Dear Friends,

Welcome to the 2008 American Society of Clinical Oncology (ASCO) Annual Meeting. The theme, One Community: Innovating Patient Care, reflects the common goal of uniting all oncology professionals to deliver the highest quality care while striving for improved treatment outcomes.

High-quality cancer care starts with good communication between doctors and patients and reliable, patient-friendly information. To help people learn about progress in cancer, ASCO publishes Cancer Advances, a series of consumer information resources. Cancer Advances: News for Patients from the 2008 ASCO Annual Meeting provides the latest information about cancer research, prevention, care, and treatment as presented at ASCO's Annual Meeting. The information in this issue was presented at the 44th ASCO Annual Meeting held in Chicago, Illinois from May 30-June 3, 2008.

I am excited and encouraged by the progress made in the prevention, diagnosis, and treatment of cancer. Together, we are making a world of difference in cancer care. For additional information about cancer, please visit Cancer.Net (www.cancer.net), ASCO’s patient information website.

Sincerely,

Nancy E. Davidson, MD
ASCO President

The study: In a large clinical trial of adjuvant therapy (treatment after surgery) for early-stage pancreatic cancer, researchers evaluated whether treatment with gemcitabine (Gemzar) helped patients live longer. Gemcitabine is the standard treatment for advanced pancreatic cancer that cannot be surgically removed. In this study (called CONKO-001), 368 patients either received treatment with gemcitabine after complete surgical removal of the tumor and no evidence of cancer remaining after surgery, or received no additional treatment after surgery (which is the standard treatment). Previous results from this study presented at the 2005 ASCO Annual Meeting showed that treatment with gemcitabine increases the amount of time that a patient is free of cancer. This study was continued to find out if treatment with gemcitabine also increases survival.

The results: Adjuvant treatment with gemcitabine increases survival for patients with early-stage pancreatic cancer. After three years, 37% of patients who received gemcitabine were alive, compared with 20% of those who did not, and cancer did not return for 24% patients who received gemcitabine, compared with 8% of patients who did not receive gemcitabine. After five years, 21% of patients who received gemcitabine were alive, compared with 9% of those who did not, and cancer did not return for 17% of patients who received gemcitabine, compared with 6% of patients who did not receive gemcitabine. A small percentage of patients (between 1% and 2%) who received gemcitabine had a slight decrease in white blood cell counts and platelets (parts of the blood that help with clotting).

What this means for patients

“The goal of chemotherapy after surgery is to improve the cure rate, and we have shown that this treatment more than doubles the overall survival five years after treatment,” said Hanno Riess, MD, PhD, Professor at Charité University Medical School in Berlin, Germany and author of the CONKO study group. “Based on earlier results of this study, this treatment is already widely used in both Europe and the United States.” Patients with early-stage pancreatic cancer that can be removed with surgery should talk with their doctor about chemotherapy.

What to ask your doctor

• What is the stage of my cancer? What does this mean?
• Can surgery be used to treat the cancer?
• What are my other treatment options?
• What are the possible side effects of this treatment?

For more information

Cancer.Net Guide to Pancreatic Cancer

The study: In a study of 1,125 patients from 30 countries, researchers looked at adding cetuximab (Erbitux) to chemotherapy with cisplatin (Platinol) and vinorelbine (Navelbine) for patients newly diagnosed with advanced non-small cell lung cancer (NSCLC). Cetuximab is a targeted therapy that blocks the epidermal growth factor receptor (EGFR), a protein that helps lung cancer cells grow and multiply. The current standard treatment for these patients is platinum-based chemotherapy, such as cisplatin or carboplatin (Paraplatin), combined with newer types of chemotherapy, such as vinorelbine, gemcitabine (Gemzar), paclitaxel (Taxol), or docetaxel (Taxotere).

In this study, 557 patients received chemotherapy and cetuximab, and 568 patients received only chemotherapy. Of these patients, nearly all had stage IV lung cancer, which means that cancer had spread to other parts of the body.

The results: Patients who received cetuximab plus chemotherapy lived slightly longer than 11 months, compared with approximately 10 months for patients who received chemotherapy alone. Treatment with chemotherapy and cetuximab slowed tumor growth and/or caused tumor shrinkage for 36% of patients, compared with 29% of patients who received only chemotherapy. Cetuximab helped patients with different subtypes of NSCLC, including adenocarcinoma and squamous cell carcinoma. Like other drugs that target EGFR, the most common side effect was an acne-like rash that was treatable with medication.

What this means for patients

“Patients with advanced NSCLC have limited treatment options, and life expectancy is short, so the survival increase shown in this study is an important step for these patients,” said lead author Robert Pirker, MD, Associate Professor of Medicine at Medical University of Vienna, Austria. “These results clearly establish cetuximab in combination with chemotherapy as a new standard for the initial treatment of advanced NSCLC.” Cetuximab is injected into the vein and is currently approved to treat colorectal and head and neck cancers.

What to ask your doctor

• What stage lung cancer do I have? What does this mean?
• What are my treatment options?
• What are the possible side effects of these treatments?

