Source: American Cancer Society
Related MedlinePlus Pages: Cancer Immunotherapy
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Mark Truty, M.D., a Mayo Clinic surgeon specialized in treatment of pancreatic cancer, discusses the evaluation, diagnosis, and treatment of pancreatic cancer. Dr. Truty emphasizes that in 2013; approximately 45,000 patients were diagnosed with pancreatic cancer. Today, with Mayo Clinic’s research and modern approach to multimodal surgical management of pancreatic cancer, patients who previously may have had very little hope, now have a greater chance of long-term survival.
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Cancer can play a cat and mouse game with our immune systems, hiding cells and making it harder to fight off the disease.
One treatment to help combat this is immunotherapy, a type of cancer treatment that helps strengthen patients’ immune systems and fight off cancer.
NIH and the National Cancer Institute are working to research and improve immunotherapy to help save lives.
What is cancer?
Our body usually forms new cells when our old cells die. Sometimes this process goes wrong. With cancer, new cells grow when you don’t need them, and old cells don’t die when they should. These extra cells can form a mass called a tumor.
How does immunotherapy combat cancer?
Some types of immunotherapy help find extra cancer cells so that they can be destroyed. Others boost your immune system to work better against cancer.
Who could benefit from immunotherapy?
Immunotherapy is not as widely used as surgery, chemotherapy, and radiation therapy. But immunotherapies have treated people with many types of cancer and are being tested in clinical trials.
Ask your health care provider if immunotherapy may be a good option for you or a loved one.
How is immunotherapy given?
Treatment can be given intravenously (in your vein), by taking a pill, or through your bladder. For patients with early skin cancer, there is an immunotherapy cream you can rub on your skin.
Where do you get immunotherapy?
You may get immunotherapy treatment at a doctor’s office, a clinic, or an outpatient unit at a hospital.
What are possible side effects of immunotherapy?
Side effects are unique to each patient and each cancer.
Some common side effects include fever, chills, weakness, dizziness, nausea or vomiting, fatigue, and other flu-like symptoms.
If you had immunotherapy through your vein, you may have pain, swelling, soreness, itchiness, or a rash at the needle site.
What is NIH’s role in immunotherapy research?
NIH and the National Cancer Institute are leading the way in immunotherapy research and development.
NCI’s Center for Cancer Research is dedicated to finding new and better treatments for cancer, including immunotherapy.
Steven Rosenberg, M.D., Ph.D., and his team at the center have pioneered immunotherapy treatment. They also work with patients at the NIH Clinical Center to test new immunotherapies and improve cancer patients’ lives.
What new immunotherapy research is NCI studying?
Just recently, Dr. Rosenberg and his team saw a complete cancer regression in a late-stage breast cancer patient thanks to an experimental immunotherapy treatment they are working on.
The patient, who is part of an ongoing clinical trial at NCI’s Center for Cancer Research, was not responsive to other treatments.
15 percent of patients in the same trial have seen similar results with both liver and colon cancers.
Mayo Clinic’s new, state of the art, Proton Beam Therapy Facility delivers radiation oncology in a way that promises lower side effects and higher cure rates, often for patients whose cancers cannot be treated safely any other way.
For some people with gallbladder cancer,
treatment can remove or destroy the cancer. The end of treatment can be both stressful and exciting. You may be relieved to finish treatment, yet it’s hard not to worry about cancer coming back. This is very common if you’ve had cancer.
For other people, the cancer might never go away completely. Some people may get regular treatment with chemotherapy or other treatments to try and help keep the cancer in check. Learning to live with cancer that doesn’t go away can be difficult and very stressful.
Life after cancer means returning to some familiar things and also making some new choices.
After you have completed treatment, your doctors will still want to watch you closely. It’s very important to go to all follow-up appointments. During these visits, your doctors will ask about symptoms, and do physical exams, and may order blood tests or imaging tests, like CT scans.
If you’ve had surgery and have no signs of cancer remaining, many doctors recommend follow-up with imaging tests about every 6 months for at least the first 2 years, but not all doctors follow this same schedule. Follow-up is needed to check for cancer that has come back or spread. It’s also needed to check for possible side effects of certain treatments.
