To examine the effects of race and ethnicity on tumor characteristics and outcomes, Dr. Steve R. Martinez, of University of California at Davis Cancer Center in Sacramento, and colleagues used the Surveillance, Epidemiology, and End Results (SEER) database to identify 6406 patients with extremity soft-tissue sarcoma treated between 1988 and 2003. Included were 4636 whites, 773 blacks, 696 Hispanics, and 411 Asians.

“Hispanics tended to be diagnosed with extremity soft-tissue sarcoma at a younger age than their white, black, and Asian counterparts, which may suggest either a biologic predisposition or an environmental contributing factor for the development of these tumors,” the authors suggest.

Hispanics and blacks were less likely to receive radiation therapy than other groups, despite presentation with larger tumors. Hispanics tended to have higher rates of well-differentiated to moderately differentiated tumors, whereas blacks presented with more poorly differentiated or undifferentiated tumors.

“Hispanics, although they are subject to several of the same socioeconomic factors and exhibit several of the same poor tumor prognostic factors and comorbidities as blacks, displayed a disease-specific survival that, although not significantly superior to whites, clearly trended in that direction,” the investigators report.

There is no simple explanation for the racial and ethnic differences observed in treatment outcomes in patients with primary extremity soft-tissue sarcoma, the researchers state. Genetics, sociodemographics, and access to specialty care all likely play a role.

“The identification of disparities represents a unique opportunity to improve care by addressing the issues leading to the disparities,” Dr. Martinez said.

“Extremity soft tissue sarcomas are rare and can be difficult to diagnose,” he added. “If possible, patients should be referred to a nearby Cancer Center or center of excellence where patients can be treated by a multidisciplinary team of experts.”

“We are going to narrow our focus to identify potential genetic or epigenetic explanations for the differences in survival noted in this study,” Dr. Martinez said. “In other words, are the survival differences between racial/ethnic populations due to the fact that these populations have, on a genetic and epigenetic level, very different diseases?”

“Research has shown that patients who are enrolled in clinical trials offering the most advanced cancer treatments do better than patients who receive conventional treatment,” lead author Dr. Peter H. Shaw, from the Children’s Hospital of Pittsburgh, said in a statement.

He added that there are two main reasons why clinical trial access is more limited for adolescents and young adults than for children. First, adolescents and young adults are often treated by adult oncologists at centers that are not participating in trials geared toward pediatric malignancies. Second, at the national level, there are simply far fewer clinical trials of cancers affecting adolescents and young adults compared with those affecting younger patients.

The findings are based on analysis of data for all patients who were diagnosed with a new malignancy at the researchers’ center between July 2001 and June 2006. The study group included 501 patients younger than 15 years old and 139 between 15 and 22 years old.

Thirty-six percent of the subjects participated in a clinical trial, which included 38% of the younger patients and 27% of the adolescents and young adults (p = 0.03). Trial unavailability accounted for non-enrollment of 57% and 41% of patients in the older and younger age groups, respectively (p = 0.04).

“We hope (this study) drives home the point that these teen and young adult oncology patients need to be seen at children’s hospitals to have access to the most up-to-date treatments and even then, we as pediatric oncologists have to make more studies available to them for better care,” Dr. Shaw said.

He added that future research needs to “address which diseases are under-represented in the clinical trial realm.”

Dr. Tracy T. Batchelor, at Massachusetts General Hospital in Boston, and colleagues treated 25 HIV-negative adult patients with newly diagnosed primary CNS lymphoma with IV methotrexate 8 g/m² every 2 weeks for up to 8 weeks or until a complete response was achieved. Complete responders were given two additional consolidation cycles of methotrexate and 11 maintenance cycles.

Twelve patients (52%) achieved a complete response to methotrexate induction, the authors report in the January 29 issue of Neurology, and five (20%) remain disease free after a median follow-up of 6.8 years.

Fourteen patients have died: 11 patients from progressive disease or of unknown cause, two from cardiac disease, and one from septic arthritis.

Multiple salvage regimens were used following relapse, including brain irradiation in 13 patients. Median overall survival was 55.4 months.

“High-dose methotrexate alone or in combination with other therapies is the most effective treatment available for primary CNS lymphoma,” Dr. Batchelor’s team concludes.

“Our findings support the safety and effectiveness of multimodality treatment,” senior investigator Dr. Ricardo Autorino said. “We found complete response, bladder-intact survival and overall survival rates to be similar to those determined in previously published series.”

Dr. Autorino and colleagues at the Second University of Naples studied 121 patients with T2, T3 or T4 bladder cancer. Their mean age was 63 years. None had hydronephrosis or significant comorbidities.

The patients underwent transurethral resection of the tumor, received 2 cycles of neoadjuvant chemotherapy and then radiotherapy or radiochemotherapy.

