What's different about the new prostate cancer screening guidelines?

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.

Rituxan approved for most common type of leukemia

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.

American Idol-esque talent competition for young adult survivors gets under way

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.

New test available that predicts risk of colon cancer recurrence

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.

Help Drew Carey give his money to the Lance Armstrong Foundation

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.

As of this post, @DrewFromTV has 390,207 followers and @LIVESTRONG has 59,510. Only about 330,000 followers left to go!

If you don't already have a Twitter account, you can sign up at twitter.com.

Curetoday.com's most-read articles and blogs of 2009

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

1. The Vitamin D Difference

2. The Good Cancer?

3. The Internal Flame

4. Trying Something New

5. Targeting the Triple Threat

6. Battling Cancer Again

7. The Final Journey

8. Reining in Renal Cancer

9. Under the Sheets

10. Fatigue-Fighting Foods

Top 10 Blogs

1. PARP inhibitors create buzz at ASCO (June 8)

2. Tips for managing the financial cost of caregiving (June 24)

3. Finally, good news for triple negative breast cancer patients! (June 9)

4. "So You Think You Can Dance" shows breast cancer struggle through art (July 24)

5. Study shows how to prevent rash from EGFR inhibitors (June 1)

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)

9. Jonathan White is a fraud -- and other strange things (July 22)

10. Ductal carcinoma in situ: Is it cancer (September 29)

Is Treanda a better mate to Rituxan than CHOP?

BY MELISSA WEBER | DECEMBER 7, 2009

Treanda (bendamustine) may soon replace CHOP as the chemotherapy buddy to Rituxan (rituximab) for patients with advanced follicular, indolent, and mantle cell lymphoma who are getting first-line treatment, following research presented today at the American Society of Hematology's annual meeting.

A phase 3 German study, dubbed StiL (Study Group Indolent Lymphomas), compared the effectiveness and safety of Rituxan plus Treanda to Rituxan plus CHOP, a cocktail that includes cyclophosphamide, doxorubicin, vincristine, and prednisone. The Treanda study arm included 260 patients; the R-CHOP arm had 253 patients.

Rituxan plus Treanda outperformed the traditional R-CHOP regimen at almost every turn. Median progression-free survival (the amount of time the cancer did not progress) hit 54.9 months in the Treanda arm, compared with 34.8 months in the R-CHOP group, and 39.6 percent of patients receiving the Treanda combo had a complete remission (disappearance of all signs of cancer) versus 30 percent of those on R-CHOP. Plus, the R-CHOP arm resulted in a higher frequency of severe side effects, namely neutropenia (46.5 percent versus 10.7 percent) and leukocytopenia (38.2 percent versus 12.1 percent). There were also higher rates of hair loss, nerve damage, and inflammation in the mucous lining of the mouth in the R-CHOP group, although more patients on Treanda developed skin-related side effects.

Investigators said that because indolent lymphoma is such a long-term disease, extended follow-up is needed to determine overall survival. They also noted that although these results suggest Treanda is a better partner to Rituxan than CHOP in patients with indolent lymphomas, R-CHOP is still the standard of care for aggressive lymphomas.

Treanda has been used for decades in other countries, but it only just gained FDA approval last year for chronic lymphocytic leukemia and indolent (slow-growing) B-cell non-Hodgkin lymphoma. For more on lymphoma, check out "Trying Something New" from the Spring 2009 issue of CURE. And look for more breaking news from ASH in the Winter issue, which drops later this month.

More frequent dose of Rituxan fails to show benefit

BY MELISSA WEBER | DECEMBER 7, 2009

The standard schedule of giving Rituxan every three weeks, as opposed to every two weeks, is still the best option for older patients with diffuse large B-cell lymphoma, according to research presented today at ASH's annual meeting.

Early analysis of a phase 3 French study found that giving eight cycles of Rituxan plus CHOP chemotherapy every 14 days, compared with the standard of every 21 days, resulted in no clinical benefit for patients. Plus, the more frequent schedule caused more blood-related side effects, requiring more red blood cell and platelet transfusions and a higher number of hospitalizations.

The final analysis of data should be available in 2010, researchers said, but currently, the two-year overall survival stands at 67 percent for patients treated every 14 days compared with 70 percent for patients treated every 21 days.

Four drugs may be better than three in older myeloma patients

BY MELISSA WEBER | DECEMBER 6, 2009

A four-drug combo with Velcade (bortezomib) followed by maintenance therapy resulted in better response rates and less neuropathy compared with the standard three-drug Velcade combo in newly diagnosed multiple myeloma patients who are over age 65.

The phase 3 study, presented today at the annual meeting of the American Society of Hematology, compared a combination of Velcade, melphalan, prednisone, and thalidomide (VMPT) followed by a maintenance regimen of Velcade and thalidomide versus the current standard of care--Velcade, melphalan, and prednisone (VMP). The intensity of both VMPT and VMP was reduced from nine six-week cycles to nine five-week cycles, with Velcade given weekly.

While roughly one-quarter (24 percent) of patients in the VMP arm had complete disappearance of cancer, known as a complete response, 38 percent of patients on VMPT had a complete response. Plus, for 60 percent of VMPT patients, the cancer had not progressed after three years, compared with 42 percent of VMP patients. Investigators said longer follow-up is needed to assess overall survival.

The weekly infusion of Velcade (as opposed to twice a week) resulted in a significantly reduced incidence of peripheral neuropathy, a debilitating side effect that affects the nerves, without affecting response or progression-free survival. Researchers noted a higher incidence of neutropenia and heart complications in the VMPT arm.

A Spanish study presented at the meeting also looked at different Velcade combinations in older myeloma patients. Although each trial used a different approach, both used four drugs in the end. You can read about that study in CURE's Winter issue, which drops in a couple weeks, or sign up for one of our blood cancer e-newsletters to get the latest news from ASH.

Coping easier for patients with advance care plans

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.