Category: News

Story: https://www.healio.com/news/hematology-oncology/20221212/lung-cancer-screening-leads-to-more-stage-i-less-stage-iv-disease-incidence

Implementation of lung cancer screening across five diverse health care systems led to higher rates of stage I diagnoses and lower rates of stage IV disease, study results showed.

Overall incidence of lung cancer did not increase during the study period, indicating a limited impact of overdiagnosis, according to the findings published in Journal of Thoracic Oncology.

Methods

Although results of clinical trials have indicated favorable shifts in disease stage and improvements in lung cancer-specific mortality, “the effectiveness of lung cancer screening in clinical practice has not been clearly demonstrated,” Anil Vachani, MD, MS, associate professor of medicine at Hospital of the University of Pennsylvania and Pittsburgh Veterans Administration Medical Center, and colleagues wrote.

The multicenter cohort analysis included 3,678 patients (median age, 69 years [interquartile range, 64-74]; 52% women) diagnosed with a primary lung cancer between Jan. 1, 2014, and Sept. 30, 2019, across five IU.S. health care systems — Henry Ford Health System, Kaiser Permanente Colorado, Kaiser Permanente Hawaii, Marshfield Clinic Health System and University of Pennsylvania Health System.

Primary outcomes included cancer stage distribution and annual age-adjusted lung cancer incidence. Receipt of at least one low-dose CT scan before lung cancer diagnosis served as the primary exposure variable.

Findings

Overall, 11% (n = 404) of all patients were diagnosed with incident lung cancer after the health care systems initiated low-dose CT screening.

Researchers found that as the volume of lung cancer screening increased, the percentage of patients diagnosed with lung cancer after initiation of screening also increased, from none in 2014 to 20% in 2019. However, lung cancer screening did not correlate with a significant change in the overall incidence of lung cancer between 2014 and 2018 (average annual percentage change [AAPC], 0.8; 95% CI, -4.7 to 3.2).

Researchers additionally observed an average 8.4% increase in the annual rate of stage I cancer (AAPC, 8; 95% CI, 0.8-15.7) and a 6.6% decrease in stage IV disease (AAPC, 6; 95% CI, 11.2 to 0.5).

Implications

“This is the first study to determine the impact of lung cancer screening on cancer stage migration using a population-based multicenter cohort,” Vachani and colleagues wrote. “The distribution of [disease] stage was similar to rates observed in prior clinical trials despite limitations, such as lower adherence to annual screening that have been observed outside of trial settings.”

“As screening implementation progresses,” they added, “future population-based studies are needed to assess the impact of screening on other effectiveness outcomes, including rates of harms related to screening and the impact on lung cancer mortality.”

Story: https://www.nbcboston.com/news/local/dont-give-up-hope-man-describes-cutting-edge-cancer-treatment/2830563/

‘Don’t Give Up Hope’: Man Describes Cutting-Edge Cancer Treatment

Paul Bristow was the first patient at Dana Farber Cancer Institute in Boston to undergo a new nuclear medicine treatment for his metastatic prostate cancer

Paul Bristow loves being active. So when the 69-year-old was diagnosed with metastatic prostate cancer, it came as a gut punch to him and his wife, Kathy.

“It is almost like an out of body experience. He’s talking to me saying that we think it could be cancer, you can’t believe it,” Bristow said.

“When you hear that word cancer, it hits you in your heart so hard,” Kathy added.

When prostate cancer gets to later stages, doctors say they are turning to new kinds of nuclear medicine.

“Even the smallest amount of cancer spread beyond prostate can now be detected with these techniques,” said Dr. Munir Ghesani, the chief of Nuclear Medicine at Mt. Sinai in New York.

The FDA recently approved this new treatment that helps extend the quality and quantity of life, he said.

“That’s targeting that same radioactive drug, but using the treatment delivery so that those cancer cells, no matter where they are in the body, can be selectively identified by these drugs,” Ghesani said.

Bristow was the first patient at Dana Farber Cancer Institute in Boston to undergo the injections.

“The side effects are kind of like chemo fatigue — joint/muscle pain, manageable. Today I mowed the lawn, I got outside, hit the pool,” he said.

Bristow said he hopes his story will help inspire others to talk with their doctors about getting screened and the treatment options out there.

“Don’t give up hope. I learned early on they had no cure for this cancer but there is always hope and again this radioactive medicine was a beam of light,” he said.

