Remarkable Breakthrough for Metastatic Breast Cancer?

What You Need to Know: Got HER2 positive cancer that is metastatic? Final results from the CLEOPATRA study show that the combination of two targeted agents (with chemotherapy) significantly improves survival, compared to Herceptin (trastazumab) alone. This may be the biggest breakthrough ever for metastatic breast cancer, but only applies to those whose tumors overexpress HER2.

Background: HER2/neu (human epidermal growth factor receptor 2), also called ErbB2, is a protein that appears on the surface of some breast cancer cells. This protein is an important part of the pathway for cell growth and survival.

  • HER2/neu-positive (HER2+) breast cancers have a lot of HER2/neu protein.
  • HER2/neu-negative (HER2-) breast cancers have little or no HER2/neu protein.
  • About 15 to 20 percent of all breast cancers are HER2+ (you also may hear the term “HER2 over-expression”). HER2 status helps guide treatment.
  • HER2+ breast cancers can benefit from anti-HER2/neu drugs, such as the drug trastuzumab (Herceptin), which directly target the HER2/neu receptor. Trastuzumab and other anti-HER2/neu targeted therapies are not used for HER2- cancers.

– See more at: http://ww5.komen.org/BreastCancer/TumorCharacteristics.html#sthash.VebNtup0.dpuf

What We Just Learned: Final results from the CLEOPATRA study show that the combination of 2 targeted agents, trastuzumab (Herceptin, Roche/Genentech) and pertuzumab (Perjeta, Roche/Genentech), significantly prolonged survival in HER2-positive metastatic breast cancer, compared with trastuzumab alone. The targeted agents were added to chemotherapy with docetaxel.

Patients with metastatic breast cancer treated with the combination of Herceptin and Perjeta plus chemotherapy lived 15.7 months longer than those who received trastuzumab and chemotherapy (median overall survival, 56.5 vs. 40.8 months; hazard ratio [HR], 0.68; P = .0002).

“I think these results are phenomenal,” said Dr. Swain, who spoke during a press briefing here at the European Society for Medical Oncology (ESMO) Congress 2014. “We all believe that the 56.5-month median overall survival is unprecedented in this indication and confirms that the pertuzumab plus trastuzumab regimen is a first-line therapy for patients with HER2-positive metastatic breast cancer.”

She noted that the median survival with trastuzumab is already very good, at 40.8 months. “That already changed things for patients with HER2-positive breast cancer, but adding pertuzumab has increased that by 15.7 months,” Dr. Swain continued.    “I’ve never seen that in any other trial of metastatic breast cancer,” she said, noting that she has worked in the field for 30 years.

These final results add another 20 months of follow-up to the last presentation of the data, Dr. Swain said. The new results include an updated progression-free survival analysis, which was 18.7 months, an improvement of 6.3 months, compared with a median of 12.4 months with trastuzumab and chemotherapy alone. “This is also very good,” she said. “For those who are looking at different end points in this blinded study, progression-free survival was a good surrogate end point for overall survival.”

“We should consider this combination as the standard of care for our patients,” coauthor Javier Cortés, MD, director of the breast cancer program at Vall d’Hebron Institute of Oncology in Barcelona, Spain, said in a statement. “I can see no reason to justify the use of trastuzumab without pertuzumab.”

“What is more surprising is that the improvement in median overall survival exceeds the improvement in progression-free survival, maybe because of the different mechanisms of action that monoclonal antibodies have,” he explained.

My Take: This study is a peek into the future for most cancers: Cancer cells are driven by a particular pathway (in this case in the HER2 overexpression track), and we are at the very beginning of learning to target them. Kudos to Dennis Slayman, MD for kicking open the HER2 door. We need more such breakthroughs by stubborn courageous big thinkers. Want to hear the thrilling story of the development of the breakthrough drug Herceptin (trastazumab)? Head to amazon.com (http://www.amazon.com/Her-2-Making-Herceptin-Revolutionary-Treatment/dp/0812991842), or better yet, order from your local bookseller. 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:

Is Soy Detrimental for Women with Breast Cancer?

What You Need to Know: Two weeks of soy supplementation was enough to increase expression of genes related to tumor proliferation.  Women with breast cancer should probably not take soy supplements, and should eat soy foods, such as tofu and tempeh, only in moderation.

