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Wednesday, December 18, 2013

First In-Human Trial of Endoxifen Shows Promise as Breast Cancer Treatment



First In-Human Trial of Endoxifen Shows Promise as Breast Cancer Treatment
First In-Human Trial of Endoxifen Shows Promise as Breast Cancer Treatment

Dec. 12, 2013 — A Phase I trial of endoxifen, an active metabolite of the cancer drug tamoxifen, indicates that the experimental drug is safe, with early evidence for anti-tumor activity, a Mayo Clinic study has found. The findings indicate that Z-endoxifen, co-developed by Mayo Clinic Cancer Center and the National Cancer Institute (NCI), may provide a new and better treatment for some women with estrogen positive breast cancer and, in particular, for those women who do not respond to tamoxifen and aromatase inhibitors. Results of the first in-human trial were presented today during the 2013 San Antonio Breast Cancer Symposium.

"We achieved up to 60 fold higher levels of endoxifen compared to endoxifen levels achieved with the standard dose of tamoxifen," says Matthew Goetz, M.D., a Mayo Clinic oncologist and lead author of the study. "We have seen evidence for tumor regression in patients who had failed standard hormonal therapies including aromatase inhibitors, fulvestrant and tamoxifen. This is an exciting first step in the development of this drug."

Tamoxifen is a hormonal therapy that has been used for over 40 years to reduce the risk of breast cancer recurrence and to prevent breast cancer. Some prior studies have demonstrated that patients with very low levels of a critical enzyme called CYP2D6 and those with low endoxifen concentrations have a higher risk of recurrence or progression when treated with tamoxifen. In 2008, Dr. Goetz and Matthew Ames, Ph.D. at the Mayo Clinic Cancer Center began to collaborate with the NCI to develop formulations of endoxifen. This formulation, known as Z-endoxifen hydrochloride (endoxifen), was tested through preclinical pharmacology studies, toxicology workups and, most recently, clinical trials conducted at Mayo Clinic and NCI.

In the Phase I study, researchers gave endoxifen once daily to 22 women with estrogen-receptor positive breast cancer that was resistant to standard hormonal therapies such as aromatase inhibitors, tamoxifen and fulvestrant. The drug appeared to be safe even at the highest dose of 160 milligrams/day.

Dr. Goetz and his colleagues are now working to determine the optimal dose of endoxifen for breast cancer patients. After that work is complete, Dr. Goetz would like to see the drug studied in premenopausal patients where tamoxifen is the only FDA approved hormonal agent for the treatment of estrogen receptor positive breast cancer. "Endoxifen may turn out to be a better drug than tamoxifen," he says, "and not just in patients who have limited CYP2D6 metabolism. This is something that has to be prospectively tested."
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Herceptin Plus Taxol Highly Effective in Low-Risk Breast Cancer



Herceptin Plus Taxol Highly Effective in Low-Risk Breast Cancer
Herceptin Plus Taxol Highly Effective in Low-Risk Breast Cancer

Dec. 11, 2013 — A remarkable 98.7 percent of certain lower-risk breast cancer patients were cancer free for at least three years after taking a combination of the drugs Herceptin and Taxol, a study has found.

The study is the first major trial to examine the Herceptin-Taxol combination in patients who have a type of breast cancer with the biology known as small, node-negative, HER2+. Results were presented during the 2013 San Antonio Breast Cancer Symposium.

"This is great news for patients and their physicians," said Kathy Albain, MD, of Loyola University Medical Center, who is one of the co-authors of the national multicenter study. "This study identifies a new treatment option for this population of patients that is highly effective and has minimal side effects." First author is Sara Tolaney, MD, of the Dana-Farber Cancer Institute.

About 1 in 4 breast patients have HER2+ breast cancer, meaning their cancer cells have a receptor protein on the surface known as HER2 (Human Epidermal growth factor Receptor 2).

