Obesity Drug Helps Unlock Clues About Cancer

An approved drug for fighting obesity is helping scientists at Wake Forest University School of Medicine uncover clues about how to stop the growth of cancerous tumors.

"Our discovery makes an exciting treatment target because theoretically you don't have to worry about harming nearby healthy tissue," said senior researcher Steven J. Kridel, Ph.D., an assistant professor in the Department of Cancer Biology.

In the current issue of Cancer Research, Kridel and colleagues are the first to report that a tubular network within cells, known as the endoplasmic reticulum (ER), is regulated by an enzyme that is tightly linked to tumor growth and development.

"When the ER cannot do its job properly, there's a series of events that gets turned on that can lead to cell suicide or death," said Kridel.

The research showed that an enzyme known as fatty acid synthase is vital for the ER to do its job. Blocking this enzyme, which makes fat in cells, has been shown to prevent tumor cell growth and to promote cell death.

"No one had made connection before between fatty acid synthase and the function of the ER in tumor cells," said Kridel. "This is the first to show that fatty acid synthesis is important in maintaining ER function and keeping tumor cells alive."

The researchers started the work five years ago when they analyzed prostate cancer cells to see which proteins and enzymes were expressed at high levels. Their hope was that treatments that reduced those levels could also stop tumor growth.

"We found that fatty acid synthase is expressed at high levels in tumor cells, but is fairly absent in normal cells," said Kridel. "Other researchers had made similar findings in other types of cancer cells, so we decided to follow up because it looked promising.

"We then made the surprising finding that OrlistatTM, a drug approved by the FDA to treat obesity, can block the function of fatty acid synthase, prevent tumor cell growth and promote tumor cell death."

Finding out exactly how the drug worked was the next step, so that better treatments could be developed. While effective in mice, Olistat's current formulation cannot be given to humans as a cancer treatment because it acts only in the digestive tract.

In the current study, Kridel and colleagues treated prostate, colon and cervical cancer cells in the laboratory with Olistat and two other agents to understand why blocking fatty acid synthase induces cell death.

"Our goal was to understand how fatty acid synthase contributes to tumor growth," said Kridel. "This might provide an explanation for why this enzyme is expressed at high levels."

Now that the scientists understand that the ER is involved -- and that inhibiting fatty acid synthase can impair its function -- they are working to develop new treatments for cancer therapy.

They are exploring the possibility of using existing FDA-approved drugs, as well as developing new drugs. They've already determined that the structure of Orlistat bound to fatty acid synthase, which is the first step in developing similar agents that could be used in humans.

"Our latest findings that connect fatty acid synthase and ER function gives us a better understanding about how the drug kills tumor cells and give us clues to make better drugs," said Kridel. "For any drugs we develop, we'll need to show that they impair the function of the ER."

###

The study was supported by the Department of Defense Prostate Cancer Research Program.

Co-researchers were graduate student Joy Little, B.S. , lead author, Frances Wheeler, B.S., and Daine Fels, B.S., all with Wake Forest, and Constantinos Koumenis, Ph.D., who was at Wake Forest at the time of the study and is now at the University of Pennsylvania School of Medicine.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in family medicine, 20th in geriatrics, 25th in primary care and 41st in research among the nation's medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

IPP-SHR - Free Online Full Text Access For Leading Austral-Asian Cancer Journal

The AJC is offering readers free online subscription, which enables members to access full text articles and participate in the journal's interactive user forums.

The AJC is the first international cancer journal to be published in Austral-Asia. It is a peer-reviewed, multidisciplinary journal that focuses upon all biomedical and psycho-social aspects of cancer treatment and research.

The Austral-Asian Journal of Cancer's (AJC) new direction ensures its online presence compliments its aim of disseminating information on cancer research to all interested practitioners, scientists, researchers and students, irrespective of their ability to pay.

This provision of free online access to the journal's entire content is intended to promote cutting-edge cancer research in both developing and developed countries.

