Grey Horizon blog posts will resume the week of January 3rd; Happy Holidays

To all Grey Horizon readers, 

Thank you for supporting the blog this past year.  Postings will resume the week of week of January 3, 2023.  

Merry Christmas and Happy Holidays!  

  

Travel time for breast cancer screening remains long for many women

 A new study conducted by the American Cancer Society and recently published in the Journal of the National Cancer Institute indicates that location of a mammography facility is associated with lower breast cancer rates particularly among women living in rural areas. According to senior scientist Dr. Daniel Wiese, "mammography is widely available in the United States but barriers, such as long drive times, are likely influencing a women's decision to get screened."  Dr. Wise further emphasizes the importance of programs aimed at removing barriers "so women can access this potentially life-saving screening."  

To read more about this study, click here. 

Source mentioned: 

Wiese D, Islami F, Henry KA. Changes in geographic accessibility to mammography by state and rural-urban status, United States, 2006-2022. J Natl Cancer Inst. 2022 Dec 14:djac217. doi: 10.1093/jnci/djac217. Epub ahead of print. PMID: 36515214.

 

Alternate approach to World Health Organization (WHO) analgesic ladder for cancer pain management

Results of a recent randomized parallel group study conducted at the Edinburgh Cancer Research Institute in the UK unveiled a new 2-step option for cancer main management which is more cost-effective than the standard 3-step analgesic ladder approach created decades ago by the World Health Organization (WHO).  The authors of this study, led by Professor Marie T. Fallon state that study findings will be of particular interest "in low- and middle-income countries where weak opioids are expensive and switching complicated."  Further, the study, the first of its kind to access the WHO analgesic ladder from a cost-effectiveness perspective, brought forth several findings, including that the 3-step approach (direct to strong opioid) did not results in fast pain relief that the 2-step (weak opioid approach).  

To read more about this study, click here. 

Sources mentioned: 

Fallon M, Dierberger K, Leng M, et al. An international, open-label, randomised trial comparing a two-step approach versus the standard three-step approach of the WHO analgesic ladder in patients with cancer. Annals of Oncology 2022;33(12):1296-1303.

Bramati PS, Bruera E. The end of the second step of the World Health Organization analgesic ladder? Annals of Oncology 2022;33(12):1212-1213.

Adjuvant pembrolizumab improves quality of life in patients with high-risk resected melanoma

 Results of the SWOG S1404 phase III randomized clinical trial were recently published in JAMA Oncology.  According to trial, "pembrolizumab provides superior clinical and patient-reported quality-of-life outcomes compared to standard care with adjuvant ipilimumab or high-dose interferon for high-risk resected melanoma."  Conducted on 1303 patients, with a variety of genders and racial backgrounds, the SWIG S1404 trial emphasized the important of physicians discussing quality-of-life issues with patients "when making shared decisions regarding the risks and benefits of adjuvant treatment in resected melanoma."  

Source mentioned: Unger JM, Darke A, Othus M, et al. Effectiveness of Adjuvant Pembrolizumab vs High-Dose Interferon or Ipilimumab for Quality-of-Life Outcomes in Patients With Resected Melanoma A Secondary Analysis of the SWOG S1404 Randomized Clinical Trial. JAMA Oncology; Published online 23 November 2022. doi:10.1001/jamaoncol.2022.5486

Press Release: Ethnic diversity and disparities in access to genetic testing impact prostate cancer development and treatment

A press release from the European Society of Medical Oncology (ESMO) discusses the importance and need for "ethnically diverse prostate cancer genomics data and accessible genetic testing."   According to Dr. Rodrigo Dienstmann, an oncologist with joint appointments at the Grupo Oncoclinicas in Sao Paulo Brazil as well as the Vall d'Hebron Institute of Oncology in Barcelona, Spain, predisposition to prostate cancer does vary across ethnicities, particularly in men of African and Caribbean descent, who are at increased risk: "such race-related differences can condition the behaviour of the disease and its treatment, yet our current knowledge of prostate cancer genomics is largely limited to data from Europe and the USA, in which Asian and other non-Caucasian ethnicities are scarcely represented." 

To learn more about this press release, click here.  

Geriatric assessment intervention reduces patient-reported symptom toxicities in older patients with advanced cancer

 Findings from GAP70+, the first study to "systematically describe baseline symptom burden as measured by the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) in older adults with advanced cancer" was recently published in the Journal of Clinical Oncology. 

