Colleen Moretti

Patients from rural, low-income households with hepatocellular carcinoma (HCC) are more prone to a more advanced tumor stage at diagnosis and higher mortality due to disparities in high-quality liver care, according to data recently published in 

Ethnic minorities and individuals living in lower-income neighborhoods are at risk for inadequate HCC surveillance, the authors wrote. That inadequacy, according to the authors, has the potential to affect the outcomes of patients with HCC in these populations.

“Poor HCC surveillance leads to more advanced tumor stage at diagnosis, which reduces potentially curative options, leading to worse survival outcomes,” they wrote. “Disproportionately lower rates of HCC surveillance among ethnic minorities and individuals of low socioeconomic status, including those from underserved rural regions and with lower household income, may further contribute to the disparities in HCC outcomes among these vulnerable populations.”

The authors conducted a comprehensive analysis study using the most updated information from the Surveillance, Epidemiology, and End Results (SEER) cancer database from the National Cancer Institute, to investigate the disparities in HCC advanced tumor status at diagnosis and survival and if neighborhood, race, and income contribute to those factors.

There were 83,237 adults (76.7% men; 63.7% aged 60 years or younger) diagnosed with HCC from 2004 to 2017. Half of the patients were non-Hispanic White, 19.5% were Hispanic, 15.7% were Asian/Pacific Islander and 13.5% were Black. Almost half (49.1%) of the patients had localized stage HCC at time of diagnosis and 14.4% had distant-stage HCC. A total of 64.5% of patients were from a metropolitan area, and 75

9% had a median annual household income of $55,000 or less.

When adjusting for household incomes, individuals in the lowest income group (less than $40,000) had a larger percentage of Black patients (25.2%), compared to their representation in the $70,000 and above household income group at 9%. Black patients were also more likely to live in rural locations (73.6%).

While men were three times more likely than women to be diagnosed with HCC, incidence trends have declined recently. HCC incidence among American Indians/Alaska Natives and Hispanics were the highest throughout the study, with 18.3 and 13.7 per 100,000 people, respectively. HCC incidence decreased for all races throughout the study, except for American Indians/Alaska Natives whose incidence continued to increase throughout.

Those living in more rural areas had a higher risk of advanced HCC and mortality, as well as individuals living in households with an annual income of less than $40,0000.

Overall, women had a higher survival rate than men and were the highest among Asians/Pacific Islanders. Those living in larger metropolitan areas and households with higher incomes had significantly higher survival than other patients.

“Despite controlling for HCC treatment, the treatment approach for advanced-stage HCC is fundamentally different (palliative versus curative intent), and this may partly explain the persistently higher mortality among rural and low-income patients with HCC,” the authors wrote.

Patients who have a lower income and live in rural areas are at a greater risk for mortality than those with higher incomes who live in metropolitan areas, as well as more advanced tumor stages. The authors noted that these disparities are “complex and multifactorial,” but are most likely due to a lack of access to proper treatment, care and resources.

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Patients with hepatocellular carcinoma who live in low-income and rural households are less likely to receive high quality care and therefore are more likely to be diagnosed with an advanced stage cancer. 

Living in Low-Income, Rural Households Associated With Greater Risk of Death for Patients With Liver Cancer

Treatment with Lorbrena (lorlatinib) demonstrated longer progression-free survival and a higher frequency of intracranial response than Xalkori (crizotinib), for those with anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC), according to study results published in 

. The drug also led to a higher increase in quality of life.

Lorbrena demonstrates antitumor activity in previously treated patients with ALK-positive NSCLC, but the drug’s efficacy compared to Xalkori is unclear, according to the authors.

They noted that a previous study once demonstrated that Xalkori was superior to platinum-based Alimta (pemetrexed) chemotherapy, which established it as a standard of care treatment in the firstline setting of ALK-positive NSCLC. But since that study, more data has become available that has demonstrated that second-generation drugs including Alecensa (alectinib), Alunbrig (brigatinib) and ensartinib were superior to Xalkori in the firstline setting. However, as the authors noted, the second-generation ALK inhibitors have their share of concerns.

“Despite the improved efficacy of second-generation inhibitors, drug resistance and recurrent disease — including central nervous system (CNS) progression, a major cause of illness and death — still develop,” they wrote.

As a result, the authors aimed to evaluate the efficacy of a third-generation inhibitor (Lorbrena) in the firstline setting of ALK-positive NSCLC, compared to Xalkori.

The study consisted of 296 patients with ALK-positive NSCLC :149 of which were randomized to Lorbrena at 100 mg daily and 147 were randomized to Xalkori at 250 mg twice daily.

Results showed that at 12 months, 78% of patients receiving Lorbrena were alive without disease progression, and 39% or patients receiving Xalkori were alive without disease progression.

A total of 76% of patients who received Lorbrena and 58% of those who received Xalkori had an objective response, meaning there was a decrease in tumor size. Among those who had measurable brain metastases 82% and 23%, respectively, had an intracranial response to therapy. Overall, 71% of patients who received Lorbrena had an intracranial response.

“Patient-reported outcomes also supported the safety and favorable side effect profile of (Lorbrena) relative to (Xalkori), and patients who received Lorbrena reported a significantly greater improvement in global quality of life than those who received Xalkori,” the study authors wrote.

