麻豆传媒

Women treated for ductal carcinoma in situ (DCIS) lived longer than women who had no history of breast cancer precursor, according to a study reported at the in Amsterdam.

The study of 9,799 women showed a standardized mortality rate (SMR) of 0.90 (95% CI 0.87-0.96), representing a 10% lower risk of death from any cause compared with the general population of women. The DCIS cohort had an increased risk of dying of breast cancer (SMR 3.3, 95% CI 2.95-3.74) but a lower risk of dying of most other chronic conditions and certain cancers.

"Being diagnosed with DCIS can be extremely distressing, and research indicates that many women overestimate the risks involved and are confused about treatment," , of the Netherlands Cancer Institute, said in a statement. "This study should provide reassurance that a diagnosis of DCIS does not raise the risk of dying."

Given the preinvasive nature of DCIS, almost all cases probably would have been diagnosed by breast cancer screening, suggesting the women with DCIS might have been a health-conscious group and well enough to participate in health screening programs, she added.

The study involved women treated for DCIS from 1989 to 2004. During a median follow-up of 10 years, 1,429 of the patients died, the most common cause being cardiovascular disease (368, 4% of the study population). Elshof reported that 3% of the DCIS group died of breast cancer during the follow-up period, increasing to 4% among those followed for 15 years.

As compared with the general population, women treated for DCIS had 20% to 30% lower SMRs for circulatory, respiratory, and digestive diseases; mental and behavioral disorders; and endocrine, nutritional, and metabolic disorders. They had a 30% lower SMR for lung cancer and 40% lower SMR for urogenital cancers.

More research should be directed toward identifying which subsets of women with DCIS develop invasive breast cancer, especially fatal breast cancer, said ECCO president-elect , of Radboud University Medical Center in Nijmegen, the Netherlands, noting that breast cancer accounted for 20% of the deaths in the study group.

PD-1 Inhibitor Active in Mucosal Melanoma

Almost 20% of patients with an uncommon, poor-prognosis form of melanoma had objective responses to treatment with pembrolizumab (Keytruda), a subgroup analysis of three randomized trials showed.

Objective responses occurred in 16 of 84 evaluable patients with mucosal melanoma. Responses were durable and ongoing in 12 of the 16 patients, with a median duration of 27.6 months. Patients previously treated with ipilimumab (Yervoy) had an objective response rate of 15%. Median overall survival (OS) for the 84 patients was 11.3 months.

By comparison, 1,483 patients with other types of melanoma had an objective response rate of 33% with pembrolizumab and a median OS of 2 years.

"There are some patients with mucosal melanoma who have had complete responses to pembrolizumab and essentially return to a normal life," , of Princess Margaret Hospital and the University of Toronto, said in a statement. "Some, of course, have less spectacular responses, but they still benefit from therapy.

"In earlier studies, mucosal melanoma was excluded, since it is a rare subtype. These findings suggest that mucosal melanoma patients should be offered immunotherapy as standard of care. Response rates may be a bit lower than for other types of melanoma, so further studies to improve benefit need to be conducted."

The results added to those of a recently reported study of nivolumab (Opdivo), showing a 23% overall response rate in a small group of patients with mucosal melanoma.

Breath Test Shows Promise

A test that measures volatile organic compounds (VOCs) in exhaled breath had diagnostic accuracy of 80% to 85% in prospective study of patients receiving treatment for gastric or esophageal cancer.

The test had a sensitivity of 80% and a specificity of 81% for cancer diagnosis and an area under the curve of 0.85 (85% overall diagnostic accuracy). If the results can be duplicated in studies of patients with undiagnosed gastric or esophageal cancer, the test might have promising for improving early detection of the cancers, which tend to be diagnosed in late stages, associated with poor prognosis.

"Because cancer cells are different from healthy ones, the produce a different mixture of chemicals," , of Imperial College London, said in a statement. "This study suggests that we may be able to detect these differences and use a breath test to indicate which patients are likely to have cancer of the esophagus and stomach and which do not."

The test employed selected-ion flow-tube mass spectrometry to analyze exhaled air for five VOCs (butyric acid, pentanoic acid, hexanoic acid, butanal, and decanal). In previous tests, the five-chemical combination had demonstrated 84% sensitivity and 88% specificity for detection of gastric and esophageal cancer. The study involved 163 patients receiving treatment for gastric or esophageal cancer and 172 control patients without cancer.

About a third of patients with gastric or esophageal cancer receive curative-intent treatment, owing primarily to late-stage diagnosis. The cancers have a 5-year survival of about 15%. A noninvasive test that could diagnose more of the cases at an earlier, treatable stage could help improve prognosis for many patients, Markar noted.