According to the GAO70+ study, more than 25% of new cancer diagnoses occur in older patients, however this demographic is often now well-represented in clinical trials, which limits understanding of the various treatment options available.  

To read more about this study, click here. 

Source mentioned: Culakova E, Mohile SG, Peppone L, et al. Effects of a Geriatric Assessment Intervention on Patient-Reported Symptomatic Toxicity in Older Adults With Advanced Cancer. JCO; Published online 10 November. DOI: 10.1200/JCO.22.00738

New study shows cancer mortality higher among American Indian and Alaska Native individuals

 A new study recently released by the American Cancer Society indicates that "cancer mortality among American Indian and Alaska Native individuals is 18% higher than among White individuals despite similar cancer incidence."  The study is the first U.S. nationwide mortality data that has been published for this demographic and explains that the "disparity is driven by common cancers that are receptive to early detection."  Thus, breast and prostate cancer incidence rates are 15% and 12% lower, but 7% and 31% higher mortality rates.  Further, mortality rates for infection-related cancers, including liver, stomach, cervix, and kidney, were twice the rate among American Indian and Alaska Native groups compared to White individuals. 

To read more about this study, click here. 

Source mentioned:  Kratzer TB, Jemal A, Miller KD, et al. Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early-onset colorectal cancer. CA Cancer J Clin. 2022;1‐27. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21757

New study shows recently diagnosed adult cancer survivors at higher risk for bone fractures

 A new study conducted by the American Cancer Society indicates that adult cancer survivors, especially those diagnosed within 5 years and/or treated with chemotherapy, "have an increased risk for bone fractures, specifically pelvic and vertebral fractures, compared to older adults without cancer." These findings were further correlated with levels of physical activity and smoking status; active adults had a lower risk of bone fractures, whereas smoking among survivors lead to an increased risk of bone issues. The study, conducted on 92,431 participants over 20 years (1997-2017) unveiled 12,943 with bone fractures.  

To read more about this study, click here. 

Evaluation of primary and secondary prevention of oral cancer

 A special report produced by the International Agency for Research on Cancer (IARC) on the primary and secondary prevention of oral cancer has determined that "cessation of tobacco smoking, alcohol consumption and areca nut use will contribute to significant reductions in the risk of oral cancer." Cancer of the lip and oral cavity is the 16th cause of mortality worldwide, with "a wide range of genetic, environmental, and behavioural factors" all contributing to oral cancer risk.  

To read more about this report, click here. 

Source mentioned: Bouvard V, Nethan ST, Singh D, at al. IARC Perspective on Oral Cancer Prevention. NEJM; Published online 18 October 2022. DOI: 10.1056/NEJMsr2210097

Long-term clinical benefit with nivolumab and ipilimubab extends beyond treatment discontinuation in patients with metastatic NCSLC, regardless of PD-L1 expression

According to a 5-year follow-up of the CheckMate 227 trial, nivolumab and ipilimumab "continued to demonstrate long-term, durable clinical benefit for previously untreated patients with metastatic non-small cell lung cancer (NSCLC) versus chemotherapy, regardless of tumour PD-L1 expression."   Following a 5-year survival rate of 24% for nivolumab and ipilimumab in PD-L1, the authors of CheckMate 227 concluded that this is the "first phase III study to report 5-year clinical outcomes with a first-line combination of ICIs for patients with metastatic NSLSC." 

To read more about CheckMate 227, click here. 

Source mentioned: Brahmer JR, Lee J-S, Ciuleanu T-E, et al. Five-Year Survival Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small Cell Lung Cancer in CheckMate 227. JCO; Published online 12 October 2022. DOI: 10.1200/JCO.22.01503

Long-term follow-up confirms pembrolizumab and pembrolizumab-chemotherapy as effective first-line treatment options for recurrent or metastatic HNSCC

 A recently published follow-up study of the first-line pembrolizumab and pembrolizumab-chemotherapy KEYNOTE-048 trial "continued to demonstrate overall survival benefit compared with cetuximab-chemotherapy" in head and neck cancer patients.  A 4-year follow-up period noted a survival plateau of 20% for patients administered pembrolizumab alone, and a 30% survival rate for those patients receiving a pembrolizumab-chemotherapy combination.  However, study authors did observe more favourable side effects in patients receive pembrolizumab alone without additional chemotherapy.  

