New research from Rhode Island Hospital may help predict outcomes for stomach cancer patients

Study identifies possible markers for cancer prognosis

PROVIDENCE, R.I. – Researchers at Rhode Island Hospital have identified two potential molecular markers that may predict outcomes for patients with stomach cancer, one of the most common and fatal cancers worldwide.

According to the study, published in the July 1 issue of Clinical Cancer Research, patients who had poor outcomes following surgery for stomach cancer also had extremely low amounts of two proteins, known as gastrokine 1 and 2 (GKN1 and GKN2), which are produced by normal stomach cells.

The study's findings confirm previous research showing that once stomach cells become cancerous, they manufacture very low amounts of GKN1 and GKN2. However, this is the first known study to link these low protein levels with outcomes following stomach cancer surgery. Researchers say this discovery could eventually help physicians better determine and individualize therapy for stomach cancer, including which patients should be offered chemotherapy and other treatments in addition to surgery.

"Unfortunately, stomach cancer is difficult to cure unless it's discovered early, but because the early stage of the disease has very few symptoms, the cancer is usually advanced by the time it's diagnosed," says lead author Steven Moss, MD, a gastroenterologist with Rhode Island Hospital and an associate professor of medicine at The Warren Alpert Medical School of Brown University.

"That's what makes our findings so significant, because if the potential markers identified in our study can help predict a patient's prognosis, we can decide right away which course of action to take and hopefully help patients live longer and more comfortably," he adds.

According to the National Cancer Institute, approximately 760,000 cases of stomach cancer are diagnosed worldwide each year. Microscopically, stomach cancers can be subdivided into those which appear "diffuse" (a more aggressive form of cancer that can occur throughout the stomach and is more likely to spread) or "intestinal" (resembling the cells normally found only in the small or large intestines). Stomach cancers of both types are often triggered by a chronic infection brought on by Helicobacter pylori (H. pylori), a common bacterium that causes stomach inflammation and ulcers. Surgery is the most common treatment for stomach cancer and can include partial or full removal of the stomach. The five-year relative survival rate of patients with stomach cancer is 24 percent.

Moss, an expert on H.pylori, and colleagues initially set out to learn more about what the bacterium does to normal stomach cells. They focused on GKN1 and GKN2 because these proteins are also suppressed by stomach infections caused by H. pylori.

After looking at tissue samples from more than 150 stomach cancer patients who underwent surgery, the researchers discovered a near total suppression of GKN1 and GKN2 in the majority of patients. This was particularly evident in those patients with the diffuse variant of stomach cancer. More than three-quarters of these patients had extremely low levels of GKN1 and 85 percent had nearly nonexistent levels of GKN2.

Furthermore, in those patients with the intestinal variant of stomach cancer, very low levels of GKN 1 or GKN 2 at the time of surgery were associated with a significantly worse outcome. The median survival was about two years in these patients compared to a survival of more than 10 years for patients with normal levels of GKN1 or GKN2.

Researchers do not yet know the exact function of GKN1 and GKN2. They say further studies are needed to demonstrate the mechanisms responsible for the loss of GKN1 and GKN2 in this patient popoulation as well as the clinical biomarker potential of these two proteins.

The study included tissue samples from 155 patients with stomach cancer (81 men and 74 women) who underwent surgery at Rhode Island Hospital and The Miriam Hospital, both in Providence, R.I. The average age at surgery was 72 years. All four stages of cancer were represented in the study, including 37 patients with Stage I, 44 patients with Stage II, 34 patients with Stage III, and 40 patients with Stage IV. More than 61 patients were being treated for the intestinal variant of stomach cancer while 90 patients had the diffuse variant.

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The study was funded by research grants from the National Institutes of Health.

Study co-authors were Murray Resnick, Edmond Sabo, John Gao, Patricia A. Meitner, and Rose Tavares from Rhode Island Hospital and Alpert Medical School; John Rommel and Anna Rubin from Alpert Medical School; Jin-Woo Lee from Inha University Hospital, South Korea; and Bruce R. Westley and Felicity E.B. May from the Northern Institute for Cancer Research at University of Newscastle upon Tyne, United Kingdom.

Founded in 1863, Rhode Island Hospital (www.rhodeislandhospital.org) is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital ranks among the country's leading independent hospitals that receive funding from the National Institutes of Health, with research awards of nearly $27 million annually. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, orthopedics, neurology and minimally invasive surgery. The hospital's pediatrics division, Hasbro Children's Hospital, has pioneered numerous procedures and is at the forefront of fetal surgery, orthopedics and pediatric neurosurgery. Rhode Island Hospital is a founding member of the Lifespan health system.

In two complementary studies

Weizmann Institute scientists have developed a new method for reconstructing a cell’s 'family tree,' and have applied this technique to trace the history of the development of cancer. So far, the scientists have been able to calculate the age of the tumor and characterize its growth pattern. The scientists believe cell lineage studies of cancer can eventually lead us to the root of cancer.

Weizmann Institute Scientists’ New Technique Gets to the Root of Cancer

In two complementary studies, Weizmann Institute scientists have developed a new method for reconstructing a cell’s 'family tree,' and have applied this technique to trace the history of the development of cancer.

The quest to understand a cell’s path of descent, called a cell lineage tree, is shared by many branches of biology and medicine as gleaning such knowledge is key to answering many fundamental questions, such as whether neurons in our brain can regenerate, or whether new eggs are created in adult females.

So far, only tree lineages of tiny organisms, such as worms, which possess only a thousand cells, or 'branches,' have been determined. Now, Prof. Ehud Shapiro of the Institute’s Biological Chemistry, and Computer Science and Applied Mathematics Departments, together with Doctoral students Dan Frumkin and Adam Wasserstrom have developed a novel way to reconstruct, in principle, trees for larger organisms, including humans.

The human body is made of about 100 trillion cells, all of which are descendants of a single cell – the fertilized egg (zygote). Cells that have undergone a small number of cell divisions are relatively close descendants (akin to branches representing children and grandchildren etc., on a family tree), while some cells may have undergone hundreds or even thousands of divisions ('distant cell generations'). Knowing the number of cell divisions since the zygote, known as the depth of cells, would enable scientists to address questions about the behavior of the body under physiological and pathological conditions.

