Switch from Imatinib to Nilotinib Improved Outcomes in Chronic Phase CML

Editor’s note: This story is about the results of a clinical trial – a research study with volunteer patients. The study tested a treatment for people with chronic phase chronic myeloid leukemia (CML) who had persistent minimal residual disease after long-term treatment with the drug imatinib (Gleevec). For the study, half of the 200 participants continued taking imatinib, and half of the patients switched to the drug nilotinib. It was found that the patients who switched to nilotinib had better outcomes than those who didn’t.

“Patients with chronic phase chronic myeloid leukemia who had persistent minimal residual disease after long-term treatment with imatinib achieved deeper molecular responses and undetectable disease when they switched to treatment with nilotinib, according to study results.

“The reduced disease burden associated with the switch to nilotinib may enable patients to enroll on treatment-free remission trials, researchers wrote.

“Timothy P. Hughes, MD, FRACP, FRCPA, head of the division of hematology at South Australia Pathology and clinical professor of medicine at University of Adelaide in Australia, and colleagues evaluated data from 207 patients with CML. All patients were in complete cytogenetic response yet had detectable BCR-ABL1 after 2 or more years of treatment with imatinib (Gleevec, Novartis).”


Drugs to Avoid in Patients on Tyrosine Kinase Inhibitors

Editor’s note: More and more people with cancer are being treated with drugs known as tyrosine kinase inhibitors (TKIs). As with any other drug, oncologists who prescribe TKIs must be aware of other drugs a patient is taking to ensure there will not be a dangerous drug-drug interaction. Researchers recently published a report outlining known and potential drug-drug interactions between TKIs and other drugs. Oncologists and patients may wish to take these into account when considering cancer treatment with TKIs.

“With the rapid and widespread uptake of tyrosine kinase inhibitors (TKIs) in oncology over the past several years, serious drug–drug interactions are an “increasing risk,” according a new report.

“To guarantee the safe use of TKIs, ‘a drugs review for each patient is needed,’ write Frank G.A. Jansman, PharmD, PhD, from Deventer Hospital in the Netherlands, and colleagues in a review published in the July issue of the Lancet Oncology.

“The review provides a comprehensive overview of known and suspected interactions between TKIs and conventional prescribed drugs, over-the-counter drugs, and herbal medicines.

“All 15 TKIs approved to date by the US Food and Drug Administration or the European Medicines Agency are evaluated.

“They are axitinib (Inlyta, Pfizer), crizotinib (Xalkori, Pfizer), dasatinib (Sprycel, Bristol-Myers Squibb and Otsuka America), erlotinib (Tarceva, Osi Pharmaceuticals), gefitinib (Iressa, AstraZeneca), imatinib (Gleevec, Novartis), lapatinib (Tykerb, GlaxoSmithKline), nilotinib (Tasigna, Novartis), pazopanib (Votrient, GlaxoSmithKline), regorafenib (Stivarga, Bayer), ruxolitinib (Jakafi, Incyte), sorafenib (Nexavar, Bayer), sunitinib (Sutent, Pfizer), vandetanib (Caprelsa, AstraZeneca), and vemurafenib (Zelboraf, Roche).”


Avastin-Containing Chemotherapy May Be Safe in Lung Cancer Patients with Brain Metastases

Bevacizumab (Avastin), which is approved for treatment of a number of advanced-stage cancer types, is commonly avoided in patients with brain metastases (cancer that has spread to the brain) because of fear of brain hemorrhages (bleeding in the brain). A retrospective study of 52 patients with advanced non-small cell lung cancer (NSCLC) who had received chemotherapy containing Avastin found no cases of serious bleeding events and no significant differences in survival or treatment side effects between patients with or without brain metastases. Avastin may therefore be a safe treatment option in NSCLC with brain metastases.

Research paper: https://www.jstage.jst.go.jp/article/acrt/20/2/20_47/_pdf


Overexpression of IGF1R and EGFR Genes May Worsen Lung Cancer Prognosis

The roles of the genes IGF1R and EGFR in lung cancer were examined in patients with non-small cell lung cancer (NSCLC) who had their primary tumor surgically removed. Patients whose tumors had increased expression of both IGFR1R and EGFR were more likely to experience recurrence of the cancer after a shorter amount of time and had shorter survival times after surgery. This finding suggests that concurrent overexpression of IGF1R and EGFR is a negative prognosis factor in NSCLC and may indicate patients who are more likely to benefit from novel treatments with IGF1R inhibitors.