According to AJC consultant, Mr Hamish Holewa, "allowing full access to online articles and professional user forums is a major step forward for the AJC."

"This initiative resonates with our ethos of providing information to those in developing and developed countries and making a difference at the coalface of healthcare," said Mr Holewa.

Online subscription to the AJC will grant users access to the full content of the journal's latest issue, in addition to that of its previous seventeen issues.

To subscribe or find out more about this journal, visit www.ajcancer.ipp-shr.cqu.edu.au.

Tarceva : European Approval For Pancreatic Cancer Treatment

Roche's innovative cancer drug Tarceva (erlotinib), has been approved today by the European Commission for the treatment of patients with metastatic pancreatic cancer, in combination with a standard chemotherapy, gemcitabine. Tarceva is the first treatment in over a decade to have shown a significant survival benefit in treating patients with this devastating disease. Pancreatic cancer has the highest one-year mortality rate of any cancer and is Europe's sixth deadliest cancer.1

"This is a much needed treatment advance for patients suffering with this difficult-to-treat disease," said William M. Burns, CEO Roche Pharmaceuticals. "The approval of Tarceva in combination with gemcitabine chemotherapy offers patients and their families some real hope."

The approval was based on data from the pivotal PA.3 Phase III Study,2 which show that for patients with metastatic disease, treatment with Tarceva plus gemcitabine results in significantly longer survival (25 percent) compared to gemcitabine alone. In addition, a higher percentage of these patients were alive at 12 months in the group treated with Tarceva plus gemcitabine, compared to those treated with chemotherapy alone (21 percent v. 15 percent). The approval follows a positive recommendation from the European Committee for Medicinal Products for Human Use (CHMP) in December 2006.

Pancreatic cancer is the sixth most frequently occurring cancer in Europe.1 In 2002, there were more than 78,000 new cases of pancreatic cancer diagnosed in Europe, with a death rate of approximately 82,000 people per year. 3 Pancreatic cancer is difficult to treat as it is often resistant to chemotherapy and radiotherapy and tends to spread quickly to other parts of the body, leading to a short life expectancy.

"Tarceva generates renewed optimism for patients and physicians," said Professor Eric Van Cutsem, of the University Hospital of Gasthuisberg, Belgium. "This approval marks a clear step forward in providing them with another treatment option for battling this terrible disease."

About the PA32 study

The results of the double-blind, placebo-controlled Phase III study conducted by the National Cancer Institute of Canada, Clinical Trials Group at Queens University and involving 569 patients showed:

-- Treatment with Tarceva plus gemcitabine in patients with metastatic pancreatic cancer resulted in significantly improved overall survival compared to gemcitabine alone (25%)

-- 21% of these patients receiving Tarceva plus gemcitabine were alive after one year, compared to 15% on gemcitabine alone

-- Overall, patients receiving Tarceva plus gemcitabine experienced significantly longer progression-free survival of 30%

-- Tarceva plus gemcitabine was generally well tolerated by patients

Tarceva plus gemcitabine is already approved for the treatment of locally advanced, unresectable or metastatic pancreatic cancer in 15 countries including America and Australia. Tarceva is approved in the US and across the European Union for patients with locally advanced or metastatic non small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen.

About Tarceva

Tarceva (erlotinib) is a small molecule that targets the human epidermal growth factor receptor (HER1) pathway. HER1, also known as EGFR, is a key component of this signalling pathway, which plays a role in the formation and growth of numerous cancers. Tarceva blocks tumour cell growth by inhibiting the tyrosine kinase activity of the HER1 signalling pathway inside the cell.

Taken as an oral, once-daily therapy, Tarceva is the only EGFR-inhibitor to have demonstrated a survival benefit in lung and pancreatic cancer. Currently most lung and pancreatic cancer patients are treated wholly with chemotherapy which can be very debilitating due to its toxic nature. Tarceva works differently to chemotherapy by specifically targeting tumour cells, and avoids the typical side-effects of chemotherapy.