Six weeks later, 102 of the 119 evaluable patients (85.7%) achieved a complete response. At a median follow-up of 5.5 years, 67 (65.7%) showed no local or distant disease recurrence. A further 17 (16.7%) had superficial local recurrence and 18 (17.6%) had muscle-invasive relapse.

The tumor-specific 5-year survival rate was 73.5%. Corresponding proportions for overall and bladder-intact survival were 67.7% and 51.2%.

The treatment was effective, but Dr. Autorino pointed out that “multimodality bladder-preserving strategies are complex, requiring, apart from high patient compliance, close cooperation among several clinical specialties.”

“Therefore, bladder preservation is feasible, even if it necessitates an extremely cautious approach,” he concluded.

The study, led by Rene-Jean Bensadoun of Antoine Lacassagne Center in Nice, is published in the January 1 issue of Cancer. It involved 282 patients with head and neck cancer.

Patients received 14 days of mucoadhesive buccal miconazole (Loramyc, BioAlliance Pharma, Paris, France), given as a single 50 mg tablet once a day, or miconazole oral gel, 500 mg, administered in four divided doses of 125 mg each.

The success rate was “statistically not inferior” with “a trend toward superiority” with mucoadhesive buccal miconazole compared with oral gel, with success rates of 56% and 49%, respectively.

Patients with multiple lesions had higher success rates with buccal tablets than with oral gel.

Clinical cure took place in 40% of patients, compared with cure rates of 21% and response rates of 53% with oral fluconazole, 50 mg for 14 days, as reported in other studies, the investigators report.

Compliance with mucoadhesive buccal miconazole was excellent, with more than 80% of patients completing treatment. The success rate of buccal miconazole is greater than with oral gel miconazole or systemic antifungal treatment, Dr. Bensadoun and colleagues conclude.

“Today, prognosis from childhood ALL is excellent, so now, more and more patients become long-term survivors,” Dr. Nobuko Hijiya from St. Jude Children’s Research Hospital, Memphis, Tennessee.

Until now, little was known about the incidence of secondary cancers beyond 15 to 20 years in childhood ALL survivors, she added.

Provenge is a therapeutic cancer vaccine designed to stimulate the immune response to cancer. It targets the prostate cancer antigen, prostatic acid phosphatase (PAP), which is found in approximately 95% of prostate cancers.

Two Dendreon studies failed to meet their main goal of slowing the progress of advanced prostate cancer, but one analysis found patients treated with the product lived about 4.5 months longer.

A U.S. Food and Drug Administration advisory panel debated whether the findings were convincing. Some said they felt uncomfortable answering the agency’s initial question of whether Dendreon had “established” efficacy.

Members ultimately reworded the query and voted 13-4 that Dendreon had provided “substantial evidence” Provenge worked.

“I think new fields… are hard to foray into if we wait until everything’s perfect,” said Sharon Terry, the panel’s consumer representative and chief executive of the Genetic Alliance Organization.

Others said it was too early to conclude Provenge was effective and urged the company to complete a new, 500-patient study. Survival results from that trial are due in 2010, the company said.

Dendreon Chief Executive Mitchell Gold said the company has planned an interim look at that trial, which has so far enrolled 400 patients, and will be working with the FDA over the coming weeks.

“Does this drug prolong life? I just don’t know at this point in time,” said Dr. Howard Scher, a panel member and specialist in genitourinary cancers at Memorial Sloan-Kettering Cancer Center in New York.

‘REASONABLY SAFE’

The panel unanimously said Provenge was “reasonably safe.” Many panelists urged Dendreon to closely watch if strokes seen in some patients may have been linked to the therapy.

Dendreon studied men with advanced prostate cancer that had stopped responding to hormone therapy but was not causing pain. Life expectancy at that stage usually ranges from 14 months to 22 months, the company said.

One analysis of 127 men showed patients infused with Provenge lived about 4.5 months longer than others given a placebo, Dendreon said.

The company said Provenge, known generically as sipuleucel-T, was less toxic than chemotherapy for advanced prostate cancer. The most common side effects included mild to moderate chills, fever and headaches within a day or two of infusion.

The FDA is scheduled to decide by May 15 whether to approve Provenge for sale. The agency usually clears products that win positive recommendations from advisory panels.

“I think all immunocompromised patients or patients with co-morbidities (including elderly) should be treated with neuraminidase inhibitors if they are diagnosed with influenza,” Dr. Roy F. Chemaly from The University of Texas M. D. Anderson Cancer Center, Houston, said.

Dr. Chemaly and associates studied the impact of neuraminidase inhibitor therapy on the outcome of 33 patients with leukemia who contracted influenza.

Only 1 of 14 patients treated with neuraminidase inhibitor therapy while they had upper respiratory symptoms went on to develop pneumonia, the authors report, and the infection resolved after treatment with oseltamivir plus ribavirin.

Three of 8 patients not treated with neuraminidase inhibitor therapy died of influenza, the results indicate, compared with none of the 25 patients who received neuraminidase inhibitor therapy. All three of the patients who died had influenza B.