Research paper: http://link.springer.com/article/10.1007/s00280-012-2056-y/fulltext.html


Study Suggests Iressa Effective for Elderly Patients with EGFR-Mutant Lung Cancer

A retrospective study in Japan examined 55 patients aged 75 years or over with inoperable non-small cell lung cancer (NSCLC) who had a mutation in the EGFR gene and received gefitinib (Iressa) as first-line therapy. The treatment was generally well tolerated and patients experienced longer periods without cancer progression (median: 13.8 months) and longer overall survival (median: 29.1 months) than commonly reported for similar patients. While studies using control groups will need to confirm that Iressa is indeed more effective than standard chemotherapy or a placebo, these findings suggest that Iressa may be a preferable first-line treatment in elderly patients with advanced EGFR-mutant NSCLC.

Research paper: http://link.springer.com/article/10.1007/s12032-012-0450-2/fulltext.html


Genetic Variation in P53 May Contribute to Lung Cancer Risk

A study of individuals with and without lung cancer in North India found that those carrying a particular version (or “polymorphism”) of a gene for the protein p53 were more likely to have lung cancer, independent of their age or smoking rate. P53 belongs to a class of proteins called “tumor suppressor proteins,” and is involved in DNA repair, regulating cell growth, and inducing cell death in damaged or abnormal cells. The findings suggest that this version of the p53 gene, called Arg72Pro, may contribute to higher susceptibility for lung cancer, at least in the North Indian population.

Research paper: http://online.liebertpub.com/doi/full/10.1089/dna.2012.1792


Abraxane-Paraplatin Combination May Be Safe and Effective in Elderly Patients with Advanced Lung Cancer

A recent study examined first-line treatment with the chemotherapy agent carboplatin (Paraplatin), combined with either albumin-bound paclitaxel (Abraxane) or standard solvent-based paclitaxel (Taxol), in both elderly and younger patients with advanced non-small cell lung cancer (NSCLC). Patients treated with Abraxane/Paraplatin exhibited higher treatment response rates and fewer toxic side effects in both age groups; elderly patients (age 70+ years) experienced longer periods without cancer progression and longer overall survival with Abraxane/Paraplatin compared to Taxol/Paraplatin treatment. Abraxane plus Paraplatin may constitute a safe, effective first-line treatment for elderly patients with advanced NSCLC, a group that has been traditionally undertreated.

Research paper: http://annonc.oxfordjournals.org/content/24/2/314.long


Variations in MMP Genes Are Associated with Differences in Lung Cancer Risk

Variations in genes for a family of proteins called matrix metalloproteases (MMPs) have been suggested to play a role in lung cancer risk. A meta-analysis of several studies on MMP genes found that a particular version (or “polymorphism”) of the MMP1 gene, called MMP1-1607 1G/2G, is associated with higher susceptibility for lung cancer in Asian patients. In contrast, the MMP2-1306 C/T version of the MMP2 gene decreases lung cancer risk in Asian patients and the MMP9-1562 C/T version of the MMP9 gene decreases lung cancer risk in white patients.

Research paper: http://www.sciencedirect.com/science/article/pii/S0378111912016447


Clinical Trial of Lung Cancer Screening That Combines Imaging and Biomarker Testing Is Enrolling Participants

National Jewish Health is performing a clinical trial to examine the benefits of lung cancer screening that combines a computed tomography (CT) chest scan with a blood test. The blood test detects anticancer antibodies created by the immune system. The trial seeks to find out whether adding the blood test, called EarlyCDT-Lung, will further improve the ability of CT chest scans to prevent lung cancer deaths in high-risk populations and avoid invasive follow-up testing in the case of CT scan “false alarms.” Participants can enroll if they are between ages 50 to 75 years, have a smoking history of at least 20 pack-years (meaning 1 pack a day for 20 years, or 2 packs a day for 10 years, etc.), are current smokers or quit fewer than 10 years ago, and have no serious illness or history of cancer other than skin cancer. Call 303-398-1911 to find out more.