Herceptin is part of the well-established standard-of-care for higher-risk HER2+ patients. But there currently is no single standard treatment patients with the for lower-risk HER2+ biology. In these patients, their tumors are small and the cancer has not spread to lymph nodes. Some of these patients currently are not receiving Herceptin, while others are being treated with Herceptin plus more toxic chemotherapy drugs.

The new study finds that an in-between treatment -- Herceptin plus a single chemotherapy drug Taxol -- is highly effective, with few adverse effects. Of the 406 patients studied, only 3.2 percent experienced severe neuropathy and only 0.5 percent experienced symptoms of congestive heart failure, which resolved after they discontinued Herceptin.
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Tuesday, December 10, 2013

Drugs- Novel Drug Regimen Can Improve Stem Cell Transplantation Outcomes



Drugs- Novel Drug Regimen Can Improve Stem Cell Transplantation Outcomes
Novel Drug Regimen Can Improve Stem Cell Transplantation Outcomes

Dec. 9, 2013 — Adding bortezomib (Velcade) to standard preventive therapy for graft-versus-host-disease (GVHD) results in improved outcomes for patients receiving stem-cell transplants from mismatched and unrelated donors, according to researchers from Dana-Farber Cancer Institute.

In a new phase 2 trial, patients treated with bortezomib had lower rates of severe acute GVHD and treatment-related mortality, and experienced better one-year overall survival than has been seen historically with such patients receiving standard preventive therapy, the investigators reported at the American Society of Hematology annual meeting.

“This regimen appears to improve not just GVHD prevention but more importantly, overall and relapse-free survival for myeloablative transplant recipients lacking matched sibling donors,” said John Koreth, MBBS, DPhil, of Dana-Farber, the lead author and study PI. The senior author is Edwin P. Alyea, III, MD, also of Dana-Farber.

Stem cell transplantation following myeloablation (high-dose chemotherapy to wipe out the patient’s bone marrow and immune system) is a curative therapy in advanced or aggressive hematologic malignancies, Koreth said. However, recipients who lack preferred matched sibling donors have worse outcomes, with higher treatment-related mortality and severe GVHD, and poorer survival.

Bortezomib, a proteasome inhibitor drug, is a mainstay of treatment for multiple myeloma. In addition to killing cancer cells, bortezomib dampens some immune responses, suggesting it may have a role in mitigating GVHD, the result of donor immune cells attacking the transplant recipient’s normal tissues.

The prospective, single-arm phase 2 trial of a bortezomib-based regimen enrolled 34 patients with hematologic malignancies who received myeloablative stem cell transplants. In addition to standard GVHD prophylaxis medications – tacrolimus and methotrexate - the patients received three doses of bortezomib (on the first, fourth and seventh day after transplant). The treatment was well-tolerated with no patients missing doses because of toxicity.

Historically, recipients of unrelated and mismatched donor transplants have severe acute GVHD rates of 28 percent and 37 percent, respectively, with one-year treatment-related mortality of 36 percent and 45 percent, respectively, and one-year overall survival of 52 percent and 43 percent, respectively.

In patients treated with bortezomib in the new study, the rate of severe acute GVHD at 180 days after transplant was only 12 percent. By two years, only 8.8 percent of patients had died from treatment-related mortality, and 5.9 percent had died from disease relapse. Overall survival at two years was high at 84 percent.
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Diabetes -Identified as Risk Factor for Liver Cancer Across Ethnic Groups



Diabetes -Identified as Risk Factor for Liver Cancer Across Ethnic Groups
Diabetes Identified as Risk Factor for Liver Cancer Across Ethnic Groups

Dec. 9, 2013 — Diabetes was associated with an increased risk for developing a type of liver cancer called hepatocellular carcinoma, and this association was highest for Latinos, followed by Hawaiians, African-Americans, and Japanese-Americans, according to results presented here at the Sixth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9.
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"People with diabetes have a two- to threefold higher risk for hepatocellular carcinoma compared with those without diabetes," said V. Wendy Setiawan, Ph.D., assistant professor in the Department of Preventive Medicine at Keck School of Medicine of the University of Southern California. "We also found that the interethnic differences in the prevalence of diabetes were consistent with the pattern of hepatocellular carcinoma incidence observed across ethnicities: Ethnic groups with a high prevalence of diabetes also have high hepatocellular carcinoma rates, and those with a lower prevalence of diabetes have lower hepatocellular carcinoma rates."

