Mayo Clinic researchers say breast cancer survival improves Herceptin used with chemotherapy

SAN ANTONIO — Using Herceptin with chemotherapy, instead of after, clearly improves treatment of women with HER2+ breast cancer, and should be the new standard of care, says a Mayo Clinic researcher who led what is regarded to be a key clinical trial determining the best use of Herceptin.

Patients using Herceptin and chemotherapy at the same time had a relative 25 percent reduction in the risk of recurrence of cancer or death, compared with women who used Herceptin after chemotherapy, says Edith Perez, M.D., chair, North Central Cancer Treatment Group (NCCTG) Breast Committee and a breast cancer researcher at the Mayo Clinic campus in Jacksonville, Fla. She presented the findings of the study at the Cancer Therapy & Research Center-American Association for Cancer Research (CTRC-AACR) 2009 San Antonio Breast Cancer Symposium.

These findings may have global implications for women being treated for HER2+ breast cancer, which makes up 20 percent to 25 percent of all cases, Dr. Perez says.

In the United States, for example, Herceptin is approved for use on either a sequential or concurrent treatment schedule with adjuvant chemotherapy (that is, chemotherapy following surgery). In much of the rest of the world, Herceptin is used sequentially, she says.

"The results of this trial have been eagerly awaited in the U.S. and in many nations as this is the only trial developed to define the optimal way to incorporate Herceptin in the context of adjuvant chemotherapy," Dr. Perez says. "The goal was to decrease the risk of cancer recurrence, and we have shown that concurrent use is the best way to achieve that."

"This could mean that up to 10,000 women around the world each year may have a better outcome if Herceptin is used along with chemotherapy. Given that, I believe this study will lead to a global re-evaluation of how Herceptin is used," she says.

Every year, approximately 250,000 women worldwide are eligible to be treated with Herceptin for invasive HER2+ breast cancer, says Dr. Perez.

Some data on part of the study, the (NCCTG) clinical trial N9831, have been released before, such as in 2005 in the New England Journal of Medicine. But this is the first time that mature outcome information on patients given sequential vs. concurrent treatment is available. The trial enrolled women who had surgery to treat Stage I-III invasive HER2+ breast cancer.

The study is the only phase III randomized clinical trial to assess chemotherapy alone (Arm A) versus either sequential (Arm B) or concurrent (Arm C) incorporation of Herceptin in patients. Chemotherapy used in the study was doxorubicin and cyclophosphamide then paclitaxel, and was administered for approximately six months. Herceptin was given for 52 weeks.

Two different comparisons were made in the study. The first looked at outcomes in Arm A (1,087 women) compared to Arm B (1,097 women) and found that five-year disease-free survival (defined as no cancer recurrence) was increased from 72 percent (Arm A) to 80 percent (Arm B). Researchers also tabulated 222 events (cancer recurrence or death) in Arm A compared to 164 events in Arm B.

The second comparison looked at 954 women enrolled in Arm B with 949 women enrolled in Arm C. Researchers found that patients in Arm C fared the best overall. Their five-year disease-free-survival increased to 84 percent, compared to 80 percent in Arm B.

"The study demonstrated that adding Herceptin clearly improves disease-free survival, with improvement if given after chemotherapy, but even more improvement if started concurrent with taxane-based chemotherapy," Dr. Perez says. "So, our recommendation for practice and regulatory agencies around the world is that Herceptin be given concurrent with adjuvant chemotherapy."

Source
  

Mayo Clinic researchers say breast cancer survival improves Herceptin used with chemotherapy

Poor being turned away from free cancer screenings

States cite budget problems and new advice for tests starting later in life.

ALBANY, N.Y. – As the economy falters and more people go without health insurance, low-income women in at least 20 states are being turned away or put on long waiting lists for free cancer screenings, according to the American Cancer Society's Cancer Action Network.

In the unofficial survey of programs for July 2008 through April 2009, the organization found that state budget strains are forcing some programs to reject people who would otherwise qualify for free mammograms and Pap smears. Just how many are turned away isn't known; in some cases, the women are screened through other programs or referred to different providers.

"I cried and I panicked," said Erin LaBarge, 47. This would have been her third straight year receiving a free mammogram through the screening program in St. Lawrence County. But the Norwood, N.Y., resident was told she couldn't get her free mammogram this year because there isn't enough money and she's not old enough.

New York used to screen women of all ages, but this year the budget crunch has forced them to focus on those considered at highest risk and exclude women under 50.

"It's a scary thought. It really is," said LaBarge, who fears she's at a higher risk because her grandmother died of breast cancer.

Read More >> 
 

Poor being turned away from free cancer screenings

Nanosensors Used to Measure Cancer Biomarkers in Blood for First Time

ScienceDaily — A team led by Yale University researchers has used nanosensors to measure cancer biomarkers in whole blood for the first time. Their findings, which appear December 13 in the advanced online publication of Nature Nanotechnology, could dramatically simplify the way physicians test for biomarkers of cancer and other diseases.

The team -- led by Mark Reed, Yale's Harold Hodgkinson Professor of Engineering & Applied Science, and Tarek Fahmy, an associate professor of biomedical and chemical engineering -- used nanowire sensors to detect and measure concentrations of two specific biomarkers: one for prostate cancer and the other for breast cancer.

"Nanosensors have been around for the past decade, but they only worked in controlled, laboratory settings," Reed said. "This is the first time we've been able to use them with whole blood, which is a complicated solution containing proteins and ions and other things that affect detection."

To overcome the challenge of whole blood detection, the researchers developed a novel device that acts as a filter, catching the biomarkers -- in this case, antigens specific to prostate and breast cancer -- on a chip while washing away the rest of the blood. Creating a buildup of the antigens on the chip allows for detection down to extremely small concentrations, on the order of picograms per milliliter, with 10 percent accuracy. This is the equivalent of being able to detect the concentration of a single grain of salt dissolved in a large swimming pool.

