Research suggests that each 10 gram (slightly less than one drink) increase in daily alcohol consumption increases the risk of breast cancer by roughly 7%-10%.[1] [2] This is a fairly modest increase in risk, but breast cancer is a common cancer; even a small increase in risk may translate into many additional cases on a population level.

Several studies have suggested that the relationship between alcohol and breast cancer varies by the hormone receptor status of the breast cancer. Alcohol tends to be more strongly linked with hormone receptor-positive breast cancer than with hormone receptor-negative breast cancer.

Fewer studies have explored whether the relationship between alcohol and breast cancer varies by type of breast cancer (ductal or lobular). Ductal carcinomas account for roughly 70% of invasive breast cancers in the United States, and lobular carcinomas account for 15%-20% of invasive breast cancers.

To assess the relationship between alcohol and type of breast cancer, researchers evaluated information from the Women’s Health Initiative (WHI) Observational Study.[3] Among more than 87,000 postmenopausal women enrolled in the study, 2,944 developed breast cancer during follow-up.

Information about alcohol intake was collected by questionnaire at the time of study enrollment.

• As expected, alcohol intake was more strongly linked with hormone receptor-positive breast cancer than hormone receptor-negative breast cancer. Compared with never drinkers, women who consumed seven or more drinks per week had an almost two-fold increase in risk of hormone receptor-positive breast cancer, but no significant increase in risk of hormone receptor-negative breast cancer.
• When looking at type of breast cancer, alcohol increased the risk of lobular carcinoma but did not appear to significantly increase the risk of ductal carcinoma. The rate of hormone receptor-positive, lobular breast cancer was 5.2 per 10,000 women per year among never drinkers and 8.5 per 10,000 women per year among current drinkers. By comparison, the rate of hormone receptor-positive, ductal carcinoma was 15.2 per 10,000 per year among never drinkers, and 17.9 per 10,000 per year among current drinkers.

An important limitation of the study is that information about alcohol intake was collected only at the time of study enrollment. The analysis did not account for changes in alcohol intake that may have occurred after study enrollment.

The researchers conclude “Although one of the well-known risks of alcohol is an increased risk of breast cancer, this study suggests that alcohol primarily increases risk of lobular and hormone receptor-positive breast cancer.”

References:

[2] Key J, Hodgson S, Omar RZ et al. Meta-analysis of alcohol and breast cancer with consideration of the methodological issues. Cancer Causes & Control. 2006;17:759-70.

[3] Li C, Chlebowski RT, Freiberg M et al. Alcohol consumption and risk of postmenopausal breast cancer by subtype: the Women’s Health Initiative Observational Study. Journal of the National Cancer Institute. Early online publication August 23, 2010.

Colorectal cancer is the second leading cause of cancer death in the United States. The colon is the first 4 to 5 feet of the large intestine, and the rectum is the last several inches.[1]

Rectal cancer tends to be most common in older people, but can affect younger people as well. In order to assess trends in rectal cancer among people under the age of 40, researchers analyzed information from a large U.S. cancer database: the Surveillance, Epidemiology, and End Results (SEER) Program.[2]

Information was collected about 7,661 patients who had been diagnosed with colon, rectal, or rectosigmoid cancer between 1973 and 2005 and before the age of 40.

• Rates of rectal cancer increased 2.6% per year. In contrast, rates of colon cancer did not change significantly during this time period.
• In spite of the increase in rectal cancer, colon cancer remained the more common type of cancer. Incidence of colon cancer during the study period was 1.11 per 100,000 and incidence of rectal cancer was 0.42 per 100,000.
• The increase in rectal cancer appeared to start around 1984. The increase was observed among all races, and among both men and women.

The reasons for this increase remain uncertain. The researchers conclude, “In the current study, we demonstrated that young patients are developing rectal and rectosigmoid cancer an increasing rate. Although these rates are not high enough to warrant a change in current screening guidelines, we suggest strong consideration of the endoscopic evaluation of young patients presenting with rectal bleeding or other common signs or symptoms of rectal or rectosigmoid cancer.”

References:

[2] Meyer JE, Narang T, Schnoll-Sussman FH, Pochapin MB, Christos PJ, Sherr DL. Increasing incidence of rectal cancer in patients aged younger than 40 years. Cancer. Early online publication August 23, 2010.

Lung cancer remains the leading cause of cancer death in the United States. Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers.

Although patients with advanced lung cancer often experience a range of symptoms, palliative care is often not provided until late in the course of disease. Earlier provision of palliative care (which can be integrated with standard cancer treatment) could reduce symptoms and improve quality of life.

