Incidence of colorectal, breast, kidney, pancreatic, and uterine cancers is increasing in young adults

 Epidemiological data regarding the incidence of 12 types of cancer among young adults was recently published in the British Journal of Cancer, June 2022.  According to the authors, "the incidence of colorectal, breast, kidney, pancreatic, and uterine cancers is increasing...whilst the incidence of lung, laryngeal, and bladder cancers is decreasing."  Further, the authors concluded that young adults with cancer are more likely to experience diagnostic delays, cautioning that "even when referred, younger patients may be referred through a less urgent route...[which] may results in cancer progressing to a less curable stage." While young adults are susceptible to lifestyle risk factors, namely obesity and smoking, the authors further emphasize that these preventable risk factors must be addressed early on. 

To read more about this study, click here. 

Source mentioned: di Martino E, Smith L, Bradley SH, et al. Incidence trends for twelve cancers in younger adults—a rapid review. Br J Cancer 2022;126:1374–1386. DOI: https://doi.org/10.1038/s41416-022-01704-x

Blog postings will resume week of May 30, 2022

  To all Grey Horizon readers, 

Please note that blog postings will resume the week of May 30, 2022. 

Thank you, take care, and stay well.  

Cancer care in war zones: what have we learnt?

 A recent clinical practice perspective interview by the European Society of Medical Oncology (ESMO), with Professor Richard Sullivan, from the Conflict and Health Research Group at King's College in London, UK, emphasizes the impact of cancer care in war zones for the global oncology community.  Discussion topics include challenges caring for refugees with cancer, coordinating cancer care support amongst different agencies, and the impact of the current conflict in Ukraine on cancer care in the future. 

To read the complete interview, click here.  

Webinar: survivorship needs for people living with advanced and metastatic Cancers

 A recent webinar by Dr. Michelle Mollica, Senior Advisor at the National Cancer Institute's (NCI) Office of Cancer Survivorship, discusses efforts by the NCI on "understanding and addressing the survivorship needs for the growing population of survivors who are living with advanced and metastatic cancers." Dr. Mollica's presentation includes discussions on managing symptoms, psychosocial support, health care delivery and behaviours. 

Fore more information and to view the webinar, click here. 

Increased risk of cancer in early life among individuals with autism spectrum disorders

Results from a recently completed population-based cohort study at the Karolinska Institutet in Sweden determined that "individuals with autism spectrum disorders, when present with comorbid intellectual disability and/or birth defects, were at a higher risk of cancer in early life."  With a focus on autism spectrum patients diagnosed with cancer before age 30, the study concluded that "autism spectrum disorders alone...without comorbid intellectual disability or birth defects...was not associated with an increased risk of any cancer."   

To read more about this study, click here. 

Study mentioned: Liu Q, Yin W, Meijjsen JJ, et al. Cancer risk in individuals with autism spectrum disorder. Annals of Oncology; Published online 13 April 2022. DOI: https://doi.org/10.1016/j.annonc.2022.04.006

First study examining mental illness and self-harm events across 26 cancer types

 Recently published findings in Nature Medicine studied risk of unnatural death following self-harm amongst 459,542 cancer patients diagnosed with 26 different types of cancer.  Due to psychological distress and depression experienced by cancer patients, the study authors concluded that the self-harm "prevalence ratio is higher among younger individuals, as they are more likely to be referred for specialized psychosocial cancer care."  In particular, the study further revealed the patients with co-occurring were mostly likely to cause self-harm to themselves during the first 12 months of a cancer diagnosis. 

To read more about this study, click here.  

Source mentioned: Chang WH, Lai AG. Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers. Nature Medicine; Published online 28 March 2022. DOI: https://doi.org/10.1038/s41591-022-01740-3

NGS is effective in identifying actionable genetic alterations for investigational targeted therapies in paediatric and young adult patients with refractory cancers

A recent study published by the Texas Children's Cancer and Hematology Center recently published findings regarding "the feasibility of a nationwide screening and centralized testing Protocol to select patients with tumours harbouring actionable alterations for enrolment in clinical studies of molecularly targeted therapies."   Following completed testing for 94.7% of tumours, actionable alternations were detected in 31.5% of the first 1,000 tumours screened, with "treatment arm assignment and enrolment occurring in 28.4% and 13.1% of patients." 

