There are many kinds of cancers of the immune system, but one, Activated B-Cell Diffuse Large B-Cell Lymphoma, or ABC-DLBCL, is particularly common and pernicious. Researchers at the University of Pennsylvania’s School of Veterinary Medicine have shown for the first time that dogs that develop this disease spontaneously share the same aberrant activation of a critical intracellular pathway with humans. They also found that a drug designed to disrupt this pathway helps to kill tumor cells in the dogs’ cancerous lymph nodes.

The research was conducted by Nicola Mason, assistant professor of medicine at Penn Veterinary, along with Michael J. May, associate professor of pharmacology; postdoctoral fellow Anita Gaurnier-Hausser; and veterinary clinical pathologist Reema Patel.

Their work was published in the journal Clinical Cancer Research.

B-cells are the part of the immune system that produce antibodies and protect the body against invading microorganisms or allergens. In ABC-DLBCL, the intracellular signaling pathway involved in B-cell activation and proliferation is, as the name of the disease suggests, constantly activated.

“This signaling pathway, called NF-kappaB, is critical in immune function; following an encounter with antigen, lymphocytes need to be activated and proliferate so that there are sufficient numbers to deal with the invading organism,” Mason said. “But in humans with ABC-DLBCL, and also in dogs with spontaneous DLBCL, this pathway is constitutively active and drives lymphocytes to proliferate continuously.”

Moreover, these malignant B-cells are resistant to apoptosis, or cell death. Their unchecked growth is the basis of the lymph node tumors that are a hallmark of the disease.

For many years, researchers have been investigating ways of interrupting the malfunctioning pathway that forms the tumors and provides resistance to chemotherapy-induced cell death. In order to test whether a canine model for inhibitors would have relevance to cancer treatment in humans, the Penn team first showed that the same aberrant activation of the NF-kappaB pathway exists in dogs.

They then went on to demonstrate that inhibition of this pathway using a drug known as NEMO Binding Domain, or NBD, peptide led to increased cell death of malignant lymphocytes in a laboratory setting. The next step was to determine whether this peptide could similarly inhibit NF-kappaB activity when used directly in the dogs with the disease.

Treatment of DLBCL in dogs is similar to humans; the cancer usually responds well to chemotherapy, but patients frequently relapse with drug-resistant disease. The five-year survival prognosis for humans is about 50 percent, but in dogs the survival rate is much worse, with more 85 percent of dogs relapsing within the first year and the majority succumbing to their disease during the first or second round of chemotherapy.

Having determined the presence of aberrant pathway activity in the dogs with spontaneous DLBCL and that inhibition of this pathway can lead to increased cell death, the researchers performed a small pilot trial to determine the efficacy of the NBD peptide in dogs that had relapsed with drug resistant lymphoma.

The results were encouraging.

“We injected one malignant lymph node with the NBD peptide and followed up with chemotherapy. One week after a single dose of peptide, the lymph node we injected was a lot smaller than the other cancerous lymph nodes,” Mason said. “This suggests that the peptide either acts alone or synergistically with the chemotherapy drugs to kill the tumor cells.”

Testing the peptide in a live animal model, rather than in tumor cells taken from cell lines in a Petri dish, accelerates the prospects of this research leading to clinical treatments for both dogs and humans.

“The identification of a comparable molecular pathogenesis of ABC-DLBCL between dogs and humans, coupled with our ability to investigate the therapeutic benefit of targeting this aberrant NF-kappaB pathway in a clinically relevant, large animal model is a perfect example of the ‘bench to bedside’ paradigm of translational medicine,” Mason said. “It’s been over 10 years since this pathway was recognized in ABC-DLBCL in humans; however, this is the first indication that specific inhibition of this pathway may have a beneficial effect in human and canine patients with this disease.”

Mason and her colleagues are now testing whether the peptide is systemically effective when introduced intravenously, rather than directly injected into a single tumor. The drug has shown to have minimal side effects on the immune systems of small animals, and a successful and safe trial in dogs could not only pave the way to a novel approach to the treatment of this disease in pet dogs but also could lead to clinical trials in humans with this type of lymphoma.

