Pancreatic Chemo Comparison Finds No Survival Boost

Search for more successful treatments for the deadly cancer continues, expert says

Pancreatic cancer patients undergoing chemotherapy after surgery don't see improved long-term survival with the drug gemcitabine, compared with patients receiving a chemotherapy regimen consisting of fluorouracil and folinic acid, new research suggests.
The finding, reported in the Sept. 8 issue of the Journal of the American Medical Association, stems from work conducted by Dr. John P. Neoptolemos, of the Cancer Research U.K. Liverpool Cancer Trials Unit at the University of Liverpool in England, and colleagues.
The study authors noted that, currently, the prognosis for pancreatic cancer is very poor, with a five-year survival rate of less than 5 percent. Surgery to remove cancerous tissue can boost the odds to as much as 10 percent, however, and there is active search underway to improve a patient's chances even more by adding in additional chemotherapy following surgery.
The pool of nearly 1,100 patients that the researchers focused on were part of the large European Study Group for Pancreatic Cancer trial that took place across 159 pancreatic cancer centers located in Europe, Canada, Australasia and Japan.
Between 2000 and 2007, the participants were divided into one of two six-month chemotherapy groups: one receiving fluorouracil and folinic acid post-surgery and the other receiving gemcitabine.
After nearly three years of treatment, the researchers found almost no difference between survival rates in the two groups.
Those who received fluorouracil and folinic acid chemotherapy had lived an average of 23 months. At the one- and two-year markers, survival rates for that group was approximately 78.5 and 48 percent, respectively.
At the three-year mark, patients on the gemcitabine regimen achieved an average survival rate of 23.6 months. One- and two-year survival rates were 80 and 49 percent, respectively, the investigators found.
"In conclusion, gemcitabine did not result in improved overall survival compared with fluorouracil plus folinic acid in patients with [surgically removed] pancreatic cancer," the authors concluded in their report.
However, the team did observe one appreciable difference: patients on gemcitabine were less likely to experience serious side effects as a result of their chemotherapy treatment than those on the fluorouracil/folinic acid treatment (7.5 percent versus 14 percent).
Dr. Michael Choti, a professor of surgery and oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, described the study as "important," but he does not believe it will alter the current approach to post-surgical chemotherapy.
"Really in the scope of things following major surgery, both are fairly tolerable regimens, and this study doesn't necessarily change the pattern of use in terms of choosing post-operative therapy," Choti said.
"But the point is that pancreatic cancer is a terrible disease, and really just a minority of patients are candidates for surgery. And even for those, unfortunately 75 to 80 percent of those will go on to recur even after the surgery appears to be successful. So, indeed, there has been a strong interest in giving the best additional therapy possible," Choti added.
"So this is not a revolutionary finding, but it's part of an effort to look at what we have and even to find newer regimens with more combinations of drugs," he noted. "And that's exactly what's already underway, as we search for more aggressive and more successful treatments."

H1N1 Pandemic Flu Even Milder Than Seasonal Strains

Though youngest were most vulnerable, fewer serious complications seen, study finds

