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Medical News from Johns Hopkins
This is a service for doctors worldwide from Johns Hopkins International. To receive reports directly, please send e-mail to jhis@jhmi.edu or visit www.jhintl.net.
1. Doctors Don't Agree on Uterine Cancer Diagnosis
2. Mutation and Certain Antidepressants Decrease Effects of Tamoxifen
3. Prostate Cancer Pill May Reduce Risk of Disease
4. Drug Extends Life in Advanced Prostate Cancer Patients
5. Controlling Glucose Improves Outcomes for Critically Ill
Items 1-4 were presented at the meeting of the American Society of Clinical Oncology last week.
1. Doctors Don't Agree on Uterine Cancer Diagnosis
A study headed by Hopkins oncologist Cornelia Trimble, M.D., shows that pathologists who evaluate uterine biopsies disagree 60 percent of the time on the correct diagnosis. After reviewing 289 biopsies classified as AEH, researchers downgraded diagnoses to "less than AEH," (a range of benign disorders) in 25.6 percent of cases; upgraded diagnoses to cancer in 29.1 percent of cases; and did not agree in 5.5 percent of the cases. The investigators agreed with the diagnosis of AEH in only 39.8 percent of cases. The authors say new standards for collecting and classifying biopsies are needed to improve the accuracy of diagnoses. Because women with diagnoses of cancerous or precancerous lesions called atypical endometrial hyperplasia (AEH) face a hysterectomy, they suggest these patients get a second opinion from a pathologist who specializes in gynecology.
2. Mutation and Antidepressants Decrease Effects of Tamoxifen
Hopkins researchers have found that some women have a gene mutation that may decrease the effectiveness of tamoxifen, a commonly used breast cancer drug. The findings may tell physicians which women might have reduced benefit from tamoxifen therapy. Results also suggest that some frequently prescribed antidepressants may reduce tamoxifen's effects because the antidepressants affect a similar metabolic pathway. Although a test for the mutation in the CYP2D6 gene is not widely available, the investigators recommend that women currently on long-term tamoxifen therapy and using SSRI antidepressants such as paroxetine and sertraline (Paxil and Zoloft, among others) consult their doctor for guidance. "There is no evidence from this study that a woman who is taking tamoxifen should automatically stop using a particular antidepressant if it is helping her," says oncologist Vered Stearns, M.D. But the researchers advise that women on tamoxifen who are considering antidepressant therapy may opt to use an antidepressant, such as venlafaxine, which may not alter tamoxifen's metabolism.
3. Prostate Cancer Pill May Reduce Risk of Disease
Recent clinical studies led by Hopkins researchers have found that a drug called atrasentan reduces the risk by 20 percent that cancer will progress in men with advanced hormone-resistant prostate cancer. "Treatment options remain limited for patients whose prostate cancer has spread and does not respond to hormone therapy, and some of these men are looking for less toxic alternatives than chemotherapy at this point in their lives," says oncologist Michael Carducci, M.D. "Atrasentan can help prevent their pain and may potentially postpone when they need more aggressive treatments like chemotherapy or radiation."
"This drug's largest effect may be its ability to stabilize the progression of prostate cancer to the bone," says Carducci. "As a result, atrasentan slows the rise in PSA levels and delays the development of pain while maintaining quality of life." Few patients in the studies experienced side effects such as a stuffy nose, headache, and swelling.
4. Drug Extends Life in Advanced Prostate Cancer Patients
Hopkins clinicians have participated in a three-year international study showing that docetaxel, a drug made from yew tree needles, decreases the chance of dying by 24 percent in advanced-stage prostate cancer patients resistant to hormone therapy. Patients receiving docetaxel every three weeks survived 2.4 months longer on average than those receiving mitoxantrone or docetaxel weekly. The results spur hopes that earlier use of the drug alone or together with other agents will provide longer improvements in survival. "This is good news for our prostate cancer patients," says oncologist Mario Eisenberger, M.D., co-chair of the study. "These data indicate that the current standard of care for these patients should be docetaxel therapy, and we should try adding new agents to build upon this success and test it in patients with aggressive disease before the cancer spreads."
5. Controlling Glucose Improves Outcomes for Critically Ill
A study conducted in 2001 concluded that when blood glucose, which elevates in response to stress, is kept under tight control, critically ill patients experience fewer infections and improve their chance of survival. Based on this study,Hopkins critical care specialist Sean Berenholtz, M.D., developed the protocol for managing blood glucose in patients in the ICU but says the process hasn't been easy.
"There's a lot of interest on the part of ICUs to get a better handle on glucose control. Unfortunately it has been a formidable challenge." While it has been difficult to generalize his findings at other centers due to differences in dedicated resources and staff to manage patient's glucoses, Berenholtz believes that tight glucose control will spread into many other areas of the hospital as its benefits become more apparent. Patients may soon expect to have glucose monitoring in addition to other vital signs.
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