Androgen Suppression Plus RT Improves DFS in Prostate Ca

“Adding 6 months of androgen suppression (AS) to radiation therapy improved biochemical disease-free survival in high-risk localized prostate cancer patients – even at radiation doses of 78 Gy – and it did so with acceptable adverse effects, according to a randomized European Organisation for Research and Treatment of Cancer trial reported in the Journal of Clinical Oncology.

“At 7.2 years’ median follow-up, the study found that combination therapy led to a 5-year biochemical disease-free survival of 82.6% (95% CI 78.4-86.1) versus 69.8% for radiation alone (95% CI 64.9-74.2) – translating to a hazard ratio of 0.52 (95% CI 0.41-0.66, P=0.001, 319 events). Adjuvant AS also improved clinical progression-free survival, for an HR of 0.63 (95% CI 0.48-0.84, P=0.001, 205 events).

“No statistically significant interaction between treatment effect and radiation dose emerged: heterogeneity P=0.79 and P=0.66, for biochemical disease-free survival and progression-free survival, respectively, according to Michel Bolla, MD, of Grenoble University Hospital in France, and colleagues.”


Neratinib Improves DFS in HER2-Positive Breast Cancer

“Treatment with the tyrosine kinase inhibitor neratinib demonstrated a 2-year disease-free survival (DFS) rate of 93.9% in patients with early-stage HER2-positive breast cancer, representing a 33% improvement compared with placebo, according to findings from the phase III ExteNET study published in The Lancet Oncology.

“In the phase III study, which was also presented at the 2015 ASCO Annual Meeting, the 2-year DFS rate with placebo was 91.6% (HR, 0.67; 95% CI, 0.50-0.91; P = .009). In patients with both HER2- and HR-positive disease, the 2-year DFS rate was 95.4% with neratinib and 91.2% with placebo, representing a 49% benefit (HR, 0.51; P = .001).”


Denosumab Benefits Postmenopausal Breast Cancer Patients

“The addition of the bone-targeting drug denosumab to adjuvant hormonal therapy in postmenopausal breast cancer patients improves disease-free survival (DFS), reducing the risk of disease recurrence by 18% compared with placebo, according to the results of the Austrian Breast and Colorectal Cancer Study Group (ABCSG)-18 trial.

“The results (abstract S2-02) were presented at the 2015 San Antonio Breast Cancer Symposium (SABCS), held December 8–12 in San Antonio, Texas.

“ ‘This is a very safe treatment and my clinical conclusion is that denosumab reduces the risk of disease recurrence or death, and this benefit is similar to what bisphosphonates can do and comes in addition to highly significantly reducing clinical fractures,’ said study author and presenter Michael Gnant, MD, professor of surgery at the Medical University of Vienna in Austria, during a press conference. ‘I believe that we should offer this treatment to postmenopausal breast cancer patients on adjuvant aromatase inhibitors.’ “


Early Initiation of Chemotherapy May Prolong DFS for Early Breast Cancer

“Shorter time to initiation of adjuvant chemotherapy may reduce relapse and improve outcomes in patients with rapidly proliferating early breast cancer, according results of a phase 3 study.

“Earlier chemotherapy may improve OS and DFS in patients with certain subtypes of breast cancer that are rapidly proliferating and aggressive, such as triple-negative or HER-2–positive disease.

“Alberto Farolfi, a medical oncologist in training at the Scientific Institute of Romagna for the Study and Treatment of Cancer in Meldola, Italy, and colleagues sought to examine the influence of time to chemotherapy on the outcome of these patients and to set a threshold value for time to chemotherapy to better define the clinical outcome.”


Lung Cancer Patients With Minimally Invasive Adenocarcinoma Have Comparable 97.7 Percent 5-Year Survival Rate as Patients With Adenocarcinoma In-Situ

The gist: New research shows that knowing whether a patient has one of two different subtypes of lung cancer—adenocarcinoma in-situ (AIS) or minimally invasive adenocarcinoma (MIA)—may not actually be helpful. Both AIS and MIA are subtypes of a type of lung cancer called bronchioloalveolar carcinoma. They both affect the cells lining the small air sacs of the lungs. The difference is that MIA tumors grow past the lining. The new research found that people with AIS have similar survival rates as people with MIA.

“Lung cancer patients with minimally invasive adenocarcinoma (MIA) have similar, positive five-year disease-free survival (DFS) and overall survival (OS) rates as patients with adenocarcinoma in-situ (AIS), according to research presented today at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology. The Symposium is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC) and The University of Chicago Medicine.

