Exciting results in immunotherapy: What do we know?

A story on BBC News  this morning quotes researchers who say a therapy using the body’s own immune system led to more than 90% of terminally ill patients they treated going into remission. The report is based on comments made Sunday at a symposium at the American Association for the Advancement of Science (AAAS) meeting in Washington D.C. The story was then picked up by CNBC, which called the results “spectacular.”

The work involves chimeric antigen receptor (CAR-T) T-cell therapy, a very promising area of research, but one that’s still very much in its infancy. We asked Chief Medical Officer Otis W. Brawley, M.D. for some perspective.

“CAR-T is known to be an exciting lead in the treatment of a number of cancers. The media reports of successful treatment using CAR-T are certainly exciting, however there’s still much we don’t know.

“The news appears to be based on comments made during a presentation discussing advances in immunotherapy. As best we know, the data have not been published or independently reviewed.

Otis Brawley

Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society

“The most we can say based on the reported comments is that this treatment sounds promising but further investigation is needed. Long term data on a larger number of patients will determine the ultimate success and risks of this approach.

“While we support this work and believe strongly that immunotherapy is promising, it is important to use caution in raising the hopes of patients based on early data that may or may not come to fruition.”

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HPV vaccination: A public health priority

Today, National Cancer Institute-designated Cancer Centers across the country issued a consensus statement urging action to increase vaccination against human papillomavirus (HPV).

The American Cancer Society’s Debbie Saslow, Ph.D., director of cancer control intervention, HPV & women’s cancers, says the time is now to increase HPV vaccination in the United States.

“We have a cancer prevention vaccine. HPV vaccines have been available for 10 years. They are safe and they work. Yet in this country only about half of girls and boys who are vaccinated with the other vaccines recommended for preteens are getting vaccinated to protect them from cancer. The reasons are complicated, but one thing is for sure: this is a national public health priority.

“The American Cancer Society strongly supports today’s call to action from National Cancer Institute-designated Cancer Centers across the country.

“HPV vaccination is underutilized despite the overwhelming evidence for its safety and effectiveness. Vaccination will prevent most cervical, vaginal, vulvar, and anal cancers and are expected to prevent most penile and oropharyngeal (throat and tongue) cancers that are diagnosed in 27,000 men and women every year. Vaccines are among the few medical interventions capable of achieving almost complete eradication of a disease. It is not often that we have an opportunity to prevent cancer, or in this case multiple cancers, with a single tool. Concerted efforts are needed so that this opportunity is not lost.

“The American Cancer Society is proud to lead the National HPV Vaccination Roundtable, a national coalition of organizations working together to prevent HPV-associated cancers and pre-cancers by increasing and sustaining U.S. HPV vaccination. The NCI-designated Cancer Centers are one of over 75 member organizations. In addition the Society is working to increase HPV vaccination rates for adolescents across the nation through improved provider awareness and education and improved system-wide processes. Our Vaccinate Adolescents against Cancer (VACs) program works through Society hundreds of health systems staff nationwide who partner with community health centers and state-based institutions and coalitions.”

Posted in Cervical, Communications, Disparities, Prevention, Society news | Tagged , , , | 1 Comment

The President’s Cancer Moonshot: An Opportunity to Save Lives

Otis Brawley, M.D., chief medical officer for the American Cancer Society, today responded to the President’s call for a national effort to fight cancer.

Photo by Saul Loeb, AFP/Getty Images

Photo by Saul Loeb, AFP/Getty Images

“The President’s commitment to a moonshot against cancer led by Vice President Biden is a galvanizing call for a renewed effort to find new tools to fight cancer. It is imperative that we continue to fund the brightest minds to explore the nature and biology of our nation’s number two killer. Done right, we can build on our past investment, and spur even more progress against the disease.

“Medical science has already made huge leaps in our understanding of the inner workings of the cancer cell, and there is much left to learn. But just as important as continuing to explore new science is a concerted

Otis Brawley

Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society

effort to gather what we already know about cancer and find ways to apply these tools more effectively to save lives. If we applied what we already know about cancer prevention, early detection, and treatment, we could prevent a substantial proportion of the nearly 600,000 cancer deaths in the U.S. each year. These remarkable tools mean nothing if they sit unused, unavailable to those in need because of gaps in care caused by poverty and other factors.

