Noted This Week
Men with Lynch syndrome should get regular prostate cancer screening beginning at age 40, according to IMPACT, an international prospective study of 828 men, 644 of whom had heritable mutations in mismatch repair genes (Lancet Oncol 2021 Oct 9 [Epub ahead of print]). During the study, 3% of men with mutations in MSH6 and 4.3% with mutations in MSH2 developed prostate cancer compared with 0% to 0.5% in non-carriers, respectively. They also developed prostate cancer at a younger age and typically had more aggressive, life-threatening tumors, leading the researchers to recommend annual PSA testing for this group.
The FDA approved atezolizumab (Tencentriq; Genentech) for a new indication in non–small cell lung cancer. The approval is for adjuvant treatment of patients with stage II to IIIA disease with at least 1% of tumor cells expressing PD-L1 and who have had surgery and platinum chemotherapy. In a study supporting approval, median disease-free survival was 35.3 months among those who received best supportive care and was not reached in patients receiving atezolizumab.
Compared with white women, African American women with breast cancer have a 41% higher mortality rate, but they are less likely to receive genetic testing and counseling (J Clin Oncol 2021 Oct 18 [Epub ahead of print]). A survey of 277 oncologists revealed that 14% of them felt their patients in general wouldn’t follow their recommendations on genetic counseling and testing, but 31% thought this about their African American patients. Because white women are five times more likely to be referred for genetic testing than African American women, the researchers suggested that this bias may contribute to the disparity in mortality rates.
AstraZeneca reported that combining two of the company's immunotherapies improved overall survival (OS) in inoperable liver cancer. In the phase III HIMALAYA trial, newly diagnosed patients who received a single priming dose of the CTLA4 inhibitor tremelimumab followed by the PD-L1 inhibitor durvalumab (Imfinzi) every 4 weeks had a higher OS than those who received standard-of-care sorafenib (Nexavar, Bayer/Onyx Pharmaceuticals). The combination had a favorable safety profile—with no increase in severe hepatic toxicity.
Testing siblings of newborns with cancer susceptibility gene variants could halve projected cancer deaths in these individuals (JAMA Netw Open 2021;4:e2129742). In a cohort of 3.7 million newborns, researchers used a modeling technique to predict that 1,584 newborns and 792 siblings would have one of 11 variants—and that 116 of the siblings would develop cancer before age 20. Diagnosis of these mutations at birth and subsequent regular screening of the siblings could avert 15 cancer deaths and save $16,910 per year of survival.
Smokers who switch to electronic cigarettes (e-cigarettes) are more likely to relapse and switch back to smoking tobacco products than people who stopped using tobacco products completely (JAMA Netw Open 2021;4:e2128810). However, e-cigarette users who relapsed were more likely to try to quit again, and not smoke for at least 3 months afterwards, compared with those who quit all tobacco products without e-cigarettes.
Former American Association for Cancer Research President Raymond DuBois, MD, PhD, testified about the importance of cancer screening at a congressional hearing devoted to bills on enhancing public health. DuBois urged a subcommittee of the U.S. House of Representatives Committee on Energy and Commerce to “consider the impact on the individual, rather than on the broader population” and asked members to ensure “all racial and ethnic groups and socioeconomic classes have the knowledge to make informed decisions as well as access to evidence-based screening and, importantly, affordable follow-up for positive screens.”