First-Line Erlotinib Triples Progression-Free Survival in NSCLC in Chinese Population

Posted on October 16, 2010 by wngai
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First-line erlotinib (Tarceva) tripled the progression-free survival in advanced non–small cell lung carcinoma (NSCLC) patients who had endothelial growth factor receptor (EGFR)-activating mutation, according to the OPTIMAL study presented at the 35th European Society for Medical Oncology Congress.

The study was carried out in a Chinese population who had not previous received chemotherapy and had an Eastern Cooperative Oncology Group performance status of 0 to 2.

Patients were randomly assigned to receive either erlotinib at 150 mg/day (n = 82) or combination chemotherapy of gemcitabine and carboplatin (n = 72) until unacceptable toxicity or progressive disease.

Patients who received erlotinib had a significantly longer progression-free survival than patients who received gemcitabine–carboplatin combination (13.1 vs 4.6 months, respectively).  The improvement represented an 84% risk reduction in disease progression. 

The incidence of adverse events and serious adverse events were also lower in the erlotinib group versus the gemcitabine–carboplatin combination group.

The excellent results of the OPTIMAL study should put erlotinib as the first-line agent for advanced non–small cell lung carcinoma (NSCLC) patients who had endothelial growth factor receptor (EGFR)-activating mutation.

Source: 35th European Society for Medical Oncology Congress: Abstract LBA14. Presented October 9, 2010.

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Diabetic Patients Are More Likely to Develop Pancreatitis

Posted on October 16, 2010 by wngai
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According to a study published online September 10th in Diabetes Care, patients with type 2 diabetes may have an increased risk of acute pancreatitis.  Furthermore, the risk appears to be more pronounced at younger ages.  

Using data from The Health Improvement Network database in the UK, researchers examined the risk of acute pancreatitis among 85,525 type 2 diabetic patients and compared their risk with 200,000 diabetes-free subjects. 

After following the subjects for 4.0 years, they discovered that diabetic patients were 1.4 times more likely to develop acute pancreatitis than the general population. 

When the researchers analyzed the risk of pancreatitis among treated and not treated diabetic patients, they discovered patients not treated with anti-diabetic pharmacotherapy had the greatest risk.  

Patients who were treated with insulin or with long-term use of metformin had a 65% and 50% risk reduction in developing pancreatitis.

Diabetes Care. Posted September 10, 2010. Abstract

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Cetuximab (Erbitux) Reduces Disease Progression in Triple Negative Breast Cancer

Posted on October 16, 2010 by wngai
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Patients with triple negative breast cancer usually have poor prognosis, but a new drug might soon be available to improve the survival in these patients.  

Mid-stage study results presented at the European Society for Medical Oncology congress indicated that cetuximab(Erbitux) in combination with cisplatin, significantly reduced the risk of disease progression in women with metastatic triple negative breast cancer, compared with cisplatin alone. 

In the trial, which included 173 women with metastatic triple negative breast cancer, the use of cetuximab more than doubled the median time before the patients’ disease progressed when compared with cisplatin alone (3.7 months versus 1.5 months). 

In addition, more patients in the cetuximab group experienced a tumor response than patients who received chemotherapy alone (20 percent in the cetuximab group versus with 10 percent in patients with cisplatin alone). 

This study suggested that cetuximab or other anti-EGFR agents might have a role in triple negative breast cancer.

Source: Ann Oncol. 2010 Oct 13

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Novel Agent Significantly Improves Survival in Men with Advanced Prostate Cancer

Posted on October 16, 2010 by wngai
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Great news for patients with advanced prostate cancer.  A new investigational agent, abiraterone acetate, was shown to significantly improved survival in men with metastatic castration-resistant prostate cancer. 

Abiraterone acetate is an investigational agent being developed by Ortho Biotech.  It acts by blocking CYP17 and potently inhibits persistent androgen synthesis from adrenal and intratumoral sources. 

In the study, investigators randomly assigned 1,195 patients with castration-resistant metastatic prostate cancer and who had been previously treated with docetaxel to 1 of 2 study groups: abiraterone 1000 mg plus prednisone 5 mg twice daily (n = 797) or placebo plus prednisone (n = 398). 

Patients who received abiraterone acetate plus prednisone had a median overall survival of 14.8 months, compared with 10.9 months for patients assigned to receive corticosteroid prednisone plus placebo. 

The most commonly observed adverse effects in the abiraterone group were fluid retention (30.5% vs 22.3%) and hypokalemia (17.1% vs 8.4%).  Grade 3/4 hypokalemia (3.8% vs 0.8%) and grade 3/4 hypertension (1.3% vs 0.3%) were infrequent. 

While 3.9 months may not seem like much in the history of prostate cancer, only 4 drugs have ever shown a survival benefit.  Furthermore, it is an oral that does not have the toxicity of chemotherapy.  

It is anticipated that this new drug will change the way doctors treat advanced prostate cancer in the future. 

Source: 35th European Society for Medical Oncology Congress: Abstract LBA5. Presented October 11, 2010.

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Coffee Drinking Reduces the Risk of Oral Cavity/Pharynx Cancers

Posted on October 16, 2010 by wngai
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In the past, data on the relation between coffee drinking and upper digestive tract cancer risk were scattered and inconclusive.  

A team of researchers, therefore, conducted a systematic analysis on the relationship between coffee drinking and the risk of different digestive tract cancer.   The results were published in the October 2009 issue of Ann Oncol, 2010. 

The results indicated that coffee drinking reduced the risk of oral cavity and pharynx cancers (36% risk reduction) but had no effect on the prevention of larynx and esophageal cancer. 

