Keeping you up to date on recent developments in oncology.

Monitoring CTCs in metastatic breast cancer key to prognosis ... A study published in the Journal of Clinical Oncology highlights the benefit of measuring the changes in circulating tumor cell (CTC) counts in patients with metastatic breast cancer to better monitor their outcomes. Specifically, greater than or equal to five CTCs per 7.5 mL of blood predicts poorer progression free survival in patients with metastatic breast cancer (MBC). This study provides the first evidence of a strong correlation between CTC results and radiographic disease progression in patients receiving chemotherapy or endocrine therapy for MBC. These findings also support the role of CTC enumeration as an adjunct to standard methods of monitoring disease status in MBC. The study, supported by Veridex (Raritan, New Jersey), was performed on patients with progressive, radiographically measurable MBC receiving chemotherapy or endocrine therapy. Serial CTC levels and radiographic studies were obtained at baseline and various intervals to determine outcomes. Veridex's CellSearch test was used to draw the CTCs out of blood samples to be identified. The CellSearch System is the first diagnostic test to automate the capture and detection of CTCs that have detached from solid tumors and entered the patient's blood.

Speaking, eating possible after tonsil cancer reconstruction surgery ... A new technique for reconstructing the palate after surgery for tonsil cancer maintained patients' ability to speak clearly and eat most foods. The technique, developed at the University of Michigan Comprehensive Cancer Center (Ann Arbor), is described in Archives of Otolaryngology - Head & Neck Surgery. "This is the area that triggers swallowing, that separates the mouth from the nasal cavity. It affects speech and eating – typically, patients have difficulty eating when they have this kind of tumor and undergo surgery. We can remove the cancer, but there are major quality of life issues," said study author Douglas Chepeha, MD, associate professor of otolaryngology head and neck surgery and director of the microvascular program at the University of Michigan Health System. Traditional reconstruction efforts have meant taking a large piece of tissue to plug the hole left when the tumor is removed. But this impairs the way the palate and tongue function. With the new technique, surgeons create a tube from the remaining palate, which separates the mouth from the nasal cavity and closes during swallowing, allowing patients to eat and speak. Then the surgeons sew up the defect in the base of the tongue to separate the tongue from the rest of the reconstruction to improve swallowing and speech. The study followed 25 patients for five years. Patients who had more than half their palate removed were more limited in what and how they could eat. Emotional scores were high for both groups, suggesting overall satisfaction with their lives.

Tool determines risk of developing cervical cancer ... Cancer experts at the National Cancer Institute are creating a tool to work out the percentage risk a woman has of developing cervical cancer with a preliminary version to be ready by the end of 2010. Current screening programs for cervical cancer usually rely on cytology as the first-line screen. Women who are found to be cytologically abnormal are triaged by carcinogenic human papillomavirus (HPV) DNA testing or by repeat cytology, or are referred directly for a colposcopic examination. At colposcopy, biopsies are taken from any apparent lesions. Treatment is decided on the basis of the combined cytological, colposcopic, and histological diagnoses during the patient's history. These decision processes are formalized in complex consensus management algorithms that narrow down the clinical management options to a single course of action. But the authors point out that, with each new technology, algorithms become exponentially more complex. "Instead of providing clinicians with algorithms, we propose to provide clinicians with their patient's risk of developing cervical cancer," the authors wrote. "As a surrogate for cervical cancer, we propose to use cervical precancer, best defined as histological cervical intraepithelial neoplasia grade 3 (CIN3) or more severe (CIN3+), or less precisely by CIN2+, a common treatment threshold."

Magnets turn cancer drugs on and off ... Many cancer drugs must be dosed intermittently over a long period of time. A few delivery techniques have been developed using an implanted heat source, an implanted electronic chip or other stimuli as an on-off switch to release the drugs. So far, none of these methods has worked reliably. Researchers led by Daniel Kohane, MD, PhD, of Children's Hospital Boston, have devised a solution that combines magnetism with nanotechnology. The team created a small implantable device, less than a half-inch in diameter, that encapsulates the drug in a specially engineered membrane, embedded with nanoparticles composed of magnetite, a mineral with natural magnetic properties. When a magnetic field is switched on outside the body, near the device, the nanoparticles heat up, causing the gels in the membrane to warm and temporarily collapse. This opens up pores that allow the drug to pass through and into the body. When the magnetic force is turned off, the membranes cool and the gels re-expand, closing the pores back up and halting drug delivery. No implanted electronics are required. The device, which Kohane's team is continuing to develop for clinical use, is described in Nano Letters.

Guatemala center launches RapidArc radiotherapy for cancer ... Cancer patients in Guatemala and across Central America now have access to advanced radiotherapy treatments, including intensity-modulated radiotherapy (IMRT) with RapidArc technology. Hope International Centro de Radioterapia has become the first treatment center in Latin America to install the fast new treatment capability from Varian Medical Systems (Palo Alto, California). RapidArc delivers a precise treatment in single or multiple arcs of the treatment machine around the patient and makes it possible to deliver image-guided IMRT two to eight times faster than is possible with conventional IMRT.

Beth Israel Deaconess awarded $11.5M to research kidney cancer ... The National Cancer Institute has awarded Beth Israel Deaconess Medical Center (BIDMC) an $11.5 million, five-year Specialized Program of Research Excellence (SPORE) grant to focus on cancers of the kidney. Michael Atkins, MD, deputy director of BIDMC's Division of Hematology/Oncology, will oversee the grant. As the only NCI-funded SPORE focused on cancers of the kidney, this grant aims to improve detection, diagnosis, treatment and prevention of kidney cancer, which affects about 54,000 Americans each year and causes approximately 14,000 deaths. During the five-year term of the SPORE, Atkins and colleagues will work to improve the understanding and treatment of kidney cancer that is resistant to standard therapies; to identify biomarkers for the purposes of early diagnosis, monitoring, and predicting treatment outcome; and to use the growing understanding of kidney cancer biology to develop novel immune and targeted therapies that improve the outcome of patients with advanced disease.

—Compiled by Lynn Yoffee, MDD