The Study: Jacqueline Bromberg, M.D., Ph.D., a breast cancer specialist at the Memorial Sloan Kettering Cancer Center in New York City, and colleagues randomly assigned 140 women with newly diagnosed, early-stage breast cancer to one of two groups. In one, women took a soy protein supplement every day for anywhere from one to four weeks; those in the other group were given milk powder as a comparison. The women were premenopausal or just past menopause. The soy supplement — a powder added to water or juice — was the equivalent of about four cups of soy milk a day. Women in the study typically used it for two weeks.

Results: Researchers found that about 20 percent of the women using soy developed high blood concentrations of genistein, a soy phytoestrogen. Among those women, some showed heightened activity in certain genes that promote breast tumor growth and spread.

“This study doesn’t tell us anything about whether soy raises the risk of developing breast cancer,” said Bromberg who also noted there was no evidence of “tumor proliferation” in women with revved-up gene activity, but the study may have been too short to detect such an effect. “All we can say is that two weeks of soy supplementation was enough to increase expression of genes related to tumor proliferation.” But to be safe, she said, women with breast cancer should probably not take soy supplements, and should eat soy foods, such as tofu and tempeh, only in moderation.

My Take: There are conflicting reports on the impact of soy on breast carcinogenesis. This study examines the effects of soy supplementation on breast cancer-related genes and pathways. While the study proves little, it seems prudent (for those with a history of breast cancer) to avoid soy supplements, and to consume soy-based foods in moderation. 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: 1. Jacqueline Bromberg, M.D., Ph.D., physician/scientist, Memorial Sloan Kettering Cancer Center, New York City; V. Craig Jordan, Ph.D., D.Sc., scientific director, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C.; Sept. 4, 2014 Journal of the National Cancer Institute; 2.  http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/soy-a-friend-or-foe-of-breast-cancer-691425.html

Some Cancers More Likely Among Taller Women

What You Need to Know:  A new study has found an increased risk for certain types of cancers in taller women.

Background: While obesity has long been named as a risk factor for cancer, a new study published in Cancer Epidemiology, Biomarkers & Prevention that adjusts for various factors including age and weight, has found an increased risk for certain types of cancers in taller women.

The Evidence: The study, which included 20,298 postmenopausal women, found that for every 10-centimeter (3.94 inches) increase in height, there was a 13% increase in the risk of developing certain cancers, including, breast, colon, endometrium, kidney, ovary, rectum, thyroid, multiple myeloma and melanoma. The most surprising finding for researchers was that weight seems to be a lower risk factor than previously assumed.

“We did examine variation in risk and there was no variation of levels of risk by weight,” says senior author Thomas Rohan, PhD, MD, chairman and professor of the department of epidemiology and population health at Albert Einstein College of Medicine.

Since you can’t really do anything about your height, what does this mean to tall women? Nothing specifically, says Dr. Rohan. He says the purpose of the study was not to make clinical recommendations and there was no thought of cancer screening or diagnosis implied in the study. Rather, the researchers were merely to try to add to the existing research into the biology of cancer development.

“We have been aware of some reports in the literature about the link between cancer and height, and we thought we could make a contribution to that research,” says Dr. Rohan.

In other words, don’t try to stunt your daughter’s growth so that her cancer risk is reduced when she is in her 70s.

Lead researcher Geoffrey Kabat, PhD, MS, a senior epidemiologist at Albert Einstein College of Medicine, noted that cancer is a result of processes having to do with growth, so hormones or other growth factors that influence height may also influence long-term cancer risk. The study also notes that height should not be thought of as a risk factor, but rather as a marker for exposures that may influence cancer risk. In other words, there are so many things that effect growth, that it’s almost beyond anyone’s ability to control.

The take-home message is not to panic, but to just appreciate one more small step in the ongoing quest to try to figure out exactly what makes cancer tick. 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: http://www.prevention.com/health/health-concerns/scary-link-between-height-and-cancer-risk

 

 

Hot Flashes: What You Need to Know

I recently got several requests (from women suffering from hot flashes) to blog about possible remedies. Apologies for the blog length, but there is much to address.

What You Need to Know: No matter how disruptive and frustrating they may be, hot flashes are not a sign of a medical problem. They are a normal response to natural hormonal changes in your body. Hot flashes usually subside after the first or second year following menopause, when estrogen levels stabilize at a low level.

