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Medications May Be Effective in Cancer Prevention

Breaking News - May 2005 - Week 3

(May 18, 2005)

Healthcare in  the News

-- Some existing medications, including statins, may be taking on a more important role in the prevention of different forms of cancer, according to studies presented at the American Society of Clinical Oncology annual meeting.

Picture of male and female co-workers in a pharmacy

Existing medications were found to be of potential benefit in preventing the onset of prostate, endometrial, and breast cancers, researchers say.

Medications Used in New Ways

For example, the hormone drug toremifene (brand name Acapodene®) reduced the risk of developing prostate cancer by nearly half in men at high risk for the disease. Toremifene is a selective estrogen receptor modulator (SERM) currently used to treat advanced breast cancer.

"Prostate cancer is the most common cancer diagnosed in the US," says study author Dr. David Price, director of urologic oncology and clinical research at Regional Urology LLC, in Shreveport, La.

In the general population, men have a one-in-eight chance of being diagnosed with the disease in their lifetime, he says.

Men with a precancerous condition called prostatic intraepithelial neoplasia (PIN) - the population analyzed in this study - have a 15-fold greater risk of being diagnosed with prostate cancer.

In the study, 514 men with PIN were randomly assigned to receive 20 milligrams, 40 milligrams, or 60 milligrams of toremifene or a placebo (inactive substance).

At the end of one year, 31.2 percent of the men in the placebo group had developed prostate cancer, vs. only 24.4 percent in the 20-milligram group. This is about equivalent to preventing 6.8 cancers per 100 patients treated every year, Dr. Price says.

Men receiving the higher doses of toremifene also had a lower incidence of prostate cancer but not a statistically significant one, Dr. Price notes. The medication was also safe and well tolerated, he adds.

This is the first time a study has documented the natural history of PIN in a large prospective study, according to Dr. Price.

Further studies are under way to confirm the data, but "nevertheless it is promising," Dr. Price says. "I have good treatment options for prostate cancer but when I diagnose men with PIN, I tell them I don't have anything to offer, we just have to follow you closely.

That generates a lot of anxiety," he says. "For the first time, we have some preliminary data that looks very promising."

Dr. Price also hopes to test the medication in other high-risk populations such as African-American men and men with a family history of the disease.

Statins Linked to Lower Risk for Breast Cancer

In another finding presented, the cholesterol-lowering drugs known as statins may reduce breast cancer risk by more than half. There is some data to indicate that statins suppress tumor growth in animals, but data in humans is conflicting, experts say.

This study, however, looked at existing data on about 40,000 female veterans. Women who took statins had a 51 percent lower risk for breast cancer than nonusers.

If statins do indeed work against tumor growth, it may be due to their ability to inhibit a particular enzyme that regulates different cell-signaling pathways, the study researchers suggest.

But the authors caution against over-interpreting the findings.

"Does that mean we should be giving statins to everyone?" asks Dr. Vikas Khurana, senior study author and assistant professor of medicine at Louisiana State University Health Sciences Center in Shreveport. "We are not ready for that yet.

"All we know is that statins are associated with a decreased risk for breast cancer," Dr. Khurana says. "There could be another factor related to statin use that might be causing the effect. Regardless, this is one step further to a randomized trial that would give us an answer."

Raloxifene Reduces Endometrial Cancer Risk

Yet a third study, this one a new analysis of patients taking the breast cancer drugs raloxifene and tamoxifen, found raloxifene may reduce the risk of endometrial cancer - cancer of the uterine lining - by 50 percent. Tamoxifen increased the risk, however.

Like tamoxifen, raloxifene is a selective estrogen receptor modulator (SERM). Unlike tamoxifen, raloxifene does not stimulate estrogen receptors in the lining of the uterus, the researchers note.

The apparent protective effect of raloxifene was most pronounced during the first three years of use, says lead investigator Dr. Angela DeMichele, an assistant professor of medicine at the Abramson Cancer Center and Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania.

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Counting Blood Cells Looks at Therapy Effectiveness

Counting the amount of a type of normal cell circulating in the blood of people with cancer could predict whether a tumor progresses or responds to therapy, according to a study presented at the American Society of Clinical Oncology meeting.

The finding, from a new study led by the University of Michigan Comprehensive Cancer Center, could give physicians an early indication of whether a treatment will be successful, sparing patients months of an ineffective therapy.

Researchers looked at the number of endothelial cells - normal cells lining the blood vessels - that were circulating in the blood of people with sarcoma.

Previous studies have shown that higher levels of circulating endothelial cells are found in people with cancer compared to people who are cancer-free.

In this study, researchers found patients whose cancer grew after two months of treatment had high levels of circulating endothelial cells before beginning therapy, while patients whose cancer remained stable had low levels of these cells.

"This test can be used to predict the patient's outcome and survival," says Dr. Laurence Baker, professor of internal medicine and pharmacology at the University of Michigan Medical School.

Circulating endothelial cells are the target of new anti-angiogenesis medications, which are designed to inhibit the growth of blood vessels that feed tumors. Angiogenesis, the natural process of blood vessel formation, is believed to contribute to the growth and development of cancer cells.

In this multicenter trial, researchers took blood samples from 88 people with advanced sarcoma, a cancer of the soft tissues, and analyzed it to determine the number of endothelial cells circulating in the blood.

"Because the endothelial cell is the target of these anti-angiogenesis drugs, you might be able to very quickly determine if therapy is working," Dr. Baker says. Traditionally, patients undergo X-rays and other imaging scans to see if the tumors have disappeared or shrunk.

In this trial, circulating endothelial cell levels in the study participant's blood were evaluated at the start of the trial, one month in, and every two months thereafter.

Researchers found that patients with low circulating endothelial cell counts, defined as fewer than 15 per sample of blood, remained on the therapy longer than people who had more than 15 circulating endothelial cells per sample at the start of treatment or a month into treatment. Patients were allowed to remain on the therapy until their tumor grew by 50 percent.

The findings suggest physicians may be able to tailor treatment based on the likelihood of response, potentially switching patients from treatments that are not working for them and sparing them months of unnecessary side effects.

Always consult your physician for a diagnosis.

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