Gefitinib Improves Progression-Free Survival in Metastatic Breast Cancer

Posted on April 12, 2010 by wngai
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According to a new study published in the Clinical Cancer Research, adding epidermal growth factor receptor (EGFR) inhibitor gefitinib (Iressa) to anastrozole (Arimidex) improved progression-free survival in postmenopausal women with hormone receptor-positive metastatic breast cancer.

The study randomized 93 postmenopausal breast cancer patients with hormone receptor-positive metastatic disease to gefitinib plus anastrozole or anastrozole.

Women who received gefitinib plus anastrozole had longer median progression-free survival (14.7 vs. 8.4 months) and higher clinical benefit rates (49% vs. 34%).

Adverse events were mostly mild in both groups, but the incidence of treatment-related adverse events was higher in the gefitinib plus anastrozole arm (79%) than in the anastrozole arm (38%). Serious adverse events, however, occurred with similar frequency in the gefitinib plus anastrozole arm (14%) and the anastrozole arm (16%).

Clin Cancer Res 2010;16:1904-1914.

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New Standard Treatment for Advanced Biliary Tract Cancer: Cisplatin Plus Gemcitabine

Posted on April 11, 2010 by wngai
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Good news for patients with advanced biliary tract cancer.  Combination of cisplatin and gemcitabine (Gemzar) have been shown to be an effective treatment option for patients with locally advanced or metastatic biliary tract cancer. 

In developed nations, biliary tract cancer is uncommon, but the incidence is increasing.  Most patients, when diagnosed, are already at advanced stage of the disease.  Although advanced biliary tract cancer responds to chemotherapy, there is no standard 1st line palliative regimen.

In the April 8 issue of the New England Journal of Medicine, British researchers reported that cisplatin plus gemcitabine was associated with a significant survival advantage, compared with gemcitabine alone. Toxicity was not substantially increased in patients who received the combination regimen.

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Uses of Herbs and Drug Interactions in Cardiovascular Patients

Posted on April 4, 2010 by wngai
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More and more consumers are taking herbal supplements as an alternative treatment for their diseases.  It is estimated that more than 15 million people in the US consume herbal remedies or high-dose vitamins, and the total number of visits to the complementary medicine providers far exceeds those to primary physicians. 

Lack of efficacy and adverse effects associated with prescription medicines lead many patients to explore herbal medicines.  Uses of herbal medicines, however, are not without any risks.  Although most of these herbal medicines have good safety profile, some herbal medicines have not been shown to be efficacious.  Some even interact with western medicines, leading to life-threatening consequences. (Table 1)

The purpose of this paper is to equip cardiovascular patients with the latest uses of commonly used herbal medicines and the potential interaction of these herbal medicines with prescription medicines.  Patients are advised to inform their primary care physicians and their specialists of the herbal supplements they are taking and to limit the use of herbal medicines to a shorter time period.

A) Aconite (烏頭草)

Uses

Traditional Chinese practitioners use aconite for pain relief caused by trigeminal and intercostal neuralgia, rheumatism, migraine, and general debilitation.

Drug interaction

Long term use might increase the risk of atrial or ventricular fibrillation. 

B) Black cohosh (黑參麻)

Uses

Black cohosh has been used to relief symptoms of menopause, pre-menstrual tension and other gynecologic problems.

Drug interaction

Black cohosh should not be used with estrogen replacement therapy (ERT) since the combination of black cohosh and ERT has been shown to increase the risk of cardiovascular events and breast cancer.  Pregnant and lactating women should avoid taking black cohosh.

C) Danshen (丹參)

Uses

Danshen is used in traditional Chinese medicine for the treatment of coronary artery disease and menstrual abnormalities.

Drug interaction

Danshen reduces the elimination of warfarin and increases the bleeding risk associated with warfarin.  It also interferes with digoxin essay.

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Posted in Arrhythmia, Cardiovascular disease, Diabetes, Heart attack, Herbal Medicine, High cholesterol, Hypertension, Insomnia, Stroke | Tagged , , , , , | 1 Comment

Taking Aspirin Can Also Improve Survival after Breast Cancer

Posted on March 29, 2010 by wngai
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Previously, we have the beneficial effect of Aspirin in reducing in the death among colorectal cancer patients. Now, a prospective, observational study published in the March issue of the Journal of Clinical Oncology suggested that aspirin can also lower the risk of distant recurrence and breast cancer death.

The results come from the study of 4,164 female registered nurses in the Nurses’ health Study who were diagnosed with stages I, II, or III breast cancer between 1976 and 2002. They were observed until death or June 2006.