The H1N1 pandemic flu, which swept across the United States last year, was actually no more serious than most seasonal strains, a new study confirms.
According to the U.S. Centers for Disease Control and Prevention, there were 43 million to 89 million cases of the H1N1 pandemic flu in the United States from April 2009 through April 10, 2010. Of these, an estimated 274,000 were hospitalized and 12,470 died.
"We found that the pandemic H1N1 virus disproportionately affected children and young adults, but the symptoms and risk of most complications were similar to those of seasonal influenza viruses," said lead researcher Dr. Edward A. Belongia, from the Marshfield Clinic Research Foundation in Marshfield, Wisc.
In fact, children, young adults, pregnant women and people with underlying chronic medical conditions had a higher risk of hospital admission and serious complications when infected with the pandemic virus, the researchers noted.
However, whether the pandemic flu was deadlier or caused more critical illness than the simultaneously circulating seasonal strains has not been studied until now, Belongia noted.
"One implication is that the higher incidence of death or serious illness from the pandemic H1N1 infection in other studies may have been due to the high level of transmission in susceptible children and young adults rather than greater virulence of the pandemic virus," he said.
However, this study did not address specific high-risk populations such as pregnant women, Belongia said.
The report is published in the Sept. 8 issue of the Journal of the American Medical Association.
For the study, Belongia's group compared the H1N1 pandemic flu with the seasonal H1N1 flu, as well as the H3N2 seasonal flu.
Out of 6,874 people who agreed to take part in the study, the researchers found 545 patients with pandemic H1N1 flu, 221 with seasonal H1N1 and 632 patients with H3N2 flu. Ages of these patients ranged from 10 to 25.
A review of hospital records revealed that, among children, H1N1 pandemic flu was not linked to hospitalization or pneumonia compared with either H1N1 seasonal flu or H3N2 seasonal flu.
Among children with H1N1 pandemic flu, 1.5 percent were hospitalized, as were 3.7 percent with H1N1 seasonal flu and 3.1 percent of those with H3N2 flu, the researchers found.
Among adults, 4 percent of those with H1N1 pandemic flu were hospitalized, as were 2.3 percent with H1N1 seasonal flu and 4.5 percent with H3N2 flu, they added.
As for pneumonia, 4 percent of adults with H1N1 pandemic flu came down with the condition, compared with 2.3 percent of those with H1N1 seasonal flu and 1.1 percent of those with H3N2 flu, Belongia's team found.
Among children, 2.5 percent of those with H1N1 pandemic flu developed pneumonia, as did 1.5 percent with H1N1 seasonal flu and 2 percent of those with H3N2 flu.
Influenza expert Dr. Marc Siegel, an associate professor of medicine at New York University in New York City, said that "this confirms what we were noticing from the beginning with H1N1, which is that, structurally, it was a mild virus."
As a mild virus it wasn't any more deadly, Siegel said. It had a predilection for the young and it was expected there would be more serious complications, but there weren't, he added.
Siegel said the virus attacked young people because they didn't have any immunity to it, which is typical with pandemic flu strains.
"Even though it was a mild virus, we didn't have immunity, so that made it somewhat unpredictable," Siegel said. "This study shows that despite our lack of immunity the complications were no greater than the yearly flu. That's a new finding."
This year, it is doubtful H1N1 pandemic flu will be noticed, Siegel said. In the first place, this year's flu vaccine contains this flu strain and in the second place most people are now immune to this strain, because it spread so far and wide, he said.
"I do not expect there to be a problem this year," Siegel said.

Decline in Adult Smoking Stalls, Alarming Experts

And more than half of U.S. kids exposed to secondhand smoke, CDC report finds

Although the hazards of smoking are well known, 20 percent of Americans still light up, U.S. health officials said Tuesday.
The number of adult smokers dropped between 2000 and 2005, but the decline has leveled out, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC).
"The 40-year decline in tobacco in the United States has stalled," CDC director Dr. Thomas R. Frieden said during an early afternoon press conference.
"Between 2005 and 2009 there was no further reduction in tobacco use," he said. And despite progress nearly 90 million American non-smokers are exposed to toxic chemicals in tobacco smoke."
Frieden laid the blame for the stalled smoking decline on the doorstep of the tobacco industry.
"The industry has gotten even better at sidestepping laws designed to get people to stop smoking," he said. "They ensure that every cigarette the sell is designed to deliver nicotine quickly and efficiently to keep people addicted."
In addition, the industry uses marketing techniques to get children to start smoking. And they create new products that get around laws to attract new smokers, Frieden said.
More men (24 percent) than women (18 percent) were smoking in 2009, says the report, which also found that people with less education and lower incomes were more likely than others to smoke.
Thirty-one percent of smokers live below the poverty level, and 25 percent never graduated from high school compared with 6 percent of those with graduate degrees, the report says.
Moreover, secondhand smoke remains a serious problem for 88 million nonsmokers. For example, 54 percent of children aged 3 to 11 are exposed to secondhand smoke, and 98 percent of kids living with a smoker have measurable levels of toxic chemicals from cigarette smoke, the report says.
Black nonsmokers are twice as likely as Mexican-American non-smokers and 33 percent more likely than white non-smokers to have measurable exposure to tobacco, the researchers say.
Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said a five-year stall in smoking rates suggests both "that those who now smoke may be diehards and tough to convert, and that perhaps we got a bit too complacent way too soon."
"Our goal should be nothing less than the elimination of tobacco use," Katz said. "This report tells us of the need to rededicate ourselves to this cause, and allocate the requisite resources."
Smoking and secondhand smoke exposure led to 443,000 deaths in 2009, making smoking the leading cause of preventable illness and death in the United States, the CDC said.
"These results underscore the need for every state and community to enact comprehensive smoke-free laws that apply to all workplaces and public places, including restaurants and bars," Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in a statement Tuesday.
Twenty-eight states, Washington, D.C., Puerto Rico and more than 550 cities have laws requiring smoke-free restaurants and bars, Myers said.
"The high level of child exposure to secondhand smoke also underscores the need for parents to take additional steps to protect children, such as ensuring that homes, cars and other places frequented by children are smoke-free," he added. "For parents who smoke, the best step to protect children is to quit smoking."
Smoking rates vary by region and state. One problem is that states are cutting back on the money they devote to tobacco control programs, Frieden said. "If all states funded tobacco control at the CDC recommended level there would be an estimated 5 million fewer smokers in this country, and that would prevent at least 1 million deaths," he said.
Last year, Utah and California had the fewest smokers. California's comprehensive tobacco control program has resulted in a decline in lung cancer at a rate four times faster than in the rest of the country, the CDC noted.
The good news, Frieden said, is that tobacco use can be reduced. "Tobacco control measures work. Places that implement tobacco control programs get dramatic results," he said.
In Washington state the smoking rates is less than 15 percent, in California it's less than 13 percent and in Rhode Island and Massachusetts it's less than 15 percent, Frieden said.
In addition, those who smoke may be smoking less. "Cigarette sales have declined significantly, especially in 2009 when the federal cigarette tax increased by 61 cents per pack," said Myers.
"This decline in cigarette consumption could be a precursor to declines in the smoking rate, especially if proven tobacco control measures are implemented more aggressively," he added.

