An abnormal baseline geriatric 8 screening tool score strongly associates with increased long-term healthcare utilization in older patients with cancer

 A recent retrospective analysis conducted in the Department of General Medical Oncology at University Hospitals Leuven in Belgium indicates that "in the first 3 months after diagnosis of cancer in older patients, the healthcare utilization peaked, typically related to active cancer treatment, and then decreased in the time thereafter."  Healthcare utilization consisted of hospital admission, length of stay, visits to the emergency department, days in intensive care, appoints with general practitioners, home care, and transfers to nursing homes.  According to Professor Hans Wildiers, (General Medical Oncology, University Hospital Leuven, Belgium) "to optimize cancer treatment for older patients, it is important to identify frailty and underlying geriatric conditions at cancer diagnosis."   

To learn more about this study, click here. 

Source mentioned: 

Depoorter V, Vanschoenbeek K, Decoster L, et al. Long-term health-care utilisation in older patients with cancer and the association with the Geriatric 8 screening tool: a retrospective analysis using linked clinical and population-based data in Belgium. The Lancet Healthy Longevity; Published online 13 June 2023. DOI: https://doi.org/10.1016/S2666-7568(23)00081-8

Concurrent chemoradiotherapy followed by adjuvant cisplatin-gemcitabine for the treatment of patients with locoregionally advanced nasopharyngeal carcinoma

The first randomized, controlled phase III trial assessing the efficacy and safety of adding adjuvant cisplatin-gemcitabine chemotherapy after concurrent chemoradiotherapy was recently unveiled at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.  The trial indicated "significant improvement in 3-year progression-free survival (PFS) compared with cisplatin-fluorouracil regimen in patients with locoregionally advanced nasopharyngeal carcinoma."  

To read more about this trial, click here. 

Sources mentioned: 

• Liu L-T, Liu H, Huang Y, et al. Concurrent chemoradiotherapy followed by adjuvant cisplatin–gemcitabine versus cisplatin–fluorouracil chemotherapy for N2–3 nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial. The Lancet Oncology; Published online 5 June 2023: DOI: https://doi.org/10.1016/S1470-2045(23)00232-2
• Yip PL, Lee AWM, Chua MLK. Adjuvant chemotherapy in nasopharyngeal carcinoma. The Lancet Oncology; Published online 5 June 2023: DOI: https://doi.org/10.1016/S1470-2045(23)00266-8
• Tang L-Q, Liu L-T, Liu H, et al. Concurrent chemoradiotherapy followed by adjuvant cisplatin-gemcitabine versus cisplatin-5-fluorouracil chemotherapy for N2-3 nasopharyngeal carcinoma: A multicentre, open-label, randomised, controlled, phase 3 trial. J Clin Oncol 41, 2023 (suppl 16; abstr 6000).

Blog postings will resume week of June 19th

To all Grey Horizon readers, 

Please note that postings will resume the week of June 19th.   

Thank you, as always, for your continued support of this blog.  

New studies presented at 2023 ASCO annual meeting ties loneliness and major financial event to cancer diagnoses and higher mortality risk

 New studies unveiled at the 2023 annual meeting of the American Society of Clinical Oncology (ASCO), held in Chicago from June 2-6, 2023, indicate loneliness and experiencing a major financial event as direct correlations to a cancer diagnosis and higher mortality risk.  

Led by Jingxuan Zhao, senior associate scientist of health services research at the American Cancer Society, cancer survivors 50 years and older reported "elevated loneliness scores [and] had higher hazard ratios, indicating higher mortality risks."  These findings occurred even after adjusting for sociodemographic characteristics, leading to strong recommendations to implement programs to screen for loneliness among cancer survivors and provide social support. 

An additional study unveiled at the ASCO annual meeting indicates that 1/3 of cancer patients experienced a major adverse financial event (AFE), such as bankruptcy, lien, or eviction, prior to being diagnosed with cancer, and were subsequently diagnosed at a later cancer stage.  Of the 101,649 patients studied, 32.6% had a major AFE before being diagnosed, most commonly among non-Hispanic Black, unmarried, and low-income patients.  However, "even 27% of patients in the highest income group had an AFE prior to diagnosis."  