The most common side effects seen in patients being treated with Lorbrena were high levels of fat particles in the blood, weight gain, pain, numbness or weakness in hands and feet (known as peripheral neuropathy) and cognitive effects. Lorbrena had more grade 3 or 4 side effects than Xalkori, and researchers relate that to the fluctuating lipid levels. Due to side effects, 7% of patients receiving Lorbrena and 9% of patients receiving Xalkori stopped treatment.

Patients with ALK-positive non-small-cell lung cancer who received Lorbrena reported better quality of life and had longer progression-free survival than patients who received Xalkori.

Patients With Lung Cancer Subset Report Better Quality of Life, Improved Survival After Treatment with Lorbrena

Men with prostate cancer and are receiving androgen deprivation therapy (ADT), a treatment that eliminates testosterone, may experience symptoms of fatigue due to an increase in the protein interleukin 6 (IL-6, a circulating marker of inflammation that helps regulate immune response), according to a study published in 

“To our knowledge, there have been no studies examining the association between inflammation and androgen deprivation therapy symptomology even though testosterone is known to modulate inflammation,” authors say. “These efforts are important to improving the quality of life in the large and growing population of patients with prostate cancer receiving androgen deprivation therapy.”

The study compared two groups: one of 47 men with prostate cancer who received ADT and another group of 82 men who did not receive treatment and had no history of cancer. Participants were assessed with the Fatigue Symptom Inventory, the Center for Epidemiological Studies Depression Scale, and a batter of neuropsychological tests, at the time of ADT therapy initiation, six months later, and 12 months later in those who received therapy, and comparable times in those who did not.

Results showed that fatigue and depression increased significantly over 12 months in men who received treatment when compared to those without cancer. Cognitive impairment rates stayed stable for men receiving treatment, while authors found a decrease in the other group of men.

Additionally, researchers saw a significant increase of IL-6 in men with prostate cancer who received ADT, and concluded that this increase could lead to an increase of fatigue symptoms over time. They however do not attribute the symptoms of depression and cognitive impairment to IL-6, but to treatment overall.

“Exercise has been shown to reduce fatigue in patients with prostate cancer, perhaps because of its effects on interleukin 6,” researchers note. “Research is needed to determine whether additional interventions to reduce overall inflammation or interleukin 6 specifically exert beneficial effect on fatigue among androgen deprivation therapy patients with prostate cancer who are unable or unwilling to exercise.”

The authors noted that the study was limited by its small sample size of 129 men, and concluded that a larger sample size is needed in future research examining whether a reduction in overall inflammation or IL-6 in particular could help relieve fatigue in men with prostate cancer, ultimately improving their quality of life during treatment and beyond.

Men who are receiving androgen deprivation therapy treatment for prostate cancer experience higher levels of fatigue and depression when compared to men who are not receiving treatment and who have no history of cancer. 

Men with Prostate Cancer Experience Higher Levels of Fatigue Due to Inflammation

Treatment with Lynparza (olaparib) at 300 mg twice daily effectively improved survival in men with metastatic castration-resistant prostate cancer, according to findings published in 

This phase three trial randomly assigned 256 patients to receive Lynparza and 131 patients to receive either Xtandi (enzalutamide) at 160 mg once daily or Zytiga (abiraterone) at 1,000 mg once daily in addition to prednisone at 5 mg twice daily as the control therapy. 

Cohort A had 245 patients with at least one alteration in 

. Cohort B had 142 patients with at least one alteration of the 12 other prespecified genes.

Results showed that in cohort A, the median overall survival was 19.1 months for those who received Lynparza , and 14.7 months for those in the control group. In cohort B, median overall survival was 14.1 months with Lynparza and 11.5 months in the control group.

Those in cohort A who received Lynparza had a significantly longer survival than those in the control group, and death risk was 31% lower with Lynparza than in the control group. There were 148 and 100 deaths in cohorts A and B, respectively.

Overall population survival was 17.3 months with Lynparza and 14 months in the control group. In the control group 86 out of 131 patients switched over to receive Lynparza, 56 of them in cohort A. Although authors note, “earlier treatment with olaparib may have an advantage over its use late in the disease course.”

Median time until second progression or death for those in cohort A was 15.5 months with Lynparza and 10.6 months in control therapy. For those in cohort B was 9.9 months and 7.9 months, and overall population was 13.4 months and 9.7 months.

The most common side effects related to Lynparza were amenia, nausea and fatigue or asthenia (feeling weak or overly tired). Side effects from the control therapy were fatigue or asthenia, nausea and decreased appetite.

Lynparza demonstrates a significantly longer duration of survival compared Xtandi or Zytiga for men with metastatic prostate cancer, one study found.

Colleen Moretti | Contributors

Living in Low-Income, Rural Households Associated With Greater Risk of Death for Patients With Liver Cancer

Patients With Lung Cancer Subset Report Better Quality of Life, Improved Survival After Treatment with Lorbrena

Men with Prostate Cancer Experience Higher Levels of Fatigue Due to Inflammation

Lynparza Leads to Longer Survival in Men With Prostate Cancer

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