There were no major or moderate adverse effects during neuraminidase inhibitor therapy, the researchers note.

“We also found that lymphopenia at the time of presentation may identify patients with leukemia who are at high risk for the development of pneumonia,” the investigators say.

“Prevention, i.e., vaccination, is still very crucial, but unfortunately our immunocompromised patients respond poorly to vaccination, which will provide suboptimal protection or no protection at all against this infection,” Dr. Chemaly pointed out .

“What I would like to look at next is the difference in outcomes (especially morbidity) in patients infected with influenza A versus B,” Dr. Chemaly added. “The other thing that I would like to investigate is the impact of neuraminidase inhibitor prophylaxis on leukemia patients.”

“There is no standard of care for patients with pancreatic cancer,” presenter Dr. Michele M. Corsini, from the Mayo Clinic in Rochester, Minnesota, said. “It is a very aggressive cancer that metastasizes early.”

To better understand how to optimize the prognosis of patients with pancreatic cancer, a team of surgeons, oncologists, and radiation oncologists conducted a retrospective study of patients who underwent complete resection at their institution in hopes of a cure.

“Our protocol is based on a study published in 1985 by the GI Tumor Study Group, where in the setting of margin-negative resected pancreatic cancer, we offer the combination of chemotherapy and radiation therapy,” Dr. Corsini explained.

“Between 1975 and 2005, there were 472 patients who had good surgery (results), with negative margins and no evidence of cancer at all,” she added. “For nine of them, by the time they returned for follow-up – within weeks — they already had metastatic disease.” Three others were lost to follow-up, and nine had adjuvant chemotherapy only.

The final analysis included 180 patients who received no adjuvant therapy; 246 who had radiation and chemotherapy; and 28 who received radiation and chemotherapy followed by another course of chemotherapy.

The patients usually started combined radiation and chemotherapy by 6 weeks after surgery. According to the presenters’ meeting abstract, the median radiation dose was 50.4 Gy in 28 fractions, and 98% of patients were also treated with concurrent 5-fluorouracil.

The median overall survival was 1.6 years among those who received no adjuvant therapy (n=180); 2.1years among those who received radiation and chemotherapy (n=246); and 2.9 years among those treated with radiation and chemotherapy plus a second round of chemotherapy (n=28). After 5 years, the overall survival was 17%, 28% and 34%, respectively.

“The patients who had disease in the local lymph nodes and high-grade tumors especially benefited from chemoradiation, even though you’d think they would have more chance of metastatic disease or dying sooner,” Dr. Corsini said. “But if you gave them radiation and chemotherapy, they lived even longer than those who were just observed.”

Those forgoing had fewer adverse prognostic factors, the oncologist continued. “Not as many had disease in the lymph nodes; not as many had high-grade tumors; and not as many patients had tumors that extended outside the pancreas. They were the best performers, which is probably why they were not offered radiation and chemotherapy. But ultimately, unfortunately, they did the worst.”

These findings reinforce the Mayo clinics’ current standard of care of offering adjuvant chemotherapy and radiation therapy to their patients with resected pancreatic cancer.

One thing has changed in recent years at the Mayo Clinics, based on the most up-to-date research. Since about 2003, gemcitabine has been offered to these patients, Dr. Corsini said. “Now patients generally get a couple cycles of gemcitabine starting at about 2 to 4 weeks after surgery, then radiation and 5FU at the same time for 5.5 or 6 weeks, then gemcitabine on its own again.”

Dr. Johannes H. M. Merks and associates at the Academic Medical Center in Amsterdam compared the prevalence of morphological abnormalities among 175 children newly diagnosed with cancer, 898 long-term survivors of childhood cancer, and 1007 schoolchildren who served as controls.

Subjects were evaluated for 214 age-independent morphological abnormalities.

Major abnormalities were present in 26.8% of patients and in 15.5% of controls (p < 0.001); prevalence of minor anomalies was 65.1% and 56.2%, respectively (p < 0.001). Cases were also significantly more likely to have combinations of morphological abnormalities.

Fourteen abnormalities were independently and significantly associated with childhood cancer. Among them, blepharophimosis, asymmetric lower limbs, Sydney crease, broad foot, and port-wine stain were at least 9-fold more common in the cancer patients.

Pattern analysis revealed an established tumor predisposition syndrome in 42 patients (3.9%), which compares with a prevalence of < 1% in the general Dutch population. In addition, two previously unidentified patterns of co-occurring morphological abnormalities were identified.

There were 13 patients with at least two abnormalities in the cluster of blepharophimosis, increased angulation of the spine, patchy skin hypopigmentation, and multiple café-au-lait spots. Twenty-one patients were affected by the cluster of asymmetric lower limbs, tall stature, midface hypoplasia, ptosis, and pectus carinatum or excavatum.

“The detection of patterns of morphological abnormalities allows identification of new tumor predisposition syndromes,” Dr. Merks’ team concludes.