Category: 10 (October 2020)

NICE: Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer

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NICE | October 2020 | Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer

Evidence-based recommendations on osimertinib (Tagrisso) for treating epidermal growth factor receptor (EGFR) T790M mutation-positive locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults.

Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer

Further information from NICE

NIHR: Breast cancer surgery is safer for older women than has been assumed

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NIHR | October 2020 |Breast cancer surgery is safer for older women than has been assumed

Between 2013-2018 over 3000 women aged 70 or over with operable breast cancer were recruited to a NIHR- funded cohort study. The majority (83.4 %) of the women underwent surgery; with researchers tracking their progress for two years. One of the study’s key findings is that no deaths were attributable to surgery for breast cancer. According to the authors of the study, this suggests that surgery for breast cancer in women in this age group is perhaps safer than thought.

This study is part of a wider- Bridging the Age Gaps in Breast Cancer- project which aims to examine the characteristics and outcomes (survival, quality of life and adverse events) of women aged at least 70 years in the UK undergoing surgery for breast cancer.

Researchers found:

  • Fewer than one in five women (19.3%) had an adverse outcome, such as a dangerous blood clot (DVT) or wound pain.
  • a woman’s age predicted what surgery she would receive. The oldest women in the group were twice as likely to have a mastectomy than the youngest women (59.1% vs 29.9%). Younger women were more likely to have breast-conserving surgery, with less breast tissue removed. This may relate to the lack of screening in older women, so cancers tend to be found when they are bigger and women feel a lump.
  • older women were less likely to have lymph glands under the armpit removed (axillary surgery) than younger women (91.4% vs 98.6%). The aim of axillary surgery is to find out if the cancer has spread, and to remove any cancer in the axilla.
  • just 2.8% of the women in this study who had a mastectomy went on to have reconstructive sugery. This compares to one in five (20%) women overall in the UK.
  • quality of life was lower after surgery particularly for those who had more breast tissue removed as in mastectomy.
  • the risk of being unable to carry out some standard day to day tasks was higher after surgery.
Morgan, J. L., George, J., Holmes, G., Martin, C., Reed, M. W., Ward, S., … & Wyld, L. (2020). Breast cancer surgery in older women: outcomes of the Bridging Age Gap in Breast Cancer study. British Journal of Surgery.

Abstract

Background

Breast cancer surgery in older women is variable and sometimes non‐standard owing to concerns about morbidity. Bridging the Age Gap in Breast Cancer is a prospective multicentre cohort study aiming to determine factors influencing treatment selection and outcomes from surgery for older patients with breast cancer.

Methods

Women aged at least 70 years with operable breast cancer were recruited from 57 UK breast units between 2013 and 2018. Associations between patient and tumour characteristics and type of surgery in the breast and axilla were evaluated using univariable and multivariable analyses. Oncological outcomes, adverse events and quality‐of‐life (QoL) outcomes were monitored for 2 years.

Results

Among 3375 women recruited, surgery was performed in 2816 patients, of whom 24 with inadequate data were excluded. Sixty‐two women had bilateral tumours, giving a total of 2854 surgical events. Median age was 76 (range 70–95) years. Breast surgery comprised mastectomy in 1138 and breast‐conserving surgery in 1716 procedures. Axillary surgery comprised axillary lymph node dissection in 575 and sentinel node biopsy in 2203; 76 had no axillary surgery. Age, frailty, dementia and co‐morbidities were predictors of mastectomy. Age, frailty and co‐morbidity were significant predictors of no axillary surgery. The rate of adverse events was moderate, with no 30‐day mortality. Long‐term QoL and functional independence were adversely affected by surgery.

Conclusion

Breast cancer surgery is safe in women aged 70 years or more, with serious adverse events being rare and no mortality. Age, ill health and frailty all influence surgical decision‐making. Surgery has a negative impact on QoL and independence, which must be considered when counselling patients about choices.

Full paper BJS Breast cancer surgery in older women: outcomes of the Bridging Age Gap in Breast Cancer study

Further information on the project is available from the University of Sheffield’s Medical School Bridging the Age Gap in Breast Cancer

Cancer Research UK: GPs say elderly are not seeking help for potential cancer symptoms

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Cancer Research UK| October 2020 | GPs say elderly are not seeking help for potential cancer symptoms

More than half (53 per cent) of GPs recently surveyed by Cancer Research mentioned that they were concerned that less older people are contacting them than before the pandemic. The leading cancer charity surveyed 1000 GPs online in September.

Respondents were asked to compare their experience prior to the pandemic.The findings also indicate a range of groups that GPs have concerns about during the pandemic these included:

  • patients with learning difficulties (40%)
  • those whose first language is not English (35%)
  • ethnic minorities (22%)
  • people from poorer backgrounds (23%)
  • those with existing health conditions (21%)

“I’m really concerned that less of my older patients are contacting the surgery and it’s worrying that colleagues across the UK are reporting this too. GP surgeries and hospitals are changing the way they do things to help keep patients and staff safe and people should be reassured that it’s safe to visit them. The first contact is likely to be by phone, and where appropriate a face to face will follow.

Dr Richard Roope, Cancer Research UK’s GP advisor

Read the full press release from Cancer Resarch UK

New advances in the diagnosis and management of hepatocellular carcinoma

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 BMJ (2020)|371| m3544 | New advances in the diagnosis and management of hepatocellular carcinoma

This BMJ Clinical Review provides a comprehensive and evidence based review of the most recent advances in surveillance, diagnosis, and treatment of hepatocellular carcinoma.

Image source: bmj.com

Abstract

Hepatocellular carcinoma is one of the leading causes of cancer related death in the world. Biannual surveillance for the disease in patients with cirrhosis and in high risk carriers of hepatitis B virus allows early stage cancer detection and treatment with good long term outcomes. Liver ultrasonography and serum α fetoprotein are the most commonly used surveillance tests. If suspicious results are found on the surveillance test, multiphasic computed tomography or magnetic resonance imaging should be undertaken to confirm the diagnosis of hepatocellular carcinoma. If radiologic tests show inconclusive results, liver biopsy or repeat imaging could be considered for confirmation of hepatocellular carcinoma. Management of the disease is complex. Patients should be evaluated by a multidisciplinary team, and the selection of treatment should consider factors such as tumor burden, severity of liver dysfunction, medical comorbidities, local expertise, and preference of patients. Early stage hepatocellular carcinoma is best managed by curative treatment, which includes resection, ablation, or transplantation. Patients with intermediate stage disease often receive locoregional treatment. Systemic treatment is reserved for patients with advanced disease. Several positive, phase III, randomized controlled trials have expanded the systemic treatment options for advanced hepatocellular carcinoma with promising long term outcomes, especially trials using combination treatments, which could also have eventual implications for the treatment of earlier stage disease.

Full review available from the BMJ

Breast Cancer UK: Almost one million women in UK miss vital breast screening due to COVID-19

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Breast Cancer UK| September 2020| Almost one million women in UK miss vital breast screening due to COVID-19

Close to a million women in the UK have missed potentially lifesaving NHS breast screening due to COVID-19, the leading UK breast cancer charity has warned on the eve of Breast Cancer Awareness Month.

Breast Cancer Now estimates that around 986,000 women missed their mammograms due to breast screening programmes being paused in March 2020, in a bid to reduce the risk of COVID-19 spreading and to free up emergency resource for the NHS.

Although the charity says screening for breast cancer is now beginning again, it cautions that this varies across the UK, with availability of appointments being significantly reduced to enable social distancing, and the programme has recommenced at different paces across England.

 Breast Cancer Now  Almost one million women in UK miss vital breast screening due to COVID-19