(Press-News.org) In patients with high-risk breast cancer, addition of the erythropoiesis-stimulating agent (ESA) epoetin alfa to the chemotherapy regimen may help avoid the decrease in hemoglobin levels and resulting anemia often seen in these patients and does not negatively affect relapse-free (RFS) or overall survival (OS). However, it can increase the risk of thrombotic events, according to a study published July 17 in the Journal of the National Cancer Institute.
To investigate the safety and efficacy of epoetin alfa, Volker Moebus, M.D., of the Department of Gynecology and Obstetrics, at the Klinikum Frankfurt Höchst in Frankfurt, Germany, and colleagues, conducted a second randomized study of patients in the intense dose-dense (IDD) chemotherapy arm of the AGO-ETC trial. Of 643 patients receiving the sequential chemotherapy regimen of epirubicin, paclitaxel, and cyclophosphamide, 324 were randomly assigned to receive the ESA epoetin alfa and 319 were assigned to the non-ESA group. The authors compared change in hemoglobin level, percentage of subjects requiring red blood cell (RBC) transfusion, incidence of thrombotic events, and, after a median follow-up of 62 months, OS, RFS and intra-mammary relapse in the two groups.
The researchers found that the patients in the non-ESA group had statistically significant reduction in hemoglobin levels and required more RBC transfusions than those in the ESA treatment group (28.1% vs 12.8%). ESA treatment had no impact on OS, RFS or intra-mammary relapse. However, patients treated with epoetin alfa were approximately twice as likely to experience thrombotic events compared with patients in the non-ESA group (7% vs 3%). The authors conclude that "…ESAs appear to be safe drugs for the treatment of chemotherapy-induced anemia in patients with IDD chemotherapy regimens."
In an accompanying editorial, Chau Dang, M.D., Clifford Hudis, M.D., and Larry Norton, M.D., of the Memorial Sloan-Kettering Cancer Center in NY, write that the study of Moebus et al. "provides important evidence that ESAs may be safe in the curative treatment of cancer." However, they cite some limitations of the study, ie, a much larger sample size would be needed to unequivocally conclude that epoetin alfa had no effect on OS or RFS; the still unacceptably high transfusion rate (13%) in the ESA group; the high cost of ESAs given that they do not improve OS or RFS, and the approximately two-fold rate of thromboembolic events in the ESA group.
In a second editorial, Brian Leyland-Jones, M.B. B.S., Ph.D., of Edith Sanford Breast Cancer Research in SD, attempted to put this article into the context of the significant controversy surrounding this field, in terms of the effect of ESAs on overall survival, tumor progression and risk of thrombosis. He especially focused on trials where ESAs were prescribed within label. He noted that these drugs are powerful pharmacological tools, and in an era dominated by personalized medicine, should be prescribed according to individualized risk-benefit ratio.
###
Contact Info:
Article: Volker Moebus, M.D., volker.moebus@klinikumfrankfurt.de
Editorial #1: Chau Dang, M.D., dangc@mskcc.org
Editorial #2: Brian Leyland-Jones, M.D., brian.leyland-jones@sanfordhealth.org
Epoetin alfa reduces anemia in breast cancer patients with no negative impact on survival
2013-07-18
ELSE PRESS RELEASES FROM THIS DATE:
Exercise, endurance sports increase arryhthmia and heart failure risk in carriers of ARVD/C mutation
2013-07-18
A Johns Hopkins study finds that healthy people who carry a genetic mutation for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are at much higher risk of developing the symptoms of the life-threatening heart disease if they participate in endurance sports and frequent exercise. The study also suggests that those carriers who significantly cut back on their exercise regimen may reduce their risk or delay the onset of symptoms.
An article on the study results is published online July 17, 2013, in the Journal of the American College of Cardiology. ...
Bodychecking rules don't reduce concussions in elite hockey
2013-07-18
Recent changes in hockey rules regulating contact to the head have not reduced the number of concussions suffered by players during National Hockey League (NHL) season, according to research published July 17 in the open access journal PLOS ONE by Michael Cusimano and colleagues from the Injury Prevention Research Office at St. Michael's Hospital, Canada.
The authors compared reports hockey players suffering concussions in the National Hockey League (NHL) before and after rules regulating head contact were changed in 2010-11 and 2011-12. Based on official game records ...
