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Breast Cancer Survival and Aromatase InhibitorsIt is unclear whether treating breast cancer patients with aromatase inhibitors and inactivators offers a survival benefit compared with more traditional hormone therapies such as tamoxifen. Mauri et al. (p. 1285) performed a meta-analysis of randomized controlled trials that compared several generations of aromatase inhibitors and inactivators with standard hormone therapy in advanced breast cancer patients. They found statistically significant survival benefits with third-generation aromatase inhibitors and inactivators but not with earlier agents. The authors conclude that aromatase inhibition, particularly with third-generation drugs, may be associated with improved survival over hormonal treatments.
In an editorial, Van Poznak and Hayes (p. 1261) note that aromatase inhibitors may be the choice for endocrine-responsive metastatic breast cancer. Depleting estrogen in postmenopausal patients by aromatase inhibition is a step forward, they write, but there is much to learn.
Idiotype Vaccination in Follicular Lymphoma
Idiotype vaccination—injecting patients with a tumor-specific antigen to elicit an immune response against their tumor—has promise as a possible way to control lymphoma. To evaluate its clinical benefit, Inogès et al. (p. 1292) studied patients with follicular lymphoma whose disease had gone into remission after a first course of chemotherapy and then relapsed. The patients received chemotherapy a second time and, after achieving a second remission, were vaccinated periodically over more than 2 years with autologous lymphoma-derived idiotype protein vaccine. Of the 25 vaccinated patients, 20 showed an immune response to their vaccine. In the 18 patients with available data, the second remission was longer than the first. By contrast, all five nonresponding patients had a shorter second remission, as is typical in follicular lymphoma.
In an editorial, Longo (p. 1263) highlights several unique features of the study. First, the authors used an innovative design in which each patient served as his or her own control. Also, the patients were exposed repeatedly to the vaccine over 2 years. He notes that the results are remarkable, but longer follow-up will be revealing.
Radiation Therapy in Older Women with DCIS
Radiation therapy lowers the risk of recurrence among patients with ductal carcinoma in situ (DCIS) treated with conservative surgery, but the clinical benefit for older women is unclear. Smith et al. (p. 1302) assembled a cohort of older women with DCIS using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database. Radiation therapy was associated with a substantially lower risk for recurrence. Among healthy women ages 66 to 79, the number needed to treat to prevent one recurrence in 5 years was 11 for high-risk patients and 15 to 16 for low-risk patients. The authors conclude that radiation therapy appears to confer a benefit, even for low-risk patients.
Kidney Cancer Incidence, Treatment, and Mortality
Kidney cancer surgery has become more prevalent over the last two decades, and it has been accompanied by a steady rise in deaths from the disease. Hollingsworth et al. (p. 1331) analyzed kidney cancer data from the SEER database and calculated trends in incidence, treatment, and mortality according to tumor size. Small tumors accounted for most of the increased incidence and more frequent surgical treatment of kidney cancer, whereas large tumors accounted for most of the increased mortality. The authors conclude that increased surgical removal of small tumors, which are often detected in asymptomatic patients using new imaging technologies, is not preventing kidney cancer deaths. They argue for careful reconsideration of the current treatment paradigm.
Estrogen Metabolism and Endometrial Cancer
Unopposed estrogen replacement therapy is associated with an increase in endometrial cancer. To investigate the mechanism of this link, Rebbeck et al. (p. 1311) evaluated the associations between endometrial cancer risk and the genotype of several steroid hormone metabolism genes. They found statistically significant associations between endometrial cancer risk and the genotype of several genes involved in sulfation; some genotypes were associated with increased risk and others with decreased risk. One genotype was associated with increased risk among long-time users of estrogen replacement therapy compared with never users.
Autoimmune Conditions and Hodgkin Lymphoma
Certain autoimmune conditions have been associated with an increased risk of non-Hodgkin lymphoma, but less is known about associations with Hodgkin lymphoma. Landgren et al. (p. 1321) used linked registry data from Sweden and Denmark to carry out a large population-based case–control study of associations between Hodgkin lymphoma and 32 autoimmune diseases and related conditions. Risks of Hodgkin lymphoma were statistically significantly elevated in people with personal and/or family histories of several autoimmune conditions. Both personal and family histories of sarcoidosis were associated with Hodgkin lymphoma, raising the possibility of shared predisposition.
Determining Disease-Free Survival Using Medicare Data
To learn whether Medicare claims data can provide an accurate measure of disease-free survival in elderly cancer patients, Lamont et al. (p. 1335) performed a validation analysis using data from 45 elderly patients with node-positive breast cancer who were treated in a randomized trial. They developed an algorithm to measure disease recurrence and death using Medicare data files and compared the results with the trial data. The algorithm accurately determined 5-year disease-free survival but was less accurate for 2-year survival. The authors expect that Medicare-based data can help determine adjuvant therapy effectiveness in elderly cancer patients with solid tumors and plan to test the algorithm in different populations.
Soy and Breast Cancer
In vitro and animal studies have yielded conflicting information about the relationship between soy and breast cancer, and human data are limited. Messina et al. (p. 1275) provide a review from a 2005 workshop. They write that the existing data on associations between soyfoods or isoflavones and breast cancer risk and survival are not conclusive. Researchers should examine the safety and efficacy of soy products by studying breast cancer risk markers in high-risk women.
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