Article: https://www.cancernetwork.com/view/phillip-h-kuo-md-phd-reviews-rationale-of-phase-3-vision-trial-of-117lu-psma-617-in-mcrpc

At the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork^® spoke with Phillip H. Kuo, MD, PhD, professor of medical imaging, biomedical engineering, and medicine as well as member of the Graduate Faculty at The University of Arizona College of Medicine in Tucson, about the rationale behind the phase 3 VISION trial (NCT03511664) which examined 177Lu-PSMA-617 (Pluctivo) in patients with previously treated metastatic castration-resistant prostate cancer. He and his colleagues presented findings from a substudy of the trial which aimed to correlate 68GA-PSMA-11 PET/CT imaging with outcomes from 177Lu-PSMA-617.

Transcript:

The VISION trial is the only completed phase 3 trial using the theragnostic paradigm of imaging with a PSMA [prostate specific membrane antigen]–PET targeted agent to select patients whose tumors express PSMA. Then we treat that with a radioligand therapy. Instead of a positron emission tracer radioactive isotope, we put in a beta-emitting therapeutic isotope that targets the same PSMA molecule in prostate cancer. The prostate cancer population that we were going after in this trial was metastatic castrate-resistant prostate cancer, [specifically] the subgroup that had already failed taxane therapy and an androgen receptor pathway inhibitor. These are patients that have few options left for therapy.

Reference

Kuo P, Hesterman J, Rahbar K, et al. [68Ga]Ga-PSMA-11 PET baseline imaging as a prognostic tool for clinical outcomes to [177Lu]Lu-PSMA-617 in patients with mCRPC: A VISION substudy. J Clin Oncol. 2022;40(suppl 16):5002. doi:10.1200/JCO.2022.40.16_suppl.5002

Article: https://healthimaging.com/topics/medical-imaging/nuclear-medicine/video-advantages-psma-pet-imaging-prostate-cancer-care

Munir Ghesani, MD, FACNM, FACR, president of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), system chief of nuclear medicine at Mount Sinai Health, and associate professor of radiology at Icahn School of Medicine at Mount Sinai, explains prostate-specific membrane antigen (PSMA) targeted radiotracers used in positron emission tomography (PET) scans are seeing rising adoption because it can significantly improve prostate cancer detection and treatment. 

Prostate cancer tumors over-express PSMA proteins, making the radiotracer bind to them more readily. This makes the prostate cancer much easier to visualize and target for treatment with PSMA-PET. This includes even very small levels of tumor cells that have metastasized to other areas of the body and are often missed with convention prostate imaging. 

“It is an exciting new technology that is in many ways changing the way prostate cancer is managed,” Ghesani explained. “I can say without any hesitation see the literature that will evolve from the widespread use of PSMA-PET in the coming years is going to result in a quite different management algorithm for prostate cancer in the future.”

Prostate cancer tumors over-express PSMA proteins, making the radiotracer bind to them more readily. This makes the prostate cancer much easier to visualize and target for treatment using PSMA-PET imaging. Ghesani said has revolutionized prostate cancer care. This is because even very small levels of tumor cells that have metastasized to other areas of the body can be seen, but are often missed using conventional prostate image techniques. This is helping catch and treat these areas of cancer beyond the prostate bed. 

Ghesani said PSMA-PET also helps radiation oncologists zero in and target metastases. He said the imaging makes it much easier to contour images and make sure these areas of small tumors are included in the treatment plan. 

Costs and time might be reduced by eliminating other exams and just using PSMA-PET

The ability of PSMA-PET to clearly see prostate cancer and its spread to other parts of the body may change the current workflow and reduce the need for extra exams. 

“We are still in the transition stage to PSMA-PET, but I can see the evolving pattern for patient workups, that it may in many instances eliminate the need for a CT scan and a bone scan first before a PSMA-PET exam,” Ghesani explained.

Related PSMA-PET Content:

GE Healthcare and Theragnostics announce global commercial partnership for late stage PSMA diagnostic for prostate cancer

‘Game changer’: FDA approves first PSMA-targeted PET imaging tracer for men with prostate cancer

‘Practice changing’: New research underscores clinical benefits of PSMA-PET for prostate cancer

PSMA-PET alters care for nearly 50% of patients with metastatic liver cancer

PSMA PET/CT better detects prostate cancer spread, long-term outcomes over conventional imaging

FDA approves Telix’s prostate cancer imaging product, improving access to PSMA-PET

Article: https://www.docwirenews.com/gu-oncology-now/gu-psma-knowledge-hub/68ga-psma-pet-ct-protocols-may-differ-for-rp-bcr/

New Research on Persisting PSA after Prostatectomy Suggests PSMA PET

New research suggests that men with PSA level persistence after undergoing radical prostatectomy (RP) should be recommended ⁶⁸Ga-PSMA PET scans even if their PSA level is considered low.

