Adding chemotherapy to standard cancer-suppressing tamoxifen (also manufactured under brand name Nolvadex) can boost survival in postmenopausal women with the most common type of breast cancer, known as estrogen receptor-positive, and it’s best given before the tamoxifen regimen starts, according to a new study.

“Chemotherapy with Adriamycin adds to your survival benefit over and above what tamoxifen would do if you are postmenopausal and have positive lymph nodes and estrogen receptor-positive cancer [the most common type],” explained Dr. Kathy Albain, the lead researcher and professor of medicine at Loyola University Chicago Stritch School of Medicine.

And in another study, Albain found that screening breast tumors with an available multi-gene test spots patients who may not need this form of chemotherapy, despite fitting the standard profile.

Both studies are published online Dec. 10, the first in the journal The Lancet and the second in The Lancet Oncology. Albain is also due to present her findings Thursday at the annual San Antonio Breast Cancer Symposium in San Antonio, Texas.

In estrogen receptor-positive cancer, tumor cells carry many receptors on their surfaces to which estrogen can attach, fueling tumor growth. Tamoxifen works by blocking the receptors.

Experts have long debated whether women with estrogen receptor-positive cancers — whose growth is fueled by circulating estrogen — would get more benefit from having a chemotherapy regimen on top of tamoxifen.

Albain led a research team from multiple centers that followed nearly 1,500 breast cancer patients for up to 13 years, with a median (half longer, half less) of nearly nine years. All were past menopause and had hormone receptor-positive cancer that had spread to at least one lymph node in the armpit area.

Albain’s team assigned 381 women to tamoxifen alone, 587 to chemotherapy alone and 590 to both, with some receiving tamoxifen and chemo together and some in a sequential manner.

Tamoxifen was taken daily for five years. The chemo regimen used is called CAF, for “cyclophosphamide, Adriamycin and 5-fluorouracil.”

In all, after accounting for study dropouts, 1,460 women received treatment.

The combined treatments of chemo plus tamoxifen increased the women’s disease-free survival by 24 percent, Albain found. When her team looked at which delivery protocol worked best — simultaneous tamoxifen and chemotherapy or chemo followed by tamoxifen — the sequential approach was found to be better, giving slightly better disease-free survival.

Ten-year disease-free survival estimates were 57 percent for the combination group and 48 percent for the tamoxifen-only group, the researchers found.

However, women receiving chemo were more likely to have drops in white blood cells, important for fighting infections, the team noted. And they were also more prone to blood clots, congestive heart failure and other complications.

In a second study, Albain’s team analyzed whether a gene test, called Oncotype DX, could predict which women would benefit from chemotherapy. Genomic Health, which makes the test, helped fund the study, along with the U.S. National Cancer Institute.

The test, which Albain said is already widely used, is done on the tumor itself. “This puts 21 genes together and comes up with a score,” she said. The score — low, intermediate, high — predicts the risk of recurrence over 10 years if a woman used tamoxifen alone.

When the researchers performed the test on 367 specimens, they found a low score identified those women who may not need the chemo, despite the fact that they have cancer that spread to lymph nodes.

“This is a positive study, there’s no question,” said Dr. Joanne Mortimer, vice chair of medical oncology for the City of Hope Cancer Center in Duarte, Calif., of the first study. “This study tells us [that] if you have positive lymph nodes [and are postmenopausal with estrogen receptor-positive cancer], you should have both chemo and tamoxifen, because the survival was better.”

But, she added, “when you give everyone [who has the estrogen receptor-positive, node-positive breast cancer] chemotherapy, probably there are some who don’t need it.”

According to Mortimer, that’s why the gene test looks promising — it may spare some women from having to have chemo while ensuring that those who will benefit from the treatment get it.

Technorati Tags: breast cancer, chemo and tamoxifen, chemotherapy, Nolvadex, tamoxifen

Men who regularly get moderate exercise may have a lower risk of developing prostate cancer — including aggressive, fast-growing tumors, a new study finds.

Researchers found that among 190 men who underwent biopsies for possible prostate cancer, those who exercised moderately — the equivalent of three to six hours of walking per week — were less likely to be diagnosed with the disease.

Compared with their sedentary counterparts, these men were two-thirds less likely to have a biopsy positive for prostate cancer. In addition, men who got the equivalent of one to three hours of walking each week had an 86 percent lower chance of having an aggressive form of the cancer.