The number of new cases of hepatocellular carcinoma in the United States tripled in the past three decades, with Latinos and African-Americans experiencing the largest increase in incidence. Prior research has suggested that diabetes may be a risk factor for hepatocellular carcinoma, and its increasing incidence may be contributing to the rising rate of hepatocellular carcinoma.

"People with diabetes should be aware that their condition is associated with a higher risk of developing hepatocellular carcinoma," Setiawan said. "Maintaining a healthy weight, managing their diabetes, preventing and treating hepatitis infection, and limiting alcohol and tobacco use should be in their priority to-do list."

In addition, Setiawan said that public health efforts encouraging obesity/diabetes prevention and effective diabetes management should be directed at high-risk populations.

Setiawan and colleagues examined if the association between diabetes and hepatocellular carcinoma differed by race/ethnic group. They analyzed data from more than 150,000 people enrolled in the Multiethnic Cohort Study between 1993 and 1996. During the study follow-up period of about 15 years, 506 cases of hepatocellular carcinoma were reported: 59 cases in non-Hispanic whites, 81 in African-Americans, 33 in Hawaiians, 158 in Japanese-Americans, and 175 in Latinos.

Compared with non-Hispanic whites, Latinos had 2.77 times the risk for being diagnosed with hepatocellular carcinoma, the highest risk identified. Native Hawaiians had 2.48 times the risk; African-Americans, 2.16; and Japanese-Americans, 2.07.

The prevalence of diabetes was consistent with that of hepatocellular carcinoma. Sixteen percent of Hawaiians, 15 percent of Latinos and African-Americans, 10 percent of Japanese-Americans, and 6 percent of non-Hispanic whites had diabetes. Compared with those without diabetes, Latinos with diabetes had 3.3-fold higher risk for hepatocellular carcinoma; Hawaiians, 2.33-fold higher risk; Japanese-Americans, 2.02-fold higher risk; African-Americans, 2.02-fold higher risk; and non-Hispanic whites had 2.17-fold higher risk.

Hepatocellular carcinoma was attributed to diabetes in 26 percent of cases in Latinos, 20 percent of Hawaiians, 13 percent of African-Americans, 12 percent of Japanese-Americans, and 6 percent of non-Hispanic whites, the researchers estimated. According to Setiawan, eliminating diabetes could potentially reduce hepatocellular carcinoma incidence in all racial/ethnic groups, with the largest potential reduction possible in Latinos.
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Friday, November 29, 2013

Diet-Vitamins Potential Damage to Body's Defences



Diet-Vitamins Potential Damage to Body's Defences
Vitamins Potential Damage to Body's Defences
Nov. 26, 2013 — Vitamin supplements are a billion-dollar industry. We want to stay healthy and fit and help our bodies with this. But perhaps we are achieving precisely the opposite?

"We believe that antioxidants are good for us, since they protect the cells from oxidative stress that may harm our genes. However, our bodies have an enormous inherent ability to handle stress. Recent research results show that the body's responses to stress in fact are important in preventing our DNA from eroding. I fear that the fragile balance in our cells can be upset when we supplement our diet with vitamin pills, says Hilde Nilsen to the research magazine Apollon. Nilsen is heading a research group at the Biotechnology Centre, University of Oslo.

Maintenance of genes
Our DNA - the genetic code that makes us who we are - is constantly exposed to damage.
In each of the hundred trillion cells in our body, up to two hundred thousand instances of damage to the DNA take place every day. These may stem from environmental causes such as smoking, stress, environmental pathogens or UV radiation, but the natural and life-sustaining processes in the organism are the primary sources of damage to our DNA.

How can the repair of damage to our DNA help us stay healthy and live long lives?

