New diagnostic imaging for lung cancer could prevent unnecessary surgery

A new type of diagnostic imaging -- which can better differentiate benign lung lesions from those which are cancerous -- could be used to prevent unnecessary surgery by enabling more accurate diagnosis of the disease. A study by Belgian researchers, presented at the European Respiratory Society's Annual Congress in Amsterdam, found that the new technique can more accurately determine whether people have the disease when compared with the current method of PET-CT scans.
PET-CT scans are currently used by a doctor to determine what stage the cancer is at and whether the detected lung lesions are cancerous. This test involves a CT scan taking pictures from around your body and a PET scan which uses a small amount of an injected radioactive drug to show uptake within structures in your body.
Whilst this is the current gold-standard for treatment, this new research has shown that a type of MRI scan, known as diffusion-weighted MRI, is more accurate. This technique measures water movement in the tissue of the lungs and can detect the structural changes that lung cancer causes, even in the early stages of the disease.
The new technique also has the advantage of being non-invasive and does not require any radiation exposure.
The research analysed 50 people who were due to be operated on and had been diagnosed with lung cancer or suspected lung cancer assessed by PET-CT scan. One day before their operation, the same group also underwent a diffusion-weighted MRI scan.
The results showed that with PET-CT scans, 33 patients were diagnosed correctly, 7 incorrectly and 10 were undetermined. With diffusion-weighted MRI scans, 45 patients were diagnosed correctly and 5 incorrectly. The 10 undetermined cases with PET-CT were correctly diagnosed using diffusion-weighted MRI scan.
Dr Johan Coolen, from University Hospitals Leuven in Belgium, said: "Our study has shown that diffusion-weighted MRI scans could become an appropriate diagnostic instrument for preoperative lung cancer patients in the near future because they have a high accuracy for differentiating benign from malignant lung lesions.
"PET/CT scans can wrongly diagnose cancer as they can misinterpret inflammation in the lungs as a malignant lesion. Especially in these inflammatory lesions, diffusion weighted MR is more accurate which could help avoid unnecessary surgical procedures for those people without malignant disease. In addition, it could help to classify patients with lung cancer to enable doctors to provide the most effective therapeutic procedures."
Professor Marc Decramer, President of the European Respiratory Society, said: "It is crucial that we continue to evaluate new diagnostic technologies and look at incorporating these into our management of lung cancer. A key recommendation of the European Respiratory Roadmap, which has been launched this week to steer the future of respiratory medicine, is to focus on effective screening processes. In a bid to improve patient care, the roadmap also suggests that personalised targeted medicine will improve a patient's quality of life. With the development and evaluation of new technologies such as the diffusion-weighted MRI scan, we can work towards achieving these goals."

**Source: European Lung Foundation

'Belly fat' linked to development of asthma

Belly fat, known clinically as central obesity, has been linked to the development of asthma in a new study. The findings, presented at the European Respiratory Society's Annual Congress in Amsterdam, have shown central obesity as a risk factor for the disease.
Excess abdominal fat has been linked with a number of health effects, such as diabetes and heart disease, but there has been little focus on its link with lung disease.
Previous studies have found a link between asthma and body mass index (BMI), which is a marker for overall obesity. This new study looked at waist circumference, which is a marker for central obesity, to see whether this form of obesity could also contribute to asthma risk. The research is one of the first prospective studies to investigate the individual and combined effect of central and overall obesity on incident asthma in adults.
Researchers followed 23,245 adults without asthma, aged 19-55 years from the second Norwegian Nord-Trondelag Health Study (HUNT), for 11 years. The participants had their BMI measured along with their waist circumference to test overall obesity and central obesity, respectively. They were also asked to report incidence of asthma.
The results showed that people who were centrally obese but not overall obese were 1.44-times more likely to develop asthma. Additionally, people who were both centrally obese and obese overall were 1.81-times more likely to develop asthma.
Ben Brumpton, from the Norwegian University of Science and Technology, said: "Asthma can affect people of all sizes, but our study has highlighted both the individual and combined effect of central obesity and overall obesity on asthma development. Both these measures have an individual impact on asthma and an additive effect when they are combined.
It is not yet clear why this association exists. Central obesity is closely associated with insulin resistance and metabolic syndrome. These factors may play important roles concerning central obesity-related asthma. We will evaluate the effects of these factors on the development of asthma in future studies."