“Cancer will not be cured this year. But we should do all we can to ensure 2016 is remembered as the year we came together in an effort to work smartly, and with all the resources we needed, to harness the power in our hands to reduce the devastating impact of cancer.”

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Four Society Researchers Make Annual List of Highly Cited Researchers

Four American Cancer Society scientists have been included on Thomson Reuters’ list of 2015 Highly Cited Researchers. The annual list recognizes leading researchers in the sciences and social sciences from around the world.The American Cancer Society researchers honored are:

Ahmedin Jemal, PhD, vice president, surveillance and health sciences research

Robert A. Smith, PhD, vice president, cancer screening prevention and early detection

Michael J. Thun, MD, retired, vice president emeritus of the American Cancer Society Surveillance and Epidemiology Research program​

Elizabeth Ward, PhD, senior vice president, intramural research​

About 3,000 researchers earned the distinction in 2015 by authoring reports officially designated by Essential Science Indicators as Highly Cited Papers — ranking among the top 1% most cited for their subject field and year of publication, earning them the mark of exceptional impact.

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Groundbreaking Trial Reports Positive Results on Screening for Ovarian Cancer

An eagerly anticipated clinical trial shows lifesaving potential for a method to screen for ovarian cancer using annual CA-125 tests and ultrasound. The algorithm used in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), whose results are published in The Lancet, reduced the risk of death from ovarian cancer an estimated 20 percent.

Ovarian cancer accounts for 1 in 20 cancer deaths in U.S. women, and causes more deaths than any other gynecological malignancy. Although survival is good when ovarian cancer is detected early, most ovarian cancers are diagnosed at an advanced stage when prognosis is poor.

The conventional approach to detect ovarian cancer early has focused on testing with a serum cancer antigen 125 (CA-125) and transvaginal ultrasound, but results to date have been disappointing. No organization recommends ovarian cancer screening.

Now, promising new results from the new trial have renewed hope for a modified approach.

Dr. Ian Jacobs and colleagues studied approximately 200,000 women over more than a decade to determine whether multi-modal screening (MMS) with a “risk of ovarian cancer algorithm” (ROCA), a quantitative algorithm based on age, risk status and CA-125 levels over time, was effective in reducing ovarian cancer mortality compared with ultrasound alone or usual care.

After a median follow-up of 11 years, the authors observed a nonsignificant 15% fewer deaths in the MMS group, but when the cases diagnosed in the first screening round were taken out of the analysis, a statistically significant 20% reduction in ovarian cancer mortality was observed. Why the adjustment? They say many of the deaths from ovarian cancer in the study group were because the cancer was already advanced at the time of the first screening exam.

The authors caution that more study is needed to better understand the efficacy and cost effectiveness of ovarian cancer screening.

We asked Robert Smith, Ph.D., vice president of cancer screening, for his thoughts on this eagerly anticipated study.

“There has been great interest in screening for ovarian cancer for as long as I’ve been involved in cancer, but until now there has been no evidence that the conventional approach of using a fixed cutoff CA-125 level combined with ultrasound was an effective approach.

Rsmith2010jpg

Robert A. Smith, PhD VP, Cancer Screening

“The findings are incredibly encouraging. We have known for some time that the ROCA appeared to have better performance, but until now, we did not have data that it was effective in reducing ovarian cancer deaths.

“But it’s important to note that this approach to testing also was associated with a high rate of invasive procedures and complications associated with false positive findings.

“The investigators are appropriately cautious, and agree that these findings are not sufficient to begin recommending that postmenopausal women start screening.

“However, the findings do mean that there is renewed urgency to answer unanswered questions to determine if and when screening for ovarian cancer might be recommended.

“As part of its ongoing guidelines development process, the American Cancer Society will review this new evidence and closely monitor on-going evaluation of the UKCTOCS data.”

You can read more about ovarian cancer, including statistics, risk factors, treatment and more here.