Furthermore, it appeared that the risk reduction was greater among the Europeans (39% risk reduction) and the Americans (44% risk reduction) than the Asians (26% risk reduction). 

Source: Ann Oncol. 2010 Oct 13 

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Alzheimer’s disease – Causes, Symptoms, Diagnosis, Prognosis and Latest Treatment

Posted on October 10, 2010 by wngai
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Alzheimer’s disease (AD) is an irreversible, progressive brain disorder that occurs gradually and results in memory loss, behavior changes, and a decline in cognitive abilities. These losses are related to the death of brain cells and the breakdown of the connections between them. 

The risk of developing AD increases with age.  While it may be that 10% of the population aged over-65 has AD, the percentage of people aged 85 and older with AD is greater than 50 percent!  (Table 1)  On average, patients with AD live for 8 to 10 years after they are diagnosed, though the disease can last for up to 20 years.

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Table 1.   Percentage of people affected by Alzheimer’s disease
Age over 65 10%
Age over 75 20%
Age over 85 50%

(Source: Progress Reports on Alzheimer’s Disease 2001)

 AD advances by stages, from early, mild forgetfulness to a severe loss of mental function. This loss is called dementia. In most people with AD, symptoms first appear after age 60. The earliest symptoms often include loss of recent memory, faulty judgment, and changes in personality. Often, people in the initial stages of AD think less clearly and forget the names of familiar people and common objects.

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Hyperprolactinemia – Causes, Symptoms, Prognosis, Diagnosis and Latest Treatment

Posted on October 10, 2010 by wngai
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Hyperprolactinemia is one of the most common pituitary abnormalities, which is caused by an increased secretion of prolactin (above 20ng/ml) from the pituitary gland.  Although the disorder is detected in less than 1% of the general population, it has been found in up to 25% of patients with secondary amenorrhea. 

The most common symptoms of hyperprolactinemia are secondary amenorrhea (cessation of menstruation) and/or galactorrhea (the secretion of breast milk in men, or in women who are not breastfeeding an infant).  In men, hyperprolactinemia may also lead to decreased libido or erectile dysfunction. 

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HER2-positive Breast Cancer with Brain Metastases? Use Lapitinibi (Tykerb) and Capecitibine (Xeloda) but NOT Trastuzumab (Herceptin)

Posted on September 27, 2010 by wngai
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Human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC) is a disease that accounts for up to one third of all invasive breast tumors. The natural history of this disease, however, has been dramatically improved with the introduction of trastuzumab (Herceptin).

Despite its positive effect on overall prognosis, one third of patients treated with trastuzumab still develop brain metastases (BM). This phenomenon is due to the limited penetration ability of trastuzumab through the blood brain barrier, making the brain a sanctuary site for the development of metastases.

Lapatinib is a small molecule that has dual HER1/HER2 inhibition ability. Two previous phase II studies have demonstrated the activity of lapatinib monotherapy in breast cancer patients with brain metastases.

Now, a new study published in the Annals of Oncology further confirmed the effectiveness of lapatinib in patients with HER2-positive breast cancer and BM.

In this study, 30 HER2+ metastatic breast cancer patients treated with lapitinib and capecitibine (LC) were analyzed. All patients were previous treated with trastuzumab for metastatic disease.

Among the patients treated with LC, 7 patients (31.8%) have partial responses and 6 patients (27.3%) have stabilized disease. Patients treated with LC had a median overall survival which was significantly longer than patients treated with trastuzumab-based therapies only (27.9 months versus 16.7 months, respectively, P =0.01)

The study that indicated that lapitinib and capecitibine improved survival in breast cancer patients with brain metastases.

Source: Annals of Oncology Aug 18, 2010.

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FDA Approves Pegloticase (Krystexxa) for Refractory Gout

Posted on September 27, 2010 by wngai
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Good news for patients with gout. The US Food and Drug Administration (FDA) has just approved a new agent, pegloticase (Krystexxa) for gout patients who are refractory to conventional therapy.

The approval was based on data from 2 replicate, multicenter, randomized, double-blind, 6-month studies which randomized 212 patients with baseline serum uric acid levels of 8 mg/dl or greater to receive either 8mg pegloticase every 2 weeks or 4 weeks or placebo.

As a prophylaxis for gout flares, all patients received nonsteroidal anti-inflammatory drugs and/or colchicine.

Results from 2 studies indicated that 38%-47% of patients receiving 8mg of pegloticase on a bimonthly basis achieved plasma uric acid levels of less than 6 mg/dl (normal level) for at least 80% of the time during month 3 and month 6, compared with 0% of those given placebo.

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History of Gout is linked to an Increase Risk of Heart Failure Events

Posted on September 27, 2010 by wngai
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It has been known that gout increases the risk of ischemic heart disease and mortality. A new study showed that gout is also associated with an increase risk of heart-failure hospitalization and death.

In Montreal, Quebec, Canadian researchers performed an analysis of 25 000 heart-failure patients to identify factors that was linked to the increase risk of heart-failure hospitalizations and death. They also investigated whether those patients who had gout and had used allopurinol were associated with better outcome.

Using statistical modeling, the researchers found that heart-failure patients who have a remote history of gout and an acute episode of gout were twice as likely to experience heart-failure re-hospitalization or to die (ARR = 1.63, p<0.001; and ARR=2.06, p<0.001, respectively).

Furthermore, heart-failure patients who had gout and had used allopurinol had their heart-failure re-hospitalization or death cut by 30%.

However, readers should be cautioned that this analysis was conducted among heart-failure patients with gout. The benefits of allopurinol might or might not apply to gout patients without heart failure.

Source: Arch Intern Med 2010; 170:1358-1364.

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