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Given the abundance of new research, it can be challenging to stay current on the latest advancements and findings. Oncology Times is here to help with summaries of the newest studies to ensure you are up-to-date on the latest innovations in oncology practice.



Multilevel small-area estimation of colorectal cancer screening in the United States

A recent study revealed colorectal cancer (CRC) screening rates varied widely between U.S. states and counties (Cancer Epidemiol Biomarkers Prev 2018;27(3):245-253). Utilizing 2014 data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS), the researchers developed models to estimate CRC screening rates. Investigators used information from 251,360 BRFSS respondents ages 50-75 and U.S. Census Bureau population estimates for all 3,142 counties. The analysis revealed that 67.3 percent of the adult population ages 50-75 was current with CRC screening. Screening varied by ethnicity; 69.2 percent of non-Hispanic whites were current with screening, while only 56.8 percent of Hispanics were current. Colonoscopy was the most popular method of CRC screening, as 63.7 percent of the adult population ages 50-75 had undergone the procedure within 10 years. Model-based state estimates found that Wyoming had the lowest prevalence of any CRC screening (58.9%), while Massachusetts had the highest prevalence (75%), researchers reported. Data showed that county estimates found that the county with the lowest prevalence in any CRC screening was in Alaska (40.1%), while the county with the highest prevalence in any CRC screening was found in Florida (79.8%). "County-modeled estimates help identify variation in colorectal cancer screening prevalence in the U.S. and guide education and enhanced screening efforts in areas of need, including areas without BRFSS direct-estimates," study authors concluded.



Prevalence of cognitive impairment and association with survival among older patients with hematologic cancers

New data showed a sizable percentage of elderly patients with blood-related cancers such as leukemia and multiple myeloma are likely to show signs of diminished cognitive functioning (JAMA Oncol 2018; doi:10.1001/jamaoncol.2017.5674). Researchers screened 360 patients 75 years of age and older who received a consultation at Dana-Farber Cancer Institute in Boston for treatment of leukemia, lymphoma, or multiple myeloma. Patients were assessed for physical frailty and took standard screening tests for cognitive impairment in working memory and executive function. The screening revealed that 35 percent of the patients had probable executive dysfunction and 17 percent had probable impairment in working memory, investigators reported. When examining whether cognitive decline impacted patient survival, researchers found the results varied depending on the area in which the decline occurred. According to study results, patients with impaired working memory lived for a median period of 10.9 months, compared to 12.9 months for those without impairment-an 18 percent decrease. For patients undergoing intensive treatment for their cancer, median survival was lower among those with impaired working memory, as well as those with executive dysfunction, researchers reported. "These data suggest that domains of cognitive dysfunction may be prevalent in older patients with blood cancer and may have differential predictive value for survival," study authors wrote. "Targeted interventions are needed for this vulnerable patient population."



Pan-cancer genome and transcriptome analyses of 1,699 paediatric leukaemias and solid tumours

Researchers have found that children and adults with cancer usually have different mutated genes driving their disease, which suggests they would likely benefit from different therapies (Nature 2018; doi:10.1038/nature25795). Six cancer subtypes were evaluated using three different next-generation sequencing approaches. The researchers compared somatic genetic mutations and their impact on key biological processes in tumor and normal tissues of 1,699 pediatric cancer patients. The approach, pan-cancer analysis, showed that only 45 percent of the mutated genes driving cancer in children are the same as the genes driving cancer in adults, according to investigators. Enrolled patients had acute lymphoblastic leukemia (ALL), both B- and T-cell; acute myeloid leukemia; osteosarcoma; Wilms tumor; and neuroblastoma. Researchers identified unexpected patterns of mutations in eight of the 689 patients with B-cell ALL. The patients' DNA had a mutational signature consistent with exposure to ultraviolet light. Additionally, the analysis revealed that rather than point mutations in DNA, a majority (62%) of the mutations driving pediatric cancer were copy-number alterations and structural variations. "These data provide a comprehensive genomic architecture for pediatric cancers and emphasize the need for pediatric cancer-specific development of precision therapies," researchers concluded.



Association of cell-free DNA tumor fraction and somatic copy number alterations with survival in metastatic triple-negative breast cancer

A clinically relevant liquid biopsy assay could be utilized to profile cancer genomes from blood and predict survival outcomes for patients with metastatic triple-negative breast cancer (TNBC), according to recently published data (J Clin Oncol 2018;36(6):543-553). In a retrospective cohort study, researchers identified 164 patients with "biopsy-proven metastatic TNBC at a single tertiary care institution who received prior chemotherapy in the (neo)adjuvant or metastatic setting." Researchers utilized a customized liquid biopsy technique they developed to distinguish levels of DNA from cancer cells and healthy cells. Whole genome sequencing was performed to identify potential mutations associated with metastatic TNBC. Data revealed that 64 percent of patients had more than 10 percent tumor DNA, and that this threshold of tumor DNA was correlated with poor survival outcomes in patients with metastatic TNBC. Genome-wide data was used to identify specific abnormal genes more frequently altered in metastatic TNBC compared with primary cases of the disease. "Evaluation of cfDNA tumor fraction was feasible for nearly all patients, and tumor fraction >= 10 percent is associated with significantly worse survival in this large metastatic TNBC cohort. Specific somatic copy number alterations are enriched and prognostic in metastatic TNBC, with implications for metastasis, resistance, and novel therapeutic approaches," study authors concluded.


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