Older women at higher risk for breast cancer now have two good drug options for preventing the disease, but they will have to weigh the trade-offs, a major study shows.

Tamoxifen, the longtime gold standard, is more effective and longer lasting, the results show. But a newer drug _ raloxifene, sold as Evista _ is safer.

“I don’t see a clear winner,” but two good choices with different risks and benefits, said Dr. Scott Lippman, a cancer specialist at the University of Texas M. D. Anderson Cancer Center.

He is editor of Cancer Prevention Research, a journal that published long-term results from the federally funded study on Monday. They also were being presented at an American Association for Cancer Research meeting in Washington.

Tamoxifen is widely used to treat cancer once it’s diagnosed, and Evista is used to treat osteoporosis. But the drugs have not found wide acceptance so far as cancer preventives. Doctors hope the findings will spur more high-risk women to consider taking one of the drugs.

They’re not recommended for women at average risk of breast cancer. But for the millions who are at higher risk because of gene mutations, family history or other factors, they can make a dramatic difference.

“Between 27 million and 30 million women in the United States might have a high enough risk to qualify for one of these drugs,” including any woman over age 60, said Dr. Gabriel Hortobagyi, a breast cancer specialist at the M. D. Anderson Cancer Center.

Tamoxifen cut the chances of developing the most serious forms of breast cancer in half, the research shows, but with a higher risk of uterine cancer. Evista cut the cancer risk by 38 percent, with fewer uterine problems and other serious side effects…… (more…)

LOS ANGELES (Reuters) – Testing lung cancer patients for tumor markers would enable doctors to choose which drug the patient is most likely to respond to, improving the chances for successful treatment, according to results from a recent trial.

The mid-stage study, conducted at the University of Texas M.D. Anderson Cancer Center in Houston and funded by the U.S. Army, enrolled 255 patients with advanced lung cancer who had previously been treated with chemotherapy.

“We are still in the dark ages with how we treat lung cancer patients,” said Dr. Edwin Kim, associate professor at the center’s thoracic/head and neck oncology department and the study’s lead investigator. Currently, they are separated only into “histologic” categories such as small cell or non-small cell lung cancer, with subtypes like squamous or non-squamous.

“As far as molecular testing nothing is standardly done in lung cancer at this time,” Kim said.

For other types of cancer — such as breast and colon — such testing has become common in recent years amid the development of biologic drugs designed to work only against tumors with specific genetic or molecular characteristics.

Patients in the MD Anderson trial had their lung tumors biopsied and tested for several “biomarkers” including epidermal growth factor receptor, or EGFR; vascular endothelial growth factor, or VEGF; a gene known as KRAS; and another that encodes for a protein called Cyclin D1.

Erlotinib, sold by Roche Holding AG and OSI Pharmaceuticals Inc under the brand name Tarceva, is designed to block EGFR, a protein found in high amounts on many types of cancer cells…. (more…)

A study conducted by a collaborative team led by researchers from the University of Southern California (USC) may lead to better insight into the clinical outcome for some patients with a particularly aggressive type of brain cancer. The research may also provide a framework for development of targeted drug treatments.

The research by The Cancer Genome Atlas (TCGA), published online in the journal Cancer Cell, used epigenomics to determine that tumor DNA methylation profiles were distinctly different in about 10 percent of patients with glioblastoma multiforme (GBM).

“Most GBM patients survive fewer than 15 months, and fewer than 10 percent live more than five years,” said Peter W. Laird of the USC Epigenome Center, who led the TCGA team in collaboration with Dr. Kenneth Aldape at M.D. Anderson Cancer Center, Dr. Stephen B. Baylin at Johns Hopkins School of Medicine and many other TCGA consortium members. “With this research, we have identified a subset of patients with a distinct type of GBM that have substantially better clinical outcomes, with a median survival time of more than three years from the time of diagnosis.”

