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The latest research developments in cancer therapy were presented at the recent joint congress of the European Cancer Organisation and the European Society for Medical Oncology.

CIN3: HPV screening could be more effective than smear tests
CIN3: HPV screening could be more effective than smear tests

Screening and vaccine could 'eradicate cervical cancer'
Cuzick J. Oncopolicy session: Drug and lifestyle mediated prevention initiatives in Europe. ECCO 15 and 34th ESMO Multidisciplinary Congress, Berlin, 24 September 2009

Cervical cancer could be eradicated within 50 years if countries implement national screening for HPV and vaccination, according to UK cancer expert Professor John Cuzick.

Speaking at the joint congress of the European Cancer Organisation (ECCO) and the European Society for Medical Oncology (ESMO), Professor Cuzick said that the current vaccine could potentially eradicate up to three-quarters of cervical cancers (caused by HPV types 16 and 18), with some cross-protection against other, related HPV types (31, 45 and 33).

In addition, new vaccines are being planned that will vaccinate against nine HPV types; if successful, he said, there should be no need to screen women who have been vaccinated. Professor Cuzick, who is John Snow Professor of Epidemiology and head of department at the Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, said that countries should be switching from Pap smears to HPV screening because 'overwhelming evidence' shows the latter is more effective. Monika Polak

Use of an enzyme inhibitor in treating pancreatic cancer
Melisi D, Xia Q, Abbruzzese JL et al. TGF-beta-activated kinase 1 (TAK1) is an in vivo druggable target for reverting pancreatic cancer chemoresistance. Abstract O-1002. Eur J Cancer Suppl 2009; 7(2): 87

Resistance to chemotherapy is one of the greatest challenges in pancreatic cancer treatment. However, US researchers have found that inhibiting the enzyme TAK-1 can overcome this.

Once the researchers had developed a drug to inhibit the enzyme, they tested it in combination with gemcitabine, oxaliplatin and SN-38 (a metabolite of irinotecan). The TAK-1 inhibitor increased the sensitivity of pancreatic cancer cells in culture to all three anticancer drugs, enabling the use of doses that were up to 70 times lower than those required in controls to kill the same number of cancer cells.

Further study in mice showed that combining the TAK-1 inhibitor with very low doses of gemcitabine resulted in a 78 per cent reduction in tumour volume and prolonged survival. Use of gemcitabine alone against the cancer in mice was ineffective. MP

Radiotherapy tailored to the patient's genetic characteristics
De Ruysscher D, Severin D, Barnes E et al. First report on the patient database of the identification of the genetic pathways involved in patients overreacting to radiotherapy: GENEPI-II. Abstract O-2007. Eur J Cancer Suppl 2009; 7(2): 153

The first step towards individualised radiotherapy dosing based on a patient's genetic characteristics and sensitivity to treatment has been taken by an international team of scientists. Their research focused on patients with hypersensitivity to radiotherapy, drawn from the genetic pathways for the prediction of the effect of irradiation (GENEPI) study, which includes information on more than 8,000 patients.

They identified 33 patients who had severe, prolonged or late onset side-effects at very low radiation levels. Of these, 11 proved to be hypersensitive to radiation, underlining the rarity of the condition. The researchers say that currently, the dose of radiation generally used is governed by the response of the most radiosensitive patients, meaning that many may receive lower than optimal doses. They hope further genetic research in combination with other patient data might lead to the development of predictive models for individual sensitivity. MP

Prostate cancer treatments and heart disease risk
Hormone therapy for prostate cancer increases men's risk of dying from heart disease, but the additional risk varies almost sevenfold for different treatments, a King's College London study has found.

The researchers examined data from 30,000 men in Sweden who had been given endocrine therapy as a primary treatment for prostate cancer. The patients were compared with 50,000 other men in Sweden with prostate cancer who had not undergone endocrine therapy.

The study looked at the incidence and risk of death from IHD, MI, heart failure and arrhythmia across the two groups. There was an increased risk from all of the types of endocrine treatment studied, namely orchiectomy, GnRH agonists and anti-androgen monotherapy. However, the additional risks varied considerably across therapies. For example, the increased risk of heart failure was 5 per cent for anti-androgens, but 34 per cent for GnRH agonists. The additional risk for IHD was 13 per cent for anti-androgens, but 30 per cent for GnRH agonists.Further studies would now be needed to verify the association and look at what causes it, the researchers concluded. Tom Moberly

How kidney cancer therapies could improve quality of life
Kidney cancer drugs in development could improve patients' quality of life and allow more effective treatment, according to Professor Robert Hawkins of Manchester University.

Drugs such as sunitinib have represented a 'step change' in kidney cancer treatment in the past few years, but have a number of side-effects, Professor Hawkins said. These can be significant, given that people take sunitinib for a year on average, but can be on it indefinitely, he added.

Professor Hawkins said that data on the developmental drug pazopanib suggested it had fewer 'off-target' effects than sunitinib: 'Pazopanib is much more specific, which potentially leads to fewer side-effects. There are two likely benefits. One is that it will lead to a better quality of life. Also, patients may tolerate the treatment at a fuller dose for longer.'

Promising data on regorafenib, another agent targeting the same receptor, were also presented at the conference. TM

Obesity and cancer risk
Renehan A. Obesity and overall cancer risk. Abstract I-327. Eur J Cancer Suppl 2009; 7(2): 79

Overweight and obesity were responsible for 124,000 new cancers in Europe in 2008, the results of a modelling study suggest. The proportion of new cancers attributable to a BMI of 25kg/m2 or more was highest among women and in central European countries.

In men, 3.2 per cent of new cancers could be attributed to overweight/obesity, and in women, 8.6 per cent. Endometrial (33,421 cases), postmenopausal breast (27,770) and colorectal (23,730) cancers accounted for 65 per cent of all cancers attributable to excess BMI. In the UK, new cases of obesity-related oesophageal cancer accounted for 54 per cent of those across all 30 countries. MP

Blood tests may have a role in screening for colorectal cancer
New blood tests could make colorectal cancer detection cheaper and simpler, research from two studies suggests.

Researchers from OncoMethylome Sciences in Belgium carried out DNA tests on 193 colorectal cancer patients and 688 controls. They found that two genes, SYNE1 and FOXE, occurred with high frequency in cancer patients, but were rarely found in healthy controls.

They then developed a blood test for these genes. It was 77 per cent sensitive and 91 per cent specific for colorectal cancer.

Researchers from Germany have developed a separate new test to help diagnose colonic, rectal and gastric cancers. A team at the Max Delbruck Centre for Molecular Medicine in Berlin examined RNA in blood plasma samples from patients with GI tumours. They found that the S100A4 mRNA transcript was present at significantly higher levels in patients with the cancer than in healthy controls. The researchers believe their test may be useful for screening at-risk populations.

Professor David Weller, of the department of community health sciences at Edinburgh University, said he believed it was important to keep an open mind about new screening tests for colorectal cancer. Blood tests can readily be incorporated into primary care practice, he pointed out. TM

- The joint 15th congress of ECCO and 34th congress of ESMO took place in Berlin, Germany, in September 2009. For further information, visit www.ecco-org.eu and www.esmo.org

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