This is the time for you to ask your cancer care team any questions and discuss any concerns you might have.
Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. Don’t hesitate to tell your cancer care team about any symptoms or side effects bothering you so they can help you manage them.
Ask your doctor for a survivorship care plan
Talk with your doctor about developing a survivorship care plan for you. This plan might include:
- A suggested schedule for follow-up exams and tests
- A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
- A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
- Diet and physical activity suggestions
- Reminders to keep your appointments with your primary care provider (PCP), who will monitor your general health care
Keeping health insurance and copies of your medical records
Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.
Can I lower my risk of gallbladder cancer progressing or coming back?
If you have (or have had) gallbladder cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. Unfortunately, it’s not yet clear if there are things you can do that will help.
Adopting healthy behaviors such as not smoking, eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. Still, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of gallbladder cancer or other cancers.
About dietary supplements
So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of gallbladder cancer progressing or coming back. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.
Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you’re thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that might be harmful.
If the cancer comes back
If the cancer does recur at some point, your treatment options will depend on where the cancer is located, what treatments you’ve had before, and your overall health. For more information on how recurrent gallbladder cancer is treated, see Treatment Options Based on the Extent of Gallbladder Cancer.
For more general information on recurrence, you may want to see Understanding Recurrence.
Getting emotional support
Some amount of feeling depressed, anxious, or worried is normal when cancer is a part of your life. Some people are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Life After Cancer.
Suzy Underhill, a patient at Mayo Clinic in Arizona, shares her story battling inflammatory breast cancer. She explains the diagnosis, treatment and how she managed to keep a positive outlook during the process. Learn more about breast cancer treatment at Mayo Clinic: http://mayocl.in/2lulFoe
Mailing colorectal cancer screening tests to patients insured by Medicaid increased screening rates for this population, report researchers at the University of North Carolina Comprehensive Cancer Center.
In collaboration with the Mecklenburg County Health Department in Charlotte, researchers with UNC Lineberger’s Carolina Cancer Screening Initiative examined the impact of targeted outreach to more than 2,100 people insured by Medicaid who were not up-to-date with colorectal cancer screening. The project resulted in a nearly 9 percentage point percent increase in screening rates for patients who received a screening kit in the mail compared with patients who just received a reminder, and it demonstrated that their method could serve as a model to improve screening on a larger scale. The findings were published in the journal Cancer.
The American Cancer Society estimates that more than 97,000 people will be diagnosed with colorectal cancer in the United States this year, and it will result in approximately 50,600 deaths. It is third most common type of cancer in the United States, and the second leading cause of cancer death. Cancer, overall, is the second killer in the US, behind heart disease.
While colorectal cancer screening has proven effective in reducing cancer deaths, researchers report too few people are getting screened. Current guidelines from ACS recommend regular screening with either a high-sensitivity stool-based test or a structural (visual) exam for average-risk people aged 45 years and older, and that all positive results should be followed with colonoscopy.
Despite these recommendation, studies have identified notable gaps in screening rates, including by race, geographic region and other socioeconomic factors. Among patients who are insured, people with Medicaid have the lowest rates of colorectal cancer testing.
“There has been a national push to increase colorectal cancer screening rates since colorectal cancer is a preventable disease, but screening rates are only about 63 percent, and low-income, and otherwise vulnerable populations, tend to be screened at even lower rates,” said the study’s first author UNC Lineberger’s Alison Brenner, Ph.D., MPH, research assistant professor in the UNC School of Medicine Department of Internal Medicine.
For the project, researchers either mailed reminders about colorectal cancer screening and instructions on how to arrange one with the health department, or reminders plus a fecal immunochemical test, or FIT kit, which can detect blood in the stool—a symptom of colon cancer. The patient completes the test at home and returns it to a provider for analysis. Patients who have a positive FIT kit result will be scheduled for a colonoscopy.
The UNC Lineberger researchers worked with the Mecklenburg County Health Department staff, who coordinated the reminders and mailings and ran the test analyses. They also partnered with Medicaid care coordinators to provide patient navigation support to patients who had abnormal test results and required a colonoscopy.
