Abstract
According to an article published online in the Journal of Clinical Oncology, participants in the Nurses' Health Study who took aspirin after they had completed therapy for early-stage breast cancer, and who lived for at least 1 year after breast cancer diagnosis, had a large reduction in their risk of death or metastasis.
Michelle Holmes (Associate Professor of Medicine and Epidemiology at Harvard Medical School, MA, USA) and her colleagues analyzed data from the long-running Nurses' Health Study, which began in 1976 and has 238,000 participants.
The team evaluated 4164 women who were diagnosed with early-stage breast cancer between 1976 and 2002 and were observed until death or to June 2006. During this period, there were 341 breast cancer deaths. Holmes' group noted a strong linear trend for reduced risk of death for days of aspirin intake per week (p < 0.001) following completion of therapy. The adjusted relative risks for 1, 2–5 and 6–7 days of aspirin use per week, compared with no aspirin, were 1.07, 0.29 and 0.36, respectively. Similar results were seen for distant recurrences, with adjusted relative risks for 1, 2–5 and 6–7 days of aspirin use per week, compared with no aspirin, of 0.91, 0.40 and 0.57, respectively. Again, there was a significant linear trend (p = 0.03). These associations were not affected significantly by stage, BMI, menopausal status or estrogen receptor status.
Data on aspirin doses were not collected but it is probable that, in most cases, the women who took aspirin regularly would have been taking it for heart disease prevention at probably 81 mg/day.
“This is the first study to find that aspirin can significantly reduce the risk of cancer spread and death for women who have been treated for early-stage breast cancer,” Holmes enthused. “If these findings are confirmed in other clinical trials, taking aspirin may become another simple, low-cost and relatively safe tool to help women with breast cancer live longer, healthier lives.”
“Aspirin cannot be considered a substitute for conventional cancer treatments, and taking aspirin does have negative effects in some…”
However, caution is required since aspirin can cause stomach bleeding in some patients, and the mechanism by which it affects cancer cells is unknown. The authors speculate that the reduced risk of metastasis and death might be a result of reduced inflammation, a known risk factor for cancer development.
“Aspirin cannot be considered a substitute for conventional cancer treatments, and taking aspirin does have negative effects in some,” Holmes acknowledged. “More study is definitely needed to establish the cause and effect of aspirin on breast cancer. But, for now, if a woman has breast cancer and is taking aspirin, she may take some comfort in knowing she might be doing something to help prevent her breast cancer from recurring.”
Sources: Holmes MD, Chen WY, Li L, Hertzmark E, Spiegelman D, Hankinson SE: Aspirin intake and survival after breast cancer. J. Clin. Oncol. 28(9), 1467–1472 (2010); ASCO press release: Large analysis finds breast cancer patients who take aspirin reduced risk of metastasis and death by half: www.asco.org
Potential treatment for dysmenorrhea shows promise in early clinical trials
At the American Chemical Society's National Meeting this year, scientists described the discovery of a new drug which is hoped to become an effective treatment option for menstrual cramps. The drug, which is developed by Vantia Ltd, a UK-based pharmaceutical company, is currently in Phase II clinical trials. Known as VA111913, the drug has been designed to specifically target the root cause of menstrual cramps, as well as ease the symptoms of the condition.
Menstrual cramps are caused by contractions of the uterus during menstruation which can result in minor pain. When the uterine contractions increase in frequency, the individual can experience severe pain. This condition is called dysmenorrhea and is diagnosed when the pain is at a level of severity such that the individual is unable to perform normal activities or medication is required. Dysmenorrhea affects between 45 and 90% of women of child-bearing age. As well as abdominal pain, women can also suffer from back pain in addition to nausea, vomiting, sweating and dizziness. Current treatments for the condition include pain-relievers, NSAIDs and oral contraceptives. However, these methods are only palliative in nature and do not address the root cause of the condition. In addition, a third of women find these treatments ineffective.
The Vantia scientists believe that the cause of menstrual cramps is due to increased levels of vasopressin, a hormone that plays a role in regulating the contraction of the uterus. It was thought that by inhibiting the action of this hormone, dysmenorrhea may be eased.
The researchers assessed hundreds of chemical compounds and eventually came across one potential candidate. This compound was altered accordingly so that its effects were improved; this included modifying the drug so that it could be administered orally rather than by injection.
Results from preclinical trials demonstrated that VA111913 can normalize smooth muscle contraction, indicating that it can specifically target the root cause of dysmenorrhea. Currently, the drug is in Phase II clinical trials and results are expected later this year.
“Dysmenorrhea not only diminishes the quality of life for millions of women, but also has a hidden, society-wide economic cost that involves an enormous number of days lost from work and school,” commented Andrzej R Batt of Vantia.
“We hope that the drug will provide a more effective treatment option for millions of women worldwide with this painful condition.”
Source: Vantia Therapeutics: www.vantiatherapeutics.com/pipeline/va111913.php
In brief…
Analgesic use and sex steroid hormone concentrations in postmenopausal women.
Gates MA, Tworoger SS, Eliassen AH, Missmer SA, Hankinson SE: Cancer Epidemiol. Biomarkers Prev. 19(4), 1033–1041 (2010).