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False positives may provide clue to future breast cancer risk

A large new study out today finds women who had a false positive mammogram had an increased risk for developing breast cancer years later. The risk was independent of breast density and remained elevated for a decade after the false-positive test. The study appears in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

CH1231_smallSome other studies had previously shown false positives were associated with a higher risk of cancer, but not consistently. So this study’s size, with over 1.3 million women who underwent more than 2 million exams, makes it notable. It confirms that certain irregular findings in mammograms that are found not to be cancer appear to be associated with an increased risk of being diagnosed with breast cancer later.

But the most important number to keep in mind may be what this increased means in real life. While having a false alarm was associated with a relative increase of 40% (for those who underwent additional imaging) to 75% (for those who underwent a biopsy), the absolute risk over a 5 or 10 year period was not large. After five years, about 2% of women who had a false positive were diagnosed with cancer, compared to about 1% of women who had negative mammograms.

Still, there is some increased risk over the short term, and for up to 10 years of follow-up. Here’s what Robert A. Smith, PhD, vice president of cancer screening at the American Cancer Society, said about that study:

Robert A. Smith, PhD VP, Cancer Screening

Robert A. Smith, PhD
VP, Cancer Screening

“The most important takeaway from this and other studies of false positives and subsequent risk of breast cancer is that this information adds to the ability to estimate risk, and may help women and their doctors make decisions about screening moving forward. A prior false positive finding should be included in the factors considered as a woman decides on the frequency and types of screening she has as she ages.”

Recently updated recommendations from the American Cancer Society say starting at age 40, a woman should discuss with her doctor when to start screening, as long as she starts by age 45. The guideline points out that while the risk of breast cancer is lower in women between the ages of 40 to 44, some women will choose to accept the greater chance of a false positive as a reasonable trade-off for the benefits of screening.

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WHO Review Links Red and Processed Meats to Cancer

The International Agency for Research on Cancer (IARC), a part of the World Health Organization, has classified processed meat as a cancer causing agent (carcinogen), and red meat as a probable carcinogen. This conclusion was based on evaluation of the world’s scientific research on the carcinogenic role of red and processed meat consumption by an expert panel of scientists convened as part of IARC’s Monograph Program which seeks to identify the causes of human cancer. Of note, Marjorie McCullough, ScD, RD, American Cancer Society Strategic Director of Nutritional Epidemiology, attended the IARC evaluation as an observer.

Below is a comment from Susan Gapstur, MPH, PhD, Vice President of Epidemiology  on the news:

“The conclusion that processed meat (e.g., hot dogs, bacon, sausage, deli meats, etc.) causes cancer and that red meat (e.g., beef, pork, lamb) is a probable cause of cancer may come as a surprise to a public that for years has relied heavily on red and processed meats as a part of its diet.

“The conclusions for both red and processed meats are based primarily on evidence showing an increased risk of colorectal cancer, the third most commonly diagnosed cancer among men and among women in the U.S. For red meat, there was also evidence of increased risk of pancreatic and prostate cancer.

“In general, the IARC conclusion is consistent with the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Continuous Update Project which found the evidence ‘convincing’ that diets high in red meat  and processed meat are associated with increased risk of colorectal cancer.

“In fact, classifying processed meat as carcinogenic and red meat as probably carcinogenic to humans is not unexpected. Indeed, based on earlier scientific studies, including findings from the American Cancer Society’s Cancer Prevention Study II, the American Cancer Society has recommended limiting consumption of red and processed meat specifically since 2002. Our most recent Guidelines on Nutrition and Physical Activity for Cancer Prevention, which were published in 2012 (CA Cancer J Clin 2012;62:30-67), emphasize the importance of choosing fish, poultry, or beans as alternatives to processed and red meat, and for those who choose to eat red meat, selecting lean cuts and eating smaller portions is important.

“The American Cancer Society Guidelines on Nutrition and Physical Activity also recommend preparing meat, poultry and fish by baking, broiling or poaching, rather than frying or charbroiling to reduce the formation of carcinogens during the cooking process.

“The IARC conclusion also provides support for the United States 2015 Dietary Guidelines for Americans Advisory Committee’s recommendation to consume a healthful dietary pattern that is ‘lower in red and processed meat.’ 

This is an important step in helping individuals make healthier dietary choices to reduce their risk of colorectal cancer in particular.”

Posted in Behavior, Colorectal, Lifestyle, Nutrition | 5 Comments