CCR Grand Rounds May 16: Oncology Nursing Lecture. Dr. Laurel Northouse, Mary Lou Willard French Professor of Nursing, University of Michigan School of Nursing, Co-Director, Socio-Behavioral Program, University of Michigan Comprehensive Cancer Center. "The Importance of Families in Cancer Care." May 23: Dr. Timothy J. Triche, Professor of Pathology & Pediatrics, University of Southern California Keck School of Medicine, Pathologist-in-Chief, Children's Hospital Los Angeles. "Genomic Analysis of Cancer: Improved Diagnosis and Treatment." CCR Grand Rounds are held 8:30 to 9:30 a.m. at the NIH campus in Bethesda, Md., in the Clinical Center's Lipsett Amphitheater.

Sentinel Node Biopsy Improves Quality of Life in Early-Stage Breast Cancer

In the May 3 Journal of the National Cancer Institute (JNCI), investigators reported results from the first multicenter randomized trial to compare postoperative quality of life between patients with early-stage breast cancer who underwent sentinel node biopsy and those who underwent standard axillary lymph node clearance.

Standard axillary lymph node clearance involves removal of all the lymph nodes in the armpit region. The procedure can cause considerable morbidity, and most women with early-stage breast cancer do not have metastases to their lymph nodes. In sentinel lymph node biopsy, a single node that is directly connected to the tumor site by the lymphatic system is examined for metastases. If none are found, no further lymph nodes are removed.

The ALMANAC trial randomly assigned patients to two groups: 1) standard axillary clearance or 2) sentinel node biopsy with delayed axillary clearance (or axillary radiation therapy if metastases were found). Surgeons performing sentinel node biopsies received special training through the trial centers. Researchers evaluated patients in both groups for side effects and for perceived quality of life.

Patients in the standard axillary treatment group were significantly more likely to report moderate or severe lymphedema at 1, 3, 6, and 12 months after surgery than were patients undergoing sentinel node biopsy. Patients in the standard axillary treatment group also had greater sensory loss and nerve damage up to 12 months after surgery. Self-reported quality of life was significantly higher at all time points for patients undergoing sentinel node biopsy than for the standard treatment group.

The authors conclude that sentinel node biopsy is a safe and effective alternative treatment for patients with early-stage breast cancer. However, they caution that data on "…relapse-free and overall survival following sentinel lymph node biopsy are required before this procedure can be accepted as the standard of care."

Study Details Factors Inhibiting Colon Cancer Patients from Completing Treatment

Hospitalization due to intolerance of side effects from the 5-fluorouracil family of drugs and low social or psychological support are the factors most closely related to whether patients with stage III colon cancer complete adjuvant chemotherapy after surgery, according to a study in the May 3 JNCI.

Previous research identified various demographic factors indicating a reduced likelihood of a patient starting chemotherapy, including race, tumor characteristics, and income.

In this study, when analyzing whether patients completed therapy, those who were female, widowed, elderly, or hospitalized during treatment were less likely to follow through with adjuvant chemotherapy, though stopping meant increasing their risk of dying from the disease.

The authors found that the strongest predictor of an incomplete course was whether a patient was admitted to the hospital again after surgery and after beginning chemotherapy - "probably representing complications from cancer therapy," they wrote. If rehospitalization occurred within 6 weeks after surgery, patients had a 66-percent chance of continuing treatment compared with a 79-percent chance for those who were not readmitted; for those rehospitalized 7 weeks or more postsurgery, the gap was even wider.

The researchers based their analysis on SEER program data linked to Medicare claims for 3,193 patients with stage III colon cancer between 1991 and 1998. Acknowledging limitations of the study, the authors conclude that interventions improving social and physical support for patients during treatment could be tested to improve adherence in the future.

Nonhormonal Therapies Have Little Effect on Hot Flashes

Hot flashes occur in half of all women undergoing menopause, and also are associated with cancer treatments such as tamoxifen and oophorectomy. Estrogen and other hormone treatments were widely used until 2002 when two large trials showed a small increased risk of blood clotting, stroke, coronary events, and cancer. Thus, information about nonhormonal treatment is of interest to cancer patients and researchers.

A review and meta-analysis of all such trials appeared in the May 3 Journal of the American Medical Association. Dr. Heidi D. Nelson and colleagues of the Oregon Health & Science University identified 4,249 potentially relevant trials published in English and selected 24 for meta-analysis.

Trials with antidepressants (primarily selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors) reduced by 1.13 the number of daily hot flashes compared with placebo. Trials with the high blood pressure drug, clonidine, showed 0.95 fewer hot flashes per day. Trials with gabapentin, an anticonvulsant, resulted in 2.05 fewer hot flashes per day. No reduction was seen with soy isoflavone extracts and results were inconclusive with red clover isoflavone extracts. "Overall, the effect of these agents on hot flashes is modest, and they all have side effects," said Dr. Jennifer Eng-Wong of the Medical Oncology Branch in NCI's Center for Cancer Research (CCR).

In an editorial, Drs. Jeffrey Tice and Deborah Grady of the University of California, San Francisco noted that "Hormone therapy is more effective than nonhormonal alternatives but should probably be avoided by women at high risk for venous thromboembolic events, cardiovascular disease, and breast cancer."

Cells from Cancer-Resistant Mice Cure Cancer in Other Mice

Researchers say they have cured some mice of cancer by injecting the animals with immune cells harvested from a mouse strain that is resistant to the disease. According to findings published online in the Proceedings of the National Academy of Sciences (PNAS), the injections eradicated large tumors in mice with highly aggressive cancers. The injected mice were also protected against developing various forms of cancer later in life.

The donor cells came from descendants of a single mouse that was found to remain healthy after being injected with cancer cells that should have caused tumors and certain death. A researcher in the laboratory of Dr. Zheng Cui at Wake Forest University School of Medicine made the discovery in 1999.

Since then, Dr. Cui and his colleagues have bred more than 2,000 of the so-called spontaneous regression/complete remission (SR/CR) mice, though the mice have not yet been widely studied outside their laboratory. The researchers believe, based on the patterns of inheritance in the mice, that a single gene is responsible for the ability to resist cancer. The gene has not yet been identified, however, and the researchers suggest that it may be a "transposon" that resides on different chromosomes in different mice.

The PNAS study explores the source of the immunity in cancer-resistant mice and whether the research could lead to a therapeutic strategy for treating cancer in humans. Though the experiments were mainly in mice, the researchers were encouraged. A major finding was that "resistance to cancer could be entirely transferred to cancer-sensitive mice for both treatment and prevention of malignancy."