New Guidelines Might Limit Need for Lymph Node Removal for Breast Cancer

MONDAY, March 24, 2014 (HealthDay News) -- Biopsies of so-called "sentinel" lymph nodes under the arms should become more widespread among breast cancer patients, according to updated guidelines from the American Society of Clinical Oncology (ASCO).

The group, which represents cancer specialists, said the new recommendations should also restrict the number of women who will require further removal of multiple nodes after biopsy, cutting down on painful side effects.

In sentinel lymph node biopsy, a few lymph nodes are removed and checked for signs of cancer -- hence the name "sentinel." Usually, if these lymph nodes have no cancer, it means the remaining, unchecked lymph nodes should also be cancer-free.

The new ASCO recommendations expand eligibility for sentinel node biopsy and will reduce the number of patients who undergo a more invasive procedure called axillary -- underarm -- lymph node dissection, which carries a higher risk of complications, the group said.

In axillary lymph node dissection, most lymph nodes under the arm on the same side as the breast tumor are removed and examined for cancer. This procedure can cause long-term side effects such as pain and numbness in the arm and swelling due to a build-up of lymph fluid.

The new guidelines state that for women whose sentinel lymph nodes show no signs of cancer, removal of more underarm lymph nodes is not recommended.

The guidelines also addressed the case of women who undergo lumpectomy instead of full mastectomy and are also scheduled for whole-breast radiation therapy to help "mop up" residual cancer. If these patients have signs of cancer in only one or two sentinel lymph nodes upon biopsy, they too may opt to avoid further node removal, the ASCO experts said.

Women who have undergone mastectomy but show signs of cancer's spread in sentinel lymph nodes should be offered further node removal, the guidelines reaffirmed.

The ASCO also said women who are diagnosed with certain breast cancers while pregnant can skip sentinel node biopsy.

The ASCO issued initial guidelines on sentinel node biopsy in 2005. The new guidelines, published March 24 in the Journal of Clinical Oncology, are based on the findings of a panel of experts who reviewed studies published between 2004 and 2013.

"The updated guideline incorporates new evidence from more recent studies -- nine randomized controlled trials and 13 cohort studies since 2005," panel co-chairman Dr. Armando Giuliano said in an ASCO news release.

"Based on these studies, we're saying more patients can safely get sentinel node biopsy without axillary lymph node [removal]," he said. "These guidelines help determine for whom sentinel node biopsy is appropriate."

Panel co-chairman Dr. Gary Lyman said, "We strongly encourage patients to talk with their surgeon and other members of their multidisciplinary team to understand their options and make sure everybody is on the same page."

"The most critical determinant of breast cancer prognosis is still the presence and extent of lymph node involvement," he said. "Therefore, the lymph nodes need to be evaluated so we can understand the extent of the disease."

Two breast cancer specialists welcomed the new guidelines.

"Over the past few years, there has been a movement to limit the amount of axillary [lymph node] surgery in patients undergoing breast conservation," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.

Bernik said the new guidelines are important because some doctors have been reluctant to move away from further underarm node removal when a patient has even one affected sentinel node. "This update will give surgeons the confidence to tell patients that a sentinel lymph node biopsy may be enough, even if there is evidence of spread, in patients undergoing [lumpectomy]," Bernik said.

"However, it is still important for surgeons to discuss the pros and cons with a patient, as not all [real-world] patients fit the study criteria," she said. "Furthermore, it needs to be stressed that the more limited surgery does not apply to women undergoing mastectomies."

Dr. Debra Patt is the medical director of an expert panel that assesses cancer care guidelines for the US Oncology Network. She said she was "thrilled" at the new ASCO guidelines because they seem to echo the results of recent studies.

"In 2010, a study presented at the ASCO annual meeting showed that women undergoing breast-conservation surgery with clinically node-negative small breast cancers could safely avoid removing all the lymph nodes from under the arm in most cases," Patt said. "There has been greater variance in treatment patterns in my community practice, and I believe these updated guidelines will direct practitioners to evidence-based patient care."

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCES: Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Debra Patt, M.D., medical director, Pathways Task Force and Healthcare Informatics, US Oncology Network; American Society of Clinical Oncology, news release, March 24, 2014

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Targeted Radiation Might Help Fight Advanced Breast Cancer: Study

MONDAY, March 24, 2014 (HealthDay News) -- A minimally invasive treatment that delivers radiation directly to tumors may slow progression of breast cancer that has spread to the liver, a new study suggests.

The treatment is called yttrium 90 (Y-90) radioembolization. Doctors insert a catheter through a tiny cut in the groin and guide it into the artery that supplies the liver. Radiation-emitting micro beads are then sent through the catheter and float out to kill small blood vessels that feed the tumor.

Researchers led by Dr. Robert Lewandowski, an associate professor of radiology at Northwestern University Feinberg School of Medicine in Chicago, looked at the outcomes of 75 patients. The women ranged in age from 26 to 82, and had chemotherapy-resistant breast cancer that had spread to the liver ("metastatic" disease). Their liver tumors were too large or too numerous to be treated with other methods, the authors noted.

