Rochman, S. Journal of the National Cancer Institute (2016) 108 (7): djw176
Dietary guidelines promote increased intake of fruits and vegetables, reduced consumption of meats, and the selection of whole grains over processed foods as ways to improve overall health and decrease cancer risk. Those recommendations are based on laboratory and epidemiology studies that suggest certain foods may trigger biological processes that help initiate cancers or create tumor-friendly environments. A new study by researchers at the University of Texas M. D. Anderson Cancer Center in Houston is the first to find a statistically significant association between measures of carbohydrate intake and lung cancer risk.
The March 2016 study in Cancer Epidemiology, Biomarkers, and Prevention (doi:10.1158/1055–9965.EPI-15–0765) investigated the relationship between two measures of carbohydrate intake—glycemic index and glycemic load—and lung cancer risk in non-Hispanic whites. Glycemic index scores measure the extent to which foods that contain equal amounts of carbohydrates increase glucose levels. Glycemic load takes into account both how many carbohydrates are eaten and the glycemic index of those foods. Previous studies looking at associations between glycemic index and glycemic load and cancer risk have had inconsistent findings.
GPs can access the summary from their desktop computer and click through to the recommendations for each symptom group. Recommendations for adults, children and young people are covered, as well as primary care investigations.
An innovative method of carrying out lung biopsies at Barnet Hospital could free up hundreds of hospital beds and provide earlier lung cancer diagnosis by increasing tenfold the number of potentially life-saving tests carried out each year. In this guest blog for NHS England, Chest radiologist Dr Sam Hare explains why his team’s ambulatory lung biopsy method should be rolled out across the NHS.
Cancer Research UK. Published online: 22 June 2016
Hodgkin lymphoma patients can be spared the serious side effects of chemotherapy thanks to high-tech scans that can predict the outcome of treatment, according to a study published in the New England Journal of Medicine
Doctors – funded by Cancer Research UK and international partners in Europe and Australasia – used positron emission tomography (PET) to scan more than 1200 patients with advanced Hodgkin lymphoma after they had been given two cycles of standard chemotherapy. Those who had a clear PET scan were split into two groups – one group continued with chemotherapy including the drug bleomycin and the other had chemotherapy without the drug. They found that patients who stopped having bleomycin had the same survival rates as those who continued it. But, importantly, they were spared side effects. Patients on the trial who did not have a clear PET scan after two rounds of chemotherapy, suggesting they had a more resistant form of the disease, were given more intense chemotherapy treatment.
Bleomycin has been an important drug to treat Hodgkin lymphoma for 30 years, but it has a potential risk of severe effects on the lungs, with the risk of scarring, even years later, that can lead to serious breathing problems. Due to these risks the researchers wanted to explore the potential of adapting treatment by stopping bleomycin for patients with a good outlook and escalating treatment only for those at highest risk of the treatment not working.
Image shows intermediate magnification micrograph of hepatocellular carcinoma
Objectives: The objective of this study was to explore the association between health-related quality of life (HRQoL) and the recommended phase 2 dose in a phase I clinical trial according to the Time to HRQoL deterioration approach (TTD).
Setting: This is a phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads performed in cirrhotic patients with hepatocellular carcinoma. Patients had to complete the EORTC QLQ-C30 HRQoL questionnaire at baseline and at days 15, 30 and 60 after TACE.
Participants: Patients aged ≥18 years with HCC unsuitable for curative treatments were evaluated for the study (N=21).
Primary and secondary outcome measurements: The primary objective was to determine the maximum tolerated dose (MTD) of idarubicin loaded after a single TACE session. MTD was defined as the dose level closest to that causing dose-limiting toxicity in 20% of patients. HRQoL was the secondary end point.
Results: Between March 2010 and March 2011, 9, 6 and 6 patients were included at idarubicin dose levels of 5, 10 and 15 mg, respectively. Calculated MTD of idarubicin was 10 mg. At the 10 mg idarubicin dose, patients presented a longer TTD than at 5 mg, for global health status (HR=0.91 (95% CI 0.18 to 4.72)), physical functioning (HR=0.38 (0.04 to 3.22)), fatigue (HR=0.67 (0.18 to 2.56)) and pain (HR=0.47 (0.05 to 4.24)).
Conclusions: These HRQoL results were consistent with the estimated MTD, with a median TTD for global health status of 41 days (21 to NA) at 5 mg, 23 days (20 to NA) at 10 mg and 25 days (17 to NA) at 15 mg. These results show the importance of studying HRQoL in phase I trials.
Ekholm, M. et al. Journal of Clinical Oncology. July 1, 2016. 34 (19). pp. 2232-2238
Purpose: The aim of this study was to evaluate the long-term effect of 2 years of adjuvant tamoxifen compared with no systemic treatment (control) in premenopausal patients with breast cancer over different time periods through long-term (> 25 years) follow-up.