Tarceva is approved in the US and across the European Union for patients with locally advanced or metastatic non small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen. It is also approved in the US for the first-line treatment of patients with locally advanced, unresectable or metastatic pancreatic cancer, in combination with gemcitabine chemotherapy. Tarceva is currently being evaluated in an extensive clinical development programme by a global alliance among OSI Pharmaceuticals, Genentech and Roche, focussing on earlier stages of NSCLC. Additionally, Tarceva is being studied in combination with Avastin in NSCLC and in a wide variety of other solid tumour types.

About Roche

Headquartered in Basel, Switzerland, Roche is one of the world's leading research-focused healthcare groups in the fields of pharmaceuticals and diagnostics. As a supplier of innovative products and services for the early detection, prevention, diagnosis and treatment of disease, the Group contributes on a broad range of fronts to improving people's health and quality of life. Roche is a world leader in diagnostics, the leading supplier of medicines for cancer and transplantation and a market leader in virology. Roche employs roughly 70,000 people in 150 countries and has R&D agreements and strategic alliances with numerous partners, including majority ownership interests in Genentech and Chugai. Additional information about the Roche Group is available on the Internet (http://www.roche.com).

All trademarks used or mentioned in this release are protected by law.

References

1) Michaud DS. 2004. Epidemiology of pancreatic cancer Minerva Chir. Apr; 59(2):99-111
2) Moore MJ, Goldstein D, Hamm J, et al. Erlotinib plus gemcitabine compared to gemcitabine alone in patients with advanced pancreatic cancer. A Phase III trial of the National Cancer Institute of Canada Clinical Trials Group [NCIC-CTG]. (Abstract #1, ASCO 2005)
3) Ferlay J et al. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, Version 2.0, Lyon; IARC Press 2004

Roche
http://www.roche.com

Saving More Breasts

A single tissue sample reveals if you have breast cancer with spread. That means the most aggressive cancer types can be detected at an early stage.

Every year 2800 Norwegian women are diagnosed with breast cancer. Some 800 of them die. The sooner the cancer is detected, the better the chances of survival.

A new method makes it possible to detect the most aggressive types far earlier than previously. At the same time, women with a 'mild' type could be notified quickly that they are out of danger and not have to carry their fears for months without reason.

Ingrid Gribbestad's research group at the MR Centre at The Norwegian University of Science and Technology (NTNU) in Trondheim has been a pioneer in the work of developing the method. The innovation involves looking at the biopsies (breast tissue samples) at molecular level.

"Today, we have to study the cancerous tumours in microscopes and observe the dangerous changes with our bare eyes. We operate on the lower level when it comes to size," Gribbestad says.

Molecular prints

The method involves taking a 'fingerprint' of the molecules in the tissue sample. The principle is already used for liquids such as oil and wine: Fish oils can be traced back to where the salmon came from, while the content of a wine bottle can be traced to a specific vineyard. However, nobody else in the world has managed to transfer the method to a medical analysis of breast cancer before.

"There is no doubt that we are at the top internationally in this area," says Gribbestad.

Based on a normal fingerprint, detectives can say something about the owner's looks and criminal record, if the person's identity is known. In the same way, Gribbestad can say something about the behaviour of a particular cancerous tumour if she knows the history and the molecules of the tumour in question.

That makes it possible, for instance, to establish whether the cancer in this tissue has spread to lymph nodes elsewhere in the body.

Disease profile adaptation

"Another positive aspect is that this 'fingerprint' also indicates whether the patient will respond to the medical treatment we initiate," Gribbestad explains.

That makes it possible to find the patients that should be given chemotherapy even before the operation. In addition, cases where it is safe to remove only the affected tissue instead of the entire breast will be easier to find. More breasts will be spared.

"With this we leave the group treatment for the benefit of individual treatment adapted to each patient's disease profile," concludes Ingrid Gribbestad.

