More Patients with Early-Stage Breast Cancer May Be Able to Avoid Chemotherapy in the Future


“Women with early-stage breast cancer who had an intermediate risk recurrence score (RS) from a 21-gene expression assay had similar outcomes, regardless of whether they received chemotherapy, a new study from The University of Texas MD Anderson Cancer finds.

“The encouraging research, published in the journal CANCER, still needs to be validated in an ongoing international trial. If verified, women with intermediate scores may one day be able to avoid chemotherapy as standard of care.”

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Analysis of Metastatic Prostate Cancers Suggests Treatment Options


“Cancer researchers have applied a comprehensive set of analytical tools to lethal cases of metastatic prostate cancer, yielding a detailed map of the complex networks of interactions among genes and proteins that enable prostate cancer cells to proliferate and evade treatment. The team also developed a computational approach for analyzing patient-specific data to help doctors choose the most effective drugs for individual patients.

“The study, published August 4 in Cell, was a collaborative effort involving research teams at UC Santa Cruz and UCLA. They began with clinical tissue samples obtained at autopsy from patients with lethal metastatic prostate cancer, then performed a range of sophisticated analyses to characterize the cancer cells from each patient in unprecedented detail. A novel computational analysis of the resulting datasets produced personalized diagrams of signaling pathways in the cancer cells of each patient, the details of which suggest potential targets for therapy.”

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Team Links Gene Expression, Immune System with Cancer Survival Rates

“Physicians have long sought a way to accurately predict cancer patients’ survival outcomes by looking at biological details of the specific cancers they have. But despite concerted efforts, no such clinical crystal ball exists for the majority of cancers.

“Now, researchers at the Stanford University School of Medicine have compiled a database that integrates gene expression patterns of 39 types of cancer from nearly 18,000 patients with data about how long those patients lived.

“Combining the data from so many people and cancers allowed the researchers to overcome reproducibility issues inherent in smaller studies. As a result, the researchers were able to clearly see broad patterns that correlate with poor or good survival outcomes. This information could help them pinpoint potential therapeutic targets.

“ ‘We were able to identify key pathways that can dramatically stratify survival across diverse cancer types,’ said Ash Alizadeh, MD, PhD, an assistant professor of medicine and a member of the Stanford Cancer Institute. ‘The patterns were very striking, especially because few such examples are currently available for the use of genes or immune cells for cancer prognosis.’ ”

One in Five Women with Breast Cancer Don't Know About Test Results That Might Help Them Avoid Chemo

“Although 90 percent of women with early-stage breast cancer said they were aware they took a genomic test that identified their level of risk for a recurrence of the disease, one in five didn’t know the results of that analysis, according to a new fact sheet by the UCLA Center for Health Policy Research.

“The test, called gene expression profiling, or GEP, is used by physicians to help guide treatment decisions and can potentially help people avoid unnecessary chemotherapy. One of a number of emerging ‘precision medicine’ genomic technologies, the GEP estimates the activity of specific genes in breast cancer cells, which can help predict whether there is a greater chance for breast cancer to return. Those with a high risk for cancer growth benefit by having chemotherapy as part of their treatment, the authors write, but chemo has no added value for those with a low risk.”

Benefits of Gene Expression Test for Localized Prostate Cancer

The gist: New research shows that doctors are willing to base their treatment recommendations on tests that measure gene expression in localized prostate cancer tumors. When a gene is expressed, that means its product, such as a protein, is made. In a cell, not all genes are expressed all the time; they can be switched on and off. Previous research has shown that the pattern of gene expression in a tumor is linked with how aggressive the tumor is. This means that gene expression testing could help predict whether a patient should be heavily treated or whether active surveillance (monitoring without immediate treatment) is a better option. The new research focused on a gene expression analysis approach called cell cycle progression (CCP) testing. The researchers found that doctors were open to using the CCP test to influence their treatment recommendations.

“Biopsy-based cell cycle progression (CCP) gene expression testing can aid in the stratification of patients with localized prostate cancer based on disease aggressiveness. This enhanced stratification method could lead to improved patient outcomes and lower costs by guiding treatment selection, specifically the utilization of active surveillance.

“E. David Crawford, MD, presented an evaluation of the economic impact of the CCP assay in localized prostate cancer in a poster session at the 15th Annual Meeting of the Society of Urologic Oncology (SUO).1 This study suggested that CCP testing could reduce costs by $2,850 per patient over 10 years. Given current health plan sizes, this could translate to over $16 million in savings.

“To gain further insight into the intricacies of these findings, OncLive interviewed Crawford, of the University of Colorado at Denver, on the main takeaway points from the study, which specifically looked at the Prolaris CCP assay.”

