Breast Cancer Risk Among Women with Family History Differs by Race

Among women with a first-degree family history of breast cancer, the lifetime risk of developing breast cancer is higher among White women than among African-American women. These results were published in the Journal of Clinical Oncology.

Women with a family history of breast cancer are known to have an increased risk of developing breast cancer themselves. There is limited information, however, about the extent to which this risk varies by race. If risk does vary by race, it will be important for women with a family history of breast cancer to receive race-specific risk estimates when being counseled about breast cancer.

To explore the relationship between race and breast cancer risk among women with a family history of breast cancer, researchers evaluated the first-degree adult female relatives (mothers, sisters, and daughters) of 2,676 White breast cancer patients and 1,525 African-American breast cancer patients.

Among the first-degree relatives of the breast cancer patients, risk of developing breast cancer before the age of 40 was similar for White and African-American women.
After the age of 40, risk diverged. Among the first-degree relatives of the breast cancer patients, lifetime risk of breast cancer was 22.4% among White women and 14.5% among African-American women.
Risk of developing breast cancer increased with the number of affected first-degree relatives. Among women with more than one first-degree relative with breast cancer, the lifetime risk of developing breast cancer was 34.1% among White women and 16.9% among African-American women.
These results suggest that after age 40, risk of breast cancer among women with a family history of breast cancer is higher among White women than among African-American women. The researchers recommend using racially- and/or ethnically-specific risk estimates when counseling women about breast cancer risk.

Reference: Simon MS, Korczak JF, Yee CL et al. Breast Cancer Risk Estimates for Relatives of White and African American Women with Breast Cancer in the Women’s Contraceptive and Reproductive Experiences Study. Journal of Clinical Oncology. 2006;24:2498-2504.

No Responses to Temodar® in Breast Cancer Patients with Cancer Spread to the Brain

According to an article published in the Annals of Oncology, the chemotherapy agent Temodar® (temozolomide) has limited activity in the treatment of patients with breast cancer spread to the brain once they’ve received extensive prior therapy.

One common place that advanced breast cancer spreads is to the brain. Unfortunately, once the cancer has spread to the brain (brain metastasis), there is no known cure. Treatment at this stage is aimed at improving the duration of survival and quality of life for these patients.

Temodar is a chemotherapy agent that is known to pass through the blood–brain barrier, a protective membrane surrounding the brain and spinal cord. Since only select molecules can pass through the blood-brain barrier, Temodar is one of only a few chemotherapy agents able to pass through the barrier. Temodar is currently approved for various types of brain cancers.

Researchers from Canada recently conducted a clinical trial to evaluate the effectiveness of Temodar in the treatment of women with breast cancer and brain metastasis. This trial included 19 patients; 14 patients had received prior chemotherapy, and 12 had received prior hormone therapy.

Treatment was well tolerated.
There was no shrinkage of detectable cancer.
Three patients achieved disease stabilization; 15 patients had disease progression.
The researchers concluded that Temodar has limited activity in patients with breast cancer that has spread to the brain.

Reference: Trudeau M, Crump M, Charpentier D, et al. Temozolomide in Metastatic Breast Cancer (MBC): a Phase II Trial of the National Cancer Institute of Canada—Clinical Trials Group (NCIC-CTG). Annals of Oncology. 2006; 17:952-956.

Addition of Herceptin® to Arimidex® Improves Progression-Free Survival in Advanced Breast Cancer

According to a press release published by Roche, the addition of Herceptin® (trastuzumab) to Arimidex® (anastrozole) improves progression-free survival compared to Arimidex alone in HER2-positive, hormone-positive advanced breast cancer.

Approximately 30% of cancers overexpress a protein known as the human epidermal growth factor receptor-2 (HER2) protein. The HER2 protein is involved in cellular growth and replication. Women with HER2-positive breast cancer tend to have a worse prognosis than women with HER2-negative breast cancer. Fortunately, the targeted agent Herceptin binds to HER2 receptors and prevents or reduces replication of cancer cells that overexpress HER2.