Twenty-one percent of patients who received FIT kits in the mail completed the screening test, compared with 12 percent of patients who just received a reminder. Eighteen people who completed FIT tests had abnormal results, and 15 of those people were eligible for a colonoscopy. Of the 10 who completed the colonoscopy, one patient had an abnormal result.
“Preventive care amongst vulnerable populations rarely rises to the top of the mental queue of things that need to get done,” Brenner said. “In North Carolina, many Medicaid recipients are on disability. Making something like colorectal cancer screening as simple and seamless as possible is really important. If it’s right in front of someone, it’s more likely to get done, even if there are simple barriers in place.”
Brenner said the study shows the potential to harness resources like the county health department for health prevention services.
“This collaborative and pragmatic quality improvement effort demonstrates the feasibility, acceptability, and efficiency of using existing health services resources and infrastructure, including Medicaid-based navigation to colonoscopy to deliver timely cancer screening services to low income populations,” said UNC Lineberger’s Stephanie Wheeler, Ph.D., MPH, associate professor in the UNC Gillings School of Global Public Health and the study’s senior author.
She said researchers plan to move forward to study whether they can implement their approach on a larger scale, and to understand all of the cost implications.
“This is looking at expanding the medical neighborhood—to harness community resources to target patients and in this case, insured patients, who are maybe not getting this from a primary health care organization, and how to increase screening rates in these types of vulnerable populations,” Brenner said.
If you are looking for a doctor to discuss the need for colon cancer screening or your results, you can find a physician at HealthLynked.com. We are the first ever healthcare social ecosystem designed to Improve HealthCare.
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Source: originally printed, “By sending tests in the mail, researchers boost colorectal cancer screening.” July 14, 2018 , UNC Lineberger Comprehensive Cancer Center
More information: Alison T. Brenner et al, Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial, Cancer (2018). DOI: 10.1002/cncr.31566
Provided by: UNC Lineberger Comprehensive Cancer Center
If you see yellow ribbons around your community during the month of July, it may mean something different than the usual “Support Our Troops” many think of when first sighted. Instead, they could be displayed in honor of Sarcoma Awareness Month, observed each July.
Sarcoma is a soft-tissue cancer that may occur in a variety of the body’s soft tissues, including the nerves, muscles, joints, blood vessels, fat and more. Sarcoma may also occur in the bones. Although rare in adults, making up just ONE percent of adult cancers, sarcoma is relatively common in children, accounting for fifteen percent of childhood cancer cases. Bone and joint cancer is most frequently diagnosed among teenagers, while soft tissue cancers typically affect those 55 years or older.
Sarcoma is most often found in the arms and legs, where the majority of connective tissues are located, but it can occur virtually anywhere. Because the disease often starts deep in the body, it may not be noticeable until a large lump or bump appears — and at this point the cancer may be difficult to treat.
The Sarcoma Foundation of America (SFA) estimates that about 20 percent of sarcoma cases are curable by surgery while another 30 percent may be effectively treated with surgery, chemotherapy and/or radiation. However, in about half of cases, the disease is resistant to all form of treatments, highlighting an urgent need for new therapies.
Soft tissue sarcomas form in cartilage, fat, muscle, blood vessels, tendons, nerves, and around joints. Osteosarcomas develop in bone; liposarcomas form in fat; rhabdomyosarcomas form in muscle; and Ewing sarcomas form in bone and soft tissue.
In 2018, over 13,000 cases of soft tissue sarcoma and 3,400 cases of bone sarcomas are expected to be diagnosed in the United States, according to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER). Approximately 5,100 and 1,590 people are expected to die from soft tissue and bone sarcomas, respectively. The five-year survival rate for soft tissue sarcomas is 50 percent, while the survival rate is 66 percent for bone sarcomas.
Because sarcomas are difficult to distinguish from other cancers when they are found within organs, their incidence is probably underestimated, according to the National Cancer Institute.
Fast facts on sarcoma
- There are over 50 types of soft tissue sarcoma.
- Symptoms may not be apparent; often, the only sign of sarcoma is a lump.
- Pain may occur depending on where the tumor is located, or if it presses on nearby nerves.
