Uterine (endometrial) cancer is the most common gynecologic cancer in the United States, with more than 42,000 new diagnoses each year.[1] Many women are diagnosed with early-stage disease, and primary treatment often involves surgical removal of the uterus, ovaries, and fallopian tubes.

After surgery, additional treatment with radiation therapy can reduce the risk of locoregional cancer recurrence (recurrence in the vagina or pelvis) among women at higher risk of recurrence. Radiation therapy is often delivered by external beam radiation therapy to the pelvis, but this approach can result in side effects such as diarrhea.

Because the vagina is a common site of endometrial cancer recurrence, researchers conducted a study known as PORTEC-2 to compare vaginal brachytherapy to external beam radiation therapy among women with high-intermediate risk endometrial cancer.[2] Vaginal brachytherapy involves the placement of radioactive material within the vagina. The hope was that vaginal brachytherapy would provide a similar level of cancer control as external beam radiation therapy, with fewer side effects.

The study enrolled 427 women from 19 Dutch radiation oncology centers. The women had Stage I or IIA high-intermediate risk endometrial cancer. After surgery, the women were assigned to receive radiation therapy with either pelvic external beam radiation therapy or vaginal brachytherapy. The primary outcome of interest was the rate of vaginal recurrence.

• Estimated five-year risk of vaginal recurrence was 1.8% among women treated with vaginal brachytherapy and 1.6% among women treated with external beam radiation therapy.
• Estimated five-year risk of vaginal or pelvic recurrence or both was 5.1% among women treated with vaginal brachytherapy and 2.1% among women treated with external beam radiation therapy.
• Overall and disease-free survivals were similar in the two groups.
• Rates of gastrointestinal side effects were lower among women treated with vaginal brachytherapy than among women treated with external beam radiation therapy (12.6% versus 53.8%).

The results indicate that vaginal brachytherapy is as effective as external beam radiation therapy at reducing the risk of vaginal recurrence, and also produces fewer side effects. The researchers conclude: “[Vaginal brachytherapy] should be the adjuvant treatment of choice for patients with endometrial carcinoma of high-intermediate risk.” These results do not apply to patients with high-risk or advanced disease.

References:

[2] Nout RA, Smit VTHBM, Putter H et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375:816-23.

Twenty to 25 percent of breast cancers overexpress (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells and a worse breast cancer prognosis. Fortunately, the development of drugs such as Herceptin® (trastuzumab) that target HER2-positive cells has improved prognosis for women with HER2-positive breast cancer.

Neratinib is an investigational, oral medication that targets HER2 as well as HER4 and the epidermal growth factor receptor (EGFR).

To evaluate neratinib in the treatment of advanced, HER2-positive breast cancer, researchers conducted a Phase II clinical trial. The study enrolled 136 women with Stage IIIB, IIIC, or IV, HER2-positive breast cancer. Roughly half the women had received prior treatment with Herceptin.

All study participants were treated with oral neratinib once daily.

• 16-week progression-free survival was 59% among women who had previously been treated with Herceptin and 78% among women with no prior Herceptin.
• A response to treatment was observed in 24% of women who had been previously treated with Herceptin and 56% of women with no prior Herceptin.
• The most common side effects of neratinib were diarrhea, nausea, vomiting, and fatigue.

The researchers concluded that neratinib is active and reasonably well tolerated among women with advanced, HER2-positive breast cancer. Neratinib will continue to be evaluated in breast cancer clinical trials.

Reference: Burstein HJ, Sun Y, Dirix LY et al. Neratinib, an irreversible ErbB Receptor tyrosine kinase inhibitor, in patients with advanced ErbB2-positive breast cancer. Journal of Clinical Oncology. 2010; 28: 1301-1307.

Non-Hodgkin’s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. It is characterized by excessive accumulation of cancerous lymphocytes, which can crowd the lymph system and suppress the formation and function of other immune and blood cells.

To explore how outcomes vary among young people with NHL, researchers collected information from large cancer registries. From 1992 through 2001, information was available for 2,442 NHL patients between the ages of 0 and 29.