  • Tobacco use, heavy alcohol use, stress, spicy foods, and heat tend to make hot flashes worse. By avoiding these risk factors, exercising regularly, and eating well, you can prevent or reduce hot flashes.
  • The body-mind connection is a powerful element of hot flashes and emotional symptoms. Rhythmic breathing exercises (paced respiration), which help you meditate and relax, may reduce your hot flashes.
  • Background: Most women experience hot flashes at some point before or after menopause, when their estrogen levels are declining. While some women have few to no hot flashes, others have them numerous times each day. If hot flashes are disrupting your sleep or daily life, you are no doubt looking for relief. Fortunately, you have a number of self-care and medical treatment options that can help you manage your symptoms.

If you have experienced hot flashes, you’re already well aware that they are sudden sensations of intense body heat, often with heavy sweating and reddening of the head, neck, and chest or the entire body. At night, they commonly cause drenching “night sweats,” making them a cause of sleep problems for perimenopausal and postmenopausal women. During a typical hot flash, your skin temperature rises. Although you may feel very warm during a hot flash, because of the heat lost by your body’s cooling mechanism (perspiration), your body temperature may actually drop. Some women feel chilly after a hot flash, and some women feel the chill without the flash.

The biochemical cause of hot flashes is not well understood. But they are linked to declining estrogen levels, and they do seem to be made worse by stress, heavy alcohol use, and cigarette smoking. Although menopausal hot flashes can be disruptive, frustrating, and at times embarrassing, they are medically harmless. They are not a sign of a medical problem, nor do they cause medical problems.

It is normal for hot flashes to:

  • Happen in women of all ages when they are upset or embarrassed.
  • Happen during the perimenopausal years before menopause, when estrogen levels fluctuate. They are most common, most frequent, and most intense during the 2 years following menopause (postmenopause), when estrogen declines.
  • Be accompanied by mild to severe heart palpitations, anxiety, or irritability. In rare cases, panic attacks are triggered at the same time as hot flashes, usually in women who have a history of panic attacks.
  • Be especially severe in women who become menopausal from chemotherapy, antiestrogen treatment for breast cancer, or surgical removal of the ovaries.
    Subside within a couple of years after menopause. But some women do continue to have hot flashes for years after menopause. There is no reliable method for predicting whether, when, or how long you will have hot flashes.
  • Hot flashes are uncommon in various places around the world. More research is necessary before experts can identify specific factors about American women’s environment and lifestyle that make hot flashes a common problem.

Lifestyle choices for preventing or reducing hot flashes

  • Eat and drink well, and avoid smoking.
  • Limit your intake of alcohol.
  • Drink cold beverages rather than hot ones.
  • Eat smaller, more frequent meals to avoid the heat generated by digesting large amounts of food.
  • Make healthy eating a priority.
  • Do not smoke or use other forms of tobacco.
    Stay cool.
  • Keep your environment cool, or use a fan.
    Dress in layers, so you can remove clothes as needed.
    Wear natural fabrics, such as cotton and silk.
    Sleep with fewer blankets.
  • Reduce stress.
  • Get regular physical exercise.
  • Use relaxation techniques, such as breathing exercises, yoga, or biofeedback. Using a breathing-for-relaxation exercise called paced respiration may reduce hot flashes and emotional symptoms.

Medical treatment options for hot flashes

Short-term, low-dose hormone therapy (HT) can reduce or stop hot flashes and other perimenopausal symptoms by raising your body’s estrogen level. Use the lowest dose needed for the shortest possible time and have regular checkups. This is because HT may increase the risk of blood clots, stroke, heart disease, breast cancer, ovarian cancer, and dementia in a small number of women. Risk varies based on when you start HT in menopause and how long you take it. Short-term use of hormone therapy in early menopause has less risk than when it is started later in menopause. If you have a history of cardiovascular disease or breast cancer, avoid using estrogen for hot-flash relief—other options are available.