A small worm provides the answer

To answer this question, Hilde Nilsen and her group of researchers have allied themselves with a small organism - a one millimetre-long nematode called Caenorhabditis elegans (C. elegans). This roundworm, which lives for only 25 days, is surprisingly sophisticated with its 20,000 genes; we humans only have a couple of thousand more.

C. elegans is a fantastically powerful tool, because we can change its hereditary properties. We can increase its ability to repair DNA damage, or we can remove it altogether. We can also monitor what happens when damage to DNA is not repaired in several hundred specimens and through their entire lifespan. Different "repair proteins" take care of various types of damage to the DNA. The most common ones are repaired by "cutting out" and replacing a single damaged base by itself or as part of a larger fragment.

Affecting lifespan with the aid of genes
In some specimens that do not have the ability to repair the damage, the researchers observe that the aging process proceeds far faster than normal. Is it because the damage accumulates in the DNA and prevents the cells from producing the proteins they need for their normal operation? Most researchers have thought so, but Hilde Nilsen doubts it.

One of the genes studied by the researchers has a somewhat shortened lifespan: on average, this mutant lives three days less than normal. Translated into human terms, this means dying at the age of 60 rather than at 70. -"We were surprised when we saw that these mutants do not in fact accumulate the DNA damage that would cause aging. On the contrary: they have less DNA damage. This happens because the little nematode changes its metabolism into low gear and releases its own antioxidant defences. Nature uses this strategy to minimize the negative consequences of its inability to repair the DNA. So why is this not the normal state? Most likely because it comes at a cost: these organisms have less ability to respond to further stress ‒ they are quite fragile.

Hilde Nilsen and her colleagues have now -for the very first time -"shown that this response is under active genetic control and is not caused by passive accumulation of damage to the DNA, as has been widely believed.

This provides an opportunity to manipulate these processes. And that's exactly what we have done: we have re-established the normal lifespan of a short-lived mutant by removing other proteins that repair damage. Hence, the cause could not be accumulation of damage, since there is no reason to assume that a mutant with no other alternative ways to repair its DNA will be less exposed to damage. There must be something else.

The researchers have gone on to discover that this "something else" in fact is the other repair proteins. They believe that the proteins inhibit damage that they fail to repair completely.

The consequence is that they establish a barrier - a road block. This triggers a cascade of signals that reprogram the cell.

Wouldn't this imply that the repair proteins defy their own purpose -"after all, the result is a shorter lifespan?

We need to remember that most likely, the purpose of the DNA repairs is to ensure that we produce healthy offspring -"not necessarily that we live as long as possible after our reproductive age interval. Initiating a survival response that reinforces the antioxidant defences means that a lack of ability to repair the DNA has less impact than it would otherwise have on our reproduction. To the species as a whole, it's a small cost that some individuals will be less good at handling stress and have a shorter life.

Because this is an active process within the cells, the researchers refer to it as reprogramming.

"We have found several proteins that trigger this reprogramming. The process has the same effect as a reduction in caloric intake, which we know helps increase the lifespan in many species. In other words, there are two routes to a long life. When we stimulate both of these two routes in our nematode at the same time, we can quadruple its normal lifespan," Nilsen says.

Can do great harm

The balance between oxidants and antioxidants is crucial to our physiology, but exactly where this equilibrium is situated varies from one person to the next.

"This is where I start worrying about the synthetic antioxidants. The cells in our body use this fragile balance to establish the best possible conditions for themselves, and it is specially adapted for each of us. When we take supplements of antioxidants, such as C and E vitamins, we may upset this balance," the researcher warns.

"It sounds intuitively correct that intake of a substance that may prevent accumulation of damage would benefit us, and that's why so many of us supplement our diet with vitamins. Our research results indicate that at the same time, we may also cause a lot of harm. The health authorities recommend that instead, we should seek to have an appropriate diet. I'm all in favour of that. It's far safer for us to take our vitamins through the food that we eat, rather than through pills," Hilde Nilsen states emphatically.
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