Whereas patients with biochemically recurrent (BCR) prostate cancer after RP should be monitored based on their PSA levels, as additional scans may not provide benefits.

A study presented at the 37^th congress of the European Association of Urology in Amsterdam analyzed 207 patients with prostate cancer who received 68Ga-PSMA PET/CT. Researchers found that the PSA levels of patients, as well as the time to BCR during PSMA PET/CT, can have an effect on the chances of positive findings during PSMA PET.

Patients were organized by their time to BCR, and researchers examined the correlation between PSA level at the time of PSMA PET and the likelihood of positive results. The median level of PSA at the time of PSMA PET/CT was 1.0 ng/ML. In the study, 38% of patients had early BCR or PSA persistence after RP.

A high PSA level and early versus late BCR at the time of PSMA PET was associated with a 2.2- and 2.6-fold increased odds of positive results. In patients with early BCR, the chance of receiving positive PSMA PET results was high even when their PSA levels were considered low, and their results continued to increase with a higher PSA level; the positive findings rate increased from 63% to 93%. Moreover, in patients with late BCR, the probability of receiving positive findings was lower than 40% if PSA values were under 0.5 ng/ml.

José Ramón García Garzón, MD, of Ascires Cetir Viladomat in Barcelona, said that “it is important to know which patients may benefit the most; screening in relation to the time after PSA elevation and the PSA value is an appealing strategy to increase the sensitivity of the test.”

Professor Otis W. Brawley, MD, of Johns Hopkins University in Baltimore, noted that “some patients are insisting on [PSMA PET scans] for routine evaluation of response…some want them with very low PSA’s where chances of a false negative are high. When doctors do not have guidelines as to when a test should be used and there is a lot of patient request, things are ripe for waste and abuse.”

To counteract unnecessary PSMA PET use, low-risk patients and those with late BCR should be monitored closely based on their PSA levels to determine if they would benefit from additional PSMA PET scans.

Article: https://www.renalandurologynews.com/home/news/urology/prostate-cancer/psma-pet-ct-lymph-node-staging-can-predict-prostate-cancer-surgery-outcomes/

Patients with prostate cancer who have pelvic lymph node metastases visualized on preoperative PSMA PET/CT staging (prostate-specific membrane antigen positron emission tomography/computed tomography) have a significantly higher risk for biochemical disease progression after robot-assisted radical prostatectomy (RARP) compared with those without pelvic lymph node metastases on imaging, recent study findings suggest.

The retrospective study included 145 patients who underwent PSMA PET/CT lymph node staging prior to RARP and had pelvic lymph node metastases found on extended pelvic lymph node dissection. The median biochemical progression-free survival was 7.9 months among the 49 patients (34%) whose preoperative imaging revealed pelvic lymph node metastases compared with 13.7 months for the 96 patients (66%) whose preoperative imaging did not, Dennie Meijer, MD, of Amsterdam University Medical Center in The Netherlands, and colleagues reported in BJU International.

In addition, the presence of more than 2 tumor-positive lymph nodes, compared with 1-2, was significantly associated with a nearly 2-fold increased risk for biochemical progression, after adjustment for multiple variables. A larger diameter of the largest nodal metastasis was significantly associated with a 12% increased risk.Today’s top picks on the Haymarket Medical NetworkNew Machine Learning Tool to Predict Pneumonia Progression Outperforms PSIAI Can Help Identify Incidental PE on Conventional Chest CT ExamsArtificial Intelligence and the Hunt for Neuroprotection in Glaucoma

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The investigators defined biochemical progression as a PSA level of 0.2 ng/mL or higher during follow-up or the initiation of additional treatment.

The median diameter of the largest nodal metastasis was significantly larger among the patients with vs without nodal metastases found on preoperative PSMA PET/CT lymph node staging (6 vs 3 mm).

At final histopathologic evaluation, the median biochemical progression-free survival for patients with 1 or 2 tumor-positive lymph nodes was 14.9 months compared with only 3.9 months for patients who had more than 2 tumor-positive lymph nodes, Dr Meijer’s team reported.

Among patients with nodal metastases visualized on preoperative PSMA PET/CT, only the diameter of the largest nodal metastasis was significantly associated with biochemical progression; the number of tumor-positive lymph nodes was not. Among patients with no nodal metastases seen on PSMA PET/CT, both the presence of more than 2 positive lymph nodes and the diameter of the largest nodal metastasis were significantly associated with biochemical progression.