To read more about this study, click here. 

Source mentioned: Parsons DW, Janeway KA, Patton DR, et al. Actionable Tumor Alterations and Treatment Protocol Enrollment of Pediatric and Young Adult Patients With Refractory Cancers in the National Cancer Institute–Children's Oncology Group Pediatric MATCH Trial. JCO; Published online 30 March 2022. DOI: 10.1200/JCO.21.02838

Children of patients with cancer more likely to experience medical financial hardship and emotional and educational challenges following parental diagnosis

 A new study conducted by researchers at the American Cancer Society indicates that children "living in families with a history of parental cancer were more likely to face financial, emotional, and educational challenges."  According to Dr. Zhiyuan Zheng, lead author of the study, 3.4% of children between 5-17 are living in families with a parental history of cancer.  As a result, these children may miss school and may be less likely to receive medical care due to lack of family financial resources.  Further, the study states that these children "were particularly vulnerable and began to experience psychosocial and behavioral challenges that often went unaddressed." 

To read more about this study, click here. 

Source mentioned: Zheng Z, Zhao J, Nogueira L, Han X, Fan Q, Yabroff KR. Associations of Parental Cancer With School Absenteeism, Medical Care Unaffordability, Health Care Use, and Mental Health Among Children. JAMA Pediatr. Published online April 11, 2022. doi:10.1001/jamapediatrics.2022.0494

 

Benefit of adjuvant capecitabine after curative resection of biliary tract cancer maintained with a long-term analysis

Results from BILAP, a 5-year study on survival data conducted at the UCL Cancer Institute in London, U.L. confirmed "the benefit of capecitabine as adjuvant therapy after surgical resection of biliary tract cancer...and should be considered as the standard of care."   Conducted between March 15 2006 - December 4, 2014 on 447 patients (of whom 223 were assigned to the capecitabine group for curative intent), indicated a period of 24.3 months for median recurrence-free survival for patients prescribed capecitabine compared to 17.4 months for those in the observation group.  

To read more about the BILAP study, click here. 

Source mentioned: Bridgewater J, Fletcher P, Palmer DH, et al. Long-Term Outcomes and Exploratory Analyses of the Randomized Phase III BILCAP Study. Journal of Clinical Oncology; Published online 22 March 2022. DOI: 10.1200/JCO.21.02568

Tumour budding demonstrates independent prognostic value for disease-free and overall survival in patients with stage III colon cancer

 Joint research conducted in Paris at the Department of Pathology, Sorbonne University, and the Department of Oncology, Georges Pompidou Hospital, indicates that the use of tumour budding as a prognostic biomarker in colon cancer could influence disease-free and overall survival for patients diagnosed at stage III.  Defined as "a single cancer cell of up to four cancer cells at the tumour invasive margin", tumour budding was applied to 1,048 stage III colon cancer patients in the joint Paris post-hoc study.  While the study authors acknowledge that further research is required, their findings do support the notion that "tumour budding seems to provide additional and clinically relevant prognostic information beside risk groups and Immunoscore." 

To learn more about this study, click here. 

Source mentioned: Basile D, Broudin C, Emile JF, et al. Tumor budding is an independent prognostic factor in stage III colon cancer patients: A post-hoc analysis of the IDEA-France phase III trial (PRODIGE-GERCOR). Annals of Oncology; Published online 16 March 2022. DOI: https://doi.org/10.1016/j.annonc.2022.03.002

COVID-19 & cancer: future of the pandemic [YouTube video presentation]

Dr. Otis Brawley, a renowned cancer control expert from Johns Hopkins University recently held a question and answer session discussing "the current state of the COVID-19 pandemic and what cancer survivors need to know going forward to best protect themselves."  Dr. Brawley's research is focused on cancer screening strategies and lifestyle reduction programs, including "striving to close racial, economic, and social disparities in the prevention, detection, and treatment of cancer in the United States and worldwide." 

