The nasopharynx is the area above the soft palate (roof of the mouth) and behind the nose. Nasopharyngeal cancer tends to be more common in people of Chinese or other Asian ancestry, and has been linked with infection with the Epstein-Barr virus.[1]

Treatment with radiation therapy and chemotherapy given concurrently (at the same time) has been shown to be effective among patients with advanced (Stage III or Stage IV) nasopharyngeal cancer, but less is known about the effectiveness of this approach among people with earlier-stage nasopharyngeal cancer.

To evaluate concurrent chemotherapy and radiation therapy among patients with Stage II nasopharyngeal cancer, researchers in Chinaconducted a Phase III clinical trial. The study enrolled 230 patients; half were treated with radiation therapy alone and half were treated with concurrent chemotherapy and radiation therapy.[2]

• Five-year overall survival was 94.5 percent among patients treated with both chemotherapy and radiation therapy, compared with 85.8 percent among patients treated with radiation therapy alone.
• Five-year survival without a worsening of the cancer was 87.9 percent among patients treated with both chemotherapy and radiation therapy, compared with 77.8 percent among patients treated with radiation therapy alone.
• Side effects were more common in the combined treatment group.

These results suggest that combined treatment with chemotherapy and radiation therapy results in better survival than radiation therapy alone among patients with Stage II nasopharyngeal cancer.

References:

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Dietary supplements are widely used by theU.S.population in the hope of preventing or treating common chronic diseases. The health effects of many of these supplements remain uncertain, and some supplements have been found to cause harm.

To explore whether supplementation with B vitamins or omega-3 fatty acids reduces the risk of cancer, researchers analyzed information from a large clinical trial of people who had survived cardiovascular disease. The study enrolled more than 2,500 people between the ages of 45 and 80 who had a history of heart attack, unstable angina, or ischemic stroke. Study participants were given supplements (B vitamins and/or omega-3 fatty acids) or placebos.

• Overall, the dietary supplements did not affect the risk of getting or dying from cancer.
• Among the female study participants, there was a suggestion that the dietary supplements may increase cancer risk. Because this result was based on fairly small numbers of people, however, it should not be considered definitive.

These results suggest that B vitamin and omega-3 fatty acid supplements are unlikely to be effective for cancer prevention. The possibility that these supplements could increase cancer risk in women requires additional research.

People who are considering taking dietary supplements are advised to discuss the decision with their doctor.

Reference: AndreevaVA, Touvier M, Kesse-Guyot E, Julia C, Galan P, Hercberg S. B Vitamin and/or omega-3 fatty acid supplementation and cancer. Archives of Internal Medicine. Early online publication February 13, 2012.

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Dietary supplements are widely used by theU.S.population in the hope of preventing or treating common chronic diseases. The health effects of many of these supplements remain uncertain, and some supplements have been found to cause harm.

To explore whether supplementation with B vitamins or omega-3 fatty acids reduces the risk of cancer, researchers analyzed information from a large clinical trial of people who had survived cardiovascular disease. The study enrolled more than 2,500 people between the ages of 45 and 80 who had a history of heart attack, unstable angina, or ischemic stroke. Study participants were given supplements (B vitamins and/or omega-3 fatty acids) or placebos.

• Overall, the dietary supplements did not affect the risk of getting or dying from cancer.
• Among the female study participants, there was a suggestion that the dietary supplements may increase cancer risk. Because this result was based on fairly small numbers of people, however, it should not be considered definitive.

These results suggest that B vitamin and omega-3 fatty acid supplements are unlikely to be effective for cancer prevention. The possibility that these supplements could increase cancer risk in women requires additional research.

People who are considering taking dietary supplements are advised to discuss the decision with their doctor.

Reference: AndreevaVA, Touvier M, Kesse-Guyot E, Julia C, Galan P, Hercberg S. B Vitamin and/or omega-3 fatty acid supplementation and cancer. Archives of Internal Medicine. Early online publication February 13, 2012.

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Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), results from inherited mutations in genes involved in DNA mismatch repair. These mutations greatly increase the risk of developing colorectal cancer. In individuals with Lynch Syndrome, the average age at diagnosis of colorectal cancer is about 44 years, compared with 64 years in the general population. Overall, roughly 3% to 5% of all colorectal cancers are thought to result from Lynch Syndrome. Several other types of cancer are also known to be more common in people with Lynch Syndrome, including cancers of the endometrium (the lining of the uterus), ovary, small intestine, ureter, and renal pelvis.