Until now, estimates of cell depth were based on theoretical calculations and assumptions, but Shapiro provides a practical way of determining cell depth precisely. The concept behind their new method is simple: Previous research indicated that each time a cell divides, harmless mutations are introduced, and that 'cell relatives' of distant generations tend to acquire more mutations, drifting away from the original DNA sequence of the zygote. Inspired by this, the team developed a non-invasive, accurate and systematic way, involving DNA amplification and computer simulations, to quantitatively estimate cell depth on the basis of the number of mutations in microsatellites (repetitive DNA sequences), and has applied it to several cell lineages in mice.

According to the team’s estimates, as reported in PLoS Computational Biology, the average depth of B cells – a type of immune cell – is related to mouse age, suggesting a rate of one cell division per day. In contrast, various types of adult stem cells underwent fewer divisions, supporting the notion that they are relatively quiescent.

Shapiro and Frumkin, in collaboration with Prof. Gideon Rechavi from the Sheba Medical Center and others then decided to apply this method to reconstruct, for the first time, the family tree of a cancer cell. 'Despite several decades of scientific research, basic properties of the growth and spread of tumor cells remain controversial. This is surprising, since cancer is primarily a disturbance of cell growth and survival, and an aberrant growth pattern is perhaps the only property that is shared by all cancers. However, because the initiation and much of the subsequent development of tumors occurs prior to diagnosis, studying the growth and spread of tumors seems to require retrospective techniques and these have not been forthcoming,' explains Shapiro.

Therefore, by reconstructing a cancer cell lineage tree and performing an analysis of mutations accumulated in the cells, scientists would be able to trace back and reveal several aspects of the tumor’s developmental history. Shapiro: 'We intend to apply this method to study key questions in human cancers, including when and where does a tumor initiate? The progression from pre-malignant to malignant states. At what stage does metastasis occur? Can the depth of tumor cells serve as a prognostic marker for cancer severity? And does chemotherapy target a subset of cells characterized by distinct lineage features (e.g. greater depth)?'

So far, their findings, featuring on the cover of the July 15th issue of Cancer Research, show that cancer cells (extracted from tissue sections of a mouse lymphoma by laser micro-dissection) had almost double the number of branched generations (i.e., had divided almost twice as many times) compared to adjacent normal lung cells in the same amount of time. They were also able to calculate the age of the tumor and characterize its growth pattern. Further analysis was sufficient to corroborate the long-standing hypothesis on the single-cell origin of cancer.

The scientists believe cell lineage studies of cancer can greatly enhance our understanding of, and eventually lead us to the root of cancer.

Prof. Ehud Shapiro's research is supported by the Clore Center for Biological Physics; the Arie and Ida Crown Memorial Charitable Fund; the Cymerman - Jakubskind Prize; the Fusfeld Research Fund; the Phyllis and Joseph Gurwin Fund for Scientific Advancement; the Henry Gutwirth Fund for Research; Ms. Sally Leafman Appelbaum, Scottsdale, AZ; the Carolito Stiftung, Switzerland; the Louis Chor Memorial Trust Fund; and the estate of Fannie Sherr, New York, NY.
Prof. Shapiro is the incumbent of the Harry Weinrebe Chair of Computer Science and Biology

The Weizmann Institute of Science in Rehovot, Israel, is one of the world's top-ranking multidisciplinary research institutions. Noted for its wide-ranging exploration of the natural and exact sciences, the Institute is home to 2,600 scientists, students, technicians and supporting staff. Institute research efforts include the search for new ways of fighting disease and hunger, examining leading questions in mathematics and computer science, probing the physics of matter and the universe, creating novel materials and developing new strategies for protecting the environment.

Weizmann Institute news releases are posted on the World Wide Web at http://wis-wander.weizmann.ac.il, and are also available at http://www.eurekalert.org.

Researchers discover link between organ transplantation and increased cancer risk

Researchers have determined a novel mechanism through which organ transplantation often leads to cancer, and their findings suggest that targeted therapies may reduce or prevent that risk.

In the July 15, 2008, issue of Cancer Research, researchers at Harvard Medical School found in animal and laboratory experiments that the anti-rejection, immunosuppressive drug cyclosporine ramps up expression of vascular endothelial growth factor (VEGF), which signals the growth of new blood vessels that can feed tumors.

They also found that simultaneously administering an anti-VEGF therapy with cyclosporine in mice repressed this tumor growth. Several inhibitors of VEGF are already in use in human cancer therapy.

The findings could offer some good news for the 15 to 20 percent of transplant patients who develop cancer within a decade of receiving new organs, according to the study's senior investigator, Soumitro Pal, Ph.D., an assistant professor at Harvard Medical School's Transplantation Research Center at Children's Hospital in Boston.

"It may be that anti-VEGF agents given judiciously after transplantation can reduce future cancer occurrence," he said.

VEGF expression is markedly increased in patients post-transplantation, and this can aid in the development of a blood supply to a transplanted organ, helping it survive and thrive. "But once the organ has stabilized, it may be possible to lower the level of VEGF expression to prevent tumor growth," he said. "We would need to figure out how to balance benefit and risk to keep cancer at bay."

Tumors that develop after transplantation may have three potential sources: they may have pre-existed or could have been a recurrence of previous cancer – and in both of these cases, a patient's pre-transplant immune system might have kept these cancers in check – or cancer-causing viruses could have come from the donor organ. Physicians have long observed that immunosuppressive agents, such as the class of calcineurin inhibitors that includes cyclosporine, appear to promote cancer development, often in organs that are not transplanted, but the cause of this was unclear. The Harvard team tested the ability of cyclosporine to promote growth of pre-existing tumors in mice implanted with human renal (kidney) cancer cells. Mice treated with the agent formed tumors faster than untreated mice, but anti-VEGF therapy substantially reduced that excessive growth.

Digging deeper into the biological pathway of VEGF activation, the scientists found that cyclosporine activates two of the three forms of the common protein catalyst, protein kinase C, which leads to increased expression of VEGF.

"We think PKC-mediated VEGF transcriptional activation is a key component in the progression of cyclosporine-induced post-transplantation cancer," Pal said. "It is likely not the whole story, but this gives us a clue that we might be able to use existing or novel therapies to reduce cancer risk in transplanted patients."