To view the complete session, click here. 

Survivors of childhood, adolescent, and young adult cancer not at increased risk of testing positive for COVID-19, nor for serious sequelae when contracting infection

A recent study conducted in Ontario explored population-based registries to identify all 5-year survivors of childhood cancer between 0-17 years of age, as well as 6 common cancers afflicting young adults between 15-21 years old.  Findings indicated that "survivors were not at increased risk of receiving a positive COVID-19 test...and were more likely to be fully vaccinated."  Further, there was no increased risk to survivors in the emergency department or who needed to be admitted, and "no survivor experienced intensive care unit admission or died after COVID-19 infection. 

To read more about this study, click here. 

Source mentioned: Gupta S, Sutradhar R, Alexander S, et al. Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Adult Cancer: A Population-Based Study in Ontario, Canada. JCO; Published online 28 February 2022. DOI: 10.1200/JCO.21.02592

Humoral response to the third dose of the MRNA-based COVID-19 vaccine in a large cohort of patients with cancer

 A recently published letter to the editor in Annals of Oncology, authored by Dr. Vincenzo Di Noia from the Regina Elena National Cancer Institute in Rome, Italy, "described the serological response to the third dose of the BNT162b2 mENA COVID-19 vaccine in a large cohort of patients with cancer."  407 patients received a third dose of BN1162b3 between September - November 2021.  366 (89.9%) of patients were on active anticancer treatment 28 days before BNT162b2 was administered.  Median age of patients was 67, with breast (28.5%) and lung (19.9%) identified as the most common cancer types.  402 (98.8%) of patients studied "had a positive serological status after the third vaccine dose." 

To read more about this study, click here. 

Study mentioned: Di Noia V, Pimpinelli F, Renna D, et al. Potentiation of humoral response to BNT162b2 vaccine after the third dose in patients with solid cancer. Annals of Oncology; Published online 21 February 2022. doi: https://doi.org/10.1016/j.annonc.2022.02.006

Higher risk of major adverse cardiovascular events and cancers with tofacitinib

 

During the recently held Pharmacovigilance Risk Assessment Conference (PRAC), the European Medicines Agency (EMA) revealed results from a study indicating that patients "taking tofacitinib for rheumatoid arthritis and who were at risk of heart disease were more likely to experience a major cardiovascular problem...and had a higher risk of developing cancer."  In 3 nearly equivalent patient groups (1455 patients received 5mg of tofacitinib twice daily; 1456 received 10mg of tofacitinib twice daily; 1451 received a TNF inhibitor), incidences of cancer were higher (2.4% for 5mg; 4.2% for 10mg) for those administered tofacitinib vs. 2.5% who received a TNF inhibitor. 

To learn more about this study, click here.  

Source mentioned: Ytterberg SR, Bhatt DL, Mikuls TR, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med 2022;386:316-326.

Blog postings will resume week of March 2, 2022

 To all Grey Horizon readers, 

Please note that blog postings will resume the week of March 2, 2022. 

Thank you, take care, and stay well.  

Greater severity of adverse events in women across multiple anticancer treatment modalities

 Results of 202 phase II and III clinical trials conducted between 1989 and 2019 on 23, 296 cancer patients has revealed "greater severity of both symptomatic adverse events and haematology adverse events in women across multiple treatment modalities."  Researchers at the SWOG Cancer Research Network determined that of the 23, 296 patients studies (8,838/37.9% women and 14,458/62.1% men) female patients "had a 34% increased risk of adverse events [across various cancer therapies administered] compared to men."  

To learn more about this study, click here. 