To further explore cancer risk in families with Lynch Syndrome, researchers conducted a study among 446 people with a Lynch Syndrome gene mutation, and 1,029 family members who did not carry a gene mutation.

Study subjects were followed for a median of five years.

• Compared with the general population, people with a Lynch Syndrome gene mutation were 20 times more likely to develop colorectal cancer, 31 times more likely to develop endometrial cancer, 19 times more likely to develop ovarian cancer, 11 times more likely to develop kidney cancer, 11 times more likely to develop pancreatic cancer, 10 times more likely to develop stomach cancer, 10 times more likely to develop bladder cancer, and 4 times more likely to develop female breast cancer.
• Family members without the gene mutation did not have an increased risk of cancer (cancer risk was similar to that of the general population).

This study confirms that people with Lynch Syndrome have an increased risk of several types of cancer, including some (breast and pancreatic cancer) that were not previously known to be linked with Lynch Syndrome.

People who come from a family with Lynch Syndrome but who do not carry the gene mutation themselves do not appear to be at increased risk of cancer.

Reference: Win AK, Young JP, LindorNMet al.Colorectal and other cancer risks for carriers and noncarriers from families with a DNA mismatch repair gene mutation: a prospective cohort study. Journal of Clinical Oncology. Early online publication February 13, 2012.

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Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia. The American Cancer Society estimates that approximately 16,000 people will be diagnosed with CLL this year. Currently, there are approximately 95,000 people in theUnited Statesliving with CLL.

CLL is characterized by the production of atypical lymphocytes. Lymphocytes are specialized immune cells that exist in two forms: B- and T-cells. These cells are produced in the bone marrow and each serves a specific function in aiding the body fight infection.

The large majority of CLL cases involve mature B-lymphocytes that tend to live much longer than normal. B-lymphocytes accumulate in the blood, bone marrow, lymph nodes, and spleen. This results in overcrowding of these areas and suppression of the formation and function of blood and immune cells. Additionally, the cancerous lymphocytes themselves do not function normally, leading to a further reduction in the body’s ability to fight infection.

Campath is a monoclonal antibody that is targeted against B-cells. It has been designed to bind to specific sites on B-cells and cause the immune system to attack the cells to which it is bound.

To evaluate the combination of Campath and fludarabine in patients with previously treated CLL, researchers conducted a Phase III clinical trial among 335 patients. All study participants had CLL that had relapsed after prior treatment or that was resistant to prior treatment. Half the patients were treated with fludarabine alone and half were treated with fludarabine plus Campath.

• Survival without cancer progression was 23.7 months among patients treated with fludarabine and Campath, versus 16.5 months among patients treated with fludarabine alone.
• Overall survival was also better among patients treated with fludarabine and Campath.
• Serious side effects were more common among patients given the combination treatment (33 percent versus 25 percent among patients treated with fludarabine alone).

These results suggest that the combination of Campath and fludarabine is more effective than fludarabine alone for patients with relapsed or refractory CLL.

Reference: Elter T, Gercheva-Kyuchukova L, Pylylpenko H et al. Fludarabine plus alemtuzumab versus fludarabine alone in patients with previously treated chronic lymphocytic leukaemia: a ramdomised phase 3 trial. Lancet Oncology. 2011;12:1204-13.

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These results were presented at the 97^th Annual Clinical Congress of theAmericanCollege of Surgeons.

The colon and rectum are parts of the body’s digestive system and together form a long, muscular tube called the large intestine. The colon is the first 6 feet of the large intestine and the rectum is the last 8-10 inches. Each year in theUnited States, more than 100,000 people are diagnosed with colon cancer and more than 40,000 are diagnosed with rectal cancer. Although rectal cancer remains relatively uncommon in young adults, incidence has increased in recent years.

Rectal cancers that involve a type of cell known as a signet cell are often diagnosed at a more advanced stage and tend to have a worse prognosis than other types of rectal cancer. To explore how the frequency of signet cell rectal cancers varies by age, researchers evaluated a largeUScancer database (the Surveillance, Epidemiology and End Results Program).

