Antibiotics crucial after chemotherapy
Prophylactic antibiotics, barrier isolation and air quality control measures can substantially reduce the risk of death in high-risk cancer patients after chemotherapy, a systematic review has shown. Researchers analysed 29 studies and found mortality risk was reduced 40 per cent at 30 days post-treatment when this combination of infection control measures was employed. However, inclusion of prophylactic antibiotics was crucial to show the beneficial effect on mortality. Analysis of a further 11 studies on inpatient versus outpatient management after haematopoietic stem-cell transplantation showed that all-cause mortality was 28 per cent lower in outpatients.
Schlesinger A, Paul M, Gafter-Gvili A et al. Lancet Infect Dis 2009; 9(2): 97-107
Child cancer survivors miss out on screening
Most young women treated with chest radiation for a childhood cancer do not undergo appropriate mammography screening, say researchers in the US. Their study of 625 women who had received chest radiation for a paediatric cancer found the strongest predictor of mammography use in those aged 25-39 was a physician recommending it. Despite the recommendation for annual screening for women exposed to moderate- to high-dose chest radiation, almost half (47.3 per cent) of cancer survivors aged 25-39 years had never had a mammogram and only 52.6 per cent of the 40-50 age group had regular screening (at least two mammograms within four years).
Oeffinger KC, Ford JS, Moskowitz CS et al. JAMA 2009; 301(4): 404-14
Combination therapy in metastatic CRC
Adding cetuximab to the treatment regimen of patients with metastatic colorectal cancer (CRC) results in worse outcomes, a controlled trial has shown. Cetuximab has some efficacy against CRC; however, combination therapy with capecitabine, oxaliplatin, bevacizumab and cetuximab resulted in a median progression-free survival of 9.4 months, compared with 10.7 months for patients receiving the capecitabine, oxaliplatin and bevacizumab regimen (P = 0.01). Quality of life scores were also lower in the cetuximab group. Patients treated with cetuximab who had tumours bearing a mutated KRAS gene had significantly reduced progression-free survival compared to those without the mutation who were receiving cetuximab, or patients with the mutation not receiving cetuximab.
Tol J, Koopman M, Cats A et al. N Engl J Med 2009; 360: 563-72
Aspirin and colorectal adenoma
Aspirin is effective for secondary prevention of colorectal adenoma, according to the results of a meta-analysis. Researchers identified four trials involving 2,967 participants aged a mean 58 years. Doses of aspirin tested were 81-325mg per day. Overall, advanced lesions were found in 12 per cent of those taking placebo and 9 per cent of those taking any dose of aspirin. The pooled risk ratio of any adenoma for any dose of aspirin versus placebo was 0.83, corresponding to an absolute risk reduction of 6.7 per cent. For any advanced lesion, the pooled risk ratio was 0.72.
Cole BF, Logan RF, Halabi S et al. J Natl Cancer Inst 2009; doi:10.1093/jnci/djn485
Sensitivity of CT colonography
CT colonography (CTC) has comparable sensitivity to colonoscopy for polyps >5mm, say researchers in Germany. Their prospective study comparing five screening tests for advanced colonic neoplasia found that the respective sensitivities of colonoscopy, CTC, flexible sigmoidoscopy, faecal immunochemical stool testing (FIT) and faecal occult blood testing (FOBT) were 100 per cent, 96.7 per cent, 83.3 per cent, 32 per cent and 20 per cent. Combining flexible sigmoidoscopy with FIT or FOBT did not increase sensitivity; where stool tests are used, the researchers recommend FIT. A total of 221 adenomas were detected in 307 subjects who completed CTC and colonoscopy; 269 patients provided stool samples for FOBT and FIT.
Graser A, Stieber P, Nagel D et al. Gut 2009; 58: 241-8
Pregnancy, lactation and cancer outcomes
Being diagnosed with cancer during pregnancy or while breastfeeding is not generally associated with increased risk of cancer-related death, researchers in Norway have found. The exceptions are cancers of the breast and ovary diagnosed during lactation. Survival was investigated among women in Norway aged 16 to 49 years diagnosed with cancer between 1967 and 2002. A comparison was made between women who were pregnant or breastfeeding when diagnosed with the most common cancers in this age group and those who were not. Results for all cancers combined showed no effect of being diagnosed with cancer during pregnancy or lactation. However, women who were diagnosed with breast or ovarian cancer during lactation had an increased risk of cause-specific death (HR 1.95 and 2.23, respectively).
Stensheim H, Moller B, van Dijk T, Fossa SD. J Clin Oncol 2009; 27: 45-51
Monitoring advanced prostate cancer
Survival and response to treatment in advanced prostate cancer can be predicted by the number of circulating tumour cells (CTCs), a study has shown. Researchers assessed CTC number before and after treatment, changes in PSA and baseline lactate dehydrogenase (LDH) in 164 patients receiving first-line chemotherapy. Before treatment, high LDH (HR 6.44), CTC count (1.58) and PSA titre (1.26) were associated with a high risk of death. Post-treatment, assessed at four, eight and 12 weeks, changes in CTC number were strongly associated with risk, but changes in PSA were only weakly associated.
Scher HI, Jia X, de Bono JS et al. Lancet Oncol 2009; doi:10.1016/S1470-2045(08)70340-1.
Anticancer properties of olives
The anticancer properties of olives have been highlighted in two research papers. First, a study from Spain has shown that the major complex phenols in extra-virgin olive oil suppress overexpression of the HER2 cancer gene in human breast cancer cells. Although the tumoricidal effects occurred at concentrations unlikely to be achieved through olive oil consumption, the researchers hope the findings will help in the development of new therapies.
In another study, also from Spain, researchers found that maslinic acid, found in the skin, leaves and wax of olives, inhibited the growth of HT29 colon cancer cells.
Menendez JA, Vazquez-Martin A, Oliveras-Ferraros C et al. Int J Oncol 2009; 34: 43-51
Reyes-Zurita FJ, Rufino-Palomares EE, Lupianez JA, Cascante M. Cancer Lett 2009; 273: 44-54