Men Seem More Susceptible to Memory Problems Than Women

Among elderly, rate of mild impairment was 1.5 times higher in males, study finds

Elderly men are more likely to suffer memory problems than women, new research shows.
The study included 2,050 people, aged 70 to 89, in Olmsted County, Minn., who were interviewed about their memory and medical history, and who underwent testing of their memory and thinking skills.
Overall, nearly 14 percent of the participants had mild cognitive impairment (MCI), but the rate was 1.5 times higher in men (19 percent) than in women (14 percent). People with MCI have memory or thinking problems that are more serious than what's associated with normal aging. Although not everyone who has MCI develops Alzheimer's disease, people with the impairment do often go on to develop it, according to the Alzheimer's Association.
The study, published in the Sept. 7 issue of the journal Neurology, also found that about 10 percent of the participants had dementia, and 76 percent had normal memory and thinking skills.
"This is the first study conducted among community-dwelling persons to find a higher prevalence of MCI in men," study author Dr. Ronald Petersen, of the Mayo Clinic in Rochester, Minn., said in an American Academy of Neurology news release.
"If these results are confirmed in other studies, it may suggest that factors related to gender play a role in the disease. For example, men may experience cognitive decline earlier in life but more gradually, whereas women may transition from normal memory directly to dementia at a later age but more quickly," he added.
The study, funded by the U.S. National Institute on Aging and a Mayo Clinic Alzheimer's disease research program, also found that MCI was more common among people who had a lower level of education or who were never married.

Immune System Genes Show Links to Type 1 Diabetes

Finding is starting point for work on the disease's origins, possible treatment, experts say

The exact cause of type 1 diabetes is still unknown, but international researchers have found a link between the blood sugar disorder and a network of immune system genes.
Using a genome-wide association study, the researchers found that a certain group of genes that react in response to viral infections were present in both rats and humans, and that those same genes were also associated with a susceptibility to type 1 diabetes.
"Diseases arise as a result of many genetic and environmental factors through gene networks that cause tissue damage," explained study senior author Dr. Stuart Cook, the group head of molecular and cellular cardiology at the Medical Research Council Clinical Sciences Centre, and a professor of clinical and molecular cardiology at Imperial College in London.
"We used an approach to identify the major control points' central command of an inflammatory gene network. This led us to uncover hundreds of new genes that might cause diabetes and one major control gene that controls the whole network," said Cook.
He added that one of the genes belongs to a class of genes that might make a good target for drug therapy in the future.
Results of the study are published in the Sept. 9 issue of Nature.
Each year, more than 30,000 people are diagnosed with type 1 diabetes, formerly known as juvenile diabetes, according to the Juvenile Diabetes Research Foundation (JDRF). People with type 1 diabetes no longer produce enough of the hormone insulin to effectively use the sugars found in carbohydrate-containing foods. To survive, people with type 1 diabetes must take insulin injections or use an insulin pump for the rest of their lives.
Experts believe the disease is an autoimmune disease, which means that the body's immune system mistakenly turns against healthy cells, such as the insulin-producing cells in the pancreas, and destroys them. People who develop type 1 diabetes are believed to have a genetic susceptibility to the disease that's then triggered by something in the environment, possibly a virus.
In the current study, the researchers didn't initially set out to look for type 1 diabetes genes. They started out by looking at a certain group of genes in rats, in this case a network of genes controlled by a gene called interferon regulatory factor 7 (IRF7). IRF7 is like a master switch that controls the genes in its network. The entire network of genes controlled by IRF7 is called the IRF7-driven inflammatory network (IDIN).
The researchers discovered that when there were differences in IRF7, there were also differences in the way other genes expressed themselves.
Cook and his colleagues then searched for a network of genes in humans that might behave the same way. They found an area on chromosome 13q32 that is controlled by a gene called the "Epstein-Barr virus induced gene 2" (Ebi2). This gene appeared to be the human equivalent of the IRF7 gene in rats.
Within this human version of the IDIN, research found a gene called IFIH1, which has been found in other research to be associated with the development of type 1 diabetes.
"Usually, research starts from the genetics and goes to function. Here, they started with a function -- [an immune system reaction] -- and were looking for a gene," explained Marie Nierras, director of research and scientific affairs for the JDRF.
"The value of such a result is that if you can get to the same place using more than one pathway, it tends to support the hypothesis," she said.
In this case, the hypothesis supported is the idea that type 1 diabetes may be triggered by an immune system response to a virus. However, Nierras stressed that this study doesn't conclusively prove that a virus is the trigger for type 1 diabetes.
"We know better today that this network of genes is involved, and with a network, you have many targets you can test. This research invites us to plan experiments going forward, and opens up many more questions, like 'If I disrupt this branch of the network, do I disrupt diabetes?' Or, 'If you look back at previous research knowing this study's results, does that help to better explain previous results?'" said Nierras.
Cook said this type of genome-wide association study can be used for other diseases as well, and that his team is hoping to eventually develop a new drug based on the genetic target they discovered.

