Abstract
A hormone therapy typically used to treat breast cancer has proved effective in selected women with advanced ovarian cancer, prolonging their lives and delaying the need for chemotherapy.
The anti-estrogen drug letrozole, already used for the treatment of breast cancer, has been shown to be effective in treating advanced estrogen receptor-positive ovarian cancer. Up to half of ovarian cancers are sensitive to estrogen.
John F Smyth, University of Edinburgh (UK), who led the research, emphasized the importance of these new findings: “This is an important landmark in the research and treatment of ovarian cancer. Despite intense scientific research over the past 20 years, there have been few new leads in our understanding of how this disease operates. But this study suggests that the addition of hormone therapy to our treatment strategy could extend and improve the lives of women with cancer.”
Ovarian cancer is the most deadly gyn+ecological cancer. Nonspecific symptoms mean that it is often diagnosed at a late stage and there have been no major treatment breakthroughs since the introduction of platinum chemotherapy in the 1980s.
The study, published recently in Clinical Cancer Research, provides the first evidence that hormone therapies might be an important future treatment option. Previous studies of letrozole in ovarian cancer patients had shown little or no improvement. The key difference in this study was that women were selected for estrogen receptor expression, and only those with highly estrogen-sensitive disease were included. A total of 44 women with estrogen-sensitive ovarian cancer that had relapsed after surgery and chemotherapy received treatment with letrozole. Progression of the disease was measured by serum levels of the tumor marker CA-125. After 6 months, a quarter of the women showed no tumor growth and a further 33% were able to delay chemotherapy. Some of the patient's lives were prolonged by up to 3 years.
“Ovarian cancer can be a devastating disease, so this new discovery is particularly exciting. We still have a lot to do, but this research has furthered our understanding of the hormone control of ovarian cancer, which could provide less grueling treatments for cancer patients. It presents new possibilities for tailor-made cancer therapy and demands further investigation”, enthused study author Simon Langdon. The authors now plan to extend the research to women at earlier stages of the disease. As in breast cancer, hormone treatment could be used alongside surgery and chemotherapy to try to prevent or delay relapse.
“Our hypothesis is that if we used hormone drugs earlier it could defer relapse, possibly for a long time. The majority of women relapse within 2 years, so this is very significant”, explained Professor Smyth.
Source: Smyth JF, Gourley C, Walker G et al.: Antiestrogen therapy is active in selected ovarian cancer cases: the use of letrozole in estrogen receptor–positive patients. Clin. Cancer Res. 13, 3617–3622 (2007).
Aspirin may help to prevent pre-eclampsia
Women with a high risk of developing pre-eclampsia who take an aspirin a day can lower their risk of developing the condition by 10%, according to a new study published recently in the Lancet.
Lead investigator Lisa Askie commented, “Preeclampsia complicates between about 2 and 8% of all pregnancies, and is associated with approximately 10–15% of the half-million maternal deaths (worldwide) that occur each year.”
Since the condition is quite common, even a modest reduction in risk could save many lives, according to Dr Askie, who commented that the use of antiplatelet therapy “could potentially result in many thousands less women who experience a bad pregnancy outcome. Hence, particularly for women at high risk of preeclampsia, a more widespread use of antiplatelet agents may be worthwhile.”
While few adverse effects were reported in this study, Dr Askie advises that “Women at risk of preeclampsia should discuss the potential benefits and harms of this treatment with their doctor.”
Source: Askie LM, Duley L, Henderson-Smart DJ, Stewart LA; PARIS Collaborative Group: Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 369(9575), 1791–1798 (2007).
in brief…
Black DM, Delmas PD, Eastell R et al.: N. Engl. J. Med. 356(18), 1809–1822 (2007). This double-blind, placebo-controlled trial demonstrated that a yearly intravenous infusions of zoledronic acid reduced the risk of fracture and improved bone density of postmenopausal women. A total of 3889 postmenopausal women were randomized to 15 min infusions of zoledronic acid or placebo every 12 months for 3 years. The risk of morphometric vertebral fracture was reduced by 70% (3.3 vs 10.9%) after 3 years in women receiving the drug compared with those receiving placebo.
