Targeted Drugs, Lung CT Screening Top Cancer Advances in 2011

Report from leading oncologists' group finds strides were made against tough-to-treat tumors

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TUESDAY, Dec. 6 (HealthDay News) -- As the war against cancer continues, a group representing U.S. oncologists has picked its "Top Five" list of advances in cancer care for 2011.

Leading the list are approvals for a bevy of new, targeted drugs for tough-to-treat malignancies, plus promising results suggesting CT chest scans may be an early-detection screen for lung cancer.

The American Society of Clinical Oncology (ASCO) this week issued its annual report on progress against cancer. The report was published online Dec. 5 in the Journal of Clinical Oncology.

"The big news has been targeted drug therapy," noted Dr. Nicholas Vogelzang, head of the section of genitourinary cancer at the Nevada Cancer Institute in Las Vegas and co-executive editor of the report.

"We now have drugs that are very selective for some solid tumors. We now have [new] drugs affecting melanoma and lung cancer, which is pretty sweet," he said. "We don't know how long the responses to these drugs last -- they appear to be pretty short -- but some of them are truly dramatic."

CT-based lung cancer screening was the other big news in the cancer field this past year, Vogelzang noted. "People who smoke have a huge increase in lung cancer -- 40 times that of the general population. If you stop the risk drops, but it never goes back to zero."

However, a widely reported study published earlier this year by the U.S. National Cancer Institute found that screening smokers and former smokers with a CT chest scan was "dramatically better than the chest X-ray," Vogelzang said.

According to experts at ASCO, this year's top five advances include:

A trial of the drug vemurafenib (Zelboraf), which targets a key gene mutation in melanoma. The study found improved survival in patients with advanced melanoma compared with standard chemotherapy.
A screening trial of more than 50,000 current and former heavy smokers found that three yearly low-dose CT scans reduced the death risk from lung cancer by 20 percent compared with people screened with three annual chest X-rays. Some experts have said that more study may be needed before recommending regular CT screening for all smokers, however, pointing to factors such as cost and high rates of false-positive results.
The U.S. Food and Drug Administration granted approval to crizotinib (Xalkori) for patients with advanced non-small-cell lung cancer who have a specific gene mutation. In one study, 50 percent of patients talking the medication saw their tumors shrink completely or partially for an average of 10 months. Another study found a 61 percent response rate that lasted an average of 12 months.
The FDA also approved ipilimumab (Yervoy) for patients with previously untreated metastatic melanoma. The drug works by activating the patient's immune response. The trial showed that when combined with standard chemotherapy using dacarbazine, Yervoy extended life by two months.
Finally, there was the first conclusive evidence that exemestane (Aromasin) a so-called aromatase inhibitor, reduced the risk of developing breast cancer, making it a preventative treatment option for postmenopausal women at high risk for breast malignancies.

According to Vogelzang, the take-home message for patients is that, "cancer therapy continues to get better and better each year. Side effects are reducing. The old story of chemotherapy is going away -- this is no longer your grandfather's Buick -- these are pills that make cancer a truly manageable disease, much like diabetes."

Other topics in the report include: Ways to deal with troublesome, ongoing shortages of certain chemotherapy drugs, and the impact of health care reform might have in addressing disparities in cancer care.

In addition, the report looked at ways to improve clinical cancer research in the United States.

The report was developed by an 18-member editorial board made up of leading oncologists. Only studies that significantly changed the way a cancer is understood or had a major impact on patient care were chosen for the report, Vogelzang noted.

Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, agreed that "we are moving into a new era of [cancer] drug development."

He explained that a better understanding the genetics of a particular cancer now makes it possible to develop medicines that target a key part of the tumor cell, making therapies more specific and effective.

"For example, in melanoma we are still using the same drug today that I used back in 1972," Lichtenfeld said. However, the advent of new drugs is starting to change that, he added.

"The extension of life may be modest, [but] we need to appreciate that they are real," Lichtenfeld said. "Ten years ago we started talking about making cancer a 'chronic disease' and we are starting to see that happen."

SOURCES: Nicholas Vogelzang, M.D., Head, Section of Genitourinary Cancer, Nevada Cancer Institute, co-executive editor of the report; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; Dec. 5, 2011, Clinical Cancer Advances 2011: ASCO's Annual Report on Progress Against Cancer, Dec. 5, 2011, Journal of Clinical Oncology, online

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