Reference

Meijer D, Ettema RH, van Leeuwen PJ et al. The prognostic value of lymph node staging with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node-positive patients with prostate cancer. BJU Int. Published online September 7, 2022. doi:10.1111/bju.15881

Article: https://medicalxpress.com/news/2022-09-psma-petct-imaging-prostate-cancer.html

Research shows PSMA PET/CT imaging changes management for close to 50% of prostate cancer patients

by Society of Nuclear Medicine and Molecular Imaging

In prostate cancer patients experiencing recurrence following a radical prostatectomy, imaging with ¹⁸F-DCFPyL PSMA PET/CT has been shown to considerably improve detection of active disease as compared to imaging with CT alone. As reported in the September issue of the Journal of Nuclear Medicine, detailed PET/CT scans resulted in a change in treatment plans for nearly 50% of patients.

Prostate specific antigen (PSA) recurrence—defined as a PSA level higher than 0.2ng/mL—occurs in 20 to 50% of all radical prostatectomy cases. In more than half of these patients, subsequent treatment with salvage radiotherapy (most commonly to the prostate bed) results in five-year biochemical control.

“For those patients who are experiencing a recurrence, it’s important to determine exactly where the cancer has spread so that it can be treated effectively with salvage radiotherapy,” said Michael Ng, MBBS (Hons), FRANZCR, radiation oncologist at GenesisCare St Vincent’s Hospital in Melbourne, Australia. “We know that prostate specific membrane antigen (PSMA) radiotracers have increased sensitivity in the detection of prostate cancer compared to conventional imaging. In this study we assessed the management impact of a novel PSMA tracer, ¹⁸F-DCFPyL PSMA PET/CT, in patients being considered for salvage radiotherapy.”

This study included 100 patients presenting with a detectable PSA following radical prostatectomy. Following patient registration and prior to any imaging, radiation oncologists outlined each patient’s “original intent” treatment plan on a questionnaire. All patients then underwent diagnostic CT and ¹⁸F-DCFPyL PSMA PET/CT. The CT results were released first, and a second “post-CT intent” questionnaire was completed. Next, the ¹⁸F-DCFPyL PSMA PET/CT results were released and a final “post-PSMA intent” questionnaire was completed. Change in management was graded based on impact and defined as major, minor, or no change demonstrated.

¹⁸F-DCFPyL PSMA PET/CT detected disease in 46.9% of patients compared to 15.5% on diagnostic CT. Major changes in the treatment plan were more likely to occur after PSMA imaging (12.5%) than after CT imaging (3.2%), and moderate changes were noted in 31.3% of patients after PSMA imaging versus 13.7% after CT imaging. The most common changes were recommendations for additional treatment, such as elective pelvic radiation, nodal boost, or concurrent androgen deprivation therapy.

Follow-up data were available at 18 months for 59 of the individuals in the study. At that timepoint, 92.5% had a PSA of below 0.20ng/mL and 74.5% had an undetectable (less than 0.03ng/mL) PSA.

“This research is novel as utilization of PSMA PET/CT allows earlier detection of prostate cancer after radical prostatectomy. The prospective study carefully collected changes in decision making and tracked the impact on patient management with outcome data available in patients who underwent radiotherapy,” noted Dr. Ng. “The group of patients studied—all post-surgery without other confounding treatments (no prior radiotherapy and no prior drug therapy) with a low and focused PSA range between 0.2-2.0ng/mL— reflects a common management problem. The study’s results are timely and applicable for patients experiencing their first recurrence after prostate surgery.”

Article: https://www.physiciansweekly.com/psa-pet-features-to-select-slnd-persons-in-recurrent-pca

For a study, researchers sought to assess the association between pre-operative PSA value, ⁶⁸Ga-prostate-specific-membrane-antigen (PSMA) PET performance, and oncologic results following salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).

In the analysis, 164 patients who had undergone pelvic±retroperitoneal sLND at 11 high-volume centers between 2012 and 2019 and had at least 2 pelvic lymph node recurrences of PCa were included. In terms of PSA readings at the time of sLND, pathologic results were divided into 4 categories: early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml), and high (>1.5 ng/ml). Multivariable analyses were used to compute the clinical recurrence (CR)-free survival following sLND and display that data over the pre-operative PSA levels.

