December 9, 2007, 5:15 PM CT

Lower dose of steroids for Multiple myeloma

Results of Eastern Cooperative Oncology Group Phase III clinical trial E4A03, for multiple myeloma, showing significantly better overall survival with lenalidomide plus low-dose dexamethasone treatment in comparison to lenalidomide plus high-dose dexamethasone, were reported today by S. Vincent Rajkumar, M.D. at the American Society of Hematologys annual meeting.

Currently lenalidomide and high-dose dexamethasone, referred to as Rev/Dex, is used as second-line therapy for myeloma. This same therapy has been used off-label (not currently approved by the U.S. Food and Drug Administration (FDA) for this particular use) by physicians for their newly-diagnosed patients, with overall response rates and one-year survival rates in the 90 percent range.

The standard therapy for myeloma commonly includes high doses of steroids such as dexamethasone. In this study we were hoping to find that a lower dose of steroids would be just as effective, says Dr. Rajkumar, Mayo Clinic Cancer Center hematologist and lead investigator of the study. We were surprised to find that the regimen with high-dose steroids actually was decreasing survival, besides contributing to increased side effects.

The study compared combination therapy of oral medications lenalidomide (a novel chemotherapeutic agent) and either high- or low-dose dexamethasone (a potent steroid effective against myeloma) in 445 patients with newly diagnosed myeloma. Lenalidomide plus high-dose dexamethasone had an 18-month survival rate of 80 percent. The comparative treatment using low-dose dexamethasone showed a significantly higher 91 percent overall survival rate at 18 months, with much less toxicity......... Posted by: Andria      Read more         Source

December 2, 2007, 8:50 PM CT

Development of colon tumors

Damaged or defective genes have long been known to be the cause of some cancers. Over the past decade, however, researchers have discovered that even healthy genes can be switched on or off and can cause cancer without any changes in the underlying DNA sequenceeventhough how this happens has remained poorly understood.

Scientists in the laboratory of Whitehead Member Rudolf Jaenisch now have established a direct causal correlation between hypermethylation (the accumulation of too a number of methyl molecules on regions of DNA) and the development of colon tumors in mice.

The research directly demonstrated that hypermethylation switches off tumor suppressor genesthe "housekeeping" genes that keep cancer cells in check. The study, published December 1 in Genes and Development, observed that hypermethylation boosted the number of intestinal tumors by 60-100 percent and significantly increased the average size of microscopic early-stage tumors.

While DNA methylation has been correlated with tumor development in numerous studies of human cancers, this is the first in vivo work demonstrating a causal connection in mammals. Better understanding of the process is a promising pathway to the prevention, diagnosis and therapy of certain cancers with minimal side effects......... Posted by: Andria      Read more         Source

November 28, 2007, 10:06 PM CT

Racial disparities in colorectal cancer risk

Risk of developing colorectal cancer is known to differ across ethnic and racial groups, and now an analysis of 26 studies, involving over 25,000 participants shows that some of these disparities might be explained by distinct patterns of genetic inheritance. A team of researchers, led by researchers at the University of Pittsburgh, present their findings today in Atlanta at the American Association for Cancer Research conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, being held November 27-30.

The scientists observed that people who have two T copies of the gene that metabolizes folate, a chemical needed to produce and maintain new cells, are 19 percent less likely to develop colorectal cancer than are individuals with two C copies of the gene.

By using individual data collected through the Genetic Susceptibility to Environmental Carcinogens study, a collaborative pooled analysis based at the University of Pittsburgh Medical Center and begun in 1997, they were able to look at genetic inheritance in different racial and ethnic groups. The researchers observed that the odds of individuals developing colorectal cancer with two T genes versus two C genes was 31 percent less in Asians, 8 percent less in Caucasians, and 4 percent more in African-Americans, eventhough results were only statistically significant in the Asian population. On the other hand, Latinos who inherited one copy of each gene instead of two C genes had a 20 percent higher risk of developing the cancer. However, this result was not statistically significant......... Posted by: Andria      Read more         Source

November 21, 2007, 5:11 AM CT

Rural patients' cancers diagnosed earlier

Rural patients are often assumed to be the top truants in American medicine, not seeking medical attention until a condition is more advanced and less treatable. However, a new study by Dartmouth scientists suggests that urban, not rural, patients are most likely to slip through the cracks-at least when it comes to colorectal and lung cancer.

