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Stomach Cancer
Eradicating Gut Bacteria Improves Stomach Cancer
Outcomes (HealthDay News-31/07/2008)
In patients who've had surgery for stomach cancer, removing Helicobacter pylori bacteria from the stomach greatly reduces the risk of cancer recurrence, a Japanese study finds.
Almost all stomach cancers not related to the heart develop from H. pylori, which has been classified as a group I carcinogen for stomach cancer by the World Health Organization, according to background information in the study.
While removal of H. pylori has been shown to have a preventive effect on stomach cancer in animals, trials in humans have produced mixed results.
This new study included 544 patients who had surgery to remove early stomach cancer. Half of them received an H. pylori eradication regimen, while the other half received no treatment. The eradication group received 30 milligrams of lansoprazole twice daily, 750 milligrams of amoxicillin twice daily, and 200 milligrams of clarithromycin twice a day for a week.
All the patients were examined at 6, 12, 24 and 36 months for signs of stomach cancer. After three years, stomach cancer had recurred in nine eradication group patients and in 24 control group patients. The eradication group patients were two-thirds less likely to suffer cancer recurrence than those in the control group, the researchers
said.
"The results of our study suggest that treatment to eradicate H. pylori reduces the risk of developing new gastric carcinoma in patients who have a history of such disease and are thus at risk for developing further gastric cancers ... we believe that our data add to those from previous studies showing a causal relationship between H. pylori infection and gastric cancer, and also support the use of H. pylori eradication to prevent the development of gastric cancer," the researchers concluded.
In an accompanying commentary, Dr. Nicholas Talley, of the Mayo Clinic in Jacksonville, Fla., noted that colonoscopy is widely used to screen for colorectal cancer even though there are no published randomized trials of benefits versus risks.
"Yet, worldwide, gastric cancer kills more people, and there is better evidence that H. pylori eradication can prevent mortality than there is for colonoscopy screening. Preventing gastric cancer by eradicating H. pylori in high-risk regions should be a priority," Talley wrote.
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Leukaemia virus may protect against stomach cancer
(Yahoo News-22/06/2008)
People in Kamigoto, Japan, have high rates of infection with human T-lymphotropic virus (HTLV-1), which can cause leukaemia. They also seem unusually free of stomach cancer, despite being no less likely than other populations to be infected with the bacterium that can trigger the disease.
When Satohiro Matsumoto of Narao Hospital in Nagasaki compared 500 residents carrying HTLV-1 and 500 free of the virus, 7 per cent of those who were virus-free developed stomach cancer, about three times the incidence in those with the virus (The Journal of Infectious Diseases, vol 198, p 10). While many bacteria are good for us, this is the first known case of a beneficial virus.
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Xeloda Approved In Europe For The Treatment Of Advanced Stomach Cancer(Yahoo
News-02/04/2007)
The European Commission approved Xeloda in combination with platinum-based chemotherapy, for first-line use in patients with advanced stomach cancer. Oral chemotherapy Xeloda is already replacing standard intravenous (i.v.) therapy 5-fluorouracil (5-FU) in other gastrointestinal cancers, and now for the first time patients with advanced stomach cancer will also benefit from this effective and convenient treatment option.
William M. Burns, CEO Roche Pharma Division, said: "The news from the European Commission is welcome by both patients and physicians. Stomach cancer is a particularly aggressive and debilitating type of cancer and with Xeloda, Roche can provide an effective oral therapy resulting in a cost effective approach with less hospital visits and more flexibility for the patient".
Stomach cancer is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related deaths worldwide1. Annually, there are an estimated 911,000 deaths worldwide2, with nearly 140,000 deaths in Europe alone3.
"Not only is capecitabine as effective and safe as intravenous treatment but it also reduces the time patients need to spend in hospital by 80%, from five days every three weeks to only one day every three weeks." said Professor Y.K. Kang of the Asan Medical Center, Seoul, South Korea. "Up to now, the standard treatment has involved using intravenous pumps which the patients find inconvenient and uncomfortable. As an oral drug, capecitabine can be taken in the comfort of your own home, making it much more convenient. The clinical community welcomes this news as we now have a new option for our patients".
