Counting tumour cells in blood predicts treatment benefit in prostate cancer

Counting the number of tumour cells circulating in the bloodstream of patients with castration-resistant prostate cancer can accurately predict how well they are responding to treatment. Researchers showed that changes in the number of circulating tumour cells predicted the outcome after chemotherapy in this hard to treat cancer.

“The results add to a growing body of evidence showing that counting these cells is a valuable method for predicting survival and for monitoring treatment benefit in these patients”, said Dr. David Olmos from The Royal Marsden NHS Foundation Trust in the UK.

“Our study shows that circulating tumour cell counts could provide information about how patients are responding to therapy earlier than other markers such as prostate-specific antigen (PSA) or time-to-disease progression,” he said. “We have observed that patients with declining numbers of circulating tumour cells can see a change in their initial prognosis, reflecting a potential benefit from therapy.”

Among the 119 patients in the study, researchers found that those with the lowest circulating cell counts had on average the longest survival.

“Because these circulating cells have broken away from either primary tumours or metastatic sites in other parts of the body, they could potentially be used to help study the specific characteristics of the cancer and perhaps personalize therapy”, Dr. Olmos said.

Treatment delays result in poor outcomes for men with breast cancer

Men who develop breast cancer are often not treated until the disease has spread to the point that treatment becomes difficult, new results show.

Although most breast cancer patients are women, men make up roughly 1% of cases, Dr. Marina Garassino from the Orion Collaborative Group and her group conducted a retrospective analysis of 146 men with invasive breast cancer who were diagnosed between 1990 and 2007 across the 12 institutions in the ORION collaborative group.

What they found was that the disease had often already reached an advanced stage when the men were diagnosed. In 50% of cases the cancer had already reached the lymph nodes.

All the men underwent surgery to remove their cancer. After surgery, 48 received radiotherapy and 100 received adjuvant chemotherapy or hormone therapy. After a median follow-up of 5.2 years, the estimated 10-year disease-free survival rates were 80% for men with the earliest stages of disease, and 44% for those with the largest tumours.

When the researchers looked at the characteristics of the tumours, they found that 73% were positive for estrogen receptors and/or progesteron receptors. Among a sub-group of 41 patients, 48.7% had tumours that overexpressed the protein HER-2/neu, which is an indication of an aggressive tumour.

“Male breast cancer is a rare disease and not well known,” Dr. Garassino said. “It is treated the same way as female breast cancer, although our large retrospective series suggests that it has somewhat different histological characteristics.”

New treatment approach promising for lymphoma patients in the developing world

Preliminary results suggest that patients with aggressive non-Hodgkin’s lymphoma in the developing world might benefit from a modified chemotherapy regimen, researchers say.

A group headed by Prof. Hamdy Azim from Cairo University reports that giving these patients chemotherapy every 2 weeks, rather than every 3 weeks as usual, improved treatment outcomes.

The standard regimen in this case is called CHOP (chemotherapy regime), which is given every 3 weeks. In the developed world, CHOP is administered in combination with an antibody therapy called rituximab.

But many patients in developing countries, including Egypt where this study was conducted, cannot afford this treatment, so they are offered CHOP alone.

“We hypothesized that if CHOP or a CHOP-like regimen was given every two weeks instead of three, a superior outcome could be achieved,” says Dr. Hatem A. Azim Jr, who presented these results.

To see if this was the case, they analyzed five trials that compared CHOP to regimens given every two weeks. Using two statistical analyses, they showed that regimens every two weeks had superior response rate, disease-free and overall survival; however in one method, the response rate analysis did not reach statistical significance.

“We believe that this work could provide good evidence to support the use of the 2-weekly regimen,” Dr. Azim Jr said. One issue that remains to be assessed is how well patients tolerate the more intense treatment, he noted.

“Patients on the 2-weekly regimens have to receive injections with 'growth factors' to ensure that severe toxicities to the white blood cells do not occur,” he said. “Even so, the cost of these injections per cycle is much lower than that of rituximab. The preliminary results are encouraging in providing patients who cannot afford the cost of rituximab, a better alternative than CHOP.”