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Study Suggests Increasing Time Between Colonoscopies
Current guidelines advise people to receive a colonoscopy to check for colorectal cancer every 10 years after age 45, but a new study indicates those with average risk for the disease may be able to safely wait 15 years between screenings. In a study published online May 2 in JAMA Oncology, researchers used health records to analyze outcomes for adults in Sweden without a family history of colorectal cancer. They looked at 110,074 people who had a negative result on their first colonoscopy at age 45 from 1990 and 2016, comparing them with nearly 2 million people who had not had a colonoscopy or were found to have cancer at their first screening. After 15 years, those who received a negative result on their colonoscopy had a lower risk of developing or dying from colorectal cancer than those in the control group. Researchers determined waiting the extra five years for a screening would lead to two missed colorectal cancer diagnoses and one colorectal cancer death per 1,000 people while avoiding 1,000 colonoscopies, NBC News reported. Some less invasive tests, such as at-home stool tests, also can screen for colorectal cancer. However, these tests generally are less accurate and need to be done more frequently than a colonoscopy, and if there is a positive result, patients need to have a follow-up colonoscopy. Some experts said extending the time between colonoscopies would allow more people access to the procedure. “We need to think about how we can potentially save resources and impact more people with the resources we have,” Andrew Chan, a gastroenterologist at Massachusetts General Cancer Center in Boston and a co-author of an editorial accompanying the study, told NBC News. However, experts cautioned the Swedish population in the study isn’t an exact match to the American public and screening should be tailored to an individual’s risk factors.
Minimally Invasive Procedure an Alternative to Prostatectomy in Prostate Cancer
Prostate cancer patients may be able to avoid having their prostate removed after a minimally invasive procedure produced similar survival outcomes in a clinical trial. Results from the trial were presented at the American Urological Association Annual Meeting, which was held May 3 to 6 in San Antonio. The trial followed 3,328 people in France with low- or intermediate-risk prostate cancer. Of these participants, 1,967 received high-intensity focused ultrasound (HIFU), a minimally invasive procedure that uses ultrasound waves to destroy the tumor, while the remaining 1,361 had a standard prostatectomy, which is surgery to remove the prostate. After 30 months, 89.9% of people who had HIFU did not require follow-up treatment, compared with 86.2% of those who had surgery. “Salvage treatment-free survival after HIFU was not inferior compared to radical prostatectomy,” Pascal Rischmann, a urologist at Toulouse Academic Hospital in France and an author of the study, said in a presentation at the meeting. Additionally, overall survival was similar in both cohorts (97.7% vs. 99.5%), and no cancer-specific deaths occurred, MedPage Today reported. Participants who had HIFU reported less urinary incontinence and erectile dysfunction than those who had prostatectomy.
Researchers Highlight Importance of Cancer Drug Dose Limits
In early phase clinical trials testing new cancer drugs, investigators steadily increase the drug dose until about a quarter of participants get sick. That dose is then deemed the “maximum tolerated dose” and is used in phase III clinical trials and in dosing instructions upon approval from the Food and Drug Administration (FDA). But such high doses can cause serious side effects when a lower dose might have the same impact on the cancer. To address that, the FDA in 2021 launched Project Optimus, which requires drug companies to find the optimal dose that balances effectiveness with side effect risks. However, patients continue to take some drugs approved prior to the start of Project Optimus at high doses that cause toxicities, KFF Health News reported. For example, Lumakras (sotorasib), a targeted therapy for non-small cell lung cancer manufactured by Amgen, has a labeled dose of 960 mg per day despite some research that found people who took 240 mg per day lived just one month less on average and avoided severe side effects, such as nausea and gastrointestinal issues. Critics say Amgen has been reluctant to reduce the suggested dose because it would lead to a 75% drop in revenue from the drug. “There’s a gap in FDA’s authority that results in patients getting excess doses of a drug at excess costs,” Mark Ratain, an oncologist who specializes in clinical pharmacology at University of Chicago Medicine, told KFF Health News. “We should do something about this.”
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