Sodium thiosulfate lowers risk for hearing loss among children with hepatoblastoma

Great news to reduce the ototoxicity of the chemotherapy

Children with standard-risk hepatoblastoma who received sodium thiosulfate 6 hours after cisplatin chemotherapy had a 48% lower incidence of cisplatin-induced hearing loss, according to phase 3 results from the SIOPEL 6 clinical trial published in The New England Journal of Medicine.

Cisplatin chemotherapy and surgery are standard treatments for children with standard-risk hepatoblastoma. However, hearing loss – a side effect of cisplatin chemotherapy - can affect learning, development and quality of life among young children.

Previous studies have shown that sodium thiosulfate may have an otoprotective effect, with maximum efficacy when administered 4 to 8 hours after cisplatin therapy.

Researchers randomly assigned children aged 1 month to 18 years to receive 80 mg/m² cisplatin alone over 6 hours (n = 52; median age, 13.4 months) or cisplatin plus 20 g/m² IV sodium thiosulfate (n = 57; median age, 12.8 months) over a 15-minute period, 6 hours after discontinuing cisplatin in four preoperative and two postoperative courses.

Investigators used the Brock grade scale to measure hearing loss.

Absolute hearing threshold at a minimum age of 3.5 years measured by pure-tone audiometry served as the primary endpoint. Secondary endpoints included OS and EFS at 3 years.

The intention-to-treat population comprised 109 children, of whom 101 could be evaluated for the primary endpoint.

Hearing loss of grade 1 or higher occurred among 18 of 55 children (33%; 95% CI, 21-47) evaluated in the cisplatin-sodium thiosulfate group compared with 29 of 46 children (63%; 95% CI, 48-77) in the cisplatin alone group.

The RR of any hearing loss with sodium thiosulfate was 0.52 (95% CI, 0.33-0.81), which indicated a 48% lower risk than with cisplatin alone.

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At median 52 months of follow-up, 3-year OS was 98% (95% CI, 88-100) in the cisplatin-sodium thiosulfate group and 92% (95% CI, 81-97) in the cisplatin-alone group.

https://www.healio.com/hematology-oncology/pediatric-oncology/news/in-the-journals/%7B632aedbb-a705-4b71-8790-7314b1677782%7D/sodium-thiosulfate-lowers-risk-for-hearing-loss-among-children-with-hepatoblastoma.

 

Cancer increases risk for subsequent diabetes

Cancer increased patients’ risk for subsequently developing diabetes, according to results of a cohort study conducted in South Korea.

The researchers performed a cohort study of 524,089 Korean individuals aged 20 to 70 years. The cohort had no history of cancer or diabetes, and they underwent observation for up to 10 years from 2003 to 2013.

Incident cancer served as an exposure, and the main outcome was incident type 2 diabetes following cancer as determined by insurance claim codes.

Over a median 7 years of follow-up for 494,189 individuals (mean age, 41.8 years; 50% women), 15,130 patients developed cancer and 26,610 developed diabetes.

Of those who developed diabetes, 834 patients had previously been diagnosed with cancer (incident rate, 17.4 per 1,000 person-years).

Cancer appeared associated with an increased risk for subsequent diabetes after adjustment for age, sex, precancer diabetes risk factors, metabolic factors and comorbidities (HR = 1.35; 95% CI, 1.26-1.45).

Diabetes risk appeared highest the first 2 years following cancer diagnosis. However, it remained elevated throughout the follow-up period.

Pancreatic cancer had the strongest association with diabetes (HR = 5.15; 95% CI, 3.32-7.99), followed by kidney (HR = 2.06; 95% CI, 1.34-3.16), liver (HR = 1.95; 95% CI, 1.5-2.54), gall bladder (HR = 1.79; 95% CI, 1.08-2.98), lung (HR = 1.74; 95% CI, 1.34-2.24), blood (HR = 1.61; 95% CI, 1.07-2.43), breast (HR = 1.6; 95% CI, 1.27-2.01), stomach (HR = 1.35; 95% CI, 1.16-1.58) and thyroid (HR = 1.33; 95% CI, 1.12-1.59) cancers.

The study was limited by a lack of information on cancer stage, as well as by little information on treatment and outcomes derived from insurance data.

https://www.healio.com/hematology-oncology/gastrointestinal-cancer/news/in-the-journals/%7B8212889b-9fc4-4366-8e8e-13be50cd9182%7D/cancer-increases-risk-for-subsequent-diabetes

Flight attendants at increased risk for breast and skin cancers

Flight attendants showed elevated incidence of several types of cancer compared with the general population, according to findings published in Environmental Health.

Among female flight attendants, the elevated incidence appeared especially pronounced for breast cancer (SPR = 1.51; 95% CI, 1.02-2.24), melanoma (SPR = 2.27; 95% CI, 1.27-4.06) and nonmelanoma skin cancer (SPR = 4.09; 95% CI, 4.7-6.2). Women who had three or more children had an increased incidence of breast cancer which appeared consistent with previous studies.

Male flight attendants demonstrated a modest increase in prevalence of melanoma (SPR = 1.47, 95% CI, 0.72-3.01) and nonmelanoma skin cancers (SPR = 1.11, 95% CI, 0.78-1.59).

Standardized prevalence ratios were increased among male and female flight attendants who had experienced significant job-related secondhand smoke.

