Breast Cancer: Bisphosphonates for Early Stage Disease?

intravenous IV chemotherapy

Yes, these “bone hardening” drugs (such as zoledronic acid) can reduce the risk of recurrence and distant spread, at least among women who are post-menopausal. A meta-analysis (study of studies) of over 22,000 women showed the use of bisphosphonate drugs (after breast cancer surgery) reduced the risk of recurrence by 34% and the risk of breast cancer death by 17% in postmenopausal women. The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported these potentially practice-changing results at the 2013 San Antonio Breast Symposium (USA).

The Study: Adjuvant (after surgery) bisphosphonates achieved reduction in bone recurrence and breast cancer deaths in postmenopausal women, regardless of estrogen receptor or nodal status. It did not matter whether the women had received chemotherapy or not. The drugs had no effects on disease outcome among premenopausal women. Let’s look at the results, with and without bisphosphonates:

  • Recurrence rate: 25.4% with bisphosphonates versus 26.6% without the drug
  • Distant relapse (metastasis) rates: 20.9% with the drug, and 22.3% without it
  • Bone recurrence: 6.9% with the drug, and 8.4% without it
  • Non-bone recurrence rate: 15%, with or without the drug

Perhaps most impressive are these results: Among postmenopausal women, the 10-year rate of death from breast cancer was 15.2% for those treated with bisphosphonates, compared to 18.3% for those receiving no bisphosphonate therapy. The corresponding risks of death from any cause were 21.5% versus 23.8%, respectively.

My Take: These results are striking in postmenopausal women. Will oncologists offer bisphosphonates to postmenopausal women with invasive breast cancer? Guidelines often drive treatment, and I look forward to seeing the bisphosphonates incorporated soon. For now, we can take heart in the fantastic improvements in breast cancer management over the last several decades: Estrogen “blockers” such as tamoxifen and the aromatase inhibitors (AIs) improve survival by nearly a third; Herceptin (trastazumab) by nearly a third for HER2-positive breast cancer, and now this study.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Coleman R, et al: Effects of bisphosphonate treatment on recurrence and cause-specific mortality in women with early breast cancer: A meta-analysis of individual patient data from randomized trials. 2013 San Antonio Breast Cancer Symposium. Abstract S4-07, Presented December 12, 2013.

Breast Cancer: Carboplatin Yields Fabulous Results for Triple Negative Type

cancer management

The results of several studies reported at the 2013 San Antonio (USA) Breast Cancer Symposium are potentially practice-changing. Let’s look at one of those reports: Carboplatin as a neoadjuvant therapy for triple negative (estrogen receptor negative, progesterone receptor negative, HER2 overexpression negative) breast cancer. Those with this subtype of breast cancer received a regimen that included the chemotherapy drug carboplatin. The odds of a pathologic complete response (disappearance of all signs of cancer (under the microscope) in the breast were 60% (compared to 46% for those not receiving this drug as a part of chemotherapy).

My Take: The role of the so-called platinum drug carboplatin as chemotherapy for “triple negative” breast cancer has been debated for many years. We finally have a randomized trial showing that carboplatin clearly increases the pathologic complete response. I think that this study will likely change how patients with this breast cancer subtype are managed, at least when chemotherapy is given before surgery. Still, we do not have long-term data to prove that this improved pathologic complete response rate translates into higher relapse-free numbers, or improved survival. Great study, and good news for those with this particularly risky type of breast cancer. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Sikov WM, et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant weekly paclitaxel followed by dose-dense AC on pathologic complete response rates in triple-negative breast cancer: CALGB 40603. Abstract S5-01. Presented December 13, 2013.

Investigation Drug PARP Inhibitor for Triple-Negative Breast Cancer

breast cancer ribbon naked woman white

Breast cancer has many subtypes. One of the most aggressive is the so-called “triple negative” type. Here, the cancer cells do not have estrogen receptors (so we can’t target these receptors with drugs such as tamoxifen), progesterone receptors, or HER2 (thus drugs that target HER2 won’t work). Many patients with this aggressive subtype of breast cancer will receive chemotherapy, but the results are still typically worse than for the other subtypes. It is in this context that investigators introduced an innovative new way to test new cancer-fighting drugs.