To read more about this study, click here. 

Sources mentioned:  

Harrington KJ, Burtness B, Greil R, et al. Pembrolizumab With or Without Chemotherapy in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Updated Results of the Phase III KEYNOTE-048 Study. JCO; Published online 11 October 2022. DOI: 10.1200/JCO.21.02508 

Ho AL. Immunotherapy, Chemotherapy, or Both: Options for First-Line Therapy for Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. JCO; Published online 12 October 2022. DOI: 10.1200/JCO.22.01408

Modest effectiveness of screening colonoscopy for the prevention of colorectal cancer: the NordICC study

 Results from the Nordic-European Initiative on Colorectal Cancer (NordICC) were recently unveiled at the United European Gastroenterology Week held in Vienna from October 8-11, 2022. Authors of the NordICC study state that "colonoscopy is considered to be more effective than sigmoidoscopy, but colonoscopy has not been adopted in many parts of the world, partly because evidence from randomized studies regarding the benefits is lacking."  The authors further emphasized that findings were significant in the 84,85 participants in NordICC (28,220 in the invited group, 11,843 of whom underwent screening, along with 56,365 participants in the usual-care group: "during a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group." 

To read more about this study, click here.  

Sources mentioned: 

Bretthauer M, Løberg M, Wieszczy P, et al., for the NordICC Study Group. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. NEJM; Published online 9 October 2022. DOI: 10.1056/NEJMoa2208375

Dominitz JA, Robertson DJ. Understanding the Results of a Randomized Trial of Screening Colonoscopy. NEJM; Published online 9 October 2022. DOI: 10.1056/NEJMe2211595

Cancer survivors delaying care due to transportation barriers use ER more; have highest risks for all-cause and cancer-specific mortality

 New findings unveiled by the American Cancer Society indicates that lack of transportation is a contributing factor in delayed care for cancer survivors and subsequent visits to the emergency room. Led by Dr. Xuesong Han, scientific director of health services research at the American Cancer Society, 30,000 cancer survivors and 500,000 adults with no cancer history were observed from 2000-2018.  The study revealed that "2.8% if cancer survivors and 1.7% if adults without a cancer history reported delays in care due to transportation barriers."   The study authors thus emphasized the need to "mitigate transportation barriers in vulnerable cancer survivor communities." 

To read more about this study, click here. 

Food, housing, transportation insecurity associated with disparities in cancer care and patient outcomes

 A series of three papers discussing housing, transportation, and food insecurity among cancer patients were recently published in the Journal of the National Cancer Institute (JNCI).  Researchers "summarized existing evidence related to disparities in cancer care and patient outcomes, as well as identifying promising interventions and research opportunities to inform policy and improve health equity."  

To read more about these studies and the programs that have been developed to combat inequities regarding access to cancer care, click here. 

Sources mentioned:  

Sanchez JI, Adjei BA, Randhawa G, Medel J, Doose M, Oh A, Jacobsen PB. National Cancer Institute-funded Social Risk Research in Cancer Care Delivery: Opportunities for Future Research. J Natl Cancer Inst. 2022 Sep 8:djac171. doi: 10.1093/jnci/djac171. Epub ahead of print. PMID: 36073952.

Graboyes EM, Chaiyachati KH, Sisto Gall J, Johnson W, Krishnan JA, McManus SS, Thompson L, Shulman LN, Yabroff KR. Addressing Transportation Insecurity Among Patients With Cancer. J Natl Cancer Inst. 2022 Sep 21:djac134. doi: 10.1093/jnci/djac134. Epub ahead of print. PMID: 36130286.

Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst. 2022 Sep 21:djac136. doi: 10.1093/jnci/djac136. Epub ahead of print. PMID: 36130291.

New study shows sugar-sweetened drinks increase risk of cancer mortality

A recent study conducted by the American Cancer Society indicates that drinking 2 or more sugar-sweetened beverages on a daily basis results in a 5% "increased risk of death from an obesity-related cancer, including gastrointestinal, postmenopausal breast, endometrial, and kidney cancer." The study, conducted on 900,000 cancer-free participants who provided information on their consumption of sugar and artificially sweetened beverages found a direct correlation between sugar consumption and known cancer risk factors including weight gain and obesity.  According to lead author of this study Dr. Marjorie McCullough, artificial sweetener use is increasing and thought to be relatively safe, however more research on use of artificial sweeteners and cancer risk is needed. 