American Academy of Sleep Medicine Find Treatment at an AASM accredited sleep center improves long-term CPAP compliance

WESTCHESTER, Ill. – Obstructive sleep apnea (OSA) patients are more likely to comply with continuous positive airway pressure (CPAP) for longer periods of time if they receive their treatment from a sleep center accredited by the American Academy of Sleep Medicine (AASM), according to a research abstract that will be presented on Tuesday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
The study, authored by Siva Ramachandran, MD, focused on 55 consecutive patients in an AASM accredited sleep center with OSA whose CPAP compliance was less than four hours at their one-month follow-up visit. All subjects were evaluated and counseled by a board certified sleep specialist and a certified respiratory therapist and were educated about OSA. CPAP desensitization and mask fittings were conducted within the center, if indicated, and patients had access to specialized CPAP clinics. All patients were offered follow up with their downloadable compliance card and had open access to their sleep specialist by telephone, e-mail or by clinic visits. There was close collaboration with center staff and DME providers in specialized multidisciplinary CPAP clinics. Patients also had access to a 24 hour CPAP hot line into the center with close tracking of problems within 24 hours. In some patients referring physicians actively collaborated with center physicians to advance optimal use of CPAP.
According to the results, 34 patients (61 percent) were compliant and were followed up for six months. CPAP compliance improved in these patients and more patients availed of mask changes and desensitization in the compliant group. Older age was related to increasing compliance.
“This study was unique as it targeted patients with high risk for CPAP failure, in a community setting with resources identified within the center, and was developed in a longitudinal model of patient care,” said Dr. Ramachandran. “Access to specialized services with close follow-up in an AASM accredited center improves long term CPAP compliance in patients with high risk of CPAP failure. Patients in the older age group are particularly responsive to multimodal CPAP rescue services and are a model for development in sleep centers.”
OSA is a sleep-related breathing disorder that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. It is estimated that four percent of men and two percent of women have OSA, and millions more remain undiagnosed.
On average, most adults need seven to eight hours of nightly sleep to feel alert and well-rested.
The AASM offers the following tips on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
First introduced as a treatment option for sleep apnea in 1981, continuous positive airway pressure (CPAP) is the most common and effective treatment for OSA. CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.
CPAP Central (www.SleepEducation.com/CPAPCentral), a Web site created by the AASM, provides the public with comprehensive, accurate and reliable information about CPAP. CPAP Central includes expanded information about OSA and CPAP, including how OSA is diagnosed, the function of CPAP, the benefits of CPAP and an overview of what to expect when beginning CPAP, the position of experts on CPAP, and tools for success. CPAP Central also features an interactive slide set that educates the public about the warning signs of OSA.
Those who think they might have OSA, or another sleep disorder, are urged to consult with their primary care physician or a sleep specialist.
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The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

Teenage Cancer Trust TResearch : Managing symptoms by mobile phone may revolutionize cancer care for young people

London, UK: Researchers are harnessing the powers of digital communications technology to help young cancer patients at home manage the side-effects caused by chemotherapy.
They have given the teenagers and young adults specially adapted mobile phones on which the patients can record and send details of all their symptoms to the medical professionals managing their care. The phones are capable of giving basic advice about the most common symptoms, and if the symptoms are serious enough, the phone triggers an alert at the hospital so that specially trained cancer nurses can ring the patient and, if necessary, ask him or her to come into hospital.
Dr Faith Gibson told Teenage Cancer Trust's Fifth International Conference on Teenage and Young Adult Cancer Medicine today (Tuesday) that the Advanced Symptom Management System for Young People (ASyMS©-YG) seemed capable of transforming the way young people with cancer were cared for.
"Chemotherapy for cancer can cause many unpleasant, distressing and sometimes life-threatening side-effects, which can have a huge impact on a young person's life," said Dr Gibson, a senior lecturer in children's cancer nursing research at the Institute of Child Health (London, UK). "The Advanced Symptom Management System for Young People that we are developing could revolutionise their care, giving them support and confidence in being able to manage their symptoms, as well as giving medical teams valuable information on a day-to-day basis about the way the patient has reacted to their treatment. I think this is a really exciting development and it could make a real difference in clinical care."
The ASyMS©-YG [1] involves young people reporting their symptoms each day after having chemotherapy by completing a questionnaire on the mobile phone, which is similar to a PDA (personal digital assistant) or Blackberry. It has a touch screen and stylus. The questionnaire includes questions about how they are feeling, what their temperature is, what symptoms they have and it includes a body outline so that the patient can indicate where the pain is. The language used is teenage-friendly and the whole system has been developed with the help of young patients.
The symptom reports are sent to a central server and nurses at the hospital can view them on a web page. The patient can also view their symptoms on the phone in the form of graphs, which show how their symptoms have changed over time. Once they have reported symptoms, the young person automatically receives a text message giving them advice about what to do. In the latest phase of development, the patient can click on a button that immediately gives them advice about management of the most common symptoms such as constipation, diarrhoea, sickness etc. If the symptoms are severe or getting worse, a nurse is automatically paged to contact the patient at home to offer advice and support.
Dr Gibson said that during the first stages of development, young people were very positive about the system. "They could really see the benefits and really liked it. When we were recruiting for the phase three trial, the young people who were randomised not to receive the phone were disappointed that they would not be able to use it." So far, it has been tested in teenagers aged 13-18 with lymphoma, soft tissue sarcoma and bone tumours, but the researchers hope to extend it to different groups, such as patients with leukaemia.
Teenagers said that it was useful because it gave them a record of their symptoms to talk about when they attended clinic: "Sometimes you may forget what symptoms you had three weeks ago," said one. It also saved them from having to continuously repeat their symptoms to different people at different times, and it meant that the patients knew that the doctors and nurses knew exactly what they were going through.
Parents commented on the system's potential to provide support and reassurance for families and the usefulness of having a record of symptoms. "I think this is a fantastic idea, it would give teenagers more control over their symptoms and what to do about them," said a mother.
Medical professionals agreed with patients and parents and said they thought it would help to improve their knowledge and understanding about young people's symptoms and that it could aid communication between the health professionals and patients. "It would give us a better understanding of what is actually happening when they are at home," said one. Dr Gibson said: "Health professionals said that the system gave the young people some independence and control back into managing their own life."
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The system has been funded up to this stage by Teenage Cancer Trust, with additional support from CLIC Sargent, and has just received further funding from Teenage Cancer Trust so that work can continue into the fourth stage involving 150 young people at six centres in the UK: the Royal Marsden and University College Hospital in London, the Christie Hospital (Manchester), St James's Hospital (Leeds) and two more still to be confirmed. The study, with a new improved version of the system, is due to start in September and will run for 30 months. After that, Dr Gibson hopes that it will be rolled out across the country so that every young cancer patient can benefit from it.
Note:
[1] The intellectual property rights to ASyMS©-YG belong to the University of Stirling (UK).

