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New cancer tools allow patients to reconsider chemo

After decades of using one-size-fits-all therapies to combat cancer, doctors are using new tools to help decide when their patients can skip chemotherapy or other harsh treatments. An approach to oncology that has been in place for decades is beginning to yield to an arsenal of long-term clinical studies, genetic tests and novel drugs that target cancer cells and their infrastructure. “What is happening is a combination of new technology and more-targeted cancer drugs,” said Dr Sandra Swain, medical director of the Cancer Institute at Washington Hospital Center and president of the American Society of Clinical Oncology (ASCO). “We've tried the approach of big, nonspecific treatments ... We have found that throwing chemo at patients has not (necessarily) cured them.” Traditional chemotherapy drugs work by interfering with the entire body's system of cell replication, causing harsh side effects like fatigue and hair loss. Since the completion of the human genome project in 2003, scientists have made progress in unlocking the genetic basis of a range of diseases, including cancer. That has paved the way for genetic testing as well as drugs that block specific pathways that cancer cells use to grow and reproduce. Such targeted cancer drugs, which sometimes preclude the need for chemotherapy, are being sold by companies ranging from Pfizer Inc, the world's largest drugmaker, to Ariad Pharmaceuticals Inc, which early this year launched its first drug, to treat leukemia. At the same time, large-scale studies that look at whether some types of patients are better off with less treatment are giving doctors more confidence to hold off on using traditional cancer drugs. Laurie Levin, now 64, was successfully treated in her 20s for non-Hodgkin's lymphoma, but faced a dilemma after being diagnosed with breast cancer in 2005 since the earlier radiation and chemotherapy had already raised her risk of developing heart problems or leukemia. A $4,000 genetic test showed that her breast cancer was unlikely to return, providing the confidence to undergo a lumpectomy and avoid chemotherapy. “It was like someone handed me my life back when I got those results,” she said. Use of the Oncotype DX test, which analyzes genes involved in tumor recurrence, has cut the use of chemotherapy in U.S. breast cancer patients by 20 percent over the past eight years, according to its maker, Genomic Health Inc. The company recently launched a similar test designed to measure whether men with prostate cancer need to undergo surgery or radiation. Tests and studies can clarify treatment, but costs remain on the upswing because the newest drugs are very expensive, with monthly price tags often in the thousands of dollars. By 2016 annual global sales of cancer drugs will nearly triple, to $88 billion from a decade earlier, according to IMS Health. 'RIGHT-SIZING TREATMENT' The “less is more” approach to cancer will be one highlight of ASCO's annual meeting in Chicago that begins at the end of this month. On Wednesday, ASCO released thousands of abstracts on new clinical trials of cancer treatments. One large, long-term study found that most men diagnosed with early-stage seminoma, a common type of testicular cancer, did fine with no treatment following surgery to remove the tumors. Cure rates for the disease have always been quite high. Several European countries, including Denmark where the study was conducted, monitor seminoma patients for any relapse before further treatment. In the United States, about half of early-stage patients