News Release

Other highlights in the Feb. 6 issue of JNCI

Peer-Reviewed Publication

Journal of the National Cancer Institute

Elderly patients should not be denied aggressive treatment, study suggests
Elderly patients who receive platinum-based chemotherapy for lung cancer have similar responses to treatment and similar survival rates compared with younger patients, suggesting that patients should not be denied aggressive treatment based on age alone, a new study concludes.

Although lung cancer incidence is highest among 70- to 80-year-olds, there is little information available on patient outcomes in this age group because the elderly tend to be underrepresented in clinical trials. In addition, elderly patients are often considered unfit for aggressive chemotherapy even if they do not have major health problems besides their cancer.

Corey J. Langer, M.D., of Fox Chase Cancer Center, Philadelphia, and colleagues reanalyzed data from a randomized phase III clinical trial of platinum-based chemotherapy for patients with non-small-cell lung cancer to look specifically at patient outcomes in terms of age. They found that response rates, survival rates, and quality-of-life outcomes were similar between patients ages 70 and older and patients younger than 70. There were more cases of leukopenia and a higher incidence of neurospychiatric toxicity in the older patient group, but there were no other differences in toxicities related to chemotherapy.

The authors conclude that, based on these results, there is no good reason to deny fit, elderly patients access to protocol therapy. They add that these results highlight the need for more elderly-specific clinical trials to examine the unique physiologic needs of the elderly population. This research appears in the Feb. 6 issue of the Journal of the National Cancer Institute.

Contact: Sue Madden, Fox Chase Cancer Center, (215) 728-7784, s_madden@fccc.edu

Treatment for Hodgkin’s Disease Associated with Increased Lung Cancer Risk
Past treatments with certain kinds of chemotherapy and radiotherapy for Hodgkin’s disease are associated with an increased risk of lung cancer, and the risk estimates drastically increase in patients who also smoke tobacco, a new study reports.

Lung cancer is the most common form of second cancer in patients who have been cured of Hodgkin’s disease. Previous studies have suggested that treatments for Hodgkin’s disease are responsible for the increased risk of lung cancer, but the exact contributions of certain chemotherapy drugs and types of radiotherapy were unknown.

In the Feb. 6 issue of the Journal of the National Cancer Institute, Lois B. Travis, M.D., of the National Cancer Institute, and colleagues, quantified the risk of treatment-associated lung cancer, taking into account tobacco use in a case–control study of Hodgkin’s disease survivors. Treatment with alkylating agents without radiotherapy was associated with a fourfold increased risk of lung cancer. Radiotherapy without alkylating agents increased the risk more than fivefold. Lung cancer risk increased with both increasing number of cycles of alkylating agents and increasing radiation dose. However, the risk further increases dramatically with a history of smoking. Tobacco use among Hodgkin’s disease survivors increased the risk of lung cancer more than 20-fold.

The authors add that “the tremendous improvement in the treatment of Hodgkin’s disease outweighs the therapy-related risks of lung cancer and other late effects, especially when compared with the burden imposed by tobacco.”

Contact: NCI Press Office, (301) 496-6641

Researchers Analyze Cost-Effectiveness of Cervical Cancer Screening Policies
Cervical cancer screening programs differ widely in their targeted age range and recommended screening interval. For example, the Netherlands recommends screening women between the ages of 30 and 60, and Australia recommends screening women between the ages of 18 and 70. Whether a country’s screening program is cost-effective depends on screening costs, possible savings in treatment, and potential health effects, such as life-years gained and cervical cancer deaths prevented.

M. Elske van den Akker-van Marle, M.Sc., of Erasmus University Rotterdam, used a microsimulation screening analysis program to perform a cost-effectiveness analysis that compared the efficiency of almost 500 cervical cancer screening policies, many of which were based on existing programs in high-income countries.

The authors concluded that most countries do not operate at the highest level of cost-effectiveness, and the diversity in cervical cancer screening policies among high-income countries does not appear to relate to the cost-effectiveness ratio of the screening policy. They present their results and these conclusions in the Feb. 6 issue of the Journal of the National Cancer Institute.

Contact: For a copy of this paper, please e-mail jncinews@oup-usa.org.

Mutation in ATM Gene Associated with Breast Cancer Risk
Two mutations in the gene for a rare genetic disorder appear to be associated with an increased risk of breast cancer, a new study suggests.

Ataxia-telangiectasia is an autosomal recessive disorder that results from the inheritance of two defective copies of the ATM gene. Previous studies have suggested that carriers of a single defective copy of the gene are predisposed to various cancers, but its link to breast cancer risk is still in question.

In the Feb. 6 issue of the Journal of the National Cancer Institute, Georgia Chenevix-Trench, Ph.D., at the Queensland Institute of Medical Research, Australia, and colleagues report that two specific mutations in the ATM gene were associated with breast cancer in women from multiple-case breast cancer families.

The authors conclude that “full mutation analysis of the ATM gene would be worthwhile in other multiple-case breast cancer families ... to clarify further the role of this gene in breast cancer susceptibility.”

Contact: Christine Borthwick, Queensland Institute of Medical Research, 61 7 3362 0291; christiB@qimr.edu.au.

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