Teenage Cancer Trust :Experts highlight gaps in knowledge on caring for survivors of teenage and young adult cancers

London, UK: Over 95% of patients with testicular cancer are cured nowadays, but this success has produced a new problem for cancer survivors, the medical profession and national governments, a cancer expert will tell Teenage Cancer Trust's Fifth International Conference on Teenage and Young Adult Cancer Medicine, which is meeting in London on Monday and Tuesday (June 9 and 10).
Dr Craig Nichols, director of program development and director of the germ cell tumor and lymphoma program at the Providence Cancer Center (Oregon, USA) will tell the conference: "Patients with testicular cancer, and, indeed, several other of the more treatable cancers, have great expectations of a cure, but this also imparts an additional responsibility of ensuring that the medical and social consequences of the disease and the cure have a minimum impact.
"We are returning an extra 50-60 years of life to teenagers and young adults who have been treated successfully for cancer. This shifts the emphasis from 'can we cure this disease?' to 'can we retain this near perfect cure rate as well as reducing the short and long term side effects of treatment, minimising the fertility consequences of therapy, reducing the long term risk of a second cancer and metabolic syndrome, and developing pre-emptive strategies for managing psychosocial consequences of cancer and cancer treatment at a young age?'.
"The medical profession and national governments need to develop strategies for meeting this challenge. They need to recognise that care cannot just stop when the patient is cured of the cancer, and that there is a huge cost still to be faced in terms of long-term care and support and in terms of collateral damage. Maximising the chances for good health for the next 50 years of life has very calculable social benefits, and people are beginning to realise this now. This is a fundamental shift."
Nearly three-quarters of children with cancer survive into adulthood, but a north American study has shown that, 30 years after diagnosis, 42% are affected by severe disease or a life-threatening condition, or have died. In the UK, there are approximately 30,000 survivors of cancer diagnosed before the age of 15, and given that cancer is more common between the ages of 15-24 than in childhood and assuming cure rates are similar to those for children, there are probably over 30,000 survivors of cancer diagnosed when they were aged between 15-24.
Dr Nichols will explain that cancer patients face a double whammy: "There are two aspects: the burden of the disease and the burden of treatment. Each makes a long-term contribution to the patient's quality of life."
Problems for cancer survivors include: the increased risk of a second cancer arising either from the first cancer or from its treatment, infertility caused by chemotherapy and radiotherapy, hypertension, kidney problems, the metabolic syndrome (a collection of disorders such as obesity, high cholesterol levels, high blood pressure and insulin resistance) and hormonal disorders. Survivors of testicular cancer may have life-long problems with low sperm counts, low testosterone levels and poor semen quality. Patients who have survived cancer as children, teenagers or young adults often have psychosocial problems as well.
"We are beginning to learn more about the psychosocial consequences such as body image, employment and sexual health," says Dr Nichols. "There's a higher incidence of lower performance in life generally among cancer survivors. They have undergone a big life disruption at a formative time in their lives. There needs to be recognition of this so that we can try to identify problems and risks early on and be pre-emptive in our use of psychosocial interventions and use of medications."
Traditionally, paediatricians have tended to drive initiatives on caring for cancer survivors because they recognised the problem some time ago. In the USA, the challenge is being met by the establishment of Adolescent and Young Adult Clinics and Specialised Survivorship Clinics under the auspices of the National Cancer Institute. In the UK, the government's recently published Cancer Reform Strategy announced the setting up of a new National Cancer Survivorship Initiative to consider a range of approaches to caring for cancer survivors.
Simon Davies, chief executive of Teenage Cancer Trust, says: "We know that this is a major issue that affects a lot of our patients and is increasingly going up the national agenda. I have just been invited to join the National Health Improvement Agency's working group on improving services to survivors of childhood cancers. I am also a member of the National Cancer Research Institute's Teenage and Young Adult Clinical Studies Development Group. One of their three strands of work is survivorship led by Professor Mike Hawkins."
Speaking before the conference started, Prof Mike Hawkins, director of the Centre for Childhood Cancer Survivor Studies at the University of Birmingham (UK) agrees that survivorship following cancer in childhood, teenage or young adult years is becoming an increasingly important area in the UK and it has been highlighted by the cancer czar, Professor Mike Richards. Prof Hawkins and his colleagues plan to follow-up approximately 25,000 survivors of cancer diagnosed between the ages of 15-24 between 1970-2000 in order to discover the specific problems this age group face.
He identifies three key areas where there need to be improvements:
the establishment of standardised guidelines for following up TYA cancer survivors;
extending the evidence base for guidelines on long-term follow-up;
providing every survivor with a "patient passport" on their discharge from hospital, which would contain a summary of all their treatments and the implications for any future medical treatments.
Some of these things are happening already, but in a fragmented way, with some guidelines in existence and some centres issuing patient passports. But Prof Hawkins believes it needs to happen in a much more organised and standardised way, and, at present, there is a big gap in knowledge about the 15-24-year-old age group.
"For teenagers and young adults we really need to extend the evidence base. There's still a huge area of ignorance in relation to the consequences of treatment in the late teenage and young adult years. We hope to address this through the NCRI group that I chair.
"In the interim, we have got to use what we know from survivors of childhood cancers. However, we are much more ahead of the game for children up to the age of 15 than we are for the generality of cancer survivors," he concludes.
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Note:
See the press release on Dan Savage for an account of what it is like to be a cancer survivor.

