Oncology Minute

Issue #3
Article #1 Final 8-Year Analysis of Intergroup Trial Shows Survival Benefit With Addition of Radiotherapy to Androgen-Deprivation Therapy in Prostate Cancer
As reported in the Journal of Clinical Oncology, Mason et al found that overall survival and cancer-specific survival at 8 years were significantly greater with the addition of radiotherapy to androgen-deprivation therapy in patients with locally advanced prostate cancer. An interim analysis had shown a 23% reduction in all-cause mortality with radiotherapy plus androgen-deprivation therapy (hazard ratio [HR] = 0.77, P = .033). Study Details: In the trial, 1,205 patients with T3-4, N0/Nx, M0 prostate cancer or T1-2 disease with either prostate-specific antigen (PSA) level of > 40 µg/L or PSA level of 20 to 40 µg/L plus a Gleason score of 8 to 10 were randomly assigned between 1995 and 2005 to receive lifelong androgen-deprivation therapy alone (n = 602) or with radiotherapy (n = 603).

Article #2 ASCO Finds Obesity Likely To Become Top Risk Factor for Cancer
An American Society of Clinical Oncology (ASCO) report found that “obesity will soon become the number one risk factor for cancer.” In response, ASCO is calling for “immediate and substantive increases in weight control education, research and advocacy to raise public awareness” of the risk of cancer connected to obesity. In general, obesity may “cause chronic inflammation,” which can lead to “increasing production of the hormone estrogen,” which “has been shown to cause breast cancer tumors.”

Article #3 Active Surveillance of Intermediate Risk Prostate Cancer may not be Advisable
A prospective study of 945 patients (237 intermediate risk and 708 low risk) by Dr Loblaw at Sunnybrook Health Sciences Center over an 18 year period (median follow up 7 years) revealed a significant lower survival than low risk patients. Ten and 15 yr survival for intermediate risk patients was 68% and 50% vs 84% and 69% for low risk patients. Not all intermediate risk patients are same and further stratification of intermediate risk group may be needed. Current NCCN guidelines offer observation as an option for men with intermediate risk and 4 times likely to die than men with low risk prostate cancer managed with active surveillance.

Issue #2
Article #1: Melanoma a Great Target for New Drugs
FDA granted accelerated approval to a star anti-PD-1 drug Opdivo (nivolumab) for metastatic melanoma in December as it clearly showed survival benefit — becoming the 7th new drug since 2011 for metastatic melanoma — the fifth commonest cancer in USA. Nivolumab is the first in an exciting new class of targeted drugs that work by inhibiting the PD-1 protein on cells, which blocks the body’s immune system from attacking melanoma tumors. Other FDA-approved treatments for melanoma include ipilimumab (2011), peginterferon (2011), vemurafenib (2011), dabrafenib (2013), trametinib (2013), and pembrolizumab (2014).

Article #2: Radiation Plus Androgen-Deprivation Therapy Prolongs Survival for Men with Prostate Cancer
Adding radiation treatment to androgen-deprivation therapy saves more lives among men with locally advanced prostate cancer than androgen-deprivation therapy alone, according to a new study involving >31,000 patients from SEER database by Bekelman et al reported in the Journal of Clinical Oncology – showing over 50% reduction in mortality rates. Two landmark clinical trials have shown that radiation plus androgen-deprivation therapy produces a large and significant improvement in survival in younger men relative to androgen-deprivation therapy alone, but until now, there has been no comparable research on treatment for older men with advanced prostate cancer.

Article #3: More Than 1.5 Million Cancer Deaths Averted During 2 Decades of Dropping Mortality
ACS has reported that a 22% drop in cancer mortality over 2 decades led to saving of more than 1.5 million lives from cancer deaths. While cancer death rates have declined in every state, generally with the states in the South showing the smallest decline and in the Northeast the largest decline. The gains are largely attributed to declining mortality from lung, breast, and colon cancers.

Issue #1
Article #1: Adjuvant Bisphosphonates Improve Breast Cancer Survival, Reduce Bone Recurrence in Postmenopausal Women With Early Disease
Key Points:
A large meta-analysis evaluated adjuvant bisphosphonate therapy in over 22,000 women with early breast cancer.
In postmenopausal women, bisphosphonate therapy was associated with fewer bone recurrences and reduced breast cancer deaths; no effect was observed in premenopausal women.
These findings may change practice in the adjuvant treatment of postmenopausal women with early breast cancer.
Adjuvant use of bisphosphonates reduced the risk of bone recurrence by 34% and the risk of breast cancer death by 17% in postmenopausal women with early breast cancer in a large meta-analysis conducted by the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). The potentially practice-changing findings were presented at the 2013 San Antonio Breast Cancer Symposium by Robert Coleman, MD, of University of Sheffield, United Kingdom (Abstract S4-07)
Adjuvant bisphosphonates achieved reductions in bone recurrence and breast cancer deaths in postmenopausal women regardless of estrogen receptor status, nodal status, and whether or not they received chemotherapy. However, no effects on disease outcome were observed in premenopausal women.
“These results are striking in postmenopausal women,” said Peter Ravdin, MD, Co-Director of the San Antonio Breast Cancer Symposium, who was not involved in this study. Dr. Ravdin is director of the Breast Health Clinic at the Cancer Therapy & Research Center (CTRC) of The University of Texas Health Science Center at San Antonio. Dr. Ravdin indicated that he believed bisphosphonates should be considered in clinical treatment guidelines for early breast cancer.
“In addition to the 17% reduction in breast cancer-related mortality, adjuvant bisphosphonates led to an absolute reduction of 3.4% in all-cause mortality,” Dr. Coleman stated.
Large Meta-Analysis
The meta-analysis was prompted by evidence from previous trials suggesting that bisphosphonates reduce distant metastases, predominantly in bone, and this effect is largely confined to postmenopausal women. The individual patient meta-analysis was based on 36 randomized controlled trials comparing adjuvant use of a bisphosphonate vs no bisphosphonate or placebo; a total of 22,982 women were enrolled in these trials.
Seven of the trials compared clodronate vs no bisphosphonate or placebo, and 29 evaluated aminobisphosponates. Two-thirds of women on aminobisphosphonates were taking zoledronic acid, about one-quarter received ibandronate, and 11% received other agents in this class.
Significant Reductions for Postmenopausal Women
Among all women no significant difference was observed in the 10-year rate of all breast cancer recurrences or distant recurrences, including recurrence in bone.
However, among 11,306 postmenopausal women (including women age > 55 if menopausal status unknown), bisphosphonates achieved a highly significant difference in distant recurrence, with rates of 18.4% in women on bisphosponates vs 21.9% in those taking no bisphosphonates (P = .0003), and in bone recurrence, with rates of 5.9% and 8.8%, respectively (P < .00001). No significant effect of bisphosphonates was observed on non-bone recurrence.
Among postmenopausal women, the rate of breast cancer mortality was 15.2% for those treated with bisphosphonates vs 18.3% for those not receiving bisphosphonates (P = .004), and the rate of all-cause mortality was 21.5% vs 23.8%, respectively (P = .007).
Dr. Coleman has provided expert testimony for Novartis and receives honoraria from Amgen.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®

Article #2: Clinical Trials
Clinical trials, also called cancer treatment or research studies, test new treatments in people with cancer. The goal of this research is to find better ways to treat cancer and help cancer patients. Clinical trials test many types of treatment such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy.
Clinical Trials are long term and have been around for 30 years.
Clinical Trials provide the best available treatment.
We intend to expand availability of Clinical Trials in tumor patients.
Safe and probably safer than regular cancer treatments.

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