BY MELISSA WEBER | APRIL 17, 2010
Patients with advanced non-small cell lung cancer now have the option of receiving a targeted drug immediately after chemotherapy--before the disease worsens.
Late Friday, the Food and Drug Administration approved Tarceva (erlotinib) as maintenance therapy for patients with locally advanced or metastatic lung cancer that has not progressed after first-line chemotherapy. Until now, the approved use of Tarceva had been limited to advanced lung cancer that grew or spread after chemotherapy. (Check out "Lung Overdue" from the Spring 2010 issue.)
Surprisingly, the approval came despite an FDA advisory panel's almost unanimous vote last December against the new use. The panel's main concern was the minimal benefit shown in the SATURN study, which served as the basis for the approval.
In the trial, nearly 900 patients with advanced non-small cell lung cancer received four cycles of first-line platinum-based chemotherapy. Patients were then split into two groups: one received placebo, and the other received maintenance Tarceva. For patients on Tarceva, median progression-free survival (the time before the cancer progressed) reached 12.3 weeks, compared with 11.1 weeks for patients taking placebo. The Tarceva group lived only slightly longer, with median overall survival reaching 12 months for patients on Tarceva versus 11 months for those on placebo. The most common side effects of Tarceva included rash and diarrhea.
Tarceva, also approved for advanced pancreatic cancer, is an oral drug that inhibits the EGFR signaling pathway inside a cancer cell. OSI Pharmaceuticals, the maker of Tarceva, is investigating the drug as a first-line treatment in lung cancer patients with an EGFR mutation, as treatment after surgery for non-small cell lung cancer, and for treating ovarian cancer and liver cancer, the company said in a statement.
Check out our lung cancer page for more.RELATED POSTS
BY MELISSA WEBER | MARCH 17, 2010
With spring break upon us and summer vacation not too far behind, you're likely making plans for your next family getaway. Whether it's a day trip to a nearby amusement park or a week at the beach, traveling can be complicated when you have a child with cancer. But if you plan ahead, you can help keep your child safe while making sure they don't miss out on any of the fun.
Parents of patients at St. Jude Children's Research Hospital and the patient and family education department at St. Jude have compiled the following list of tips for traveling with a child who has cancer:
• Carry the names, addresses, and phone numbers of emergency contacts.
• Carry your insurance information (medical and pharmacy).
• Carry the name, phone number, and e-mail address of your child's doctor.
• Identify a children's hospital or other reliable health care facility near your destination. Your child's doctor may be able to offer suggestions.
• Bring your child's face mask. Wearing a face mask is not always comfortable for your child, but it is essential for helping keep germs away.
• Carry small bottles of alcohol-based hand cleaner so you and your child can clean your hands often.
• If your child has a central venous line, be sure to bring all the supplies needed to keep up with the cleaning schedule.
• Before traveling, make an organized chart or list of medicines that you will need to give your child and note when you should give them.
• Keep medicines in the original, childproof containers.
• If traveling by car, do not store medicines in the glove compartment or trunk of your car. These areas can become hot and humid, which can alter how well some medicines work.
• Keep all medicines with you in a carry-on bag when traveling by train, plane, or bus. Your child may need a dose during travel. If your luggage gets lost, you could be without the medicine for several days.
• It might be helpful to carry a note from your child's doctor that explains what medicines your child takes. With increased security at airports, you might find that security officers are more concerned about what you have in your bags, especially certain medical supplies, such as syringes.
• Bring more of your child's medicines and medical supplies than you think you will need, just in case your stay becomes longer than planned.
• Carry an empty, wide-mouth plastic container with a tight-fitting lid. You never know when your child will feel sick to his stomach.
• A change of clothes will be helpful if your child has been nauseated or has diarrhea.
• If you are heading to a warm climate, keep in mind that certain medicines could make your child's skin more sensitive. Know which medicines might make skin more sensitive to sunlight. Apply sunscreen with an SPF of 30 or more.