The research was supported by the National Institutes of Health, American Cancer Society, Mari Lowe Center for Comparative Oncology and American Kennel Club’s Canine Health Foundation.

Source:
Evan Lerner

University of Pennsylvania

Electronic nose sniffs out asthma

New evidence shows that an “electronic nose” containing an array of gas sensors may have the ability to identify asthma in patients. Researchers from Italy compared the diagnostic performance of the electronic nose with lung function tests and fraction of exhaled nitric oxide (FENO) in seven patients with asthma and seven healthy subjects. For each person, the electronic nose analysis was performed on total exhaled air and alveolar air. Results showed that the diagnostic performance for the electronic nose, FENO, and lung function testing was 87.5 percent, 79.2 percent, and 70.8 percent, respectively. Overall, the electronic nose analysis obtained the best results when performed on alveolar air and in combination with FENO. Researchers conclude that the electronic nose discriminates between patients with asthma and healthy patients, with increased diagnostic performance when combined with FENO. This article is published in the April issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(4):790.

Oral vaccine may reduce exacerbations in patients with COPD

A novel vaccine may help reduce the number and severity of exacerbations in patients with severe chronic obstructive pulmonary disease (COPD). Australian researchers developed a new oral immunotherapy (HI-164OV) using Haemophilus influenzae, the bacteria causing meningitis in children. In a randomized, multicenter, double blind, placebo-controlled trial, researchers tested the efficacy of the new vaccine and its effects on outcomes in 38 patients with severe COPD. Results showed significant reductions in the areas of moderate to severe exacerbations (63 percent reduction), mean duration of episode (37 percent reduction), prescribed antibiotics (56 percent reduction), and exacerbations requiring hospital admission (90 percent reduction). No specific adverse effect was detected. Researchers conclude that the vaccine shows potential in improving the health of patients with COPD. The article is published in the April issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(4):805.

Link between acid reflux and sleep apnea challenged

New research suggests that a causal link between gastroesophageal reflux (GER) and obstructive sleep apnea (OSA) may not exist. Researchers from the Medical College of Wisconsin studied the sleep events of nine patients with GER without OSA, six patients with OSA without GER, 11 patients with OSA and GER, and 15 control subjects. Although GER is thought to be induced by decreasing intraesophageal pressure during OSA, study results showed that esophageal pressures progressively increased during OSA. The incidence of GER during sleep in patients with OSA and GER did not differ from the remaining three groups. Researchers speculate that OSA may not induce GER or other reflux events. This study is published in the April issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(4):769.

Source:
Jennifer Stawarz

American College of Chest Physicians

A new study revealed that the occurrence of narcolepsy in China is related highly to seasonal patterns, with onset most common in April. Following the 2009-2010 H1N1 pandemic, a significant rise in narcolepsy cases were also observed. However, the findings indicated flu vaccination was unlikely the cause of the rise. The study is now available in Annals of Neurology, a journal of the American Neurological Association and the Child Neurology Society.

Caused by a deficit of hypocretin – a neurotransmitter in the brain that is responsible for communication of biological processes, such as sleep. Narcolepsy is a chronic neurological disorder. An inability to control sleep-wake cycles occurs when brain cells lose hypocretin. Individuals with the disorder experience sudden bouts of sleep at any time, a sudden loss of voluntary muscle tone (cataplexy), vivid dreams or hallucinations, and short periods of total paralysis, according to the National Institutes of Neurological Disorders and Stroke (NINDS).

Medical evidence reveals that narcolepsy-cataplexy affects less than 1% of the world population and 1 in 3,000 Americans have this disorder, estimates NINDS. Investigations reported, following the 2009-2010 H1N1 pandemic, patients who were receiving the Pandermrix vaccine had an increased incidence in narcolepsy and increased risk of narcolepsy. Other research revealed that infection with streptococcus preceded the onset of narcolepsy in Caucasian patients, suggesting upper airway infections may set off the disorder.

