Posts Tagged ‘oncology’

Breast radiation trial provides more convenience, better compliance, lowered cost and patient outcomes on par with current treatment

These interim results of the 5-year Phase II clinical trial using the experimental regimen are being presented at the Breast Cancer Symposium 2014 in San Francisco by Anthony E. Dragun, M.D., vice chair and associate professor of radiation oncology at the University of Louisville.

Dragun, a radiation oncologist with University of Louisville Physicians, launched the trial three years ago at UofL’s James Graham Brown Cancer Center, a part of KentuckyOne Health and the only site offering the experimental regimen in the United States. A second KentuckyOne Health site is being planned, he said, and is expected to begin enrolling patients this autumn.

Reviewing data from Europe — the United Kingdom in particular — Dragun found an alternative to the currently standard daily radiation treatments prescribed to patients after a lumpectomy. Physicians in the U.K. and other European countries were reporting excellent results with a regimen of radiation administered once-weekly.

“Instead of daily treatments for 25-30 days, five to six treatments administered once each week were being used,” he said. “I thought this regimen would give our patients here in Kentucky a great deal of access and choice, so we developed the trial and launched it in 2011.”

Approximately 150 female patients have been enrolled in the trial thus far, he said. Patients undergoing a lumpectomy following diagnosis of breast cancer are given a choice of the current standard of daily radiation treatments or the option to enroll in the trial and receive treatment one time per week.

The radiation dosing has been calibrated to compensate for the change in how the treatments are administered, but no adverse effects have been seen, Dragun said. “The outcomes with once-weekly treatments are absolutely in line with what we see in daily breast irradiation,” he said. “The standard of care is maintained.”

Giving women the choice of how their treatment is administered means more women complete their treatment, he said. “Finding time for daily treatments for 6 weeks or more just isn’t possible for many women,” Dragun said. “Scheduling once-weekly treatments is much easier to fit into the busy lives our patients lead.

“We also see many patients who depend on public transportation or live in rural areas that are 30 miles or more from our center, and they have told us that they would not have been able to complete a traditional course of daily radiation treatment. Their only alternative would be a mastectomy,” he said.

Because radiation treatment is reimbursed on a per-treatment basis, Dragun said the overall cost is lowered. “We have reduced the number of treatments to about one-fourth to one-third of what the current daily treatment regimen is,” he said. “Medicare reimburses radiation costs on a per-treatment basis, and most private insurers do likewise.

“This means we’ve been able to reduce the cost by 50 to 60 percent without jeopardizing the quality of care.”

Dragun plans to enroll another 50 patients at the Louisville site and 30 at the future trial site. After the completion of this trial, he intends to expand into a multi-center Phase III trial at facilities in other states.

“We believe the once-weekly regimen such as this will become a standard option in the next decade,” he said.

source : http://www.sciencedaily.com/releases/2014/09/140904121041.htm

Three-quarters of depressed cancer patients do not receive treatment for depression; new approach could transform care

An analysis of data from more than 21,000 patients attending cancer clinics in Scotland, UK, published in The Lancet Psychiatry, found that major depression is substantially more common in cancer patients than in the general population. Major depression was most common in patients with lung cancer (13%) and lowest in those with genitourinary cancer (6%). Moreover, nearly three quarters (73%) of depressed cancer patients were not receiving treatment.

To address the problem of inadequate treatment the SMaRT Oncology-2 randomised trial, published in The Lancet, evaluated the effectiveness of a new treatment program called ‘Depression Care for People with Cancer’ (DCPC). DCPC is delivered by a team of specially trained cancer nurses and psychiatrists, working in collaboration with the patient’s cancer team and general practitioner, and is given as part of cancer care. It is a systematic treatment program that includes both antidepressants and psychological therapy.

The trial, involving 500 adults with major depression and a cancer with a good prognosis (predicted survival more than 12 months) compared DCPC with usual care [1]. DCPC was strikingly more effective at reducing depression. At 6 months, 62% of the patients who received DCPC responded to treatment (at least a 50% reduction in the severity of their depression) compared with only 17% of those who received usual care. This benefit was sustained at 12 months. DCPC also improved anxiety, pain, fatigue, functioning, and overall quality of life. Moreover, the cost of providing DCPC was modest (£613 per patient) making it a cost-effective way to improve cancer patients’ quality of life.

According to lead author Professor Michael Sharpe from the University of Oxford in the UK, “The huge benefit that DCPC delivers for patients with cancer and depression shows what we can achieve for patients if we take as much care with the treatment of their depression as we do with the treatment of their cancer.”

To see if patients with a poor prognosis cancer could also benefit from this approach, the SMaRT Oncology-3 randomised trial, published in The Lancet Oncology, tested a version of DCPC adapted for patients with a typically poor prognosis cancer (lung cancer). The trial, involving 142 patients with lung cancer and major depression, found that those who received the lung cancer version of DCPC had a significantly greater improvement in depression than those who received usual care during 32 weeks of follow-up. The lung cancer-specific version of DCPC also improved anxiety, functioning, and quality of life.

According to study leader Dr Jane Walker from the University of Oxford and Sobell House Hospice in Oxford in the UK, “Patients with lung cancer often have a poor prognosis. If they also have major depression that can blight the time they have left to live. This trial shows that we can effectively treat depression in patients with poor prognosis cancers like lung cancer and really improve patients’ lives.”

source : http://www.sciencedaily.com/releases/2014/08/140827203635.htm

New tool to probe cancer’s molecular make-up

Researchers from the Cancer Research UK Manchester Institute based at The University of Manchester — part of the Manchester Cancer Research Centre — and the Institute of Cancer Research, London, looked at protein kinases, molecules that control various aspects of cellular function.

The study, funded by a Biotechnology and Biological Sciences Research Council (BBSRC)/Pfizer CASE studentship and CRUK,was published in Nature Methods this week (24 August).

Earlier work has shown that mutations or increases in a range of protein kinases are linked to tumour growth, and for several decades researchers have looked to develop drugs that target and prevent this activity in order to kill cancer cells. Ten types of drugs which reduce the activity have so far been approved for cancer treatment in patients.

Dr Claus Jørgensen, who led the study as team leader in the Division of Cancer Biology at The Institute of Cancer Research, London, before taking up a new post as head of the Systems Oncology group at the Cancer Research UK Manchester Institute, said: “Protein kinases regulate how cells communicate. When these molecules are deregulated it corresponds to cells “hearing voices” with a resulting change in their behaviour. Doctors need a way to spot changes in kinase levels in individual tumours so they can see how they respond to treatments and match patients to the treatment that works best for them.”

The team investigated the make-up of over 200 protein kinases. They used a technique known as mass spectrometry to develop a method that can both identify and measure the amount of various kinases in a biological sample — for example from a part of a tumour removed in surgery. “Our new method can correctly measure the amount of protein kinases in a sample. It means we can monitor cancer cell behaviour and also how tumours respond to different therapy in cancer patients,” added Dr Jørgensen.

source : http://www.sciencedaily.com/releases/2014/08/140826085853.htm