The American Society of Clinical Oncology, or ASCO, held its 2010 annual meeting from June 4 to 8 in Chicago. The features below highlight some of the news emerging from the meeting.
A New Screening Strategy for Ovarian Cancer [back to top]
The Particulars: More than 70% of ovarian cancers are diagnosed when they have already grown to an advanced stage. There are currently no effective screening tools for the early detection of ovarian cancer in women at average risk. A screening strategy that incorporated change of CA-125 levels over time and age of the participant was assessed to estimate the risk of ovarian cancer using the Risk of Ovarian Cancer Algorithm (ROCA), followed by transvaginal sonography (TVS).
Data Breakdown: : In an analysis of 3,238 women who participated in the 8-year study, researchers found that the combined specificity of ROCA followed by TVS for referral to surgery was 99.7%. The average annual rate of referral to 3 monthly CA-125 screenings was 6.8%, and the average annual rate of TVS and gynecologic oncology referral was 0.9%. Cumulatively, 85 women received TVS and referral to a gynecologic oncologist. Eight women subsequently underwent surgery based on the TVS and referral, with three invasive ovarian cancers, two borderline ovarian tumors, and three benign ovarian tumors, providing a positive predictive value of 37.5%. Less than 1% of participants annually required a TVS. The invasive high-grade ovarian cancers that were detected were early stage.
Take Home Pearls: ROCA followed by TVS appears to demonstrate excellent specificity and positive predictive value in women who are at average risk for ovarian cancer. ROCA followed by TVS may be a feasible strategy for screening women over the age of 50.
Yoga Improves Sleep in Cancer Survivors [back to top]
The Particulars: Impaired sleep quality (SQ) and fatigue are the most prevalent and troublesome side effects that cancer survivors experience, and both significantly impair quality of life (QOL). A study was performed to examine the efficacy of yoga for improving SQ, fatigue, and QOL among cancer survivors.
Data Breakdown: More than 600 elderly women with clinical stage I, estrogen receptor-positive breast cancer treated by lumpectomy were randomized to receive tamoxifen or tamoxifen plus radiation were assessed. The probability at 10 years of being free from mastectomy was 96% for the tamoxifen-only group and 98% for the tamoxifen plus radiation group. Similarly, the 10-year breast-cancer-specific survival was 98% vs 96%, respectively, and overall survival was 63% vs 61%, respectively.
Take Home Pearl: At 10.5 years median follow-up, data continue to demonstrate that the addition of radiation does not appear to impact survival, distant disease-free survival, breast cancer-specific survival, or breast conservation in women aged 70 or older with early breast cancer. Lumpectomy with anti-estrogen therapy, but without the addition of radiation, appears to be an appropriate treatment option for older women with node-negative hormone receptor positive disease.
Genetics, Heart Disease & Dosing of Chemotherapy [back to top]
The Particulars: Anthracycline-related cardiomyopathy is a well-recognized dose-limiting complication among childhood cancer survivors. Carbonyl reductases (CBR) are enzymes that help metabolize anthracyclines into substances that can damage the heart. Variants in two CBR-producing genes, CBR1 and CBR3, are known to affect CBR activity.
Data Breakdown: Among patients with cardiomyopathy who had been treated with high doses (>250 mg/m2) of anthracyclines, the CBR genes had little effect on heart disease risk. However, among those who developed cardiomyopathy and received low drug doses (<250 mg/m2), both CBR1 and CBR3 variants increased the cardiomyopathy risk. Those carrying the CBR1 variant had a 5.3-fold increased risk for cardiomyopathy, compared with those carrying the low-risk variant; those with the CBR3 variant had a 3.1-fold increased risk.
Take Home Pearl: Survivors of childhood cancer who carry variants of the CBR gene and who received low doses of anthracycline chemotherapy appear to be more likely to develop heart disease than those without this form of the gene who received low doses.
Maintenance Therapy May Cut Risk of Lymphoma Recurrence [back to top]
The Particulars: Many patients with follicular lymphoma are at risk for a relapse within 3 to 6 years of their initial therapy. The goal of maintenance therapy is to prolong remission of cancer. The PRIMA trial, a phase III study, sought to determine disease progression when using rituximab as maintenance therapy.
Data Breakdown: Patients with stage III or IV follicular lymphoma whose disease was reduced or eliminated by rituximab-based combination chemotherapy were randomly assigned to receive 2 additional years of rituximab as maintenance therapy or no maintenance therapy. After 25 months, disease progression occurred in 18% of the rituximab group, compared with 34% of the observation group. The benefits of rituximab maintenance therapy were observed regardless of patients’ stage of remission, age, or prior treatment regimen.
Take Home Pearl: It appears that 2 years of rituximab maintenance therapy reduces the risk of follicular lymphoma recurrence by 50% in patients who responded to initial chemotherapy.