At the end of the study, the investigators found that daily use of aspirin per week was associated with a 9% reduction in the risk of breast cancer death, 2 to 5 days per week use of aspirin was associated with a 60% reduction and 6 to 7 days per week use of aspirin was associated with 43% reduction in the risk of breast cancer death.

The association did not differ by stage, menopausal status, body mass index, or estrogen receptor status.

The investigators concluded that among women living at least 1 year after a breast cancer diagnosis can have their risk of distant recurrence and breast cancer death reduced by taking aspirin.

J Clin. Oncol 28; 1467-1472

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Normalized level of Vitamin-D cut the Risk of CVD and Death

Posted on March 28, 2010 by wngai
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You cut your risk of cardiovascular events by normalizing your vitamin-D level. A new study has found that people who has low vitamin-D levels but managed to normalize their levels were significantly less likely to develop cardiovascular events after six years of follow-up. The results were presented at the American College of Cardiology (ACC) 2010.

The investigators looked at the vitamin-D levels of 9,491 subjects with known vitamin-D deficiency and their subsequent rates of death, cardiovascular disease, stroke and renal failure.

After a mean of one-year of follow-up, those who had normalized their vitamin-D levels were 30% less likely to die from cardiovascular disease than those who remained vitamin-D deficient.

What is the optimal level of Vitamin-D?

A poster presented by Muhlestein and colleagues suggested that a vitamin D level greater than 43ng/ml will decrease the risk of cardiovascular disease. His study was based on analyzing the vitamin D level and cardiovascular events among 31,000 patients.

In the United States, the prevalence of inadequate vitamin B6 intake for adults older than 50 years is about 20% for men and 40% for women.

Presented at the Scientific Sessions of the American College of Cardiology (ACC) 2010.

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Alternative 1st Treatment for Small-Cell Lung Cancer Patients with Extensive Disease

Posted on March 28, 2010 by wngai
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Lung cancer is the most common diagnosed cancer worldwide and small-cell lung cancer (SCLC) accounts for only 10%-15% of lung cancer cases.  Etoposide in combination with cisplatin (EP) or carboplatin is currently considered the standard of care in most countries, but the survival rates are generally poor.  The median survival rates of this regimen are less than 12 months.

A new study published in the March issue of the Annals of Oncology reported that irinotecan in combination with cisplatin (IP) can be an alternative 1st treatment for patients with small-cell lung cancer with extensive disease. 

The study randomized 400 previously untreated small-cell lung cancer patients with extensive disease to either IP (irinotecan plus cisplatin) or EP (etoposide plus cisplatin).  The results indicated that there was no difference in median overall survival between the two regimens (10.2 vs. 9.7 months respectively), even thought patients on the IP regimen trended towards a better outcome.  The 1- and 2- year survival rates were 41.9% versus 38.9 and 16.3% versus 8.2% respectively. 

The two regimens differed in side-effects profile.  More patients in the IP arm that the EP arm experienced Grade ¾ vomiting (10.9% vs. 4.4%) and diarrhea (15.4% versus 0.5%).  Hematological toxicity, however, was more frequent in the EP arm than the IP arm (59.6% vs. 38.1%).

To conclude, IP can be considered an alternative treatment option for patients with small-cell lung cancer patients with extensive disease.

Zatloukal P et.al.  Annals of Oncology, March 15, 2010

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Melanoma Cases on the Rise – Latest Incidence, Prevention and Detection

Posted on March 25, 2010 by wngai
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Incidence

While the incidence of other cancer such as prostate cancer has leveled off, the incidence of melanoma in US is on the rise, according a presentation at the 68th Annual Meeting of the American Academy of Dermatology. 

In his presentation at Annual Meeting of the American Academy of Dermatology, Dr. Rigel pointed out that the average American’s risk of developing melanoma in his or her lifetime increased from one in 1,500 in 1930, to one in 250 in 1980 and one in 74 in 2000.  By 2004, the risk of getting this deadly skin cancer increased to one in 65 and by today, the risk is 58.

If this rate continues, he predicted the risk will be one in 50 by 2015!

He did not believe the risk in melanoma is due to increase in the number of skin cancer screenings.  If that was true, we should see a sudden rise in melanoma cases and then leveled off.

Prevention

Melanoma is caused by too much exposure to ultraviolet (UV) radiation, whether from the sun or indoor tanning beds and lamps. To prevent yourself from getting melanoma, make sure you have put on sunscreen before going under the sun.  Also, avoid using the tanning beds, which is known to increase your risk of melanoma and serious eye problems.