  • Estrogen-progestin birth control pills (before menopause) can reduce or stop hot flashes and other perimenopausal symptoms by evening out fluctuating hormones. Don’t use estrogen for hot-flash relief if you are older than 35 and smoke; have diabetes, cardiovascular disease, or breast cancer; or have a family history of breast cancer.
    Antidepressant medicine can reduce the number and severity of hot flashes by improving the brain’s use of serotonin, which helps regulate body temperature. Side effects are possible. This type of medicine is a good choice if hot flashes, irritability, or mood swings are your only perimenopausal symptom.
  • Clonidine may relieve hot flashes for some women. But studies have not shown that clonidine makes hot flashes less severe or less frequent. This type of medicine is a good choice if hot flashes are your only perimenopausal symptom, especially if you have high blood pressure.
  • Gabapentin, an antiseizure medicine, may lower the number of hot flashes each day and the intensity of hot flashes.
  • Black cohosh may reduce or prevent hot flashes, depression, and anxiety. As with HT, have regular checkups when taking black cohosh. The use of black cohosh during pregnancy has not been rigorously studied. Thus, it would be prudent for pregnant women not to take black cohosh unless they do so under the supervision of their health care provider. Women with breast cancer may want to avoid black cohosh until its effects on breast tissue are understood. In the United States, the U.S. Pharmacopeia (the standards-setting organization for foods and drugs) advises that black cohosh products be labeled with the following cautionary statement: “Discontinue use and consult a healthcare practitioner if you have a liver disorder or develop symptoms of liver trouble, such as abdominal pain, dark urine, or jaundice.” Individuals with liver disorders should avoid black cohosh. Individuals who develop symptoms of liver trouble such as abdominal pain, dark urine, or jaundice while taking the supplement should discontinue use and contact their doctor.
  • Some women eat and drink a lot of soy to even out hot flashes and other perimenopausal symptoms. So far, studies have used many different soy sources and different measures of success, which are hard for experts to compare. Soy isoflavone (rather than soy protein) studies have shown the most promise for hot flash treatment.

I’m Dr. Michael Hunter. I hope that this post helps you.

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: http://www.webmd.com/menopause/managing-hot-flashes#

Breath Temperature: Can We Tell if You Have Lung Cancer?

What You Need to Know: The temperature of exhaled breath could be used to diagnose lung cancer. Results of a recent study demonstrate that patients with lung cancer have a higher breath temperature than those without. The temperature also increases with the number of years a person had smoked and the stage of their lung cancer.

Background: Many research teams have been looking at the possibility of using breath tests for a number of cancers. This is the first study looking at breath temperature as a marker in lung cancer.

The Study: The research, presented at the European Respiratory Society (ERS) International Congress in Munich, suggests that testing the temperature of breath could be a simple and noninvasive method to either confirm or reject the presence of lung cancer. The researchers enrolled 82 people in the study who had been referred for a full diagnostic test after an x-ray suggested the presence of lung cancer. 40 patients received a positive diagnosis, while 42 patients had the diagnosis rejected. Researchers measured the temperature of exhaled breath in all patients using a breath thermometer device, known as an X-Halo device.

Results: Patients with lung cancer had a higher breath temperature than those without. Breath temperature also increased with the number of years a person had smoked and the stage at which their lung cancer had developed. The researchers also identified a cut-off value in the measurement of temperature, which they proved could identify lung cancer with a high level of accuracy.

Professor Giovanna Elisiana Carpagnano, lead author of the study from the University of Foggia, Italy, said: “Our results suggest that lung cancer causes an increase in the exhaled temperature. This is a significant finding and could change the way we currently diagnose the disease. If we are able to refine a test to diagnose lung cancer by measuring breath temperature, we will improve the diagnostic process by providing patients with a stress-free and simple test that is also cheaper and less intensive for clinicians.”

My Take: Exciting. But not ready for general use. So: 1) Don’t smoke; 2) If you smoke, quit; 3) if you have a 30 pack-year history of cigarette use (fro example, 1 pack per day for 30 years, or 2 packs per day for 15), ask your healthcare provider whether you may be a candidate for a low-dose screening CT scan. 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: European Lung Foundation. “Breath temperature test could identify lung cancer.” ScienceDaily. ScienceDaily, 8 September 2014. <www.sciencedaily.com/releases/2014/09/140908083738.htm>.

PSA Blood Test Saves Lives

What You Need to Know: Prostate-specific antigen (PSA) screening is controversial, but a new study shows PSA is associated with a lasting reduction in your risk of dying from prostate cancer, with an increased effect at 13 years compared with nine or 11 years.

The Study: European Randomised study of Screening for Prostate Cancer (ERSPC) is a multi center, randomized trial assessmentt of PSA testing in eight European countries for men ages 50 to 72. Data truncated at 13 years.

Results: At 13 years, the absolute risk reduction of death from prostate cancer was 0.11 per 1,000 person-years or 1.28 per 1,000 men randomized.

My Take: In this update, the ERSPC confirms a meaningful reduction in prostate cancer mortality attributable to the PSA blood test, with an even greater effect at 13 years compared to 9 and 11 years. While the use of screening PSA is controversial, this well-done study points to a PSA-linked reduction in the risk of prostate-related death. 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: The Lancet, Early Online Publication, 7 August 2014.