Cancer最新文献

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dose-limiting chemotoxicity caused by oxaliplatin. This study investigated the relationship between dietary quality and the development of moderate and/or severe CIPN in colon cancer survivors using data from the Focus on Reducing Dose-Limiting Toxicities in Colon Cancer with Resistance Exercise trial (ClinicalTrials.gov identifier NCT03291951).

Methods: Diet quality was collected using a 127-item food-frequency questionnaire and was scored using the Alternative Healthy Eating Index-2010 (AHEI-2010). CIPN was assessed with the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events at each chemotherapy cycle. The association of dietary quality with time to the first moderate-to-severe (moderate-severe) or severe event of CIPN was estimated using Cox proportional hazards models. Only participants who received oxaliplatin were included in this analysis (n = 132).

Results: Seventy-four participants (56.1%) reported moderate-severe CIPN. Higher dietary quality was associated with a significantly decreased risk of moderate-severe CIPN (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.93-0.99) and severe CIPN (HR, 0.91; 95% CI, 0.85-0.98). Consumption of red and processed meat (HR, 1.78; 95% CI, 1.07-2.83) and sugar-sweetened beverages (HR, 1.33; 95% CI, 1.10-1.59) was associated with an increased risk of moderate-severe CIPN. Consumption of sugar-sweetened beverages also was associated with an increased risk of severe CIPN (HR, 1.57; 95% CI, 1.14-2.18), whereas vegetable consumption was associated with a reduced risk of severe CIPN (HR, 0.29; 95% CI, 0.09-0.73).

Conclusions: Among patients with colon cancer who received oxaliplatin-based chemotherapy, higher baseline dietary quality was associated with a reduced risk of moderate-severe CIPN.

Background: The visceral adiposity index (VAI) is a marker of visceral fat accumulation and metabolic dysfunction, but there is limited evidence of its association with cancer. The objective of this study was to investigate associations between the VAI and both incident cancer at 23 sites and all-cause cancer.

Methods: In total, 385,477 participants (53.3% women; mean age, 56.3 years) from the UK Biobank prospective cohort were included in this study. The median follow-up was 8.2 years (interquartile range, 7.3-8.9 years). The VAI was calculated using formula the published by Amato et al. and was categorized into sex-specific tertiles. Twenty-four incident cancers were the outcomes. Cox proportional hazard models were adjusted for sociodemographics, lifestyle factors, and multimorbidity counts.

Results: Over the follow-up period, 47,882 individuals developed cancer. In the fully adjusted models, the VAI was associated with a higher risk of six cancer sites. Individuals in the highest tertile, compared with those in the lowest tertile, had higher risks of uterine (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.76-2.49), gallbladder (HR, 1.83; 95% CI, 1.26-2.66), kidney (HR, 1.39; 95% CI, 1.18-1.64), liver (HR, 1.25; 95% CI, 1.00-1.56), colorectal (HR, 1.14; 95% CI, 1.05-1.24), and breast (HR, 1.11; 95% CI, 1.03-1.19) cancers and of all-cause cancer (HR, 1.05). There was no evidence of a nonlinear association between the VAI and cancer risk.

Conclusions: The VAI was associated with six cancer sites and with all-cause cancer. The prognostic and etiologic roles of visceral fat accumulation and dysfunction in cancer warrant further research.

Background: Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigated the associations of health insurance coverage disruptions, also known as coverage churn, and receipt of breast and colorectal cancer screening.

Methods: Adults who were age-eligible and younger than 65 years (range, 50-64 years) for breast (n = 17,128 women) and colorectal (n = 32,562 individuals) cancer screening were identified from 5 years of the National Health Interview Survey. Adults were categorized into five groups based on insurance type at survey (private, public, none) and prior coverage disruptions within the past year. Screening outcomes included: (1) ever-screened, (2) past-year screening, and (3) guideline-concordant screening. Separate multivariate logistic regression models were used to evaluate the associations between insurance coverage disruptions and cancer screening.