Herceptin is currently approved as initial therapy in addition to the chemotherapy agent Taxol® (paclitaxel) in advanced, HER2-positive breast cancer, or as a single agent in patients whose breast cancer has progressed following prior therapy. Herceptin continues to be evaluated in various stages of breast cancer, as well as several different types of cancer.

Approximately two-thirds of women with breast cancer have hormone-positive breast cancer. Hormone-positive breast cancers are stimulated to grow from exposure to the female hormones estrogen and/or progesterone. Women with hormone-positive breast cancer are treated with hormone therapy, in which the levels of these female hormones are reduced or are prevented from properly binding to the cancer cell. This reduces or inhibits the cancer cell’s growth and ability to spread. Arimidex is an aromatase inhibitor, which prevents the formation of the active form of estrogen.

Researchers from 25 countries conducted a phase III clinical trial referred to as the TAnDEM study to evaluate the addition of Herceptin to Arimidex in women with HER2-positive, hormone-positive advanced breast cancer. This study included 208 postmenopausal women who were treated with Arimidex. Approximately half of the patients were also treated with Herceptin.

Patients who were treated with Herceptin/Arimidex had a significant improvement in progression-free survival compared to those treated with Arimidex only.
There were no significant side effects reported in either group of patients that would indicate the combination of Herceptin and Arimidex would be prohibitively risky.
Longer follow-up will provide more data on side effects and overall outcomes.
The researchers concluded that the addition of Herceptin to Arimidex significantly improves progression-free survival compared to Arimidex alone in postmenopausal women with HER2-positive, hormone-positive advanced breast cancer. More specific data will be released at further follow-up.

Reference: Roche. Herceptin Added to Hormonal Therapy Prolongs Progression-Free Survival for Patients with Advanced HER2-Positive Breast Cancer. Available at: http://www.roche.com/med-cor-2006-05-29. Accessed May 2006.

Clinical Trial Will Evaluate Individualized Treatment for Breast Cancer

The National Cancer Institute recently announced the launch of a breast cancer clinical trial called the Trial Assigning Individualized Options for Treatment (TAILORx). The trial will assess the role of the Oncotype DX™ test in guiding chemotherapy decisions among women with early breast cancer.

Although chemotherapy is recommended for many women with early-stage, node-negative breast cancer, the benefit of chemotherapy varies. Identifying in advance those women who are most likely to benefit from chemotherapy may allow for more individualized treatment. This would allow women who are unlikely to benefit from chemotherapy to avoid the toxic effects of treatment.

A gene expression test known as Oncotype DX may help guide decisions about the use of chemotherapy in women with early breast cancer. The test is indicated for patients with newly diagnosed stage I or II, node-negative, estrogen-receptor positive breast cancer who will be treated with tamoxifen. The test evaluates a panel of 21 genes to predict a patient’s 10-year risk of cancer recurrence. The test classifies patients as being at high, intermediate, or low risk of recurrence based on a Recurrence Score™. The Recurrence Score ranges from zero0 to 100, with a higher score indicating a greater risk of recurrence.

A study recently published in the Journal of Clinical Oncology reported that chemotherapy benefit among women with node-negative, estrogen receptor-positive breast cancer appeared to vary by the Oncotype DX Recurrence Score.[1] Women with a high risk of recurrence benefited from chemotherapy whereas women with a low risk of recurrence did not. The role of chemotherapy among women with an intermediate risk of recurrence remains uncertain.

To further explore the use of Oncotype DX in guiding chemotherapy decisions, the TAILORx trial will enroll more than 10,000 breast cancer patients from the United States and Canada.[2] The study will focus on breast cancer that is estrogen receptor-positive and/or progesterone receptor-positive, does not involve lymph nodes, and is Her2/neu negative.