- Treatment, as for other forms of cancer, can include surgery, radiation therapy, and chemotherapy.
Symptoms of soft tissue sarcoma
People with soft tissue sarcomas often have no symptoms. There may be no signs until the lump grows to a large size and can be felt; however, even this may go unnoticed. The main symptoms are:
- Pain – the most obvious symptom. Once the tumor affects local tissues, nerves, or muscles, it can be felt as pain in the general area.
- Inflammation – the tumor grows and eventually affects the area with inflammation and swelling.
- Location specific symptoms – inability to move limbs properly (if the sarcoma is on the arms or legs for example) and other impairments depending on the location.
Specific symptoms may reflect the particular type of sarcoma. For instance, tumors in the gastrointestinal system may bleed, so these sarcomas might produce symptoms like blood in the stool, or a stool that has a black, tarry appearance.
Types of sarcoma
Types of soft tissue sarcoma are defined by the specific tissue or location affected; they include:
- Undifferentiated pleomorphic sarcoma – previously known as malignant fibrous histiocytoma – this tumor is most often found in the arms or legs but sometimes at the back of the abdomen.
- Gastrointestinal stromal tumor (GIST) – this affects specialized neuromuscular cells of the gut.
- Liposarcoma – sarcoma of fat tissue.
- Leiomyosarcoma – affects smooth muscle in organ walls.
- Synovial sarcomas – these are usually found around a joint in the arms or legs.
- Malignant peripheral nerve sheath tumor – also known as neurofibrosarcoma, it affects the protective lining of the nerves.
- Rhabdomyosarcoma – this forms in muscle and is a childhood cancer. While rare overall, it is a relatively common tumor in children.
- Angiosarcomas – these develop in the cells of the blood or lymph vessels.
- Fibrosarcomas – sarcomas that usually form in the limbs or on the trunk, forming from fibroblasts, the most common cell type in connective tissue.
- Kaposi’s sarcoma – a sarcoma that affects the skin and is caused by a virus. The most common form of Kaposi’s sarcoma is related to AIDS. Kaposi’s tumors often produce distinctive skin lesions but also affect other soft tissues. Kaposi’s sarcoma is caused by the human herpesvirus 8.
- Further examples – these include dermatofibrosarcoma protuberans, a skin lesion; epithelioid sarcoma, which often affects young adults’ hands or feet; myxoma, which affects older adults, usually in the arms and legs; mesenchymomas, which are rare and combine elements of other sarcomas and can be found in any part of the body; vascular sarcomas, containing many blood vessels; and malignant neurilemmoma (also known as schwannoma). Sarcoma of the bone includes osteosarcoma, Ewing sarcoma, and chondrosarcoma.
Causes of sarcoma
The causes behind sarcoma are unknown, but there are some known risk factors. In adults, for instance, exposure to phenoxy acetic acid in herbicides or chlorophenols in wood preservatives may increase the risk. High doses of radiation are also known to cause sarcomas in some people, as are certain rare genetic alterations. The following inherited diseases are also associated with an increase sarcoma risk, according to SFA:
- Li-Fraumeni syndrome, which is associated with alterations in the p53 gene
- Von Recklinghausen’s disease (neurofibromatosis), which is associated with alterations in the NF1 gene
Having certain inherited disorders can increase the risk for other soft tissue sarcomas, including retinoblastoma, tuberous sclerosis, Werner syndrome, and nevoid basal cell carcinoma syndrome. Other risk factors for soft tissue sarcoma include past treatment with radiation therapy for certain cancers; exposure to certain chemicals, such as thorium dioxide, vinyl chloride, or arsenic; and long-term lymphedema in the arms or legs.
Past treatment with radiation can increase the risk of osteosarcoma and other types of bone cancers. Other risk factors for osteosarcoma include treatment with anticancer drugs called alkylating agents, having a certain change in the retinoblastoma gene, and having certain conditions including Paget disease, Diamond-Blackfan anemia, and Werner syndrome.
Tests and diagnosis of sarcoma
After understanding a patient’s medical history and completing a medical examination, medical imaging scans will help to inform a diagnosis, which will need to be confirmed through laboratory analysis of a tumor sample.