About the THE NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY (NTNU)

The Norwegian University of Science and Technology (NTNU) in Trondheim represents academic eminence in technology and the natural sciences as well as in other academic disciplines ranging from the social sciences, the arts, medicine, architecture to fine arts. Cross-disciplinary cooperation results in ideas no one else has thought of, and creative solutions that change our daily lives.

NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY (NTNU)
Gloshaugen
http://www.ntnu.no/indexe.php

Higher-Volume Hospitals May Be Better Choice For Breast Cancer Surgery

When it comes to breast-cancer operations, a new study suggests that experience may be crucial: fewer patients die at hospitals that perform more surgeries.

So you should go to a hospital that performs the most surgeries, right? Not necessarily. While researchers see a connection between the number of surgeries and death rates, they still don't understand the full equation.

"We're not ready to say, 'You need to go see a surgeon who has done this many operations, or to a hospital that's done this many operations," said study lead author Mary Ann Gilligan, M.D, associate professor of medicine at the Medical College of Wisconsin. "Really, what [the study] is doing is raising some issues that need to be further evaluated."

Gilligan and colleagues looked at 11,225 Medicare patients who were treated for early-stage breast cancer between 1994 and 1996. The patients were treated at 457 hospitals.

The risk of dying from breast cancer was 20 percent lower in hospitals that performed a high number of breast-cancer surgeries. The risk of dying from all causes was 17 percent lower for patients treated in those hospitals.

The study appears in the March issue of the American Journal of Public Health.

Other studies have shown that more experienced surgeons do a better job with the most technically demanding cancer surgeries, such as those for esophageal or pancreatic cancer, Gilligan said.

But the breast cancer numbers leave plenty of room for speculation, she said. "It may not be the surgical expertise at all. It may be that these hospitals that have higher volumes have systems in place [with] better follow-through, making sure the patients are getting the follow-up they need."

It makes sense that hospitals with the most practice would have the best survival rates, said Pushpendu Banerjee, M.D., an oncologist at Scripps Memorial Hospital La Jolla, in California.

"If you tend to do something on a repetitive basis and you do higher numbers, you're more likely to be better at it," he said. "That's the nature of human beings no matter what we do."

But there are caveats: Smaller hospitals might be home to a single surgeon with an excellent record, Banerjee said. And a busy hospital could be an exception to the rule. "You can't jump to conclusions that a high-volume place will definitely be better for you," he said.

The American Journal of Public Health is the monthly journal of the American Public Health Association. Visit http://www.apha.org for more information.

Gilligan MA, et al. Relationship between hospital volume of breast cancer operations and 5-year survival after treatment for early stage breast cancer. Am J Public Health 97(3), 2007.

Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
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Patients At High Risk For Melanoma Benefit When Partner Is Involved In Skin Self-Exams

Early detection of melanoma, the most serious form of skin cancer, is critical to effectively treat this potentially fatal disease that accounts for more than 73 percent of all skin cancer deaths. While dermatologists have long stressed the importance of conducting regular skin self-exams as an important detection tool in the fight against skin cancer, a new study finds that people who are assisted by a partner in performing skin self-exams are more likely to follow a regular detection routine than those who rely solely on themselves for motivation.

Speaking today at the 65th Annual Meeting of the American Academy of Dermatology, dermatologist June K. Robinson, MD, FAAD, professor of clinical dermatology at Northwestern University Feinberg School of Medicine in Chicago, discussed her article entitled "Examination of mediating variables in a partner assistance intervention designed to increase performance of skin self-examination" to be published in an upcoming issue of the Journal of the American Academy of Dermatology.

"There is evidence suggesting that deaths from melanoma could be lowered by as much as 63 percent if the general public performed monthly skin self-examinations," said Dr. Robinson. "However, routine skin self-exams may be even more important in people at high risk for skin cancer, such as those with a personal or family history of skin cancer. Our study examined how involving a partner affected detection attitudes and behaviors in a group of patients with melanoma or atypical moles."

Study participants included 130 patients with a history of melanoma who were randomly assigned to either a solo-learning control group or a partner-learning group (65 participants in each group). Partners were either a spouse of the participant or a person living in the same household as the participant for at least one year prior to the study.