Women in the trial will be assigned to a treatment group based on their Recurrence Score:

Women with a high Recurrence Score (greater than 25) will receive adjuvant treatment with chemotherapy plus hormonal therapy.
Women with a low Recurrence Score (less than 11) will receive adjuvant treatment with hormonal therapy alone.
Women with an intermediate Recurrence Score (from 11 to 25) will be randomly assigned to receive adjuvant treatment with either hormonal therapy alone or hormonal therapy plus chemotherapy.
The main focus of the study is the role of the Oncotype DX test in women with an intermediate risk of recurrence. In these women, the benefit of chemotherapy remains uncertain.

Reference:



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[1] Paik S, Tang G, Shak S et al. Gene Expression and Benefit of Chemotherapy in Women with Node-Negative, Estrogen Receptor-Positive Breast Cancer. Journal of Clinical Oncology. Early online publication May 23, 2006.
[2] National Cancer Institute. Press Release. Personalized Treatment Trial for Breast Cancer Launched. Available at: http://www.cancer.gov/newscenter/pressreleases/TAILORxRelease. Accessed May 26, 2006.

Oncotype DX™ Predicts Chemotherapy Response in Early Breast Cancer

Among women with node-negative, estrogen receptor-positive breast cancer, the Oncotype DX™ test predicts the likely benefit of chemotherapy. These results were published in the Journal of Clinical Oncology.

Although chemotherapy is recommended for many women with early-stage, node-negative breast cancer, the benefit of chemotherapy varies. Identifying in advance those women who are most likely to benefit from chemotherapy may allow for more individualized treatment. This would allow women who are unlikely to benefit from chemotherapy to avoid the toxic effects of treatment.

Gene expression profiling explores the patterns of genes that are active in tumor cells. Studies suggest that gene expression may provide information about prognosis or likely response to treatment in several types of cancer, including breast cancer.

Oncotype DX is a test that performs gene expression profiling. The test is indicated for patients with newly diagnosed stage I or II, node-negative, estrogen-receptor positive breast cancer who will be treated with tamoxifen. The test evaluates a panel of 21 genes to predict a patient’s ten-year risk of cancer recurrence. The test classifies patients as being at high, intermediate, or low risk of recurrence based on a Recurrence Score™. The Recurrence Score ranges from 0 to 100, with a higher score indicating a greater risk of recurrence.

Previous reports have suggested that in addition to predicting a patient’s risk of breast cancer recurrence, Oncotype DX may also provide information about likely response to chemotherapy. In order to further evaluate the link between Oncotype DX’s Recurrence Score and response to chemotherapy, researchers conducted a study among 651 patients with node-negative, estrogen receptor-positive breast cancer.

Oncotype DX classified 353 patients (54%) as having a low risk of recurrence (Recurrence Score less than 18), 124 patients (21%) as having an intermediate risk of recurrence (Recurrence Score between 18 and 30), and 164 patients (25%) as having a high risk of recurrence (Recurrence Score greater than 30).

The addition of chemotherapy to tamoxifen improved survival for women at high risk of recurrence based on the Recurrence Score, but did not improve survival among women at low or intermediate risk of recurrence.

Among women at high risk of recurrence, the probability of surviving for 10 years without a distant cancer recurrence was 61% among women treated with tamoxifen alone, and 88% among women treated with tamoxifen and chemotherapy.
Among women at low or intermediate risk of recurrence, the probability of surviving for 10 years without a distant cancer recurrence was similar whether or not a woman received chemotherapy. The researchers note, however, that additional study of the risks and benefits of chemotherapy is needed for women with an intermediate risk of recurrence.
The researchers conclude that Oncotype DX not only provides information about risk of recurrence in women with node-negative, estrogen receptor-positive breast cancer, but also provides information about the likely benefit of chemotherapy.

Reference: Paik S, Tang G, Shak S et al. Gene Expression and Benefit of Chemotherapy in Women with Node-Negative, Estrogen Receptor-Positive Breast Cancer. Journal of Clinical Oncology. Early online publication May 23, 2006.