In a recent study, researchers examined the relationship between use of aspirin, nonaspirin NSAIDs, acetaminophen and sex steroid hormone concentrations among 740 postmenopausal women (average age: 61.5 years) from the Nurses' Health Study. All women in the study reported their analgesic use in 1988 or 1990 and provided a blood sample in 1989 to 1990. The adjusted geometric mean estrogen and androgen levels for each category of analgesic was calculated, as well as the p-value for trend with increasing frequency of use. No association between days of use per month of aspirin, nonaspirin NSAIDs or acetaminophen in 1990 and hormone levels was found. However, significant inverse trends between the estimated number of aspirin tablets per month in 1988 and concentrations of estrone and estrone sulfate were observed. Frequency of use of all analgesics in 1990 was inversely associated with concentrations of estradiol, free estradiol, estrone sulfate and the ratio of estradiol to testosterone. In women who regularly used aspirin or nonaspirin NSAIDs, the average estradiol levels were 10.5% lower compared with women who never used the drugs. Similarly, free estradiol levels were 10.6% lower and estrone sulfate levels were 11.1% lower among regular users of aspirin or other NSAIDs. Among regular users of any analgesic (aspirin, NSAIDs or acetaminophen), levels of these hormones were 15.2, 12.9 and 12.6% lower, respectively.
Prediagnosis food patterns are associated with length of survival from epithelial ovarian cancer.
Dolecek TA, McCarthy BJ, Joslin CE et al.: J. Am. Diet. Assoc. 110(3), 369–382 (2010).
A recent study investigated the effect of prediagnosis diet on survival in ovarian cancer patients. A sample of 341 women from Illinois, USA, diagnosed with incident epithelial ovarian cancer between 1994 and 1998, were studied. These women had all previously participated in a case-control study that collected demographic, clinico-pathologic and lifestyle-related information including details regarding diet. The participants had each completed a food questionnaire. The data collected from these questionnaires was categorized using the Dietary Guidelines for Americans 2005. Higher total fruit and vegetable consumption, as well as higher vegetable consumption alone, led to a survival advantage. A statistically significant improvement in survival was also observed for women who regularly ate healthier grains, whereas higher intakes of less-healthy meats were linked to a survival disadvantage. Further subgroup analyses showed that only yellow vegetables and cruciferous vegetables, such as those belonging to the cabbage and cauliflower family, had a significant association with longer survival time. The association between high-meat diets and shorter survival rate was specifically linked to the red and cured/processed meats subgroups. The authors conclude that prediagnosis adherence to healthy diets reflecting recommendations for optimal nutrition and cancer prevention may have benefits that continue even once a patient has been diagnosed with ovarian cancer.
Study suggests that use of oral contraceptives is not associated with increased long-term risk of death
Results from the Royal College of General Practitioners Oral Contraception Study, one of the largest continuing investigations into the health effects of oral contraceptive use, have demonstrated that women who have previously used the pill are less likely to die from cancer or other causes than women who have never used this form of contraception. The details were published in the British Medical Journal after the analysis of data accumulated from the observation of 46,112 women for up to 39 years.
The investigators at the University of Aberdeen, UK, found that women who had used oral contraceptives had a significantly lower risk of death from all cancers, including large bowel/rectum, uterine body and ovarian cancer, as well as the main gynecological cancers combined, compared with those women who had never used oral contraceptives (adjusted relative risk: 0.85).
Philip Hannaford, the lead investigator, described the importance of their findings. “Many women, especially those who used the first generation of oral contraceptives many years ago, are likely to be reassured by our results. However, our findings might not reflect the experience of women using oral contraceptives today, if currently available preparations have a different risk than earlier products.”
The authors conclude that their results demonstrated that “oral contraception is not significantly associated with an increased long-term risk of death … indeed a net benefit was apparent.” However, they point out that “the level of reduction in mortality seen in different parts of the world will depend of factors such as levels of oral contraceptive usage, duration of use, age at stopping and the prevalence of disease.”
Sources: Hannaford PC, Iversen L, Macfarlane TV, Elliott AM, Angus V, Lee AJ: Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study. BMJ 340, C927 (2010).
Combination of gemcitabine and cisplatin demonstrates encouraging results in women suffering from advanced endometrial cancer
Recent results from a single-institution study reported that combination treatment of gemcitabine and cisplatin produced a response rate in 50% of patients suffering from advanced or recurrent endometrial cancer.
Endometrial cancer is the most common gynecologic malignancy and the fourth most common cancer among women in the USA. While early-stage endometrial cancer responds well to therapy, more effective treatment options are needed in order to combat the advanced or recurrent form of the disease.
Researchers at the MD Anderson Cancer Center, led by Jubilee Brown, associate professor in the Department of Gynecologic Oncology, conducted a Phase II study involving 20 patients suffering from stage IV or recurrent endometrial cancer. Patients were treated with gemcitabine followed by cisplatin twice during each chemotherapy cycle. All patients underwent an average of five cycles. Physical and pelvic examinations were used to evaluate patient response after every three cycles.
The results showed that out of 20 patients, two had a complete remission, eight had a partial response, six patients experienced stabilization of disease and four experienced a progression in disease. In summary, these findings demonstrated a 50% overall response rate, or improvement in disease.
“These results are encouraging, offering a new direction for our research for women who suffer from advanced disease,” enthused Brown. “The findings have the potential to offer another option to these patients, but establishing this treatment as a standard of care will require more research.”
The combination regimen of gemcitabine and cisplatin is used in the treatment of other types of cancer. If proven to be successful, it is hoped that it will also become a treatment option for women suffering from advanced endometrial cancer. As Brown noted, larger scale clinical trials conducted at multiple institutions are required to assess the efficacy of this chemotherapy combination for this indication.
Source: Researchers find new chemotherapy combination shows promise in advanced or recurrent endometrial cancer: www.mdanderson.org/newsroom/news-releases/2010/researchers-find-new-chemotherapy-combination-shows-promise-in-advanced-or-recurrent-endometrial-cancer.html