are still given radiation or chemotherapy, according to ASCO. “Opting for surveillance spares patients, most of whom are young men, from the harmful side effects of chemotherapy and radiation without diminishing their chances for a long and healthy life,” said ASCO's incoming president, Dr Clifford Hudis, in a statement. Physicians say it is difficult to quantify in statistics, but there is growing recognition that less is more in terms of potentially toxic cancer treatments. The approach is especially important for young patients who will have many years ahead of them after beating an initial bout of cancer. “We are right-sizing treatment,” said Dr. James Mohler, chair of the department of urology at Roswell Park Cancer Institute in Buffalo, New York. He pointed to recent national guidelines calling for “active surveillance” of older men diagnosed with slower-growing prostate cancer. A study presented earlier this year at an ASCO meeting in Florida found similar survival rates for men with high-risk prostate cancer who received radiation and either 18 or 36 months of hormone therapy. The findings suggest the therapy, which causes significant side effects, could be given for less than the current standard of 24 to 36 months. Another recent study out of the Duke Cancer Institute in Durham, North Carolina, found that survival odds for women with early-stage breast cancer who underwent breast-preserving surgery such as lumpectomy were as good as, or even better than, the odds for women who had mastectomies. “We are going to see reevaluations of very successful therapies to determine whether or not we can achieve the same results using less treatment,” said Dr Armand Keating, director of the hematology division at the University of Toronto and president of the American Society of Hematology. The first-ever study showing that a type of leukemia could be cured without using chemotherapy was released in December. The Italian-German study found that a combination of a derivative of vitamin A, known as ATRA, and arsenic trioxide, a newer drug, worked as well as ATRA and chemotherapy in patients newly diagnosed with acute promyelocytic leukemia (APL). “APL used to be one of the most dreaded strains of cancer, but with ATRA and chemo the results are very gratifying,” Keating said. “Now we have two agents that are not chemo agents ... That to me is a milestone. I can't see any reason why this wouldn't become the standard of care.” A recent trial conducted in France found that omitting standard chemotherapy, which has been linked to heart damage, from the initial treatment of a type of childhood leukemia did not reduce survival outcomes. “The nice thing is you have omitted a potentially toxic agent that contributes to morbidity and maybe mortality down the road,” Keating said. The priciest therapies are designed to take advantage of genetic mutations associated with cancer cells, some of them found only in a small percentage of patients. A new drug for melanoma, BRAF inhibitor Zelboraf from Roche Holding AG, is designed to work by targeting a specific genetic mutation found in about half of all melanomas. Patients are first tested to see if they have it. Pfizer's lung-cancer drug Xalkori, which targets a mutation in the ALK gene, works in about 4 percent of lung cancer patients. It also has been effective as a treatment for a rare but aggressive type of childhood lymphoma. “We've been really trying for years to be more precise about who needs treatment ... Now we are more able to achieve it,” said Swain.source : http://www.foxnews.com/health/2013/05/16/new-cancer-tools-allow-patients-to-reconsider-chemo/