Soy Intake May Adversely Affect Gene Expression in Early Breast Cancer

The gist: Researchers performed a clinical trial—a research study with volunteer patients—to test the effects of soy supplements on women with early-stage breast cancer. Their findings raise concerns that, for some women, soy could affect gene expression that could potentially contribute to cancer growth.

“In a randomized study reported in the Journal of the National Cancer Institute, Shike et al found that soy supplementation resulting in high genistein levels was associated with overexpression of the tumorigenic growth factor receptor FGFR2 and genes that drive cell cycle and proliferation pathways…

“In the study, 140 women with early-stage breast cancer were randomly assigned to receive soy protein supplementation (25.8 g soy protein powder twice a day, n = 70) or placebo (25.8 g milk protein twice a day, n = 70) for 7 to 30 days from diagnosis until surgery. Adherence was determined by the plasma isoflavones genistein and daidzein, the major phytoestrogens of soy. Gene expression changes were evaluated by NanoString in pre- and post-treatment tumor samples. Genome-wide expression analysis was performed on post-treatment samples, and proliferation (Ki67) and apoptosis (Cas3) were measured by immunohistochemistry…

“The investigators concluded: ‘Gene expression associated with soy intake and high plasma genistein defines a signature characterized by overexpression of FGFR2 and genes that drive cell cycle and proliferation pathways. These findings raise the concerns that in a subset of women soy could adversely affect gene expression in breast cancer.’ ”

Soy Supplementation Adversely Effects Expression of Breast Cancer-Related Genes

“Soy supplementation alters expression of genes associated with breast cancer, raising concerns that soy could have adverse effects in breast cancer, according to a new study published September 4 in the JNCI: Journal of the National Cancer Institute.

“The impact of soy consumption on breast cancer prevention and treatment is not clear although many women believe soy supplementation is beneficial based primarily on results from epidemiological studies. Moshe Shike, M.D., from the Department of Medicine at Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College in New York, NY, and colleagues conducted a randomized placebo-controlled study of the effects of soy supplementation on gene expression and markers of breast cancer risk among women diagnosed with invasive breast cancer. The study, run between 2003 and 2007 at Memorial Sloan-Kettering, enrolled a total of 140 patients who were randomized to either soy supplementation (soy protein) or placebo (milk protein), which lasted from the initial surgical consultation to the day before surgery (range=7-30 days). Tumor tissues from the diagnostic biopsy (pre-treatment) and at the time of resection (post-treatment) were then analyzed. They observed changes in several genes that promote cell cycle progression and cell proliferation among women in the soy group.

“The authors conclude, ‘These data raise concern that soy may exert a stimulating effect on breast cancer in a subset of women.’ ”

Melanoma of the Eye: Better Diagnostics and Future Treatments

Laitr Keiows / Wikimedia Commons Laitr Keiows / Wikimedia Commons

Ocular melanomas, or melanomas found in the eye, are fairly infrequent, but they are the most common type of eye tumor. In the U.S., there are about 2,000 cases diagnosed each year. They occur within one of the three parts of the eye: the iris, the choroid, or the ciliary body. Collectively, these are known as the ‘uvea,’ hence an alternative name for this cancer: uveal melanoma. Continue reading…

Study Shows Castle Biosciences’ Gene Expression Profile Test Successfully Identified High Risk Disease in a Cohort of 217 Melanoma Patients Who Underwent Sentinel Lymph Node Biopsy

“Castle Biosciences Inc. today announced results of a 217-patient study demonstrating that its gene expression profile (GEP) test, DecisionDx-Melanoma, identified primary cutaneous (skin) melanoma tumors that were sentinel lymph node biopsy negative but were at high risk of metastasis. The GEP test also identified tumors that were unlikely to become metastatic, independent of nodal status. The data are being reviewed today at the 50th Annual Meeting of the American Society of Clinical Oncology (ASCO) in the Melanoma/Skin Cancers Poster Highlights Session by David H. Lawson, M.D., Professor of Hematology and Medical Oncology, Winship Cancer Institute, Emory University.”

Editor’s note: More and more, doctors are using molecular testing methods to make diagnoses and guide treatment decisions. Now, molecular testing may be able to help determine whether a melanoma tumor is likely to metastasize (spread to other parts of the body). A procedure called sentinel lymph node biopsy is commonly used to measure the severity of a melanoma diagnosis; a “negative” sentinel node biopsy indicates low risk of metastasis. But some patients with negative sentinel node biopsies still go on to experience metastasis. A new molecular test called DecisionDx-Melanoma can identify cutaneous melanoma tumors that are at risk of metastasizing, regardless of sentinel node biopsy results. The test analyzes the activity of 31 genes in a tumor to determine risk of metastasis.