Signet cell cancers accounted for close to 5 percent of all rectal cancers among people under the age of 40, but only 1 percent of rectal cancers among people over the age of 40.

These results—coupled with the increasing incidence of rectal cancer in young adults—highlight the need for more attention to the problem of rectal cancer in people under the age of 40.

Reference:AmericanCollegeof Surgeons. News from the Clinical Congress. Surgeons find higher than expected rate of aggressive rectal cancer in younger adults. 2011.

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Similar to adults with arthritis, children with JIA experience joint pain, swelling, tenderness, and stiffness. The condition affects an estimated 294,000USchildren under the age of 17.

Drugs known as TNF inhibitors may be used to treat arthritis in children and adults, but these drugs have been linked with a possible increase in the risk of certain types of cancer.

To explore cancer risk among children with JIA, researchers used US Medicaid records to identify 7,812 children with JIA. The cancer risk in these children was compared with the cancer risk in a large group of children without JIA. The children without JIA were selected from among children with either asthma or attention-deficit hyperactivity disorder.

For the children with JIA, researchers collected information about whether the children had ever been treated with a TNF inhibitor or methotrexate. Roughly half the children had taken methotrexate, and one-fifth had taken a TNF inhibitor.

Ten cases of cancer were diagnosed among the children with JIA. These cancers included brain, leukemia, soft tissue, gastrointestinal tract, and uterus.

• Compared with the children who did not have JIA, children with JIA were more than four times more likely to develop cancer.
• The subset of children with JIA treated with methotrexate had a risk of cancer that was similar to the overall JIA group.
• No cases of cancer were identified among JIA children treated with TNF inhibitors.

These results suggest that children with JIA have a higher risk of cancer than other children. This increased risk, however, does not appear to be due to drugs used to treat JIA. Larger studies with longer follow-up will be necessary to confirm these findings.

Reference: Beukelman T, Haynes K, Curtis JR et al. Rates of malignancy associated with juvenile idiopathic arthritis and its treatment. Arthritis and Rheumatism. Early online publication February 13, 2012.

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Hodgkin’s lymphoma is a cancer of the lymph system. It is diagnosed by the presence of a cell that is characteristic of the disease, the Reed-Sternberg cell. Hodgkin’s lymphoma typically begins in the lymph nodes in one region of the body and then spreads throughout the lymph system. It may spread outside the lymph system to other organs, such as the lungs, liver, bone, and bone marrow.

A chemotherapy regimen known as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is commonly used in the initial treatment of Hodgkin’s lymphoma. Treatment with both ABVD and radiation therapy is effective in controlling Hodgkin’s lymphoma, but can cause later, radiation-related health problems.

To explore the use of chemotherapy alone in the management of limited Hodgkin’s lymphoma, researchers conducted a clinical trial among 405 patients with previously untreated, Stage IA or Stage IIA non-bulky Hodgkin’s lymphoma.[1] Half the patients received chemotherapy alone and half received treatment that included radiation therapy. Radiation was given alone or in combination with chemotherapy, depending on the characteristics of the cancer.

• 12-year overall survival was 94 percent among patients treated with chemotherapy alone, compared with 87 percent among patients who received radiation therapy (with or without chemotherapy).
• Among the patients treated with chemotherapy alone, 6 patients died from Hodgkin’s lymphoma or an early treatment complication and 6 died from another cause.
• Among the patients given treatment that included radiation therapy, 4 patients died from Hodgkin’s lymphoma or an early treatment complication and 20 died from another cause.

These results suggest that for patients with limited Hodgkin’s lymphoma, treatment with chemotherapy alone resulted in better overall survival than treatment that included radiation therapy. Avoidance of radiation therapy reduced the risk of death from other causes.

A limitation of this study is that it began at a time when a more intensive radiation therapy regimen was used. It’s uncertain whether the results of this study would be the same if patients were treated with current approaches to radiation therapy, which may produce fewer long-term health problems.

An accompanying editorial notes “Although radiation therapy remains a useful tool for the treatment of some patients with Hodgkin’s lymphoma, the challenge is to define the subgroup of patients for whom the benefits outweigh the increased risk of late complications. Several recent clinical trials are attempting to address this issue…”[2]

References:

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Of the more than 200,000 cases of breast cancer diagnosed each year in theUnited States, roughly 40 percent occur in women over the age of 65. Research that explores how breast cancer outcomes change as women age has the potential to improve care for this large group of women.