To read more about this study, click here. 

Early cancer detection with blood test may change cancer screening paradigms

New data from a study conducted in France suggests that multi-cancer early detection (MCED) tests (currently in development) have the ability to determine common cancer signals from over 50 different types of cancer.  Known as PATHFINDER, the MCED test "detected a cancer signal in 1.4% of 6621 people aged 50 years and over who were not known to have cancer, and cancer was confirmed in 38% of those with a positive test. Of 6290 people who were cancer free, 99.1% received a negative test result." 

To read more about this study, click here. 

Sources mentioned:  

Abstract 903O ‘A prospective study of a multi-cancer early detection blood test’ will be presented by Deb Schrag during the proffered paper session “Basic science and translational research” on Sunday, 11 September, 16:30 to 18:00 CEST in Orléans Auditorium. Annals of Oncology, Volume 33 Supplement 7, September 2022

Swanton C, Neal RD, Johnson PWM et al. NHS-Galleri Trial Design: Equitable study recruitment tactics for targeted population-level screening with a multi-cancer early detection (MCED) test. J Clin Oncol 2022; 40(16) suppl. 

Blog postings will resume week of September 12th

 To all Grey Horizon readers, 

Please note that blog postings will resume the week of September 12, 2022. 

Thank you, take care, and stay well.  

TIL densities association with disease-free survival differs by primary tumour sidedness in stage III colon cancer

 Findings from a recently completed phase 2 study by NCCTG N0147 alliance researchers "found significantly higher tumour infiltrating lymphocyte (TIL) densities in right- versus left-sided colon cancers."  Following an extensive analysis and dichotomy of 1532 colon cancer patients, the study authors concluded that TILs "were second only to N stage for prediction of DFS [disease-free survival] and their relative contribution was substantially greater (16-fold) in right - vs. left-sided tumours." 

To read more about this study, click here.  

Source mentioned: Saberzadeh-Ardestani B, Foster NR, Lee HE, et al. Association of Tumor-infiltrating Lymphocytes (TILs) with Survival Depends on Primary Tumor Sidedness in Stage III Colon Cancers (NCCTG N0147) [Alliance]. Annals of Oncology; Published online 10 August 2022.

Teclistamab results in a high rate of deep and durable response in patients with triple-class-exposed relapsed or refractory myeloma

 Researchers at the Memorial Sloan Kettering Cancer Center in New York recently released findings of a phase I/II study of patients with relapsed or refractory multiple myeloma who received a "once-weekly subcutaneous dose of a bispecific antibody, teclistamab that mediates T-cell activation and subsequent lysis of myeloma cells expressing B-cell maturation antigen (BCMA)."  Of the 165 patients who were administered teclistamab, 65 patients (39.4%) had a complete response or better after a follow-up period of 14.1 months.

To read more about this study, click here.   

Sources mentioned:  Moreau P, Garfall AL, van de Donk NWCJ, et al. Teclistamab in Relapsed or Refractory Multiple Myeloma. N Engl J Med 2022;387:495-505.

Mailankody S, Landgren O. T-Cell Engagers — Modern Immune-Based Therapies for Multiple Myeloma. N Engl J Med 2022;387:558-561.

Study on frequent aspirin use supports reduction in ovarian cancer risk

A study recently published in the Journal of Clinical Oncology indicates that frequent aspirin use is associated with reduction in ovarian cancer risk.  Further, secondary analyses of RCTs observing administration of aspirin for cardiovascular disease prevention "have noted a decreased risk of female reproductive cancers with at least 3 years of aspirin use."  While study authors point out that the ovarian cancer individual cases diagnosed in the study populations were not robust enough to draw definitive conclusions,  "meta-analyses and pooled analyses of cohort and case-control studies have found that aspirin may reduce ovarian cancer risk by 10%-20%, particularly when used frequently (e.g. daily or almost daily)."   

To learn more about this study, click here. 