The following physical features should prompt a doctor to investigate:
- larger than 2 inches in diameter or growing in size
- fixed, immovable, or deep
- return of tumor previously removed
Medical imaging helps to locate, characterize, and give further information about a tumor to guide diagnosis. It may also be used to gauge the success of treatment or to look for spread of cancer.
Imaging techniques include X-rays, CT scan (computed tomography), MRI(magnetic resonance imaging), ultrasound, and PET (positron emission tomography).
Treatments for soft tissue sarcoma
The following treatment options can be used for sarcomas:
- Surgery – the most common sarcoma treatment. It aims to remove the tumor and even some of the normal surrounding tissue. A biopsy sample is often taken at the same time to confirm the exact type of tumor.
- Radiation therapy – this destroys cancer cells and may be done in addition to surgery, before or after the operation.
- Chemotherapy – this could also be used in addition to surgery, though less often than radiation therapy.
Some soft tissue sarcomas have other available treatments, such as specific drug treatments, gene-targeted therapies, or biological therapies such as immunotherapy.
Treatment choice and intensity are also guided by the stage and grade of cancer, by the size of the tumor, and extent of any spread.
Prevention of sarcoma
Sarcoma is not typically preventable. Radiation therapy is a risk factor, so reducing exposure to it may be preventive, although a need for radiation therapy usually outweighs any subsequent sarcoma risk.
Observing Sarcoma Awareness Month
Sarcoma is still considered to be the “forgotten cancer.” Efforts to encourage research and drug development are made more challenging due to a lack of awareness and understanding. How as a community do we raise funds for vital research if people don’t know that this cancer exists?
Though the Sarcoma Foundation of America works tirelessly every day to raise awareness, during Sarcoma Awareness Month, they aim to further highlight the extraordinary challenges sarcoma patients face and the need for more sarcoma research and better sarcoma therapies. Please join in efforts and pledge to bring awareness to your community. Here are a few ways you can help highlight the need for ongoing research on sarcoma:
- This July, take a moment to share a message via social media or speak with your friends and family about this relatively unknown condition.
- Join sarcoma patients, survivors and their loved ones for the Steps to Cure Sarcoma. Every dollar raised will be used to fund research, patient advocacy and education.
- Take a moment to listen to a Sarcoma Awareness Month Public Service Announcement campaign. Share it online to raise awareness.
- Get together with others in the sarcoma community and donate today!
Since sarcoma is a rare cancer, many people are unfamiliar with the disease and have not been affected personally. However, many children’s lives have been altered because of this disease, and advances in early detection and treatment could help save lives.
A number of clinical trails are underway for people with sarcoma. If you’ve been recently diagnosed, ask your doctor if a clinical trial, which could give you access to novel treatment options, is right for you.
Trying to find the right doctor to determine if that lump or new pain is something more than just a little annoying is made easy at HealthLynked. We are the first ever social ecosystem designed to connect physicians and patients in a truly collaborative platform to Improve HealthCare.
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Han, MD, Seunggu. “Sarcoma: Symptoms, types, treatments, and causes.” Medical News Today. 23 May 2017.
12, 2017, by NCI Staff
The approval, announced on September 22, covers the use of pembrolizumab in patients with advanced gastric cancer or gastroesophageal junction cancer that has progressed despite two or more prior lines of treatment with standard therapies. The gastroesophageal junction is a narrow space where the esophagus meets the stomach.
To receive the drug, patients’ tumors also must express the protein PD-L1. In conjunction with the pembrolizumab approval, FDA also cleared the Dako PD-L1 IHC 22C3 pharmDx assay to measure PD-L1 expression in patients with gastric cancer.
As is often the case with accelerated approvals, FDA based its decision on promising results from an early- or mid-stage clinical trial. In this case, the approval was based on findings from a stage 2 clinical trial, called Keynote-059, in which all patients, regardless of PD-L1 status, received pembrolizumab.
In the trial, which enrolled 259 patients with advanced gastric or gastroesophageal junction cancer, approximately 12% of patients experienced at least partial tumor shrinkage following treatment. However, patients in the trial whose tumors expressed PD-L1 (i.e., were PD-L1 positive) were more likely to respond.
