WEDNESDAY, Dec. 26 (HealthDay News)-- Chemotherapy drugs known as anthracyclines help boost survival for women with HER2-positive breast cancer who have undergone surgery, but they may not offer any survival benefit for those with HER2-negative tumors.

That's the conclusion of a wide-ranging analysis that pooled the results of eight randomized trials that compared the drugs with non-anthracyclines and took into account the women's HER2 status.

HER2-positive cancers test positive for a protein called human epidermal growth factor receptor 2 (HER2) and tend to grow quickly, the researchers said.

Since anthracyclines (such as doxorubicin and epirubicin) were introduced in the 1980s, they have been widely used as supplementary chemotherapy for breast cancer, said Dr. Alessandra Gennari, a medical oncologist at the National Cancer Research Institute in Genoa, Italy, and lead author of the study.

But the new analysis may change that, Gennari said. "Our study provides convincing statistical evidence that the added benefit of adjuvant chemotherapy with anthracyclines is confined to women who have breast tumors in which HER2 is overexpressed or amplified," she said.

"Since only about 25 to 30 percent of all breast cancers are HER2-positive, the vast majority of patients, with HER2-negative disease, may be spared unnecessary toxicities related to the use of this class of agents," she added.

The study findings were published online Dec. 25 in the Journal of the National Cancer Institute.

Anthracyclines have been associated with an increased risk of heart damage in some patients -- a risk doctors have known about for some time. An increased risk of leukemia, which can strike years later, is also associated with use of the drugs.

But, Gennari said, anthracyclines came into widespread use despite these risks, because a previous meta-analysis found they improved overall survival. "As a result, anthracyclines-based regimens have been long regarded as the standard therapeutic option in the vast majority of early breast cancer patients. However, when individual trials are taken into account, the absolute magnitude of this benefit is not consistent across studies," she added.

The new study suggests the drugs work best for those women whose tumors are HER2-positive. Of the 6,564 patients reviewed, 5,354 had HER2 status information available. In those women with tumors that were HER2-positive, the anthracyclines produced a greater reduction in risk of relapse or death than non-anthracycline regimens, the study found.

For women with HER2-negative tumors, however, there was no difference in survival between the chemotherapy regimens.

But, in an accompanying editorial in the journal, Dr. Charles Geyer Jr. and his colleagues from the National Surgical Adjuvant Breast and Bowel Project in Pittsburgh, said that it may not be as simple as determining who should get anthracyclines based just on HER2 status.

That's because other research has suggested that the overexpression of another gene called topoisomerase II alpha (or topo2) may also play a role in how well anthracyclines work. "The topo2 gene is thought to be the real target of the anthracyclines," said Geyer, director of medical affairs for the NSABB project. And it may or may not be overexpressed along with the HER2 gene, he said.

The new study's conclusions, Geyer added, provide another example of therapies becoming more and more tailored to the specific type of breast cancer.

In another study in the same issue of the journal, researchers reported that women with breast cancer getting chemotherapy and tamoxifen had reduced risk of getting cancer in the healthy breast. Chemotherapy reduced the risk for at least 10 years and tamoxifen for five years, the study said.

More information

To learn more about anthracyclines and other chemotherapy drugs, visit the American Cancer Society  .

THURSDAY, Dec. 20 (HealthDay News) -- A patient's sex and race, along with the type of treatment they receive, can impact their survival after a diagnosis of advanced laryngeal cancer, say U.S. researchers.

They analyzed data from a national cancer registry on more than 7,000 patients diagnosed with advanced laryngeal cancer between 1995 and 1998.

Of those patients, 53.6 percent had a total laryngectomy (removal of the larynx), 30.6 percent had radiation therapy (radiotherapy) alone, and 15.8 percent had combined chemotherapy and radiotherapy.

"Controlling for the other included factors, the radiotherapy and chemo-radiotherapy groups had lower odds of survival than did the total laryngectomy group. The increased risk associated with death is approximately 30 percent for the chemo-radiotherapy group and 60 percent for the radiotherapy group," wrote study authors Dr. Amy Y. Chen, of Emory University and the American Cancer Society, and Dr. Michael Halpern, of the American Cancer Society.

They also found that men were less likely to survive than women; patients with stage IV disease were less likely to survive than those with stage III disease; black patients were more likely to die than white patients; and uninsured patients or those with Medicaid, Medicare or other government health plan coverage were more likely to die than those with private health insurance.

"We do not believe that insurance status in this analysis represents differential treatment or quality of care for patients with advanced laryngeal cancer. Rather, insurance status is likely a proxy for multiple medical issues, including usual source of medical care, participation in screening and preventive care activities and exposure to related risk factors, including alcohol and/or tobacco use and poor diet, all of which can influence overall survival," the study authors wrote.

"In conclusion, this analysis demonstrates that total laryngectomy yields the highest likelihood of survival for patients with advanced laryngeal cancer," the researchers added.

The study was published in the December issue of the Archives of Otolaryngology -- Head and Neck Cancer.

More information

The U.S. National Cancer Institute has more about treatment of laryngeal cancer.

TUESDAY, Dec. 18 (HealthDay News) -- A new robotic surgical system shows promise in the removal of cancer involving the tonsils, researchers say.