First prospective trial shows molecular profiling timely for tailoring therapy

CUSTOM is the first completed prospective clinical trial that used genetic analysis alone to assign cancer treatment for patients with one of three different cancers. "We expected it would take five years to enroll 600 patients into CUSTOM. But in less than two years, 668 patients were recruited," says the study’s lead investigator, Giuseppe Giaccone, MD, PhD, associate director for clinical research at Georgetown Lombardi Comprehensive Cancer Center. "This was a surprise to all of us, especially since patients with advanced cancer who already had biopsies needed to undergo an additional biopsy for the study. …

Ultra-low salt intake may not boost health, U.S. panel says

Americans at high risk for heart problems who have been told for years to sharply cut salt from their diet may not actually benefit from ultra-low sodium diets and could even face some harm, an independent panel of health experts said on Tuesday. The influential Institute of Medicine, in a report to U.S. health officials, reviewed the latest data on the link between salt intake and health. While blacks, diabetics and others more likely to have heart problems are urged to slash their salt intake, the IOM review showed there was limited evidence such a diet helped, and that too little salt might increase the risk of heart trouble. “The evidence on both the benefit and harm is not strong enough to indicate that these subgroups should be treated differently from the general U.S. population,” the panel wrote. That suggests higher-risk populations may not need such a drastic reduction of salt in their diets and that other steps to curb heart disease risk may be needed. Americans are still consuming far too much salt, the IOM experts said. On average, U.S. adults eat about 1.5 teaspoons of salt over the course of the day, or about 3,400 milligrams. Federal guidelines recommend that healthy people consume no more than 2,300 milligrams daily. But the latest data calls into question whether individuals with higher risk factors for heart disease or stroke should limit their daily intake to 1,500 milligrams, as the government recommends. Brian Strom, the panel's chairman and a public health professor at the University of Pennsylvania, said the newest studies back the known benefits of “reducing sodium from very high intake levels to moderate levels.” “But they also suggest that lowering sodium intake too much may actually increase a person's risk of some health problems,” he said, including heart ailments. Still, the studies are limited and in some cases flawed, so more research is needed, the IOM panel told the Centers for Disease Control and Prevention, which requested the report. Health advocates including the American Heart Association were quick to dismiss the findings, saying the recent studies reviewed by IOM focused on sick patients and not the majority of Americans, most of whom eat too much salt. “The bottom line for consumers is still: cut back on sodium,” said the Center for Science in the Public Interest's (CSPI) Bonnie Liebman. 'IT'S PRETTY TOUGH' The problem is not just food loaded with salt. It's also that Americans eat a lot of food that contains lower amounts of salt, such as bread and pasta, without realizing their sodium content. Health officials have called for Americans to take various steps to cut back, such as asking for no-salt dishes in restaurants and eating more naturally low-salt foods like fruits and vegetables. Health advocates said the IOM's review was beside the point given the high levels of sodium that still plague U.S. foods. It's almost impossible to ingest just 1,500 milligrams a day, said Liebman, director of nutrition for CSPI. “Virtually any meal at any restaurant would give you at least half-a-day's worth of sodium, maybe a whole day's worth, maybe more,” Liebman said. “You'd have to make everything from scratch. ... It's pretty tough.” Consumer groups and some lawmakers have for years called on the U.S. Food and Drug Administration to set federal salt levels for food, a recommendation that the IOM backed in 2010. In New York City, health officials have been working with restaurants and food companies to voluntarily remove salt from everyday foods. A trio of studies published on Monday found that smaller restaurants still load their food with salt even as national chains and food manufacturers have cut back.  The FDA, in a statement, said it was reviewing the IOM's report, calling it consistent with its “efforts to work toward achievable and reasonable voluntary reductions in the sodium content of the U.S. food supply.” IOM was not asked to review current federal salt intake guidelines, which were issued in 2010. U.S. health officials are expected to revise the guidelines on salt and other nutrients in 2015.source : http://www.foxnews.com/health/2013/05/15/ultra-low-salt-intake-may-not-boost-health-us-panel-says/

Study IDs key protein for cell death

When cells suffer too much DNA damage, they are usually forced to undergo programmed cell death, or apoptosis. However, cancer cells often ignore these signals, flourishing even after chemotherapy drugs have ravaged their DNA. A new finding from MIT researchers may offer a way to overcome that resistance: The team has identified a key protein involved in an alternative death pathway known as programmed necrosis. …