To learn more about these studies, click here and here. 

Use of immune checkpoint inhibitors safe and effective in cancer patients with HIV and on antiretroviral therapy

 A recently conducted retrospective study by the Cancer Therapy Using Checkpoint Inhibitors in People Living with HIV-International (CATCH0IT) Consortium determined that immune checkpoint inhibitors were found to be safe and had "differential activity across tumour types."  CATCH-IT enrolled 390 cancer patients with HIV into their cohort, "who received anti-PD-1 or anto-PD-L1 therapies and evaluated the safety and activity." This cohort was unique, as patients with HIV are at higher risk for developing cancer, due to dysfunctional immune systems.   The 3 most common cancer identified in the cohort included non-small-cell lung cancer (28%), hepatocellular carcinoma (11%), and head and neck squamous cell carcinoma (10%).  While the study authors acknowledged the relatively small sample size for this study, the results do support "the growing body of evidence [among] the use of ICIs [in] patients with HIV to enhance their inclusion in clinical studies." 

To read more about this study, click here.

Source mentioned: 

El Zarif T, Nassar AH, Adib E, et al. Safety and Activity of Immune Checkpoint Inhibitors in People Living With HIV and Cancer: A Real-World Report From the Cancer Therapy Using Checkpoint Inhibitors in People Living With HIV-International (CATCH-IT) Consortium. JCO; Published online 16 May 2023. DOI: 10.1200/JCO.22.02459

New study shows mortality rates for most cancers decreasing globally, except liver cancer in men and lung cancer in women increasing

A new study conducted by the American Cancer Society has found a downward trend in mortality rates for major cancers worldwide, with the exception of liver cancer in men and lung cancer in women.  According to Dr. Ahmedin Jemal, senior author of the study, "these findings reinforce the importance of strengthening the health systems not only in resource-limited countries but also in high-income countries across the world for broad and equitable implementation of known cancer prevention and control interventions."   24 countries in the study reported higher mortality rates from lung cancer in women, with the highest increase noted in Spain (4.3%), Uruguay (3.7%), and Greece (3.2%).  For men, highest increases in liver cancer were found in Ireland (5.8%), Norway (5.3%), and Malta (4.8%), increases which have been attributed to hepatitis C infection, and nonviral etiology, including obesity, diabetes, and heavy alcohol consumption.  

To read more about this study, click here. 

ESMO launches living guidelines to enhance the usability in routine cancer patient care

 A recent press release from the European Society of Medical Oncology (ESMO) announces the release of the ESMO Living Guidelines, "a new tool designed to make [guidelines] easier to use in oncologists' routine clinical practice and support optimal decision-making in a rapidly evolving medical field." The guidelines provide an overview of patient management, including decision-making algorithms and key recommendations; they are to be considered a supplement to the ESMO Clinical Practice Guidelines, which remain the key "reference source for the optimal management of each tumour type and disease setting."  

To read more about these guidelines, click here.  

Initial results of the CanScreen5, an authentic data repository for cancer screening globally

Findings from a 3 year analysis of CanScreen5, a world-wide cancer screening data repository with contributions from 84 countries and launched by the International Agency for Research on Cancer (IARC) were recently published in Nature Medicine.   Focusing on screening programs for breast, cervical, and colorectal cancer, CanScreen5 unveiled "large variability...regarding compliance to further assessment of screening programmes and detection rates reported for precancerous and cancers."  Screening coverage for breast cancer ranged from 1.7% in Bangladesh to 85.5% in England; for cervical cancer screening, programs range from 2.1% in the Ivory Coast to 86.3% for Sweden, while colorectal cancer screening programs ranged from 0.6% in Hungary to 64.5% in the Netherlands. 

To read more about the CanScreen5 study, click here. 