*Source: European Lung Foundation

El mejor antivirus está en el hígado del tiburón

La aleta del tiburón tan codiciada en Asia, podría quedar relegada a un segundo plano si los orientales reciben de buen grado los beneficios descubiertos en el hígado de los escualos. Porque, según científicos de la Universidad de Georgetown de Washington (EE UU), la escualamina (sustancia producida en este órgano) podría ayudar a combatir virus como la hepatitis o la fiebre amarilla.

No es nuevo. A principios de los 90 esta sustancia ya era conocida por sus propiedades anticancerígenas y sus beneficios en el tratamiento de dolencias oculares. Pero el trabajo estadounidense que publica ahora la revista «Proceedings of the National Academy of Sciences» es el primero en el que se ha analizado minuciosamente su posible impacto contra algunos virus. Los investigadores descubrieron que la escualamina logró frenar la progresión de infecciones virales en animales (roedores) y en algunos casos logró curarlas.

Así, observaron su capacidad de proteger a las células contra el dengue o la hepatitis B y D. Michael Zasloff, director del Instituto de Trasplante de la Universidad de Georgetown cree que «la escualamina pertenece a una familia de compuestos que protegen de ciertos virus a los tiburones y a otros vertebrados “primitivos” del océano, como la lamprea de mar». El experto matiza que esta sustancia «protege frente virus que atacan el hígado y el tejido sanguíneo, ya que solamente es capaz de entrar en ciertas células, como arterias, venas, capilares y las células hepáticas».

Aconsejan ingerir antitumorales con «el estómago lleno»

La tendencia de recomendar a los pacientes con cáncer que tomen sus fármacos orales en ayunas, aumenta el riesgo de sobredosis y los fuerza «a tirar por el retrete costosas medicinas». Así lo asegura Mark Ratain, director del Centro de terapias personalizadas en la Universidad de Medicina de Chicago (EE UU). Y así lo ha reflejado en el «Journal of Clinical Oncology».
El investigador afirma que tomar la medicación en las comidas «podría ser más seguro, eficaz y económicamente más eficiente, si estudiaran bien los fármacos que se absorben mejor con la comida. En vez de tomar altas dosis con el estómago vacío –que es como se administran la mayoría– sería mejor tomar cantidades menores con algo en el estómago».
Por su parte, la farmacéutica Patricia Brañas García, explica que «cada medicamento tiene un pH de absorción óptimo para lograr su máxima biodisponibilidad en el organismo. Existen ciertos fármacos para los que el pH o algunos alimentos tomados conjuntamente apenas afecta, pero para otros es crítico, como ocurre con los antitumorales. Su índice terapéutico (diferencia entre la concentración en sangre necesaria para obtener el efecto y los niveles tóxicos) es tan estrecho que ligeras variaciones en la absorción a nivel gastrointestinal condicionan el éxito o la toxicidad». Para cada fármaco, «habría que estudiar la dosis en presencia o no de alimento. Y en este tipo de fármacos sería recomendable escoger la que fuese menor», explica Brañas. Así «obtendremos menos efectos indeseables derivados del metabolismo de estas moléculas», concluye la experta.

**Publicado en "LA RAZON"

Abiraterone acetate improves fatigue in prostate cancer patients, says international clinical trial