The findings, which appear in the current issue of the Journal of Urology, do not prove that exercise helps prevent prostate cancer. But they could offer men yet more incentive to get active.

“If you need one more reason to exercise, this could be one,” said senior researcher Dr. Stephen J. Freedland, of the Duke University Prostate Center and the VA Medical Center in Durham, North Carolina.

A number of studies have looked at the relationship between exercise and prostate cancer, and while most have pointed to a protective effect, about one-third have found no association, Freedland told Reuters Health.

One question has been whether the positive findings reflect a greater tendency of health-conscious exercisers to get screened for prostate cancer. This study avoided that issue, Freedland said, by focusing on men who were sent for biopsies after concerning findings from prostate specific antigen (PSA) testing or a digital rectal exam.

He and his colleagues found that among the 111 sedentary men in the study, half were diagnosed with cancer after biopsy. That compared with 27 percent of those men who got the equivalent of three to six hours of walking each week.

And among men diagnosed with prostate cancer, 51 percent of sedentary patients had more-aggressive cancer, versus 22 percent of those who had been mildly active — getting the equivalent of one to three hours of moderate walking per week.

Exercise itself remained linked to a lower risk of prostate cancer after the researchers accounted for a number of other factors, like age, weight and race.

Along with studies finding a relationship between exercise habits and lower prostate cancer risk, there is also research showing that the connection is biologically plausible, Freedland said.

For one, he noted, exercise has been shown to lower blood levels of testosterone and other hormones that may stimulate prostate tumor growth. Exercise is also believed to stimulate the immune system and the body’s natural antioxidant mechanisms, both of which may help prevent the development of prostate cancer.

SOURCE: Journal of Urology, November 2009.

Technorati Tags: antioxidant mechanisms, exercise and prostate cancer, prostate cancer

Weight loss and malnutrition are serious threats to patients battling cancer, who can find that their tumors or treatment sap their appetite, cause nausea and other side effects and block absorption the nutrients they do force down. Here are some tips from cancer specialists and dietitians to help:

• Try to eat five or six small meals throughout the day rather than three large ones.
• Cancer patients tend to need more protein than healthy people. Peanut butter crackers, yogurt and fruit, a hard-boiled egg and piece of toast all are good mini-meals.
• Drink between meals, not with them, to avoid filling up on liquid.
• Don’t try your comfort food if you’re vomiting. It may create an aversion.
• Foods high in fat or fiber make nausea last longer.
• White, bland foods tend to help with nausea, such as Cream of Wheat, mashed potatoes, cottage cheese.
• Odors often worsen nausea, and foods served at room temperature rather than warm tend to have milder odors.
• Fresh ginger about 30 minutes before eating also can take the edge off nausea, but not ginger flavoring common in many sodas. A study published last week found ginger capsules work, too.
• Certain cancer medications, particularly painkillers, cause constipation, so keep up the fiber whenever the nausea passes.
• Take special care to stay hydrated when diarrhea strikes. Bananas, rice, applesauce and toast are good options.
• Many patients find foods that once tasted good now taste metallic. Citrus sometimes counters that; try sucking lemon drops, or drinking lemonade with meals, or using citrus-based marinades. Other patients may have a treatment-caused, and correctable, zinc deficiency.
• Tell your doctor about any over-the-counter dietary supplements. Some, such as St. John’s wort, can cause dangerous interactions with numerous anti cancer medications. Even high amounts of acidic vitamin C can worsen stomach problems.
• Staying hydrated and eating foods moistened with sauces and gravies helps dry mouth; doctors also can prescribe an artificial saliva.
• High-protein, high-calorie milkshakes and canned supplements like Ensure help sneak in extra nutrients and are especially helpful for patients with mouth sores. Make your own with whole milk and a few tablespoons of dry milk or protein powder.
• Ask for a consultation with a dietitian who specializes in cancer before you start losing weight. Specially designated cancer centers have dietitians on staff, and insurance may cover other consultations if the doctor orders it. The American Cancer Society’s toll-free hot line — 1-800-ACS-2345 connects patients in the Southeast to dietitians on call, and will find nutrition answers for people elsewhere. To find nearby dietitians, try http://www.eatright.org.
• Look for recipes targeted to cancer patients. The cancer society posts some at http://www.cancer.org, and plans a new cookbook in July.

Technorati Tags: anti cancer medications, Cancer, Cancer nutrition, Cancer nutrition tips, dietary supplements, dietitian, start losing weight