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Thalidomide Used to Manage Myeloma PatientsTreatment with thalidomide increased survival time without side effects from medication or cancer recurrence in multiple myeloma patients when combined with the chemotherapy drug melphalan, according to a new study. However, the drug did not improve overall survival, and it had important adverse effects.
Bart Barlogie, M.D., Ph.D., of the University of Arkansas for Medical Sciences in Little Rock, and colleagues treated 668 multiple myeloma patients with melphalan chemotherapy and a stem cell transplant from the patients' own tissue. Half (323) of the patients were randomly assigned to also receive thalidomide treatment. Patients were treated from October 1998 to February 2004, with a mean follow-up of 42 months.
Of patients taking thalidomide, 62% were cancer free for 6 months or more after surgery, and 56% lived for 5 years without a recurrence, compared with 43% and 44% in control patients. However, overall survival was similar in the two groups, and those taking thalidomide experienced higher rates of venous thrombosis, embolism, syncope, bowel obstructions, tremors, and peripheral neuropathy than control patients. Thalidomide has been used to treat leprosy and caused birth defects when given to pregnant women.
The study was published in the March 9 issue of the New England Journal of Medicine.
U.S. Commercial Genetic Testing Misses Some Breast Cancer Mutations
A new study suggests that 12% of breast cancer patients from high-risk families carry previously undetected mutations for breast cancer.
Mutations in several genes—BRCA1, BRCA2, CHEK2, TP53, and PTEN—can place a person at a higher risk for developing breast cancer. These high-risk women can undergo preventive surgeries that often lower the risk of developing cancer, but the surgeries may have harmful side effects.
Mary-Claire King, Ph.D., from the University of Washington in Seattle, and colleagues examined DNA and RNA samples from an initial member of 300 families who had negative results from genetic testing for BRCA1 and BRCA2 mutations using tests commercially available in the United States. King and colleagues were searching for one of the five mutations leading to an increased risk of breast cancer.
The authors found that 17% of the 300 subjects carried previously unidentified mutations for different genes that could put a woman at high breast cancer risk: BRCA1 or BRCA2 (12%), CHEK2 (5%), or TP53 (1%). The authors suggest that genetic testing methods are available for mutations missed by common commercial testing and should be made available to women at high risk for breast cancer.
The study was published in the March 22/29 issue of JAMA.
Preventive Surgery Cost Effective for Women with BRCA1 or BRCA2 Mutations
New research reports that the most cost-effective strategies for cancer prevention in BRCA1 and BRCA2 mutation carriers include an oophorectomy (removal of the ovaries) or oophorectomy combined with mastectomy.
Victor R. Grann, M.D., at Columbia University in New York, and colleagues used statistical methods to estimate the cost-effectiveness of various preventive strategies—chemoprevention, oophorectomy, mastectomy, surgical removal of cancer, and increased surveillance—for women with a BRCA1 or BRCA2 mutation.
The authors found that the most cost-effective strategies for women with BRCA1 or BRCA2 mutations involved oophorectomy or oophorectomy with mastectomy. The benefit was greatest for younger women. For BRCA1 mutation carriers, oophorectomy was far more cost-effective than any other strategy, with a cost-effectiveness of $2,352 per year of life saved.
The study was published in the March 21 issue of Annals of Internal Medicine.
Genetic Diversity in Tumor Cells Associated with Increased Risk of Cancer
A precancerous tumor with a population of genetically diverse cells is more likely to progress to full-blown cancer than one whose cells are genetically similar, according to a new study. Carlo Maley, Ph.D., of the Wistar Institute in Philadelphia, and colleagues analyzed data from a precancerous condition known as Barrett's esophagus in 268 patients, 37 of whom developed cancerous tumors. Patients whose precancerous tumors were highly genetically diverse were more likely to see tumors progress to cancer, with the risk doubling with each additional cell type.
The study was published online March 26 in Nature Genetics.
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