Find more on CURE's childhood cancer page.RELATED POSTS
BY MELISSA WEBER | MARCH 3, 2010
With its first update in almost a decade, the American Cancer Society today released revised guidelines for prostate cancer screening. Although some recommendations haven't changed--most notably, they still don't support routine screening for prostate cancer--the society is offering some new advice.
For men who choose to be screened, the revamped guidelines recommend annual screening for those with a PSA (prostate-specific antigen) level of 2.5 ng/ml or higher, but screening can be stretched to every two years for men whose PSA is under 2.5 ng/ml. Once the PSA level hits 4.0 ng/ml, the society recommends further evaluation or biopsy. For levels that fall between 2.5 ng/mL and 4.0 ng/mL, doctors should assess individual risk before deciding how to proceed.
The society put greater emphasis on shared decision-making, offering physicians specific suggestions, such as use of decision aids (check out the ACS decision aid), to help facilitate conversations with patients about the risks and benefits of screening. (Read about the cancer screening debate in "Life Preserver?" from the Fall 2009 issue.)
The controversy surrounding PSA screening again ignited a year ago when two studies were reported in The New England Journal of Medicine. One study found the test saved lives, while the other found it didn't. (Check out our coverage of the research.) These conflicting findings are what led the ACS to focus attention on informed decision-making in the new guidelines.
The guidelines also acknowledge the limits of digital rectal exams, stating that screening can be performed using PSA with or without the digital rectal exam.
As for community-based prostate cancer screening programs, the society discourages men from participating in programs unless they provide appropriate counseling and follow-up care to men with abnormal screening results. "Availability of follow-up care must not be an afterthought. Unless these program elements are in place, community-based screening should not be initiated," the guidelines say.
Read the complete guidelines in CA: A Cancer Journal for Clinicians.RELATED POSTS
BY MELISSA WEBER | FEBRUARY 19, 2010
Last night, the Food and Drug Administration announced its approval of Rituxan (rituximab) in combination with fludarabine and cyclophosphamide (FC) for the treatment of CD20-positive chronic lymphocytic leukemia. The combination can be given to CLL patients who have not received previous treatment as well as those whose cancer has not responded to other drugs.
The agency based its decision on two phase 3 studies. The first trial showed progression-free survival--the amount of time patients lived without the disease getting worse--was eight months longer (39.8 months versus 31.5 months) in patients who received Rituxan plus FC compared with patients who received FC alone. In the second study, patients on the Rituxan combo lived five months longer without disease progression than patients receiving chemotherapy alone (26.7 months versus 21.7 months).
Already approved for non-Hodgkin lymphoma, Rituxan is a monoclonal antibody that works by targeting the CD20 protein that is found at high levels on cancerous B cells. Side effects of the drug can include fever, chills, headache, and, rarely, infusion reactions (Rituxan is administered intravenously).
About 16,000 people in the U.S. are diagnosed with CLL each year, making it the most common type of adult leukemia.
Rituxan becomes the third drug approved for CLL in the past two years. The FDA gave the green light to Arzerra (ofatumumab) last October for patients whose cancer stopped responding to other forms of chemotherapy, and Treanda (bendamustine) received the FDA's OK in March 2008 for patients who had not received prior treatment.
Watch for our feature on CLL in CURE's Summer issue, which drops in June. And for more, visit our leukemia page.RELATED POSTS
BY MELISSA WEBER | JANUARY 26, 2010
Instead of American Idol or So You Think You Can Dance, young musicians and dancers with cancer now have a competition of their own.
Vital Options has launched Surviving Idol: Young Adults with Cancer Expressing Themselves in support of National Young Adult Cancer Awareness Week, which takes place the first week of April. Cancer survivors between ages 17 and 40 can compete in the global talent contest in any of three categories: vocal, instrumental, and dance.
A panel of advocates and celebrities affected by cancer will select the finalists in each category, but in true Idol fashion, you vote for your favorites. The winners of Surviving Idol will be featured in an upcoming concert, with other plans in the works as well.