For more information

Cancer.Net Guide to Lung Cancer

Cancer.Net Feature: Understanding Targeted Treatments

Cancer.Net: Skin Reactions to Targeted Therapies

The study: Researchers looked at adding the targeted therapy bevacizumab (Avastin) to chemotherapy with docetaxel (Taxotere) for women newly diagnosed with locally advanced or metastatic breast cancer (breast cancer that has spread outside of the breast and nearby lymph nodes). Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development. Bevacizumab blocks angiogenesis (the formation of new blood vessels), which is needed for tumor growth and spread. Paclitaxel (Taxol), a drug similar to docetaxel, is already approved in combination with bevacizumab by the U.S. Food and Drug Administration for the treatment of newly diagnosed metastatic breast cancer.

In this study, 736 women received treatment with either docetaxel alone, a higher dose of bevacizumab plus docetaxel, or a lower dose of bevacizumab plus docetaxel. The higher dose of bevacizumab is the standard established in previous breast cancer studies, and the lower dose is the standard used for colorectal cancer treatment.

The results: After approximately 11 months, women who received the lower dose of bevacizumab were 21% less likely to have their breast cancer grow or spread, and women who received the higher dose of bevacizumab were 28% less likely to have their breast cancer grow or spread, compared with the women who received only docetaxel. Also, this study showed that the tumors shrank in 44% of women who received docetaxel alone, compared with 55% of women who received the lower dose of bevacizumab, and 63% of women who received the higher dose of bevacizumab. Because of the small size of the study, researchers were not able to compare the higher and lower doses.

About three-fourths (75%) of women taking either dose of bevacizumab experienced severe side effects, compared with 67% of women who received docetaxel alone. Although most side effects were from the chemotherapy, the most common side effect of bevacizumab was high blood pressure, which is treatable with medication. Severe bowel perforation (a hole in the intestinal wall), a side effect seen in other bevacizumab studies, occurred in few patients. 

What this means for patients

“This study shows that the use of an anti-angiogenic drug to treat breast cancer is effective when combined with either docetaxel or paclitaxel and does not greatly increase the side effects,” said lead author David Miles, MD, Professor and Medical Oncologist at the Mount Vernon Cancer Centre in England. Women with advanced breast cancer should talk with their doctor about this and other treatment options.

What to ask the doctor

• What is the stage of my breast cancer?
• What are my treatment options?
• What are the short-term and long-term side effects of this treatment?

For more information

Cancer.Net Guide to Breast Cancer

Cancer.Net Feature: Breast Cancer: Questions to Ask Your Doctor

The study: Researchers looked at whether zoledronic acid (Zometa) lowers the risk of breast cancer recurrence (cancer that comes back after treatment) for premenopausal women with early-stage breast cancer. Zoledronic acid is a drug called a bisphosphonate that is used to reduce bone loss caused by cancer treatment. The women were treated with surgery, ovarian suppression (drugs that stop the production of hormones by the ovaries), and hormone therapy. Hormone therapy is the used to treat breast cancer that is hormone-receptor positive (uses estrogen or progesterone to grow) and includes tamoxifen (Nolvadex) and anastrozole (Arimidex),.

In this study, 1,803 women who were undergoing drug-induced ovarian suppression were divided into four treatment groups: tamoxifen only, anastrozole only, tamoxifen and zoledronic acid, or anastrozole and zoledronic acid. Tamoxifen is the standard treatment for premenopausal women with hormone-receptor positive tumors. Anastrozole is only approved for the treatment of postmenopausal women with hormone-receptor positive tumors. However, premenopausal women in this study were able to take this drug while receiving ovarian suppression.

The results: After approximately five years, treatment with zoledronic acid combined with hormone therapy reduced a woman’s risk of recurrence by 35%, compared with women who received hormone therapy alone. There was no difference in the reduction of the risk of recurrence between the tamoxifen and anastrozole. Women in this study had no unexpected side effects, and the overall occurrence of side effects was low. 

What this means for patients

“It’s very exciting to find that in addition to preventing bone loss in women receiving hormone therapy for breast cancer, zoledronic acid can also reduce the likelihood that breast cancer will return in some women,” said lead author Michael Gnant, MD, Professor of Surgery at the Medical University of Vienna and President of the Austrian Breast and Colorectal Cancer Study Group. “Future research will focus on developing the appropriate treatment schedule and determining which women will benefit the most from this treatment.”

What to ask the doctor

• What is the stage of my breast cancer?
• What is the chance that the cancer will recur?
• What is my current treatment plan?
• Would I benefit from treatment to reduce bone loss?

For more information

Cancer.Net Guide to Breast Cancer

Cancer.Net Feature: Breast Cancer: Questions to Ask Your Doctor

ASCO Patient Guide: Bisphosphonates for Breast Cancer

The study: Researchers analyzed tumors from 587 patients with metastatic colorectal cancer (cancer that has spread) for a mutated (changed) KRAS gene to determine which patients will benefit the most from treatment with a combination of chemotherapy and cetuximab (Erbitux). The KRAS gene is involved in the growth of cancer cells. About 30% to 45% of colorectal cancers have a KRAS mutation, which has been shown in previous studies to predict whether patients will benefit from treatment with drugs that block the epidermal growth factor receptor (EGFR), such as cetuximab.