Y-90 radioembolization therapy stabilized 98.5 percent of the treated liver tumors, according to the study, which was to be presented Monday in San Diego at the annual meeting of the Society of Interventional Radiology.

In addition, 24 of the women experienced a more than 30 percent shrinkage in tumor size after treatment, which caused few side effects.

"Although this is not a cure, Y-90 radioembolization can shrink liver tumors, relieve painful symptoms, improve the quality of life and potentially extend survival," Lewandowski said in a society news release.

"While patient selection is important, the therapy is not limited by tumor size, shape, location or number, and it can ease the severity of disease in patients who cannot be treated effectively with other approaches," he added.

Two breast cancer experts were cautiously optimistic about the findings.

According to Dr. Neelima Denduluri, "while these results appear promising, this is a very small retrospective study," meaning that it fell short of the "gold standard" type of prospective trial that tracks patients going forward over time. "Randomized controlled prospective studies addressing this issue are necessary before radioembolization can be incorporated routinely," she believes.

For now, "in women that cannot receive systemic therapy due to toxicities [side effects], are not eligible for clinical trials that utilize new agents, or have exhausted conventional chemotherapy options, radioembolization may be a choice," said Denduluri, a medical oncologist with Virginia Cancer Specialists in Arlington, Va., a US Oncology Network affiliate.

Dr. Stephanie Bernik is chief of surgical oncology at Lenox Hill Hospital in New York City. She said that while this type of therapy has been used to fight liver tumors, "the ability to use this therapy in treatment of metastatic breast cancer to the liver offers some hope to patients with the disease."

Bernik stressed that, right now, the treatment can only extend survival for women with advanced breast cancer, it is not a cure. However, "as the technique is modified and perfected, it is hoped the [treatment] can help achieve remission in women with advanced disease."

Each year in the United States, about 117,000 patients are diagnosed with breast cancer that has spread to the liver. Chemotherapy is the standard treatment in such cases, but is not effective in, or suitable for, all patients.

Experts note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCES: Neelima Denduluri, M.D., medical oncologist, Virginia Cancer Specialists, Arlington, Va., a US Oncology Network affiliate; Stephanie Bernik, M.D., chief of surgical oncology, Lenox Hill Hospital, New York City; Society of Interventional Radiology, news release, March 24, 2014

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Fibromyalgia Might Be Harder on Younger Patients, Study Finds

SATURDAY, Oct. 26 (HealthDay News) -- Young and middle-aged fibromyalgia patients report worse symptoms and poorer quality of life than older patients, a new study reveals.

Fibromyalgia is characterized by symptoms such as musculoskeletal pain and tenderness, fatigue, and sleep and memory problems. The disorder, which most often affects women, has no known causes and few effective treatments.

The study included 978 fibromyalgia patients who were divided into three age groups: 39 and younger, 50 to 59, and 60 and older. The younger and middle-aged patients were more likely to be employed, unmarried, smokers, have a higher education level and lower body-mass index (BMI), a measure of body fat that takes height and weight into account.

They were also more likely to have a history of abuse and to have had fibromyalgia symptoms for a shorter length of time than older patients, the study authors said.

"Among the three age groups of young, middle-aged and older, symptom severity and quality of life differs," study senior author Dr. Terry Oh, a physical medicine and rehabilitation physician at the Mayo Clinic in Rochester, Minn., said in a clinic news release.

The findings were surprising, because older people generally have poorer quality of life and physical health than younger people, Oh said.

The researcher noted that female fibromyalgia patients in all three age groups reported a lower quality of life than average U.S. women, and that the difference between their physical health and that of the average woman was more significant than mental health differences, particularly in young patients.

The study was to be presented this week at the American College of Rheumatology annual meeting, in San Diego.

In other Mayo studies presented at the meeting, researchers found that about 7 percent of fibromyalgia patients have inflammatory rheumatic conditions and that these patients don't respond as well to treatment as those without rheumatic diseases, and that fibromyalgia patients may also have skin-related symptoms such as excessive sweating, burning and other sensations.

Because the studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Mayo Clinic, news release, Oct. 26, 2013

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Current Colon Cancer Screening Guidelines Might Miss Some Patients

FRIDAY, Oct. 25 (HealthDay News) -- Current U.S. colon cancer screening guidelines may result in 10 percent of colon cancers being missed in people with a family history of colon polyps that can lead to cancer, a new study suggests.

"The biggest surprise was the percentage of missed cancers under the current guidelines. We figured there would be a few percent, but 10 percent is a large number," study author Dr. N. Jewel Samadder, of the Huntsman Cancer Institute at the University of Utah, said in a university news release.

Colorectal cancer is the third most common cancer in the United States and the second deadliest.

Samadder's team looked at data from nearly 127,000 people, aged 50- to 80, who underwent colonoscopy in Utah between 1995 and 2009. They found that first-degree relatives -- parents, siblings, children -- of people with adenomas (polyps linked to cancer) or advanced adenomas had a 35 percent to 70 percent increased risk of developing colon cancer than relatives of patients without these growths.