Lin J, Manson JE, Lee IM, Cook NR, Buring JE, Zhang SM: Arch. Intern. Med. 167(10), 1050–1059 (2007).
Suggests that higher calcium and vitamin D levels may be protective against breast cancer. A total of 10,578 premenopausal and 20,909 postmenopausal women, all healthy at baseline, were evaluated for calcium and vitamin D intake and followed for 10 years. During follow up, 276 premenopausal and 743 postmenpusal developed breast cancer. Premenopausal women with the highest calcium and vitamin D intakes were 30% less likely to devlop breast cancer than those in with the lowest intake. However, this association did not occur in postmenopausal women and the authors conclude it is too early to recommend supplementation.
El-Nashar SA, Hopkins MR, Feitoza SS et al.: Obstet. Gynecol. 109(6), 1381–1387 (2007). Demonstrates that endometrial ablation for menorrhagia is safe and effective in women with bleeding disorders. This retrospective cohort study examined 44 women with coagulopathy and 111 randomly selected women without coagulopathy, all of whom underwent global endometrial ablation. There was no significant difference in treatment complications or time to treatment failure between the two groups, leading the authors to conclude that endometrial ablation is a good option for treating menorraghia in women with coagulopathy.
Awareness and treatment of cardiovascular disease in women must be improved
Younger women are unaware of heart attack symptoms and many physicians are slow to prescribe preventive drugs, according to three new studies.
Three recent studies have drawn attention again to the issue of cardiovascular disease in women, which is often under-recognized and undertreated.
A team of researchers from Yale Medical School (CT, USA) have found that most younger women were unaware of the signs of heart attack, with only half presenting at the emergency room within an hour of the onset of severe chest pain.
The investigators questioned a sample of 24 of the 40,000 women aged under 55 years who are hospitalized for heart disease in the USA every year. Nearly 90% suffered from severe chest pain and many had pain in shoulder or jaw, nausea and sweating (so-called atypical symptoms), but many were worried that their symptoms weren't real or assumed that they were caused by indigestion. “We have to get the messages across to young women that they are at risk for a heart attack, they might experience not only typical but also atypical symptoms, and they need to be aware of their own risk factors, including family history”, stated lead author Judith Lichtman.
The lack of awareness of heart disease in women, amongst women themselves and physicians, was also highlighted in a separate study by the the National Committee for Quality Assurance, examining the treatment of high LDL cholesterol, an important risk factor for heart attack. Women were less likely than men to have their cholesterol levels adequately controlled, with African–American women faring particularly poorly.
“This study highlights the importance of not just knowing your health, but also taking an active role in your care”, commented National Committee for Quality Assurance President Margaret E O'Kane. “The data show that we've got our work cut out for us in terms of raising awareness among both physicians and patients.”
“We have to get the messages across to young women that they are at risk for a heart attack”
A third study has revealed that women are less likely than men to receive surgery or medications after heart tests. While women were more likely to suffer chest pain and have negative ECG readings during cardiac stress testing, they were less likely to be referred for coronary angioplasty or revascularization, or be prescribed statins, ACE inhibitors or β-blockers, after 6 months. “Future studies should further investigate whether these management differences explain sex differences in cardiovascular disease outcomes”, concluded the study authors.
Sources: American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, 11th May, Washington, DC, USA (2007)
Chou AF, Scholle SH, Weisman CS et al.: Gender disparities in the quality of cardiovascular disease care in private managed care plans. Womens Health Issues 17(3), 120–130 (2007).
HPV vaccination may protect against other cancers too
A new study, published recently in the Lancet, has suggested that the human papillomavirus (HPV) vaccine Gardasil® is effective in preventing not only cervical cancer, but also vulval and vaginal cancers.