Sources mentioned: 

Zhang L, Mosquera I, Lucas E, et al. & CanScreen5 collaborators. CanScreen5, a global repository for breast, cervical and colorectal cancer screening programs. Nature Medicine; Published online 27 April 2023. DOI: https://doi.org/10.1038/s41591-023-02315-6

Wang F, Dong X, Li N. A call to improve the quality of screening programs. Nature Medicine; Published online 27 April 2023. DOI: https://doi.org/10.1038/s41591-023-02305-8

Patients diagnosed with cancer during pregnancy may have increased risk of mortality

 A recently completed population-based cohort study at the University of Calgary's Department of Obstetrics and Gynaecology indicates that patients diagnosed with cancer while pregnant "had elevated mortality, but this association was not consistent across all cancer sites."  According to Dr. Amy Metcalfe and colleagues, cancer is the 2nd leading cause of death in premenopausal women, attributable to "increases in delayed childbearing, , improvements in diagnostic testing, awareness of genetic risk factors and subsequent screening, and expansion of population-based screening programs."  Further, only 25% of cancers are diagnosed during pregnancy; 75% of diagnoses occur in the postpartum period. 

To read more about this study, click here. 

Source mentioned: Cairncross ZF, Shack L, Nelson G, et al. Long-term Mortality in Individuals Diagnosed With Cancer During Pregnancy or Postpartum. JAMA Oncology; Published online 6 April 2023. doi:10.1001/jamaoncol.2023.0339.

Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis

 According to the Childhood Cancer Survivor Study (CCSS) cohort, "long-term survivors of childhood cancer are at four times the risk of death compared with the general, ageing population."  Particularly in the 5-9 year survival period after diagnosis, health-related causes of death include heart disease, cerebrovascular disease, influenza, pneumonia, sepsis, and kidney failure, conditions normally attributable to a diagnosis during middle age.  

To learn more about this study, click here.  

Sources mentioned:  

• Dixon SB, Liu Q, Chow EJ, et al. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. The Lancet; Published online 5 April 2023. DOI: https://doi.org/10.1016/S0140-6736(22)02471-0 
• Tonorezos ES, Marcil V. Childhood cancer survivors: healthy beahviours and late mortality. The Lancet; Published online 5 April 2023. DOI: https://doi.org/10.1016/S0140-6736(22)02632-0

New study shows more deaths with cancer as contributing cause during first year of pandemic

 A new study unveiled by the American Cancer Society indicates that "individuals living with cancer were at higher risk of COVID-19 infection and experiencing more severe symptoms due to their health conditions and treatment-related immune suppression."  Jingxuan Zhao, senior associate scientist and lead researcher in the study further explains that strict pandemic measures, especially orders to stay at home, along with a pause of non-emergency treatment had a different effect on delays in cancer screening, diagnosis, and treatment.  

To read more about this study, click here.  

Source mentioned:  Zhao J, Han X, Miller KD, Zheng Z, Nogueira L, Islami F, Jemal A, Yabroff KR. Association of the COVID-19 Pandemic and Changes in Patterns of Cancer-Related Mortality in the United States. JCO Oncol Pract. 2023 Apr 11:OP2200522. doi: 10.1200/OP.22.00522. Epub ahead of print. PMID: 37040580.

Happy Easter - blog postings will resume week of April 17th.

 To all Grey Horizon readers, 

Please note that postings will resume the week of April 17th following the Easter break. 

Thank you, as always, for your continued support of this blog.  

Helicobacter Pylori infection modifies the risk of gastric cancer associated with germline pathogenic variants in homologous recombination genes

A joint Japanese and Australian cohort study, led by the RIKEN Center for Integrative Medical Sciences in Yokohama, indicated that "pathogenic variants and Helicobacter pylori infection interacted to markedly increase the risk of gastric cancer..."   According to lead researcher Dr. Yukihide Momozawa, evaluation and eradication of Helicobacter pylori is of particular importance in individuals "known to carry a pathogenic variant in a homologous recombinant gene."  

To read more about this study, click here. 

Sources mentioned: 

• Usui Y, Taniyama Y, Endo M, et al. Helicobacter pylori, Homologous-Recombination Genes, and Gastric Cancer. N Engl J Med 2023;388:1181-1190.
• Müller A, He J. A Double Whammy on Gastric Cancer Risk. N Engl J Med 2023;388:1225-1229.