Men with prostate cancer that has spread to other parts of the body and that is resistant to hormone therapy suffer less from fatigue if they are treated with a combination of abiraterone acetate and prednisone, according to results from a phase III clinical trial presented today.
Dr Cora Sternberg told the 2011 European Multidisciplinary Cancer Congress, in Stockholm today, that the significant improvements in fatigue were important for this group of difficult-to-treat patients who had few available therapeutic options.
"Metastatic castration-resistant prostate cancer is cancer that has spread from the prostate and that develops resistance to therapies targeting the male sex hormones such as androgen that drive the cancer’s growth. It is a chronic, progressive disease and, until now, men have few treatment options and poor prognosis. If treatment with androgen deprivation and docetaxel chemotherapy fails, then the average survival is only around 18-19 months," said Dr Sternberg, head of the Department of Medical Oncology at the San Camillo and Forlanini Hospitals in Rome, Italy.
"One of the most distressing issues these metastatic castration-resistant prostate cancer patients face during hormone treatment is extreme fatigue. Our results show that abiraterone acetate therapy has the potential to reduce cancer-related fatigue in this patient population, in addition to the previously demonstrated survival benefit," she said.
Abiraterone acetate (ZYTIGA™) is a new oral drug that specifically blocks the production of the male sex hormones (androgens) by the prostate tumour itself, as well as the testes and adrenal glands, all androgen sources which can fuel prostate cancer progression.
Dr Sternberg and her colleagues carried out a retrospective analysis assessing the effect of abiraterone acetate therapy on patient-reported fatigue using data from the COU-AA-301 international Phase III study. The study randomised 1195 patients with metastatic castration-resistant prostate cancer, who had previously received the chemotherapy drug docetaxel, to receive the steroid prednisone with either abiraterone acetate (797 patients) or placebo (398 patients). Patient-reported fatigue was measured using the Brief Fatigue Inventory (BFI) questionnaire at various times during the study.
"We conducted a series of analyses to assess different aspects of the impact of abiraterone acetate on both fatigue intensity and interference with general activity, mood, walking, work, relationships and enjoyment of life," she said. "We also employed different analytical approaches to test our hypotheses. The results are clinically meaningful and remain robust after adjusting for non-random missing data."
The data indicated that patients who received abiraterone acetate had significantly better patient-reported outcomes for fatigue than the placebo group over the study duration. Indeed, the progression of fatigue intensity and interference with general activity, mood, walking, work, relationships and enjoyment of life was significantly delayed in patients who received abiraterone acetate.
At a later stage, Dr Sternberg and her colleagues are planning to explore potential associations between the improvements in patient-reported fatigue and other clinical variables such as overall survival and disease progression.
Dr Sternberg added: "The future looks brighter for men with this disease and with several new therapies recently approved for advanced prostate cancer, we have more hope for our patients, because they are not only living longer, they are also living better. I think this is a huge step forward in the treatment of metastatic castration-resistant prostate cancer."
Cancer of the prostate is the second most commonly reported cancer in men, with more than 890,000 cases diagnosed worldwide every year. It usually occurs in older patients, and globally more than 250,000 men died from the disease in 2008.
"It is very important that research into new anti-cancer strategies not only evaluates its impact on prevention of tumour progression and improvement of survival time, but also evaluates in detail whether and how the treatment affects quality of life and the activity of patients," said Professor Michael Baumann, President of ECCO. "Severe fatigue is a very distressing side effect of some therapies against prostate cancer and research into therapeutic options leading to less fatigue is of great value for patients and their families."

Aromatase inhibitor letrozole guards against breast cancer relapse for up to eight years

