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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.



High-risk human papillomavirus status and prognosis in invasive cervical cancer: a nationwide cohort study

New research suggests that the presence of the high-risk human papillomavirus (hrHPV) in the diagnosis of invasive cervical cancer is linked to a greatly improved prognosis compared with if high-risk HPV cannot be identified in the tumor (PLoS Med 2018; doi:10.1371/journal.pmed.1002666). Researchers gathered data on all cases of invasive cervical cancer in Sweden between 2002 and 2011 (4,254 confirmed cases in total). HPV data was then collected from the regional biobanks for 2,845 of these women and compared survival data from national registers. Results show that the 5-year relative survival rate for women with hrHPV-positive tumors was 74 percent compared with the female population of the same age and during the same calendar year, while it was only 54 percent for women with hrHPV-negative tumors. HrHPV could be identified in just over 80 percent of the tumors, according to investigators. Women with hrHPV-positive tumors were more likely to be discovered through screening, were younger, and had a high socioeconomic status. They were also discovered at an earlier clinical stage than women with hrHPV-negative tumors, the study authors reported. After controlling for age, tumor type, tumor stage at diagnosis, and educational background, the researchers found that women with hrHPV-positive tumors still had a lower risk of dying than the women with hrHPV-negative tumors. "The underlying biological mechanisms relating lack of detectable tumor hrHPV to considerably worse prognosis are not known and should be further investigated," study authors concluded.



Sex differences in cancer driver genes and biomarkers

Analysis of male- and female-derived tumor samples revealed differences in prognostic biomarkers as well as regulation of key pathways that may predict responses to treatment (Cancer Res 2018; doi:10.1158/0008-5472.CAN-18-0362). Researchers utilized data from The Cancer Genome Atlas to analyze "sex biases in mutation burden, somatic copy number aberrations, and somatic single nucleotide variants in male- and female-derived tumors from a variety of cancer types." The investigators observed large differences in both mutation density and the frequency of mutation of specific genes between male and female samples; however, the data showed that not all tumor types displayed significant sex biases. The results suggested that tumors from males had decreased mRNA abundance of DNA mismatch repair genes across several tumor types, which was reflected in a higher tumor mutational burden. "Sex-biased genes include well-known drivers of cancer such as [beta]-catenin and BAP1. Sex influenced biomarkers of patient outcome, where different genes were associated with tumor aggression in each sex," study authors reported. "These data call for increased study and consideration of the molecular role of sex in cancer etiology, progression, treatment, and personalized therapy."



Successful treatment of HIV-associated Kaposi sarcoma with immune checkpoint blockade

Among a small cohort of patients with HIV-associated Kaposi sarcoma treated with immune checkpoint inhibitors, more than 65 percent had partial or complete remission, according to a recent study (Cancer Immunol Res 2018; doi:10.1158/2326-6066.CIR-18-0121). Data was analyzed from nine men with Kaposi sarcoma treated with anti-PD-1 immune checkpoint inhibitors between August 2013 and December 2017. All patients had received retroviral therapy and a median of one prior line of treatment for Kaposi sarcoma, according to the study authors. Eight patients were treated with nivolumab and one patient was treated with pembrolizumab. In addition to survival data, the investigators utilized next-generation sequencing data from tissue and circulating tumor DNA to analyze tumor mutational burden (TMB) and PD-L1 expression levels. Following treatment, five patients had a partial response, three patients had stable disease, and one patient had complete remission, researchers reported. All patients remained on treatment, and none showed disease progression at 6.5 months of follow-up. According to study results, PD-L1 expression was negative in all four evaluable patients. Additionally, all three evaluable patients had low TMB (between 1-4 mutations per megabase).



Cancer-related cognitive outcomes among older breast cancer survivors in the thinking and living with cancer study

A large U.S. study of older breast cancer patients found that within the first 2 years after diagnosis and treatment, most women do not experience cancer-related cognitive problems (J Clin Oncol 2018; doi:10.1200/JCO.18.00140). The research team also observed that a small subset of women who experienced cognitive decline were unique in having the APOE4 gene, and this effect was most pronounced after chemotherapy. The study included 344 newly diagnosed women with non-metastatic breast cancer and 347 non-cancer controls. The groups were matched in terms of age, general health status, race, education, lifestyle, and other factors. No one had any cognitive problems or dementia at the start of the study. Both cohorts were given cognitive tests before treatment with chemo- or hormonal therapy, and 12 and 24 months later. About 95 percent of participants in each group provided biospecimens for APOE4 testing, according to researchers. The neuropsychological tests measured attention, processing speed, and executive function (APE) as well as learning and memory (LM). Participants also filled out self-assessments of their cognitive function. "Treatment was related to longitudinal cognition scores, with survivors who received chemotherapy having increasingly worse APE scores (p=.05) and those initiating hormonal therapy having lower LM scores at 12 months (p=.03) than other groups," according to study results. Researchers found that patients with the APOE4 gene tended to show a steady decline in cognitive function test scores after chemotherapy compared to APOE4-negative patients, and non-cancer participants. "Breast cancer systemic treatment and aging-related phenotypes and genotypes are associated with longitudinal decreases in cognitive function scores in older survivors," study authors wrote. "These data could inform treatment decision making and survivorship care planning."


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