Chemotherapy Combination Produces Promising Results in Ewing’s Sarcoma

Among patients with high-risk Ewing’s sarcoma family of tumors (ESFT), treatment with an intensified chemotherapy regimen of ifosfamide, carboplatin, and etoposide (ICE) plus cyclophosphamide, doxorubicin, and vincristine (CAV) resulted in good control of disease and made it easier to perform surgery. These results were published in the journal Cancer.

The Ewing’s Sarcoma family of tumors includes Ewing’s sarcoma as well as peripheral primitive neuroepithelial tumor. These are rare diseases in which cancerous cells affect the bone and soft tissues. They are most common in teenagers and young adults. Ewing’s sarcoma can occur in any bone of the body, although the most frequent sites are the pelvis, thigh, lower leg, upper arm, and ribs. Ewing’s may also arise in the soft tissues of the body.

The prognosis for Ewing’s depends on the choice of treatment, the location of the tumor, the size of the tumor, the stage of the cancer (how far it has spread), how the tumor responds to treatment as well as the patient’s age and overall health.

To evaluate an intensified chemotherapy regimen for ESFT, researchers in Italy conducted a pilot study among 38 patients with high-risk ESFT.

Patients were classified as high-risk if they had a large tumor volume, a tumor site with a poor prognosis, or cancer that had spread to the bone marrow or lungs. Half the patients received chemotherapy with ICE (ifosfamide, carboplatin, and etoposide) plus CAV (cyclophosphamide, doxorubicin, and vincristine) and half the patients received a variety of other chemotherapy regimens.

Cancer was brought under control more rapidly in the patients treated with ICE plus CAV.
Surgery was more easily performed in the patients treated with ICE plus CAV.
90% of patients treated with ICE plus CAV responded to treatment.
Estimated three-year survival among patients treated with ICE plus CAV was 67%.
The researchers conclude that in this small study of patients with high-risk Ewing’s sarcoma, the chemotherapy regimen of ICE plus CAV resulted in good control of the disease. A study involving a larger number of patients and longer follow-up is necessary to confirm the risks and benefits of this approach.

Reference: Milano GM, Cozza R, Ilari I et al. High Histologic and Overall Response to Dose Intensification of Ifosfamide, Carboplatin, and Etoposide with Cyclophosphamide, Doxorubicin, and Vincristine in Patients with High-Risk Ewing Sarcoma. Cancer .

Computed Tomography (CT) Misses Large Portion of Cancer Spread to Lung in Osteosarcoma

According to a recent article published in the Journal of Pediatric Surgery, computed tomograhy (CT) scans miss over one-third of cancers that have spread to the lung in pediatric patients diagnosed with osteosarcoma.

Osteosarcoma is a cancer that starts in the bone. It is a disease that mainly affects young adults or adolescents. The most common site of cancer origin is in the bones around the knee. At present, patients are grouped according to whether the cancer is localized (has not spread from its site of origin) or metastatic (spread to distant sites in the body).

Cure rates for osteosarcoma are largely influenced by whether the cancer can be completely removed by surgery. Therefore, it is crucial that physicians know if and where the cancer has spread before and during surgery; this allows surgeons to remove as much of the cancer as possible.

Currently, CT scans are routinely used to help determine if and where the cancer has spread in pediatric patients diagnosed with osteosarcoma. The lung is a common place for cancer to spread (metastasize); cancer spread to the lungs is often surgically removed. However, the accuracy of a CT scans is important since surgeons rely on these results to guide treatment.

Researchers from the Memorial Slone-Kettering Cancer Center recently conducted a study to evaluate the accuracy of results from CT scans in determining the presence of lung metastasis in pediatric patients with osteosarcoma. This study included 28 patients who had received CT scans at a median of 20 days prior to a thoracotomy (surgery in which the chest is exposed) between 1996 and 2004.

During surgery, the surgeons manually palpated the lung to feel for masses. Overall, CT scans missed more than approximately one-third of lung metastases in these patients.