Looking at national data on those two types of cancer, the study observed that urban patients tend to be diagnosed at a later stage than their rural counterparts-even when the study controlled for other factors linked to late-stage presentation, such as age, race, gender, marital status, income level, and level of education.

The paper, "Rural Versus Urban Colorectal and Lung Cancer Patients: Differences in Stage at Presentation," was reported in the November 2007 Journal of the American College of Surgeons. The authors are Ian Paquette, a general surgery resident at the Dartmouth-Hitchcock Medical Center (DHMC), and Sam Finlayson, a DHMC surgeon and vice chair for academic affairs for the Department of Surgery of the Dartmouth Medical School.

The team's findings fly in the face of the anecdotal evidence, including the sorts of tales traded in the corridors of DHMC, which serves a rural slice of New Hampshire and Vermont. "Where we practice, most doctors can tell stories about patients who have presented at a very late stage of a disease, and we find it hard to imagine that they could have ignored their symptoms for so long," said Paquette......... Posted by: Andria      Read more         Source

November 19, 2007, 8:28 PM CT

Stress Hormone May Hasten Blood Cancers

Scientists here have shown that in cell cultures, the stress hormone norepinephrine appears to promote the biochemical signals that stimulate certain tumor cells to grow and spread.

The finding, if verified, may suggest a way of slowing the progression and spread of some cancers enough so that conventional chemotherapeutic therapys would have a better chance to work.

The study also showed that stress hormones may play a completely different role in cancer development than scientists had once thought.

The results appear in the current issue of the journal Brain, Behavior and Immunity.

"We would not be surprised if we see similar effects of norepinephrine on tumor progression in several different forms of cancer," explained Eric Yang, first author of the paper and a research scientist with the Institute for Behavioral Medicine Research (IBMR) at Ohio State University.

Yang and colleague Ron Glaser, a professor of molecular virology, immunology and medical genetics, last year showed that the stress hormone norepinephrine was able to increase the production of proteins in cultures of nasopharyngeal carcinoma tumor cells that can foster the aggressive spread of the disease, a process known as metastasis. Glaser is director of the IBMR and a member of the Comprehensive Cancer Center at Ohio State......... Posted by: Andria      Read more         Source

November 18, 2007, 9:08 PM CT

The age for prostate cancer detection

Should the UK lower the age for prostate cancer detection in line with the USA?

Prostate cancer screening occurs in a number of countries ahead of evidence from ongoing trials. In a number of countries, early detection (including the UK, when practised), and opportunistic screening commences at 50 years, but a lower age limit has recently been adopted in the USA based on two studies that found elevated prostate specific antigen (PSA) levels in men in their 40s was linked to subsequent prostate cancer.

So a team of UK scientists set out to investigate the feasibility of prostate cancer testing, disease prevalence and characteristics in a random group of younger men. Their findings are published on bmj.com today.

The study involved 473 men aged 45-49 years randomly selected from eight general practices in one UK city.

Of 442 men (34%) who agreed to PSA testing, 54 (12%) had an elevated PSA result. These men were invited for further testing (an ultrasound-guided prostate biopsy, a repeat PSA test, and a digital rectal examination).

Ten prostate cancers were detected (a 2.3% detection rate, similar to that in older men). The five men whose tumours were potentially risky to health agreed to have one of three therapy options (radiotherapy, surgery, or active monitoring)......... Posted by: Andria      Read more         Source

November 12, 2007, 10:21 PM CT

Smac-ing lung cancer to death

Howard Hughes Medical Institute scientists have developed a small molecule that can turn the survival signal for a variety of cancer cells into a death signal. The molecule mimics the activity of Smac, a protein that triggers the suicide of some types of cancer cells.

The scientists say their findings suggest that Smac-mimetic compounds could be useful as targeted cancer therapys for lung and other cancers. Such treatment may be less toxic to healthy cells than current compounds used in cancer chemotherapy.

The researchers, led by Howard Hughes Medical Institute investigator Xiaodong Wang, published their findings in the November, 2007, issue of the journal Cancer Cell. Wang is at the University of Texas Southwestern Medical Center.