The investigation team for the current study, led by Dr. Fang Han from the Beijing University People’s Hospital in China and Dr. Emmanuel Mignot with the Stanford Center for Sleep Sciences and Medicine in Palo Alto, California, conducted a retrospective examination of narcolepsy onset in patients diagnosed between 1998 and 2011 in Beijing. Information was gathered from 629 patients (86% children), who were participants of the Stanford-Beijing University Chinese narcolepsy study cohort, on the month and year of narcolepsy onset. 182 participants who developed narcolepsy after October 2009 provided a vaccination history.

Dr. Han explained,

“Our findings show a seasonal variation in narcolepsy onset in a Chinese population, occurring most frequently in late spring and early summer. Analysis revealed that onset of narcolepsy was least frequent in November and occurred most often in April, with close to a 7-fold increase from lowest point to peak time.”

Year-to-year variations were also researched by the investigators, identifying 173 cases of narcolepsy following the 2009-2010 H1N1 flu pandemic which represented a three fold rise in the disorder. Dr. Mignot noted, “The increase in narcolepsy incidence was unlikely caused by increased vaccination as only 6% of study narcolepsy participants reported receiving a vaccination against H1N1. A five to seven month delay between the seasonal peak in flu and peak in the onset of narcolepsy was also observed.”

He concluded,

“These findings are reminiscent of the encephalitis lethargica epidemic that followed the great Spanish influenza pandemic of 1917-1918. Not only narcolepsy, but also psychosis and Parkinson’s disease may follow winter infections, and further research is needed in the area of autoimmune diseases of the brain.”

Grace Rattue

UroToday – Urothelial Expression of Hepatocarcinoma-Intestine-pancreas/Pancreatitis-associated Protein (HIP)/(PAP) Expressed in Patients with Interstitial Cystitis.

A protein called regenerating gene was originally identified in regenerating pancreatic islet cells. A family of related genes has been identified and described under a rather varied nomenclature such as PAP and HIP and has been broadly categorized into 4 subtypes. Recently, it was assumed that HIP/PAP expression is associated with inflammation because it is expressed as a secretory protein in acute pancreatitis, and is expressed in human gut epithelial cells in inflammatory bowel disease.

Dr. Tetsuya Makino and colleagues from Osaka, Japan have demonstrated in a rat cyclophosamide cystitis model that PAP III is expressed in the urothelium of the bladder and PAP I was expressed in the primary afferent neurons of dorsal root ganglia that innervate the bladder. Now, the same group has looked at urothelium in BPS/IC patients. Twenty-seven females who met NIDDK criteria for IC were compared with 27 female controls. Positive staining of the urothelium for HIP/PAP was found in 15/17 IC patients and 1/17 controls. Urinary levels of HIP/PAP in IC patients were higher than those in normal controls. Increased immunoreactivity for HIP/PAP was frequently observed in the umbrella cells of the urothelium in IC patients, suggesting that expression of HIP/PAP is induced in the urothelium and then released into the urine of IC patients. Urinary levels correlated with severity of urinary symptoms.

The researchers conclude that the intense HIP/PAP immunoreactivity in the umbrella cell layer in IC patients suggests that umbrella cells have a crucial role as an anti-inflammatory mediator. HIP/PAP could be another candidate for a BPS/IC marker, and may help to reveal the ultimate pathophysiology of this syndrome.

Makino T, Kawashima H, Konishi H, Nakatani T, Kiyama H
Urology. 2009 Jul 29. Epub ahead of print.
doi:10.1016/j.urology.2009.05.044

UroToday Contributing Editor Philip M. Hanno, MD, MPH

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2009 – UroToday

Health Canada is advising consumers not to use unapproved products containing yohimbine or yohimbe bark, including Strauss Energy SIX capsules. Yohimbine is a prescription substance that can pose serious health risks for people with underlying risk factors.

