“More U.S. physicians are sparing their low-risk prostate cancer patients from surgery, radiation and hormone therapy in favor of monitoring their patients over time — a strategy called watchful waiting, a new study shows.
“The number of low-risk patients who didn’t undergo treatment jumped from as low as 7 percent from 1990-2009 to 40 percent from 2010-2013, the study revealed. These findings indicate that more patients are being monitored to see if their conditions get worse.
“This is ‘excellent news’ about the popularity of ‘active surveillance,’ said study author Dr. Matthew Cooperberg, the Helen Diller Family Chair in Urology at the University of California, San Francisco.
” ‘We expected to see a rise in surveillance rates, but were surprised by the steepness of the trajectory,’ he said. ‘This really does represent a paradigm change, and it’s faster than the typical pace of medical evolution.’ “
“Men with advanced prostate cancer who have the androgen receptor splice variant-7 respond to chemotherapy equally as well as those who do not have the variant, according to findings from a small clinical trial.
“Further, taxane chemotherapy may be more effective than hormone therapy for men with the androgen receptor splice variant-7 (AR-V7).
” ‘The key finding from this study is that men with detectable AR-V7 in their circulating tumor cells may respond more favorably to chemotherapy (docetaxel or cabazitaxel [Jevtana, Sanofi]) compared to novel hormonal therapies (abiraterone and enzalutamide),’ Emmanuel S. Antonarakis, MBBCh, assistant professor of oncology and assistant professor of urology at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, told HemOnc Today. ‘This finding was quite a relief because AR-V7–positive prostate cancer can be very lethal, and now we have at least one class of drugs that may work for these patients.’ ”
“Mounting evidence supports the addition of docetaxel to standard hormone and radiation treatment in men with high-risk prostate cancer. This latest comes from a federally funded phase 3 clinical trial presented here at this year’s American Society of Clinical Oncology meeting.
“The 4-year overall survival rates were higher with docetaxel than standard therapy. The add-on chemotherapy was given for 18 weeks, starting a month after radiation.
” ‘This finding could improve outcomes for thousands of men,’ lead investigator Howard Sandler, MD, from Cedars-Sinai Medical Center in Los Angeles, said in a statement issued in advance of the news conference on the study. ‘We also expect to see an even bigger survival advantage over time,’ he said.”
“A Phase III trial of Pfizer Inc’s Ibrance showed that, in combination with hormone therapy, the drug more than doubled the duration of disease control for women with the most common type of breast cancer.
“At the time of an interim analysis, patients given Ibrance and AstraZeneca Plc’s Faslodex (fulvestrant), a widely used treatment to block estrogen, lived an average of 9.2 months before their cancer worsened. This compared with 3.8 months for patients treated with Faslodex and a placebo.
“The trial, presented in Chicago at a meeting of the American Society of Clinical Oncology, enrolled 521 patients whose breast cancer was classified as estrogen-receptor positive, human epidermal growth factor receptor 2-negative. This category accounts for about 75 percent of all breast cancers.
“Ibrance, or palbociclib, was given conditional approval by the U.S. Food and Drug Administration in February for such patients, but only those who had not previously been treated for advanced breast cancer.”
“Women with luminal A subtype breast cancer – and particularly those older than 60 – may not need radiation treatment if they are already taking hormone therapy, shows clinical research led by radiation oncologists at the Princess Margaret Cancer Centre published online today in the Journal of Clinical Oncology.
“The findings potentially advance delivery of personalized cancer medicine for up to 25% of women diagnosed with breast cancer in North America every year, say co-principal investigators Dr. Fei-Fei Liu, Chief, Radiation Medicine, and Dr. Anthony Fyles, staff radiation oncologist. Dr. Liu is Chair, Department of Radiation Oncology, University of Toronto, where Dr. Fyles is also a Professor. In Ontario alone, they estimate, this could save the provincial health care system up to $3 million annually. Drs. Liu and Fyles talk about their research at https://www.youtube.com/watch?v=mrl5-1gsoSg .
“They stress, however: ‘For all other breast cancer subtypes, radiation therapy is definitely of benefit and the required treatment.’
Drs. Liu and Fyles examined tumour specimens from participants in a prior randomized clinical trial who received either tamoxifen (hormone therapy) plus whole-breast radiation therapy, or only tamoxifen.”
“Nearly 15 million people are living after a cancer diagnosis in the United States. This number represent over 4 percent of the population, an astonishing figure. And a growing one, as reported last year by the ACS and outlined by the NCI’s Office of Cancer Survivorship.
“As cancer patients survive longer they face additional health problems. Radiation to the chest, chemotherapy, antibody therapy and hormone changes can affect blood vessels and heart function in the short term and long, during treatment or years later. But millions affected – and their physicians – remain insufficiently mindful about the risk of heart disease.
“It’s the kind of problem a person who’s had cancer, or a doctor who’s prescribed generally helpful treatment, may not want to think about.
“Years ago, heart complications of cancer treatment didn’t garner so much attention says, Dr. Javid Moslehi, a cardiologist who leads a program in cardio-oncology at the Vanderbilt University School of Medicine in Nashville, TN. The emerging field involves cardiologists, oncologists, scientists and others who study the long-term effects of cancer treatment on the heart.”
“Among early-stage breast cancer patients in the U.S., black women are less likely than white women to take their prescribed hormone medications, according to a new study that partly – but not entirely – blames economic disparities between races.
“Black women are less likely to be diagnosed with breast cancer than white women, but more likely to die from it, a disparity that emerged in the 1980s and has widened ever since, the authors note in the introduction.
“When it comes to hormone prescriptions, women with fewer financial resources and higher prescription drug co-pays, which are more common for black women, are less likely to stick to the therapy, according to the new study that was led by Dr. Dawn L. Hershman of Herbert Irving Comprehensive Cancer Center at Columbia University in New York.
“For the study, Hershman’s team used an insurance claims database including more than 10,000 women over age 50 who were diagnosed with early-stage breast cancer between 2007 and 2011 and given a prescription for aromatase inhibitors or tamoxifen, both hormonal therapies.”
Androgen deprivation therapy (ADT) has long been a mainstay in the management of prostate cancer. Indeed, the vast majority of prostate cancers depend on androgens (hormones like testosterone) for their growth. Lowering testosterone levels with ADT is a reasonable approach. But it comes with two sets of problems. Continue reading…
“Some older women with breast cancer could safely avoid radiotherapy, without harming their chances of survival, a study has shown.
“Older women with early breast cancer who are given breast-conserving surgery and hormone therapy gain very modest benefit from radiotherapy, researchers say.
“The findings suggest that a carefully defined group of patients who are at low risk of recurrence could avoid the health risks and side effects associated with radiotherapy, such as fatigue and cardiac damage.
“Currently older women with early hormone-sensitive breast cancer are offered surgery to remove their tumour, followed by hormone treatment and radiotherapy. Few trials have assessed the benefits of radiotherapy in older women treated by breast-conserving surgery.”