Similarity of molecular portraits in synchronous bilateral breast cancers could be influenced by common environmental factors

 A recent study conducted within the Translational Research Department, Institut Curie, Universite de Paris, found that in breast cancer patients, "immune infiltration was not determined purely by local tumour microenvironment properties, but was different according to the subtype of the contralateral tumour."  The study further unveiled that 5% of patients with bilateral breast cancers carry BRCA1 or BRCA2 mutations; from the 17575 patients listed in the Institut Curie clinical databases, only 2.3% (404) patients had synchronous bilateral breast cancers.  

To read more about this study, click here. 

Source mentioned: Hamy A-S, Abécassis J, Driouch K, et al. Evolution of synchronous female bilateral breast cancers and response to treatment. Nature Medicine; Published online 6 March 2023. DOI: https://doi.org/10.1038/s41591-023-02216-8

HRQoL data support benefit of adding pembrolizumab to chemotherapy in patients with persistent, recurrent, or metastatic cervical cancer

 Findings from the Keynote-826 study indicate favourable outcomes on the use of pembrolizumab and chemotherapy with or without bevacizumab as a standard treatment regimen for patients with persistent, recurrent, or metastatic cervical cancer.  Cervical cancer "is commonly associate with bleeding, fatigue, pain, bladder, and bowel dysfunction, leg swelling, and sexual dysfunction", symptoms which worsen in advanced or recurrent stages.  The goal of the standard treatment regimen mentioned above is to prolong, preserve, and improve health-related quality of life.  

To learn more about this study, click here. 

Source mentioned: 

Monk BJ, Tewari KS, Dubot C, et al. Health-related quality of life with pembrolizumab or placebo plus chemotherapy with or without bevacizumab for persistent, recurrent, or metastatic cervical cancer (KEYNOTE-826): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Oncology; Published online 3 March 2023. DOI: https://doi.org/10.1016/S1470-2045(23)00052-9

Estimate of the global economic cost of the most prevalent cancers in 204 countries from 2020 To 2050

 A recent decision analytical modelling study, using a "health-augmented macroeconomic model...to estimate the global economic cost of 29 cancer types for 204 countries..." is the first of its kind to study productivity loss among individuals with different educational and experience levels.  Study authors have found the estimated global economic cost of cancers from 2020-2050 to be $25.2 trillion, with tracheal bronchus, and lung cancer (15.4%), colon and rectal cancer (10.9%), breast cancer (7.7%), liver cancer (6.5%), and leukaemia (6.3%) deemed to sustain the highest economic costs. 

To read more about this study, click here. 

Sources mentioned: 

• Chen S, Cao Z, Prettner K, et al. Estimates and Projections of the Global Economic Cost of 29 Cancers in 204 Countries and Territories From 2020 to 2050. JAMA Oncology; Published online 23 February 2023. doi:10.1001/jamaoncol.2022.7826
• Lopes G. The Global Economic Cost of Cancer—Estimating It Is Just the First Step! JAMA Oncology; Published online 23 February 2023. doi:10.1001/jamaoncol.2022.7133

Exposure to antibiotics before treatment with immune checkpoint inhibitor associated with worse overall survival among older adults with cancer

A large population-level study from the Princess Margaret Cancer Centre in Toronto indicated that "antibiotic exposure and specifically fluoroquinolones before treatment with immune checkpoint inhibitor were associated with worse overall survival, with fluoroquinolone exposure conferring up to a 65% increased risk of mortality among older adults with cancer."   Of the 2,737 cancer patients who were administered immune checkpoint inhibitors, 59% received antibiotics 1 year before ICU treatment, while 19% received antibiotics 60 days before ICI.  The authors of the study further state that more data is required to further explore the association between antibiotic exposure, ICI treatment and survival outcomes among cancer patients in diverse settings. 

To read more about this study, click here. 

