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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.



Lifetime occurrence of brain metastases arising from lung, breast, and skin cancers in the elderly: a SEER-Medicare study

Elderly survivors of breast cancer, lung cancer, and melanoma face risk of brain metastasis later in life and may require extra surveillance in the years following initial cancer treatment, according to recently published data (Cancer Epidemiol Biomarkers Prev 2019; doi:10.1158/1055-9965.EPI-18-1116). Researchers analyzed rates of synchronous brain metastases (SBM) and lifetime brain metastases (LBM). Primary cancers in this study were lung cancer, breast cancer, and melanoma. The researchers linked data from the NCI's SEER database to Medicare claims data on brain metastases to investigate rates of brain metastasis in elderly patients. Final data included patients diagnosed in 2010 through 2012, with 70,974 lung cancer cases, 67,362 breast cancer cases, and 21,860 melanoma cases. The researchers calculated incidence proportion (IP), the ratio of brain metastases counts to the total number of cases, for each primary cancer. The SBM IP in lung, breast, and melanoma cancers were 9.6 percent, 0.3 percent, and 1.1 percent, respectively; the corresponding LBM IP were 13.5 percent, 1.8 percent, and 3.6 percent, according to the researchers. The highest rates of metastasis were in small-cell and non-small cell lung carcinoma, compared with adenocarcinoma. The rates of brain metastasis were lowest among patients who had localized breast tumors and highest among those whose cancer had already spread to another part of the body. The rates also varied by molecular subtype, with the highest rates for triple-negative breast cancer. "Using a large dataset that is representative of the elderly population in the U.S., these analyses estimate synchronous and lifetime incidence of brain metastases in lung cancers, breast cancers, and melanomas," study authors wrote. "These and other population-based estimates may be used to guide development of brain metastases screening policy and evaluation of real-world data sources."



Gait speed, grip strength and clinical outcomes in older patients with hematologic malignancies

A new sign has been found for gauging survival and the likelihood of having an unplanned hospitalization in older patients with blood cancers: the speed at which they can walk. Researchers recently reported that for every 0.1 meter per second decrease in how fast patients walk 4 meters (about 13 feet), the risk of dying, unexpectedly going to the hospital, or using the emergency room increased by 22 percent, 33 percent, and 34 percent, respectively (Blood 2019; The strongest association was seen in patients with non-Hodgkin lymphoma. The study enrolled 448 adults ages 75 years and older who had hematologic cancers. Participants were 79.7 years old on average and completed several screenings for cognition, frailty, gait, and grip strength. Gait speed was measured using the NIH 4-meter gait speed test. Patients were asked to walk at a normal pace for 4 meters and their speed was recorded in meters per second using a stopwatch. The association between slower walking speed and poorer outcomes persisted even after adjusting for cancer type and aggressiveness, patient age, and other demographic factors, as well as traditional measures of frailty and functional status. Gait speed remained an independent predictor of death even after accounting for standard measures of physical health, according to the investigators. Patients whose performance status was rated as very good or excellent by their physician were stratified into three groups by gait speed-those at risk or frail, pre-frail, or robust. Of the 314 patients in this group, nearly 20 percent had an unplanned hospital stay unrelated to elective or scheduled treatments, and 16.8 percent visited the emergency department. "In summary, gait speed is an easily obtained 'vital sign' that accurately identifies frailty and predicts outcomes independent of performance status among older patients with blood cancers," researchers noted.



Smoking cessation and the risk of bladder cancer among postmenopausal women

A large study of postmenopausal women indicated that quitting cigarette smoking was associated with significantly reduced risk of bladder cancer, according to recent findings (Cancer Prev Res 2019; doi:10.1158/1940-6207.CAPR-18-0441). The most significant reduction in risk occurred in the first 10 years after quitting, with a modest but continued decline in later years, the researchers reported. The investigators sought to analyze the dose-response relationship between time since quitting smoking and risk of bladder cancer among postmenopausal women, and to investigate whether risk among former smokers ever normalized to the risk faced by those who never smoked. Data from the Women's Health Initiative, a long-term national health study of postmenopausal women, was examined. The researchers included data from 143,279 women, all of whom had supplied information on whether they had ever smoked cigarettes, how much they had smoked, and whether they were current smokers. In all, 52.7 percent of the women were categorized as "never smokers," 40.2 percent as former smokers, and 7.1 percent as current smokers. There were 870 bladder cancer cases identified over an average of 14.8 years of follow-up, researchers reported. "After adjusting for pack-years of smoking, bladder cancer risk among former smokers declined by 25 percent within the first 10 years of cessation and continued to decrease as cessation time increased, but remained higher than never smokers after 30 years of quitting." The findings showed that smokers who quit smoking had a lower risk of bladder cancer compared with current smokers (HR, 0.61; 95% CI, 0.40-0.94). "We conclude that, among postmenopausal women, there is a significant reduction in the risk of bladder cancer after quitting smoking," study authors wrote. "In addition to primary prevention, smoking cessation is critical to prevent the incidence of bladder cancer in older women."



Detecting MYB and MYBL1 fusion genes in tracheobronchial adenoid cystic carcinoma by targeted RNA-sequencing

Utilizing next-generation sequencing (NGS) based RNA-sequencing, researchers found a fusion gene signature in primary tracheobronchial adenoid cystic carcinoma, a rare disease accounting for less than 1 percent of all lung tumors (Mod Pathol 2019; Seven specimens of the carcinoma were studied, and the investigators detected fusions of either MYB or MYBL1 genes in all seven. Three cases had MYB-NFIB, and three had MYBL1-NFIB. The remaining case showed a rare MYBL1-RAD51B fusion, which had never been reported in tracheobronchial adenoid cystic carcinoma, according to the study authors. "These findings suggest that rearrangement involving MYB or MYBL1 is a hallmark of tracheobronchial adenoid cystic carcinoma," the study authors concluded. This targeted RNA fusion NGS panel is in its development stage for clinical use and will be available for clinicians soon.


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