Doctors should ask patients about alcohol misuse, panel says

Primary care doctors should ask adults how much and how often they drink alcohol and counsel those with risky and dangerous drinking habits, a government-backed panel said today. Based on a review of studies conducted since 1985, the U.S. Preventive Services Task Force (USPSTF) determined there is good enough evidence both that screening can accurately detect alcohol misuse and that counseling can reduce heavy drinking in people age 18 and older. Screening “takes hardly any time at all, and it works pretty well,” said Dr. Michael LeFevre, co-vice chair of the Task Force and a family medicine doctor at the University of Missouri School of Medicine in Columbia. “From my point of view as a family physician, the shorter and easier the better,” he said. Risky drinking is defined by the National Institute on Alcohol Abuse and Alcoholism as more than four drinks in a single day or 14 drinks per week for men and more than three drinks in a day or seven in a week for women. Research suggests about one third of U.S. adults misuse alcohol. Asking men the last time they had five drinks in one sitting, and women the last time they had four, is a good start, according to LeFevre. “If they can name a time, that means we should be talking to them more about what their alcohol consumption looks like,” he said. If that time was for the patient's birthday, and the only time in years the patient had binge drank, it's probably not a big deal. But if that happens on a regular basis, he said, that would point toward alcohol misuse. The review behind the new recommendations included 23 trials that randomly assigned risky drinkers to behavioral counseling or normal care. Overall, counseling interventions led to a 12 percent absolute increase in the proportion of people who reported no heavy drinking episodes one year later, and an average reduction in weekly drinks from 23 to 19. Brief counseling sessions, the USPSTF noted, are more likely to help people who have a few too many drinks on occasion than those who abuse or are dependent on alcohol. People with a serious drinking problem may need more specialty treatment, according to the Task Force, which published its recommendations Monday in the Annals of Internal Medicine. “A brief intervention as applied by, say, a primary care physician in practice is probably not going to be adequate intervention for people on the alcohol dependence end of the spectrum,” LeFevre said. The USPSTF said there weren't enough data for it to weigh the possible benefits and harms of asking younger teenagers about their alcohol use. “The Task Force felt that it would be inappropriate to assume that what we have learned about the best ways to screen and manage adults (is) in fact applicable to adolescents,” LeFevre said. However, he added, that's not a recommendation against asking teens about their alcohol use - it's just a call for more studies to figure out the most effective way to do that. Dr. Sharon Levy said she hoped doctors didn't choose not to talk to teens about alcohol based on the new recommendations. “We recognize that there's not a lot of data, but we also recognize that alcohol use is one of the most significant contributors to (illness) and mortality in adolescents,” said Levy, director of the Adolescent Substance Abuse Program at Children's Hospital Boston. “There's no question that alcohol use is a serious problem for this age group,” she said. Levy, who wasn't involved in drafting the new guidelines, co-authored a statement from the American Academy of Pediatrics recommending that doctors screen adolescents for drug and alcohol use. She said the type of brief interventions recommended for adults who drink too much are also “developmentally appropriate” for teens. “They work with adults and they seem really adaptable,” Levy said.source : http://www.foxnews.com/health/2013/05/14/doctors-should-ask-patients-about-alcohol-misuse-panel-says/

Fish oil doesn’t seem to help age-related macular degeneration

Another key finding of the Age-Related Eye Disease Study 2, or AREDS 2, is that lutein and zeaxanthin may be safer than beta-carotene in reducing risk of disease progression. "If you look at all the analysis performed in the AREDS 2 study, it looks like lutein taken with zeaxanthin is at least as effective and may be better than beta-carotene," Brown said. "If you also consider that beta-carotene was associated with increased lung cancer rates in all former smokers, I no longer recommend any formulations containing beta-carotene." Researchers saw a modest decrease in the development of age-related macular degeneration (AMD) among those who took high amounts of zinc, but that result was not statistically significant. …

Breakthrough in the understanding of how pancreatic cancer cells ingest nutrients points to new drug target

Now new research reveals a possible chink in the armor of this recalcitrant disease. Many cancers, including pancreatic, lung, and colon cancer, feature a mutated protein known as Ras that plays a central role in a complex molecular chain of events that drives cancer cell growth and proliferation…

Four new genetic risk factors for testicular cancer identified

The discovery of these genetic variations — chromosomal "typos," so to speak — could ultimately help researchers better understand which men are at high risk and allow for early detection or prevention of the disease. "As we continue to cast a wider net, we identify additional genetic risk factors, which point to new mechanisms for disease," said Katherine L. Nathanson, MD, associate professor in the division of Translational Medicine and Human Genetics within the department of Medicine. …

Popular diabetes drug does not improve survival rates after cancer

The study, published in the journal Diabetes Care, failed to show an improved survival rate in older breast cancer patients with diabetes taking the drug metformin, a first-line treatment for diabetes. However, the authors caution further research is necessary to validate the study’s findings. "Metformin is a drug commonly used by diabetic patients to control the amount of glucose in their blood," said the study’s lead author Dr. Iliana Lega, a research fellow at Women’s College Research Institute…