About 131 (80%) of the patients had one positive spot on the PET scan, and the median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml. All patients had a retroperitoneal dissection in addition to pelvic sLND, whereas 91 (55%) males did so. Around 15 (6, 28) was the median (IQR) number of nodes eliminated. As a function of pre-operative PSA value, the rate of positive pathology increased, with the greatest rates occurring in patients with pre-operative PSA values>1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, 67 (41%) males had PSA levels≤ 0.3 ng/ml. Pre-operative PSA was connected to PSA response in multivariable analysis (P<0.0001). Fifty-one CRs were recorded following sLND. After correcting for covariates, they discovered a strong, non-linear correlation between PSA level at sLND and the 12-month CR-free survival (P<0.0001), with patients who got sLND at PSA ≥1 ng/ml having the best likelihood of being free from CR.

Salvage surgery was done on males with PSA 1 ng/ml and was linked with the best short-term oncologic outcomes in cases with PET-detected nodal recurrences amenable to sLND. The findings may assist medical professionals in choosing the best time for ⁶⁸Ga-PSMA PET in patients with biochemically recurrent PCa while awaiting confirmation from prospective studies.

Reference: 

bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.182

Article: https://www.medscape.com/viewarticle/979929?reg=1&icd=ssl_login_success_221019

Nearly 123,000 cancer deaths – or almost 30% of all cancer deaths – in the United States in 2019 were linked to cigarette smoking, a new analysis suggests.

That corresponds to more than 2 million person-years of lost life and nearly $21 billion in annual lost earnings.

“During the past few decades, smoking has substantially declined in the U.S., followed by great declines in mortality from lung cancer and some other smoking-related cancers,” says lead author Farhad Islami, MD, senior scientific director of cancer disparity research at the American Cancer Society.

Despite this “remarkable progress, our results indicate that smoking is still associated with about 30% of all cancer deaths and substantial lost earnings in the U.S., and that more work should be done to further reduce smoking in the country,” he says.

The study was published online Aug. 10 in the International Journal of Cancer.

Islami and colleagues had found that lost earnings from cancer deaths in 2015 came to nearly $95 billion. Other research showed that a substantial portion of lost earnings from cancer deaths could be traced to cigarette smoking, but estimates were more than a decade old.

To provide more recent estimates and help guide tobacco control policies, Islami and colleagues estimated person-years of life lost (PYLL) and lost earnings from cigarette smoking-related cancer deaths in 2019.

Of the 418,563 cancer deaths in adults ages 25 to 79 years, an estimated 122,951 could be linked to cigarette smoking. That corresponds to 29.4% of all cancer deaths and roughly 2.2 million PYLL. Translated to lost earnings, the authors estimated $20.9 billion total, with average lost earnings of $170,000 per cancer death linked to smoking.

By cancer type, lung cancer accounted for about 62%, or $12.9 billion, of the total lost earnings linked to smoking, followed by esophageal cancer (7%, or $1.5 billion), colorectal cancer (6%, or $1.2 billion), and liver cancer (5%, or $1.1 billion).

Smoking-related death rates were highest in the 13 “tobacco nation” states with weaker tobacco control policies and a higher rate of cigarette smoking. These states are Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia.

The lost earnings rate in all 13 tobacco nation states combined was about 44% higher, compared with other states and the District of Columbia combined, and the annual PYLL rate was 47% higher in tobacco nation states.

The researchers estimated that if PYLL and lost earnings rates in all states matched those in Utah, which has the lowest rates, more than half of the total PYLL and lost earnings nationally would have been avoided. In other words, that would mean 1.27 million PYLL and $10.5 billion saved in 2019.

Ending the “Scourge of Tobacco”

To kick the smoking habit, health providers should “screen patients for tobacco use, document tobacco use status, advise people who smoke to quit, and assist in attempts to quit,” Islami says.

Getting more people to screen for lung cancer in the U.S. is also important, given that only 6.6% of eligible people in 2019 received screening.

In a statement, Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said this report “further demonstrates just how critical reducing tobacco use is to ending suffering and death from cancer.”

To end the “scourge of tobacco,” local, state, and federal lawmakers need to pass proven tobacco control policies, she said.

These include regular and significant tobacco tax increases, thorough statewide smoke-free laws, and enough funding for state programs to prevent and stop smoking. It also means ensuring all Medicaid enrollees have access to all services that can help smokers quit as well as access to all FDA-approved medications that help users stop smoking.

“We have the tools to get this done, we just need lawmakers to act,” Lacasse said.

The study had no commercial funding. The authors have declared no competing interests.

Sources

International Journal of Cancer: Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019.”

American Cancer Society: “New Study Shows Two Million Life-Years Lost and $21 Billion in Lost Earnings Annually Due to Smoking Associated Cancer Deaths.”

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WebMD Health News © 2022 
Cite this: Nearly 30% of US Cancer Deaths Linked to Smoking – Medscape – Aug 29, 2022.