Source mentioned: Unger JM, Vaidya R, Albain KS, et al. Sex Differences in Risk of Severe Adverse Events in Patients Receiving Immunotherapy, Targeted Therapy, or Chemotherapy in Cancer Clinical Trials. JCO; Published online 4 February 2022. DOI: 10.1200/JCO.21.02377

Trial alert from the PACIFIC study: Robust and sustained survival benefit with consolidation durvalumab after concurrent chemoradiotherapy for unresectable, stage III non-small-cell lung cancer

 Recently released results on survival analyses from the PACIFIC study focusing on the benefits of durvalumab in patients with unresectable, stage iii non-small-cell lung cancer (NSCLC) and no cancer progression following concurrent chemoradiotherapy treatment indicated that "42.9% of patients randomly assigned to durvalumab remain alive at 5 years and 33.1^ of patients remain alive and free of disease progression. 

Click here to read more about this study, the first to "demonstrate a survival advantage with immune checkpoint inhibitor in a curative-intent setting."

Source mentioned: Spigel DR, Faivre-Finn C, Gray JE, et al. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non–Small-Cell Lung Cancer. JCO; Published online 2 February 2022. DOI: 10.1200/JCO.21.01308

Personalized immunotherapy for metastatic breast cancer

 Results from an ongoing clinical trial conducted at the National Cancer Institute's (NCI) Center for Cancer Research, has found that "many people with metastatic breast cancer can mount an immune reaction against their tumors."  The clinical trial conducted on 42 women with metastatic breast cancer showed that 67% (28 of the 42 trial participants) had an immune response towards their cancer affliction.  As such, the immune reaction approach was applied to treat 6 of the 28 women, "half of whom experienced measurable tumor shrinkage."  

To read more about the results of this trial, click here. 

Source mentioned: Zacharakis N, Lutfi LM, Seitter SJ, et al. Breast Cancers Are Immungenic: Immunologic Analyses and a Phase II Pilot Clinical Trial Using Mutation-Reactive Autologous Lymphocytes. February 1, 2022. JCO. DOI: 10.1200/JCO.21.02170.

Artificial intelligence for diagnosis and Gleason grading of prostate cancer

 The Prostate Cancer Grade Assessment (PANDA) Challenge, a global artificial intelligence competition, recently published findings of their "blueprint for evaluating AI [artificial intelligence] algorithms in digital pathology" for prostate cancer patients.  In the PANDA report, prostate tumours were categorized into 5 grade groups, based on the Gleason growth patterns of tumour tissue.  Following the application of AI to grade 10,616 digitized prostate biopsies, "the algorithms achieved agreements of 0.862...[compared with] 0.868 with expert uropathologists." 

To read more about the PANDA Challenge, click here. 

Source mentioned: Bulten W, Kartasalo K, Chen P-HC, et al. Artificial intelligence for diagnosis and Gleason grading of prostate cancer: the PANDA challenge. Nature Medicine; Published online 13 January 2022. DOI: https://doi.org/10.1038/s41591-021-01620-2

Breakthrough SARS-CoV-2 infection following COVID-19 vaccination in patients with cancer

 Research conducted by the COVID-19 and Cancer Consortium, the results of which were recently published in the Annals of Oncology maintains that cancer patients who contract COVID-19 despite being vaccinated "remain susceptible to severe outcomes."  Dr. Toni K. Choueri of the Department of Medical Oncology at the Dana-Farber Cancer Institute in Boston, emphasizes that "vaccination of close contacts, masking, boosters, and social distancing are needed to protect patients with cancer", particularly if cancer patients come into contact with members of the public that are unvaccinated. 

Click here to read more about this study, believed to be the first to evaluate clinical characteristics and outcomes of cancer patients being infected by COVID-19 after vaccination.    