The approval of Xeloda in combination with platinum-based chemotherapy (with or without epirubicin), was based on two trials, called ML17032 and REAL 2. Both these trials showed that patients on the Xeloda-containing arms lived at least as long overall as those on the 5-FU arms. In fact, the REAL 2 study showed patients on one of the Xeloda-containing arms (EOX) lived significantly longer than the reference 5-FU arm
(ECF). Xeloda on its own is already available in other gastrointestinal cancers, including colorectal cancer that has spread and post-surgery colon cancer. Recently, Xeloda has been filed in the USA for first and second line treatment (with or without Avastin) of advanced colorectal cancer. Additional filings of Xeloda and Avastin combination therapy are planned in the near future. In addition, Roche is running a large Phase III program in early stage colon cancer, which includes Xeloda in combination with oxaliplatin (XELOX) with or without Avastin.
About Study ML17032
The study, led by Professor Y K Kang and his team, is a large randomised, open-label, international phase III study in advanced stomach cancer.
It was conducted in 316 patients enrolled in 46 centres across 13 countries in Asia, South America and Europe.
The study compared the efficacy and safety of Xeloda and cisplatin (XP) with intravenous (i.v.) 5-FU and cisplatin (FP): FP is a standard treatment of stomach cancer, and is accepted by the majority of regulatory agencies as one of the reference regimens against which all other regimens should be compared. The primary end point was non-inferiority in progression-free survival.
Patients receiving the XP combination therapy lived at least as long without the cancer progressing as those treated with FP.
Patients on XP also lived at least as long overall as those on FP, showing evidence of non inferiority. The study confirms that Xeloda can effectively replace the old standard i.v. 5-FU, in combination with cisplatin, as first-line therapy for advanced stomach cancer.
About REAL 2 Study
The largest-ever phase III study in advanced gastro-oesophageal cancer. It was conducted in 1002 advanced gastro-oesophageal cancer patients from 61 centres mainly in the UK.
The study aimed to establish the potential use of Xeloda (X) and oxaliplatin (O) in untreated patients. Patients were randomised to one of four regimens: epirubicin, cisplatin and 5-FU (ECF), epirubicin, oxaliplatin and 5-FU (EOF), epirubicin, cisplatin and Xeloda (ECX) or epirubicin, oxaliplatin and Xeloda
(EOX). The primary comparison was overall survival between the Xeloda and 5-FU containing arms (ECX + EOX versus ECF + EOF) and the oxaliplatin and cisplatin containing arms (EOF + EOX versus ECF + ECX). A further comparison was survival between all four regimens.
The study showed that Xeloda was as effective as 5-FU and could replace 5-FU. The study showed that patients treated with the combination of Xeloda plus oxaliplatin and epirubicin (EOX) live significantly longer, compared to patients treated with standard epirubicin, cisplatin and 5-FU
(ECF).
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Chemo Drug
Improves Stomach Cancer Survival for Japanese Patients -(HealthDay-
31/10/2007)
Treatment of stomach cancer with
an experimental chemotherapy drug after surgery improved survival rates
for Japanese patients, a new study found.
The results of the trial won't mean much for Americans with stomach
cancer, because the drug, designated S-1, is classified as
"investigational" in the United States. But the study results could add
impetus to the use of drug and/or radiation therapy against stomach
cancer, U.S. experts said.
"This is the third large study that demonstrates a significant benefit
of adjuvant (combination) therapy either before or after surgery for
gastric cancer," said Dr. Manish Shah, an assistant attending oncologist
at Memorial Sloan-Kettering Cancer Center in New York City.
Until relatively recently, it had generally been thought that drug or
radiation therapy for stomach cancer wouldn't accomplish much, Shah
said. "With less than one-year survival with metastatic disease, there
may have been a sense that it didn't do any good," he said.