Sources mentioned: 

• Eng L, Sutradhar R, Niu Y, et al. Impact of Antibiotic Exposure Before Immune Checkpoint Inhibitor Treatment on Overall Survival in Older Adults With Cancer: A Population-Based Study. JCO; Published online 24 February 2023. DOI: 10.1200/JCO.22.00074
• Pinato DJ, Cortellini A. Antibiotic Therapy: The Cornerstone of Iatrogenic Resistance to Immune Checkpoint Inhibitors. JCO; Published online 24 February 2023. DOI: 10.1200/JCO.23.00049

New study finds millions in U.S. missed cancer screening during second year of COVID-19 pandemic

 A new study released by the American Cancer Society has unveiled that 4.4 million fewer women were screened for cervical cancer in 2021, compared to 2019.  For breast cancer, the numbers are 1.1 million fewer breast cancer screening tests administered, along with 700,000 thousand fewer for prostate cancer. According to associate scientist Jessica Star, "the COVID-19 pandemic continues to have a detrimental effect on important cancer screenings...", highlighting the importance of creating greater advocacy and awareness among get screened campaigns. 

To read more about this study, click here. 

study of Hodgkin lymphoma survivors suggests a dose-response association of colorectal cancer risk with subdiaphragmatic radiotherapy

 Findings from a case-control study of Hodgkin lymphoma survivors after a 5-year period found a "dose-response association between radiotherapy and colorectal cancer risk, and modification of this association by procarbazine."  Study authors also indicated that Hodgkin lymphoma survivors have a 2.8 times higher rate of a colorectal cancer diagnosis, a rate that remains at this increased level for over 40 years.  While these results are specific to a 5-year period (patients treated more recently would experience lower radiotherapy and chemotherapy doses), "an understanding of the dose-response relationship is needed to quantify and estimate the risk of secondary cancers based on individual treatment exposures." 

To learn more about this study, click here. 

Source mentioned: Geurts YM; Shakir R, Ntentas G, et al. Association of Radiation and Procarbazine Dose With Risk of Colorectal Cancer Among Survivors of Hodgkin Lymphoma. JAMA Oncology. Published online 2 February 2023. doi: 10.1001/jamaoncol.2022.7153.

First-line serplulimab in combination with chemotherapy improves survival in patients with PD-L1-positive, locally advanced or metastatic oesophageal squamous cell carcinoma

 Findings from the ASTRUM-007 study, focusing on the the use of first-line Serplulimab and chemotherapy every 2 weeks for patients with locally advanced or metastatic PD-L1 positive oesophageal squamous cell carcinoma, were recently published in Nature Medicine. 

The respecified fine analysis of the study, assessed by a blinded Independent Radiological Review Committee (IRRC) determined that "Serplulimab plus chemotherapy significantly improved PFS compared with placebo plus chemotherapy with median PFS of 5.8 months and 5.3 months." 

To read more about this study, click here. 

Source mentioned: Song Y, Zhang B, Xin D, et al. First-line serplulimab or placebo plus chemotherapy in PD-L1-positive esophageal squamous cell carcinoma: a randomized, double-blind phase 3 trial. Nature Medicine; Published online 2 February 2023. DOI: https://doi.org/10.1038/s41591-022-02179-2 

Large genomic analysis identifies persistent tumour mutational burden associated with immunotherapy response

Findings from a recently completed genomic analysis published in Nature Medicine indicates that "a high persistent TMB [tumour mutational burden], a biologically relevant measure of tumour foreignness within the overall TMB, represents an 'uneditable' target set for adaptive immune responses and may function as an intrinsic driver of sustained immunologic tumour control that cannot be readily bypassed by neoantigen loss via chromosomal deletions during cancer evolution."  Following an extensive evaluation of mutations across 31 tumour types amongst 9,242 patients, along with 8 patient cohorts (total of 524 patients) diagnosed with non-small-cell lung cancer, melanoma, mesothelioma, and head and neck cancer patients, the study team discovered that "mutations in single-copy regions and those present in multiple copies per cell constitute a pTMB...linked with response to immune checkpoint blockade. 

To read more about this study, click here. 

Source mentioned: Niknafs N, Balan A, Cherry C, et al. Persistent mutation burden drives sustained anti-tumor immune responses. Nature Medicine; Published online 26 January 2023. DOI: https://doi.org/10.1038/s41591-022-02163-w

Prognostic role of ctDNA in patients with surgically resectable colorectal cancer

 Results from GALAXY, part of the CIRCULATE study from Japan, analyzing circulating tumour DNA (ctDNA) was recently published in Nature Medicine.  Investigators from GALAXY demonstrated that "postsurgical ctDNA status is a most significant prognostic biomarker than the currently used high-risk clinicopathological features in resectable colorectal cancer and can potentially be predictive of adjuvant chemotherapy benefit."  The study authors thus believe that incorporating postsurgical ctDNA into TNM staging criteria can be further developed as a result of findings from GALAXY. 