The researchers concluded that results from CT scans miss approximately one-third of lung metastases present in pediatric patients diagnosed with osteosarcoma. They suggest that manual palpation should be a routine part of thoracotamies in these patients.

Reference: Kayton M, Huvos A, Casher J, et al. Computed Tomographic Scan of the Chest Underestimates the Number of Metastaic Lesions in Osteosarcoma. Journal of Pediatric Surgery. 2006; 41:200-206.

Surgical Removal of Cancer Spread to the Lung Significantly Improves Survival in Osteosarcoma

According to a recent article published in the Journal of Pediatric Surgery, the surgical removal of cancer spread to the lung significantly improves survival among pediatric patients diagnosed with osteosarcoma.

Osteosarcoma is a cancer that starts in the bone. It is a disease that mainly affects young adults or adolescents. The most common site of cancer origin is in the bones around the knee. At present, patients are grouped according to whether the cancer is localized (has not spread from its site of origin) or metastatic (spread to distant sites in the body).

The lung is a common place for cancer to spread (metastasize) in many types of cancer. More evidence is indicating that the surgical removal of lung metastasis may improve survival in patients who are eligible for surgery. Researchers continue to evaluate which patients may benefit from this type of surgery.

Researchers from the University of Texas and the University of Tennessee recently conducted a study focused on clarifying the benefits of the surgical removal of lung metastasis in patients diagnosed with osteosarcoma. Patients underwent chemotherapy prior to surgery. This study included 137 patients who were under the age of 21 years and treated between 1980 and 2000.

Overall survival among all patients with lung metastasis was 40.2% at 3 years and 22.6% at 5 years.
The average survival for patients who underwent the surgical removal of lung metastasis was approximately 34 months, compared to approximately 10 months for those who did not undergo the surgical removal of lung metastasis.
No significant differences in survival were noted in regards to the number of lung metastasis that were surgically removed per individual patient.
Patients who responded better to chemotherapy and those who were free of cancer longer before they developed lung metastasis had improved survival.
The researchers concluded that the surgical removal of lung metastasis—even multiple lung metastases—significantly improves the duration of survival among pediatric patients diagnosed with osteosarcoma. These results help define the survival benefit of this surgical procedure. Furthermore, the authors advocate repeat surgery to remove lung metastasis in patients who experience a recurrence of lung metastasis. Patients diagnosed with osteosarcoma with lung metastasis may wish to speak with their physician regarding their individual risks and benefits of surgery to remove their metastasis.

Reference: Harting M, Blakely M, Jaffe N, et al. Long-Term Survival after Aggressive Resection of Pulmonary Metastases among Children and Adolescents with Osteosarcoma. Journal of Pediatric Surgery. 2006; 41: 194-199.

Cisplatin Benefits Patients with Metastatic Osteosarcoma

A comparison of two clinical trials suggests that the chemotherapy drug cisplatin is more effective against metastatic osteosarcoma than the chemotherapy drug carboplatin. These results were published in the journal Cancer.

Osteosarcoma is a type of cancer that originates in the bone. Patients with osteosarcoma are often young; the disease most commonly affects individuals between 10 and 25 years of age. Metastatic osteosarcoma refers to osteosarcoma that has spread to other parts of the body. Osteosarcoma most often spreads to other bone or to the lungs. Because the prognosis for metastatic osteosarcoma is poor, researchers continue to evaluate new treatment approaches.

Between 1986 and 1997, researchers at St. Jude Children’s Hospital in Memphis, Tennessee, conducted two clinical trials of different chemotherapy regimens among patients with metastatic osteosarcoma. In both trials, patients received neoadjuvant chemotherapy (chemotherapy given before the primary treatment), followed by surgery, which was followed by adjuvant chemotherapy (chemotherapy given after the primary treatment).

The first trial assessed the chemotherapy drugs ifosfamide, cisplatin, doxorubicin, and high-dose methotrexate. The second trial used carboplatin in place of cisplatin. Comparison of these two trials enabled the researchers compare the effectiveness of carboplatin to the effectiveness of cisplatin.

