Targeted Axillary Dissection of Lymph Nodes after Chemotherapy Improves Staging Accuracy of Node-Positive Breast Cancer

“A new procedure developed by surgeons at The University of Texas MD Anderson Cancer Center improves the accuracy of axillary staging and pathologic evaluation in clinically node-positive breast cancer, and reduces the need for a more invasive procedure with debilitating complications.

“The research, published in the Journal of Clinical Oncology, has changed treatment guidelines at the institution for a select group of breast cancer patients with lymph node metastasis, who will now receive Targeted Axillary Dissection (TAD).

“The TAD procedure involves removing sentinel lymph nodes, as well as additional cancerous lymph nodes found during diagnosis. At the time of diagnosis, those select nodes are clipped for identification during later surgery.”

Case for Testing Cancer in Blood Builds, One Study at a Time

“Two new studies published on Wednesday of patients with breast and prostate cancers add to growing evidence that detecting bits of cancer DNA circulating in the blood can guide patient treatment.

“Enthusiasm is building for ‘liquid biopsies,’ which offer a non-invasive alternative to standard tissue biopsies and are expected to be a multibillion-dollar market.

“But a key question remains: Do they really work?

“The stakes are high. At least 38 companies are working on liquid biopsies for cancer, according to analysts at investment bank PiperJaffray, who think the U.S. market alone could eventually reach $29 billion a year.”

Stereotactic Ablative Radiotherapy Achieves Better Overall Survival than Surgery for Early Lung Cancer

“Patients with operable stage I non-small cell lung cancer (NSCLC) could achieve better overall survival rates if treated with Stereotactic Ablative Radiotherapy (SABR) rather than the current standard of care — invasive surgery — according to research from a phase III randomized international study from The University of Texas MD Anderson Cancer Center.

“The findings, published today in The Lancet Oncology, are from the first randomized clinical trials comparing SABR and surgery.

” ‘For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,’ said the first author and principal investigator Joe Y. Chang, M.D., Ph.D., professor, Radiation Oncology. ‘Stereotactic radiation treatment is a relatively new approach for operable early stage lung cancer, while surgery has been the standard for a century. This study can give physicians confidence to consider a non-invasive option.’ “

Ultrasound May Lead to Less Invasive Surgery in Lymph Node-Positive Breast Cancer

“Women with lymph node-positive breast cancer who demonstrate complete nodal response by axillary ultrasound after neoadjuvant chemotherapy may be able to avoid axillary dissection, according to study results.

“ ‘Our goal here is really to try to get away from, “Every patient with breast cancer needs these drugs and this amount of chemotherapy and surgery,” and instead to personalize surgical treatment based on how the patient responds to chemotherapy,’ Judy Boughey, MD, chair of the division of surgery research at Mayo Clinic in Rochester, Minnesota, said in a press release.

“The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial included 687 patients with T0-4, N1-2, M0 primary invasive breast cancer. All patients completed neoadjuvant chemotherapy, underwent sentinel lymph node surgery and axillary dissection, and had axillary ultrasound images available for review.

“Previously published results indicated a 12.6% false-negative rate for sentinel lymph node surgery after neoadjuvant chemotherapy for patients who presented with node-positive disease and had two or more sentinel lymph nodes identified and removed. This false-negative rate exceeded the predetermined acceptable rate of 10%. The result suggested patient selection or technique must be improved prior to widespread adoption of sentinel lymph node surgery in this setting, according to study background…

“ ‘That’s one of the really nice things about giving chemotherapy up front,’ Boughey said. ‘It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy.’ “

FDA Approves DNA Screening Test for Colorectal Cancer

“Yesterday, the US Food and Drug Administration (FDA) approved the first DNA-based stool sample screening test for colorectal cancer. The new test, called the Cologuard test, was developed by Exact Sciences.

“The trial that led to the approval, which compared Cologuard to the fecal immunochemical test (FIT), included 10,023 participants. FIT is a commonly used screening test that detects blood in the stool and is also non-invasive.

“ ‘This approval offers patients and physicians another option to screen for colorectal cancer,’ said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Health at the FDA’s Center for Devices and Radiological Health, in a press release. ‘Fecal blood testing is a well-established screening tool and the clinical data showed that the test detected more cancers than a commonly used fecal occult test.’

