Showing papers by "Talha Khan Burki published in 2013"

Isolation and cancer care

Abstract: Thousands of patients with cancer in the UK are isolated from friends and family, according to a new survey from Macmillan Cancer Support. The survey of 155 health-care professionals and more than 1700 patients with cancer showed that roughly one in four people newly diagnosed with cancer lacked support. Although extrapolation can be problematic, if translated to the entire country, this could amount to about 70 000 patients a year. Most isolated patients reported skipping meals, and being unable to deal with household chores. 11% had missed hospital or doctors appointments, and 18% had been unable to collect a prescription. Further, more than 50% of questioned health-care professionals affi rmed that isolated patients make worse decisions about their treatment. “Many of our specialist nurses and clinicians see people who are badly aff ected by a lack of support at home”, explains Macmillan’s Siobhan McClelland. “This is the fi rst time we have tried to gauge the possible scale of isolation in a quantitative way.” Previous research has suggested an association between isolation and poor treatment outcomes—a 2006 paper , for example, showed that mortality was higher in socially isolated women in whom breast cancer was diagnosed than in those who were better supported. McClelland notes that there is “a wealth of anecdotal evidence that a lack of support at home can badly aff ect patients”. Indeed, more than 50% of the surveyed health-care professionals cited instances of patients foregoing treatment because they did not have adequate support. Reasons for isolation vary. Often, friends and family were either too busy or inaccessible. The fi nancial toll that cancer takes meant that many patients could no longer aff ord to socialise. McClelland emphasises the importance of clinicians recognising the serious consequences of isolation. “We want to ensure patients’ living situation or support network is assessed, to highlight any extra support they may need from health and social care professionals.” Macmillan’s sur vey showed that 37% of health-care professionals do not always ask about patients’ support structures. Conceivably, this could be because they feel powerless to resolve problems related to isolation, particularly in terms of practical support. “It is important that professionals have some resources—a list of sources of help such as cancer support groups, helplines, and online forums for socially isolated patients”, Cancer Research UK’s Martin Ledwick told The Lancet Oncology.

Abiraterone and castration-resistant prostate cancer.

Abstract: Abiraterone signifi cantly prolongs radiographic progression-free survival in patients with metastatic castration-resistant prostate cancer who have not previously had chemotherapy, according to the results of a randomised phase 3 study in 1088 patients . US regulators have accordingly licensed abiraterone—an androgen biosynthesis inhibitor—for use in this population of patients (it is already approved for postchemotherapy use) and a similar amendment is expected in Europe. Since at least half of patients with prostrate cancer—a largely elderly cohort—do not receive chemotherapy, this expansion of abiraterone’s license potentially doubles the number of patients who can be given the drug. Median time to radiographic progression was 16·5 months for patients who received abiraterone plus prednisone versus 8·3 months for those who received prednisone alone. Abiraterone also delayed clinical decline, need for chemotherapy, and onset of pain. The fi ndings prompted the independent data monitoring committee to recommend the study be unblinded and patients from the placebo group be permitted to crossover, which means it will be diffi cult to conclusively show the “strong trend toward improved survival” that the authors described. “For one of the fi rst times with this disease, we have a treatment option that is designed around preserving function and preserving a good quality of life in delaying progression of cancer”, explains coauthor Charles Ryan (University of California, San Francisco, CA, USA). Nick James (University of Birmingham, Birmingham, UK) agrees. “Abiraterone is non-toxic, probably improves survival, and certainly has a big eff ect on radiologic progression-free survival, which is a meaningful endpoint.” Ryan cautioned that a third of patients in the study were un responsive to abiraterone, while more than half developed resistance. “We need to have further therapies available for these patients”, he told The Lancet Oncology. A novel androgen-receptor blocking drug— enzalutamide—is expected to receive European approval sometime next year. If radium-223, an isotope that targets bone metastases, also gains approval, then two new therapies with diff erent modes of action would be available. “Patients with prostate cancer tend to sequentially respond to treatment”, said James. “I think we’re going to see all these treatments options bolted one on top of the other.”

