This blog will be a reference guide to patients, families, and anyone interested in being informed on the practice changing updates in cancer. We will report on events and news happening in the world of cancer. The column will cater to preventive, genetics and treatment updates in cancer that have the largest impact.
Questions are invited from readers on anything related to cancer or queries about screening, prevention etc. We will answer your questions as precisely as possible given the constraints of print space.
CANCER NEWS & EVENT UPDATE
Obesity in cancer
There is clear evidence linking obesity with increased risk and poor outcomes in breast cancer. More than 80 cancer studies, including over 200,000 women with breast cancer, showed a decrease in survival by a staggering 41% in obese patients irrespective of the type of breast cancer. Obesity is associated with poorer survival rates in uterus, prostate, pancreatic, colon, ovarian, and some blood cancers.
Clinical trials like the ENERGY, LEAN and RENEW trials delivered a 2-year weight loss intervention to about 700 breast, prostate and colorectal cancer survivors after providing intensive intervention offered by dietitians, face-to-face counseling, pedometer, in-person counseling, and telephone counseling for 4-6 months. As a result, a 30% decrease in C-reactive protein (inflammatory marker in the blood) was seen. Women who lost at least 5% of their baseline weight saw decreases in metabolic and inflammatory markers. Just a 3% to 5% weight loss can reduce the risk of type 2 diabetes and cardiovascular disease as well.
In short, obesity is a major risk factor for cancer and increases its chance of recurrence. If nothing else, that alone should get us moving.
American society of clinical oncology provides a Toolkit (www.asco.org/practice-guidelines/cancer-care-initiatives/prevention-survivorship/obesity-cancer), providing practical help for both patients and providers to help with obesity prevention and treatment guidelines.
MELANOMA (SKIN CANCER) UPDATE
Most patients with Stage III melanoma (melanoma skin cancer involving lymph nodes) have a high risk of recurrence without additional treatment. Treatment after melanoma surgery has either been not helpful or poorly tolerated. Recent clinical trials have provided immense hope though. Those with stage III skin melanoma or stage IV disease, who have undergone complete resection of all sites of disease, and who have received immunotherapy with a drug called Nivolumab seem to have a 45% lower risk of recurrence compared to what had been available. It is now approved by the US Food and Drug Administration for this indication. Immunotherapy treatments stimulate a patient’s immune system to fight cancer with dramatically reduced side effects compared to chemotherapy.
About half of the patients with melanoma have mutations in a gene called BRAF that leads to constant activation of a pathway that fuels tumor growth. In the COMBI-AD clinical trial of 870 patients, the targeted oral therapies dabrafenib (Tafinlar®) and trametinib (Mekinist®), blocked the action of cancer proteins and patients had a 3-year recurrence-free rate of 58% for the combination therapy group and 39% for the placebo group. Talk to your oncologist about which option would suit you the best.
LUNG CANCER UPDATE
Despite administration of chemotherapy and radiotherapy, the prognosis for stage III non-small cell lung cancer (NSCLC) remains poor. In an important phase III trial, over 700 patients with stage III lung cancer without progression after completion of platinum-based chemoradiotherapy received an immunotherapy drug (PD-L1) antibody Durvalumab. Patients who received this drug lived an average of 16.8 months versus 5.6 months, with no additional increase in side effects compared to those who received nothing. Based on these data, the US Food and Drug Administration (FDA) approved Durvalumab for patients with unresectable stage III NSCLC whose disease has not progressed following chemoradiotherapy. This drug provides the largest improvement in survival for patients in decades. If you have received chemoradiation for lung cancer and are within 42 days of treatment discuss this option with your oncologist.
For individuals with iron deficiency who are treated with oral iron, doctors are now suggesting that Iron tablets or liquid formulations be taken every other day rather than every day.
Oral iron taken three times a day can cause significant gastrointestinal side effects. Iron will almost always cause constipation or nausea and can leave a metallic taste in the mouth leading to poor adherence to treatment. A small, trial published in Lancet Oncology has now demonstrated that giving oral iron every other day rather than every day resulted in greater iron absorption and fewer gastrointestinal side effects.
Alternate – day dosing is also supported by studies that showed taking iron multiple times a day blocks its own absorption and only allows 6-10% of the iron to actually be absorbed by the body. IV iron infusions can be used effectively to bypass these side effects if alternate day iron is not tolerated or doesn’t improve the anemia. So, if you are on iron pills and are taking it daily or multiple times a day and having a miserable time with it, discuss with your doctor to adjust down to 1 to 2 tabs once a day and to take on alternate days.
Reader Q&A SECTION
Q: My mother had breast cancer when she was 45. When should I be getting mammograms, do I need genetic testing to see if I will get breast cancer?
A: Let’s try to answer that with an infographic. (See figure)
Oncologists and genetic counselor will individualize your recommendations. For example, if a woman has a sister diagnosed with breast cancer at 30, her breast MRI screening should begin at age 25. If there are any immediate relatives with ovarian cancer, genetic and hereditary testing is mandatory. If testing shows that you have the BRCA gene (or other breast cancer risk genes like PALB, CHECK2 etc.) your risk of getting breast cancer is as high as 80% and ovarian cancer risk of up to 40% which may lead to the recommendation of preventive mastectomy or removal of ovaries. These should, however, be discussed with an oncologist or genetics counselor.