Colour tagging to identify cancer cells
A new colour tagging method developed by the Antibody Technology Group at the University of Westminster could help to detect cancer cells at an earlier stage. The REDantibody was created using molecular engineering principles and a fluorescent protein isolated from the red coral Discosoma. This causes targeted cells or cell components to glow under a microscope or detector, paving the way for early cancer diagnosis, as well as precise and accurate differentiation of tumour types. The technology was initially developed for imaging parasites such as Trypanosoma cruzi. Markiv A, Anani B, Durvasula RV et al. J Immunol Methods 2010 Nov 3
Antibody-drug conjugate brentuximab vedotin in lymphoma
An antibody-drug conjugate has induced tumour regression in a phase I study of patients with relapsed or refractory CD30-positive lymphomas. Previous attempts at targeting the CD30 antigen have had limited success. In this multicentre dose-escalation study, researchers created an antibody-drug conjugate, brentuximab vedotin, and administered it every 3 weeks to 45 patients with relapsed or refractory haematological cancers. They found that 17 patients experienced objective response, 11 of whom were complete remissions, and 86% of patients experienced tumour regression. The maximum tolerated dose was 1.8mg per kg every 3 weeks. Adverse effects included fatigue, pyrexia, nausea, diarrhoea and peripheral neuropathy. Younes A, Bartlett NL, Leonard JP et al. N Engl J Med 2010; 363: 1812-21
Free margins in breast-conserving surgery
Breast-conserving surgery with adjuvant radiotherapy is an established alternative to mastectomy in breast cancer patients, but is associated with increased local recurrence. The width of free margin necessary to reduce residual disease and local recurrence is controversial and researchers have carried out a study of 303 patients to investigate this. Residual disease was assessed in patients undergoing wide excision. The study found that if the free margin was 2mm or more, the probability of finding residual disease was 2.4%, although it was higher for ductal carcinoma in situ and did not decline with increasing the free margin width. Ward ST, Jones BG, Jewkes AJ. Int J Clin Pract 2010; 64: 1675-80
Prostate cancer treatment and QoL
The effect of primary prostate cancer treatments on quality of life has been investigated in a prospective study of 435 patients, comparing the impact of radical prostatectomy, external beam radiotherapy (EBR) and brachytherapy on quality of life. The prostatectomy group had greater deterioration in urinary incontinence and sexual dysfunction, but less urinary obstruction than those in the brachytherapy group. The EBR group experienced adverse effects to the bowel. These results are a useful aid in decision-making. Pardo Y, Guedea F, Aguilo F et al. J Clin Oncol 2010; 28(31): 4687-96
Preserving fertility in breast cancer treatment
Referring young women with breast cancer to reproductive specialists at an early stage is advantageous for fertility preservation, researchers have found. By analysing a cohort of 93 women on a prospective database of breast cancer patients who were undergoing ovarian stimulation, they discovered that those referred for fertility preservation before breast surgery (n = 35) underwent chemotherapy and cryopreservation earlier than patients referred after surgery (n = 58) and could undergo multiple cycles, allowing a greater number of oocytes or embryos to be cryopreserved. Lee S, Ozkavukcu S, Heytens E et al. J Clin Oncol 2010
Prognosis in pancreatic cancer
Pancreatic cancer mostly presents at an advanced metastatic stage and the prognosis is very poor. It was previously unknown whether this was because the disease is highly aggressive from the outset or due to late diagnosis. In this study, researchers have discovered that it takes at least 10 years for an initial single mutation in a pancreatic cell to give rise to a pancreatic tumour and a further 5 years for the tumour to develop metastases; patients usually die 2 years later. These results emphasise the importance of early diagnosis to improve survival for patients with pancreatic cancer. Yachida S, Jones S, Bozic I et al. Nature 2010; 467: 1114-17
Lifestyle and colorectal cancer risk
Researchers in Denmark have investigated the association between adherence to public health recommendations on lifestyle and risk of colorectal cancer, in a prospective cohort study of 55,487 men and women aged 50-64 years. The lifestyle index was based on 5 factors: physical activity, smoking, alcohol intake, waist circumference and diet. A total of 678 participants were diagnosed with colorectal cancer during a median follow-up period of 9.9 years. Each lifestyle recommendation that was met was associated with reduced risk of colorectal cancer. The authors estimated that 23% of cases could have been avoided if the subjects had followed the 5 recommendations. Kirkegaard H, Fons Johnsen N, Christensen J et al. BMJ 2010; 341: c5504
HPV genotypes in cervical cancer
Researchers have carried out a study to assess the worldwide HPV genotype distribution in cervical cancer patients. In the study, paraffin-embedded samples of invasive cervical cancer were collected from patients in 38 countries. A total of 22,661 samples were taken from 14,249 women in Europe, North America, South America, Asia, Africa and Oceania; 8,977 samples were positive for HPV DNA. HPV 16, 18, 31, 33, 35, 45, 52 and 58 were the most common types found, accounting for 91% of cases.