According to the most recent data from the trial, presented last month at the European Society for Medical Oncology (ESMO) annual meeting, 16% of PD-L1-positive patients achieved at least a partial response to the treatment, including several patients who had a complete disappearance of their tumors (complete response).
The results confirm suggestions from earlier studies that pembrolizumab “is clearly active in patients with gastric cancer,” said the lead investigator of Keynote-059, Charles Fuchs, M.D., M.P.H., director of the Yale Cancer Center.
Addressing the Biology of Stomach Cancer
Patients with advanced gastric cancer have few effective treatment options, particularly those whose cancer has stopped responding to existing therapies.
The targeted therapy trastuzumab (Herceptin®) is approved as an initial, or first-line, treatment for patients with advanced gastric cancer that overexpresses the HER2 protein. The only FDA-approved therapy for patients whose disease has stopped responding to initial treatment is ramucirumab (Cyramza®), which was shown to modestly improve how long patients lived in two large clinical trials.
Little progress has been made in finding new, more-effective therapies for stomach cancer, said Dr. Fuchs, because so few drugs have been designed to address its specific biology.
With the exception of ramucirumab, “there’s never been a drug that was explicitly developed and approved for stomach cancer,” he explained.
But a door opened with the findings from the first studies from The Cancer Genome Atlas.
Those studies revealed that tumors in a substantial portion of patients with gastric cancer express PD-L1, Dr. Fuchs explained. PD-L1 is a protein on tumor cells and other cells in the tumor microenvironment that binds to PD-1 on immune cells, an action that serves to tamp down the immune response against tumors.
That finding, Dr. Fuchs said, created an opportunity for researchers to test whether agents that target PD-L1 or, like pembrolizumab, its binding partner on immune cells, PD-1, may provide a new option for gastric cancer.
Durable Responses, Including in Some PD-L1-Negative Patients
In the KEYNOTE-059 trial, which was funded by pembrolizumab’s manufacturer, Merck, 148 patients had tumors that expressed PD-L1.
Many of the partial and complete responses seen in these patients persisted for long periods, ranging from just a few months to more than a year.
“The responses really are quite robust and far longer than you would see with any cytotoxic chemotherapy agent,” Dr. Fuchs said.
In addition, three patients whose tumors were PD-L1-negative—according to the parameters used for the trial and the approved test kit—also had complete responses.
In general, patients in the trial tolerated pembrolizumab well, Dr. Fuchs said, with most experiencing only mild side effects. Common side effects included fatigue, anemia, and dehydration. Seven patients, however, had to stop treatment because of severe side effects, and two patients died from treatment-related side effects.
More Research Needed on Biomarkers, Combinations
Drugs that target PD-L1 “will clearly have a role in advanced gastric cancer,” Eric Van Cutsem, M.D., Ph.D., head of the Division of Clinical Digestive Oncology at the University Hospitals Gasthuisberg in Belgium, said after the Keynote-059 results were presented at the ESMO meeting.
But he cautioned that further research is needed to understand how these agents can be used most effectively in patients with stomach cancer.
“The role of PD-L1 expression [as a predictive biomarker] has to be clarified,” Dr. Van Cutsem said, adding that other predictive markers also need to be identified.
A close analysis of the Keynote-059 trial data does provide some additional guidance on which patients are more likely to respond to pembrolizumab, Dr. Fuchs explained.
Patients who were PD-L1 positive and who had undergone only two prior lines of treatment were more likely to respond than patients receiving the drug as a fourth- or fifth-line treatment.
“So, you see a clearly diminishing response rate” in patients who have received more prior lines of treatment, he said.
“Regrettably, there are still many patients who don’t respond,” Dr. Fuchs continued. The data suggest that there are “two opportunities” to change that. One, he said, “is to look at [pembrolizumab] in earlier lines of therapy, and the other is to figure out what [therapy] to partner with it to augment that response.”
Over the last decade, medicine has seen great advances in the diagnosis and treatment of cancer. Many people with the disease are living longer and many are cured. That’s thanks to cancer research and people who are willing to make sacrifices. Sacrifices such as donating bone marrow.
