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Circulating tumor cells correlate with poorer survival in pancreatic cancer patients

CHICAGO, IL. (May 28, 2010) -- -- Fox Chase Cancer Center investigators find that pancreatic cancer patients who have circulating tumor cells tend to have worse outcomes than patients without circulating tumor cells. Additionally, the team has uncovered evidence that not all circulating tumor cells are the same, and some may predict worse outcomes than others. Benjamin P. Negin, M.D., a medical oncology fellow at Fox Chase, will present the study at the 46th Annual Meeting of the American Society of Clinical Oncology on Sunday, June 6. "Eventually, we hope we can use changes in number of circulating tumor cells to make real-time treatment decisions, instead of having to wait weeks for radiological scans," says Negin. "This is one of the first studies looking at the role of circulating tumor cells in pancreatic cancer." Previous work has demonstrated that prostate, colon, or breast cancer patients who have more circulating tumor cells have poorer survival than patients with fewer circulating tumor cells. To learn whether a similar scenario occurs in pancreatic cancer patients, Negin and colleagues enrolled 48 patients with pancreatic cancer in the current study (additional patients still being added). The team used an immunomagnetic separation system to isolate circulating tumor cells from patients' blood at three time points. The time points included study entry, seven days after the start of therapy, and at the time of their first radiological evaluation, which was six to ten weeks after initiating therapy. The team found that 50% of the patients had one or more circulating tumor cell per 7.5 mL peripheral blood at baseline. That proportion decreased to 40% after seven days of therapy and to 32% at the time of the first scan. In addition, the presence of circulating tumor cells correlated with patient outcomes. Patients with circulating tumor cells at study entry had a median overall survival of 191 days compared with 269 days for those without circulating tumor cells, although the difference did not reach statistical significance in the small study population. A similar trend appeared for progression-free survival, with a median of 85 days for those with detectable circulating tumor cells compared with 137 days for those without. Patients who had circulating tumor cells at either point after therapy initiation also trended towards poorer overall or progression-free survival. Interestingly, the investigators found that some circulating tumor cells may be worse than others. Patients whose circulating tumor cells expressed the MUC1 protein, which has been associated with more aggressive pancreatic cancer, trended towards a shorter median overall survival than those whose circulating tumor cells did not express the protein, at 85.5 and 310 days, respectively. "We find that having circulating tumor cells is bad," Negin says. "But the more interesting story that appears to be coming out of our study is that not all circulating tumor cells are equal. The MUC1 cells seem particularly bad, suggesting that there is a difference in the biology of these tumors and providing some insight into how these tumors function." Fox Chase Cancer Center is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation's first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center's nursing program has received the Magnet status for excellence three consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, visit Fox Chase's Web site at www.fccc.org or call 1-888-FOX CHASE or (1-888-369-2427). Presentation: Gastrointestinal (Noncolorectal) Cancer Presentation Title: "Characterization and Prognostic Significance of Circulating Tumor Cells in the Peripheral Blood of Patients with Metastatic Pancreatic Cancer" Presentation Time: Sunday, June 6 from 2:00 -- 6:00 p.m.

May 27, 2010

Health

Cold sore virus may contribute to cognitive and brain abnormalities in schizophrenia

Exposure to the common virus that causes cold sores may be partially responsible for shrinking regions of the brain and the loss of concentration skills, memory, coordinated movement and dexterity widely seen in patients with schizophrenia, according to research led by Johns Hopkins scientists. "We're finding that some portion of cognitive impairment usually blamed solely on the disease of schizophrenia might actually be a combination of schizophrenia and prior exposure to herpes simplex virus 1 infection, which reproduces in the brain," says study leader David J. Schretlen, Ph.D., an associate professor in the Department of Psychiatry at Johns Hopkins University School of Medicine. The research, described in the May Schizophrenia Research, could lead to new ways to treat or prevent the cognitive impairment that typically accompanies this mental illness, including with antiviral drugs, the scientists say. Doctors have long known that cognitive impairment, including problems with psychomotor speed, concentration, learning, and memory, are prevalent features of schizophrenia, which affects an estimated one percent of the U.S. population. Cognitive deficits often surface months to years before symptoms that are traditionally used to diagnose this disease, such as delusions or hallucinations. Some previous studies have shown that schizophrenic patients with antibodies to herpes simplex virus 1 (HSV-1), the virus that causes cold sores, often have more severe cognitive deficits than patients without these antibodies. Other studies have shown that patients with HSV-1 antibodies have decreased brain volumes compared to patients without the antibodies. However, it has been unclear whether the cognitive deficits are directly related to the decreased brain volume. To investigate, Schretlen and his colleagues recruited 40 schizophrenic patients from outpatient clinics at the Johns Hopkins and Sheppard Enoch Pratt hospitals in Baltimore, Md. Blood tests showed that 25 of the patients had antibodies for HSV-1 and 15 didn't. The researchers gave all of the patients tests to measure speed of coordination, organizational skills and verbal memory. The patients then underwent MRI brain scans to measure the volume of particular regions of their brains. As in previous studies, results showed that patients with antibodies to HSV-1 performed significantly worse on the cognitive tests than patients without the antibodies. But expanding on those earlier studies, analysis of the brain scans showed that the same patients who performed poorly on the tests also had reduced brain volume in the anterior cingulate, which controls processing speed and the ability to switch tasks. There was also shrinkage in the cerebellum, which controls motor function. These results suggest that HSV-1 might be directly causing the cognitive deficits by attacking these brain regions, Schretlen says. Though the researchers aren't sure why schizophrenia might make brains more vulnerable to a viral assault, Schretlen says the results already suggest new ways of treating the disorder. Data from other studies has shown that antiviral medications can reduce psychiatric symptoms in some patients with schizophrenia. "If we can identify schizophrenic patients with HSV-1 antibodies early on, it might be possible to reduce the risk or the extent of cognitive deficits," he adds. Other Johns Hopkins researchers who participated in this study include Tracy D. Vannorsdall, Ph.D., Jessica M. Winicki, B.A., Takatoshi Hikida, M.D., Akira Sawa, M.D., Ph.D., Robert H. Yolken, M.D., and Nicola G. Cascella, M.D. For more information, go to: http://www.hopkinsmedicine.org/psychiatry/expert_team/faculty/S/Schretlen.html http://www.hopkinsmedicine.org/psychiatry/specialty_areas/schizophrenia/ http://www.hopkinsmedicine.org/psychiatry/