“Lung adenocarcinoma accounts for 60 percent of all non-small cell lung cancers and is the most common form of lung cancer in both smokers and non-smokers and patients younger than 45 years old. Bronchioloalveolar carcinoma is a type of adenocarcinoma that affects the cells lining the alveoli (small air sacs) of the lungs. Invasion occurs when the tumor extends beyond the alveolar lining and evokes a fibroblastic stromal response. These types of tumors, if ≤3 cm in size, are reclassified as AIS (no tumor invasion) or MIA (≤0.5 cm of tumor invasion), according to the 2011 IASLC/American Thoracic Society /European Respiratory Society (IASLC/ATS/ERS) International Multidisciplinary Classification of Lung Adenocarcinoma. This study examines the difference in DFS and OS rates for patients with diseases classified as AIS and MIA and determines if it is beneficial to categorize tumors according to additional sub-types…

” ‘Some researchers have advocated that AIS and MIA should have separate categorization,’ said lead author Madhusmita Behera, PhD, associate director of research in the Department of Hematology and Medical Oncology at Winship Cancer Institute of Emory University in Atlanta. ‘Our analysis demonstrates that these carcinomas, especially when the tumor is 3 centimeters or less in size, are associated with excellent survival outcomes; therefore, tumor sub-classification into AIS and MIA may not provide additional prognostic information.’ “


No Disease-Free Survival Benefit of Adjuvant Zoledronic Acid in High-Risk Patients With Early Breast Cancer

The gist: Some people with breast cancer are treated with adjuvant therapy after surgery to keep their cancer from returning. A recent study with volunteer patients tested the effectiveness of adjuvant therapy with zoledronic acid. It was found that the treatment did not, in fact, increase the amount of time that high-risk, early-stage breast cancer patients lived without their cancer returning. However, it did reduce the risk of bone metastases.

“In the open-label phase III AZURE trial reported in The Lancet Oncology, Coleman et al found that adjuvant zoledronic acid treatment in patients with high-risk early-stage breast cancer provided no overall disease-free survival benefit. A reduction in bone metastases was observed, and women who were > 5 years postmenopause appeared to derive a disease-free survival benefit…

“In the trial, 3,360 women with stage II or III breast cancer from 174 centers in seven countries were randomly assigned between September 2003 and February 2006 to receive standard systemic adjuvant therapy with or without intravenous zoledronic acid. Zoledronic acid was given at 4 mg every 3 to 4 weeks for six doses, every 3 months for eight doses, and every 6 months for five doses, for a total of 5 years of treatment. The primary endpoint was disease-free survival in the intent-to-treat population…

“Median follow-up was 84 months. Compared with the control group, the zoledronic acid group had similar disease-free survival (adjusted hazard ratio [HR] = 0.94, P =  .30), invasive disease-free survival (HR = 0.93, P = .22), overall survival (HR = 0.93, P =  .37), and risk of distant recurrence (HR = 0.93, P = .29). Patients in the zoledronic acid group had reduced risk of bone metastases as a first event (HR = 0.78, P = .020) and at any time during follow-up (HR = .81, P = .022).”


Prophylactic Cranial Irradiation Increased DFS in Patients with Stage III NSCLC

Editor’s note: People who are at risk of having their cancer spread (metastasize) to the brain can receive “prophylactic cranial irradiation” to help prevent it. In this procedure, the head is treated with radiation to kill any cancer cells that may have already spread there but are not yet detectable. A recent study investigated the benefits of prophylactic cranial irradiation for people with fully resected (surgically removed), stage IIIA N2 non-small cell lung cancer (NSCLC). The study involved volunteer patients at high risk of brain metastases whose lung tumors had been surgically removed and who had received post-surgery chemotherapy to keep the cancer from returning. Some of the patients were given prophylactic cranial irradiation, and some were not. The researchers found that patients who received prophylactic cranial irradiation had a decreased risk of brain metastases and also had a longer period of survival without return of their cancer.

Excerpt:

“Prophylactic cranial irradiation prolonged disease-free survival and decreased the incidence for brain metastases in patients with fully-resected stage IIIA N2 non–small cell lung cancer at high-risk for cerebral metastases after completing adjuvant chemotherapy, according to results presented at the ASCO Annual Meeting.

“Si-Yu Wang, MD, of the department of thoracic surgery at the Sun Yat-sen University Cancer Center in China and colleagues assessed whether prophylactic cranial irradiation improves survival in this population of patients.

“Between 2005 and 2009, researchers randomly assigned 156 patients to 30 Gy prophylactic cranial irradiation in 10 fractions (n=81) or observation (n=75). DFS served as the primary outcome measure; secondary outcome measures included the incidence for brain metastases, OS and adverse events. The study was halted early due to slow accrual.

“Patients treated with prophylactic cranial irradiation experienced a decreased risk for brain metastases (5-year brain relapse rate, 13.6% vs. 41.3%; OR=0.223; 95% CI, 0.102-0.489).

“DFS was significantly higher in patients assigned prophylactic cranial irradiation (28.5 months) compared with controls (21.2 months; HR=0.67; 95% CI, 0.46-0.98). Three-year DFS was 42% and 5-year DFS was 26.1% in the prophylactic cranial irradiation group vs. 29.8% at 3 years and 18.5% at 5 years for controls.”