At the beginning of the study, participants in each group (including partners) received instructions that included a 10-minute educational presentation, a skills training session about the rules of early melanoma detection, and a demonstration using a magnifying glass to look for moles with irregular borders and uneven colors. Each participant was given a take-home kit that consisted of a brochure, a lighted handheld magnifying glass and a bound set of body maps consisting of several diagrams of the body with a place to mark areas that were examined and any suspicious lesions. Using the body maps to document moles served as the key behavioral measure of the monthly examinations.

In conducting this study, Dr. Robinson and her team theorized that involving a partner would increase the likelihood of conducting regular skin self-exams by providing social support and modeling behaviors for the exams, by assisting participants in examining hard-to-see places and by helping participants understand the instructions and information provided to complete the study.

"Our study showed that participants in the partner-learning group were significantly more likely to conduct skin self-exams at the four-month follow-up compared with those in the solo-learning group," noted Dr. Robinson. "When we compared how each group used the body maps, we found that participants assisted by a partner used them twice as much as participants without a partner."

In order to assess what factors had the greatest impact on increasing the effectiveness of involving a partner in the skin self-exams, Dr. Robinson and her team measured six core belief/attitudinal variables. The variables that were measured included:

-- Attitudes toward skin self-exams

-- Self-efficacy or confidence in the ability to effectively perform skin -- self-exams

-- Comfort with having a partner help with skin self-exams

-- Perceived melanoma/skin cancer risk

-- Concern about developing skin cancer/sun damage, and

-- Melanoma/skin cancer knowledge.

"Having a partner assist in skin self-exams led to significantly more positive attitudes toward the importance of skin self-exams, higher reports of self-efficacy or confidence in the ability to perform the exams and more comfort with someone helping to examine their skin compared with those in the solo-learning group," reported Dr. Robinson. "It is interesting to note that participants with partners had significantly less concern about developing sun-damaged skin in the future than participants in the solo-learning group. This could be attributed to the fact that those with a partner may have felt more confident than the solo learners in their ability to protect themselves from the sun."

The other two variables that were studied perceived risk of skin cancer and knowledge about skin cancer did not produce significantly different attitude changes among either group of participants.

"Across both study groups, we found that as attitudes about the importance of skin self-exams increased, behaviors increased as well," added Dr. Robinson. "While this short-term study demonstrated the positive effects of enlisting the help of a partner in performing skin self-exams, future research should be conducted to test whether the reported attitudinal and behavioral changes lead to sustained, long-term screening behaviors. In the meantime, patients should be encouraged to utilize a partner when performing skin self-exams."

To learn more about a skin self-exam, visit http://www.aad.org/aad/newsroom.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or http://www.aad.org.

American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
United States
http://www.aad.org

Percutaneous Computerized Tomography Guided Renal Cryoablation Using Local Anesthesia: Pain Assessment

UroToday.com- As the technique of laparoscopic and open cryoablation of renal tumors has been popularized, an increasing number of investigators have continued to raise the bar attempting similar ablations using a percutaneous technique.

In the September issue of the Journal of Urology, Permpongkosol, Kavoussi and colleagues from Johns Hopkins and North Shore-Long Island Jewish Health System report their experience with 25 patients with 30 renal tumors treated with cryoablation using only local anesthesia.

The mean patient age was 67 years (range 33 to 80) with a mean tumor size of 2.1 cm. Mean ice ball size was 4.1 cm. A mean of 44 cc of 1% lidocaine was injected in the skin, subcutaneous tissue, muscle and renal capsule along the tracts where the cryotherapy probes would be placed. Ablations were performed in the prone position using CT guidance with an average treatment time of 68 minutes. Pain scores were assessed during and after the procedure (scale 0 to 1).

