New research was virtually presented at AACR 2021, the American Association for Cancer Research virtual Annual Meeting, from April 10-15 and May 17-21. The features below highlight some of the studies that emerged from the conference.
Healthy Lifestyle May Offset Genetic Risk of Lethal Prostate Cancer
Data indicate that 58% of the variability in prostate cancer incidence is explained by the significant contributions of inherited genetic factors to prostate cancer risk. To determine if adherence to a healthy lifestyle can offset the increased genetic risk of prostate cancer, including progression to lethal disease, researchers quantified the genetic risk of prostate cancer in more than 10,000 men with a validated polygenic risk score (PDS). They also applied a validated lifestyle score for lethal prostate cancer (including healthy weight, vigorous physical activity, not smoking, and high consumption of tomatoes, fatty fish, and reduced intake of processed meat) and examined overall and lethal prostate cancer incidence. Men in the highest genetic risk quartiles had a 5.4-fold increased risk of overall prostate cancer and a 3.5-fold greater risk of lethal prostate cancer when compared with those in the lowest quartile. Among men in the highest quartile, healthy lifestyle adherence was significantly associated with decreased lethal prostate cancer risk when compared with the least healthy lifestyle, but it was not associated with decreased risk of overall prostate cancer. Among men with highest genetic risk, a healthy lifestyle at study entry was associated with a lifetime cumulative incidence of lethal prostate cancer of 3%, compared with 6% for those with the least healthy lifestyle and 3% for the population average.
Patients With Ovarian Cancer at Increased Risk for Mental Illness
To compare the risk for mental illness of women with ovarian cancer with that for women without cancer, investigators analyzed data from 1,689 patients with ovarian cancer diagnosed between 1996 and 2012 and a matched group of 7,038 women without cancer. Electronic health records were used to identify new mental health diagnoses following cancer diagnosis. Ovarian cancer survivors experienced increased risks for mental illnesses, particularly within the first 2 years after cancer diagnosis (hazard ratio [HR], 3.48), compared with the general population. Within the first 2 years after diagnosis, the risks for depression among ovarian cancer survivors were highest (HR, 3.11) and dropped for years 2-5 (HR, 1.67). Results were similar for the risk for anxiety disorder (years 0-2 HR, 3.54; years 2-5 HR, 1.86). The risk for adjustment disorders also was elevated in women diagnosed with ovarian cancer compared with women in the general population. Among patients with ovarian cancer, those who received a mental health diagnosis (HR, 1.8) or a depression diagnosis (HR, 1.94) were more likely to die compared with those without a mental health diagnosis.
Personalized Cancer Vaccine Tolerated & Feasible
Researchers developed a personalized genomic vaccine for use in patients who have undergone curative-intent surgery or autologous stem cell transplant and for whom there is a greater than 30% chance for recurrence. For a study, they identified candidate neoantigens following sequencing of tumor and germline DNA and RNA and use of the OpenVax custom computation pipeline. the OpenVax pipeline identified an average of 67.1 neoantigens/patient within 15 patients enrolled; only two patients did not have an adequate number of neoantigens identified to synthesize 10 peptides. Thirteen of the patients (10 with solid tumors and three with multiple myeloma) received the vaccine; 11 received all 10 doses. The vaccine was well tolerated; in 31% of patients, there were grade 1 injection site reactions. One patient was lost to follow-up; the median progression-free survival was 618 days from the time of surgery or transplant. Four patients remained without evidence of disease, with a mean follow-up of 925 days; four are receiving subsequent lines of therapy and four have died (two with documented recurrence).
Lack of Trust & Psychological Impact of Cancer Affect African Americans’ Clinical Trial Participation
“Improving clinical trial participation among African Americans is fundamental to reduce cancer health disparities knowing that their participation will significantly increase the state of knowledge regarding cancer treatment and survivability and ensure that African Americans can benefit from the newest therapies,” write the authors of a qualitative study that included two focus groups of African-American men and women older than 50 who were cancer survivors, caregivers, or spouses of survivors. Sessions were meant to assess participants’ perceptions of cancer clinical trials, prostate cancer, and other health concerns. Physicians, health magazines, and both survivor and cancer support groups were identified as preferred sources of health information. Men were less familiar with clinical trials than women. Several men expressed concerns with clinical trial participation due to a historical lack of trust, with the Tuskegee Study mentioned as an example. Men and women both expressed the importance of addressing the psychological impacts of cancer. While levels of knowledge about prostate cancer and cancer in general varied, most were more knowledgeable following diagnosis. Men and women also both described the presence and companionship of wives or significant others as key to men’s support. “Addressing the lack of trust as well as the psychological impact of cancer in culturally sensitive ways may lead to improved perspectives about clinical trials, and facilitate and promote the participation of African Americans in clinical trials research,” concluded the study team.
Unique Disease Course in Patients With Melanoma & HIV
Despite data indicating that melanoma is diagnosed more frequently in patients living with HIV (PLWH) than in the general US population and that HIV-infected patients with melanoma having higher rates of cancer-specific mortality, the mechanisms underlying these disparities remain unclear, and data are lacking that describe tumor pathology and non-mortality outcomes in this patient population. Investigators conducted a study to describe differences in tumor presentation and disease course among patients with melanoma with or without underlying HIV infection in the era of effective HIV therapy. By HIV status, certain melanoma pathology features differed, with a higher prevalence of elevated mitotic rate (78.9% vs 41.2%) and vertical growth phase (90% vs 55%) among participants with HIV. While the vast majority of patients underwent lesion excision, PLWH had more post-treatment complications (44.8% vs 24.0%). Among those who received systemic therapy after excision, 100% of PLWH had progressive disease, compared with 30% of those without HIV, and 66.7% of PLWH experienced events that interrupted systemic therapy, compared with 30% of those without HIV. However, overall survival rates were similar between PLWH (79.3%) and those without HIV (82.8%).