Archive for February, 2009

By Ed Susman

ORLANDO, FL – Researchers suggested that routine chest x-rays might be omitted as part of surveillance of patients who have undergone treatment for testicular cancer.

“The yield of chest x-rays as the sole method to detect relapse in surveillance patients was zero,” said Shaun Tolan, MBBCh, clinical research fellow in radiation oncology at the Princess Margaret Hospital, Toronto, Canada, in his presentation at the Genitourinary Cancers Symposium here.

Dr. Tolan and his colleagues reviewed the medical records of 527 patients who had undergone treatment for testicular cancer between 1982 and 2005. These patients underwent chest x-rays every eight months in the first three years of surveillance; then had a chest x-ray every year after that. Abdominal and pelvis computer-assisted tomography scans were performed twice as often as the chest x-rays.

Of the patient population, 75 individuals experience a relapse – with 73 of them having an abnormal abdominal/pelvic scan; one patient had both an abnormal chest x-ray and an abnormal abdominal/pelvic CT scan; one person had a normal chest x-ray and a proven inguinal node metastasis.

“No patient had a normal computer-assisted tomography abdominal/pelvic scan or physical examination with an abnormal chest x-ray at relapse,” Dr. Tolan said. “Chest x-rays can be safely omitted from seminoma surveillance protocols.”

“Most people would not change practice just based on an abstract presented at a meeting,” said Howard M. Sandler, MD, chair of the department of radiation oncology at Cedars-Sinai Medical Center, Los Angeles, CA.

He said that the National Comprehensive Cancer Network guidelines for surveillance of testicular cancer
patients calls for regular chest x-rays. “The Princess Margaret group is very influential in testicular cancer surveillance,” Dr. Sandler said. “Once this study is published, I think that guidelines for this treatment might be changed. I think most doctors believe that taking these chest x-rays is the right thing to do for their patients.”

The symposium is co-sponsored by the American Society for Clinical Oncology; the American Society for Radiation Oncology and the Society of Urologic Oncology.

2-28-2009

DALLAS, Tx – UT Southwestern Medical Center’s primary adult teaching hospital has cut its rate of preterm births by more than half in the past 15 years, even as national rates are rising, researchers have found.

The drop at Parkland Memorial Hospital, from 10.4 percent in 1988 to 4.9 percent in 2006, was associated with a program of strictly coordinated and easy-to-access care – including prenatal care – for the largely minority, indigent population served by the county hospital, the UT Southwestern researchers said.

“This is a model for the uninsured in the country,” said Dr. Kenneth Leveno, professor of obstetrics and gynecology at UT Southwestern and lead author of the study, which appears in the March issue of Obstetrics & Gynecology. “I think we all should be proud of this system.”

The researchers began their analysis in response to a 2006 report on preterm births by the Institute of Medicine. The institute stated that the national rate of prematurity was 9.4 percent in 1981 and 12.5
percent in 2004, representing a 33 percent increase.

“Infant mortality is one way in which societies measure how they take care of their people, and two-thirds of infant mortality is due to premature birth,” said Dr. Leveno. “It’s a measure of the social fabric.”

Parkland has one of the country’s largest and busiest obstetrics services, with about 16,000 births a year. One in every 250 births in the U.S. takes place at Parkland. Attending physicians are faculty members of UT Southwestern’s Department of Obstetrics and Gynecology.

The researchers studied data from 260,167 women who had given birth tosingleton babies at Parkland from 1988 to 2006.

Preterm birth was defined as birth before the 37th week of pregnancy, with babies weighing 1.1 pounds or more.

The decrease at Parkland was especially notable, as minority women are more likely to have premature babies because of their higher rate of poverty, the researchers noted. In 1988, Parkland began a program
designed to provide minority women better care during pregnancy and birth and just after birth. When the program started, 88 percent of Parkland patients received prenatal care. By 2006, that number had increased to 98 percent.

One feature that allows smooth care in the Parkland system is a strict protocol that lays out how to respond to specific situations. For instance, if a woman goes to a satellite clinic for prenatal care and is
found to have a condition that makes the pregnancy risky, she is automatically referred to the main hospital, Dr. Leveno said.

In addition, Parkland has a large staff of nurse-midwives and nurse practitioners who handle routine births, freeing the doctors to work on high-risk cases. And because the hospital is the only public hospital in
Dallas County, many indigent patients receive all their medical care through the system, so they have a single medical record that is easily tracked.

“It’s a complex interaction of a lot of pieces,” Dr. Leveno said.

-MFP Wire Services

2–27-2009

By Ed Susman

ORLANDO,FL – Doctors said they are encoiyuraged by early results with an experiemntal gtreatment for men who have advanced prostate cancer that has been uncontrolled by hormal therapies.

In a multi-center Phase II study, treatment with abiraterone resulted in objective shrinkage of tumors in about one fourth of the men; while tumor prograssion halted in another 31% of the pateints in the study.

“Abiraterone acetate was well-tokerated and and demosntrates considerable activity in the prechometherapy setting as a secondary hormonal therapy,” said Charles J. Ryan, MD, associate professor of medicine at the University of California, San Francisco.

The researchers measured prostate specific antigen (PSA) levels in the patients as well since PSA levels can indicate the response of the tumor to the drug. Decreasing PSA levels can indicate effectiveness in controlling the tumor. After 12 weeks of treatment, abiraterone reduced PSA levels by 50% or more in 71% the men. In two men, PSA fell to undetectable levels.

Dr. Ryan presented the results here at the 2009 Genitourinary Cancers Symposium, sponsored by by the American Society of Clinical Oncology, the Americn Society for Radioation Oncology and the Society of Urologic Oncology.

In the study, Dr. Ryan and colleagues recruited 33 pateitns who were treated with a once daily dose of abiraterone 1000 mg plus prednisone 5 mg twice a day. Abiraterone blocks the synthesis of androgens – hormones that feed the growth of tumors. Current treatments — surgical removal of the testes or medication — prevent the production of male hormones in the testes. But these approaches do not prevent other parts of the body from making male hormones. Abiraterone targets an enzyme called CYP17 that is necessary to the production of male hormones throughout the body.

“This is currently the most promising prostate cancer drug on the horizon,” said Howard Sandler, MD, chairman of radiation oncology at the Samuel Oschin Cancer Institute at Cedars-Sinai Medical Center in Los Angeles. He said these preliminary studies appear to show that the drug is active in men thought to be unresponsive to hormone therapy.

The men in the study were about 71 years of age and had previously been treated with hormonal therapies. None had been treated with chemotherapy. Dr. Ryan said the drug was generally well tolerated, with no patient stopping treatment due to side effects.

The new study was funded by Cougar Biosciences, which makes abiraterone.

Researchers are now enrolling men for a Phase III tiral.

2-27-2009