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On our radar: Cancer

Wednesday April 16, 2014
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Molecular profile of invasive bladder cancer resembles that of breast cancer

Researchers who took a fresh look at muscle-invasive bladder cancer through the lens of gene expression discovered it looks remarkably similar to breast cancer, according to a news release. Scientists at The University of Texas MD Anderson Cancer Center reported in the February edition of Cancer Cell that the gene expression profiles of advanced bladder cancer fall into three molecular categories that closely resemble three of the four major subtypes of breast cancer. “There are no targeted therapies for this high-grade cancer now, so a future implication of these findings is developing new, better approaches for treating our patients,” study senior author David McConkey, PhD, professor of urology at the cancer center, said in the release.

Muscle-invasive disease makes up about 30% of bladder cancer cases and causes about 15,000 deaths in the U.S. each year. “We know that cisplatin-based chemotherapy combinations work for about 30-40% of cases, but there’s no way to identify patients in advance who are likely to benefit,” McConkey said in the release.

McConkey and colleagues identified a basal subtype of invasive bladder cancer that’s aggressive but vulnerable to chemotherapy and a p53-like luminal subtype that’s highly resistant to chemotherapy. These observations could lead to pre-treatment tumor analysis that guides the chemotherapy decision. The third subtype of high-grade bladder cancer may be vulnerable to targeted therapies used in those subtypes of breast cancer, including estrogen receptor blockers, according to study.

Public has access to cancer data from Pennsylvania hospitals

The American College of Surgeons Commission on Cancer has joined with the Pennsylvania Health Care Quality Alliance to make cancer quality data from participating Pennsylvania hospitals available to the public. The initiative, the first of its kind in the U.S., includes data from 72%, or 52 of all CoC-accredited cancer program. The healthcare quality initiative is important for patients because it provides public access to quality data from participating facilities in Pennsylvania, said CoC Chairman Daniel P. McKellar, MD, FACS, in a news release. The website also provides a list of CoC-accredited cancer centers in Pennsylvania. He also noted all CoC programs must report data on each cancer patient treated at their institutions. The data is used to monitor compliance with the quality measures, which are specific cancer care recommendations utilized for quality improvement.
Initiative outcomes are available at www.PHCQA.org.

Young women who smoke face increased risk of common breast cancer

Young women who smoke and have been smoking a pack a day for a decade or more had a 60% increased risk of developing estrogen receptor positive breast cancer, the most common type of breast cancer, according to an analysis published online in Cancer, a peer-reviewed journal of the American Cancer Society.

The majority of recent studies evaluating the relationship between smoking and breast cancer risk among young women have found smoking is linked with an increased risk. However, few studies have evaluated risks according to different subtypes of breast cancer.

Christopher Li, MD, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and his colleagues conducted a population-based study consisting of 778 patients with estrogen receptor positive breast cancer and 182 patients with triple-negative breast cancer, according to the journal article. Estrogen receptor positive breast cancer is the most common subtype of breast cancer, while triple-negative breast cancer is less common but tends to be more aggressive. Patients in the study were 20 to 44 years old and were diagnosed from 2004-2010 in the Seattle-Puget Sound metropolitan area. The study also included 938 cancer-free controls.

Research shows radically modified cells

With funding from the National Science Foundation, two researchers with Kansas State University in Manhattan, Kan., are attempting to develop a new materials treatment method that uses a type of white blood cell called a neutrophil to slip medications past the brain’s protective barrier and strike down malignant tumors directly, according to a news release.

Glioblastoma multiforme tumors hide behind a protective barrier in the brain and attack white blood cells that serve as the body’s defense. The researchers are trying to enable the white cells to attack the cancer right back. “Defensive cells — essentially white blood cells — have the ability of moving through [the blood-brain barrier] to tumors and metastases,” Stefan Bossmann, PhD, one of the researchers, said in the release. “The goal of our research is to use cells as transport ships for anticancer drugs.”

Bossmann and researcher Deryl Troyer, PhD, DVM, are developing a new class of protease-activatable polymer-caged liposomes, according to the release. The researchers are creating self-assembling “cages” that wrap around liposomes, turning them into more secure cargo-holds. Their process involves loading caged liposomes with anticancer medicine before uptake by neutrophils that will self-destruct and release the drugs when they reach tumors.

Disarming gene may be effective new approach to treating leukemia

A group of researchers discovered a promising new approach to treat leukemia by disarming a gene that is responsible for tumor progression, according to a March 6 article in Oncology Nurse Advisor. The gene, Brg1, is a key regulator of leukemia stem cells that are the root cause of the disease, its resistance to treatment and relapse, according to the ONA article by Kathy Boltz, PhD.

Investigators at the Institute for Research in Immunology and Cancer of Université de Montréal in Quebec, Canada, have spent the last four years studying the gene in collaboration with another research group at Stanford University in California. The results of their study were reported in February in Blood, a journal published by the American Hematology Society.

The study showed striking results on laboratory animals and human leukemia cells but still is a long way from moving to the clinic, according to the article. The group is performing experiments to identify such drugs that can disarm the Brg1 gene, thereby stopping leukemia stem cells from generating malignant cells.