The Study: The I-SPY 2 trial uses an adaptive design to move promising drugs forward in clinical development. In this Phase II study evaluating a novel targeted drug (veliparib) plus chemotherapy (carboplatin) for treatment before surgery, the odds of the tumor disappearing from the breast (under the microscope) were:

  • Chemotherapy alone 26%
  • Chemotherapy plus veliparib 52%

My Take: This study is remarkable for several reasons: 1) the novel design shows that we can start and conduct trials rapidly; 2) we can choose patients based on their cancer’s molecular fingerprint (profile), using drugs based on their targets. With such a design, we may be able to quickly eliminate drugs that are not promising, and advance better ones into higher level clinical trials. In this study, some PARP inhibitors (for example iniparib) didn’t work well, but others did (veliparib). Triple negative breast cancer is challenging, and the I-SPY 2 trial brings new hope. Phase III trials should better define how good veliparib really is. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Rugo, HS, et al. Veliparib/carboplatin plus standard neoadjuvant therapy for high-risk breast cancer: First efficacy results from the I-SPY 2 trial. 2013 San Antonio Breast Cancer Symposium. Abstract S5-02. Presented December 13, 2013.

You Should Know This About Human Papilloma Virus (HPV)

teens teenagers young adults kids children

Americans are more aware that there is a test for human papillomavirus (HPV) than their counterparts in the UK and Australia, according to a new study, but few people know much more than that.

“Awareness of HPV has tended to be low but has been rising since the introduction of testing and vaccination,” said Jo Waller, the study’s senior author.

Background: HPV is a virus that you may not know much about, but you should. There are about 30 to 40 types of HPV that can affect the genital areas. The US Centers for Disease Control and Prevention (CDC) offers that there are about 6 million new cases of genital HPV infections in the USA annually. About 74% are among 15 to 24 year olds. Exposure can occur with any genital contact (not just intercourse), and the virus itself causes no symptoms. F9r many people, HPV is transmitted during their first 2 to 3 years of sexual contact.

  • HPV typically clears on its own. But for those who don’t clear certain subtypes, HPV can cause cervix, vaginal, and vulvar cancer among females. Other types can result in genital warts and anal cancer among both women and men.
  • HPV is now the leading cause (above even tobacco and alcohol) of cancers of the oropharynx (including the base of tongue and tonsils).
  • There is now a vaccine that can help protect against high-risk types of HPV. In the USA, Gardasil may be offered to girls and young women ages 9 to 26. Boys and young men may be offered it, too. Still, only a doctor or health professional can decide (with you) if the vaccine is appropriate for you. The vaccine is not used for treatment.

People seem to be more aware of HPV vaccination than testing, however, which is not surprising given the publicity around the vaccine, added Waller, a public health researcher at University College London.

  • The Pap test used to look for abnormal cell changes in the cervix is much older and generally familiar to most people, but the newer HPV test looks for the virus that causes those changes, Waller said. The HPV test was only introduced in the 1990s and it’s used a little differently in each of the countries that were included in the new study, Waller pointed out.

Worldwide Variation: In the U.S., HPV testing is used as a screening tool in women over the age of 30. In both the U.S. and the UK, HPV testing is also used along with the Pap test to determine the next steps in treatment – for instance, biopsy. In the UK and Australia, the HPV test is also used to monitor treatment results.

Waller said that many studies have attempted to assess the public’s knowledge about HPV and HPV testing, but they all used different methods and asked questions in different ways, so it’s hard to compare the findings. “We wanted to use the same questionnaire to look at knowledge across three countries where HPV testing is used in different ways,” she told Reuters Health in an email.

The Study: The researchers used an online survey to find out if participants in the the U.S., UK and Australia were aware of HPV testing and HPV in general.

  • The first question asked was ‘Before today, had you ever heard of HPV?’ Participants who responded ‘yes’ were then directed to 15 general questions about HPV.
  • Participants were then asked ‘Have you ever heard of HPV testing?’ Those who responded ‘yes’ were asked six more questions about the test.

Of the 2,409 men and women who answered the survey, about 61% had heard of HPV. Among those who had heard of the virus, only half were aware of the HPV test. Awareness of the HPV test was higher in the U.S. than in the UK and Australia.

The participants who had heard of HPV testing, on average, answered less than half of questions about details of testing correctly. Overall, women knew more than men.

  • Most of the survey participants did know, for example, that the HPV test can be done at the same time as the Pap test, and that a positive HPV test doesn’t mean a woman will definitely get cervical cancer.
  • But they didn’t know a negative HPV test indicates a low risk of cervical cancer. Few also knew that the HPV test is not an indicator of whether the HPV vaccine is needed.

“It’s important for people to understand that although the HPV vaccine protects against HPV, it’s still really important for women to have screening, to check for (virus) types not covered by the vaccine,” Waller said. Women who are screened and found not to have the HPV virus should be reassured that their risk of developing cervical cancer over the next five years is extremely low, Waller added.

And now you know a bit more about HPV (Human Papilloma Virus). I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Sex Transm Infect doi:10.1136/sextrans-2013-051402; http://gardasil.com/hpv-and-your-child/who-gets-hpv/

Staying Physically Fit Keeps You Mentally Fit

happy man white male smiling elderly senior older

Today we turn to an unusual study that gauged participants’ fitness levels by measuring oxygen levels during strenuous exercise. The results suggest that being in good physical condition may help you to preserve memory and cognition over time.