Compared with children and adolescents, young adults (20-29 years of age) were roughly twice as likely to die. Differences in survival by age persisted even after accounting for stage at diagnosis and NHL subtype.

These results suggest that young adults with NHL have a higher risk of death than children and teens with NHL. In order to improve outcomes among young adults, the researchers recommend greater enrollment in clinical trials and increased access to care.

Reference: Tai E, Pollack LA, Townsend J, Li J, Steele CB, Richardson LC. Differences in non-Hodgkin lymphoma survival between young adults and children. Archives of Pediatrics and Adolescent Medicine. 2010;164:218-224.



The kidneys are each filled with tiny tubules that clean and filter the blood; this process removes waste and makes urine. Renal cell cancer (RCC) is a malignancy involving these tubules of the kidney.

Small RCC is usually treated with nephron-sparing surgery or, more recently, cryoablation. Radiofrequency ablation (RFA) is commonly used for the treatment of tumors that are not amenable to surgery in the liver, lung, and elsewhere. The procedure involves the use of a small probe that is inserted into the site of cancer. The physician guides the probe through CT or MRI scans so that the treatment can be contained to the site of cancer, limiting the effect on surrounding tissue. Radio waves flow through the probe to the site of cancer, thereby destroying the cells. RFA typically requires local anesthesia, and affects only the site of cancer without causing side effects to the rest of the body. RFA is currently being evaluated in a variety of tumors in different parts of the body.

The current study included 124 patients with small kidney growths (median tumor size 2.8 cm) treated with RFA. Of 108 pretreatment biopsies, 77 were positive for RCC.  Some patients had metastatic RCC; radiofrequency ablation was used to treat the primary lesion.

The one- and three-year local recurrence-free survivals were 99.0% and 94.6%, respectively. There were eight deaths from RCC, but all had metastatic disease at the time of treatment with radiofrequency ablation.

These authors concluded: “RFA of small renal masses is a reasonable option offering good local control for renal primary tumors in selected patients with localized or metastatic RCC.”

Reference: Karam JA, Ahrar K, Jonasch E, et al. Radiofrequency ablation (RFA) of renal tumors: Clinical, radiographic and pathological results from a tertiary cancer center. 2010 Genitourinary Cancers Symposium; abstract number 316.

Each year an estimated 300,000 surgeries are performed in the United States to evaluate ovarian masses. For women with ovarian cancer, outcomes tend to be best when surgery is performed by a gynecologic oncologist. Before surgery is performed, however, it can be difficult to predict which ovarian masses are cancerous.

If standard clinical and radiological assessments suggest ovarian cancer, referral to a gynecologic oncologist is appropriate. If these tests are negative, however, additional testing with OVA1 may be useful in guiding surgeon selection. The OVA1 test uses a blood test to assess the levels of five proteins that may change due to ovarian cancer. The results of the test provide information about the likelihood that an ovarian mass is cancerous.

The test has been shown to identify women who would benefit from surgery by a gynecologic oncologist but who were not identified as such by standard pre-surgical evaluation.

The OVA1 test has been cleared by the U.S. Food and Drug Administration. It is intended only for women who are 18 years of age or older and who are already selected for surgery because of an ovarian mass. The test is not intended to be used as a screening or diagnostic test. The test can supplement (but not replace) other standard clinical and radiological tests.

References:

FDA news release. FDA clears a test for ovarian cancer. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm182057.htm Accessed March 10, 2010.

Quest Diagnostics press release. OVA1 Blood Test Now Available to Aid Pre-surgical Evaluation of Women for Ovarian Cancer. Available at: http://questdiagnostics.mediaroom.com/index.php?s=43&item=397 Accessed March 10, 2010.

Obesity is increasingly being recognized as a risk factor not only for cancer development but also for worse outcomes after cancer treatment. Links between obesity and endometrial cancer, postmenopausal breast cancer, and colorectal cancer are well established, but the effects of obesity appear to extend to several other types of cancer as well.

Body mass index (BMI) is a commonly used (though imperfect) measure of body size. It involves a comparison of weight to height (weight in kilograms divided by height in meters squared). A BMI between 18.5 and 24.9 is generally considered healthy, a BMI between 25 and 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.