Teenage Cancer Trust : 'Cancer was one of the best things to happen to me... but I worry about the future'

London, UK: For Dan Savage, surviving testicular cancer has been a spur to him making the most of his life and taking more adventurous decisions, and he says, that in retrospect, it was probably one of the best things that has happened to him. But as he approaches the end of his fifth year in remission from the disease, when he will be signed off as "cured" by the medical profession, he worries that from now on he will have no regular medical checks that might pick up early signs of the cancer returning. It will be down to him to contact the cancer clinic if he is worried about any new symptoms.
Dan, aged 25, is now an award-winning artist. He has set up his own studio in York (UK) and specialises in creating glass artwork for architectural spaces. He is also an ambassador for Teenage Cancer Trust and will be speaking at the charity's Fifth International Conference on Teenage and Young Adult Cancer Medicine on Tuesday.
Dan was 20 and studying art at Lancaster University when he discovered a lump the size of half a pea in his right testicle. After having surgery at Lancaster he was transferred to St James's hospital in Leeds for chemotherapy.
"The chemotherapy was largely precautionary. The outward appearance of the tumour suggested it had been caught early, but when they dissected it, they found it was quite developed, just on the brink of spreading and they didn't want to take that risk. Also they found that I had the most aggressive form of testicular cancer, teratoma," says Dan.
Dan feels he got off fairly lightly, although the chemotherapy made him very sick and he lost his hair. Looking back now, he says: "Having cancer, for me, was one of the best things to happen. It gave me a real drive to succeed and make the most of my life. I know, from speaking to other cancer survivors, that many of them agree. I have gained more confidence. Starting up my own business isn't necessarily what I would have done prior to having cancer." Cancer didn't stop his studies: he went back to university, completed his degree and went on to do a Masters degree in Glass. He has also married his long-term girlfriend.
Dan has not suffered any particular problems following his treatment, although he finds he is more susceptible to common colds and other illnesses that are going around.
"I'm much more aware now of my own body and if anything is slightly out of kilter, I'm probably a lot more paranoid about it," he says. "On a day-to-day basis I'm fairly relaxed, but if I have an ache or pain I start to worry.
"One thing I am getting a bit worried about is that I'm coming up to five years in remission, and will be signed off by the doctors in June. Thereafter it's up to me. People say I'm cured but I don't see it like that. Something could crop up. It worries me that I won't have any more medical checks. I know that if I find anything that's odd I can go straight back to the clinic rather than the GP, which is good because the GP route was a bit of a nightmare. So that is reassuring. But I get reassurance from having regular checks, from having a blood test and even if I don't hear anything after the blood test has been taken, I still know someone has seen it and it's OK. I would prefer to keep the checks going for longer."
Before his chemotherapy the doctors talked to him about fertility and he had sperm samples frozen. The samples were good quality, but, as he was young, fit and healthy (apart from the cancer), he knows he has a good chance of his fertility returning to normal levels, although he hasn't re-visited the fertility clinic to check yet.
Dan says he has become very health conscious in terms of fitness levels and diet. "I drink a lot of green tea!"
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Note:
This press release is intended as a case study to accompany the press release on the problems cancer survivors face, quoting Dr Craig Nichols and Professor Mike Hawkins.

American Academy of Sleep Medicine : Poor sleep a problem in long-term breast cancer survivors

WESTCHESTER, Ill. – A research abstract that will be presented on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS), finds that poor sleep is a problem in long-term breast cancer survivors.
The study, authored by Julie L. Elam, of Indiana University, was based on 246 breast cancer survivors with an average age of 48 years. Seventy-six percent of the participants were Caucasian, 73 percent employed, 73 percent married or partnered, 70 percent postmenopausal, 58 percent with a college education, and 43 percent with at least one concurrent medical problem. The women were an average of 5.62 years post-treatment.
According to the results, 65 percent of breast cancer survivors scored at or above the cut-off for poor sleep. Breast cancer survivors in the minority, those with hot flashes, with high physical functioning, and high depressive symptoms were more likely to have poor scores on the Pittsburgh Sleep Quality Index, self-rated questionnaire that assesses sleep quality and disturbances over a one-month time interval.
“This study provided new information about predictors of poor sleep in long-term breast cancer survivors,” said Elam. “The purpose of the study was to examine a comprehensive list of physiological, psychological, and environmental factors that contribute to poor sleep for this population. The findings indicated that sleep disturbances were problematic in long-term survivors with physiological and psychological predictors of poor sleep.”
Sleep plays a vital role in promoting a woman’s health and well being. Getting the required amount of sleep is likely to enhance a woman’s overall quality of life. Yet, women face many potential barriers – such as life events, depression, illness, and medication use – that can disrupt and disturb her sleep. Overcoming these challenges can help her enjoy the daily benefits of feeling alert and well rested.
It is recommended that women get between seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips for women on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not bring your worries to bed with you.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.
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The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

American Cancer Society research find Family history and screening for colorectal cancer

A new study indicates that African Americans with a family history of colorectal cancer are less likely to be screened than African Americans at average risk for the disease. There is also some evidence to indicate that AA with a family history are less likely to be screened than their white counterparts. The study is published in the July 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
African Americans have the highest colorectal cancer (CRC) incidence and death rates of all racial groups in the United States. The reason for this is thought to be multifactorial but remains poorly understood. Overall, African Americans have low rates of colorectal cancer screening compared to most other racial groups. Early detection is especially important for those with family histories of CRC who are at higher risk of developing the disease. Factors associated with CRC screening are not well understood for African Americans, both those with and without family histories of CRC.
To investigate the factors associated with risk-appropriate CRC screening, Kathleen Griffith, Ph.D., CRNP, of the Johns Hopkins University School of Nursing and colleagues at the University of Maryland Baltimore analyzed data from the 2002 Maryland Cancer Survey, a telephone survey of more than 5,000 Maryland residents, performed under the Maryland Cigarette Restitution Fund Program, to identify predictors of screening among African Americans.
The researchers' analyses revealed that for African Americans, regardless of family history, a health care provider's recommendation for colorectal cancer screening was strongly correlated with a higher likelihood of screening. Furthermore, individuals who were more physically active were also more likely to have been screened for colorectal cancer. Surprisingly, though, having a family history of colorectal cancer did not predict a higher likelihood of screening. In fact, the researchers found that African Americans with a family history were less likely to have received risk-appropriate screening than those without a family history. Family history of colorectal cancer is often associated with increased rates of screening in whites.
The authors say it is difficult to explain why a perception of increased risk, which is significantly higher in African Americans with a family history of CRC than in those without, did not translate into screening. Their findings suggest that other unknown or unmeasured factors may play a role is screening decisions. Additional studies to determine what those factors might be could lead to culturally tailored interventions designed to increase screening rates, which in turn could ultimately improve early detection and reduce colorectal cancer deaths in African Americans. "This study suggests that African Americans would benefit from a primary care approach that evaluates their risk factors for colorectal cancer, and provides corresponding recommendations for appropriate screening tests," the authors write.
Regular colorectal cancer screening is one of the most powerful weapons in preventing colorectal cancer. It can, in many cases, prevent colorectal cancer altogether. Experts estimate adherence to national screening guidelines could prevent up to eight in ten deaths from the disease. The American Cancer Society recommends that people at average risk begin screening for colorectal cancer at age 50. Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, as well as the third leading cause of cancer-related death among both men and women in the United States.
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Article: "Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans." Kathleen A. Griffith, Deborah B. McGuire, Renee Royak-Schaler, Keith O. Plowden, and Eileen K. Steinberger. CANCER; Published Online: June 9, 2008 (DOI: 10.1002/cncr.23550); Print Issue Date: July 15, 2008.
Contact: Lynn Schultz-Writsel, Johns Hopkins University School of Nursing. 410-955-7552 or lwritsel@jhmi.edu.