May 27, 2010

Health

Researchers report no difference in breast cancer characteristics after oophorectomy

CHICAGO, IL. (May 28, 2010) -- -- More than half a million women in the United States undergo a hysterectomy each year and approximately half of those surgeries include removal of the ovaries. Researchers know that removing a woman's ovaries is associated with a reduction in the risk of developing breast cancer, but it has not been clear whether those cancers that do arise in these women differ from breast cancers in the general population. Now, investigators at Fox Chase Cancer Center report that women who have had a bilateral oophorectomy tend to have smaller tumors and to have their tumors detected by mammography rather than by physical exam. The use of hormone therapy after surgery, however, wipes out any difference in tumor size or detection method. The investigators, led by James R. Nitzkorski, M.D., a surgical oncology fellow at Fox Chase, will present their results at the 46th Annual Meeting of the American Society of Clinical Oncology on Saturday, June 5. "It is helpful to know that tumors that develop after bilateral oophorectomy are not necessarily a more aggressive type of disease," Nitzkorski says. "There was no difference in overall survival or in prognostic factors, such as estrogen receptor status, progesterone receptor status, or HER2/neu status between women who had had an oophorectomy or not." Removal of a woman's ovaries is associated with an 11% decrease in lifetime risk of breast cancer (the risk reduction associated with the surgery climbs to about 50% in women with a BRCA1/2 mutation). Given that reduction in risk, Nitzkorski and colleagues initially hypothesized that the tumors that do develop in women after a bilateral oophorectomy might be worse than the tumors that arise in the general population because they had to overcome the protective environment that exists in the absence of ovaries -- -- that was not the case. "I think women can be counseled that although they have developed breast cancer in the protective environment of an oophorectomy, we don't expect their cancer will be any better or worse than that of a woman who didn't have an oophorectomy," Nitzkorski says. To evaluate the impact of ovary removal on breast cancers, the team identified 687 women diagnosed with invasive breast cancer between 2004 and 2008 at Fox Chase and who had a known ovary status. Of these, 71 (10.3%) had undergone a prior bilateral oophorectomy. The women who had had their ovaries removed were significantly more likely to have taken hormone replacement therapy than women who still had their ovaries, 56.3% versus 19.0%. Tumors in the women who had undergone a bilateral oophorectomy were smaller than those in women who had their ovaries, with a median of 1.3 cm compared with 1.5 cm, which was a statistically significant difference. Additionally, mammographic detection was more common in women who had had their ovaries removed than in women with their ovaries, 69.0% compared with 47.9%, respectively. Although patient's cancer tumor and lymph node staging was accounted for, Nitzkorski and colleagues have not seen any difference in overall survival related to oophorectomy with in their 20 months of follow up Fox Chase Cancer Center is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation's first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center's nursing program has received the Magnet status for excellence three consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, visit Fox Chase's Web site at www.fccc.org or call 1-888-FOX CHASE or (1-888-369-2427). Abstract #: 1596 Presentation Title: "Characteristics and behavior of invasive breast cancer developed despite prior oophorectomy" Presentation Time: Saturday, June 5, at 8:00 a.m.