Until now, detection methods have only been able to determine whether or not a certain biomarker is present in the blood at sufficiently high concentrations for the detection equipment to give reliable estimates of its presence. "This new method is much more precise in reading out concentrations, and is much less dependent on the individual operator's interpretation," Fahmy said.

In addition to relying on somewhat subjective interpretations, current tests are also labor intensive. They involve taking a blood sample, sending it to a lab, using a centrifuge to separate the different components, isolating the plasma and putting it through an hours-long chemical analysis. The whole process takes several days. In comparison, the new device is able to read out biomarker concentrations in a just a few minutes.

"Doctors could have these small, portable devices in their offices and get nearly instant readings," Fahmy said. "They could also carry them into the field and test patients on site."

The new device could also be used to test for a wide range of biomarkers at the same time, from ovarian cancer to cardiovascular disease, Reed said. "The advantage of this technology is that it takes the same effort to make a million devices as it does to make just one. We've brought the power of modern microelectronics to cancer detection."

Authors of the paper include Eric Stern, Aleksandar Vacic, Nitin Rajan, Jason Criscione, Jason Park, Mark Reed and Tarek Fahmy (all of Yale University); Bojan Ilic (Cornell University); David Mooney (Harvard University).

Nanosensors Used to Measure Cancer Biomarkers in Blood for First Time

Cancer Death Rate Continues to Fall

 Researchers Say More Cancers Are Being Detected Early or Prevented Through Screening

Dec. 7, 2009 -- New cancer cases and the cancer death rate continue to fall in the U.S., driven largely by declines in lung, prostate, and colorectal cancers in men and breast and colorectal cancers in women.

For all types of cancer, new cases declined by nearly 1% a year between 1999 and 2006. During much of the 1990s cancer incidence rates were stable, after increasing steadily from the mid-1970s.

The cancer death rate -- the best predictor of progress against the disease -- has been falling for more than a decade and a half.  Deaths from cancer declined by about 1% annually between 1993 and 2001 and 1.6% annually from 2002 to 2006.

Fewer Americans are smoking and more cancers are being detected early or prevented entirely through screening.

These two trends have played a big part in reducing cancer deaths in the U. S., experts say.

"We continue to make progress in the battle against cancer, and this progress is reflected in the continued decline in deaths," Elizabeth Ward, PhD, of the American Cancer Society tells WebMD.

Breast, Colon, and Prostate Cancer Deaths Fall

The annual report examining cancer incidence and cancer death trends in the U.S. is a joint effort by the CDC, the National Cancer Institute, the American Cancer Society, and the North American Association of Central Cancer Registries.

Among the major findings:

• The overall cancer incidence continues to be higher for men than for women, but men experienced the greatest declines in new cases and deaths.
• New cases declined for the three leading cancers in men -- prostate, lung, and colorectal cancer -- as well as for brain cancer, stomach cancer, and cancer of the oral cavity. No change was seen in the rate of pancreatic cancer and non-Hodgkin's lymphoma and increases were reported for cancers of the brain, esophagus, kidney, and liver and for melanoma and myeloma.
• Among women, declines were reported for two of the three most widely diagnosed cancers: breast and colorectal. New cases of lung cancer rose slightly.
• For men and women, death rates declined for colorectal, stomach, kidney, and brain cancers, as well as for leukemia, non-Hodgkin's lymphoma, and myeloma. Lung cancer death rates dropped by 2% annually among men and remained unchanged for women.
• Deaths from prostate cancer fell by about 4% annually between 2001 and 2006 and deaths from breast cancer fell by almost 2% a year during the same period.

"The continued decline in death rates from all cancers combined for men and women reflects the impact of increased screening, reduction of risk factors, and improved treatment," the report notes.
While the death rate from cancer continues to fall, the actual number of Americans who die from the disease is projected to rise in coming years as the population increases and baby boomers reach the high-risk age for cancer.

Screening Spurs Decline in Colorectal Cancer

The report included a special section on colorectal cancer, which is the third most frequently diagnosed malignancy in both men and women in the U.S. Deaths from colorectal cancer have been declining since the mid-1980s in men and the mid-1970s in women. For both sexes, the rate of decline accelerated beginning early in the current decade.

Improved screening is largely responsible for the decline, Brenda K. Edwards, PhD, of the National Cancer Institute tells WebMD.

Based on a model they developed, Edwards and colleagues predicted that colorectal cancer deaths could drop by another 50% over the next decade.

The projection assumes lifestyle factors like smoking rates will continue to decline and more Americans will be screened for colorectal cancer, and better results from cancer treatment.

"The model is a bit ambitious, but we think this rate of decline is achievable," she says.

Smoking, obesity, not exercising, and a diet high in red meat are all believed to be risk factors for colorectal cancer.

Cleveland Clinic colorectal cancer surgeon James Church, MD, agrees that increased screening would result in dramatic further reductions in colorectal cancer deaths.

"Colorectal cancer is preventable," he tells WebMD. "Every colorectal cancer starts off as a polyp, so if we find polyps early and take them out we prevent cancer from happening."

Church says as many as 85% of colorectal cancers could be prevented if everyone who was eligible for screening actually got screened.

Screening is recommended beginning at age 50 for most people. Those with risk factors for the cancer or a family history of the disease may need to be screened earlier.

"The average lifetime risk for colorectal cancer in the U.S. is about 6%," Church says. "The risk doubles for someone with a mom or dad who had the disease and it is four times higher when a parent is diagnosed at a young age."

--
Source: WebMD

Cancer Death Rate Continues to Fall