To explore the effects of early palliative care, researchers conducted a study among 151 patients with newly diagnosed, metastatic, NSCLC. Patients were assigned to receive either early palliative care integrated with standard cancer care, or standard cancer care alone.

Patients assigned to early palliative care met with a member of the palliative care team at least monthly. Palliative care visits included assessment of physical and psychosocial symptoms, discussion of goals of care, and assistance with treatment decisions.

Outcomes of interest included quality of life, mood, survival, and receipt of aggressive care at the end of life. Aggressive end-of-life care was defined as any of the following: chemotherapy within 14 days before death, no hospice care, or admission to hospice three days or less before death.

• Patients in the early palliative care group reported better quality of life and mood. Depressive symptoms were reported by 16% of patients in the early palliative care group compared with 38% of patients in the standard care group.
• Patients in the early palliative care were less likely to received aggressive end-of-life care. Aggressive end-of-life care was received by 33% of patients in the early palliative care group compared with 54% of patients in the standard care group.
• In spite of the less aggressive end-of-life care, patients in the early palliative care group tended to live longer. Median survival was 11.6 months among patients in the early palliative care group compared with 8.9 months among patients in standard care group.

The results indicate that for patients with advanced lung cancer, early palliative care improves quality of life and mood. Patients in the palliative care group received less aggressive care at the end of life but lived longer.

Reference: Temel JS, Greer JA, Muzikansky A et al. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine. 2010;363:733-742.

Cutaneous T-cell lymphoma (CTCL) is a rare type of non-Hodgkin’s lymphoma that begins in the skin. The most common type of CTCL is mycosis fungoides.

Istodax—a histone deacetylase (HDAC) inhibitor—works by slowing the growth of cancer cells. It was approved in 2009 for the treatment of CTCL in patients who had received at least one prior systemic therapy.

The current report provides final results from one of the studies that contributed to the approval of Istodax. The study enrolled 96 patients with Stage IB to IVA CTCL who had received at least one prior systemic therapy. All patients were treated with Istodax on days 1, 8, and 15 of each 28-day cycle.

• 34% of patients had a response to treatment (reduction or elimination of detectable lymphoma). Six patients had a complete response (no detectable lymphoma).
• Among patients with advanced disease, 38% had a response to treatment. Five patients had a complete response.
• The median time to response was two months, and the median duration of response was 15 months.
• 43% of patients experienced an reduction in itching.
• Side effects tended to be mild, and most commonly involved gastrointestinal disturbances and weakness or lack of energy.

These results provide additional evidence that Istodax is active against refractory CTCL, and generally well tolerated by patients.

Reference: Whittaker SJ, Demierre M-F, Kim EJ et al. Final results from a multicenter, international, pivotal study of romidepsin in refractory cutaneous T-cell lymphoma. Journal of Clinical Oncology. Early online publication August 9, 2010.

As women reach menopause and beyond, more than 80% will experience symptoms such as hot flashes, night sweats, sleep disturbance, and vaginal dryness. Estrogen, with or without progestin, is an effective treatment for many of these symptoms. Over the last several years, however, studies have raised important concerns about the health effects of menopausal hormone therapy.

Studies conducted as part of the Women’s Health Initiative (WHI) have evaluated a range of health outcomes among postmenopausal women treated with either estrogen alone or estrogen plus progestin. Use of estrogen plus progestin was linked with an increased risk of heart disease, breast cancer, stroke, and blood clots and a decreased risk of fractures and colorectal cancer. Use of estrogen alone, which is generally reserved for women who have had a hysterectomy, was linked with an increased risk of strokes and a decreased risk of fractures.

Researchers have also evaluated lung cancer risk in these studies. A previous report from the WHI indicated that combined estrogen plus progestin did not increase the likelihood of getting lung cancer, but did increase the risk of dying of lung cancer.[1]

The current report evaluated lung cancer risk among women treated with estrogen alone.[2] Information was available for 10,730 postmenopausal women between the ages of 50 and 79. All had had a hysterectomy. Women received either estrogen alone or a placebo.

Study participants have now been followed for an average of almost eight years.

The risk of getting or dying from lung cancer was similar among women treated with estrogen and women treated with a placebo.

These results suggest that unlike combined estrogen plus progestin, estrogen alone does not affect lung cancer incidence or mortality in postmenopausal women.

References:

[2] Chlebowski RT, Anderson GL, Manson JE et al. Lung cancer among postmenopausal women treated with estrogen alone in the Women’s Health Initiative Randomized Trial. Journal of the National Cancer Institute. Early online publication August 13, 2010.

Hodgkin’s lymphoma is a cancer of the lymph system and is diagnosed by the identification of a characteristic cell under the microscope (the Reed-Sternberg cell). Hodgkin’s lymphoma typically begins in the lymph nodes in one region of the body and then spreads through the lymph system in a predictable manner. It may spread outside the lymph system to other organs such as the lungs, liver, bone, and bone marrow.