American Cancer Society research find Family history and screening for colorectal cancer

A new study indicates that African Americans with a family history of colorectal cancer are less likely to be screened than African Americans at average risk for the disease. There is also some evidence to indicate that AA with a family history are less likely to be screened than their white counterparts. The study is published in the July 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
African Americans have the highest colorectal cancer (CRC) incidence and death rates of all racial groups in the United States. The reason for this is thought to be multifactorial but remains poorly understood. Overall, African Americans have low rates of colorectal cancer screening compared to most other racial groups. Early detection is especially important for those with family histories of CRC who are at higher risk of developing the disease. Factors associated with CRC screening are not well understood for African Americans, both those with and without family histories of CRC.
To investigate the factors associated with risk-appropriate CRC screening, Kathleen Griffith, Ph.D., CRNP, of the Johns Hopkins University School of Nursing and colleagues at the University of Maryland Baltimore analyzed data from the 2002 Maryland Cancer Survey, a telephone survey of more than 5,000 Maryland residents, performed under the Maryland Cigarette Restitution Fund Program, to identify predictors of screening among African Americans.
The researchers' analyses revealed that for African Americans, regardless of family history, a health care provider's recommendation for colorectal cancer screening was strongly correlated with a higher likelihood of screening. Furthermore, individuals who were more physically active were also more likely to have been screened for colorectal cancer. Surprisingly, though, having a family history of colorectal cancer did not predict a higher likelihood of screening. In fact, the researchers found that African Americans with a family history were less likely to have received risk-appropriate screening than those without a family history. Family history of colorectal cancer is often associated with increased rates of screening in whites.
The authors say it is difficult to explain why a perception of increased risk, which is significantly higher in African Americans with a family history of CRC than in those without, did not translate into screening. Their findings suggest that other unknown or unmeasured factors may play a role is screening decisions. Additional studies to determine what those factors might be could lead to culturally tailored interventions designed to increase screening rates, which in turn could ultimately improve early detection and reduce colorectal cancer deaths in African Americans. "This study suggests that African Americans would benefit from a primary care approach that evaluates their risk factors for colorectal cancer, and provides corresponding recommendations for appropriate screening tests," the authors write.
Regular colorectal cancer screening is one of the most powerful weapons in preventing colorectal cancer. It can, in many cases, prevent colorectal cancer altogether. Experts estimate adherence to national screening guidelines could prevent up to eight in ten deaths from the disease. The American Cancer Society recommends that people at average risk begin screening for colorectal cancer at age 50. Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, as well as the third leading cause of cancer-related death among both men and women in the United States.
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Article: "Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans." Kathleen A. Griffith, Deborah B. McGuire, Renee Royak-Schaler, Keith O. Plowden, and Eileen K. Steinberger. CANCER; Published Online: June 9, 2008 (DOI: 10.1002/cncr.23550); Print Issue Date: July 15, 2008.
Contact: Lynn Schultz-Writsel, Johns Hopkins University School of Nursing. 410-955-7552 or lwritsel@jhmi.edu.

American Academy of Sleep Medicine : Women worrying about cancer are more likely to experience sleep disturbances

WESTCHESTER, Ill. – A significant number of women worrying about cancer may be experiencing sleep disturbances, even without a breast cancer diagnosis, according to a research abstract that will be presented by Amita Dharawat, MD, on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
This collaborative study, from the Brooklyn Health Disparities Center at SUNY Downstate Medical Center and Long Island University in Brooklyn, New York, focused on 1,038 community-based residents, between 50 and 70 years of age; none of whom had a history of a physician-diagnosed cancer. Sleep complaint was defined as a report of either difficulty initiating sleep, maintaining sleep, or early morning awakening.
According to the results, 65 percent of the women reported that they worried about developing breast cancer, and 49 percent reported a sleep complaint. Twenty-seven percent indicated that cancer worry affected their mood, while 25 percent indicated that it affected their daily activity. The odds of reporting sleep complaints for women who worry about cancer were nearly 50 percent greater than odds for women who reported no cancer worry, independent of several confounders.
“This is a unique and important finding because sleep-related complaints have never been studied in women who worry about cancer, without a diagnosis, and it provides practitioners with knowledge with regards to identifying and targeting women who report sleep-related complaints with cognitive behavioral therapy,” said Dr. Dharawat, who is a second year medical resident, working with Dr. Girardin Jean-Louis on an NIH funded ‘Women’s Health Project’.
Cognitive behavioral therapy (CBT) helps eliminate negative images and thoughts that compromise one’s ability to sleep well. It helps develop habits that promote a healthy pattern of sleep. CBT is most often used for people who suffer from insomnia.
Sleep plays a vital role in promoting women’s health and well being. Getting the required amount of sleep is likely to enhance women’s overall quality of life. Yet, they face many potential barriers – such as life events, depression, illness, and medication use – that often disrupt their sleep patterns. Overcoming these challenges can help women enjoy the daily benefits of feeling alert and well rested.
It is recommended that women get between seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips for women on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not bring your worries to bed with you.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.
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More information about “women and sleep” is available from the AASM at http://www.SleepEducation.com/Topic.aspx?id=67.
The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

University of California : Moores UCSD Cancer Center study links vitamin D, type 1 diabetes