Pain scores were zero before and after the procedure in all patients. Mean pain score after the first freeze was 1.8. Successful completion of ablation with local anesthesia only was completed in 85% of patients. Mean time to recovery was 112 minutes. Five complications occurred, including contrast allergy, transhepatic probe insertion with hematoma, perinephric hematoma with pleural effusion (2 units transfused), and 2 patients with transient nausea.

While these data suggest that percutaneous renal cryoablation using only local anesthesia is feasible, the question remains, what is the down-side of administering intravenous sedation in this setting, since it may be given with minimal morbidity with the added amnestic effects. Perhaps if a patient with a 2.1 cm mass has too many co morbidities to undergo conscious sedation, his renal mass should undergo active surveillance.

PermpongkosolВ S, SulmanВ A, SolomonВ SB, GongВ GX, KavoussiВ LR
J Urol 176(3): 915-918, 2006.

Reviewed by UroToday.com Contributing Editor Ricardo SГЎnchez-Ortiz, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

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Copyright © 2006 - UroToday

The Future Of Allogeneic Hematopoietic Stem Cell Transplantation For Metastatic Renal Cell Carcinoma In The Era Of Target-Specific Therapy

UroToday.com - Allogeneic hematopoietic stem cell transplantation (BMT) for metastatic renal cell carcinoma (RCC) was first reported by Childs in 1999. In that report, patients received a conditioning regimen of fludarabine/cyclophosphamide, prior to BMT. The incidence of acute graft versus host disease (GVHD, thought to be linked to tumor response) was 53% and chronic GVHD was 21%. Overall response rate was 53%, with 3 complete and 7 partial responses, although treatment related mortality was 11%.

Subsequently, 16 other studies examining the role of BMT in RCC have been published, involving 167 patients. In summary, these studies report an acute GVHD rate of 50%, a chronic GVHD rate of 30%, a treatment related mortality rate of 14%, and a significantly lower response rate of 22%. It should be noted that these patients, for the most part, had failed other prior therapies, had progressive disease, and had large tumor burdens. One limitation of this therapy is the need for a matched donor of stem cells, which can be identified only 20-30% of the time. More recent studies have examined the role of stem cells isolated from unrelated umbilical cord blood, which may circumvent the need for a matched donor.

In contrast, targeted therapies (sunitinib, sorafenib, bevacizumab, etc.) have demonstrated significant delays in time to progression, improved survival, but few, if any, clinically significant responses. For the most part, patients demonstrate minor responses or prolonged stabilization of disease, but no durable complete responses as those seen with immunotherapy such as interferon, interleukin 2, and BMT. Targeted therapy is rapidly becoming front line therapy for metastatic RCC due to the ease of administration and management of toxicity, thus raising the question as to whether there remains a role for immunotherapeutic approaches such as BMT in the future.

The authors conclude that there is, indeed, a role for BMT in the treatment of patients with metastatic RCC, but further refinements in the technology are required to improve efficacy, decrease toxicity, and minimize treatment related mortality before more widespread acceptance will occur. These include:

-- Identification of tumor specific antigens that can be targeted to minimize or eliminate the toxicity of GVHD.

-- Need to identify optimal standard conditioning regimen.

-- Need to identify sources of stem cells that will allow more widespread application of this treatment modality (such as umbilical cord blood).

-- Need for improved patient selection. Treatment related responses can take months to ensue after engraftment. Patients with rapidly progressive disease, large tumor burdens, or those that have failed multiple prior regimens demonstrate a biology that is not conducive to enduring this delay in time to treatment effect. To utilize this therapy, there is a 2-3 month window of preparative time prior to treatment, and therefore this modality should be considered early rather than late in the course of a patient's disease.

With these advances, the authors argue that BMT (and other immunotherapy approaches) remains a viable and attractive therapy for patients with metastatic RCC, due in large part to the higher incidence of durable responses when compared to the newer targeted therapies.

Ueno NT and Cheng YC
Bone Marrow Transplantation 38: 711-714, 2006.