“In clinical testing Cologuard detected 92% of colorectal cancers and 42% of advanced adenomas. FIT detected 74% of cancers and 24% of advanced adenomas. The Cologuard test detects particular DNA mutations in stool samples that can be an early sign of cancer, and people who test positive for these are recommended for colonoscopies.”

New Prostate Cancer Blood Test Now Available in the U.S.

“Beckman Coulter Diagnostics, a global leader in prostate cancer diagnostics, announces national availability of the Prostate Health Index (phi), a simple, non‐invasive blood test that is three times more specific in detecting prostate cancer than PSA (prostate‐specific antigen). The new test’s accuracy decreases the need for many men who test positive for elevated PSA levels to undergo a biopsy in order to achieve a reliable diagnosis.

“The most widely used screening test for prostate cancer is currently the PSA test, which measures the blood’s level of PSA — a protein that is naturally produced by the prostate gland and is typically increased when cancer is present. However, it is widely recognized that PSA results can often indicate the possibility of prostate cancer when none is present.

” ‘The PSA test is based on the fact that men with higher levels of the PSA protein are more likely to have prostate cancer,’ said William Catalona, MD, principal investigator on the Prostate Health Index clinical study and urologist at Northwestern Medicine and director of the Clinical Prostate Cancer Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, where they began using the phi test on patients in February. Dr. Catalona, who was the first physician in the U.S. to run the phi test, added, ‘However, the problem is that higher levels of PSA can also be caused by a benign enlargement or inflammation of the prostate, leading to many false‐positives for cancer and ultimately unnecessarily invasive biopsies and an increased potential for patient harm.’ “

Combined eNose and Sputum Hypermethylation Tests May Help Detect Lung Cancer

“A combination of two non-invasive tests can detect a wide range of lung cancers, a new study suggests.

“Used together, a test for hypermethylation of the RASSF1A biomarker in sputum and an exhaled breath analysis done using the eNose device are complementary for lung cancer diagnosis, showing 100% sensitivity in symptomatic patients, the authors report online June 10 in Journal of Clinical Pathology.

” ‘This is one of the first studies to show that simple non-invasive tests in combination can detect lung cancer with 100% sensitivity, meaning that no lung cancers in this study have been missed,’ wrote Dr. Johann C. Brandes of Winship Cancer Institute of Emory University in Atlanta, Georgia, in an email to Reuters Health.”

” ‘While the combined tests still falsely identify a significant proportion of patients as having lung cancer although they do not have it, this rate may be lower than with chest computed tomography (CT), which is currently the gold standard for lung cancer screening,’ he wrote.

“Although the new finding “exceeds expectations,” it will have to be validated in a larger group of patients, added Dr. Brandes, who was not involved in the study.”

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.

General Oncology – Six-Gene Signature Predicts Survival After Targeted Therapy for NSCLC

“The presence of a six-gene profile in the microRNA of patients with advanced non-squamous non-small-cell lung cancer (NSCLC) predicts reduced survival likelihood after first-line treatment with targeted therapy followed by chemotherapy for disease progression, indicate research results.

“While the findings ‘should be further validated’, the researchers believe their analysis ‘supports the hypothesis that circulating [microRNA’s] may further be developed as predictive markers for EGFR-targeted treatment’ in an NSCLC population whose response to epidermal growth-factor receptor (EGFR) tyrosine kinase inhibitors is unknown.”

Editor’s note: This story describes a new, blood test-based method by which oncologists may be able to predict the effects of targeted therapy treatment on the survival of patients with non-squamous non-small cell lung cancer (NSCLC). Specifically, it may be able to predict the effects of first-line treatment with drugs known as EGFR inhibitors, which are prescribed to people whose tumors have mutations in the EGFR gene, as detected by molecular testing. In a study with volunteer patients, scientists took blood samples just before and just after the patients began taking the drugs bevacizumab or erlotinib. The scientists identified six different kinds of a molecule called microRNA that, if present, were associated with a lower chance of survival (29 months versus more than 45 months). More testing will be needed to determine if this six-gene signature can be used widely; it would be a non-invasive alternative to making predictions and monitoring treatment effectiveness using repeat tumor biopsies.