New chemotherapy approach offers breast cancer patients a better quality of life

The chemotherapy drug capecitabine gives patients a better quality of life and is as effective at preventing breast cancer from returning as the alternative regimen called CMF, when given following epirubicin. | ScienceDaily | Cancer Research UK

Around 4,400 patients on the TACT2 clinical trial were treated with the chemotherapy drug epirubicin followed by either capecitabine or CMF, after surgery.

Researchers at The Institute of Cancer Research, London, and the Cancer Research UK Edinburgh Centre found that capecitabine resulted in patients experiencing fewer side effects and having a better quality of life, and it was as effective at preventing cancer’s return as CMF.

Most patients experienced some side effects regardless of the treatment they were given. But those taking CMF were more likely to experience severe side effects including early menopause, nausea, infection, thrombosis, and anemia.

During the trial, patients were followed up after 12, 18 and 24 months, and then yearly for at least 10 years, to see if their cancer had returned and to monitor side effects. More than 85 per cent of patients did not experience their cancer returning for at least five years.

More detail at

• Cancer Research UK
•  ScienceDaily

Link to the research:

Cameron, D., et al.  Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer in the randomised UK TACT2 trial (CRUK/05/19): a multicentre, phase 3, open-label, randomised, controlled trial. The Lancet Oncology.

Breast cancer e-support program vs routine care

Zhu, J. et al. (2017) BMC Cancer. 17:291

Background: Women with breast cancer undergoing chemotherapy suffer from a number of symptoms and report receiving inadequate support from health care professionals. Innovative and easily accessible interventions are lacking. Breast Cancer e-Support is a mobile Application program (App) that provides patients with individually tailored information and a support group of peers and health care professionals. Breast Cancer e-Support aims to promote women’s self-efficacy, social support and symptom management, thus improving their quality of life and psychological well-being.

Discussion: This is the first study of its kind in China to evaluate the use of a mobile application intervention with a rigorous research design and theoretical framework. This study will contribute to evidence regarding the effectiveness of a theory-based mobile application to support women with breast cancer undergoing chemotherapy. The results should provide a better understanding of the role of self-efficacy and social support in reducing symptom distress and of the credibility of using a theoretical framework to develop internet-based interventions. The results will provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.

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Measuring patients’ muscles to predict chemotherapy side effects

Measuring patients’ muscle mass and quality could potentially help doctors better identify patients at high risk for toxic side effects that could require hospitalizations, researchers report | ScienceDaily

Researchers at the University of North Carolina Lineberger Comprehensive Cancer Center report in the journal Clinical Cancer Research that a tool developed at UNC could potentially help doctors better identify patients at high risk for toxic side effects that could require hospitalizations.

Shlomit Strulov Shachar, MD, the study’s first author, said they found that low measures of muscle quality and quantity in patients with early-stage breast cancer were linked to serious side effects and hospitalizations. Based on their findings, the researchers believe measuring muscle composition could be helpful in predicting which patients will experience side effects from chemotherapy, and in determining appropriate drug doses.

Read the full overview here

Read the original research abstract here

Prevalence of cancer chemotherapy-related problems and associated supportive care

Wagland, R. et al. (2016) Supportive Care in Cancer. 24(12) pp. 4901–4911

Purpose: The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres.

Conclusion: The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.

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Cost-effectiveness research in cancer therapy

Al-Badriyeh, D. et al. (2017) BMJ Open, 7:e012648

Objective: To perform a first-time analysis of the cost-effectiveness (CE) literature on chemotherapies, of all types, in cancer, in terms of trends and change over time, including the influence of industry funding.

Conclusions: This analysis demonstrates clear trends in how the CE cancer research is presented to the practicing community, including in relation to journals, study designs, authorship and consultation, together with increased financial sponsorship by pharmaceutical industries, which may be more influencing study outcomes than other funding sources.

Read the full systematic review here

Overuse of chemotherapy among younger patients with colon cancer

Young and middle-aged patients with colon cancer are nearly two to eight times more likely to receive postoperative chemotherapy than older patients, yet there seems to be no added survival benefits for these patients | ScienceDaily

Colorectal cancer is the third leading cause of cancer death in the U.S. There were more than 49,000 deaths in 2016, and more than 134,000 new cases are expected this year. While incidence and mortality rates among adults age 50 and older have decreased recently in the U.S., the same trend hasn’t been observed for patients 20 to 49. Treatment options remain to be defined for patients with young-onset colon cancer and their effects on prognosis are unclear.