To read more about this study, click here. 

Source mentioned: Kotani D, Oki E, Nakamura Y, Yukami H, Mishima S, Bando H, Shirasu H, Yamazaki K, Watanabe J, Kotaka M, Hirata K, Akazawa N, Kataoka K, Sharma S, Aushev VN, Aleshin A, Misumi T, Taniguchi H, Takemasa I, Kato T, Mori M, Yoshino T. Molecular residual disease and efficacy of adjuvant chemotherapy in patients with colorectal cancer. Nat Med. 2023 Jan;29(1):127-134. doi: 10.1038/s41591-022-02115-4. Epub 2023 Jan 16. PMID: 36646802; PMCID: PMC9873552.

Suicide risk higher among individuals with cancer

 A new study conducted by researchers at the American Cancer Society (ACS) indicates that "the risk for suicide of individuals diagnosed with cancer...is 26% higher compared with the general population."  While the study explains that additional characteristics, including geographic, racial/ethnic, and socioeconomic also play contributing roles to this statistic, Dr. Xuesong Han, senior study author explains that joint efforts by local and national governments are needed to ensure insurance coverage for psycho-oncological and psychosocial issues, as well as "development of appropriate clinical guidelines for suicide risk screening and inclusion of suicide prevention in survivorship care plans."  

To read more about this study, click here. 

Implementation of clinical trials regulation in the EU and EEA

 Effective January 31, 2023, the Clinical Trials Information System (CTIS) "will become the single-entry point for sponsors and regulators of clinical trials for the submission and assessment of clinical trial data which includes a public searchable database for healthcare professionals, patients, and the public."  Soft-launched nearly one year ago on January 31, 2022, CTIS was created to regulate how clinical trials are authorized and supervised across the European Union.  

To read more about CTIS, including access to training material and webinars, click here. 

Patient-reported symptom burden and supportive care needs of patients with stage II-III colorectal cancer during and after adjuvant systemic treatment

 A retrospective population-based cohort study conducted on newly diagnosed stage II-III colorectal cancer patients in Calgary, Alberta, Canada was recently published in JCO Oncology Practice.  The study, conducted on 303 patients over a period of 3 years (January 2016 - January 2019), indicated that while symptom severity was low and most systems either remained stable and/or or improved following adjuvant systemic treatment, "ongoing assessments and interventions to address physical and psychologic symptoms and supportive care needs in patients [with colorectal cancer] during and after treatment are needed." 

Study mentioned: Cuthbert CA, O'Sullivan DE, Boyne DJ, Brenner DR, Cheung WY. Patient-Reported Symptom Burden and Supportive Care Needs of Patients With Stage II-III Colorectal Cancer During and After Adjuvant Systemic Treatment: A Real-World Evidence Study. JCO Oncol Pract. 2023 Jan 6:OP2200462. doi: 10.1200/OP.22.00462. Epub ahead of print. PMID: 36608313.

Western region of U.S. has highest prostate cancer mortality among white men; black men face highest prostate cancer mortality overall

A recent study completed by researchers at the American Cancer Society indicates that the highest mortality rates for prostate cancer in white men occurred in the western part of the United States, particularly in California, while "black men...had an estimated 70%-110% higher incidence and mortality rate for prostate cancer than white men overall..."  The study also indicated socioeconomic disparities in four genitourinary cancers (bladder, kidney, prostate, testicular), among both men and women in the United States.   In addition to the aforementioned prostate cancer findings, the study also uncovered highest incidence of bladder cancer among white individuals in the U.S. Northeast, while kidney cancer incidence was most prevalent in the Appalachia and southern regions.  Among ethnic and racial groups, rates of bladder cancer were highest among American Indian and Alaska Natives, while mortality rates were highest in Hispanic men afflicted with testicular cancer. 

To read more about this study, click here. 

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!