Carboplatin is known to be less toxic than cisplatin, and if it also proved to be as or more effective than cisplatin, it could offer improved treatment for patients with osteosarcoma. Results among patients with localized osteosarcoma suggested that the two drugs produced similar benefits, but the effect among patients with metastatic osteosarcoma was uncertain.

The first trial included 12 patients with metastatic osteosarcoma and the second trial included 17 patients with metastatic osteosarcoma. Median age at diagnosis was 15 years in both studies, and the most common site of metastasis was the lung.

Across the two studies, five-year overall survival was 24%.
Overall, five of the 29 patients survived. Four of the 12 patients in the first trial (the trial that used cisplatin) survived, compared to only one of the 17 patients in the second trial (the trial that used carboplatin).
Because of the better survival in the trial that used cisplatin, the researchers conclude that use of cisplatin is warranted—in spite of its greater toxicity—in the treatment of patients with metastatic osteosarcoma. Given the poor survival in both trials, however, new treatment approaches must continue to be evaluated.

Reference: Daw NC, Billups CA, Rodriguez-Galindo C et al. Metastatic Osteosarcoma: Results of Two Consecutive Therapeutic Trials at St. Jude Children’s Research Hospital. Cancer. 2006;106:403-12.

Type of Treatment Influences Survival with Radiation-Induced Osteosarcoma

Aggressive treatment appears to significantly improve survival among patients who develop radiation-induced osteosarcoma following treatment of childhood cancer, according to a study published in the International Journal of Radiation Oncology, Biology, Physics.

Osteosarcoma is a type of cancer that originates in the bone. Standard treatment for osteosarcoma depends largely on the stage or extent of spread. If the cancer is confined to an extremity, standard treatment typically consists of chemotherapy, surgery to remove the cancer, and possibly radiation therapy.

Radiation-induced osteosarcoma results from radiation therapy for a prior cancer. In the past, radiation-induced osteosarcomas had a poor prognosis. In order to describe the characteristics of radiation-induced osteosarcoma that develops after treatment for childhood cancer, researchers reviewed published reports of this condition.

The researchers identified 30 relevant studies published between 1981 and 2004. The studies evaluated patients who were under the age of 21 at the time of their first cancer. The information collected from these studies included type of cancer treated with radiation therapy, radiation dose, time between radiation therapy and the development of radiation-induced osteosarcoma, and treatment and outcome of radiation-induced osteosarcoma.

The 30 evaluated studies included a total of 109 patients. Half the patients were under the age of six years at the time of their initial cancer. The most common primary cancers were Ewing’s sarcoma, rhabdomyosarcoma, retinoblastoma, Hodgkin’s lymphoma, brain tumor, and Wilm’s tumor.

Radiation-induced osteosarcoma developed a median of eight years after radiation therapy.
Three-year overall survival was 42%.
Five-year overall survival was 40%.
Survival after osteosarcoma did not vary by age at radiation therapy, primary cancer site, total radiation dose, or time between radiation and development of osteosarcoma.
Survival did vary by type of treatment for radiation-induced osteosarcoma. Five-year overall survival was 17% for patients treated with chemotherapy alone, 50% for patients treated with surgery alone, and 68% for patients treated with surgery and chemotherapy.
The researchers conclude that “Patients who develop [radiation-induced osteosarcoma] should be aggressively treated, because outcome is not as dismal as once thought.”

Reference: Koshy M, Paulino AC, Mai WY et al. Radiation-Induced Osteosarcomas in the Pediatric Population. International Journal of Radiation Oncology, Biology, Physics . 2005;63:1169-1174.

Circulating Cancer Cells Indicate Worse Outcomes Following Autologous Stem Cell Transplantation in Multiple Myeloma

According to an article recently published in the journal Blood, the presence of cancer cells circulating in the blood is associated with a less favorable prognosis following an autologous stem cell transplant in patients with multiple myeloma.