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Read the original research article here

Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls

Janelsins, M.C. et al. Journal of Clinical Oncology. Published online: December 28 2016

Purpose: Cancer-related cognitive impairment is an important problem for patients with breast cancer, yet its trajectory is not fully understood. Some previous cancer-related cognitive impairment research is limited by heterogeneous populations, small samples, lack of prechemotherapy and longitudinal assessments, use of normative data, and lack of generalizability. We addressed these limitations in a large prospective, longitudinal, nationwide study.

Conclusion: Patients with breast cancer who were treated in community oncology clinics report substantially more cognitive difficulties up to 6 months after treatment with chemotherapy than do age-matched noncancer controls.

Read the full abstract here

Cancer drugs, survival, and ethics

Wise, P.H. (2016) BMJ. 355:i5792

Despite considerable investment and innovation, chemotherapy drugs have had little effect on survival in adults with metastatic cancer. Peter Wise explores the ethical issues relating to research, regulation, and practice

Cancer survival has improved in recent decades. Trends in the US show that five year relative survival in adults with solid cancer has increased from 49% to 68% over 40 years. There have been important advances in chemotherapy in recent years, including for melanoma, medullary thyroid cancer, and prostate cancer. Immunotherapy, together with targeted and precision (personalised) approaches guided by patient and tumour biomarkers, also produces benefit in subgroups of the more common cancers. But how much of the improvement in cancer survival can we attribute to drugs?

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Use of maintenance endocrine therapy after chemotherapy in metastatic breast cancer

Sutherland, S. et al. European Journal of Cancer.Published online: November 12 2016

Image source: Annie Cavanagh, Wellcome Images // CC BY-NC-ND 4.0 

Image of breast cancer cells.

Background: For women with oestrogen receptor+ metastatic breast cancer (MBC), the options for systemic treatment include endocrine therapy (ET) and chemotherapy. For women whose disease is also HER2+, anti-HER2 therapies are also routinely used either with chemotherapy or less commonly with ET. Where chemotherapy is used as initial therapy, treatment is often discontinued due to cumulative toxicity in the absence of disease progression. In this setting, there is the option of introducing ET with the aim of prolonging response and delaying relapse.

Methods: Literature review revealed four trials addressing the question of whether there is a benefit from introducing ET following chemotherapy for MBC. We also sought evidence for alternative approaches, including concurrent chemotherapy and ET and continuing chemotherapy until disease progression.

Results: The evidence for the use of ET after chemotherapy in MBC is limited, and the trials done were small. Furthermore, they were performed at a time when both the chemotherapy regimens and ET were different from those used currently. Despite these limitations, there is probably a modest improvement in time to progression for the sequential use of ET after chemotherapy but with no overall survival benefit. An alternative approach, particularly considering agents with relatively low toxicity, such as orally bioavailable fluoropyrimidines, is to continue chemotherapy until disease progression.

Conclusion: Where chemotherapy for MBC is discontinued due to toxicity, in the absence of progression, the use of ET, with its relatively low toxicity, is a reasonable approach with the aim of delaying relapse.

Read the abstract here

The impact of diabetes mellitus on survival following resection and adjuvant chemotherapy for pancreatic cancer

Kleeff, J. et al. (2016) British Journal of Cancer.115, pp. 887-894

Background: Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease.

Methods: We analysed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from three European Study Group for Pancreatic Cancer randomised controlled trials. Analyses were carried out to assess the association between clinical characteristics and the presence of preoperative diabetes, as well as the effect of diabetic status on overall survival.

Results: In total, 1105 patients were included in the analysis, of whom 257 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval (CI)) unadjusted overall survival in non-diabetic patients was 22.3 (20.8–24.1) months compared with 18.8 (16.9–22.1) months for diabetic patients (P=0.24). Diabetic patients were older, had increased weight and more co-morbidities. Following adjustment, multivariable analysis demonstrated that diabetic patients had an increased risk of death (hazard ratio: 1.19 (95% CI 1.01, 1.40), P=0.034). Maximum tumour size of diabetic patients was larger at randomisation (33.6 vs 29.7 mm, P=0.026).

Conclusions: Diabetes mellitus was associated with increased tumour size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.

Read the abstract here