HPV 16 and 18 were detected in 71% of invasive cervical cancer cases and HPV 16, 18 and 45 were detected in 94% of cervical adenocarcinomas. Unknown HPV types accounted for 1% of invasive cervical cancer cases. The researchers suggest that with regard to the introduction of prophylactic HPV vaccines, the most prevalent types should be given priority. De Sanjose S, Quint GV, Alemany L et al. Lancet Oncol 2010; 11: 1048-56
Imatinib in chronic myeloid leukaemia
Patients with chronic myeloid leukaemia (CML) experience significant survival benefit when treated with imatinib, but until now, the effect of discontinuation on relapse was unknown. This study has indicated that patients with CML who have been in complete molecular remission for at least 2 years can safely discontinue imatinib.
This prospective, multicentre, non-randomised trial included 100 patients with CML aged 18 years and over who were in complete molecular remission. Their rate of relapse was assessed using RT-PCR. Median follow-up was 17 months and 69 patients experienced relapse; the probability of persistent complete molecular remission for these patients was 41% at 12 months. Mahon FX, Rea D, Guilhot J et al. Lancet Oncol 2010; 11: 1029-35
ALK inhibition in non-small cell lung cancer
A small proportion of non-small cell lung cancers have genes consisting of anaplastic lymphoma kinase (ALK). This study investigated the therapeutic potential of inhibiting ALK using crizotinib, a small-molecule inhibitor of the ALK tyrosine kinase. Eighty-two patients with ALK-positive disease were eligible for inclusion and were treated with 250mg crizotinib twice daily in 28-day cycles. The overall response rate was 57% after a mean treatment period of 6.4 months and 27 patients had stable disease at that time. The estimated 6-month progression-free survival was 72% and treatment was associated with grade 1 or 2 GI adverse effects. Kwak EL, Bang YJ, Camidge R et al. N Engl J Med 2010; 363: 1693-1703
Androgen suppression in prostate cancer
A randomised phase III trial has assessed the benefit of adding an LHRH agonist to external irradiation in prostate cancer patients who are at high risk of developing metastases.
A total of 415 patients were randomly assigned to receive radiotherapy alone (n = 208) or radiotherapy plus androgen suppression with goserelin acetate (n = 207) for three years. Median follow-up was 9.1 years; 10-year disease-free survival was 22.7% in the radiotherapy group and 47.7% in the combined group.
Ten-year overall survival was 39.8% in the radiotherapy group, compared with 58.1% in the combined group. These results show that androgen suppression given during, and for 3 years after, irradiation improves disease-free and overall survival for high-risk prostate cancer patients. Bolla M, van Tienhoven G, Warde P et al. Lancet Oncol 2010; 11: 1066-73
Curry spice in chemotherapy
Curry spice could be used to aid chemotherapy, scientists have suggested. Researchers from the University of Leicester used a novel formulation of curcumin to target cells resistant to chemotherapy in colorectal tumour tissue. In the study, 80 nude mice were implanted with oxaliplatin-resistant colorectal cancer cells and randomised into one of four treatment groups (control, curcumin only, oxaliplatin only, curcumin and oxaliplatin). Results indicated that curcumin and oxaliplatin decreased the proliferative capacity of oxaliplatin-resistant cell lines more effectively than oxaliplatin alone. It also decreased markers associated with proliferation. Howells LM, Sale S, Sriramareddy SN et al. Int J Cancer 2010