Metastatic means that the gastric cancer has spread outside the stomach,
establishing microscopic colonies beyond the reach of surgery. But the
almost 1,060 participants in the Japanese trial were potentially curable
with surgery, because the disease had not spread. Half were assigned S-1
treatment plus surgery, while the other half had surgery followed by
observation alone.
The trial, scheduled to last three years, was stopped after 12 months,
because the survival rate for the S-1 group was 80.1 percent, compared
to 70.1 percent for the surgery-only group.
The findings are published in the Nov. 1 issue of the New England
Journal of Medicine.
S-1 had been used in some U.S. trials but was abandoned because of the
high rate of side effects, Shah said. Japanese people apparently
metabolize the drug differently than Caucasians, minimizing its side
effects, he said.
Other drugs are being used successfully against stomach cancer, as is
radiation, said Dr. Jaffer Ajani, professor of medicine at the
University of Texas M.D. Anderson Cancer Center in Houston. But surgery
is the essential first step in treatment of stomach cancer, he said.
"Chemotherapy alone has never been shown to be beneficial," Ajani said.
The U.S. National Cancer Institute estimates that there are 21,260 new
cases of stomach cancer among Americans each year, with 11,210 deaths.
"Treatment for my patients includes radiation and chemotherapy
together," Ajani said. "Not for every patient, but for most patients."
Use of such adjuvant therapy for stomach cancer began slowly, with
studies showing that "chemotherapy was better than not for patients with
metastatic disease," Shah said. Later trials showed benefits for people
whose cancers had not spread.
"For gastric cancer, since 2001, some kind of adjuvant therapy has been
given here in the United States, along with radiation," Shah said.
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Sanofi Cancer
Drug Gets Priority Review -(Yahoo News- 2/12/2006)
Sanofi Aventis Says FDA Agrees to Speed Up Review for Company's
Application to Sell Cancer Drug. French drug giant Sanofi Aventis said Friday
that federal regulators have agreed to speed up the review process for
the company's application to sell a new chemotherapy treatment for
advanced stomach cancer.
Sanofi, maker of the Allegra allergy drug and Ambien insomnia treatment,
said the Food and Drug Administration granted a priority review for the
drug Taxotere in combination with chemotherapy treatment cisplatin. The
decision means the agency could act within six months of the
application's submission.
Sanofi said an international study of 457 patients with advanced stomach
cancer found that those treated with a Taxotere-based chemotherapy
showed significant improvements in overall survival compared with
patients who received a standard chemotherapy treatment.
Taxotere is currently approved in the United States to treat certain
types of breast cancer and, in combination with cisplatin, some lung
cancers. It is also approved to treat some prostate cancer in
combination with prednisone, a steriod.
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Digestive
cancers and the Chinese male factor -(Yahoo News)
Digestive cancer can strike anyone, but
possibly due to diet Chinese men seem to be more susceptible. Globally, three million new cases of digestive cancers are reported each
year, resulting in two million related deaths annually. In Malaysia,
stomach, colon and rectal cancers are the most common cancers and have
been on the list of the top 10 cancers for the past five years. As our
life expectancy increases, our chances of developing cancers in general
will also increase. However, current data indicates that Chinese males may
be more prone to develop digestive cancers such as stomach, colon, rectal
and liver cancer.
Consultant gastroenterologist Datuk Dr Goh Khean Lee observed that stomach
(gastric) cancer seems to affect mostly Malaysian Chinese men in numbers
similar to those of men in China or other overseas Chinese communities.
Current data indicates that gastric cancer is two times more common in
males than females and usually affects those between the ages of 50 and
70.
Over 99 per cent of gastric cancer starts from the lining of the stomach.
The cells lining the stomach grow uncontrollably and form tumours, causing
adenocarcinoma (cancer of the stomach glands). The cancer develops and
invades normal tissues to spread to other parts of the body.
A stomach bug that is on the World Health Organisation list of
cancer-causing agents is now known to increase its human host’s risk of
getting gastric cancer. Although not all people found with the
Helicobacter Pylori (H. Pylori) bacteria develop gastric cancers, it is
implicated in 70 per cent of gastric cancer cases.Dr Goh explained that other factors including a diet of mainly food that
is preserved, pickled or with a high salt content; lifestyle habits such
as smoking and excessive alcohol intake; and genetics play a part in
determining if an H. pylori infected person will develop cancer.