Detection

Monitor your mole regularly.  Make sure you mole does not have any of the following characteristics.

  • Asymmetry: one half unlike the other half.
  • Border: irregular, scalloped or poorly defined.
  • Color: varies from one area to another; shades of tan and brown, black; sometimes white, red or blue.
  • Diameter: the size of a pencil eraser or larger.
  • Evolving: changing in size, shape or color.

If you see a mole with any of the above characteristics, you should see a dermatologist immediately.  Also, mole that grows bleeds, crusts, or changes also required immediately doctor’s attention.

Presentation at the 68th Annual Meeting of the American Academy of Dermatology. 

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Psoriasis Is Associated With an Increased Risk of Cancer

Posted on March 24, 2010 by wngai
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If you have psoriasis, you might have an increased risk of cancer, including melanoma, prostate cancer and non-Hodgkin’s lymphoma, according to a new research presented at the 68th annual meeting of the American Academy of Dermatology (AAD 2010). 

The researchers evaluated the incidence of psoriasis and cancers in 37,159 patients and 111,473 controls from a large insurance claims database.

Their analysis found that patients with psoriasis had a 56% higher risk for any type of cancer, 76% higher risk for melanoma, 12% higher risk for breast cancer, 75% higher risk for non-Hodgkin’s disease, 87% higher risk for lymphoma and 22% higher risk for prostate cancer.

The results might not be too surprising since patients with psoriasis are known to have defected immune system and defected immune system is associated with cancer. 

However, the results of this study indicated that patients who have psoriasis will need to monitor not only their skin symptoms, but also for their overall health, co morbidities, and well-being.

Presented at the 68th annual meeting of the American Academy of Dermatology (AAD 2010). 

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Beyond Cardiovascular Benefits – NSAID and Statin Reduce the Cancer Risk with PPI-Treated Barrett’s Esophagus

Posted on March 23, 2010 by wngai
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It is well known that NSAID (Advil, Motrin and Aspirin) and statin (Zocor, Mevacor, Lipitor, Crestor, Pravachol and Lescol) offer cardiovascular benefits. However, a new study published in the February issue of Gastroenterology suggested that non-steroidal anti-inflammatory drugs (NSAIDs) and statins can also cut the risk of esophageal adenocarcinoma by half in patients taking proton-pump inhibitors (PPIs) for Barrett’s esophagus.

Using the Department of Veterans Affairs database that included 116 case patients and 696 controls with Barrett’s Esophagus, the researchers analyzed the incidence of PPI, NSAID/aspirin and statin prescriptions and the incidents of cancer among patients who have Barrett’s esophagus.

Using statistical analysis, the researchers found that individuals who filled prescriptions for NSAID/aspirin and statin were 36% and 45% less likely to have esophageal cancer than were those who did not fill such prescriptions. Furthermore, as the duration of statin use increased, the risk of esophageal cancer continued to fall.

Since this is only an observational study, the investigators suggested further prospective, head-to-head comparison studies are required to confirm the cancer risk reduction benefits of NSAID and statin. Also, since NSAID such as aspirin might be associated with bleeding risk, patients are advice to consult their physicians before starting the NSAIDs.

Gastroenterology. Published online February 25, 2010.

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Vitamin B6 might reduce the Risk of Colorectal Cancer

Posted on March 22, 2010 by wngai
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Not all vitamins are created equal. While vitamins such as vitamins C has not been shown to prevent cancer, a meta-analysis published in the March 17, 2010 issue of JAMA indicated that intake of vitamin B6 might be associated with a reduced risk of colorectal cancer.

The analysis was a combination of the results of 14 previous clinical studies that evaluated the relationship between the intake of vitamin B6 or blood levels of pyridoxal 6’-phosphate (PLP; the active form of vitamin b6) and the risk of colorectal cancer.

Overall, patients who take vitamin B6 have a 20% reduction in the risk of colorectal cancer. This translates to a 49% reduction in colorectal cancer for every 100-pmol/mL increase in blood PDP levels.

Vitamin B6 may suppress colorectal carcinogenesis by reducing cell proliferation, angiogenesis, oxidative stress, inflammation, and nitric oxide synthesis. 

Major food sources of vitamin B6 include fortified cereals, meat, fish, poultry, starchy vegetables, and some fruits (eg. Bananas and avocado).

In the United States, the prevalence of inadequate vitamin B6 intake for adults older than 50 years is about 20% for men and 40% for women.

JAMA 2010; 303(11):1077-1083

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