Second-degree relatives (aunts, uncles, grandparents) and third-degree relatives (cousins, nieces, nephews, great-grandparents) of people with adenomas were also at increased risk for colon cancer, according to the study published online Oct. 25 in the journal Cancer.

"We expected to see increased risk in first-degree relatives, but we weren't sure the risk would also be higher for more distant relatives in multiple generations," Samadder said.

Current national guidelines for colon cancer screening recommend colonoscopy every 10 years starting at age 50 for the general population. But first-degree relatives of people diagnosed with either colorectal cancer or advanced adenomas before age 60 should have a colonoscopy every five years beginning at age 40, according to the guidelines.

However, screening recommendations for second- and third-degree relatives of people diagnosed before age 60 are the same as for the general public.

So, the new findings "raise the issue of whether some level of more aggressive screening should be considered, not only for first-degree relatives of patients with polyps diagnosed at or below age 60, but also for those first-degree relatives of patients diagnosed above age 60," Samadder said.

One expert not connected to the study said the findings may be important, but it's often difficult to assess a patient's family history when it comes to colon cancer.

"This information is important not only to specialists who treat colon and rectal and cancer but all primary care providers who recommend screening programs for their patients," said Dr. Jerald Wishner, director of colorectal surgery at Northern Westchester Hospital in Mount KIsco, NY.

However, he added that, "It will be difficult to apply this information in everyday clinical practice. I regularly see patients who know their relatives have had surgery for cancer don't know the type. Finding out if their relatives have had adenomas or advanced adenomas will be very difficult. This will be further complicated as we seek information about second or third degree relatives."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jerald Wishner, M.D., director, colorectal surgery, Northern Westchester Hospital, Mount Kisco, N.Y; University of Utah, news release, Oct. 22, 2013

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AIDS Virus in Cats Might Help Human Vaccine Effort, Study Hints

THURSDAY, Oct. 3 (HealthDay News) -- Cats may hold a key to developing an HIV vaccine for people, a new study suggests.

Researchers found that a protein from the virus that causes AIDS in cats triggered an immune response in blood from HIV-infected people. The virus that causes AIDS in people is called the human immunodeficiency virus while the one that affects cats is called the feline immunodeficiency virus (FIV).

The findings, reported in the October issue of the Journal of Virology suggest that further research with FIV could lead to an HIV vaccine for people, the University of Florida and University of California, San Francisco investigators said.

"One major reason why there has been no successful HIV vaccine to date is that we do not know which parts of HIV to combine to produce the most effective vaccine," study corresponding author Janet Yamamoto, a professor of retroviral immunology at the UF College of Veterinary Medicine, said in a university news release.

In previous studies, scientists have combined various whole HIV proteins as vaccine ingredients, but none worked well enough to be used as a commercial vaccine, she explained.

"Surprisingly, we have found that certain peptides of the feline AIDS virus can work exceptionally well at producing human T-cells that fight against HIV," Yamamoto said. T-cells are immune system cells that attack cells infected with viruses.

The FIV protein that triggered the human T-cell response is present in multiple HIV-like viruses in different animal species, she said. By studying FIV, the researchers believe that it may be possible to identify regions of HIV that might prove useful targets for a vaccine.

One researcher emphasized that different viruses affect people and cats.

"We want to stress that our findings do not mean that the feline AIDS virus infects humans, but rather that the cat virus resembles the human virus sufficiently so that this cross-reaction can be observed," study co-author Dr. Jay Levy, a professor of medicine at UCSF, said in the news release.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Florida, news release

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Nail Fungus Drug Might Help Against HIV, Study Suggests

MONDAY, Sept. 23 (HealthDay News) -- A common drug used to treat nail fungus may hold promise against HIV, the virus that causes AIDS, according to a new study.

In laboratory research, the anti-fungal drug Ciclopirox allowed HIV-infected cells to get killed off by blocking the cells' mitochondria -- their powerhouse. In addition, Ciclopirox eliminated HIV from cell cultures, and the virus did not return when the anti-fungal drug was stopped, the study authors said.

This does not occur with currently available anti-HIV drugs, which must be taken for the rest of a patient's life, said study leaders Michael Mathews and Hartmut Hanauske-Abel, of the Rutgers New Jersey Medical School.

The effectiveness of Ciclopirox against HIV needs to be confirmed in human clinical trials. But because the drug is already approved by the U.S. Food and Drug Administration for treatment of fungal infection and is considered safe, the clinical trial process for this treatment could be quicker and less costly than usual, the researchers said.

The study is published in the current edition of the journal PLoS One.

The use of combination antiretroviral drugs have vastly improved HIV treatment, the study authors said in a Rutgers news release. These so-called drug cocktails are effective at keeping HIV under control, but they never completely eradicate the infection.

HIV's persistence is partially due to its ability to disable a cell's so-called suicide pathway, which is normally triggered when a cell becomes infected or damaged.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Rutgers New Jersey Medical School, news release, Sept. 23, 2013

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