The researchers wrote that the results indicated flight attendants in the U.S. should be monitored for radiation exposure and should have their schedules arranged to minimize exposure to radiation and disruption to circadian rhythms.

https://www.healio.com/hematology-oncology/breast-cancer/news/in-the-journals/%7B779e759c-6208-4bc5-9832-00ea4444d4c5%7D/flight-attendants-at-increased-risk-for-breast-skin-cancers?nc=1#searc

 

The emerging field of integrative oncology

Yoga, meditation, acupuncture and more can be safely used to relieve side effects of standard treatment

Integrative oncology coordinates the delivery of evidence-based complementary therapies with conventional cancer care. It’s not about using acupuncture or yoga or meditation or other therapies instead of surgery, chemo, radiation and hormone therapy, but rather using them with standard treatments to alleviate their well-documented side effects. Integrative oncology is informed by scientific, not anecdotal, evidence; it also takes a more holistic approach than conventional Western medicine by catering to a patient’s mind, body and spirit.

The American Society of Clinical Oncology has endorsed the integrative oncology this year. And at the same time has offered advice for a higher recognition of it.

How did the various therapies rank?

1. Meditation, music therapy, yoga and group stress management programs were all recommended for reducing anxiety, while acupuncture, massage and relaxation could be “selectively offered” to individual patients.
2. Acupressure, electro-acupuncture, ginger and relaxation could also be “selectively offered” to individual patients along with anti-emetic drugs for nausea and vomiting during chemo. Use of the supplement glutamine was discouraged, though, due to lack of an effect.
3. Meditation (particularly mindfulness-based stress reduction), relaxation, yoga, massage and music therapy were all recommended for treating depression and mood disturbance while acupuncture, healing touch, and stress management could be “selectively offered” to individual patients.
4. Hypnosis, ginseng, acupuncture and yoga could be “selectively offered” to individual patients to help with treatment-related fatigue, but ASCO advised patients to seek guidance from their health care team before using ginseng or any dietary supplement. Some ginseng has estrogenic properties, which could harm certain breast cancer patients. ASCO also discouraged the use of Acetyl-L-carnitine and guarana for fatigue.
5. Low-level laser therapy, manual lymphatic drainage and compression bandaging, ASCO found, could be “selectively offered” to individual patients for lymphedema.
6. Acupuncture, healing touch, hypnosis and music therapy could also be selectively offered to individual patients for managing pain.
7. Meditation and yoga were recommended for improving quality of life; acupuncture, mistletoe, qigong, reflexology, and stress management could be considered and “selectively offered.”
8. Natural medicine like mistletoe use should only be subcutaneous, since ingestion of high doses of mistletoe berry or leaf can cause serious adverse reactions.

HUGE news with the approval today of pembrolizumab for PD-L1+ cervical cancer... An exciting new option for patients with previously-treated advanced disease.

https://www.onclive.com/web-exclusives/fda-approves-pembrolizumab-for-pdl1-cervical-cancer

High dose of Nexium® with aspirin reduces risk of developing esophageal cancer

A Phase III randomized trial has demonstrated that taking a high dose of the acid-reducing medicine esomeprazole (Nexium®) with low dose aspirin for a minimum of 7 years can reduce the risk of developing esophageal cancer, a pre-cancerous lesion termed high-grade dysplasia or delay death from any cause in people with Barrett’s esophagus. This rare condition increases the risk of esophageal disease by 50-fold.

 A new cancer care dilemma: Patients want immunotherapy even when evidence is lacking

Immunotherapy is a source of great hope in cancer care. It has rescued some patients from the brink, while giving others a reason to believe that they, too, could beat the long odds.

But these therapies are also creating a vexing dilemma for doctors: Their patients, citing television add and media accounts of miraculous recoveries, are pushing hard to try them, even when there is little to no evidence the drugs will work for their particular cancer.

Doctors want to give their patients every shot at survival, but can they justify prescribing a drug when it hasn’t been tested for that patient’s type of cancer? Many of these treatments bring risks of painful — even life-threatening— side effects and carry total price tags pushing $1 million. In some cases, insurers won’t pay.

https://www.statnews.com/2018/06/04/cancer-care-dilemma-immunotherapy/

Systematic review and meta-analysis confirm evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy

Cancer-related malnutrition frequently develops, with prevalence ranging from 30% to 90% depending on tumor site, stage of disease and treatment. Major causes are cancer-induced metabolic alterations and/or cancer-induced symptoms (e.g. anorexia, nausea, pain) resulting in decreased food intake. Malnutrition can be exacerbated by the side-effects of anticancer drugs such as fatigue, anorexia, altered hedonic input and a wide range of GI symptoms, and/or by physical inactivity resulting from physical and psychosocial distress, which may lead to further loss of muscle mass. Malnutrition impairs tolerance to anticancer treatments including chemotherapy and is associated with decreased response to treatment, decreased quality of life (QoL) and shorter survival

Driven by reduced intake and metabolic alterations, cancer-related malnutrition negatively impacts clinical outcomes. A systematic review suggests an overall positive effect of nutritional interventions during chemo(radio)therapy on body weight. Subgroup analyses showed effects were driven by high-protein n-3 PUFA-enriched oral nutritional supplements (ONS), suggesting the benefit of targeting metabolic alterations. Dietary counseling and/or high-energy ONS were less effective, likely due to cumulative caloric deficits despite interventions.

https://academic.oup.com/annonc/article/29/5/1141/4975730