The site is still a work in progress, but they're already accepting entries at survivingidol.com.RELATED POSTS
BY MELISSA WEBER | JANUARY 21, 2010
Genomic Health announced today that its Oncotype DX colon cancer test to determine the risk of recurrence in patients with stage 2 colon cancer is now commercially available.
The colon cancer test looks at the activity of 12 genes in the patient's tumor to come up with a score that predicts how likely it is that the cancer will come back. It's this information that can help patients and doctors decide whether chemotherapy is needed after surgery.
Research will be presented this weekend at the American Society of Clinical Oncology's Gastrointestinal Cancers Symposium that suggests the test may have a potential role in stage 3 colon cancer, although further study is needed. And as we reported at last year's ASCO annual meeting, although the test successfully predicted recurrence, it did not predict which patients would benefit from chemotherapy.
A similar 21-gene test for early-stage breast cancer has been available since 2004, and Genomic Health is currently developing tests for prostate cancer, non-small cell lung cancer, kidney cancer, and melanoma.RELATED POSTS
BY MELISSA WEBER | JANUARY 20, 2010
Drew Carey really wants to give the Lance Armstrong Foundation a million bucks. Last fall, the actor and host of The Price Is Right said he would donate $1 million to LAF if his @DrewFromTV Twitter account reached a million followers before the ball dropped on New Year's Eve.
Then, in a tweet on December 30, he changed the rules: Follow him or LAF's @LIVESTRONG Twitter account and when the combined number of followers hits one million – regardless of the date – a check for as much is in the mail.
If you don't already have a Twitter account, you can sign up at twitter.com.RELATED POSTS
BY MELISSA WEBER | DECEMBER 31, 2009
So, which stories caught your eye during the past year? Based on the top 10 most popular articles and blogs on curetoday.com, you sampled a little bit of everything--nutrition, treatment, finances, end of life, and late effects.
We followed your clicks, and below are your faves in order of most viewed.
Top 10 Articles
Top 10 Blogs
1. PARP inhibitors create buzz at ASCO (June 8)
2. Tips for managing the financial cost of caregiving (June 24)
6. Should you be concerned about the H1N1 virus (October 9)
7. Would you date a cancer survivor? (July 20)
8. Cancer survivors sought for online study (September 10)
10. Ductal carcinoma in situ: Is it cancer (September 29)RELATED POSTS
BY MELISSA WEBER | DECEMBER 6, 2009
Advanced care planning--that is, having a living will and a designated health care proxy--helps patients with blood cancers better cope, according to research presented today at the American Society of Hematology's annual meeting in New Orleans.
Researchers from the University of Nebraska Medical Center and Fred Hutchinson Cancer Research Center compared the psychological well-being of patients who had advance care planning with those who did not, and although both groups were found to have similar levels of social support, depression and anxiety, and quality of life, they each had different patterns for coping. Patients with ACP were constructive "copers." They were problem-solvers who took advice, planned, and sought moral support or discussed their feelings with others. Patients without ACP, on the other hand, were emotional copers, utilizing techniques like self-blame, denial, and behavioral or mental disengagement.
Considering that previous studies found only half of blood cancer patients undergoing a high-risk procedure, such as a stem cell transplant, have advance care planning, this new study can help cancer care providers design interventions that engage more patients in ACP. What may appeal to patients, regardless of coping style, is to highlight the positives and practical importance of ACP while de-emphasizing the emotional aspects, researchers said.
Check out the American Cancer Society's advance directives webpage for detailed information on living wills and other important health care-related documents.RELATED POSTS
BY MELISSA WEBER | NOVEMBER 9, 2009
Each year, the American Society of Clinical Oncology releases a report that pinpoints the top advances in cancer treatment, prevention and screening. This year, ASCO identified 15 key advances in four areas. (The advances were not ranked.)