The study, a meta-analysis of three trials, included over 18,000 women aged 16–26 years. Overall, the vaccination reduced the incidence of high-grade vaginal or vulval lesions by 49%.
“We've spent a lot of time over the last 20 years trying to show that HPV was associated with vulval and vaginal cancers, so that's very exciting”, commented Leo Twiggs, University of Miami (FL, USA).
Another recent study, which appeared in the New England Journal of Medicine, has suggested that HPV may also be responsible for the majority of throat cancers. The investigators, from John Hopkins University (MD, USA) compared biopsies from 100 patients with throat cancer with biopsies from 200 healthy controls, and found that the biopsy samples from patients with throat cancer were 12fold more likely to be infected with HPV. This puts HPV at the top of the list of risk factors for throat cancer, above traditional risk factors such as smoking and drinking.
HPV vaccination may be effective against several cancers in addition to its primary target, cervical cancer.
Oral HPV is typically contracted through oral sex and affects both men and women, suggesting that HPV vaccination could be of benefit to men as well. The authors say it is too early to tell whether HPV vaccination prevents throat cancer, but they are discussing further trials to determine this.
Sources: Joura EA, Leodolter S, Hernandez-Avila M et al.: Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials.
D'Souza G, Kreimer AR, Viscidi R et al.: Case–control study of human papillomavirus and oropharyngeal cancer. N. Engl. J. Med. 356, 1944–1956 (2007)
Stem cells used to construct vagina
Stem cells have been used for the first time to produce vaginal mucosal tissue, offering hope to two women with a rare genetic condition characterized by the absence of a vagina.
Cinzia Marchese, Policlinico Umberto, Rome (Italy) used biopsies of the area where the women should have a vagina to collect stem cells, which were used to grow mucosal tissue to be used in recontructive surgery. This is similar to the way stem cells have been used to grow skin grafts for burns victims.
Mayer–Von Rokitansky–Kuster–Hauser Syndrome, the condition from which the two women suffered, causes a complete absence of a vagina.
Until now, surgical reconstruction of the vagina has used skin grafted from other areas of the body. It is hoped that the new technique may make surgical treatment faster and less painful.
Source: Panici PB, Bellati F, Boni T, Francescangeli F, Frati L, Marchese C: Vaginoplasty using autologous in vitro cultured vaginal tissue in a patient with Mayer–von–Rokitansky–Kuster–Hauser syndrome. Hum. Reprod.[Epub ahead of print] (2007).
Good news for breast cancer patients receiving trastuzumab
Two new analyses of long-term data on trastuzumab have revealed that the drug remains effective in preventing relapse after 4 years and that the risk of heart failure does not increase over this period.
Both studies were reported at the 2007 American Society for Clinical Oncology meeting in Chicago. The first study, investigating the risk of congestive heart failure, found that there was no increase in risk of heart failure between 2 and 5 years of treatment. In addition, the study added to scientists' knowledge of the risk profile for women receiving trastuzumab. At greater risk of heart problems are older women, those who used hypertensive medications and those who had a low normal baseline left ventricular ejection-fraction. The investigators hope to use this data to produce a risk–benefit calculator.
The second study examined long-term outcomes in women receiving trastuzumab after surgery and chemotherapy. Compared with those receiving placebo, women receiving trastuzumab had improved survival and a lower risk of relapse after 4 years. Trastuzumab decreased the chances of cancer recurrence by 52% and the risk of death by 35%.
“When we presented the original data in 2005, people wondered if the benefits were going to be maintained or were we just seeing acute, short-term benefits in this aggressive type of breast cancer”, commented principal investigator Edith Perez, Mayo Clinic (FL, USA). “The data now state that the benefit is completely maintained over time, maybe even increasing, without any increase in toxicity.”
Source: 43rd ASCO Annual Meeting, June 1–5, Chicago, IL, USA (2007).
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