review | gastric cancer

Looking to get a quick update on gastric cancer? Look no further than this review in the BMJ, here.

review | immunotherapy for melanoma

Immunotherapy for melanoma has revolutionised the treatment options for what can be a devastating disease – you’ve seen that we’ve talked time and time again about the newer agents that can be used. But what exactly is their role?

Cancer associated thrombosis

You may have been told before that low molecular weight heparin is more effective than oral anticoagulant therapy for patients with cancer associated DVTs or pulmonary emboli – after all, that data is now over 10 years old. After that though, there are still many more questions to be answered.

How long do you keep going for? How do you manage recurrence? How do you handle those who have a high risk of bleeding? What role do the new anticoagulants play?

There’s a nice little review in Blood that covers these questions and more. Have a read over here.

guideline | cholangiocarcinoma

 

Left of the image looks OK, the right not so much – it’s not the diagnosis, but the treatment that can be hard to manage.

The effects of statin on cancer

In late 2010, we mentioned an article from Gut talking about statins reducing the risk of colorectal cancer, albeit by just 8%. Now there’s a new article from the New England Journal of Medicine suggesting reduced cancer related mortality overall in those on statin therapy.

An update on cervical cancer screening

No one likes getting a Pap smear done. It can be quite daunting and frightening the first time, but we all know that early detection offers the best chance of cure. Over in the US, a joint group including the American Cancer Society have released some brand new guidelines in screening for cervical cancer. 

Put a spi(ri)n on things

There have been previous studies showing the benefit of aspirin as an anti-cancer agent, particularly for colorectal adenomas. This study from the Lancet looks at its use in preventing colorectal cancer itself in those at higher risk (carriers of Lynch syndrome).

Screen with a reason

You might have seen word of this PLCO (Prostate, Lung, Colorectal, Ovarian) trial around the traps; it’s one of the seminal oncology trials of the last decade, and it’s putting out a collection of papers. This one from JAMA looks at the benefit of screening people annually with chest-X rays versus standard of care. 

It’s not a small trial; over 77,000 patients in each arm of the trial. About 4 out of 5 adhered to the annual X-ray program (only 1 of 10 patients were advised to have an annual X-ray) , and followed up for over 10 years. There were similar rates of lung cancer in each group, and importantly, the relative risk of mortality was 0.94 with a non significant confidence interval.


So there you go – have a chest X-ray every year won’t drop your risk of dying from lung cancer. The NEJM has already looked at using CT as a screening tool, but that doesn’t come without risk. 


Check out the article in JAMA. 




source | JAMA
image | NIH

The future of lung cancer? Why, it’s er…lotinib

When you look at chemotherapy regimes carefully, you’ll realise that there are many agents in use that have been around for decades. Over time, doses and timing have been modified, and slowly, we’ve seen the advent of new agents creeping in together with the old stuff. 


We recently talked about the new agents for melanoma, in relation to BRAF, IL-2, and CTLA-4. The acronym in vogue for non-small cell lung cancer? EGFR. 

EGFR, or epidermal growth factor receptor, is one of the tyrosine kinases, in the same family as HER-2. EGFR lives on the surface of the cell, and when mutated, could lead to uncontrolled cell division – and you know what that means. 


In fact, it’s associated with lung, breast, anal and colorectal cancer as well as glioblastoma multiforme. Gefinitib, a tyrosine kinase inhibitor, was the first generation, and was proven to significantly improve progression free survival in patients who have a mutation of EGFR, compared with carboplatin and paclitaxel.


Then there was the SATURN trial, checking out erlotinib as maintenance therapy, where it found a good footing in improving progression free survival after first line chemotherapy. 


Now, there’s this from the Lancet – erlotinib as first line therapy in those with non small cell lung cancer with a proven EGFR mutation. Compared with the combination of gemcitabine and carboplatin, progression free survival was markedly longer – 13.1 months vs 4.6 months. Being more specific than the standard chemotherapy, the side effects were significantly less as well. 


Funded by Roche, but still an interesting result nonetheless, and signals a new area of chemotherapy for solid organ malignancy. Check out this study here. 

The new black

Melanoma, particularly when metastatic is an aggressive disease. Australians are blessed with fantastic sunshine all year round – but it means that the highest rates of melanoma occur here as well. Here’s a round up of three exciting new therapies for melanoma that are changing the face of oncology. 

First up is vemurafenib, a BRAF kinase inhibitor. You may have heard of this one from the phase I and II clinical trials that were in NEJM last year. Certain melanoma cell lines have a BRAF mutation, V600E, which activated the MAP kinase pathway. From the results, progression free survival and overall survival were both prolonged with 84% vs. 64% at 6 months. Here’s the first NEJM article to see, and watch this over at the BBC. 


Ipilimumab (marketing as Yervoy), is a monoclonal antibody against CTLA-4 – cytotoxic T-lymphocyte associated antigen 4, also known as CD 152. This normally sends inhibitor signals to T cells, so by blocking this, the immune system is less tolerant toward the tumour. Sounds good – but does it work? Overall survival goes up by about 2 months, with an survival rates at 3 years of 20.8% vs 12.2% favouring the ipilimumab group, but it does have some pretty powerful potential adverse effects. Read this one here. 


Last but not least, we have the gp100 vaccine combined with IL-2. Both of these stimulate T cells into action, and work synergistically, with the hope of inducing an anti-tumour effect. Certainly the combination of both resulted in improved outcomes over just the IL-2 alone; however the study may not be powered well enough to differentiate the treatment effect alone vs. other factors. This one’s here. 


Immune and molecular therapies are invading all parts of medicine, and melanoma is a particular highlight. This is a great series of articles – have a flip when you get a minute. If you don’t have time for that right now, check out my favourite dermatology website here, and read the latest guidelines on melanoma, here. 


Oh, and don’t forget to remind all your patients to get a skin check. Despite all this treatment, there’s nothing like picking it up early. 


IMAGE National Cancer Institute