Source mentioned: Hurwitz LM, Townsend MK, Jordan SJ, et al. Modification of the Association Between Frequent Aspirin Use and Ovarian Cancer Risk: A Meta-Analysis Using Individual-Level Data From Two Ovarian Cancer Consortia. JCO; Published online 22 July 2022. DOI: 10.1200/JCO.21.01900

Older age and smoking most important risk factors for developing any type of cancer

 A recently completed study by the American Cancer Society as identified older age and smoking as "the two most important risk factors associated with a relative and absolute five-year risk of developing any cancer."  The cohort study, comprising 429,991 participants across the USA with no prior history of cancer were followed; within a 5-year period, 15,226 of these participants were diagnosed with cancer.  In addition, risk factors including alcohol intake, family history of cancer, read meet consumption and physical inactivity contributed to an "absolute five-year risk as high as 29% in men and 25% in women." 

To learn more about this study, click here. 

Blog postings will resume week of August 8th

To all Grey Horizon readers, 

Please note that blog postings will resume the week of August 8, 2022. 

Thank you, take care, and stay well.  

Anticancer drugs in the adjuvant setting have considerable costs, raising questions of sustainability

A recently released cross-sectional analysis of approved anticancer drugs by the U.S. Food and Drug Administration (FDA) over a 4 year period (January 2018 - March 2022), determined that "the price of anticancer drugs is on an upward trajectory" worldwide, "with forecasts of global oncology therapeutic sales reaching $250 billion U.S. by 2024."   The authors of this cross-sectional analysis further emphasis the importance of estimating the cost per event averted in adjuvant therapies.  While only 11 approvals were analyzed, "the median cost per event averted of drugs in the adjuvant setting was $1 610 000 US, with...the median cost of a complete adjuvant treatment" totaled $158 000 US per patient. 

To read more about this analysis, click here.  

Source mentioned: Mousavi I, Olivier T, Prasad V. Cost per Event Averted in Cancer Trials in the Adjuvant Setting From 2018 to 2022. JAMA Netw Open 2022;5(6):e2216058.

Only a quarter of phase III studies demonstrated improved quality of life in advanced cancer setting

 A recently completed retrospective cohort study published by the Division of Cancer Care and Epidemiology at the Cancer Research Institute in Queen's University (Kingston, Ontario) indicated that nearly 50% of anticancer drug studies "demonstrated improved PFS [progression-free survival] (but) showed no improves in OS [overall survival] or QOL [quality of life]."  Led by Dr. Bishal Gyawali, the study authors further mentioned that studies with negative QOL results are either published after considerable delay or not at all, however "focusing on non-curative settings only is a strength rather than a limitation of the analysis because the risk-benefit thresholds are different in curative settings." 

To read more about this study, click here. 

Source mentioned: Samuel JN, Booth CM, Eisenhauer E, et al. Association of Quality-of-Life Outcomes in Cancer Drug Trials With Survival Outcomes and Drug Class. JAMA Oncol 2022;8(6):879-886.

Electronic symptom monitoring with PROs improves patient-reported physical function, symptom control and HRQOL

 Results from the PRO-TECT randomized controlled trial, conducted in 52 community oncology practices was recently published in JAMA.  The purpose of PRO-TECT was to "determine whether electronic monitoring of symptoms by patients undergoing treatment for metastatic cancer improves survival, quality of life outcomes and other outcomes compared with usual care."  Following enrollment of 1191 adult metastatic cancer patients, patients in the PRO group "had significantly greater odds of experiencing clinical meaningful benefits versus usual care for physical function", with an improvement of at least 5 points in 7.7% of patients studied. 

To read more about the PRO-TECT trial, click here. 

Source mentioned: Basch E, Schrag D, Henson S, et al. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer A Randomized Clinical Trial. JAMA 2022;327(24):2413-2422.

Some patients with NSCLC (non-small cell lung cancer) may respond poorly to COVID-19 MRNA vaccines

 A recently completed study from the Emory University School of Medicine in Atlanta, Georgia, determined that 25% of patients with non-small cell lung cancer (NSCLC) experienced a negative antibody response after receiving COVID-19 mRNA vaccines.  Study lead Professor Rafi Ahmed further emphasized that his team "did not find a correlation with the type of cancer treatment and the magnitude of the antibody response."  In addition, further research is required as the Emory University study was small, comprised of 82 patients with NSCLC and 53 heathy volunteers.

To read more about this study click here.  

Source mentioned: Valanparambil RM, Carlisle J, Linderman SL, et al. Antibody Response to COVID-19 mRNA Vaccine in Patients With Lung Cancer After Primary Immunization and Booster: Reactivity to the SARS-CoV-2 WT Virus and Omicron Variant. JCO; Published online 27 June 2022. DOI: 10.1200/JCO.21.02986