“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.”
“Adding radiation treatment to hormone therapy saves more lives among older men with locally advanced prostate therapy than hormone therapy alone, according to a new study in the Journal of Clinical Oncology this week from Penn Medicine researchers.
“The researchers found that hormone therapy plus radiation reduced cancer deaths by nearly 50 percent in men aged 76 to 85 compared to men who only received hormone therapy. Past studies have shown that 40 percent of men with aggressive prostate cancers are treated with hormone therapy alone, exposing a large gap in curative cancer care among baby boomers aging into their 70s.
” ‘Failure to use effective treatments for older patients with cancer is a health care quality concern in the United States. Radiation plus hormone therapy is such a treatment for men with aggressive prostate cancers,’ said lead author Justin E. Bekelman, MD, an assistant professor of Radiation Oncology, Medical Ethics and Health Policy at Penn’s Perelman School of Medicine and Abramson Cancer Center. ‘Patients and their physicians should carefully discuss curative treatment options for prostate cancer and reduce the use of hormone therapy alone.’ “
The gist: A new vaccine treatment called Prostvac might help treat advanced prostate cancer patients whose tumors are resistant to hormone therapy and who have had either surgery or radiation. Prostvac boosts a patient’s own immune system to fight cancer. A small clinical trial showed that Prostvac is safe and can be given to patients earlier. More research is needed to see just how well the vaccine works.
“Aiming to increase treatment options for prostate cancer patients who have an early relapse, investigators from a multi-institutional cooperative group — including Rutgers Cancer Institute of New Jersey — have demonstrated that a vaccine therapy that stimulates the body’s own immune defenses can be given safely and earlier in the course of prostate cancer progression.
“As part of a Phase II clinical trial, adult patients with advanced prostate cancer (as evidenced by two rising prostate-specific antigen or PSA values and no visible metastasis) whose cancer is resistant to hormone therapy and had either surgery or radiation were recruited from member institutions in the ECOG-ACRIN Cancer Research Group. In their work, published in the current online edition of European Urology, ECOG-ACRIN investigators examined two different experimental treatment options.
“In step one, patients were treated with PROSTVAC-V/TRICOM and PROSTVAC-F/TRICOM. PROSTVAC-V is derived from a vaccinia virus that was used for many years to vaccinate against smallpox. This virus is modified to produce a PSA protein that helps focus the body’s immune response to the PSA in the prostate tumor. In addition, it is modified to produce three other proteins that help increase an immune cell’s ability to destroy its target (TRICOM). PROSTVAC-F is made from the fowlpox virus, which is found in birds and not known to cause any human disease. It contains the same genetic material as PROSTAC-V, but is given multiple times to further boost the body’s immune system.”
The gist: A clinical trial compared postmenopausal breast cancer patients who took tamoxifen after surgery with patients who took tamoxifen plus the drug anastrozole. They researchers found that, after three years, more women with lobular breast cancer who took anastrozole were alive than those who took only tamoxifen. These results suggest that anastrozole may benefit postmenopausal women with lobular breast cancer.
“The survival benefit postmenopausal patients with breast cancer derive from anastrozole vs. tamoxifen varies considerably by histology, according to an analysis of phase 3 study results presented at the San Antonio Breast Cancer Symposium.
“Researchers suggested the finding may help refine adjuvant endocrine treatment decisions.
“Several prior studies showed aromatase inhibitors improved outcomes among postmenopausal patients with breast cancer compared with tamoxifen monotherapy. A meta-analysis by Forbes and colleagues, which included data on 11,798 patients included in randomized trials that compared 5 years of tamoxifen vs. a sequence of tamoxifen followed by aromatase inhibitors, showed patients assigned aromatase inhibitors demonstrated a significant reduction in recurrence (RR=0.84; 95% CI, 0.73-0.97). Researchers also observed significantly fewer deaths in the aromatase inhibitor group (RR=0.84; 0.73-0.97)…
“ ‘In summary, among all patients with lobular cancer, anastrozole was associated with a significant reduction in OS events compared to tamoxifen,’ Knauer said. ‘However, anastrozole efficacy was strongly depending on histology and intrinsic subtype of breast cancer.’ ”
Note: This article describes research that was done in a laboratory setting, and not in people. However, the drug combination (ganetespib plus hormone therapy) is being tested in patients in clinical trials.
“US researchers have found that combining conventional hormone therapy with an experimental cancer drug helped overcome drug resistance in breast cancer cells in the lab.
“The research focused on a molecular ‘Sherpa’ that helps cells adapt to stressful environments, known as heat-shock protein 90 (HSP90)…
“Trials of ganetespib in combination with hormone therapy are now underway in the US, and the researchers are hoping to see results within the next few years.”
“Many men on hormone therapy for prostate cancer aren’t getting bone-strengthening drugs they may need, new Canadian research contends.
“Hormone therapy, which suppresses male hormones called androgens, helps stop cancer cells from growing. But one consequence of the treatment is weakening of the bones, which can lead to fractures. To reduce this risk, men can be given oral bisphosphonates, such as Fosamax, or an intravenous treatment once a month or once a year with similar drugs, such as Reclast.
” ‘There seems to be a clear mismatch between Canadian guidelines regarding bisphosphonate usage in men undergoing hormone therapy for prostate cancer and actual clinical practice,’ said lead researcher Dr. Shabbir Alibhai, a senior scientist at the University Health Network in Toronto.
“While the low rates of bisphosphonate prescriptions may be appropriate for patients who are at low risk for fracture, most men with osteoporosis or other bone conditions should be taking a bisphosphonate, he said.”
The gist: A drug called galeterone might help lower PSA levels in certain men with castration-resistant prostate cancer (CRPC). A clinical trial recently tested the treatment in volunteer patients.
“Results from a trial of the anti-cancer drug galeterone show that it is successful in lowering prostate-specific antigen (PSA) levels in men with a form of prostate cancer that is resistant to treatment with hormone therapy (castration-resistant prostate cancer or CRPC).
“Associate professor Mary-Ellen Taplin, of the Dana-Farber Cancer Institute, Boston, USA, will tell the 26th EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics in Barcelona, Spain, today (Wednesday) that galeterone was well tolerated by patients in the ARMOR2 trial, and also lowered PSA levels in a subset of men with CRPC that was resistant to other drugs that target the cancer, such as enzalutamide and abiraterone.
” ‘Recent data have shown that a variant of the androgen receptor called AR-V7, found in tumour cells circulating in the blood of patients with metastatic CRPC, predicted resistance to treatment with enzalutamide and abiraterone,’ she will say. ‘Indeed, we believe AR-V7 and other, related variants are a mechanism of resistance in this disease and patients who have them may have a poorer prognosis.’ ”