Multiple myeloma is a cancer of the blood that affects the plasma cells. Plasma cells are an important part of the immune system; they produce antibodies to help fight infection and disease. Multiple Myeloma is characterized by an excess production of abnormal plasma cells. Symptoms include increased risk of bacterial infections and impaired immune responses.

Myeloma may also damage the kidneys and cause osteoporosis, anemia, and an elevated blood calcium level.

In a stem cell transplant, high doses of therapy are used to kill more cancer cells than conventional doses. Unfortunately, the higher doses tend to destroy important hematopoietic stem cells (immature blood cells).

These stem cells mature into the following: red blood cells, which transport oxygen and nutrients to tissues in the body; white blood cells, which help the body fight infection; and platelets, which aid the blood in clotting. Low levels of hematopoietic stem cells caused by high-dose treatment can result in life-threatening conditions.

There are two general types of stem cell transplants: an autologous transplant and an allogeneic transplant. During an autologous transplant, the patients’ own hematopoietic stem cells are collected prior to therapy, frozen, and then re-infused following high-dose treatment.

Although an autologous stem cell transplant is not considered a curative approach in the treatment of multiple myeloma, it allows a significant portion of patients to survive for extended periods of time without additional therapy. However, since the treatment is associated with serious side effects, researchers are trying to determine which patients will gain the most benefit from the procedure; patients who will not achieve significant benefit can thus be identified and offered alternative treatments.

Researchers from the Mayo Clinic recently conducted a clinical trial to evaluate the potential association between cancer cells that are found circulating in the blood directly prior to transplant and outcomes of treatment. They evaluated 246 patients with multiple myeloma who were treated with an autologous stem cell transplant.

Patients with circulating myeloma cells (CMCs) had a worse prognosis than those who did not have detectable circulating myeloma cells.

Ninety-five patients had CMCs as detected through a blood test.
Complete disappearances of detectable cancer following the transplantation were similar between patients with and without CMCs.
Overall survival was 33.2 months following the transplant among patients with CMCs compared with 58.6 months for those without CMCs.
Time before cancer progressed was 14.1 months following the transplant among patients with CMCs compared with 22 months for those without CMCs.
When combined with cytogenetics (measurement of specific genetic alterations), CMCs were associated with an even greater difference in outcomes: those with established “poor prognosis” cytogenetics plus the presence of CMCs had a median overall survival of only 21.5 months compared with 55 months for those with “good prognosis” cytogenetics and no CMCs.
Median time to cancer progression was only 6.5 months among patients with poor-prognosis cytogenetics plus CMCs compared with 22 months for those with good-prognosis cytogenetics and no CMCs.
The researchers concluded that the addition of the presence or absence of CMCs in combination with cytogenetic results provide a powerful predictor for outcomes following autologous stem cell transplants among multiple myeloma patients. Those patients who will not receive a great benefit from an autologous stem cell transplant may wish to pursue alternative treatments.

Patients with multiple myeloma who are planning to undergo an autologous stem cell transplant may wish to speak with their physician regarding their individual risks and benefits of testing for CMCs.

Guidelines Urge Doctors to Discuss Fertility Preservation with Cancer Patients Early

Oncologists should discuss fertility preservation for people with cancer early, while there is still time for interventions to maintain patients' ability to have children, according to new guidelines released by the American Society of Clinical Oncology.

An expert panel was convened because of evolving evidence that "a substantial proportion of women (with cancer) were concerned about their fertility, but felt it had not been adequately addressed," panelist Dr. Ann H. Partridge, an oncologist from Dana-Farber Cancer Institute in Boston, told Reuters Health. "We need to do more to put this on the forefront for the younger cancer patients."

The panel conducted an electronic database search for clinical trials addressing the success and impact of fertility interventions for cancer patients, in which they documented 233 trial reports plus 43 supplementary studies or reviews. They found that few large or randomized studies have been conducted, so most of their data came from cohort studies, case series, small clinical trials or case reports.