Source mentioned: Schmidt AL, Labaki C, Hsu C-Y, et al. COVID-19 vaccination and breakthrough infections in patients with cancer. Annals of Oncology; Published online 24 December 2021. DOI: https://doi.org/10.1016/j.annonc.2021.12.006

Dual inhibition of LAG-3 and PD-1 in patients with previously untreated metastatic or unresectable melanoma

 Findings from a recent phase II/III trial, RELATIVITY-047, evaluating "dual inhibition of LAG-3 and PD-1 using a new combination of LAG-3-blocking antibody relatlimab and PD-1 blocking antibody nivolumab..." were published by the Texas MD Anderson Cancer Center in The New England Journal of Medicine.  A cell surface molecule expressed on immune cells, LAG-3 "negatively regulates T-cell proliferation and effector T-cell function."  The RELATIVITY-047 study evaluated relatlimib and nivolumab together as a fixed dose regimen compared to patients receiving only nivolumab alone over a 4 week period in patents with untreated metastatic or unresectable melanoma.  Progression free survival was 10.1 months in patients receiving the relatlimab-nivolumab combination vs 4.6 months for those only being administered nivolumab. 

To read more about this trial, click here. 

Sources mentioned

• Tawbi HA, Schadendorf D, Lipson EJ, et al. Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma. N Engl J Med 2022;386:24-34. DOI: 10.1056/NEJMoa2109970
• Frampton AE, Sivakumar S. A New Combination Immunotherapy in Advanced Melanoma. N Engl J Med 2022;386:91-92. DOI: 10.1056/NEJMe2116892

Lung cancer leading cause of cancer death in Canada

A recent study conducted by Health Canada as part of the Canadian Health Measures Survey has revealed that lung cancer is the most commonly diagnosed cancer and leading cause of cancer death in Canada.  While exact figures have not been tabulated, it is estimated that 21,000 Canadians will have died from lung cancer in 2021, more than colorectal, pancreatic and breast cancers combined.  The study further reports that "about half of all lung cancers are diagnosed at stage IV, at which point survival is extremely low: five-year survival is 4%."   

To read more about the findings from this report, click here 

Happy Holidays - Grey Horizon posts will resume week of January 4, 2022

 Dear all Grey Horizon readers, 

Thank you for your support over the past year.  Blog postings will resume the week of January 4, 2022. 

Happy Holidays and best wishes for a healthy New Year! 

Immunogenicity of COVID-19 MRNA-based vaccine in patients with actively treated solid malignancies

 Results from the Vax-On study of mRNA-BNT 162b2 immunogenicity in cancer patients with solid malignancies receiving treatment indicates that "seroconversion response...remains adequate even 5 months after the second COVID-19 vaccine dose."  According to Dr. Fabrizio Nelli of the Department of Oncology and Haematology at the Hospital of Belcolle in Viterbo, Italy, provide evidence in favour of cancer patients receiving a third dose of vaccine.  

To read more about the Vax-On study, click here. 

Source mentioned: Nelli F, Fabbri A, Onorato A, et al. Six-months immunogenicity of COVID-19 mRNA-BNT162b2 vaccine in actively treated cancer patients: Updated results of the Vax-On study. Annals of Oncology; Published online 9 December 2021. DOI: https://doi.org/10.1016/j.annonc.2021.12.001

Two years of adjuvant Palbociclib added to endocrine therapy does not improve outcomes in early breast cancer

 Results of a phase III trial, the Palbociclib CoLlaborative Adjuvant Study (PALLAS), presented at the 2021 San Antonio Breast Cancer Symposium (SABCS), December 7-10, 2021, "does not show significant improvements in survival endpoints for the addition of Palbociclib to adjuvant endocrine therapy over endocrine therapy alone in patients with early hormone receptor-positive, HER-2 negative breast cancer."  Further, the trial unveiled that nearly half (44.9%) of patients were not able to complete the full 2 years of Palbociclib treatment due to neutropenia.  

To read more about the results of this trial, click here. 