Lambrolizumab induces advanced melanoma regression

Abstract: Formerly known as MK-3475, lambrolizumab is an antibody that targets PD-1, and a phase 1 clinical trial has indicated that it could be a highly eff ective therapy for advanced melanoma. The researchers prescribed lambrolizumab to 135 patients with advanced melanoma. 48 of these patients had previously been treated with ipilimumab. The overall response rate was 38% (95% CI 25–44); those in the cohort with the highest dose of lambrolizumab had a response rate of 52% (95% CI 38–66). Moreover, the responses were durable. 81% of patients who had a response continued to receive treatment at the time of analysis. “Treatment with lambrolizumab resulted in a high rate of sustained tumour regression with mainly grade 1 or 2 toxic eff ects”, the authors concluded. Interestingly, the response rate was roughly the same regardless of whether patients’ had previously received ipilimumab. “It is related to the idea that all immunotherapies are diff erent; whether you’ve had previous therapy or not, you still have a high chance of responding”, explains coauthor Omid Hamid (Angeles Clinic and Research Institute, Los Angeles, California, USA). The future will bring trials of the drug in combination, while a randomised trial between lambrolizumab and chemotherapy is ongoing. “Clearly the goal of this drug is to fi nd its way towards approval for metastatic melanoma and also to look at it in terms of other solid tumours including breast cancer and lung cancer”, Hamid told The Lancet Oncology. “All the PD-1 and PDL-1 inhibitors are paradigm shifters for therapy”, adds Hamid. “They don’t just shift the paradigm for melanoma; they have the ability to shift it for all solid tumours”. In which case, a robust biomarker would be extremely useful. “We’d like to know which patients should receive PD-1 treatment, and we still don’t really know that”, affi rmed Lynn Schuchter (University of Pennsylvania, USA). Schuchter believes that lambrolizumab has enormous potential. “To see this kind of activity with a lack of signifi cant autoimmune toxicity is certainly encouraging”. She points out that it has been diffi cult to partner molecularly targeted therapies, BRAF inhibitors, with ipilimumab. “Maybe with this more favourable safety profi le, we will be able to partner the PD-1 antibodies with the BRAF inhibitors”, she told The Lancet Oncology.

Selection processes for lung cancer screening

Abstract: A risk-prediction model is a more eff ective method of selecting patients for lung cancer screening than are the criteria used by the US National Lung Screening trial (NLST), according to the results of a new study. Organisations such as the American Cancer Society have endorsed screening of high-risk individuals for lung cancer (assuming that highquality radiology and treatment are available). Consequently, institutions and universities in the USA have started to establish screening programmes. The NLST showed a 20% reduction in cancer mortality with screening and low-dose CT. US screening programmes frequently use the NLST criteria—specifi cally, individuals aged 55–74 years, with a history of smoking of at least 30 packyears, and, for ex-smokers, having quit no more than 15 years previously (or some combination of these factors). Researchers led by Martin Tammemagi (Brock University, St Catharines, ON, Canada) modifi ed the lung cancer risk-prediction model previously developed for the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) screening trial. The model takes into account variables such as age, body-mass index, chronic obstructive pulmonary disease status, and smoking-related factors. The researchers applied the NLST screening criteria and the risk-prediction model to the PLCO population, and compared the results. The risk-prediction model proved more sensitive (83·0% vs 71·1%) and had a higher positive predictive value (4·0% vs 3·4%) than the NLST criteria. “Most importantly”, notes Tammemagi, “the risk-prediction model missed 41·3% fewer cancers than the NLST criteria”. Research recently published by Jiemin Ma and colleagues suggested that if all eligible Americans were screened for lung cancer, 12 000 deaths would be averted each year. If the risk-prediction model rather than the NLST criteria were used in screening programmes, a further 2750 lives would be saved (although in a real-world setting, such high numbers are unlikely to be realised). “It is a signifi cant but small step forward”, affi rms Michael Seckl (Imperial College London, London, UK). But lung cancer screening with low-dose CT throws up a huge number of false-positives—around 95%. “What we really need is some kind of additional test to determine risk, a blood test, for example, or a urine test”, Seckl added. Forthcoming costeff ectiveness studies will help to shape the future of lung cancer screening (the NLST data suggested that 320 screenings would avert one death, which compares favourably with similar studies for mammograms), as will the recommendation of the US Preventive Services Taskforce, expected later in 2013.