Pediatrics Group Urges Flu Shots for All Health-Care Workers

AAP calls mandatory shots 'ethically justified, necessary, and long overdue to ensure patient safety'

A group representing America's pediatricians is urging that flu shots be mandatory for all U.S. health-care workers in order to protect patients.
While many organizations have used voluntary programs in an effort to improve coverage, flu vaccination rates among health-care workers remain unacceptably low, said the members of the Committee on Infectious Diseases at the American Academy of Pediatrics.
"Mandatory influenza immunization for all health-care personnel is ethically justified, necessary, and long overdue to ensure patient safety," they wrote in the AAP policy statement, which will appear in the October issue of the journal Pediatrics.
Immunization rates of 80 percent or higher are needed to achieve the "herd immunity" required to have a major impact of flu transmission by health-care workers, but current rates of flu vaccination for this group remain near 40 percent, the authors said.
They noted that mandatory immunization for health-care workers is not unusual. For example, many medical facilities require specific vaccines and a tuberculin skin test as conditions of employment or to be allowed to work in specific areas of an institution.
Medical and religious exemptions to mandatory flu vaccination can be granted on an individual basis, the statement authors suggested.
They offered a number of examples of the effectiveness of mandatory flu vaccination policies. The Virginia Mason Medical Center in Seattle achieved a 99 percent compliance rate after it made influenza vaccination mandatory in 2005. The compliance rate was 100 percent after the U.S. National Institutes of Health Clinical Center made flu vaccination mandatory for employees who had contact with patients.
Flu outbreaks are a common and serious public health problem. Each year in the United States, influenza causes more than 36,000 deaths and 200,000 hospitalizations and costs the country $87 billion, according to the AAP statement.

2 Genes Have Possible Link to Deadly Ovarian Cancer

Scientists say findings may lead to new therapies for ovarian clear cell carcinoma

Mutations in two genes may be associated with one of the most deadly types of ovarian cancer, U.S. researchers have found.
In the study, researchers at the Johns Hopkins Kimmel Cancer Center looked for mutations in 18,000 protein-encoding genes in ovarian clear cell tumors from eight patients. The investigators found 268 mutations in 253 genes, with an average of 20 mutations per tumor.
Further investigation revealed that two genes -- ARID1A and PPP2R1A -- were more commonly mutated than other genes. ARID1A mutations were present in 57 percent of tumors while PPP2R1A mutations were present in 7.1 percent of tumors, according to the report published in the Sept. 8 online edition of Science Express.
ARID1A is a gene whose product normally suppresses tumors. PPP2R1A is a gene that, when altered, helps turn normal cells into tumor cells. The genes had not previously been linked to ovarian cancer, the researchers explained in a news release from the Johns Hopkins Kimmel Cancer Center.
The findings "may provide opportunities for developing new biomarkers and therapies that target those genes," Nickolas Papadopoulos, associate professor of oncology and director of Translational Genetics at the Ludwig Center for Cancer Genetics & Therapeutics at the cancer center, said in the news release.
Ovarian clear cell carcinoma, which accounts for about 10 percent of cancers that start in cells on the surface of the ovaries, mainly affects women aged 40 to 80 and is resistant to chemotherapy, according to background information in the news release.