May 27, 2010

Health

Response to preoperative therapy may predict survival in pancreatic cancer patients

CHICAGO, IL. (May 28, 2010) -- -- Cancer of the pancreas -- -- a glandular organ that lies behind the stomach and secretes vital enzymes and hormones -- -- seldom is detected in early stages, making treatment difficult and survival statistics particularly grim. However, new research from Fox Chase Cancer Center finds that patients with pancreatic adenocarcinoma whose tumors respond most to preoperative chemotherapy and radiation survive four times as long, on average, as those whose tumors respond least. The research, led by Yun Shin Chun, M.D., a surgical oncologist at Fox Chase, will be presented at the 46th Annual Meeting of the American Society of Clinical Oncology on Sunday, June 6. Since the 1980s, Fox Chase has been committed to finding better treatments for this intractable disease. In 1986, the Center conducted the first trial in pancreatic cancer of "multimodal" preoperative therapy (the use of more than one kind of treatment, such as chemotherapy and radiation, to kill tumor cells before surgery), and a phase I trial of gemcitabine in the 1990s established the safe dosage for the chemotherapy drug, now widely used in treating the disease. In the current study, Chun and colleagues wanted to know whether response to preoperative therapy predicts survival in pancreatic adenocarcinoma -- -- the most common type of pancreatic cancer. "For many cancers -- -- breast, esophagus, stomach, and colorectal liver metastases -- -- it has been shown that survival is much better in people who have a good pathologic response to preoperative therapy -- -- meaning that many tumor cells are killed -- -- than in people who do not have a good pathologic response," says Chun. "But this has not been established in pancreatic cancer; previous studies have shown conflicting results." In hopes of clearing up the confusion, Chun and colleagues reviewed data on 135 patients who had preoperative therapy and surgery. Fox Chase pathologist Harry Cooper, M.D., examined slides of the patients' tumors and classified their response to preoperative treatment as minor, partial, or major, based on the amount of fibrosis (scarring) in tumor tissue. For patients whose tumors showed major response to preoperative therapy, the median survival was more than five years, compared to seventeen months for those who showed minor response. Although major response is relatively rare -- -- only 19 percent of patients in the study were so classified -- -- the findings give researchers and clinicians important information to build upon. "Going forward, if we can identify molecular factors in tumors associated with a major pathologic response, then we can make important progress in this disease," says Dr. Chun. In addition to Chun and Cooper, the paper's authors are James Watson, M.D., F.A.C.S.; and John P. Hoffman, M.D., F.A.C.S. Fox Chase Cancer Center is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation's first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center's nursing program has received the Magnet status for excellence three consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, visit Fox Chase's Web site at www.fccc.org or call 1-888-FOX CHASE or (1-888-369-2427). Abstract #: 4067 Presentation Title: Significance of pathologic response to preoperative therapy in pancreatic cancer Presentation Time: Sunday, June 6 from 2:00 -- 6:00 p.m.

May 27, 2010

Earth & Environment

Study finds reforestation may lower the climate change mitigation potential of forests

Norman, Okla. -- Scientists at the University of Oklahoma and the Fudan University in Shanghai, China, have found that reforestation and afforestation -- the creation of new forests -- may lower the potential of forests for climate change lessening. Yiqi Luo, professor of ecology in the OU College of Arts and Sciences Department of Botany and Microbiology, and Changzhang Liao, Bo Li and Changming Fang, professors of ecology in the Fudon University Department of Ecology and Evolutionary Biology, examined whether plantations have the same ecosystem carbon stock as natural forests. By synthesizing 86 experimental studies between plantations and their natural forest counterparts, Luo and colleagues found plantations substantially reduce carbon stock in ecosystems in comparison with natural forests. "That decrease in ecosystem carbon stock should be accounted for, together with other forest products such as the harvested wood, when the total mitigation of reforestation is evaluated," said Luo. This study challenges the idea that planting non-native or native-improved growth species on historical forest land yields greater carbon accumulations rates. They argue against the replacement of natural forests by reforestation, also known as plantations, to help stave off climate change. Plantations established on non-forested fields such as agricultural lands do help with the control of carbon emissions; however, converting farmland to forests decreases the amount of carbon absorbed by the soil. Another form of gas, methane, also is affected by the conversion. Converted soil loses 80 percent of capability to degrade methane as compared to natural forests when it is developed as a plantation. To minimize negative effects of plantation, appropriate forest management practices need to be adopted. Site preparation without burning, for example, leads to less soil carbon loss than that with burning. To avoid ecosystem degradation associated with plantations, restoration measures need to be implemented to engineer ecosystems toward their natural potentials. "The shifts from natural forests to plantations can also generate other ecological problems," writes Luo. "For example, soil bulk density, representing the degree of soil compaction, increases, possibly leading to limitation of rooting systems and destruction of soil structure in plantations. Additionally, plantations decrease stream flow. "On the positive side, plantations can provide commodities for human needs (e.g., timbers). Therefore, we are now facing a great challenge of developing a management policy for plantation practice that minimizes their negative impacts on ecosystems but maximizes their commodity values." Findings from this research were recently published in the scientific journal PLoS One.

May 27, 2010