Physical Fitness and Mental FitnessResearchers asked 1400 adults (ages 19 to 94) to walk, jog, or run on a treadmill until theory were out of breath. The amount of oxygen subjects inhaled and the amount of carbon dioxide they exhaled was carefully measured, allowing scientists to calculate their VO2max (maximal amount of oxygen used by the lungs during one minute of strenuous exercise). A higher VO2max generally indicated better health associated with better lung function.

Participants were tracked for up to 18 years following the treadmill test, and took periodic cognitive tests measuring such factors as memory and attention. Participants with lower VO2max scores showed significantly accelerated cognitive decline (compared with those who started out with better fitness scores).

My Take: Cariovascular fitness measured at a point in time may help predict levels of future memory function. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: The Journals of Gerontology: Series A (05 November 2013); Massachusetts General Hospital: Mind, Mood & Memory (February 2014)

Music Therapy for Young Patients with Cancer

music therapy improvisation notes

A new study has found that adolescents and young adults undergoing cancer treatment gain coping skills and resilience-related outcomes when they participate in a therapeutic music process that includes writing song lyrics and producing videos. The findings indicate that such music therapy interventions can provide essential psychosocial support to help young patients positively adjust to cancer.

Few interventions target the unique psychosocial needs of adolescents and young adults with cancer. Joan E. Haase, PhD, RN, FAAN, and Sheri L. Robb, PhD, MT-BC, led a team that tested a music therapy intervention designed to improve resilience in such patients undergoing stem cell transplant treatments for cancer. Resilience is the process of positively adjusting to stressors, including those associated with a cancer diagnosis and treatment.

The researchers’ Therapeutic Music Video intervention was designed to help adolescents and young adults explore and express thoughts and emotions about their disease and treatment that might otherwise go unspoken. Through the creative process of writing song lyrics and producing videos, a board-certified music therapist offers structure and support to help patients reflect on their experiences and identify what is important to them, such as their spirituality, family, and relationships with peers and healthcare providers. As they move through phases of the intervention — including sound recordings, collecting video images, and storyboarding — patients have opportunities to involve family, friends, and healthcare providers in their project, maintaining those important connections during treatment and encouraging communication. Once complete, videos can be shared through video premieres, which allow others an opportunity to gain a better understanding about the patients’ perspectives on their cancer, their treatments, and their desires for the future.

For the study, 113 patients aged 11 to 24 years who were undergoing stem cell transplant treatments for cancer were randomized to be part of a Therapeutic Music Video intervention group or to be part of a control group that received audiobooks. Participants completed six sessions over three weeks.

After the intervention, the Therapeutic Music Video group reported significantly better courageous coping. One hundred days after stem cell transplant treatments, the Therapeutic Music Video group reported significantly better social integration and family environment. The investigators found that several protective factors helped adolescents and young adults to be resilient in the face of cancer treatments. These factors included spiritual beliefs and practices; having a strong family environment characterized by adaptability, cohesion, and positive communication; and feeling socially connected and supported by friends and healthcare providers.

“These protective factors influence the ways adolescents and young adults cope, gain hope, and find meaning in the midst of their cancer journey,” said Dr. Haase. “Adolescents and young adults who are resilient have the ability to rise above their illness, gain a sense of mastery and confidence in how they have dealt with their cancer, and demonstrate a desire to reach out and help others,” she added.

When the investigators interviewed the patients’ parents, they found that the videos gave parents insights into their children’s cancer experiences; however, parents needed help to initiate and sustain important conversations about messages shared through their children’s videos. To address this need, the study team has received funding from the National Institutes of Health and the Children’s Oncology Group to examine the potential benefits of adding a parent communication component to their intervention.

The study’s findings provide evidence supporting the use of a music-based intervention delivered by a music therapist to help adolescents and young adults positively cope with high-risk, high-intensity cancer treatments. “The availability of music therapy services from a board-certified music therapist in the United States has become more widespread, and through studies like this one, we hope to see increased availability and access to this important allied health service,” said Dr. Robb. “One of the challenges in healthcare today is making sure that research findings from studies such as ours are used to inform healthcare practices and service delivery. One of our team’s next steps is to disseminate findings, train professional music therapists on this intervention, and then conduct an implementation study to examine how the intervention may change as it moves into the standard care setting and whether, in the presence of these changes, patient benefits are maintained.”

I’m Dr. Michael Hunter.

Reference: Wiley. “Music therapy’s positive effects on young cancer patients’ coping skills, social integration.” ScienceDaily. ScienceDaily, 27 January 2014. <www.sciencedaily.com/releases/2014/01/140127093134.htm>.