The use of any unapproved products containing yohimbine, that have not been prescribed by a physician, may result in serious adverse reactions, particularly in people with high blood pressure, heart, kidney or liver disease.

Yohimbine should not be used by pregnant or nursing women, or children. The potential for serious complications for those at risk requires that yohimbine should be available only under medical supervision.

The most consistently reported side effects associated with yohimbine are anxiety and increased urinary frequency. Other reported reactions include dizziness, gastrointestinal disturbances, headache, sweating, insomnia, tremors, palpitations and severe hypertension.

One of the unapproved products found by Health Canada to contain yohimbine is Strauss Energy SIX, manufactured by Strauss Herb Company, of Kamloops B.C.

Strauss Energy SIX is not authorized for sale in Canada but is promoted to increase energy levels, build body mass, and restore or enhance sexual performance, and is available at retail outlets and over the Internet. The manufacturer has refused to comply with Health Canada’s request to stop selling the product. Health Canada will take further action to remove the product from the market.

Consumers who have used Strauss Energy SIX or another product containing yohimbine and have concerns about their health should contact their physicians or health care practitioner.

To report a suspected adverse reaction, please contact the Canadian Adverse Drug Reaction Monitoring Program (CADRMP) of Health Canada by one of the following methods:

Telephone: 866-234-2345
Facsimile: 866-678-6789

CADRMP
Marketed Health Products Directorate
Health Protection Building, Tunney’s Pasture, AL 0701C
Email: cadrmphc-sc.gc

Consumers requiring more information about this advisory can contact Health Canada’s public enquiries line at (613) 957-2991, or toll free at 1-866-225-0709. To report finding these products on the Canadian market please contact the Health Products and Food Branch Inspectorate at: 1-800-267-9675.

HEALTH CANADA

NeoVista, Inc. announced that the U.S. Food and Drug Administration (FDA) has granted the
company’s request to expand the number of sites participating in its
pivotal Phase 3 trial from 10 to 30 in the United States. The approved
expansion of CABERNET (CNV Secondary to AMD Treated with BEta RadiatioN
Epiretinal Therapy) trial, which seeks to evaluate the safety and efficacy
of the company’s novel epiretinal brachytherapy for the wet form of
age-related macular degeneration (AMD), was dependent on the FDA’s review
of 90-day safety data, typical of new-to-market medical devices.

“With this expansion to 30 sites, we will not only be able to recruit
more patients at a higher rate, taking us one step closer to
commercialization in the United States, but it will also allow additional
retina specialists to see the benefits of our novel therapy first-hand
while treating their patients,” said John N. Hendrick, President and CEO of
NeoVista. “It’s an exciting time at NeoVista with our recent CE Mark
approval in the EU and the FDA approval of our trial expansion. We are
getting closer and closer to seeing our investigational therapy become an
approved treatment option for millions of patients worldwide afflicted with
wet AMD.”

CABERNET is a multicenter, randomized, controlled study that will
enroll 450 subjects at clinical centers worldwide. The study will evaluate
the safety and efficacy of NeoVista’s epiretinal brachytherapy, delivered
utilizing a limited vitrectomy, concomitant with two intravitreal
injections of the FDA-approved antiangiogenic therapy Lucentis(R)
(ranibizumab) versus Lucentis alone. For those enrolled in the trial arm
utilizing brachytherapy, Lucentis is injected once at the time of the
surgery and once again 30 days later. The co-primary endpoints in the
CABERNET trial are 1) the noninferiority of epiretinal brachytherapy plus
Lucentis versus Lucentis alone based on the proportion of subjects losing
fewer than 15 letters on the Early Treatment Diabetic Retinopathy Study
(ETDRS) chart at 12 months as compared to baseline or 2) the superiority of
epiretinal brachytherapy plus Lucentis versus Lucentis alone based on the
proportion of subjects gaining 15 letters or more on the ETDRS chart at 12
months.