To assess the relationship between BMI and colon cancer prognosis, researchers evaluated more than 4,000 people with Stage II or Stage III colon cancer.

Twenty percent of the patients had a BMI of 30 or greater.

Obesity was linked with worse overall survival and a higher risk of cancer recurrence. The impact of obesity on prognosis appeared to be greater for men than for women.

The results provide additional evidence regarding the adverse effects of obesity on cancer prognosis.

Reference: Sinicrope FA, Foster NR, Sargent DJ, O’Connell MJ, Rankin C. Obesity is an independent prognostic variable in colon cancer survivors. Clinical Cancer Research. 2010;16:1884-93.

Oncotype DX is a genomic test that has been shown to predict the likelihood of distant cancer recurrence and the likelihood of chemotherapy benefit in women with early-stage, estrogen receptor-positive breast cancer that is treated with tamoxifen. The test evaluates the activity of 21 genes from a sample of the patient’s cancer to determine the patient’s Recurrence Score. The higher the Recurrence Score, the higher the risk of cancer recurrence. Oncotype DX has been added to U.S. medical guidelines for early-stage breast cancer.

The current analysis assessed how the Recurrence Score performed among women treated with the aromatase inhibitor drug Arimidex and among those with node-positive breast cancer.

The researchers collected information from 1,231 women who participated in the ATAC (Arimidex, Tamoxifen, Alone or in Combination) study. The study enrolled postmenopausal women with early, hormone receptor-positive breast cancer. Study participants received hormonal therapy with either tamoxifen or Arimidex.

The Recurrence Score (RS) predicted the risk of distant cancer recurrence among women with node-negative and node-positive breast cancer:

• Among women with node-negative breast cancer, nine-year risk of distant cancer recurrence was 4% among women with a low Recurrence Score, 12% among women with an intermediate Recurrence Score, and 25% among women with a high Recurrence Score.
• Among women with node-positive breast cancer, nine-year risk of distant cancer recurrence was 17% among women with a low Recurrence Score, 28% among women with an intermediate Recurrence Score, and 49% among women with a high Recurrence Score.

The relationship between Recurrence Score and risk of distant cancer recurrence was similar regardless of the type of hormonal therapy that the women received.

This study suggests that the Oncotype DX test provides information about risk of distant cancer recurrence in both node-negative and node-positive, hormone-receptor positive breast cancer. Furthermore, Oncotype DX was predictive of distant recurrence risk among women treated with tamoxifen as well as women treated with Arimidex.

Reference: Dowsett M, Cuzick J, Wales C et al. Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study. Journal of Clinical Oncology [early online publication]. March 8, 2010.

Early-stage prostate cancer refers to Stage I or II prostate cancer that is limited to the prostate and nearby lymph nodes and has not spread from the prostate to distant sites in the body. Men who have intermediate-risk, early-stage prostate cancer have disease that is likely to recur.

Standard therapy for early-stage prostate cancer may include surgery, radiation therapy, watchful waiting (no treatment until disease progression), and hormone therapy. Optimal treatment for early prostate cancer is still under debate, though it appears that individualized approaches may provide the best outcomes.

Though hormone therapy is often used to slow the growth of advanced prostate cancer, its use in early-stage cancer is still being evaluated. A large Phase III Radiation Therapy Oncology Group (RTOG) study involved 1,979 men with early-stage prostate cancer who had a PSA of 20 or less; 987 men received four months of hormone therapy (HRT), starting two months prior to radiation therapy, and 992 men received the standard treatment of radiation therapy alone.

After a median follow-up of 8.4 years in the HRT group and 8.1 years in the radiation-only group, 51% of patients who received HRT were still alive at 12 years compared with 46% of those who received radiation alone. The survival benefit appeared to be greatest for men with intermediate-risk disease; men with low-risk disease did not benefit from the addition of HRT. Furthermore, two years following treatment, 843 men underwent prostate biopsies. Seventy-eight percent of biopsies in the HRT group showed no cancer compared with 60% in the radiation-only group. The hormone therapy was well tolerated.