Results from the longest-running trial comparing tamoxifen with the aromatase inhibitor letrozole show unequivocally that letrozole has withstood the test of time and continues to prevent breast cancer recurrences and reduce the risk of death in post-menopausal women with hormone receptor-positive early breast cancer.
Professor Richard Gelber told delegates at the 2011 European Multidisciplinary Cancer Congress , in Stockholm today (Monday 26 September) that a 12-year update of results from the Breast International Group (BIG) 1-98 trial showed that if women with early breast cancer (cancer that has not spread from the breast) were given letrozole after surgery for at least five years, they continued to do better and have fewer recurrences of the disease than those who were given tamoxifen.
"Over a median of eight years of follow-up, women who were assigned to receive five years of letrozole after surgery had an 18% reduced risk of relapse and a 21% reduced risk of death compared with those assigned to receive tamoxifen," said Prof Gelber, Director of the International Breast Cancer Study Group (IBCSG) Statistical and Data Management Center at the Dana-Farber Cancer Institute, Boston, MA, USA.
"The current 12-year update is the longest follow-up to date and includes much more information than we had after ten years. For instance, there have been 32% more relapses and 39% more deaths since the ten-year update, which increases substantially the reliability of the results and provides reassurance regarding the long-term value of letrozole. This additional follow-up and accumulation of information on relapses and deaths show that the overall survival advantage for adjuvant letrozole compared to tamoxifen continues to be statistically significant."
Adjuvant therapy (treatment that is given after surgery), using drugs that target hormones such as oestrogen, is given to patients with early breast cancer who have hormone receptor-positive tumours. These tumours occur in approximately 75% of breast cancer cases. Tamoxifen has been the "gold standard" hormone treatment for women with early, oestrogen-receptor-positive breast cancer and works by blocking the growth-promoting action of oestrogen on the cancer cells. Aromatase inhibitors, such as letrozole, are newer and alter the function of aromatase, an enzyme involved in oestrogen production. They can be used in sequence with, or as an alternative to tamoxifen for post-menopausal women.
In the BIG 1-98 trial, researchers enrolled 8,010 patients to receive letrozole and tamoxifen either alone or in sequence, with a total of 4,922 patients included in the monotherapy arms of the study.
Efficacy analyses comparing the treatment groups were conducted every two years following the initial report of results, because the patients had a long-term risk of recurrence. This 12-year update shows that, among all 8,010 patients, there were 2,074 relapses and 1,284 deaths, compared with 1,569 relapses and 923 deaths at the ten-year update.
"The data also show that the sequential use of letrozole and tamoxifen (two years of one agent followed by three years of the other) provided similar outcomes compared with five years of letrozole alone for patients who are not at high risk for recurrence," said Prof Gelber.

Radiotherapy between or during chemotherapy cycles reduces risk of breast cancer recurrence

A major UK trial has produced firm evidence that giving radiotherapy between or during chemotherapy cycles to women with early breast cancer significantly reduces the risk of the cancer recurring in the breast or chest wall. The treatment, known as synchronous chemoradiation, has minimal adverse side-effects and no detrimental effect on the patients’ quality of life.
Findings from the SEquencing of Chemotherapy and Radiotherapy in Adjuvant Breast cancer (SECRAB) study, which was carried out at 48 centres in the UK and is the largest study to investigate the treatment, will be presented today (Sunday) in Stockholm, to delegates at the 2011 European Multidisciplinary Cancer Congress.
"The results show that synchronous chemoradiation reduces the risk of local cancer recurrence by 35% in women with early breast cancer. After a follow-up of over eight years, only 41 patients in the synchronous chemoradiation group had suffered a recurrence compared with 63 patients in the sequential chemoradiation group," says Dr Indrajit Fernando, a Consultant Clinical Oncologist at University Hospitals Birmingham NHS Foundation Trust and Honorary Senior Lecturer at the University of Birmingham, UK.
Radiotherapy and chemotherapy are usually given after breast cancer surgery to destroy any remaining cancer cells in the breast, chest wall or underarm area, in order to reduce the risk of a local cancer recurrence. Sequential chemoradiation is the standard treatment schedule where chemotherapy is given first followed by radiotherapy.
Dr Fernando, the principal investigator of the study, will say: "The five-year local recurrence rates were 2.8% and 5.1% in the synchronous and sequential chemoradiation groups, respectively. This difference of 2.3% between treatment groups was statistically significant."
He will add: "According to the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), one breast cancer death can be avoided for every four local recurrences prevented. Therefore, even a 2.3% reduction in local recurrence rates will have an impact worldwide when we consider that this is a very common cancer."
The optimal timing of radiotherapy with chemotherapy has been a subject of debate among cancer experts. The aim of this trial was to determine the best schedule for giving radiotherapy with cyclophosphamide/methotrexate/fluorouracil (CMF) or anthracycline–CMF chemotherapy after surgery to women with early breast cancer.
This randomised Phase III trial enrolled 2,296 women who had undergone breast conserving surgery (1,285 women) or mastectomy (1,011 women) to remove their tumour. All the patients received chemoradiation after surgery, either sequential (1,146 patients) or synchronous, where the radiotherapy was given in the gaps between chemotherapy cycles (1,150 patients). More than 60% of patients received 40Gy in 15 fractions over three weeks.