Patients and Methods: Premenopausal patients with primary breast cancer (N = 564) were randomly assigned to 2 years of tamoxifen (n = 276) or no systemic treatment (n = 288). Data regarding date and cause of death were obtained from the Swedish Cause of Death Register. End points were cumulative mortality (CM) and cumulative breast cancer–related mortality (CBCM). The median follow-up for the 250 patients still alive in April 2014 was 26.3 years (range, 22.7 to 29.7 years).
Results: In patients with estrogen receptor–positive tumors (n = 362), tamoxifen was associated with a marginal reduction in CM (hazard ratio [HR], 0.77; 95% CI, 0.58 to 1.03; P = .075) and a significant reduction in CBCM (HR, 0.73; 95% CI, 0.53 to 0.99;P = .046). The effect seemed to vary over time (CM years 0 to 5: HR, 1.05; 95% CI, 0.64 to 1.73; years > 5 to 15: HR, 0.58; 95% CI, 0.37 to 0.91; and after 15 years: HR, 0.82; 95% CI, 0.48 to 1.42; CBCM years 0 to 5: HR, 1.09; 95% CI, 0.65 to 1.82; years > 5 to 15: HR, 0.53; 95% CI, 0.33 to 0.86; and after 15 years: HR, 0.72; 95% CI, 0.36 to 1.44).
Conclusion: Two years of adjuvant tamoxifen resulted in a long-term survival benefit in premenopausal patients with estrogen receptor–positive primary breast cancer.
Smyth, D. Cancer Nursing Practice. Vol 15(5). pp. 15-15. Published in print: 10 June 2016
Pancreatic cancer is a significant cause of cancer mortality, with a poor five-year survival rate: 5% compared with 85% or more for breast cancer. In this Chinese study, two independent examiners undertook a retrospective analysis of the records of 38 patients with pathologically proven disease and surgically treated curative or palliative disease. They looked at whether there was a difference in the rates of detection and staging of the disease in two non-invasive diagnostic measures: computed tomography (CT) and magnetic resonance imaging (MRI).
Almost 80% of children and adolescents currently treated for cancer or leukemia will be long term survivors. Paediatric oncologists are concerned that side effects such as low fertility, infertility and early menopause can reduce the quality of life for survivors. Indeed, in females, cancer treatments can result in premature ovarian insufficiency (POI). Therefore, preserving fertility in young girls is becoming a key issue for improving quality of life. However, only a few teams performing OTC in children have reported on their practice.
The paper reports on 13 years’ experience of ovarian tissue cryopreservation before sterilising treatment. The aim of the study on OTC in 36 girls at risk of early menopause, aged between 2 and 19 years old, at the Clermont-Ferrand City Paediatric Oncology Department is to assess how effective, feasible and risky this treatment is.
Laparoscopy was used to collect a third of each ovary that was frozen by a slow cooling protocol. Histological analysis of one random sample of each harvested ovarian tissue fragment was routinely performed before freezing.
The study uncovers unresolved issues in the practice of OTC. The minimum age to offer OTC remains undetermined, there is no current consensus on the quantity of ovarian cortex to be harvested for cryopreservation or whether best practice is to remove an entire ovary or to remove part of each ovary. Detecting ovarian damage is difficult too as it is not standardised, and re-introducing cancer cells via an ovarian graft because of malignant cells in frozen thawed ovarian tissue remains a concern.
Dorff, T. B. et al. BMC Cancer. 2016 16:360. Published online: 10th June 2016
Background: Short-term starvation prior to chemotherapy administration protects mice against toxicity. We undertook dose-escalation of fasting prior to platinum-based chemotherapy to determine safety and feasibility in cancer patients.
Methods: 3 cohorts fasted before chemotherapy for 24, 48 and 72 h (divided as 48 pre-chemo and 24 post-chemo) and recorded all calories consumed. Feasibility was defined as ≥ 3/6 subjects in each cohort consuming ≤ 200 kcal per 24 h during the fast period without excess toxicity. Oxidative stress was evaluated in leukocytes using the COMET assay. Insulin, glucose, ketones, insulin-like growth factor-1 (IGF-1) and IGF binding proteins (IGFBPs) were measured as biomarkers of the fasting state.
Results: The median age of our 20 subjects was 61, and 85 % were women. Feasibility criteria were met. Fasting-related toxicities were limited to ≤ grade 2, most commonly fatigue, headache, and dizziness. The COMET assay indicated reduced DNA damage in leukocytes from subjects who fasted for ≥48 h (p = 0.08). There was a non-significant trend toward less grade 3 or 4 neutropenia in the 48 and 72 h cohorts compared to 24 h cohort (p = 0.17). IGF-1 levels decreased by 30, 33 and 8 % in the 24, 48 and 72 h fasting cohorts respectively after the first fasting period.
Conclusion: Fasting for 72 h around chemotherapy administration is safe and feasible for cancer patients. Biomarkers such as IGF-1 may facilitate assessment of differences in chemotherapy toxicity in subgroups achieving the physiologic fasting state. An onging randomized trial is studying the effect of 72 h of fasting.