The researchers concluded that men with intermediate-risk, early-stage prostate cancer may benefit from the addition of HRT to radiation. Research will be ongoing to evaluate the risks and benefits of this treatment strategy.

Reference:

Bladder cancer is common; approximately 55,000 new cases are diagnosed in the U.S. each year. Superficial bladder cancer refers to cancer that has not spread to muscles of the bladder or nearby lymph nodes. Patients treated for superficial, or early-stage, bladder cancer have a high risk of recurrence and typically undergo routine screening with cystoscopy every three to six months. (During a cystoscopy, a physician places a lighted tube into the bladder to search for abnormal areas of tissue that indicate cancer.)

Because cystoscopy can miss some cancers, some physicians have begun to test the urine for certain cancer biomarkers in the hopes of increasing the likelihood of detecting a cancer recurrence early. However, it has been unclear whether these tests improve cancer detection.

Researchers at the University of Texas M. D. Anderson Cancer Center performed an analysis comparing the accuracy and costs of bladder cancer surveillance strategies in 200 patients with a history of bladder cancer. They compared the use of cystoscopy alone with the use of cystoscopy and several urine tests (NMP22, FISH, cytology, and NMP22 plus FISH to confirm abnormal NMP22).

They found that cystoscopy alone was the least expensive test ($7,692) and was also associated with the fewest false-positive results (two). Cystoscopy plus the urine biomarker tests grew increasingly more expensive. Cystoscopy plus FISH was the most expensive screening method ($19,111) and also resulted in the highest number of false-positive results (30). Notably, the urine tests did not appear to improve tumor detection.

The researchers concluded that cystoscopy alone is the most cost-effective method for monitoring for bladder cancer recurrence and also results in the fewest false-positive tests.

Reference:

Since the late 1980s, the primary screening tool for early detection of prostate cancer has been the prostate specific antigen (PSA) test. While this test is widely used, it remains controversial, due to both false positive and false negative test results. Produced by cells in the prostate, PSA levels in the blood tend to be elevated in men who have prostate cancer. However, not all men with prostate cancer have elevated PSA, and not all men with elevated PSA have prostate cancer. PSA levels can also become elevated as a result of noncancerous conditions of the prostate.

Men who have elevated levels of PSA are often referred for a prostate biopsy in order to determine whether prostate cancer is present. Men who have a negative first biopsy, however, are often likely to remain uncertain about their risk of prostate cancer. This is because a biopsy only samples small areas of the prostate, and it’s not uncommon for a repeat biopsy to detect cancer that was missed by the first biopsy.

PCA3 is a test that could potentially help guide decisions about the need for repeat prostate biopsy in men suspected of having prostate cancer. PCA3 (prostate cancer gene 3) is overexpressed in men with prostate cancer but not in men with noncancerous prostate problems. The PCA3 test measures PCA3 expression in a sample of urine.

In the study presented at the Genitourinary Cancers Symposium, the PCA3 test was evaluated in 1,072 men who had PSA levels between 2.5 and 10 ng/mL and a negative initial biopsy. Repeat biopsies were performed after the second and fourth year of the study.

• A higher PCA3 result indicated a greater likelihood of finding prostate cancer on a repeat prostate biopsy. Prostate cancer was diagnosed in only 6% of men with a low PCA3 score but in 57% of men with a high PCA3 score.
• PCA3 results were correlated with cancer aggressiveness: men with high-grade cancers tended to have higher PCA3 results than men with low-grade cancer.
• PCA3 results also provided information about the likelihood of a future positive biopsy: men who had high PCA3 but a negative prostate biopsy at the two-year mark were more than twice as likely to have prostate cancer detected at the four-year mark than men with low PCA3.

These results suggest that the PCA3 test provides useful information about the need for repeat prostate biopsy in men with elevated PSA.

Reference: Groskopf J, Aubin SM, Reid J et al. Validation of the PCA3 molecular urine test for predicting repeat prostate biopsy outcome in the placebo arm of the dutasteride REDUCE trial. Presented at the ASCO 2010 Genitourinary Cancers Symposium. March 5-7, 2010. San Francisco, CA. Abstract 5.