Results: Among adults who had coverage at the time of the survey, 3.1% with private insurance and 6.5% with public insurance reported prior coverage disruptions. Individuals without health insurance coverage had the lowest level of screening. Among individuals who had private coverage, prior disruptions were associated with lower guideline-concordant screening in adjusted analyses (breast cancer screening: adjusted prevalence ratio [aPR], 0.82; 95% confidence interval [CI], 0.75-0.89; colorectal cancer screening: aPR, 0.78; 95% CI, 0.72-0.86); among those who had public coverage, prior disruptions were also associated with lower guideline-concordant breast cancer screening (aPR, 0.73; 95% CI, 0.60-0.89) and colorectal cancer screening (aPR, 0.84; 95% CI, 0.72-0.99).

Conclusions: Health insurance coverage disruptions were associated with lower past-year and guideline-concordant breast and colorectal cancer screening. The current findings underscore the importance of stable health insurance coverage to improve cancer screening and early detection when treatment is most effective.

Background: Following breast cancer (BC), many young women are interested in future childbearing and some may wish to breastfeed. However, limited information is available regarding their lactation experiences.

Methods: Participants in the Young Women's Breast Cancer Study, a multicenter, prospective cohort study of women ≤40 years diagnosed with stage 0-III BC between 2006-2016 and who reported one or more live births following diagnosis, were surveyed about pregnancy and breastfeeding after BC treatment, including reasons for attempting and stopping breastfeeding, satisfaction, and supports.

Results: Of 143 eligible women sent a survey, 115 responded and 94 were included in the analytic cohort. Breastfeeding was attempted by 55% of women (52 of 94). Among those who had not attempted, 93% noted prior bilateral mastectomies (39 of 42). Among those who attempted breastfeeding, 69% had undergone lumpectomy and radiotherapy (36 of 52), 83% of whom reported no milk production from their treated breast (30 of 36). Most (65%, 34 of 52) were at least somewhat satisfied with their ability to breastfeed. Reasons for stopping breastfeeding included: having completed the planned duration (36%, 19 of 52); to start/resume endocrine therapy (21%, 11 of 52); and to resume breast imaging (8%, 4 of 52). Approximately half (27 of 55) of women who had not undergone bilateral mastectomies recalled receiving specific information about breastfeeding after BC, mostly from the oncology team (59%, 16 of 27), online resources (48%, 13 of 27), or a lactation consultant (44%, 12 of 27).

Conclusion: Most young BC survivors who attempted to breastfeed were able to and were satisfied with the experience, despite challenges. Specific resources to support BC survivors who wish to breastfeed are needed.

Background: Cell cycle inhibition is an established therapeutic approach for some cancers. A multicenter, single-arm, phase 2 trial (ClinicalTrials.gov identifier NCT00937937) of the cyclin-dependent kinase inhibitor SCH 727965 (NSC 747135; dinaciclib) was conducted in patients with metastatic melanoma to determine its clinical activity.

Methods: Patients with metastatic melanoma of cutaneous or mucosal origin were eligible if they had zero to one previous treatments, a Zubrod performance status of 0-1, and adequate organ function. SCH 727965 50 mg/m² was given intravenously every 3 weeks until progression. Co-primary end points were 1-year overall survival (OS) and 6-month progression-free survival (PFS).

Results: Seventy-two patients were enrolled from July 1, 2009, to November 1, 2010, at 24 institutions. Sixty-eight percent of patients had M1c disease, and 43% had elevated lactate dehydrogenase levels. Twenty-eight patients (39%) experienced grade 4 adverse events, including 20 cases of neutropenia. Sixty-seven patients were evaluable for response. There was a response in zero of 67 patients (95% confidence interval [CI], 0%-5%), and stable disease was observed in 21%. The estimated median PFS was 1.4 months (95% CI, 1.4-1.5 months), and the 6-month PFS rate was 6% (2%-13%). The median OS was 8.2 months (95% CI, 5.5-10.5 months), and the 1-year OS rate was 38% (95% CI, 26%-49%).

Conclusions: This multicenter, US National Cancer Institute Cancer Therapy Evaluation Program-sponsored trial of SCH 727965 was conducted at a time when the current generation of effective therapies for melanoma were not available. Although the null hypothesis of 1-year OS was rejected, the minimal PFS impact and substantive toxicity indicated that this regimen lacks justification for further investigation as a single agent.

