Men whose brothers have aggressive prostate cancer at increased riskal. J Clin Oncol. 2018;doi:10.1200/JCO.2017.76.6907.

Men whose brothers had non-low-risk prostate cancer faced a significantly increased risk for developing an aggressive form of the malignancy, according to results of a study conducted in Sweden.

Men with one or two first-degree relatives with prostate cancer have a two- to fivefold increased risk [for] being diagnosed with prostate cancer compared with men with no family history of prostate cancer, and the risk is also increased among men with second- and third-degree relatives with prostate cancer. Previous twin studies have assessed the concordance of a prostate cancer diagnosis but not the concordance of the type of prostate cancer. “If there is prognostic concordance within families, then knowledge of tumor characteristics and disease development among relatives may be helpful when counseling men with suspected or newly diagnosed prostate cancer.”

The researchers used the Swedish Prostate Cancer Database to identify 4,262 sets of brothers who both were diagnosed with prostate cancer. Jansson and colleagues categorized cancers as either low risk (Gleason score, 6 or lower; clinical stage, T1 to T2; PSA, 10 ng/mL or less) or non-low risk. They used logistic regression to calculate odds ratios for concordance of non-low-risk cancer among monozygotic twins, dizygotic twins, full brothers and half brothers.

After adjusting for year of diagnosis and age, the highest concordance of non-low-risk disease occurred among monozygotic twins (OR = 3.82; 95% CI, 0.99-16.72). Full brothers also had a significant concordance (OR = 1.21; 95% CI, 1.04-1.39). These results persisted when researchers restricted analysis to brothers diagnosed within 4 years of each other.

Monozygotic twins had a significantly shorter median time between diagnoses than other groups (1.1 years) than full brothers (3.2 years; P < .001), dizygotic twins (2.8 years; P < .014), paternal half brothers (4.1 years; P < .001) and maternal half brothers (3 years; P < .003). The results suggest that a man whose brother has been diagnosed with a non-low-risk prostate cancer is at a clinically relevant increased risk for] developing an aggressive prostate cancer himself.

https://www.healio.com/hematology-oncology/prostate-cancer/news/in-the-journals/%7B6ae1a9af-356a-4699-ab69-44d7ae3c119f%7D/men-whose-brothers-have-aggressive-prostate-cancer-at-increased-risk

Low-fat diet improves breast cancer survival

Chlebowski RT, et al. JAMA Oncol. 2018;doi:10.1001/jamaoncol.2018.1212.

Women diagnosed  with breast cancer while eating a low-fat diet had better OS than those who ate a usual diet, according to a secondary analysis of a randomized trial. This reduction in mortality appeared partly due to increased survival from other health issues.

Researchers of the randomized Women’s Health Initiative study assessed the impact of a low-fat diet on the prevention of breast cancer. During follow-up, researchers observed significantly fewer deaths among women with breast cancer in the dietary intervention group (HR = 0.82; 95% CI, 0.7-0.96).The observed favorable effects on deaths after breast cancer could have resulted from prediagnosis dietary influences on cancer characteristics.

The trial was conducted at 40 centers across the U.S. from 1993 through 1998 — which included 48,835 postmenopausal women with no breast cancer history and a dietary fat intake of more than 32%.

The dietary intervention (n = 19,541; 40%) reduced participants’ fat intake to 20%, as well as increased consumption of fruits, vegetables and grains. Women diagnosed with breast cancer during the study continued the dietary intervention.

Post hoc analyses for OS for breast cancer diagnosed during the intervention, which ran for a median of 8.5 years, served as the main outcome. Analyses occurred after a median of 11.5 years following diagnosis.

A total of 1,764 women were diagnosed with breast cancer during the intervention period. Median age at screening was 62.7 years, and median age at time of diagnosis was 67.6 years.

A total of 516 women died.

Breast cancer OS in the dietary intervention group significantly improved compared with the usual diet group (10-year OS, 82% vs. 78%; HR = 0.78; 95% CI, 0.62-0.94).

Sixty-eight women in the dietary group died of breast cancer compared with 120 in the usual diet group (HR = 0.86; 95% CI, 0.64-1.17).

Fewer women in the dietary group died of other cancers (36 vs. 65; HR = 0.76; 95% CI, 0.5-1.17), or of cardiovascular disease (27 vs. 64; HR = 0.62; 95% CI, 0.39-0.99).

The researchers acknowledged that the study was limited by a “modest” increase in fruit, vegetable and grain intake, as well as incomplete information on patients’ breast cancer therapies.

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“In women who received a diagnosis of breast cancer during the dietary intervention period, those in the dietary group had increased breast cancer OS compared with those in the usual-diet comparison group,” the researchers wrote. “This increase is likely due, in part, to better survival from several causes of death.”

https://www.healio.com/hematology-oncology/breast-cancer/news/in-the-journals/%7B9be1c3f1-25ad-4f30-b1d7-4df1a978f34b%7D/low-fat-diet-improves-breast-cancer-survival

 

Breath analysis test shows strong accuracy for detecting esophagogastric cancer

arkar SR, et al. JAMA Oncol. 2018;doi:10.1001/jamaoncol.2018.0991The breath test showed good sensitivity and specificity in detecting early-stage esophagogastric cancer, according to researchers in the U.K.

“Current U.K. referral guidelines for suspected esophagogastric cancers focus on alarm symptoms such as dysphagia and odynophagia, despite these symptoms having poor sensitivity and specificity for esophagogastric cancer and often only occur in advanced disease translating into a poor outcome and overall survival.“

Volatile organic compounds (VOCs) emitted from the human body have been of interest to researchers for several decades, with associations previously suggested between specific volatile organic compounds and breath and lung, bladder and breast cancers. Researchers collected breath samples from 335 patients at three London hospitals (n = 172 in control group, n = 163 with esophagogastric cancer). The researchers then performed selected ion flow tube mass spectrometry analysis on the samples. Researchers sampled the air in hospital rooms, trained researchers in breath sampling, calibrated instruments regularly and conducted unambiguous VOC identification to ensure the quality of the breath samples. Researchers used a previously generated 5-VOCs model to determine the risk for cancer based on the air samples compared with proven diagnoses.

The group with proven cancer was older than those in the control group (median age, 68 years vs. 55 years) and had a larger proportion of men (82.2% vs. 47.4%).

Most patients in the diagnosed group had a tumor stage of T3 or T4 (n = 123; 69%), and most had nodal metastasis (n = 106; 65%).

The breath analysis test demonstrated a sensitivity of 80%, and a specificity of 81%.

“The next stage is a large-scale diagnostic accuracy study among the primary care population where the test is intended to be employed”

https://www.healio.com/hematology-oncology/gastrointestinal-cancer/news/in-the-journals/%7B33e382f0-2f85-43cc-aa68-b26982794c4a%7D/breath-analysis-test-shows-strong-accuracy-for-detecting-esophagogastric-cancer

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