Global view supports concept of using vitamin D in reducing disease risks
Sun exposure and vitamin D levels may play a strong role in risk of type 1 diabetes in children, according to new findings by researchers at the Moores Cancer Center at University of California, San Diego (UCSD) and the Department of Family and Preventive Medicine. This association comes on the heels of similar research findings by this same group regarding vitamin D levels and several major cancers.
In this new study, the researchers found that populations living at or near the equator, where there is abundant sunshine (and ultraviolet B irradiance) have low incidence rates of type 1 diabetes. Conversely, populations at higher latitudes, where available sunlight is scarcer, have higher incidence rates. These findings add new support to the concept of a role of vitamin D in reducing risk of this disease.
Ultraviolet B (UVB) exposure triggers photosynthesis of vitamin D3 in the skin. This form of vitamin D also is available through diet and supplements.
"This is the first study, to our knowledge, to show that higher serum levels of vitamin D are associated with reduced incidence rates of type 1 diabetes worldwide," said Cedric F. Garland, Dr. P.H., professor of Family and Preventive Medicine in the UCSD School of Medicine, and member of the Moores UCSD Cancer Center.
The study is published June 5 in the online version of the scientific journal Diabetologia.
Type 1 diabetes is the second most common chronic disease in children, second only to asthma. Every day, 1.5 million Americans deal with type 1 diabetes and its complications. About 15,000 new cases are diagnosed in the United States each year, where this disease is the main cause of blindness in young and middle-aged adults and is among the top reasons for kidney failure and transplants in youth and midlife.
"This research suggests that childhood type 1 diabetes may be preventable with a modest intake of vitamin D3 (1000 IU/day) for children, ideally with 5 to 10 minutes of sunlight around noontime, when good weather allows," said Garland. "Infants less than a year old should not be given more than 400 IU per day without consulting a doctor. Hats and dark glasses are a good idea to wear when in the sun at any age, and can be used if the child will tolerate them."
The association of UVB irradiance to incidence of type 1 diabetes remained strong even after the researchers accounted for per capita healthcare expenditure. This was an important consideration because regions located near the equator tend to have lower per capita healthcare expenditures, which could result in under-reporting of type 1 diabetes.
The researchers created a graph with a vertical axis for diabetes incidence rates, and a horizontal axis for latitude. The latitudes range from -60 for the southern hemisphere, to zero for the equator, to +70 for the northern hemisphere. They then plotted incidence rates for 51 regions according to latitude. The resulting chart was a parabolic curve that looks like a smile.
In the paper the researchers call for public health action to address widespread vitamin D inadequacy in U.S. children.
"This study presents strong epidemiological evidence to suggest that we may be able to prevent new cases of type 1 diabetes," said Garland. "By preventing this disease, we would prevent its many devastating consequences."
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This is the fifth environmental paper from this research team to show a strong association between vitamin D and various major diseases using global incidence data. The previous four were related to cancer incidence, the first of which illuminated a similar pattern for kidney cancer, published Sept. 15, 2006, in the International Journal of Cancer. The second, on ovarian cancer, was published Oct. 31, 2006, in the American Journal of Preventive Medicine. The third, on endometrial cancer, was published Sept. 16, 2007, in Preventive Medicine. The fourth, on breast cancer, was published in the May-June 2008 issue of The Breast Journal.
Authors on the diabetes study are Sharif B. Mohr, M.P.H., Cedric F. Garland, Dr. P.H., Frank C. Garland, Ph.D., and Edward D. Gorham, Ph.D. of the UCSD Department of Family and Preventive Medicine and Moores UCSD Cancer Center.

Anti Tumor Vaccine

The vaccine triggers mainly the cellular antitumoral immune responses which enable a complete destruction of different malignant and benign tumors. The vaccine possesses a vast and strong antitumoral properties due to a unique combination of telomerase antigen imitators together with more than 40 other tumor specific antigen imitators in its composition. The antigens, which are imitated by the drug, are present in cells of the most common malignant (see the list here) and benign tumors containing fibrotic and glandular tissues. When the drug is introduced into an organism, a numerous clones of antitumoral lymphocytes are formed. In those cases when thus formed antitumor immunity could achieve a complete destruction of the tumors, relapses do not occur, due to the formation of the immunological memory.
The chances of the complete destruction of a tumor depend on:1) Number of tumor cells (size of a tumor) and their mitotic activities; 2) Type of tumor- histological structures, antigen structures, the number of HLA-A class molecules on tumor cells;3) Initial state of the immune system.
In the treatment of the malignant tumors it is most effective as an antimetastatic drug, when used in combination with surgical resection of a primary tumor which, depending on the stage of the cancers, results in to a complete destruction of tumor in 30-90% of cases. RESAN vaccine when used in the complex therapy of inoperable malignant tumor (T3-T4) can give a considerable therapeutic effect. The drug does not render any toxic effect in normal cells of an organism, has no mutagenic and teratogenic effect and does not contain any cells and tissues of tumors. The main components of the vaccine are glycoproteins which imitate particular fragments of tumor antigens.
Latin name of the drug is RESAN. The antitumoral activities of the drug were researched and proved during 1992 - 2008 years. Today, the irony in the cancer world is that in spite of the great need of such drugs, they are practically absent in the medical pharmaceutical markets.

breast cancer : Metformin increases pathologic complete response rates in breast cancer patients with diabetes

Ana M. Gonzalez-Angulo, M.D., assistant professor, in M. D. Anderson's Department of Breast Medical Oncology.

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First clinical study looking at the role of metformin as possible anti-tumor agent