Epigenomics is the study of how DNA is packaged and marked to control which genes can be used in a particular type of cell or tissue. The distribution of one of these marks along the DNA, called DNA methylation, is often abnormal in cancer, contributing to the disease process. The characteristic epigenetic profile discovered by the TCGA team is called G-CIMP (Glioma CpG Island Methylator Phenotype) and was found to occur in much younger patients. G-CIMP tumors have other distinct alterations in their genomic landscape, revealing an interesting association with an acquired mutation in the IDH1 gene.

“Such findings are critical to the detection and treatment of brain cancer based on the genetic or epigenetic profile of each patient’s disease,” said National Institutes of Health (NIH) Director Francis Collins, M.D., Ph.D. “The depth and breadth of expertise in The Cancer Genome Atlas research network, combined with ever-improving genomic technologies, is generating remarkably detailed insights into cancer.”

Noushmehr H., et al., Identification of a CpG Island Methylator Phenotype that Defines a Distinct Subgroup of Glioma, Cancer Cell (2010), doi:10.1016/j.ccr.2010.03.017

Source:

Leslie Ridgeway

University of Southern California

via:medicalnewstoday.com/

Via:international clinical study conducted in Europe and the US presented April 16 at the International Liver CongressTM 2010, the Annual Meeting of the European Association for the Study of Liver in Vienna, Austria, have identified a genomic portrait able to predict recurrence in hepatocellular carcinoma (HCC), the fifth most common cancer in men .

HCC is a primary cancer of the liver. Worldwide, it accounts for approximately 5.4% of all cancers1 and it is the third cause of cancer-related death with more than 660,000 deaths per year1. Only around 20-30% of patients are treated with curative treatments, including resection and local ablation, but recurrence complicated the outcome in more than two thirds of these cases .

Results of this study identified two gene signatures- one coming from the tumor and the other from the cirrhotic liver — able to identify patients with poor disease outcome. The study concluded that these genetic tools can ultimately be used to select patients for preventive therapies. In addition, specific genes included in these signatures should be evaluated as potential targets for adjuvant treatment, following surgical intervention in HCC patients.

Dr Josep Llovet, Professor from the Hospital Clinic of Barcelona-IDIBAPS and Mount Sinai School of Medicine in New York, who led the study and highlighted this topic at EASL’s official press conference said, “The results of our study demonstrate the potential that molecular classification offers to future clinical management of diseases such as HCC. By successfully identifying certain genomic signatures that clearly predict both overall and early recurrence of HCC post-surgery, we now have a clearer focus for future research into therapeutic options that may in time improve patients’ chances of survival.”… (more…)

The country’s biggest cancer charity has expressed shock at government figures revealing huge variations in patients’ chances of surviving from one area of the UK to another. The biggest survival gap was in lung cancer, where Department of Health figures showed patients in Herefordshire were three times more likely to die within a year of diagnosis than those in Kensington and Chelsea. In the London borough, 44% of patients survived the first year after diagnosis, compared with only 15% in Herefordshire.

In bowel cancer there was also a big gap in survival – 80% in Telford and Wrekin after one year, but only 58% in Waltham Forest and Hastings and Rother. The gap was less pronounced in breast cancer, with the best rate in Torbay, where 99% survived for one year, compared with 89% in Tower Hamlets.

“There is no excuse for such a big difference between different areas,” said Harpal Kumar, chief executive of Cancer Research UK. “It is appalling that someone with lung cancer in Herefordshire should be three times more likely to die within a year than a patient in Kensington, or that a person diagnosed with bowel cancer in Waltham Forest or Hastings should be 22% more likely to die within a year than a patient in Telford. This is the worst kind of postcode lottery.”

Very few primary care trusts (PCTs) had survival rates that were as good as other countries in Europe now or even as good as Europe was achieving 10 years ago, which Kumar called “a disgrace”.

“We’re pleased that the Department of Health have been bold enough to publish these figures,” he said. “The NHS now needs to take them very seriously.”…. (more…)