Study mentioned: Gnant M, Dueck AC, Frantal S, et al. Adjuvant Palbociclib for Early Breast Cancer: The PALLAS Trial Results (ABCSG-42/AFT-05/BIG-14-03). JCO; Published online 7 December 2021. DOI: 10.1200/JCO.21.02554

Clinical trial alert: Significant interaction between chemotherapy benefit and menopausal status in invasive disease-free survival

 

Findings of the RxPONDER clinical trial, a study led by Dr. Kevin Kalinsky of the Winship Cancer Institute at Emory University in Atlanta, GA, USA were recently published in the New England Journal of Medicine.  RxPONDER (a clinical trial RX for positive node, endocrine responsive breast cancer), "randomly assigned participants [~5000 women] with hormone receptor-positive, HER2-negative breast cancer, 1 to 3 positive axillary lymph nodes (nodal stage N1), and a recurrence score of 25 or lower to endocrine therapy only or to chemoendocrine therapy."  After a period of 5 years, the study determined that the relative chemotherapy benefit did not increase as the recurrence score increased. 

To read more about this trial, click here. 

Study mentioned: Kalinsky K, Barlow WE, Gralow JR, et al. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. NEJM; Published online 1 December 2021. DOI: 10.1056/NEJMoa2108873

Clinical trial alert: Long-term outcomes from the Checkmate 067 study patients with advanced melanoma

Data collected over 6.5 years fro the CheckMate 067 on clinical outcomes with nivolumab plus ipillimumab or nivolumab vs. impillimumab in patients with advanced melanoma, was recently reported in the Journal of Clinical Oncology.  Overall survival rates (with minimum 6.5 year follow-up was "72.1, 36.9, and 19.9 months in the combination, nivolumab, and ipillimumab groups, respectively."  For patients who discontinued treatment, median treatment-free survival was 27.6, 2.3, and 1.9 months. 

To learn more about CheckMate 067, click here.  

Study mentioned: Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Long-Term Outcomes With Nivolumab Plus Ipilimumab or Nivolumab Alone Versus Ipilimumab in Patients With Advanced Melanoma. JCO; Published online 24 November 2021. DOI: 10.1200/JCO.21.02229

Breast cancer: the role of exercise

 A recent post on Medical News Today re-emphasized the importance of regular exercise for breast cancer patients.  Benefits include increased survival, reduced risk of recurrence, improved mood and energy, improved treatment tolerance, and improved physical function.  The post also goes several tips on starting an exercise routine, namely discussing exercise plans with a medical care team, and referral to a physical therapist.  

To read more, click here. 

New trial alert: drug combination helps children with acute promyelocytic leukemia avoid conventional chemotherapy

The results of a new clinical trial has determined that "the combination of all-trans retinoic acid, ...a metabolite of vitamin A and arsenic trioxide is highly effective in children with standard- and high-risk acute promyelocytic leukemia, or APL."   The trial, conducted on 154 children between 1-22 years old who were recently diagnosed with standard or high-risk APL, showed 2-year event-free survival rates of 96%-98%, with fewer than 10% experiencing severe side effects. 

To learn more about this trial, click here. 

Study mentioned: Kutny MA, Alonzo TA, Abla O, et al. Assessment of Arsenic Trioxide and All-trans Retinoic Acid for the Treatment of Pediatric Acute Promyelocytic Leukemia A Report From the Children’s Oncology Group AAML1331 Trial. JAMA Oncology November 11, 2021. DOI: 10.1001/jamaoncol.2021.5206.

New trial alert: Ibrutinib improves survival for younger people with diffuse large B-cell lymphoma

 New analysis of a phase 3 trial has unveiled that adding Ibrutinib (Imbruvica) to chemotherapy can improve survival rates for patients younger than 60 with diffuse large B-cell lymphoma (DLBCL).  DLBCL is the most common type of lymphoma, occurring in 40% of lymphoma cases.  According to Dr Louis M. Staudt, chief of the Lymphoid Malignancies Branch at the National Cancer Institute, "for years we have only had chemotherapy and rituximab to offer these patients...Now, we hope that adding Ibrutinib to current therapy may give younger patients a better chance of surviving this aggressive cancer." 

To read more about this trial, click here. 

Source mentioned: Wilson WH, Wright G, Huang DA, et al. Effect of ibrutinib with R-CHOP chemotherapy in genetic subtypes of DLBCL. Cancer Cell November 4, 2021. DOI: 10.1016/j.ccell.2021.10.006.