CCR Grand Rounds April 24: Dr. Merrill J. Egorin, Professor of Medicine and Pharmacology, University of Pittsburgh Cancer Institute. "The Relevance of Old-Fashioned Clinical Pharmacology to Modern Anticancer Chemotherapy." May 1: Dr. Stephen J. Elledge, Gregor Mendel Professor of Genetics and Medicine, Harvard Medical School. "The Phosphoproteomics of the DNA Damage Response." 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.

Gleevec Protects Against Recurrence of Gastrointestinal Tumors

Imatinib (Gleevec) can reduce the recurrence of gastrointestinal stromal tumors (GIST) in patients whose tumors have been surgically removed, a large, randomized clinical trial has found. The final-stage clinical trial, sponsored by NCI, was cut short after an interim analysis of the data showed that taking imatinib was associated with a decreased risk of recurrence. Imatinib was made available to all patients participating in the trial.

A network of researchers led by the American College of Surgeons Oncology Group conducted the study, which involved more than 600 patients. The interim analysis showed that 97 percent of patients who received 1 year of imatinib after surgery did not have a recurrence of their cancer compared with 83 percent of patients who received 1 year of placebo. Imatinib, which has been taken by more than 100,000 patients worldwide for GIST and chronic myelogenous leukemia, was well tolerated.

The standard treatment for primary GIST is the surgical removal of the tumor without additional therapy. Conventional chemotherapy agents have been notoriously ineffective against GIST, a type of tumor usually found in the stomach or small intestine.

"This study for the first time demonstrated that targeted molecular therapy reduces the rate of recurrence after complete removal of a primary GIST," said the principal investigator, Dr. Ronald DeMatteo of Memorial Sloan-Kettering Cancer Center. "These results have major implications for patients with primary GIST."

Palliative Radiation Extends Survival for Elderly Patients with Glioblastoma

The investigators enrolled 81 patients 70 years of age or older with glioblastoma into the trial. All patients had good functional status. Forty-two received supportive care alone, including antiseizure medication, physical and psychological support, and access to a palliative care team. The other 39 patients received supportive care and radiation therapy (50 Gy in doses of 1.8 Gy per day, given 5 days a week).

Patients receiving radiation therapy had a median survival of 29.1 weeks compared with 16.9 weeks for those receiving supportive care alone. Radiation therapy produced a survival benefit regardless of the extent of surgery performed, which ranged from biopsy alone to complete resection. Physical and mental status declined over time in both groups, with no significant differences observed between the groups. Perceived quality of life also did not differ between the groups.

The authors stated that "radiotherapy increases the median survival of elderly patients with glioblastoma who have a good performance status at the start of treatment." They also noted that "the optimal dose of radiotherapy in elderly patients remains undetermined." Other studies have indicated that various other palliative radiation regimens, using different doses and fractionation schemes, may provide similar benefit.

Hispanic Breast Cancer Differences Persist with Equal Access to Care

Despite equal access to health care services, differences persist in the size, stage, and grade of breast cancer for Hispanic women compared with non-Hispanic white (NHW) women, according to results from a study published online April 9 in Cancer.

The study compared 139 Hispanic women and 2,118 NHW women with breast cancer who were all established members of the Kaiser Permanente Colorado health plan. The Hispanic women were diagnosed at a younger age; at a later stage of disease; with larger, higher grade tumors; and with less treatable estrogen- and progesterone-negative tumors, reported the investigators led by Dr. A. Tyler Watlington at the University of Colorado Health Sciences Center.

"The results of this study confirm those of many previous studies that breast cancer presents differently in Hispanic women," the researchers noted. Previous research has suggested that the differences may be due to socioeconomic factors, especially lack of or inadequate health insurance and less access to care among low-income Hispanic women. However, the current study shows that "these differences were apparent even among a group of Hispanic women with equal access to care and similar health care utilization," they added.

"The results of this study, in our opinion, lend further support to the evidence for a biologic/genetic basis for these differences," the researchers stated. Future research should more carefully explore differences in clinical presentation as well as biologic differences in tumor genotypes and phenotypes, "as different strategies for breast cancer prevention may then be warranted for Hispanic women," they concluded.

Age, Race, and Income Level Associated with Undertreatment of Ovarian Cancer

Women with ovarian cancer who are aged 70 and older, African American or Hispanic, or insured by Medicaid were less likely to receive the recommended comprehensive surgical treatment, according to study results in the May 15 Cancer.

Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States, accounting for more than 14,000 deaths each year. Providing comprehensive surgical treatment for women with ovarian cancer, which is often diagnosed at advanced stages, is one of the most effective ways to improve survival outcomes.

Dr. Barbara Goff of the University of Washington, Seattle, and colleagues analyzed hospital admissions data of 10,432 women aged 21 and older who were diagnosed with ovarian cancer and underwent surgical removal of their ovaries (oophorectomy). Researchers identified patients across nine states from 1999 to 2002 using the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project's state inpatient databases, which contain discharge information, such as demographics, place of residence, and diagnosis.

Researchers found that 66.9 percent of the patients received comprehensive surgical treatment (oophorectomy plus surgical removal of all visible extra-ovarian tumors). Women who were 70 or older, African American or Hispanic, or Medicaid patients were all less likely to receive comprehensive surgery compared with women who were between the age of 21 and 50, Caucasian, and had private insurance. Women in hospitals with obstetrics-gynecology teaching programs were also more likely than women in nonteaching hospitals to receive comprehensive surgery. Surgeons that performed fewer than 10 ovarian cancer surgeries per year were significantly less likely to provide comprehensive surgical care.

The authors noted, "Because optimal surgery with cytoreduction is associated with improved overall survival, efforts should be made to ensure that all women with ovarian cancer, especially those who are vulnerable because of age, race, or socioeconomic status, are referred to centers or surgeons from whom they are more likely to get optimal surgery."