Cells that are defective or that become unnecessary during growth and development are induced to commit suicide through a finely balanced process known as apoptosis, or programmed cell death. A protein called Smac, which is a shortened version of second mitochondria-derived activator of apoptosis, is a part of the cells programmed cell death machinery. When that machinery is switched on, Smac is released from the mitochondria and triggers the pathway that kills damaged or abnormal cells. Cancer cells, however, can survive Smacs death signal by switching off the apoptotic machinery......... Posted by: Andria      Read more         Source

November 4, 2007, 9:15 PM CT

Folic Acid Linked to Increased Cancer Rate

Two recent commentaries appearing in the recent issue of Nutrition Reviews find that the introduction of flour fortified with folic acid into common foods was followed by an increase in colon cancer diagnoses in the U.S. and Canada. The two new review articles address these recent findings and provide an overview of the current evidence on folic acid fortification and the associated policy issues.

For nearly a decade, folic acid, a chemical form of a common B vitamin (folate), has been added to wheat flour and other grain products in the U.S. and Canada. This public health measure was enacted after evidence was discovered linking folic acid with a reduced rate of a specific birth defect that affected the development of the spinal cord and central nervous system. During the same period, however, rates of colorectal cancer in the U.S. inexplicably began rising, even as regular colonoscopy check-ups became more common. In Canada, where folic acid supplementation was introduced a bit later, the same trend has been observed.

Dr. Solomons, author of one of the review commentaries, "Food Fortification with Folic Acid: Has the Other Shoe Dropped?" advises that a careful reconsideration of the fortification program is needed. "One size of dietary folic acid exposure does not fit all. It can be beneficial to some and detrimental to others at the same time," comments Solomons......... Posted by: Andria      Read more         Source

October 29, 2007, 10:24 PM CT

Radiation plus chemo for GBM

Over four times as a number of patients with a rapidly fatal type of brain cancer, glioblastoma multiforme (GBM), who are treated with the chemotherapy drug temozolomide (TMZ) and radiation treatment, can live for four years after diagnosis, in comparison to those who receive only radiation therapy, as per updated results of a large, international trial presented at the Plenary I session on October 29, 2007, at the American Society for Therapeutic Radiology and Oncologys 49th Annual Meeting in Los Angeles.

Previously, GBM patients only typically lived between six to 12 months after diagnosis, and there were almost no survivors beyond two years. This type of cancer accounts for 20 percent to 25 percent of all primary brain tumors.

A substantial number of patients with glioblastoma now have a good chance of surviving at least a few years now and of enjoying a productive life during this time, which was almost unthinkable less than a decade ago, said Rene-Olivier Mirimanoff, M.D., lead author of the study and a radiation oncologist at the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland. Considering how quickly this type of cancer grows, patients who live four or five years after diagnosis are indeed considered long-term cancer survivors.

Early results of the Phase III trial published by Stupp in the New England Journal (NEJM) in 2005 showed for the first time that twice as a number of GBM patients who were treated with TMZ and radiation treatment survived two years after diagnosis, in comparison to those who received radiation alone. The trial involved 573 patients who were randomized to receive TMZ during and after radiation treatment or radiation alone. This therapy immediately became the standard therapy for GBM patients worldwide......... Posted by: Andria      Read more         Source

October 28, 2007, 2:10 PM CT

PET scans track small tumors

Readily available CT screening for lung cancer is increasing the discovery of small, primary lung cancers. For a number of, a radiation technique called stereotactic body radiotherapy presents a less invasive therapy option to surgery that is typically offered to non-surgical candidates. Currently there is great interest in evaluating this approach in surgical candidates, but scientists have yet to identify an early method to determine the effectiveness in therapy which is vital. In a study presented today at the American Society for Therapeutic Radiology and Oncologys 49th Annual Meeting in Los Angeles, scientists present data showing metabolic response monitored by FDG PET may be an early surrogate for local therapy failure which may allow timely salvage surgery if deemed necessary.

Stereotactic body radiotherapy may be as effective a therapy of these small tumors as in comparison to surgery, explained Steven Feigenberg, M.D., an attending doctor in the Department of Radiation Oncology at Fox Chase Cancer Center. Because the technique causes scaring in the lungs, it can be difficult to identify progression of the tumor on a Computerized axial tomography scan in a timely fashion, our standard way of tracking lung tumors, which may adversely affect outcomes due to potential therapy delays......... Posted by: Andria      Read more         Source