Localized Hodgkin’s lymphoma can be treated with chemotherapy, radiation therapy, or the combination of these approaches. These treatments cure many patients, but the long-term side effects of treatment are an ongoing focus of research. The optimal therapy that cures the most patients with the least side effects is still being determined.

To evaluate treatment with fewer chemotherapy cycles and a reduced dose of radiation therapy, researchers conducted a study among 1370 patients with newly diagnosed Hodgkin’s lymphoma and a favorable prognosis. Patients were assigned to one of four treatment groups:

1. Four cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) followed by 30 Gy of radiation therapy
2. Four cycles of ABVD followed by 20 Gy of radiation therapy
3. Two cycles of ABVD followed by 30 Gy of radiation therapy
4. Two cycles of ABVD followed by 20 Gy of radiation therapy

Freedom from treatment failure and overall survival were similar across treatment groups. Patients who received the most chemotherapy and the highest dose of radiation experienced the highest rate of adverse treatment effects.

These results suggest that treatment with fewer cycles of chemotherapy and a reduced dose of radiation therapy may be as effective as, but less toxic than, more intensive treatment. The researchers caution, however, that the long-term effects of these treatments have not been fully assessed.

Reference: Engert A, Plutschow A, Eich HT et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. New England Journal of Medicine. 2010;363:640-52.

Men with early-stage prostate cancer have the option of being treated aggressively, which may include radiation therapy and surgery, or conservatively, which may involve no therapy until symptoms appear (watchful waiting or active surveillance). The choice of treatment can be difficult; for men with low-risk prostate, cancer there is no clear proof that early treatment prolongs survival compared with treatment that is deferred until there is evidence of disease progression.

Some patients who have other medical conditions (comorbidities) in addition to prostate cancer may not live long enough to benefit from prostate cancer treatment. Accurate assessment of comorbidities among patients with early-stage prostate cancer could help doctors and patients make treatment decisions.

The Total Illness Burden Index for Prostate Cancer (TIBI-CaP) is a questionnaire that assesses comorbidities among patients with prostate cancer. Among the advantages of TIBI-CaP is efficiency—the questionnaire takes only 15 minutes to complete. Higher TIBI-CaP scores indicate greater presence and severity of illnesses in addition to prostate cancer.

In a previous evaluation of TIBI-CaP, men with the highest scores (12 or higher) were 13 times more likely to die of causes other than prostate cancer within 3.5 years of completing the questionnaire compared with men with lower scores. To further evaluate the association between TIBI-CaP scores and death from other causes, researchers recently conducted a follow-up of study participants.

• At a median of six years after receiving treatment for early-stage prostate cancer, 15% of study participants had died. The majority of deaths were from causes other than prostate cancer; only 3% had died from prostate cancer.
• 41% of patients with the highest TIBI-CaP scores (12 or higher) died of causes other than prostate cancer compared with 6% of those with the lowest scores.

According to the researchers, higher TIBI-CaP scores were “significantly associated” with greater risk of death from causes other than prostate cancer, as men with the highest scores were 10 times more likely to die of other causes compared with men with the lowest scores. As to how these findings may affect treatment decisions, the researchers stated: “Because men with significant comorbidity have a high likelihood of short- to intermediate-term mortality, they may wish to strongly consider conservative over aggressive treatment for their clinically localized prostate cancer.”

Reference: Daskivich T, Sadetsky N, Sherrie H. Kaplan SH,et al. Severity of comorbidity and non–prostate cancer mortality in men with early-stage prostate cancer [Research Letter]. Archives of Internal Medicine. VOL 170 (NO. 15), AUG 9/23, 2010.

Head and neck cancers originate in the tissues in or around the mouth, nose, and throat. Risk factors for head and neck cancer include smoking, alcohol consumption, and infection with high-risk types of human papillomavirus (HPV). Patients with head and neck cancer that has spread to other parts of the body or that has returned after initial treatment have limited treatment options, and researchers continue to explore new and more effective approaches to treatment.

Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target,” targeted therapies may slow cancer cell growth or increase cancer cell death.

Vectibix inhibits cancer cell growth and survival by targeting a protein known as the epidermal growth factor receptor (EGFR). Vectibix has been approved for the treatment of EGFR-expressing, metastatic colorectal cancer that has progressed on or following fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy regimens. Vectibix appears to benefit only those patients whose cancers do not contain a mutation in a gene known as KRAS. KRAS mutations occur in an estimated 40-50% of metastatic colorectal cancers and can be identified by testing a sample of tumor tissue.