In contrast to previous forms of radiation therapy for wet AMD,
NeoVista’s therapy delivers a one-time peak dose of beta particle energy
(24 Gy) directly to the lesion, and the normal retinal vasculature receives
minimal exposure. Utilizing strontium 90, the focused energy is delivered
to a target area up to 3 mm in depth and up to 5.4 mm in diameter; the
radiation exposure within the ocular compartment is below the clinical
threshold of observable tissue damage for all structures including the
lens, optic disc, and retina. Importantly for patients, the systemic
exposure to radiation is minimal, as the effective dose to the entire body
from NeoVista’s epiretinal device is less than that from a typical chest
x-ray.

Prior to the CABERNET trial, the company had conducted a feasibility
trial to test the efficacy and safety of their brachytherapy device when
used concomitantly with two intravitreal injections of Avastin(R)
(bevacizumab), which yielded promising results after 12 months. At the 1
year follow-up evaluation of 33 participants, subjects had experienced a
mean improvement in best-corrected visual acuity of 10 letters from
baseline using the ETDRS chart.

About NeoVista, Inc.

NeoVista, Inc. is a privately held development-stage medical device
company based in Fremont, California. NeoVista’s epiretinal brachytherapy
is currently being studied in a definitive Phase III clinical study to
support eventual filing for regulatory approval to market the product in
the United States. NeoVista recently got approval to apply the CE Mark on
its device overseas, giving them ability to distribute and sell its product
throughout all EU countries. For more information about the company, the
clinical trial or this novel wet AMD therapy, please visit the company’s
Web site at neovistainc.

NeoVista, Inc.
neovistainc

View drug information on Lucentis.

Levees and floodwalls surrounding New Orleans — no matter how large or sturdy — cannot provide absolute protection against overtopping or failure in extreme events, says a new report by the National Academy of Engineering and the National Research Council. The voluntary relocation of people and neighborhoods from areas that are vulnerable to flooding should be considered as a viable public policy option, the report says. If relocation is not feasible, an alternative would be to elevate the first floor of buildings to at least the 100-year flood level.

The report is the fifth and final one to provide recommendations to the Interagency Performance Evaluation Task Force (IPET), formed by the U.S. Army Corps of Engineers to examine why New Orleans’ hurricane-protection system failed during Hurricane Katrina and how it can be strengthened. The previous four reports by the NAE and Research Council examined various draft volumes of the IPET. This report reviews the 7,500-page IPET draft final report, reflects upon the lessons learned from Katrina, and offers advice for how to improve the hurricane-protection system in the New Orleans area.

Although some of the report’s recommendations to enhance hurricane preparedness have been widely acknowledged for years, many have not been adequately implemented, said the committee that wrote the report. For instance, levees and floodwalls should be viewed as a way to reduce risks from hurricanes and storm surges, not as measures that completely eliminate risk. As with any structure built to protect against flooding, the New Orleans hurricane-protection system promoted a false sense of security that areas behind the structures were absolutely safe for habitation and development, the report says. Unfortunately, there are substantial risks that never were adequately communicated to the public and undue optimism that the 350-mile structure network could provide reliable flood protection, the committee noted.

Comprehensive flood planning and risk management should be based on a combination of structural and nonstructural measures, including the option of voluntary relocations, floodproofing and elevation of structures, and evacuation, the committee urged. Rebuilding the New Orleans area and its hurricane-protection system to its pre-Katrina state would leave the city and its inhabitants vulnerable to similar disasters. Instead, settlement in areas most vulnerable to flooding should be discouraged, and some consideration should be given to new designs of the New Orleans metro hurricane-protection system. As part of the future design, relocation of some structures and residents would help improve public safety and reduce flood damages.

For structures in hazardous areas and residents who do not relocate, the committee recommended major floodproofing measures — such as elevating the first floor of buildings to at least the 100-year flood level and strengthening electric power, water, gas, and telecommunication supplies. Also, a comprehensive evacuation program should be established that includes well-designed and tested evacuation plans; improved local and regional shelters that would make evacuations less imposing; and long-term strategies that could enhance the efficiency of evacuations, such as locating facilities for the ill and elderly away from hazardous areas.