WHO data on gastric cancer prevalence shows that people who love salty
food, such as salted cod, or bacalao, in Portugal and Brazil; salted
pickles and salad in Japan and Korea, are populations with equally high
stomach cancer rates.
It can be prevented, according to Professor Dr Drs H.C. Meinhard Classen, co-chairman of
the International Digestive Cancer Alliance, an organisation that promotes
screening, early detection and primary prevention of digestive cancers
worldwide.
Dr Classen was in Malaysia to attend GUT 2005, the annual scientific
meeting of the Malaysian Society of Gastroenterology and Hepatology, in
Langkawi recently.
He said that cancer prevention starts with a healthy diet and regular
exercise. The European Prospective Investigation into Cancer and Nutrition
(EPIC), suggests that daily consumption of 500g of fruit and vegetables
can decrease the incidence of cancers of the digestive tract by up to 25
per cent.
Dr Classen also recommended 20 minutes of brisk exercise daily.
Unfortunately not many people exercise regularly, observed Dr Classen, who
went on to explain the link between inactivity, obesity and cancer.
“We always say that obesity is a risk factor for heart disease but an
interesting study between obesity and cancer has shown us that insulin is
not only responsible for obesity as it stimulates the appetite. It also
stimulates the growth of malignant cells and causes cancers.”
Early detection and elimination of the H. pylori bacterium will
substantially reduce your risk of gastric cancer, especially if you have a
family history of digestive cancer.
Dr Classen explained that H. pylori infection can occur as early as
childhood.
He said: “It takes many years for this bacterial infection to develop into
gastric cancer and we now know that in mother to child transmission, the
infected child is 10 times more likely to develop gastric cancer than if
the bacteria infection was picked up much later.”
If untreated, the bacteria may cause inflammation of the lining, an ulcer
or pre-cancerous lesion. In such cases getting rid of the bug may not
reduce this person’s risk of developing cancer. However, if there is no
lesion, treating the infection can prevent stomach cancer.
As part of its cancer prevention initiative, the IDCA is conducting a
campaign in Shandong province, China, where 60 per cent of the population
is H. Pylori infected with a goal to treat as many adults between 25 and
40 years old as possible.
Dr Classen said: “We hope to cover 100,000 young adults but it would
depend on the funds available for the project. We know that eradication of
the bacterial infection early would really reduce the incidence of gastric
cancer in that area.
“By treating the young women and mothers we can stop the mother and child
transmission that may develop into gastric cancer in later years.”
Colon cancer is also on the increase, and again Chinese men appear to be
at greater risk.
According to Dr Goh, the gene factor in colon cancer is very strong and
close family members of a person diagnosed with colon cancer should be
screened as well.
Colon cancer starts off as a benign adenomatous polyp. At this stage,
patients have no symptoms. It may take up to 20 years before this polyp
turns into a malignant cancer.
It is suggested that high-risk patients with a family history of gastric
cancer in one or more first-degree relatives should have annual digital
rectal examination and faecal occult blood testing from as early as age
35.
A screening colonoscopy, whereby the doctor examines the inside of the
colon with a special tube, should be performed at age 40.
If the immediate family have had cancer at under 40 years old, these tests
should be performed even earlier. If the examination is normal a repeat
scope can be carried out five years later.
If polyps (usually benign at this early stage) are seen during the
examination, removing them can prevent the development of colon cancer.
Colon cancer may be inherited but it appears other factors may be in play
to promote the disease.
Dr Goh said: “In areas where the Chinese embrace the ‘western-style diet’,
high in saturated fats, refined carbohydrates and animal proteins, he is
more likely to develop cancers than someone on the traditional Chinese
diet.”
Epidemiological studies suggest that the risk of developing colon cancer
can be reduced by eating less meat (particularly processed meat) and
increasing the intake of vegetables and fruit.
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