncology, Hillmen et al assessed the safety and activity of adding rituximab (Rituxan) to chlorambucil (Leukeran) in first-line treatment of chronic lymphocytic leukemia (CLL). Such a regimen may be an alternative to fludarabine-based treatment or chlorambucil monotherapy in elderly patients and those with comorbidities.

“In the study, 100 patients in 12 UK centers received first-line rituximab (375 mg/m2 on day 1 of cycle 1 and 500 mg/m2 thereafter) plus chlorambucil (10 mg/m2 on days 1–7) for six 28-day cycles. Patients responding but not achieving complete response could receive an additional six cycles of chlorambucil alone.

“Patients had a median age of 70 years (range, 43–86 years) and a median of seven comorbidities, 66% were male, 56% had Binet stage C disease, 36% had IgVH mutation, and 13q deletion, 12q trisomy, 11q deletion, and 17p deletion were present in 43%, 16%, 13%, and 3%, respectively.”

Editor’s note: A new clinical trial with volunteer patients tested a treatment that combines the drug chlorambucil (Leukeran) with the drug rituximab (Rituxan). The treatment was found to be safe, and may be more effective than treatment with chlorambucil alone. This combination treatment might be a good option for people with chronic lymphocytic leukemia (CLL) who might not be able to take fludarabine-based treatment, especially elderly patients and patients with comorbidities (two or more diseases).


Deaths from Lung Cancer Are Decreasing

Deaths from lung cancer have been decreasing across the U.S., contributing to an overall trend of falling cancer death rates, according to a report coauthored by several major medical and research institutions. Covering the period from 1975 to 2010, the report finds that the decrease in lung cancer deaths has accelerated in recent years. The rate of new lung cancer cases has also fallen, though to a lesser extent. Much of this trend is likely due to the significant reduction in tobacco smoking in past decades, which is producing a delayed effect. The report also showed that the presence of additional illnesses aside from cancer, which can greatly affect outcomes in some other cancer types, has less of an effect on prognosis in lung cancer.


Cancer Screening Less Beneficial in Older Patients

Although cancer rates increase with age, screening for cancer may not be useful past a certain age. Older patients already have a shorter life expectancy and may die of other causes before the cancer becomes a problem. Indeed, the psychological burden of a cancer diagnosis and the side effects of cancer treatment may unnecessarily lower a person’s quality of life. While the U.S. Preventive Services Task Force recommends that colorectal cancer screening and mammograms for breast cancer screening be stopped after age 75 years, a recent study by the National Cancer Institute suggests that a patient’s overall health should be taken into account. An older patient with multiple chronic illnesses will have a lower life expectancy, while a healthy patient the same age may still benefit from cancer screening.


Cancer Screening Less Beneficial in Older Patients

Although cancer rates increase with age, screening for cancer may not be useful past a certain age. Older patients already have a shorter life expectancy and may die of other causes before the cancer becomes a problem. Indeed, the psychological burden of a cancer diagnosis and the side effects of cancer treatment may unnecessarily lower a person’s quality of life. While the U.S. Preventive Services Task Force recommends that colorectal cancer screening and mammograms for breast cancer screening be stopped after age 75 years, a recent study by the National Cancer Institute suggests that a patient’s overall health should be taken into account. An older patient with multiple chronic illnesses will have a lower life expectancy, while a healthy patient the same age may still benefit from cancer screening.


Cancer Screening Less Beneficial in Older Patients

Although cancer rates increase with age, screening for cancer may not be useful past a certain age. Older patients already have a shorter life expectancy and may die of other causes before the cancer becomes a problem. Indeed, the psychological burden of a cancer diagnosis and the side effects of cancer treatment may unnecessarily lower a person’s quality of life. While the U.S. Preventive Services Task Force recommends that colorectal cancer screening and mammograms for breast cancer screening be stopped after age 75 years, a recent study by the National Cancer Institute suggests that a patient’s overall health should be taken into account. An older patient with multiple chronic illnesses will have a lower life expectancy, while a healthy patient the same age may still benefit from cancer screening.


Avastin-Containing Chemotherapy May Be Safe in Lung Cancer Patients with Brain Metastases

Bevacizumab (Avastin), which is approved for treatment of a number of advanced-stage cancer types, is commonly avoided in patients with brain metastases (cancer that has spread to the brain) because of fear of brain hemorrhages (bleeding in the brain). A retrospective study of 52 patients with advanced non-small cell lung cancer (NSCLC) who had received chemotherapy containing Avastin found no cases of serious bleeding events and no significant differences in survival or treatment side effects between patients with or without brain metastases. Avastin may therefore be a safe treatment option in NSCLC with brain metastases.

Research paper: https://www.jstage.jst.go.jp/article/acrt/20/2/20_47/_pdf


Overexpression of IGF1R and EGFR Genes May Worsen Lung Cancer Prognosis

The roles of the genes IGF1R and EGFR in lung cancer were examined in patients with non-small cell lung cancer (NSCLC) who had their primary tumor surgically removed. Patients whose tumors had increased expression of both IGFR1R and EGFR were more likely to experience recurrence of the cancer after a shorter amount of time and had shorter survival times after surgery. This finding suggests that concurrent overexpression of IGF1R and EGFR is a negative prognosis factor in NSCLC and may indicate patients who are more likely to benefit from novel treatments with IGF1R inhibitors.

Research paper: http://link.springer.com/article/10.1007/s00280-012-2056-y/fulltext.html


Study Suggests Iressa Effective for Elderly Patients with EGFR-Mutant Lung Cancer

A retrospective study in Japan examined 55 patients aged 75 years or over with inoperable non-small cell lung cancer (NSCLC) who had a mutation in the EGFR gene and received gefitinib (Iressa) as first-line therapy. The treatment was generally well tolerated and patients experienced longer periods without cancer progression (median: 13.8 months) and longer overall survival (median: 29.1 months) than commonly reported for similar patients. While studies using control groups will need to confirm that Iressa is indeed more effective than standard chemotherapy or a placebo, these findings suggest that Iressa may be a preferable first-line treatment in elderly patients with advanced EGFR-mutant NSCLC.

Research paper: http://link.springer.com/article/10.1007/s12032-012-0450-2/fulltext.html


Genetic Variation in P53 May Contribute to Lung Cancer Risk

A study of individuals with and without lung cancer in North India found that those carrying a particular version (or “polymorphism”) of a gene for the protein p53 were more likely to have lung cancer, independent of their age or smoking rate. P53 belongs to a class of proteins called “tumor suppressor proteins,” and is involved in DNA repair, regulating cell growth, and inducing cell death in damaged or abnormal cells. The findings suggest that this version of the p53 gene, called Arg72Pro, may contribute to higher susceptibility for lung cancer, at least in the North Indian population.

Research paper: http://online.liebertpub.com/doi/full/10.1089/dna.2012.1792