Click here to view as PDF.â–º News from the International Symposium on Supportive Care in OncologyCancer Management in the Era of Targeted Agents
Highly targeted chemotherapeutic agents, which have emerged over the past decade, offer renewed hope to many patients diagnosed with cancers once considered difficult or impossible to treat. However, with the new hope many of these “super drugs” bring come new challenges in the management of side effects, some which can become debilitating enough to interfere with cancer treatment. These cross-discipline challenges were the focus of the Sixth International Symposium on Supportive Care in Oncology: Cancer Management in the Era of Targeted Agents held in New York City on February 22–23. Following are just some of the topics addressed; for a full list visit www.cancerconferences.com.
â–º Tamoxifin and Aromatase Inhibitors Affect Bone Health Differently in Patients With Breast CancerDiet and exercise become an even greater part of protecting bone health in patients with cancer
While aromatase inhibitors (AIs) are emerging as an additional treatment option for some women with early-stage breast cancer instead of tamoxifen, women taking tamoxifen generally have more bone mass and less bone fractures. This finding will be reflected in new treatment guidelines presented at the annual American Society of Clinical Oncology (ASCO) meeting in May 2008.
The new guidelines will consider when or if oncologists should intervene when a breast cancer patient on chemotherapy shows bone deterioration and how to treat it.
“Oncology specialists need to take an expanded role in routine and regular assessment of bone health in women receiving breast cancer treatment,” said Dr. Julie Gralow, director of the clinical research unit and Women’s Cancer Research program at Jonsson Comprehensive Cancer Center, UCLA School of Medicine.
The findings on the effect of AIs versus selective estrogen receptor modulators (SERMs) like tamoxifen on bone health emerged from the Anastrazole Prevents Relapse in Early Breast Cancer (ATAC) Trial, published in 2005. Anastrozole (Arimidex) was significantly better than tamoxifen (Nolvadex) (or the combination of tamoxifen and anastrozole) in terms of preventing a recurrence of breast cancer in postmenopausal women whose early-stage tumors were hormonesensitive, according to the National Cancer Institute. Patients taking anastrozole also experienced fewer serious side effects (endometrial cancer, blood clots, vaginal bleeding, hot flashes). Anastrozole is now considered a standard adjuvant treatment for this group of patients.
Yet bone fractures and joint pain were up to 50% more likely to occur among the anastrozole group, according to Dr. Gralow, who says this may be caused by in part the drug’s negative effect on the ability of estrogen to reach bone cells.
Preliminary results from some ongoing studies suggest ways oncologists can slow or prevent the loss of bone mass in women taking AIs. The Zometa-Femara Adjuvant Synergy Trial (Z-FAST) and the SABRE Trials showed the addition of bisphosphonates may prevent bone fractures, although Dr. Gralow said bone fractures began showing up 36 months into the Z-FAST trial. Other trials include an ongoing phase III trial examining the combination of a RANK ligand inhibitor (Amgen’s denosumab) with AIs to increase bone density of the spine. Another trial currently open for enrollment (S0307) is examining whether adding a bisphosphonate to hormonal therapy or chemotherapy will help prevent cancer from spreading to the bones or other parts of the body.
Before adding any osteoporosis drug to a breast cancer patient’s care plan, however, Dr. Gralow emphasized oncologists need to coordinate care with other doctors women with breast cancer may be seeing. “Oncologists need to make sure that other doctors are not giving patients osteoporosis drugs which may be adversely interacting with their chemotherapy regimens,” she said.
Steps oncologists can take now to protect the bone health of their breast cancer patients include the addition of calcium and vitamin D to their diets. Dr. Gralow said she regularly gives out information from the National Institutes of Health Office of Dietary Supplements (http://dietary-supplements. info.nih.gov) to her own patients. She also encourages them to exercise regularly and incorporate weight-bearing exercises into their daily lives.
“All of my patients have to exercise,” she said, “although they usually start two weeks before they have to see me.”
â–º Management of Peripheral Neuropathy, Thrombocytopenia With Proteasome Inhibitor UseMultiple myeloma, mantle-cell Lymphoma patients require close monitoring and adjustments
Proteasome inhibitors like bortezomib (Velcade) have given new treatment options to oncologists and patients grappling with difficult-to-treat cancers like multiple myeloma (MM) and mantle cell lymphoma. But along with new hope, newer drugs have brought an increase in adverse events oncologists need to be aware of so that they can most effectively manage/optimize treatment and the benefits they confer.