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18, 2018, by NCI Staff
A type of cancer that occurs in the lower stomach has been increasing among some Americans under the age of 50, even though in the general population the incidence of all stomach cancers has been declining for decades, according to a new NCI-led study.
The study tracked the incidence in the United States of cancer of the lower stomach, known as noncardia gastric cancer.
Between 1995 and 2003, the incidence of noncardia gastric cancer in the general population declined by about 2.3% per year, researchers reported January 18 in the Journal of the National Cancer Institute. But when they analyzed the data by birth year, they identified two distinct trends.
Among Americans over age 50, incidence rates fell by 2.6% per year; for those under age 50, however, the rates increased 1.3% per year.
“These results were surprising,” said M. Constanza Camargo, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, who led the study. The general decrease in incidence rates for noncardia gastric cancer initially masked the divergence between older and younger individuals, she added.
Risk Factors and Shifting Incidence Rates
Two of the main causes of noncardia gastric cancer are infection by the bacterium Helicobacter pylori and autoimmune gastritis, which occurs when a person’s immune system attacks the lining of the stomach.
The prevalence of H. pylori infection has clearly decreased in the United States over the past century, whereas autoimmune gastritis may have become more common in recent decades.
To assess possible impact of these trends on the incidence of noncardia gastric cancer, the researchers analyzed data from the North American Association of Central Cancer Registries. These registries cover 45 states, or roughly 80% of the US population.
The increased incidence of noncardia gastric cancer among individuals under age 50 was most pronounced among non-Hispanic whites, particularly among women.
There was also a modest increase in incidence among young Hispanic whites during the time period of the study. However, there was no increase among non-Hispanic blacks or other races.
A New Type of Stomach Cancer?
Taken together, the findings suggest that there is “a new [type of] gastric cancer among us,”—one that occurs primarily in the gastric corpus region of the stomach, especially in women younger than age 50, wrote Martin Blaser, M.D., and Yu Chen, M.D., Ph.D., of the New York University School of Medicine, in an accompanying editorial. The corpus is the main body of the stomach.
Drs. Blaser and Chen cited three lines of evidence to support the idea that these tumors represent a new type of stomach cancer: the age-specific effect (increasing incidence among younger generations); the location of the tumors in the stomach (primarily in the gastric corpus and adjacent areas); and the strong sex effect.
“The rapid increases in younger women are especially alarming,” the editorialists wrote. More research is critically needed to truly understand the roots of this cancer, they added.
Increased Incidence: Do Antibiotics Play a Role?
Although the new study was not designed to identify the causes of the increased incidence rates, the study authors noted that trends in incidence rates began to change around the time that antibiotic medications began to see widespread use in the 1950s.
“We are seeing an increasing risk of this cancer in people born after 1950, and that coincides with the introduction of antibiotics,” said Dr. Camargo. “The increase in noncardia gastric cancer rates is more pronounced in females than males, and we know that females take more antibiotics than males.”
The use of antibiotics can disrupt the stomach’s collection of microbes, or microbiome, Dr. Camargo noted. In theory, she added, these changes, including the loss of H. pylori, may lead to autoimmune gastritis, which increases the risk of noncardia gastric cancer.
Noting that more studies are needed to determine the potential effect of antibiotics on the risk of stomach cancer, Dr. Camargo stressed that these drugs save lives and should be used when medically necessary.
Predicting a Reversal of Current Incidence Trends
In addition to gaining a better understanding of the biology of this cancer, researchers need to develop strategies for diagnosing the disease. Gastric cancer is often diagnosed in its later stages, when the disease may be more difficult to treat.
“We need to learn more about the molecular characteristics of these tumors,” said Dr. Camargo. “And we’re trying to identify people who are at high risk of developing noncardia gastric cancer.”
Based on their results, the researchers predict two major changes related to this cancer in the United States. First, around 2025, its incidence will be higher in women than men, which would reverse the current pattern. Second, by 2030, the overall incidence of noncardia gastric cancer will be increasing rather than decreasing.
In their editorial, Drs. Blaser and Chen agreed that such changes were possible and congratulated the researchers “for their keen observations that sound a warning about a growing menace.”