Purpose: Prior studies testing the association between insulin resistance (IR) and prostate cancer (PC) risk are inconsistent. We examined the association between Homeostatic Assessment of Insulin Resistance (HOMA-IR; calculated from fasting baseline insulin and glucose) and PC in REDUCE, a 4-year randomized trial of dutasteride vs. placebo for PC prevention.

Experimental design: All patients had prestudy negative biopsies and underwent study mandated biopsies at 2 and 4 years regardless of prostate-specific antigen. Multivariable logistic regression models were used to investigate the associations between log-transformed or categorized HOMA-IR scores and PC risk. Multinominal regression was used to assess associations between HOMA-IR scores and tumor grade (low grade [grade group 1]; high-grade [grade groups 2-5]).

Results: Among 5430 REDUCE participants (1212 with PC; 856 low- and 356 high-grade), higher HOMA-IR was associated with lower PC risk (log-HOMA-IR: OR, 0.89; 95% CI, 0.80-0.99; p = .03; categorized HOMA-IR: p-trend = .04). When stratified by grade, HOMA-IR was significantly associated with reduced low-grade PC risk (log-HOMA-IR: OR, 0.84; 95% CI , 0.74-0.94; p = .003; categorized HOMA-IR: p-trend = .002) but was unrelated to high-grade PC (log-HOMA-IR: OR, 1.02; 95% CI, 0.86-1.21; p = .81; categorized HOMA-IR: p-trend = .26). Results were similar in placebo and treatment arms.

Conclusions: In summary, higher HOMA-IR was associated with a reduced risk of low-grade PC but was not associated with high-grade disease. The mechanisms to explain these findings are unclear.

The addition of chemotherapy to radiation therapy for patients with localized recurrences of endometrial cancer does not improve survival outcomes and increases toxicity according to a prospective, randomized study published in the Journal of Clinical Oncology.¹

Although concurrent chemotherapy and radiation are widely used to treat other gynecologic cancers such as cervical cancer, the benefit of adding chemotherapy to radiation for patients with endometrial recurrences localized to the pelvis has not been evaluated.

This study was conducted to fill that gap. The study included 165 patients randomized 1:1 to receive radiation alone or a combination of cisplatin and radiation. Most patients had low-grade tumors with endometrioid histology (82%) with recurrences confined to the vagina with or without pelvic lymph node involvement (86%). All patients received initial external-beam radiation therapy to the whole pelvis (4500 cGy in 25 fractions), which was followed by a boost of either brachytherapy or external-beam therapy according to the extent of disease recurrence. Patients in the concurrent chemotherapy/radiation arm received cisplatin (40 mg/m²) once weekly for five cycles.

At a median follow-up of 62 months, no significant difference was seen in progression-free survival between the two treatment arms, as demonstrated by a hazard ratio of 1.25 (95% CI, 0.75–2.07). Patients treated with concurrent chemotherapy and radiation had a higher rate of grade 3 toxicity (57% vs. 31% with radiation alone).

At 3 years, 73% of patients treated with radiation alone were free from disease progression, whereas 62% of patients treated with concurrent chemotherapy and radiation were.

“Patients with localized recurrences of endometrial cancer can be treated with radiation alone, especially patients who have low-grade vaginal recurrences, which was the most common presentation for patients in the study,” says the lead author of the study, Ann Klopp, MD, PhD, professor of radiation oncology at The University of Texas MD Anderson Cancer Center.

She underscores that the high survival rate seen with radiation alone highlights the importance of detecting recurrences of endometrial cancer localized to the pelvis “and treating them curatively with radiation, including brachytherapy.”

Dr Klopp and her colleagues adopted principles of image-guided brachytherapy in cervical cancer to inform the use of brachytherapy in the study and noted that in the future, magnetic resonance imaging–guided adaptive brachytherapy, which has improved local control rates for recurrences in cervical cancer, also may improve them for recurrences in endometrial cancer.