Wednesday, April 21, 2010

Neutropenia still prevalent despite drug availability

According to findings from a pan-European patient and nurse survey presented at the 7th Annual European Oncology Nursing Society (EONS) Spring Convention, held from 15th to 16th April, in the Hague, the Netherlands, 30 per cent of patients surveyed experienced an infection as a result of chemotherapy (CT), 45 per cent of which were associated with neutropenia or febrile neutropenia (FN). These results suggest that despite the widespread availability of prophylactic treatments, a significant number of cancer patients continue to be affected by neutropenia and its consequences.

The survey, which was sponsored by Amgen, was conducted by the EONS in nine European countries to explore current perceptions and issues relating to cancer therapy and infection, specifically neutropenia and FN. The survey found that 57 per cent of patients with an infection required hospitalisation, whilst 37 per cent had to have their CT delayed or changed as a result of neutropenia, infection or FN. More than nine out of ten nurses questioned agreed that preventing infections, such as FN, is important to achieve a successful outcome for patients undergoing CT. Kay Leonard, EONS Board Member, commented: "The survey results suggest that the risk of neutropenia and the impact this can have on patients' clinical care and quality of life must be taken even more seriously...it is important to ensure patients are receiving the most effective and appropriate prophylactic therapies as early as possible to help achieve positive treatment outcomes and prevent related complications before they develop."

Treatments are available to prevent and manage CT-induced infections, and significant progress has been made in the development of proactive therapies to help manage side effects of CT. For example, in March, the European Medicines Agency's CHMP adopted a positive opinion recommending the granting of a marketing authorisation for Hospira's Nivestim (filgrastim), a recombinant human G-CSF intended for the treatment of neutropenia. This medicine has been shown to be similar to Amgen's Neupogen (filgrastim), which is already authorised in the EU for the same indication and as one of the company's major products, achieved 2009 sales of US$1,288 million. Further, Sandoz' (Novartis) Zarzio (filgrastim) was launched in the UK last year and has been shown to have an efficacy and safety profile comparable with Neupogen, but is 10 per cent less expensive.

Many recombinant human G-CSFs are available to treat or prevent neutropenia, and therefore reduce associated complications. This is reflected in 54 per cent of nurse survey respondents who confirmed using G-CSFs prophylactically to prevent FN in patients receiving CT. An additional 27 per cent of nurses reported using both G-CSFs and antibiotics, however, 85 per cent of nurse respondents expressed concerns regarding patient compliance to treatment.

Moreover, it was reported by patients in the survey that access to and provision of treatments that prevent infection varies widely across Europe. A significant number of patient respondents did not appear to fully understand their risk of developing FN, which suggests a need for improvement in communication between patients and healthcare providers.

Alice Rossiter
Editor, Cancer Drug News

Friday, April 9, 2010

Skin cancer rates rapidly rising

In line with its launch of the 2010 SunSmart campaign, Cancer Research UK (CRUK) has revealed that people aged 60 to 79 years of age are now over five-times more likely to be diagnosed with malignant melanoma (MM) than their parents would have been 30 years ago.

Of all ages, this generation has seen the biggest increase in incidence rates of melanoma, rising from seven cases per 100,000 people in the mid-1970s to 36 cases per 100,000 today. This rise shows the impact that a shift in tanning behaviour has had on a whole generation of men and women who would have been in their 20s and 30s in the 1970s, when holidays in the sun became cheap and popular, and sunbeds arrived in the UK.

According to CRUK statistics, the most common kind of skin cancer is non-melanoma skin cancer. More than 75,000 cases are registered each year in the UK, but it is estimated that the actual number is at least 100,000. More than 10,400 cases of MM are diagnosed each year in the UK and more than 2,000 people a year die from the disease.

For men in their 60s and 70s, the rates of melanoma have risen most dramatically; they are over seven-times more likely to be diagnosed with the disease than in the 1970s. For men and women of all ages, melanoma incidence rates have quadrupled since the 1970s. This rise in incidence rates is expected to continue: by 2024, rates in people aged 60 to 79 are predicted to increase by one-third from current statistics. Caroline Cerny, SunSmart manager at CRUK, commented: "The battle against melanoma is far from won. Today, the problem threatens to get worse as teenagers continue to crave a tan on the beach and top it up cheaply on sunbeds."

CRUK also noted that there has been a large increase in the overall death rates. Over a similar period, they have more than doubled from 1.2 per 100,000 in 1971 to 2.6 per 100,000 in the UK in 2007. If melanoma death rates had stayed the same as they were in 1973, approximately 19,000 fewer people would have died from the disease.

Although the incidence rates are predicted to rise, there are currently many promising drugs in development for MM. Of particular note, Pain Therapeutics (PT) recently reported encouraging clinical data with PTI-188, an early-stage drug for MM. Although efficacy was not a primary endpoint, PT and its clinical investigators were encouraged by the number of melanoma tumours that had either stabilised or decreased in size after a single dose of PTI-188. Further, Vical recently completed enrolment of the planned 375 subjects in its multi-national, Phase III trial of Allovectin-7 in patients with MM. Allovectin-7 is a novel gene-based immunotherapeutic with a unique mechanism of action that is fundamentally different from currently-approved treatments and has the potential to be the first new primary treatment approved for MM in nearly 20 years.

Alice Rossiter
Editor, Cancer Drug News