Furthermore, the 100-year flood level — which is a crucial flood insurance standard — is inadequate for flood protection structures in heavily populated areas such as New Orleans, where the failure of the system would be catastrophic. Use of this standard in the New Orleans area has escalated the costs of protection, encouraged settlement in areas behind levees, and resulted in losses of life and vast federal expenditures following numerous flood and hurricane disasters, the committee said.

Regarding IPET’s draft final report, the committee concluded that it contained important advances in characterizing and understanding the nature of Gulf hurricane storm surges and waves — in particular explaining the storm surge generated by Hurricane Katrina, how waters from the surge entered the New Orleans metro region, and the amount of flooding across the city. In addition, IPET’s studies have made significant contributions to simulating hurricane impacts, characterizing the collective effects of hurricane damage, and improving knowledge of regional vulnerability to hurricanes and storm surge.

However, the final IPET report should provide a better explanation of its methods to evaluate flood risks, the committee said. The final report also should be written in a more clear and organized manner, using layman’s terminology that can be understood by the public and officials. Such clarity is lacking in Volume VIII, which was the principal focus of the final two years of IPET’s study. This volume assesses the risks posed by future tropical storms and contains inundation maps that show the areas at most risk for future flooding. These maps are important to citizens, businesses, and government agencies for planning resettlement and redevelopment in the region, but the volume contains limited discussion of the implications of these maps. Moreover, at times the extensive technical information presented in the volume overshadows key results.

The committee also recommended that a professional technical firm prepare a second document for the public and officials that would be shorter and focus on explaining IPET report results and implications for reconstruction and resettlement.

The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are independent, nonprofit institutions that provide science, technology, and health policy advice under an 1863 congressional charter. Committee members, who serve pro bono as volunteers, are chosen by the Academies for each study based on their expertise and experience and must satisfy the Academies’ conflict-of-interest standards. The resulting consensus reports undergo external peer review before completion.

Source:
Jennifer Walsh

National Academy of Sciences

The AMA is working with state and federal health bodies to help ensure doctors are advised of a swine flu breakout that has reportedly impacted on several countries worldwide.

AMA President, Dr Rosanna Capolingua, said that this appears to be a new strain of influenza A virus.

“The World Health Organization has confirmed that there are identified cases in southwest USA, and cases of severe respiratory illness and deaths in Mexico. The majority of cases have occurred in healthy individuals. This strain has elements of human (H1N1), swine and avian influenza viruses.

“GPs are now on the look out for patients who present with flu like symptoms who have recently travelled to Mexico, the US or Canada.

“People in these circumstances should practice personal hygiene to limit the spread of the flu, and also see their GP – but it is important that they not become overly concerned. We know that many of the people who have contracted the virus in Mexico and the US have only mild symptoms.

“The GP will take a careful history of your travels and your symptoms, take a nose and throat swab, advise health authorities if appropriate, and ask patients to stay at home and away from public places until they feel better. Of course, if symptoms become worse, patients should call their GP.

“Government says the virus appears to be sensitive to widely used anti-viral medications such as TamiFlu and Relenza.

“In the meantime there are every day actions people should take to protect themselves and others.

“Cover your nose and mouth with a tissue when you cough or sneeze, and dispose of the tissue immediately.

“Wash hands often with soap and water, especially after you cough or sneeze – alcohol-based hand cleaners are also effective.

“Avoid touching your eyes, nose or mouth. Germs spread that way.

“Avoid close contact with sick people, and if you are sick, stay away from work or school.

“The AMA will continue to work closely with authorities to ensure the best possible care is provided to our patients.”

Source
Kirk Coningham
General Manager Communication
Australian Medical Association
Further information on Swine Flu

See a Map Of H1N1 Outbreaks
See our Mexico Swine Flu Blog

View drug information on Relenza; Tamiflu capsule.