Cancer stem cells appear to be more resistant to radiotherapy and chemotherapy than the bulk of the tumor and often are responsible for cancer relapse. Inhibiting residual leukemia stem cells from dividing is the key to obtaining irreversible impairment of tumor growth and long-term remission in patients.

New guideline aims to reduce costs, improve course of breast cancer treatment

The Society of Surgical Oncology in Rosemont, Ill., has released a consensus guideline for physicians treating breast cancer that aims to reduce healthcare costs and improve the course of treatment, according to a news release.

Developed in conjunction with the American Society of Radiation Oncology, the guideline outlines an evidence-based surgical treatment path designed to save patients from unnecessary surgery. “A significant portion of breast cancer surgeries in the United States are performed by our surgical oncologists, and the definition of an adequate margin has been a major controversy,” Monica Morrow, MD, SSO immediate past president and co-chairwoman of the consensus panel, said in the release. “Therefore, it was only natural that we decided to create a definitive guideline that helps to minimize unnecessary surgery while maintaining the excellent outcomes seen with lumpectomy and radiation therapy.”

The review of scientific evidence by SSO, ASTRO and contributing experts did not support the routine removal of larger amounts of healthy breast tissue beyond having no cancerous cells touching the edge of the lumpectomy specimen. The panel found this was true regardless of patient age as well as for women with the more aggressive, triple-negative cancer types.

“Our hope is that this guideline will ultimately lead to significant reductions in the high re-excision rate for women with early-stage breast cancer undergoing breast conserving surgery,” Meena S. Moran, MD, associate professor of therapeutic radiology at Yale School of Medicine and Yale Cancer Center and co-chairwoman of the margin consensus panel, said in the release.

Screening to detect early stage lung cancer has not gained awareness

A 2013 screening recommended to detect early stage lung cancers in chronic smokers has not gained the awareness level it merits. That was the assessment of Corey J. Langer, MD, professor of medicine, Abrahamson Cancer Center, University of Pennsylvania, at a panel discussion convened by The American Journal of Managed Care, according to a news release.

While breast cancer has a monthlong campaign to get women screened and colonoscopies experienced an upsurge after former Today Show host Katie Couric had an onscreen exam after losing her husband to colon cancer, screenings for lung cancer did not see a similar surge last summer when it was recommended for the roster of tests for which insurance must pay under the Affordable Care Act, Langer said.

On Dec. 31, the U.S. Preventive Services Task Force released its final recommendation for annual lung cancer screenings with low-dose computed tomography in adults ages 55 to 80, who have smoked 30 “pack years.” A pack-year means the person has smoked at least a pack a day for a year; a person who smoked two packs a day for 15 years would have 30 pack years.

Langer’s comments were part of a wide-ranging discussion on treatment strategies for non-small cell lung cancer, including new and emerging agents, the need for precision in pathology to identify the characteristics and stage of the disease, and the use of molecular-level tests and agents.

On its website, the American Lung Association said the stigma associated with cigarette smoking has clouded efforts to promote lung cancer screening.

Study finds targeted antitumor agent has potential to improve cervical cancer treatment

A clinical study has found that erlotinib, a targeted antitumor agent, has promising potential to improve treatment for cervical cancer, according to a news release. Published online in Cancer, a peer-reviewed journal of the American Cancer Society, the results indicate larger trials are warranted to determine whether the drug should become part of standard therapy for women with the disease.
“To the best of our knowledge, this is the first study to present that a targeted agent has promising activity in the management of locally advanced cervical disease,” Angélica Nogueira-Rodrigues, MD, PhD, of the Brazilian National Cancer Insitute, said in the release.

She said targeted therapies may be added to the standard treatment for locally advanced cervical cancer if randomized trials confirm the study’s results.

Cisplatin-based chemoradiation is the standard therapy for locally advanced cervical cancer. However, treatment responses are unpredictable and often disappointingly brief. A potentially promising new treatment strategy involves targeting the epithelial growth factor receptor, which is frequently overexpressed in cervical cancer. Inhibiting this receptor is known to have antitumor effects against a variety of cancers.

Nogueira-Rodrigues and her colleagues designed a phase 2 clinical trial to test the potential of the EFGR inhibitor erlotinib combined with chemoradiation therapy in 36 women with cervical cancer. Median duration of therapy was 77 days and median follow-up time was 59.3 months. The therapy was well tolerated overall and 34 patients (94.4%) achieved a complete response, meaning the disappearance of all cancerous lesions. After two years, 91.7% of women were alive and 80.6% experienced no progression of their disease. After three years, 80% of women were alive and 73.8% experienced no disease progression.

Nurse cancer survivor inspires others to take charge of their health

Helene Neville, LPN, a Clark County detention nurse in Las Vegas, decided not to allow a cancer diagnosis dictate how she would live her life. Instead, she decided to share a message of wellness with other nurses. She also is founder and CEO of the National Nurses Health Institute, a marathon runner, author and inspirational speaker.
Neville’s story and top tips for everyone to achieve their own own best fitness is available in an online Nurse.com article written by Tracey Long, RN.

To read the full story, visit Nurse.com/Article/Nevada-Nurse.

To see what else is trending in cancer, visit www.Nurse.com/Cancer.


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