To explore the potential role of Vectibix in advanced head and neck cancers, researchers conducted a Phase III clinical trial among 658 patients with recurrent and/or metastatic squamous cell head and neck cancer. Patients received treatment with either chemotherapy alone or chemotherapy plus Vectibix. Chemotherapy consisted of cisplatin and 5-FU.

The primary outcome of interest was overall survival. Researchers also evaluated response rate and progression-free survival.

• Overall survival was 11.1 months among patients treated with chemotherapy plus Vectibix versus 9.0 months among patients treated with chemotherapy alone. This difference between groups did not meet the criteria for statistical significance, suggesting that it could have occurred by chance alone.
• Survival without cancer progression was 5.8 months among patients treated with chemotherapy plus Vectibix and 4.6 months among patients treated with chemotherapy alone.
• A response to treatment (a reduction in detectable cancer) occurred in 36% of patients treated with chemotherapy plus Vectibix and 25% of patients treated with chemotherapy alone.
• The most common side effects in the Vectibix group included nausea, rash, low white blood cell counts, and vomiting.

Detailed results from this study will be presented at the 35^th European Society for Medical Oncology (ESMO) conference in October.

Though these results are disappointing for patients with head and neck cancer, Vectibix remains an important treatment option for selected patients with metastatic colorectal cancer.

Reference: Amgen News Release. Amgen announces top-line results of phase 3 head and neck cancer trial. August 11, 2010.

Rectal cancer is a disease in which malignant cells arise from the cells of the rectum. The rectum is part of the digestive system and is the final 6 inches of the large intestine. Current treatments for rectal cancer include surgery, chemotherapy, and radiation. Some of the factors that influence the choice of treatment include the likelihood of cancer recurrence, the extent of the cancer, and the general health of the patient. Compared with surgery alone, chemotherapy and radiation given before surgery (neoadjuvant) has been shown to improve patient outcomes in patients with locally advanced rectal cancer.

In the current study, researchers reviewed data from 17 studies to determine whether pathological complete response following preoperative chemoradiation therapy predicted better long-term outcomes in patients with locally advanced rectal cancer. Of the 3,105 patients in the reviewed studies, 484 had a pathological complete response following chemoradiation therapy. Approximate five-year disease-free survival was 83.3% for patients with a pathological complete response compared with 65.6% for those who did not achieve a pathological complete response. Disease-free survival was also improved in pathological complete responders.

The researchers concluded that this pooled analysis of multiple datasets indicates that pathological complete response following chemoradiation therapy appears to be a predictor for better long-term outcome in patients with locally advanced rectal cancer.

Reference:

As women reach menopause and beyond, more than 80% will experience symptoms such as hot flashes, night sweats, sleep disturbance, and vaginal dryness. Estrogen, with or without progestin, is an effective treatment for many of these symptoms. Over the last several years, however, studies have raised important concerns about the health effects of menopausal hormone therapy.

Use of estrogen plus progestin has been linked with an increased risk of heart disease, breast cancer, stroke, and blood clots and a decreased risk of fractures and colorectal cancer. Use of estrogen alone, which is generally reserved for women who have had a hysterectomy, has been linked with an increased risk of strokes and a decreased risk of fractures.

Although it is now well established that menopausal hormone therapy with estrogen plus progestin increases the risk of breast cancer, researchers continue to explore the question of which subgroups of women are at greatest risk. This information would help personalize messages about the risks and benefits of hormone therapy.

The current study evaluated information from the California Teachers Study. Of the more than 56,000 perimenopausal or postmenopausal women in the study, 2,857 developed invasive breast cancer during 10 years of follow-up.

• Compared with women who had never used hormone therapy, women who had used estrogen alone for 15 years or longer had a 19% increased risk of breast cancer. Women who had used estrogen plus progestin for 15 years or longer had an 83% increased risk of breast cancer.
• For users of estrogen plus progestin, risk varied by the specific type of regimen used. Continuous regimens (progestin every day of the month) appeared to increase breast cancer risk to a greater extent than sequential regimens (progestin only some days of the month).
• The increased risk of breast cancer among users of hormone therapy was most apparent among thinner women.
• Use of hormone therapy increased the risk of cancers that were estrogen receptor-positive and progesterone receptor-positive.

These results provide additional evidence regarding the links between menopausal hormone therapy and risk of breast cancer. Women who are considering hormone therapy to manage menopausal symptoms are advised to talk with their doctor about the risks and benefits.

Reference: Saxena T, Lee E, Henderson K et al. Menopausal hormone therapy and subsequent risk of specific invasive breast cancer subtypes in the California Teachers Study. Cancer Epidemiology, Biomarkers, & Prevention [early online publication]. August 10, 2010.