This study is a continuation of the CRYSTAL trial, which was the first study to compare chemotherapy alone with chemotherapy plus cetuximab as the primary treatment for patients with metastatic colorectal cancer.

The results: KRAS mutations were found in the tumor samples of 36% of patients. Of the patients whose tumors did not have a KRAS mutation, 59% of the patients who received cetuximab and chemotherapy had a reduction in tumor size, compared with 43% of patients who received only chemotherapy. Patients with tumors with a mutated KRAS gene did not receive any benefit when cetuximab was added to chemotherapy.

What this means for patients

“This study helps us to identify which patients are most likely to benefit from adding cetuximab to treatment,” said lead author Eric Van Cutsem, MD, PhD, Professor at the University Hospital Gasthuisberg in Leuven, Belgium. “KRAS testing in all people with colorectal cancer immediately after diagnosis could help doctors find the best treatment strategies for the individual patient.”

What to ask your doctor

• Would you explain my pathology report (laboratory tests results) to me?
• What are my treatment options?

For more information

Cancer.Net Guide to Colorectal Cancer

Cancer Advances: News from the 2008 Gastrointestinal Cancers Symposium

The study: Dutch researchers compared the use of vaginal brachytherapy (radiation therapy given internally, using implants) to external-beam radiation therapy (radiation given from a machine outside the body) to treat uterine cancer that has a higher risk of recurrence (cancer that comes back after treatment). For women with this type of uterine cancer, the standard treatment is surgery followed by external-beam radiation therapy. Brachytherapy is typically used with external-beam radiation therapy for women with advanced uterine cancer.

In this study, 214 women with uterine cancer that has a moderate- to high-risk of recurrence were given external-beam radiation therapy to the pelvis, and 213 women received vaginal brachytherapy. All 427 women had previously been treated with surgery to remove the uterus and ovaries.

The results: Brachytherapy is as effective as external-beam radiation therapy and has fewer side effects. After three years, women who received brachytherapy had similar rates of recurrence as women who received external-beam radiation therapy. For example, about 1% of women had a recurrence in the pelvis, and 6% had a recurrence to other areas of the body, regardless of the type of radiation therapy. In addition, 90% of women who received brachytherapy were still alive after three years, compared with 91% of women who received external-beam radiation therapy.

The most common side effect in this study was diarrhea, which was more common in the women who received external-beam radiation therapy both during and after treatment.

What this means for patients

“Based on this study, we expect that vaginal brachytherapy will be adopted as the new standard of care for women with this type of uterine cancer,” said lead author Remi A. Nout, MD, a Radiation Oncology Resident in the Department of Clinical Oncology at Leiden University Medical Center in the Netherlands. “This treatment is simpler and just as effective as external-beam radiation therapy, and it makes treatment and recovery for many women much more manageable, allowing them to have a better quality of life during and after treatment.”

What to ask the doctor

• What is the stage of my cancer?
• What is my current treatment plan? Will I receive radiation therapy?
• Would I benefit from brachytherapy instead of external-beam radiation therapy?
• How might this treatment affect my quality of life?

For more information

Cancer.Net Guide to Uterine Cancer

Cancer.Net Feature: Understanding Radiation Therapy

Cancer.Net Feature: Frequently Asked Questions About Radiation Therapy

Cancer.Net Feature: Side Effects of Radiation Therapy

The study: Researchers looked at the long-term effectiveness of treatment with a single dose of chemotherapy compared with radiation therapy, the current standard of care, for men with early-stage testicular cancer. The men who participated in this study had a type of tumor called a seminoma and were first treated with surgery to remove the affected testicle. In this study, 573 men received a single dose of the chemotherapy carboplatin (Paraplatin), and 904 men received daily radiation therapy for 2 or 3 weeks.

The results: After five years, 5% of the men who received chemotherapy and 4% of the men who received radiation therapy had a recurrence (cancer that comes back after treatment). After approximately seven years, men who received carboplatin were 78% less likely to develop a tumor in the other testicle. One man who received radiation therapy died of testicular cancer, and none of the men who received carboplatin died of testicular cancer. The occurrence of side effects was low for both types of treatment, although 24% of men who received radiation therapy experienced a lack of energy 4 weeks after starting treatment, compared with 7% of those who received carboplatin.

What this means for patients

“Personal preference is becoming a more important factor in determining the best treatment for men with testicular cancer,” said lead author Tim Oliver, MD, Professor Emeritus of Medical Oncology at St. Bartholomew’s Hospital in London, England. “This study established surgery followed by carboplatin chemotherapy as a safe new option for men who have early-stage seminoma and would prefer a treatment that lasts a shorter time.”

What to ask your doctor

• What type of testicular cancer do I have?
• What is the stage of the cancer?
• What are my treatment options?
• What are the risks and benefits of these treatments?

For more information

Cancer.Net Guide to Testicular Cancer