Clinical Abstracts from Overseas: June 2007

By Stanton R. Mehr
Published: Wednesday, Jul 14, 2010

     Hopes for Trastuzamab Use in Endometrial Cancer

The link between HER-2/neu receptors and endometrial cancer is growing stronger, and this may point the way to treatment with existing therapies, according to research conducted in Norway.

Samples from 316 patients with endometrial carcinoma were used to determine the presence of these receptors, found in many patients with breast cancer, and overall how epidermal growth factor receptor (EGFR) was expressed in this tissue. The researchers found that in 23% of the patients, the preoperative curettage material had evidence of HER-2/neu expression. The study also revealed that 25% of patients had overexpression of EGFR, but this was not correlated with any prognostic measures. They did find that those tumors with HER-2/neu overexpression were related to aggressive growth and proliferation.

Presenting their findings at the 2007 American Association of Cancer Researchers annual meeting in Los Angeles, the Norwegian researchers stated that these samples also demonstrated lower levels of estrogen and progesterone receptors compared with tissue that did not show HER-2/neu overex¬pression.

Since trastuzamab is used as a first-line therapy in patients with breast cancer associated with HER-2/neu receptors, it is hoped that trastuzamab can also be useful in patients with endometrial tumors expressing this receptor. A large trial is being undertaken in the United States to test its efficacy for endometrial carcinoma.

   Engelson IB, Stefansson IM, Beroukhim R, et al: HER-2/neu expression is associated with increased tumor cell proliferation, loss of hormone receptors, and an aggressive phenotype in a population-based setting of endometrial carcinomas. Presented at the 2007 annual meeting of the American Association of Cancer Researchers, Los Angeles, April 18, 2007.


     New Guidelines Highlight Use of Bisphosphonates in Elderly Patients With Bone Metastases

Used in the United States for many years in younger patients with bone cancer, bisphosphonate agents have been especially valuable in treating hypercalcemia. However, little data exist regarding their use in elderly patients, and physicians have often been warned to be careful in their choice of bisphosphonate because of problems in those with impaired renal function. The International Society of Geriatric Oncology, based in Genolier, Switzerland, had recently completed a literature review on this population and issued its recommendations.

The Society’s task force, headed by Belgian physicians, specified that not only are intravenously administered bisphosphonates preferred for the treatment of hypercalcemia, but these agents (all forms) are desirable for the prevention of brittle bones in patients with bone metastases.

The guidelineauthors also specified that ibandronate, pamidronate, and zoledronic acid are effective at relieving acute pain in patients with bone metastases.

Creatinine clearance should be monitored because of possible renal impairment, and a drug that is less toxic to the kidneys (e.g., ibondronate) may be preferable in certain patients. Another possible side effect of bisphosphonate therapy is osteonecrosis of the jaw; the guidelines suggest that oral and dental examination be conducted before initiating therapy.

The task force noted that although the literature does address the elderly population with osteoporosis taking these products, more research is needed to further define the role of bisphosphonates in geriatric populations with bone metastases.

   Body JJ, Coleman R, Clezardin P, et al: International Society of Geriatric Oncology (SIOG) clinical practice recommendations for the use of bisphosphonates in elderly patients. Eur J Cancer 2007 Mar;43(5):852-8. Epub 2007 Jan 26.


     Bringing Out All of the Artillery to Fight Mesothelioma

The treatment of pleural mesothelioma has hinged on catching the disease early, attempting surgical resection, and hoping (with little success) that metastases did not occur. In advanced-stage disease, management strategy in general consisted of palliative care only. Italian researchers have tried a new approach to the disorder— a complex, staged approach using four modalities—have reported some success in a nonrandomized, noncontrolled study.

In this phase II trial, 49 patients (41 men; median age, 61 yr) with stage II to III disease were studied over a six-year period. First, they were given interleukin-2 (18 X 106 IU/ day for three days) administered through the pleura. The patients then underwent pleurectomy and decortication. Postoperatively, they were given epidoxorubicin (25 mg/m2 for three days) administered intrapleurally, with another cycle of interleukin-2 therapy, adjuvant radiotherapy (30 Gy), up to six cycles of systemic chemotherapy with cisplatin and gemcitabine. Finally, their long-term therapy comprised interleukin-2 (3 X 106 IU/day) given subcutaneously.

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