“In a head-to-head comparison of two immunotherapy drugs used to prevent relapse in certain patients with advanced melanoma, one treatment was the clear winner — and it’s not the one that most people get.
“The international study, released Sunday, involved 900 patients whose tumors were removed by surgery but who remained at high risk of recurrence of melanoma, an often aggressive form of skin cancer.”
“Prostate cancer patients and their doctors may want to think twice about the best timing for chemotherapy or radiation therapy in conjunction with a common nonsurgical treatment, based on international research findings led by UT Southwestern Medical Center investigators.
“Researchers using mouse models found that many medical androgen deprivation therapies (ADTs) – the most commonly used nonsurgical treatments for prostate cancer – may suppress patients’ adaptive immune responses, preventing immunotherapies from working if both treatments are used but not sequenced properly. ADTs are anti-hormone therapies that decrease the body’s levels of androgens, the type of hormone that is required for prostate cancer to survive and grow.
“The study findings were published this week in Science Translational Medicine.”
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“A blood test can detect changes in tumor DNA, potentially helping doctors detect melanoma relapse far earlier, according to a study in England.
“Scientists at Cancer Research UK found the blood test detects mutations in circulating tumor DNA indicating potential drug resistance or relapse, which would allow treatment to start earlier and increase the chance for a patient’s survival.
“Although the study was small, and scientists say the test’s accuracy needs to be tested in a much larger trial before it is used in clinics, any possibility of improving how cancer is tracked will improve treatment.”
“Melanoma is predicted to result in approximately 10,000 deaths in 2015. The majority of these deaths are due to advanced stage disease that has spread or metastasized to other sites. The prognosis for patients with metastatic melanoma remains poor, with 5-year survival rates of 63 percent in patients who have metastatic disease in regional lymph nodes, and only 17 percent in patients who have metastatic disease in distant sites. Moffitt Cancer Center researchers participated in an international phase 3 study that demonstrated that a drug called ipilimumab improves the relapse-free survival of advanced stage melanoma patients rendered free of disease surgically but at high risk for relapse.
“Ipilimumab is approved for the treatment of melanoma that cannot be surgically removed or that has metastasized to different sites. Ipilimumab targets a protein called cytotoxic T lymphocytic antigen-4 (CTLA-4) that is found on a type of immune cell called a T cell. CTLA-4 keeps the immune system in check to avoid autoimmune disease by downregulating T cell activity. Tumors take advantage of CTLA-4 activity to avoid immune detection. By targeting CTLA-4, ipilimumab restimulates the immune system to target tumor cells.
“Researchers wanted to determine if ipilimumab could improve the survival of advanced-stage melanoma patients if it was given after the surgical removal of both their primary melanoma tumors and their regional lymph nodes.”
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 rate of breast cancer relapse decreased by 50% from the early 1990s to 2004 and beyond for all disease subtypes, according to a comparison of matched cohorts.
“Year-by-year comparisons showed similar reductions across 9 years of follow-up. The latter-period cohort had a substantially lower relapse rate irrespective of hormone receptor status, HER2 status, or histologic subtype. The pattern of relapse, however, did not differ between the two study periods, Karen Gelmon, MD, of the British Columbia Cancer Agency in Vancouver, and colleagues reported online in the Journal of Clinical Oncology…
“The findings reported by Gelmon and colleagues came from an analysis of 7,178 patients with early breast cancer (stages I-III). The study population consisted of matched cohorts of 3,589 patients each whose cancer was diagnosed from 1986 to 1992 or from 2004 to 2008. The primary objective was to determine whether patterns of relapse differed between the two periods with respect to ER and HER2 status.
“Overall, 70.8% of patients had ER-positive/HER2-negative breast cancer, followed by 15.8% ER-negative/HER2-positive, 6.9% ER-positive/HER2-positive, 6.6% ER-negative/HER2-positive. The earlier cohort had a median follow-up of 15.5 years compared with 6.1 years for the later group. During the first 9 years of follow-up, a total of 1,704 patients had breast cancer relapse.”
“Many men with an early sign of a prostate cancer relapse can safely wait before starting hormone therapy, avoiding side effects without shortening their lives, according to the results of a study released on Wednesday.
“Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, said the study ‘certainly does not provide evidence that you have to rush in with treatment, and it does provide comfort if you choose for any reason to withhold treatment at the beginning, that you’re probably not risking much.’ “
“Researchers have made an important advance in understanding genetic changes associated with terminal prostate cancer. The research highlights why relapses could happen in some men following hormone therapy. And it could help identify those patients that will develop fatal prostate cancer much earlier for life-extending therapy.”