Reviewed by UroToday.com Contributing Editor Christopher G. Wood, MD, FACS

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
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Copyright © 2006 - UroToday

Contribution Of 11C-Choline Positron Emission Tomography/Computerized Tomography To Preoperative Staging Of Advanced Transitional Cell Carcinoma

UroToday.com- The SWOG neoadjuvant trial published in the New England Journal of Medicine in 2003 suggested that select patients with locally advanced bladder cancer might benefit from chemotherapy before surgery. Even in the most experienced investigators, however, the question remains: what criteria should we use to select patients for neoadjuvant chemotherapy?

In the September issue of the Journal of Urology, Gofrit and colleagues from the Hadassah-Hebrew University Medical Center present encouraging data suggesting that PET CT may identify patients with metastatic bladder cancer.

A total of 18 patients with 19 transitional cell carcinomas (17 bladder and 2 upper tract) underwent preoperative staging with CT scan of the chest, abdomen, and pelvis showing no evidence of metastatic disease. 11C-choline positron emission tomography with CT was performed in all patients.

11C-choline uptake was seen in all primary tumors, with 6 patients exhibiting uptake of regional lymph nodes as small as 5 mm. Histologic confirmation was obtained in 3 of the 4 patients who underwent surgery. Furthermore, despite an initial negative traditional staging evaluation, metastases to bone were seen in 4 patients using PET CT technology. All metastases were confirmed by additional computerized tomography.

In summary, this small study suggests that PET CT technology may serve as a useful additional tool in the staging of patients with advanced urothelial cancer.

GofritВ ON, MishaniВ E, OreviВ M, KleinВ M, FreedmanВ N, PodeВ D, ShapiroВ A, KatzВ R, LibsonВ E, ChisinВ R
J Urol 176(3): 940-94, 2006.

Reviewed by UroToday.com Contributing Editor Ricardo Sanchez-Ortiz, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
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Copyright © 2006 - UroToday

Second Primary Malignancies Associated With Renal Cell Carcinoma Histological Subtypes

UroToday.com- While several population-based studies have found an association between renal cancer and lymphoma, few studies have specifically evaluated the association between renal cancer and secondary malignancies using a comprehensive institutional renal cancer database.

In the September issue of the Journal of Urology, Thompson and colleagues from the Mayo Clinic reviewed their database of 2,722 patients who underwent nephrectomy at their institution for sporadic renal cancer over a 30 year-period. The risk of an antecendent, concurrent, or subsequent secondary malignancy was evaluated according to tumor histology.

Tumor histology was distributed as follows: conventional (80.4%), papillary (13.9%), chromophobe (4.7%), collecting duct (0.2%), purely sarcomatoid (0.1%), and unclassified ((0.7%). Median follow-up was approximately 7 years.

Compared with patients exhibiting conventional histology, patients with papillary renal cancer had a higher likelihood of having any secondary malignancy (26.5% vs. 18.5%, p = 0.001) or multiple malignancies (5.6% vs. 1.5%, p < 0.001).

Patients with papillary and chromophobe RCC were also more likely to have colon cancer when compared with conventional histology (3.7% vs. 2.0% and 5.5% vs. 2.0%, respectively, p 0.02). While there was no difference in the incidence of breast cancer by histology, men with papillary RCC exhibited a higher likelihood of prostate cancer when compared with men with conventional histology (15.3% vs. 9.6%, p =0.003).

These data with a cohort of patients treated for renal cancer in a single institution suggest that patients with papillary RCC may have a higher risk of secondary malignancies (particularly of the colon and prostate) when compared to conventional renal cancer. While these conclusions need to be validated in a larger cohort of patients, they underscore the importance of a thorough surveillance protocol including secondary malignancies.

ThompsonВ RH, LeibovichВ BC, ChevilleВ JC, WebsterВ WS, LohseВ CM, KwonВ ED, ZinckeВ H, BluteВ ML
J Urol. 176(3): 900-904, 2006

Reviewed by UroToday.com Contributing Editor Ricardo F. SГЎnchez-Ortiz, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday.com

Copyright © 2006 - UroToday