Jack West, MD: Top Five Lung Cancer Abstracts at ESMO 2017

Excerpt:

“The European Society for Medical Oncology (ESMO) 2017 Congress is just around the corner, and we can already say with confidence that there will be many provocative presentations, including several that are poised to change practice. At this point, we can only rely on the abstracts and press releases for several of these, but here are my early impressions on the top five presentations in lung cancer for ESMO 2017.”

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Blood Tumor Markers May Warn When Lung Cancer Patients Are Progressing on Targeted Treatments

Excerpt:

“For many years, oncologists have known that cancers can secrete complex molecules into the blood and that levels of these molecules can be easily measured. These so-called ‘tumor markers’ are traditionally associated with a single dominant cancer type, for example Prostate Specific Antigen (PSA) linked to prostate cancer, Carcinoembryonic antigen (CEA) to colorectal cancer, CA125 to ovarian cancer, CA19.9 to pancreatic cancer and CA27.29 to breast cancer. However, the real challenge has been to determine a practical use for these markers. They don’t appear to be useful as a means of screening otherwise healthy people for evidence of underlying cancers.”

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Active Surveillance Should Be Standard for Favorable-Risk Prostate Cancer

“Long-term follow-up data supports the use of active surveillance for men with favorable-risk prostate cancer, according to prospective study results.

“These men should be informed of the the low likelihood of harm from their diagnosis and encouraged to consider active surveillance over a curative approach, according to researchers.

“H. Ballentine Carter, MD, director of the division of adult urology at the Brady Urological Institute and the Bernard L. Schwartz distinguished professor of urologic oncology at Johns Hopkins Medicine, and colleagues sought to assess the long-term outcomes for men with favorable-risk prostate cancer in a prospective, active surveillance program.”


Men Who Forgo Aggressive Treatment for Prostate Cancer Don't Receive Appropriate Monitoring

“An increasing number of men diagnosed with low-risk prostate cancer are opting for active surveillance – closely monitoring their cancer – rather than aggressive treatment to avoid the debilitating potential side effects of surgery and radiation, such as erectile and urinary dysfunction.

“However, a new study by UCLA researchers has found that less than 5 percent of men who chose to forgo aggressive treatment are being monitored as closely as they should be, putting them in danger of their cancer progressing or metastasizing without their knowledge.

“The study, published today in the peer-reviewed journal Cancer, examined the records of 37,687 men diagnosed with prostate cancer from 2004 to 2007 who were followed through 2009. They found that of the 3,656 men diagnosed with prostate cancer who did not undergo aggressive treatment, only 166 men, or 4.5 percent, were being monitored appropriately, said Dr. Karim Chamie, the study’s first author and an assistant professor of urology at UCLA.”


'Watchful Waiting' Common for Prostate Cancer

“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.’ “


Study Provides Evidence for New Approaches to Prostate Cancer

“Monitoring prostate cancer (PC) by active surveillance (AS), with the expectation to initiate treatment if the cancer progresses, is a preferred initial option for men with low-risk PC and a life expectancy of at least 10 years. According to the results of a new study conducted at Brigham and Women’s Hospital (BWH), there is evidence to also support AS as an initial approach for men with favorable intermediate-risk of PC (men with no evidence of the cancer spreading beyond the prostate, a Gleason score of 3+4 or less and PSA, prostate-specific antigen, under 20). These findings are published online by JAMA Oncology.

” ‘We found that men with favorable intermediate-risk prostate cancer did not have significantly increased risks of death compared to men with low-risk prostate cancer,’ said Ann Caroline Raldow, MD, first author of the study and resident physician at BWH and the Harvard Radiation Oncology Program. ‘The clinical significance of our findings is that men with favorable intermediate-risk prostate cancer may also be able to avoid, or at least defer the side effects of, prostate cancer treatment, and enter an active surveillance program as an initial approach.’ “


With Gene Mutations, Second Breast Cancer Risk Rises over Time

“Women who are genetically susceptible to breast cancer and develop it in one breast are at higher than average risk for a tumor in the other breast, and that risk may increase as time goes on, according to a new analysis.

“Mutations in the BRCA 1 or 2 genes increase the risk for several types of cancer and account for 5 percent to 10 percent of breast cancers, according to the National Cancer Institute.

“Researchers from Spain reviewed 20 studies of the risk of cancer in the second breast of BRCA 1 and 2 carriers.

“For breast cancer patients with the BRCA 1 mutation, the risk of a cancer in the opposite breast rose from 15 percent at five years after diagnosis to 27 percent at 10 years and 33 percent at 15 years.

“For the BRCA 2 mutation, the risk increased from nine percent at five years to 19 percent at 10 years to 23 percent at 15 years.

“For women with neither mutation, the risk of cancer in the opposite breast stayed low at 3 percent and 5 percent at the five and 10 year marks, according to results in the journal The Breast. There wasn’t enough data to estimate the 15-year risk in this group, the authors write.”


Circulating Tumor Cells Provide Genomic Snapshot of Breast Cancer

“The genetic fingerprint of a metastatic cancer is constantly changing, which means that the therapy that may have stopped a patient’s cancer growth today, won’t necessarily work tomorrow. Although doctors can continue to biopsy the cancer during the course of the treatment and send samples for genomic analysis, not all patients can receive repeat biopsies. Taking biopsies from metastatic cancer patients is an invasive procedure that it is frequently impossible due to the lack of accessible lesions. Research published October 10th in the journal Breast Cancer Research suggest that tumor cells circulating in the blood of metastatic patients could give as accurate a genomic read-out as tumor biopsies.

“Counting the number of circulating (CTCs) can tell us whether a patient’s cancer is aggressive, or whether it is stable and responding to therapy,” says the article’s first author Sandra V. Fernandez, Ph.D., assistant professor of Medical Oncology at Thomas Jefferson University. “Our work suggests that these in the blood also accurately reflect the genetic status of the parent tumor or its metastases, potentially giving us a new and easy to source of genomic information to guide treatment.”


Innovative Non-Invasive 'Liquid Biopsy' Method to Capture Circulating Tumor Cells from Blood Samples for Genetic Testing

“Researchers seek partners to commercialize a clinically proven non-invasive fluorescence virus-guided capture system of human colorectal circulating tumor cells (CTCs) from blood samples for genetic testing. This non-invasive companion diagnostics is important for personalized targeted cancer therapy.”

Editor’s note: Cells sometimes break off of a tumor and enter the bloodstream of a patient; these cells are known as “circulating tumor cells” (CTCs). Researchers have developed a new blood test for CTCs that could reveal information about which treatments might work best for a patient. In particular, the test could pinpoint genetic mutations in the tumor cells that would indicate whether certain targeted therapies might work for a patient. The test is notable because it only requires a blood sample from a patient, instead of an invasive surgical biopsy to retrieve cells directly from a tumor. The researchers who developed the test are hoping to work with partners to help them commercialize the test and make it widely available to patients.