Plant-eating dinosaurs replaced teeth often, carried spares
2013-07-18
VIDEO:
This is a CT-generated movie of the premaxilla of Diplodocus (YPM 4677), with bone rendered transparent and teeth opaque.
Click here for more information.
Some of the largest herbivorous dinosaurs replaced their teeth at a rate of approximately one tooth every 1-2 months to compensate for tooth wear from crunching up plants, according to research published July 17 in the open access journal PLOS ONE by Michael D'Emic from Stony Brook University and colleagues from other ...
Keeping the reserve force home
2013-07-18
KANSAS CITY, MO - Hematopoietic stem cells—bone marrow-derived adult stem cells that give rise to the wide variety of specialized blood cells—come in two flavors: the reserve force sits quietly waiting to be called upon while the active arm continually proliferates spawning billions of blood cells every day. In their latest study, researchers at the Stowers Institute for Medical Research reveal a new mechanism that is critical in maintaining the delicate balance between the two.
Publishing in the July 17 advance online issue of Nature, the team led by Stowers Investigator ...
Protein responsible for 'bad' blood vessel growth discovered
2013-07-18
The discovery of a protein that encourages blood vessel growth, and especially 'bad' blood vessels – the kind that characterise diseases as diverse as cancer, age-related macular degeneration and rheumatoid arthritis – has been reported in the journal Nature.
The team at the UCL Institute of Ophthalmology discovered the new protein, called LRG1, by screening for mouse genes that are over-expressed in abnormal retinal blood vessels in diseased eyes.
In these diseased retinas the LRG1 protein is expressed by blood vessel endothelial cells, which line blood vessel walls. ...
Molecular switch controls the destiny of self-eating cells
2013-07-18
The study is the result of a collaboration of scientists at Karolinska Institutet in Sweden, University of Michigan, and University of California San Diego, USA, who were interested in finding out whether autophagy can be affected by events in the cell nucleus. Surprisingly, they discovered that a signal chain in the nucleus serves as a kind of molecular switch that determines whether the cell dies or survives.
Put simply autophagy is a process whereby the cell consumes parts of itself, and is a way for it to clean up abnormal lumps of proteins and rid itself of damaged ...
Routine tasks pose problems for older individuals with vitamin D deficiency
2013-07-18
Chevy Chase, MD—Vitamin D-deficient older individuals are more likely to struggle with everyday tasks such as dressing or climbing stairs, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
Scientists estimate many as 90 percent of older individuals are vitamin D deficient. The vitamin – typically absorbed from sunlight or on a supplementary basis through diet – plays a key role in bone and muscle health. Vitamin D deficiency can lead to a decline in bone density, muscle weakness, osteoporosis ...
PFC exposure tied to altered thyroid function
2013-07-18
Chevy Chase, MD—Exposure to perfluorinated chemicals is linked to changes in thyroid function and may raise the risk of mild hypothyroidism in women, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
Perfluorinated chemicals, or PFCs, are compounds used to manufacture fabrics, carpets, paper coatings, cosmetics and a variety of other products. Among humans and wildlife, PFC exposure is widespread, according to the National Institutes of Health's National Institute of Environmental Health ...
UMMS scientists show proof-of-principal for silencing extra chromosome responsible for Down syndrome
2013-07-18
WORCESTER, MA – Scientists at the University of Massachusetts Medical School are the first to establish that a naturally occurring X chromosome "off switch" can be rerouted to neutralize the extra chromosome responsible for trisomy 21, also known as Down syndrome, a genetic disorder characterized by cognitive impairment.
The discovery provides the first evidence that the underlying genetic defect responsible for Down syndrome can be suppressed in cells in culture (in vitro). This paves the way for researchers to study the cell pathologies and identify genome-wide pathways ...
Bees under threat from disease-carrying bumblebee imports, research reveals
2013-07-18
Stricter controls over bumblebee imports to the UK are urgently required to prevent diseases spreading to native bumblebees and honeybees, scientists have warned. The call follows the discovery of parasites in over three-quarters of imported bumblebee colonies they tested. The study - the first of its kind in the UK - is published today in the Journal of Applied Ecology.
While wild species of bees and other insects pollinate many crops, commercially-reared and imported bumblebees are essential for pollination of greenhouse crops such as tomatoes. They are also used to ...