CHICAGO - Metformin, the common first-line drug for type 2 diabetes, may be effective in increasing pathologic complete response rates in diabetic women with early stage breast cancer who took the drug during chemotherapy prior to having surgery, paving the way for further research of the drug as a potential cancer therapy, according to researchers at The University of Texas M. D. Anderson Cancer Center.
The retrospective study is the first clinical research observation of the diabetes drug as a potential anti-tumor agent. The findings will be presented in a poster discussion session at the annual meeting at the American Society of Clinical Oncology (ASCO) by Sao Jirlerspong, M.D., Ph.D., a fellow, and Ana M. Gonzalez-Angulo, M.D., assistant professor, both in M. D. Anderson's Department of Breast Medical Oncology.
Metformin, an oral medication, is the most common drug prescribed for type 2 diabetes; according to Gonzalez-Angulo, more than 35 million prescription of the drug are filled annually. It's most often given to diabetic patients who are obese or have insulin resistance.
The authors decided to conduct the research after a large, intriguing epidemiologic study published last year showed that patients with diabetes who took metformin had lower incidences of cancer as well as better outcomes.
"Metformin has a novel mechanism of action. There have been a number of papers published recently that describe its action through activation of the AMP kinase pathway, which is a cellular energy sensor of the cells and potentially important pathway for the development of cancer," said Jiralerspong.
"The other interesting aspect is that Metformin works by decreasing the amount of insulin- resistance in diabetics and insulin seems to be a growth factor for cancer," said Gonzalez-Angulo.
Using the M. D. Anderson Breast Medical Oncology database, Gonzalez-Angulo, Jiralerspong and their team identified 2,529 women with early-stage breast cancer who received chemotherapy in the neoadjuvant setting, before surgery. Of the patients, 2,374 were non-diabetic, 68 were diabetic but not taking metaformin and 87 were diabetic and taking the drug. The study's endpoint was pathologic complete response, or the absence of cancer at the time of surgery.
The researchers found that the pathologic complete response rates in the diabetic breast cancer patients taking Metformin was 24 percent, three times higher than the rates in diabetic patients not taking the drug, 8 percent. In the non-diabetic women, the pathologic complete response rate was 16 percent. After adjusting for other factors, the researchers found that metformin was an independent predictor of pathologic complete response in diabetic patients.
While very exciting, the findings are still very early, cautioned Jiralerspong and Gonzalez-Angulo, and further investigation with metformin is needed.
"We need to study the mechanism of the drug - perhaps it's the decrease in insulin levels, or it may be that the drug has an anti-tumor effect that we to look at in vivo," said Gonzalez-Angulo. "Our next step is to conduct a number correlative studies to try and further understand its mechanism."
M. D. Anderson also plans to open a clinical trial with metformin in combination with hormonal therapy for metastatic breast cancer patients who are obese. The study will be led by Francisco Esteva, M.D., Ph.D., associate professor in the Department of Breast Medical Oncology.
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In addition to Gonzalez-Angulo and Jiralerspong, other authors of the all-M. D. Anderson study include: Gabriel Hortobagyi, M.D., Mien Chie Hung, Ph.D., Sharon Giordano, M.D., Funda Meric-Bernstam, M.D., Chad Barnett and Shu-Wan Kau.
Updated data, including information about body mass index will be presented 8 a.m. - noon on Mon., June 2 and will be discussed at 12:30 p.m. in a poster discussion session, "Breast Cancer - Local, Regional and Adjuvant Therapy."
The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For five of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.

insight into oral cancer, chronic pediatric ear infections, and hearing health:New research offers

New research exemplifies wide variety of issues addressed by ENTs
Alexandria, VA – Three new studies published in the June 2008 edition of Otolaryngology – Head and Neck Surgery focus on what role gender plays in the prognosis of oral tongue cancer, chronic ear infections in children, and the success rates of hearing aid implants in the elderly.
“These studies are prime examples of the wide variety of critical research being undertaken every day by otolaryngologist-head and neck surgeons; research that will improve physicians’ ability to provide the best patient care for the ear, nose, throat, head and neck,” said journal editor Richard M. Rosenfeld, MD.
Researchers at the University of Milano-Bicocca, Italy, found that although oral cancer is more prevalent in men, in their study group of 71 women and 142 men diagnosed with tongue cancer, gender did not influence prognosis. Based on this, the researchers concluded that employing a less aggressive course of treatment in female patients due to their gender was not justified.
A second study looks into speech performance when using digital hearing aids of the “young elderly” (65-80) compared with older elderly people (over 80). In this study by Taiwanese researchers, 59 patients with hearing loss and digital hearing aids were divided into two groups based on age. The study showed that age played no role in the improvement of a patient’s ability to hear, with both groups exhibiting improved performance in the four months following the hearing aid fitting. The authors believe that based on this research, physicians should not view age as a limiting factor as to whether to fit older patients with hearing aids.
A third study focuses on pediatric care, looking into the cause and treatment of chronic ear infections where fluid is present behind the ear drum (otitis media with effusion). Results from this study, conducted by Australian researchers, indicate that the presence of intracellular bacteria in the middle ear plays an important role in the development of inflamed tissue and mucus in the area. Therefore, according to researchers, using antibiotics that specifically target intracellular bacteria may prove to be a more effective course of treatment.
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Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Reporters who wish to obtain a copy of any of the three studies should contact Matt Daigle at 1-703-519-1563, or at newsroom@entnet.org.
About the AAO-HNS
The American Academy of Otolaryngology – Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents nearly 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission: “Working for the Best Ear, Nose, and Throat Care.”

promising for melanoma patients,New combination therapy safe

CHICAGO, June 1 – The combination of two different biotherapies may be beneficial for patients with inoperable melanoma, according to a University of Pittsburgh Cancer Institute (UPCI) study presented at the 44th annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.
Researchers in the melanoma and skin cancer program at UPCI combined two biotherapies – treatments that stimulate the immune system to fight cancer – and found the results promising in terms of anti-tumor effects and tolerable in terms of toxicity. High-dose interferon alfa-2b, a standard treatment for metastatic skin cancer, and tremelimumab, an antibody thought to instigate the body’s immune system to attack tumors, were combined for the first time in this phase 2 clinical trial.
“With each new study, we learn something important about melanoma,” said John M. Kirkwood, M.D., leader of the program and professor and vice chairman for clinical research in the Department of Medicine, University of Pittsburgh School of Medicine. “With this study, we learned that adding tremelimumab to traditional treatment is not only safe, but an effective way to induce an anti-tumor response, which is very exciting.”
For this study, 16 patients diagnosed with stage 4 melanoma, all of whom received and had not benefited from at least one round of previous therapy, were given the combination treatment. The overall response rate was 19 percent, and the study has since moved into the second stage, where it will enroll 21 additional patients.
Melanoma is a rare form of skin cancer, but it causes the majority of skin cancer-related deaths. Each year, approximately 160,000 new cases are diagnosed worldwide, and currently surgery is the only effective cure. For patients with inoperable disease, like those enrolled in this study, discovering a safe and effective treatment is vital.
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Ahmad Tarhini, M.D., assistant professor at the University of Pittsburgh School of Medicine and lead author of this study, will give the accompanying oral presentation at 10:15 a.m., June 1. Other investigators include S.S. Moschos, M.D.; J.J. Schelsselman, Ph.D.; J. Shipe-Spotloe, P.A.; M. Denmark, all of UPCI.
The study is published as abstract number 9009 in the 2008 ASCO Annual Meeting Proceedings.
Founded in 1984, the University of Pittsburgh Cancer Institute became a National Cancer Institute (NCI)-designated Comprehensive Cancer Center in record time (by 1990). UPCI, the only cancer center in western Pennsylvania with this elite designation, serves the region’s population of more than six million. Presently, UPCI receives a total of $154 million in research grants and is ranked 10th in funding from the NCI.