Study Finds Bladder Cancer Recurrence And Mortality Could Improve With Better Treatment Compliance

Main Category: Cancer / Oncology
Also Included In: Urology / Nephrology;??Compliance
Article Date: 05 Jun 2013 - 0:00 PDT Current ratings for:
Study Finds Bladder Cancer Recurrence And Mortality Could Improve With Better Treatment Compliance

Researchers at UCLA's Jonsson Comprehensive Cancer Center led by Dr. Karim Chamie, assistant professor-in-residence in the department of urology, have found that the burden of bladder cancer on the population is very high, and that more intense surveillance and treatment in the first two years after diagnosis could reduce the number of patients whose cancer returns after treatment and lower the death rate from this disease. The study was published online ahead of press today in the journal Cancer.

Based on their previous research showing underutilization of care for patients with bladder cancer, this is the first study to examine the natural history of the disease from a population standpoint. To date no one has examined the morbidity of recurrence of disease in the US. Chamie and colleagues found that nearly three quarters of patients with high-grade, non-muscle-invasive bladder cancer will suffer return of the disease (recurrence) within 10 years. Thirty-three percent of patients will have their cancers progress to a more advanced form requiring removal of their bladder, radiation therapy, or systemic chemotherapy. An additional 41% will recur without further spread of the disease (progression).

"Even though 80% of bladder cancer patients don't die of their disease within 5 years, most patients will either die of other causes or bladder cancer, require aggressive treatment (removal of the bladder, radiation, and/or chemotherapy), or have recurrence of their disease. What this study hopes to do is highlight the need to comply with treatment guidelines--prevent recurrences by instilling anticancer agents inside the bladder (intravesical) and follow patients more closely within the first two years of diagnosis," said Chamie.

The study was based on a nationwide sample of Medicare Beneficiaries who had high-grade, non-muscle-invasive bladder cancer. "We have level-one evidence that demonstrates that a single instillation of chemotherapy into the bladder can minimize recurrences, and that six instillations can minimize recurrence and progression," Chamie stated further, "Efforts should be increased to offer patients intravesical therapy with the goal of minimizing the burden of this disease."

The researchers also found that the elderly, women, and African-American patients had higher likelihood of dying of bladder cancer than younger patients, men, and whites, respectively.

This study was supported by the American Cancer Society, Ruth L. Kirschstein National Research Service Award Extramural, Jonsson Comprehensive Cancer Center, National Institutes of Health, and National Institute of Diabetes and Digestive and Kidney Diseases.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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BRCA1/2 Mutations Linked with Better Outcome in Triple-negative Breast Cancer

According to the results of a small study, approximately 20% of women with triple-negative breast cancer are carriers of a BRCA1 or BRCA2 gene mutation. Triple-negative breast cancer patients with these mutations appear to have better survival than patients without these mutations. These results were recently presented at the 2010 Breast Cancer Symposium.[i]

Some breast cancers display different characteristics that require different types of treatment. The majority of breast cancers are hormone receptor-positive, meaning that the cancer cells are stimulated to grow by exposure to the female hormones estrogen and/or progesterone. These cancers are typically treated with hormonal therapy that reduces the production of these hormones or blocks their effects.? Other cancers are referred to as HER2-positive, which means that they overexpress the human epidermal growth factor receptor 2, part of a biologic pathway that is involved in replication and growth of a cell. HER2-positive breast cancers account for approximately 20-25% of breast cancers and are treated with agents that target the receptor to slow growth and replication.

Triple-negative breast cancer refers to cancers that are estrogen receptor-negative, progesterone receptor-negative, and HER2-negative. Triple-negative breast cancers tend to be more aggressive than other breast cancers and have fewer treatment options. Research is ongoing to determine prognostic factors such as gene mutations that may impact prognosis and help to individualize care.

In the current study, researchers from the M. D. Anderson Cancer Center evaluated the frequency and effects of BRCA1 and BRCA2 gene mutations among 77 women with triple-negative breast cancer. Inherited mutations in these genes can be passed down through either the mother’s or the father’s side of the family and greatly increase the risk of breast and ovarian cancer.

15 of the 77 patients (20%) had a BRCA1 or BRCA2 mutation. Five-year relapse-free survival was 86% for patients with a BRCA mutation compared with 52% for patients without a BRCA mutation.

The researchers concluded that triple-negative breast cancer patients with BRCA mutations experienced a significantly lower recurrence rate. These findings were unexpected because previous studies had not shown a difference in recurrence rates.

Patients with triple-negative breast cancer may wish to speak with their healthcare team regarding the risks and benefits of genetic testing.

It should be noted that other studies have not found as high a rate of BRCA mutations in women with triple negative breast, so it is possible that the results of this study represent an overestimate.

[i] Gonzalez-Angulo M, Chen H, Timms K, et al. Incidence and outcome of BRCA mutation carriers with triple receptor-negative breast cancer (TNBC). Presented at the 2010 Breast Cancer Symposium, Washington, DC, October 1-3, 2010. Abstract 160.

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