HIV and sexual health charity Terrence Higgins Trust (THT) will be running a free seven week course in partnership with NHS East Sussex Community Health Services in January aimed at helping gay men to quit smoking. The stop smoking course is targeted specifically with gay men in mind because research shows that gay men are more likely to smoke, start smoking earlier, and continue smoking longer than heterosexual men.
Men interested in signing up to the course are invited to come to a free taster session at the Hartington Pub in Eastbourne on Thursday 6 January from 4-6pm to find out more. The seven week course will start the following week at the Hartington every Thursday. The team are also able to give general information and support around sexual health as well as give free condoms.

The charity is also running the course because smoking can be even more damaging to your health if you have HIV. HIV positive smokers are at a higher risk of smoking related illnesses than HIV negative smokers, and smoking has been shown to increase the risk of HIV-related illnesses such as lung cancer and emphysema.

Daniel Murray, Health Promotion Practitioner from THT in Eastbourne said: “Thinking of quitting smoking as part of your new year’s resolutions? Tried to give up before and never made it past the final hurdle? If you want to give up but don’t know where to start, we can help with our stop smoking course. We all know that giving up smoking can improve your health and reduce the risk of smoking-related illnesses whether you’re HIV positive or not. So if you’ve been thinking of giving up smoking why not find out more about our course and take advantage of all the extra support available?”

For more information on the stop smoking course contact Daniel on 07584 086590 or email daniel.murraytht

Source:
Terrence Higgins Trust

Cancer specialists and researchers at Princess Margaret Hospital, University Health Network (UHN), are tackling an ongoing controversy about the best way to treat an aggressive form of bladder cancer immediate radical surgery or a more conservative initial approach using immunotherapy?

To answer that question, Drs. Girish Kulkarni, Shabbir Alibhai and colleagues calculated the life expectancy and the quality of life expected from the two treatment methods. The team used a decision analysis tool the Markov model a first for this form of bladder cancer.

The results will be released Sept. 25 in PloS Medicine, the journal of the Public Library of Science, which is a peer-reviewed, open access journal that publishes original research relevant to improving human health.

Cystectomy the surgical removal of the bladder is considered an excellent treatment to cure this form of bladder cancer. In some cases, a new bladder is fashioned from part of the bowel. In others, an opening is created to collect urine in a pouch outside the body. Immunotherapy uses bacillus Calmette-Guerin (BCG; the tuberculosis bacterium) to treat cancer cells directly in the bladder and avoids the need for a major operation. BCG stimulates an immune response that diminishes the risk of tumour recurrence and/or progression. The researchers compared the pros and cons of each treatment in their model.

The findings demonstrate that patients under the age of 60 who opt for immediate surgery can live longer with a higher quality of life than if they had chosen the more conservative option. On the other hand, the better choice for patients over age 70 with other health issues or for those who place a high value on retaining sexual function and avoiding other side effects of surgery that may impair quality of life was the more conservative initial approach using immunotherapy.

More importantly, the study identified the major quality of life factors that should be discussed with patients when choosing between these treatment options.

“Our findings highlight the trade off that exists when deciding between radical surgery and a more conservative approach to treating this pre-invasive form of bladder cancer. The results of this study should help urologists to discuss the balance between quantity and quality of life, particularly with patients aged 60 to 70 years,” says PMH surgical oncologist Dr. Antonio Finelli, a co-investigator in the study.

“What may appear to be the most suitable treatment initially may not be the case when you consider other health issues and how well an individual will cope with effects of surgery that reduce their quality of life.”

The research was supported in part by the Canadian Institutes of Health Research and the National Cancer Institute of Canada.

Princess Margaret Hospital and its research arm, Ontario Cancer Institute, have achieved an international reputation as global leaders in the fight against cancer. Princess Margaret Hospital is a member of the University Health Network, which also includes Toronto General Hospital and Toronto Western Hospital. All three are research hospitals affiliated with the University of Toronto. For more information, go to uhn

University Health Network (UHN)
Toronto, Ontario M5G 2M9
Canada
uhn