According to a team at the University of Pennsylvania, the transoral robotic surgery (TORS) system includes three instrument-holding robotic arms and a central arm with an endoscope, an optical instrument with two video cameras that offers a three-dimensional view for the surgeon, who uses handles on a console to control the movement of the robotic arms.

This study included 27 patients who had radical tonsillectomy to treat cancer. In 25 (93 percent) of the patients, surgeons were able to use TORS to remove all cancerous tissues. The average length of stay after surgery was just under two hours. After the procedure, 26 of the patients were able to swallow without the use of a stomach tube.

Complications occurred in five (19 percent) of the patients, and most of those were resolved without significant consequences, the study authors said.

"Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity," or complications, the researchers concluded. "Future reports will focus on long-term oncologic and functional outcomes."

Two of the study authors received payment from Intuitive Surgical Inc. for time, materials and teaching a TORS workshop.

The findings were published in the December issue of the journal Archives of Otolaryngology -- Head & Neck Surgery.

More information

Cancer Research UK has more about tonsil cancer  .

MONDAY, Dec. 17 (HealthDay News) -- Cancer continues to cut a deadly swath across the globe, with the American Cancer Society reporting 12 million new cases of malignancy diagnosed worldwide in 2007, with 7.6 million people dying from the disease.

The report, Global Cancer Facts & Figures, finds that 5.4 million of those cancers and 2.9 million deaths are in more affluent, developed nations, while 6.7 million new cancer cases and 4.7 million deaths hit people in developing countries.

"The point of the report is to promote cancer control worldwide, and increase awareness worldwide," said report co-author Dr. Ahmedin Jemal, director of the society's Cancer Occurrence Office.

The number of cancers and cancer deaths around the world is on the rise, Jemal said, mostly due to an aging population. "There is increasing life expectancy, and cancer occurs more frequently in older age groups," he noted.

Lifestyle may be another reason for the rise in malignancies in developing countries, Jemal said, as people adopt Western behaviors such as smoking, high-fat diets and less physical activity.

The best way to stem the increasing number of cancer cases and deaths is prevention, especially in poorer countries, the expert said. In many developing nations, the health-care infrastructure simply isn't there to offer cancer screening and treatment for most people, Jemal added.

In developed countries, the most common cancers among men are prostate, lung and colorectal cancer. Among women, the most common cancers are breast, colorectal and lung cancer, according to the report.

However, in developing countries the three most common cancers among men are lung, stomach and liver, and among women, breast, cervix uteri and stomach.

Worldwide, some 15 percent of all cancers are thought to be related to infections, including hepatitis (liver cancer) and human papilloma virus (cervical cancer). But the incidence of infection-related cancers remains three times higher in developing countries compared with developed countries (26 percent vs. 8 percent), according to the report.

In addition, cancer survival rates in many developing countries are far below those in developed countries. This is mostly due to the lack of early detection and treatment services. For example, in North America five-year childhood cancer survival rates are about 75 percent compared with three-year survival rates of 48 percent to 62 percent in Central America, the report notes. The report estimates that 60 percent of the world's children who develop cancer have little or no access to treatment.

The report also includes a section on the toll tobacco use takes around the world. In 2000, some 5 million people worldwide died from tobacco use. Of these, about 30 percent (1.42 million) died from cancer -- 850,000 from lung cancer alone.

Jemal believes smoking is a key culprit.

"Smoking prevalence is decreasing in developed countries. So, as tobacco companies are losing market in developed countries they are trying to expand their market in developing countries," he said.

In China alone, more than 350 million people smoke. "That's more than the entire population of the United States," Jemal said. "If these current patterns continue, there will be 2 billion smokers worldwide by the year 2030, half of whom will die of smoking-related diseases if they do not quit," he added.

In the 20th century, tobacco use caused about 100 million deaths around the world. In this century, that figure is expected to rise to over 1 billion people. Most of these will occur in developing countries.

One expert agreed that many cancer deaths can be avoided through lifestyle changes.

"What is most provocative here is not the total global burden of suffering and death cancer causes, dramatic though that may be, but the variations in cancer occurrence around the world, and the insights provided about how much of the cancer burden need not occur at all," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine.

In developing countries, cancer of the uterine cervix is a leading cause of death in women, Katz noted.

"Yet this infection-related cancer is now preventable by vaccine, and long treatable when detected early using the Pap smear. As a result, death from cervical cancer in developed countries is dramatically lower. Its toll in the developing world is testimony to missed opportunities to apply our resources effectively, and equitably," he said.

Cancer of the liver, often related to hepatitis infection, is a leading cause of death in developing countries, but not so in developed countries. "Again, an infection preventable with vaccine is causing death because of inequities in the distribution and use of existing resources," Katz said.

Prostate and colon cancers are more common in wealthier countries, where they are likely related to poor diet and obesity, Katz said. "Unnecessary suffering and death are occurring in affluent countries due to dietary excesses," he said.

Katz also noted that tobacco-related cancer is largely preventable. "The toll of tobacco-related disease, including lung cancer, is an appalling example of a global willingness to tolerate preventable suffering and death for the sake of profit," he said.

These data show both developed and developing countries how to move toward the lower rates of specific cancers, Katz said.

"It will be a tragic failure for public health if instead of applying these lessons developed countries continue to export tobacco and dietary transgressions so that the developing world adds to its current cancer burden ours as well," he said.

More information

For more information on cancer, visit the American Cancer Society  .