Here's a breakdown of the findings, provided by ASCO:
1. Advances in Personalized Medicine and Targeted Therapies
Multiple trials this year demonstrated that oncology is no longer "one size fits all" medicine. Rather, increased understanding of the biology of cancer is enabling researchers to develop highly targeted drugs and personalized treatment regimens for patients. Advances in this category include:
• The targeted drug trastuzumab (Herceptin), which has been successful against breast tumors that overexpress the HER2 protein, was found to improve survival for HER2+ gastric cancer. [We'll cover this topic in detail in the Winter issue of CURE, which drops in December.]
• Researchers identified the first effective immunotherapy for neuroblastoma – chimeric anti-GD2 antibody ch.14.18.
• For the first time in 30 years, a randomized trial identified a regimen – initial chemotherapy combined with the EGFR-targeted drug cetuximab (Erbitux) – that increases survival for people with metastatic head and neck cancer.
• Researchers identified a specific subset of patients with non-small cell lung cancer (NSCLC) who benefit from first-line treatment with the targeted drug gefitinib (Iressa). [Watch for our lung cancer feature in the Spring 2010 issue of CURE, which publishes in March.]
• The FDA approved new indications for targeted drugs to treat glioblastoma and advanced kidney cancer, both highly challenging forms of cancer. Bevacizumab (Avastin) was approved as a single agent for treatment of glioblastoma and when combined with interferon, for treatment of advanced kidney cancer. Additionally, everolimus (Afinitor) was approved for kidney cancer in patients whose disease has progressed despite treatment with other targeted drugs. [Read our kidney cancer coverage here.]
2. New Standards of Care
Results from several long-awaited clinical trials this year affirmed the superiority of certain treatment regimens for biliary, lung, and prostate cancers. These include:
• The first-ever standard of care for advanced biliary cancer (cancers of the gallbladder and bile ducts) – results from the largest clinical trial to date for this disease stage showed that combination gemcitabine (Gemzar) and cisplatin treatment increases survival and slows cancer progression, compared with gemcitabine treatment alone.
• Data from a late-stage trial reporting that maintenance therapy with pemetrexed (Alimta) extends survival for patients with nonsquamous forms of advanced NSCLC – a finding that establishes a new standard and gives patients a long-term, easily-administered treatment option with low toxicity. [Watch for our lung cancer feature in the Spring 2010 issue of CURE, which drops in March.]
• Practice-changing findings showing that radiation following prostatectomy improves survival and reduces risk of metastasis for men with early-stage prostate cancer.
3. Cancer Prevention and Screening
This year, findings from large trials shed new light on widely used cancer detection, monitoring and prevention tools. Major research advances in this category include:
• Interim results from two large trials showing that routine PSA testing has a minimal effect on reducing prostate cancer mortality – findings that add new insight to a long-time debate. [Read our coverage here.]
• A large trial showing that treating relapsed ovarian cancer based on rising levels of a protein in the blood called CA125 does not improve outcomes, compared with monitoring for physical symptoms of ovarian cancer relapse. These findings will help spare women from the anxiety and costs of frequent CA125 testing, as well as the toxicity of earlier treatment. [Read our coverage here.]
• Research suggesting that more women may benefit from HPV vaccination than previously thought, based on findings showing that Gardasil reduces the risk of HPV infection, cervical cancer and other HPV-related disease in women aged 25 to 45.
4. Large Trials Settle Key Debates in Colon, Breast Cancer Treatment
The results of two closely watched studies settled major debates in the treatment of colon and breast cancers. These include:
• In the first trial to examine bevacizumab in the adjuvant setting, researchers demonstrated that adjuvant bevacizumab treatment does not prevent colon cancer recurrence in patients who have undergone surgery for their disease. [Read our coverage here.]
• Standard three-drug chemotherapy is more effective and less toxic than single-drug treatment with capecitabine (Xeloda) in women age 65 and older undergoing adjuvant treatment for early-stage breast cancer. Researchers had thought that single-drug treatment may be more tolerable for older women, but this was not found to be the case.
The full report--plus reports from previous years--is available at www.cancer.net.RELATED POSTS