To evaluate breast cancer outcomes by age, researchers analyzed information from a clinical trial known as TEAM (Tamoxifen, Exemestane, Adjuvant, Multinational). The study enrolled more than 9,700 postmenopausal women with non-metastatic, hormone receptor-positive breast cancer. All women were treated with surgery and hormonal therapy. Decisions about chemotherapy and/or radiation therapy were left to the treating physician.

Women were followed for just over five years.

• Death from breast cancer occurred in 5.7 percent of women under the age of 65, 6.3 percent of women between the ages of 65 and 74, and 8.3 percent of women age 75 or older.
• Older women continued to be more likely to die from breast cancer even after the researchers accounted for tumor characteristics and other factors known to affect outcomes.

One of the possible explanations for the worse breast cancer outcomes among older women involves treatment. Studies have suggested that older women are less likely than younger women to received standard breast cancer treatments, possibly due to concern that about the ability of older women to tolerate these treatments. In the current study, for example, 48 percent of the oldest women had breast cancer that had spread to the lymph nodes, but only 5 percent received chemotherapy. Older women were also less likely than younger women to receive radiation therapy after a lumpectomy.

Although older women in this study were more likely to die of breast cancer than younger women, it should be noted that most women—regardless of their age—did not die of breast cancer. It should also be noted that all of the women in this study were postmenopausal. This study did not address cancer outcomes in premenopausal women.

Reference: van de Water W, Markopoulos C, van de Velde CJH et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012;307:590-597.

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Follicular lymphoma is an indolent (slow-growing) type of non-Hodgkin’s lymphoma. It involves a type of white blood cell known as a B cell. Low-tumor-burden follicular lymphoma refers to lymphoma with a small tumor size, limited lymph node involvement, and limited or no symptoms.

Rituxan is a targeted therapy that binds to a marker known as CD20 on the surface of B-cells. This binding prompts the immune system to destroy the cell, and may also have direct anticancer effects on the cell.

Early treatment with Rituxan may benefit some patients with low-tumor-burden follicular lymphoma. After initial treatment with Rituxan, however, it’s uncertain whether Rituxan should be continued indefinitely (Rituxan maintenance), or whether additional treatment can be deferred until the lymphoma gets worse (Rituxan as-needed).

To compare these two different approaches to Rituxan treatment, researchers conducted a Phase III clinical trial known as RESORT. The study enrolled 384 people with previously untreated, low-tumor-burden follicular lymphoma. All of the study participants received Rituxan for four weeks. Patients were then assigned to ongoing maintenance therapy with Rituxan (a single dose of Rituxan every three months) or to an as-needed treatment group (four weekly doses of Rituxan when the lymphoma shows signs of worsening).

• Patients in the as-needed group received many fewer doses of Rituxan than patients in the maintenance therapy group (4.5 doses on average, versus 15.8 doses).
• Time to treatment failure (disease progression or nonresponse, or need for other therapy) was similar in the two study groups and better than has been reported previously among untreated (“watch-and-wait”) patients.  Time to treatment failure was 3.6 years in the as-needed group and 3.9 years in the maintenance therapy group. The difference between the two study groups was not statistically significant, suggesting that it could have occurred by chance alone.
• A secondary outcome of interest was time to chemotherapy. After three years of follow-up, 86 percent of patients in the as-needed group had avoided the need for chemotherapy, compared with 95 percent of patients in the maintenance therapy group. This difference favored the maintenance therapy group and was statistically significant (unlikely to be due to chance), but also required many additional Rituxan doses.

These results suggest both approaches to Rituxan are effective for low-tumor-burden follicular lymphoma. The as-needed approach, however, has the advantage of requiring many fewer doses of Rituxan.

Reference: Kahl BS, Hong F, Williams ME et al. Results of Eastern Cooperative Oncology Group Protocol E4402 (RESORT): A randomized Phase III study comparing two different rituximab dosing strategies for low tumor burden follicular lymphoma. Presented at the 53rd Annual Meeting of the American Society of Hematology. December 10-13, 2011. Abstract LBA-6.

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