European Journal of Cancer: Highlights of Issue 38:11

Stopping smoking cuts the risk

Women diagnosed with breast cancer should be encouraged to stop smoking

This is the message from a study by Prochazka and colleagues in this issue. They examined, using data from the Swedish Cancer Registry (SCR), the risk of developing lung cancer following the diagnosis of breast cancer. They were particularly interested in whether post-surgical radiotherapy was associated with an increased risk. Data from approximately 141 000 women were examined and standardised incidence ratios and expected numbers of lung cancer cases were calculated based on the incidence rates from the SCR. Although there was a significantly reduced risk less than 5 years after a diagnosis of breast cancer (that was restricted to those aged > 60 years), there was a significantly increased risk after 5 years. Moreover, an increase for lung cancer on the same side as the breast cancer was also observed > 10 years after diagnosis. Worryingly, those birth cohorts with a higher smoking prevalence had a significantly higher risk and the authors speculate that this is related to a possible interaction between radiotherapy and smoking and suggest that women diagnosed with breast cancer should be encouraged to stop smoking. This type of study is particularly important given that there are an increasing number of breast cancer survivors.

Predicting tolerance to chemotherapy in older cancer patients

Cancer is predominantly a disease of the elderly. Since the older population is likely to increase in size in the future, it is important to determine how to predict those patients who will tolerate chemotherapy. In a prospective pilot study Extermann and colleagues have examined in this issue the predictors of tolerance to chemotherapy in 59 patients aged 70 years and over. 47% experienced grade 4 haematological toxicity and/or grade 3/4 non-haematological toxicity. They designed a factor known as MAX2 as a means to compare the known published toxicities of the regimens used. The MAX2 factor (as might be expected) was significantly associated with toxicity in univariate analyses as were several other factors including diastolic blood pressure, bone marrow invasion and lactate dehydrogenase (LDH) levels. Interestingly, these factors, with the exception of LDH, retained their significance after adjustment for the published toxicity. The authors urge caution in the interpretation of their data due to the small numbers involved, but state that “designing a composite predictive score to use in assessing the toxicity of multiple chemotherapy regimens appears to be a valid undertaking.”

A dose-finding study of cisplatin and paclitaxel treatment of metastatic/irresectable oesophageal cancer patients

The prognosis for the majority of patients with squamous cell or adenocarcinoma of the oesophagus is poor as they tend to present with either systemic disease or relapse after surgery. The impact of chemotherapy in these patients is unclear. Polee and colleagues report in this issue a dose-finding study of weekly fixed dosed cisplatin (70mg/m2) and escalated paclitaxel (from 80-110mg/m2). Six administrations were given on days 1, 8, 15, 29, 36 and 43 to 24 patients with metastatic/irresectable oesophageal cancer. 19/24(79%) received all 6 administrations. All patients were eligible for toxicity and the dose-limiting toxicity was observed at 110mg/m2 and was gastrointestinal. A response rate of 50% (11 of 22 eligible patients) was obtained. The authors state that any diarrhoea should be carefully monitored, as toxicities of grades 3 and 4 were observed in 4(17%) of the patients. They conclude that the “response rate of this dose-dense schedule seems encouraging” and “further evaluation of this regimen as an induction treatment for resectable or locoregionally advanced oesophageal cancer and other tumour types is warranted”.

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