The only proven fertility preservation method for men is sperm cryopreservation, while women can consider embryo cryopreservation, conservative gynecologic surgery, and ovarian transposition outside the field of radiation.

Clinical trials are currently investigating other techniques such as cryopreservation of testicular or ovarian tissue, cryopreservation of oocytes, and gonadal suppression. The authors note that testicular or ovarian tissue cryopreservation may be the only approach available to children before the age of puberty.

Studies suggest that only about half of oncologists discuss fertility preservation with their patients.

"It is eye opening that even when patients are facing cancer, they are also very concerned about their survivorship, including fertility," Dr. Partridge said. "Many oncologists assume that patients are just hoping to survive the cancer. I think our findings speak to the hope and increasing importance of survivorship issues in general."

Oncologists may also hesitate to discuss fertility preservation because of prohibitive costs. However, Dr. Partridge pointed out, there are programs such as Fertile Hope (www.fertilehope.org) that can provide information and even financial assistance.

The guidelines advise that oncologists raise these issues and refer patients to reproductive specialists at the earliest possible opportunity. But at the same time, they should take care to not present unrealistic expectations.

"The clinician has to read the patient," Dr. Partridge said. "Sometimes it might be too much for patients to digest on the day they receive the diagnosis, but oncologists should bring it up as soon as possible, using good clinical judgment, before it's too late to take the appropriate measures."

The guidelines are slated for publication in the June 20th issue of the Journal of Clinical Oncology and can be accessed now at www.asco.org/guidelines .

Acupuncture May Control Vomiting after Chemo

Acupuncture, in conjunction with the latest drugs to prevent nausea and vomiting, seems to help relieve chemotherapy-induced vomiting, a new report suggests.

Despite the advent of new drug that control nausea and vomiting related to chemotherapy (anti-emetics), many cancer patients still experience these unpleasant side effects, which can impair quality of life, cause emotional distress, and aggravate cancer-related symptoms such as weight loss, lethargy and weakness.

The ancient Chinese technique of acupuncture, used to treat a variety of ailments by stimulating specific points on the body, has become increasingly popular for chemotherapy-induced nausea and vomiting, based on what the National Institutes of Health recently called "promising" research.

The current findings are based on pooled data from up to 11 trials that looked at the impact of acupuncture-point stimulation on chemotherapy-induced nausea and vomiting in more than 1,200 cancer patients.

The studies looked at several different types of acupuncture, including electroacupuncture, in which a small electrical current is passed through very thin needles that penetrate the skin; noninvasive electrostimulation of the skin surface using a wristwatch-like device; manual acupuncture -- the most well-known type that involves insertion and manual rotation of very fine needles; or acupressure, which involves pressing on the points usually with fingertips.

According to investigators, 22 percent of patients who underwent acupuncture experienced vomiting the first day after chemotherapy compared with 31 percent of those who did not undergo acupuncture.

Co-author of the report, Jeanette M. Ezzo, of James P. Swyers Enterprises, a Baltimore-based company that develops complementary and alternative medicines, and associates also found that electroacupuncture reduces first-day vomiting, whereas noninvasive electrostimulation of the skin surface does not.

Manual acupuncture also appears to be largely ineffective for chemotherapy-induced nausea or vomiting.

Acupressure, the team found, reduces first-day nausea, but is not effective for "delayed" symptoms of nausea or vomiting.

In all of the trials included in the analysis, patients received concomitant anti-emetics, and all patients, except those in the electroacupuncture trials, received "state-of-the-art" drugs such as Zofran and Anzemet, which are currently recommended for chemotherapy-related nausea and vomiting.

Therefore, it's not known if electroacupuncture adds anything to the most current anti-emetic drugs. This is an important unknown that needs to be studied, note the investigators.

This review, published in the current issue of The Cochrane Library, complements data on post-operative nausea and vomiting suggesting that acupuncture has a biologic effect, Ezzo and colleagues conclude.