Increasing OC rates call for more research

According to the American Cancer Society, oral cancer (OC) has increased by 21 per cent in the last five years, while new cancers of all types have risen by 8 per cent. Tongue squamous cell carcinoma (TSCC) is one of the most common types of OC and has increased by more than 37 per cent in this period. Although overall cancer deaths decreased during this period, those due to OC increased by 4 per cent and those due to TSCC by 10 per cent. According to Cancer Research UK, while female OC rates have remained significantly lower than male rates, incidence trends have been similar, with an average increase of 3 per cent each year since 1989. It is well documented that this increase in OC is largely due to lifestyle, with smoking and heavy alcohol consumption significantly increasing the risk of an individual developing the disease.

However, new research by scientists at the University of Illinois at Chicago (UIC) may help in the fight against this ever-increasing cancer. According to the researchers, the spread of cancer cells in the tongue may be reduced if a gene that regulates cancer cell migration can be controlled. Dr Xiaofeng Zhou, assistant professor in the UIC Center for Molecular Biology of Oral Diseases, led the study and believes that OC is an under-treated and poorly-understood disease, noting that improvements in patient survival require better understanding of tumour invasion and how the cancer spreads.

The study, which was published in the 1st August issue of the International Journal of Cancer (2010;127:505-512), examined a non-coding gene, called miR-138, and demonstrated that a reduced level of it is associated with enhanced ability of TSCC cells to spread. Previously, the same team reported that reduced miR-138 level is correlated with enhanced metastatic potential in TSCC cells. In the current study, it was demonstrated that miR-138 suppresses TSCC cell migration and invasion by regulating two key genes in the Rho GTPase signalling pathway, RhoC and ROCK2. The scientists believe that miR-138 may serve as a novel therapeutic target for TSCC patients at risk of metastatic disease.

Further, Case Western Reserve University School of Dental Medicine researchers recently discovered a biomarker, called human beta defensin-3, which may serve as an early warning to OC. The defensin is present in all OCs and associated with the early stages of the disease. It is thought that using the biomarker to detect OC holds potential for saving lives when the cancer is most curable.

The increasing prevalence of OC highlights the need for more work like this to be conducted. Research such as that carried out by UIC and Case Western may mean that aggressive tumours can be detected early and targeted therapies can eventually be developed in the fight against this disease.

Alice Rossiter
Editor, Cancer Drug News

Shares tumble as trials fail

Several Phase II and III trials have recently produced disappointing data, resulting in the failure to meet primary and secondary endpoints. The impact of this can be huge for some of the smaller companies, causing share prices to drop considerably.

Of particular note, Curis, Roche and Genentech's Phase II trial of GDC-0449, a first-in-class Hedgehog pathway inhibitor, tested in combination with Avastin (bevacizumab) and FOLFOX or FOLFIRI chemotherapy in first-line metastatic colorectal cancer (MCRC) patients did not meet its primary endpoint of extending the time from randomisation to disease progression or death when compared to patients who received only the current standard-of-care treatment. As a result, Curis' share price sank by 48 per cent, whereas the company's stock had more than doubled during the past year until this point. Despite these disappointing results in MCRC, Curis remains encouraged that the clinical development of GDC-0449 in other cancers continues to make good progress.

Further disappointment arose for Bayer HealthCare and Onyx Pharmaceuticals, when a final analysis of the Phase III NExUS trial evaluating Nexavar (sorafenib) in patients with advanced non-squamous non-small cell lung cancer (NSCLC) showed that the study did not meet its primary endpoint of improving overall survival (OS) in the first-line setting, although a positive secondary endpoint of progression-free survival (PFS) was observed. The two companies are to further review the findings of this analysis to determine what, if any, impact these data might have on other ongoing clinical trials evaluating the safety and efficacy of sorafenib.

Marshall Edwards (Novogen) recently experienced a similar blow, when a final analysis of the company's Phase III OVATURE trial of orally-administered phenoxodiol in women with recurrent ovarian cancer determined that the study did not show a statistically significant improvement in its primary (PFS) or secondary (OS) endpoints. Following this news, the company's share price dropped by 50 per cent.

Also, in May, GTx reported top-line results of a Phase III trial evaluating toremifene 20mg for the prevention of prostate cancer (PCA) in men with high-grade prostatic intraepithelial neoplasia, which showed that the incidence of PCA was lower in men receiving the drug compared to placebo, but not statistically significantly different (p=0.385). A 10.2 per cent relative risk reduction at three years was observed. Following these results, the company's share price dropped by over 33 per cent. Dr Mitchell S Steiner, CEO of GTx, commented: "We designed the Phase III trial based upon the successful outcome of our Phase IIb clinical trial. Toremifene 20mg did also reduce prostate cancer in our Phase III study, but based on our review of the top-line data, there is not a sufficient reduction in cancers compared to placebo over a three-year period to demonstrate the statistical significance required for this study."

Alice Rossiter
Editor, Cancer Drug News

Potential miRNA drug target identified for mesothelioma

Although mesothelioma is generally regarded to be a rare cancer, it appears to be getting more common. More than 2,300 people are diagnosed with the disease every year in the UK alone, with approximately five-times as many cases in men as in women. According to Cancer Research UK, the number of cases of mesothelioma in the UK each year is expected to rise dramatically over the next 20 years because of the heavy use of asbestos in industry from the end of the second world war up until the mid-1970s. Mesothelioma in the chest (pleural mesothelioma; PM) is much more common than in the abdomen (peritoneal mesothelioma).

Recent work by Rosetta Genomics and New York University demonstrated the potential of miR-31, an miRNA that has recently been characterised as a suppressor of breast cancer metastases, to be used for the development of new therapies against mesothelioma and other cancers. In the study, published in the 12th May online edition of the Journal of Biological Chemistry (10.1074/jbc.M110.100354), cell lines derived from mesothelioma patients were found not to express miR-31. Functional assessment of miR-31 activity revealed its ability to inhibit proliferation, migration, invasion and clonogenicity of mesothelioma cells. The reintroduction of miR-31 suppressed cell cycle and inhibited expression of multiple factors involved in co-operative maintenance of DNA replication and cell cycle progression.

miRNAs, described as the body's master switches, hold significant potential for therapeutic applications, and have been shown to be highly-sensitive and specific biomarkers in recent work. Kenneth A Berlin, President and CEO of Rosetta, commented: "This latest publication is another demonstration of miRNAs' potential role in cancer therapeutics and details the significant impact a single miRNA can have on disease course." Using its diagnostic tests for cancer, and robust and diverse miRNA-based product pipeline, Rosetta plans to continue its research in this field by harnessing the power of miRNAs.

A further development in mesothelioma also occurred in May, as MolMed received clearance from the FDA for the IND application filed to initiate a Phase III trial of its investigational antitumour drug, NGR-hTNF, for the treatment of malignant PM (MPM). The study, NGR015, is a pivotal randomised, double-blind, placebo-controlled, international, multi-centre, Phase III trial, expecting to enrol adult patients affected by MPM with disease progressing after chemotherapy. The main endpoint of the trial is overall survival; secondary endpoints include progression-free survival, disease control rate, safety and patient quality of life. Based on the positive results of a multi-centre, Phase II study, this Phase III trial is optimally designed to investigate the full therapeutic potential of NGR-hTNF in the treatment of MPM. If positive data are yielded from this study, NGR-hTNF may represent a novel treatment option for malignant mesothelioma.

Alice Rossiter
Editor, Cancer Drug News

New findings could advance fight against BC

Recent findings by scientists could help advance the fight against breast cancer (BC). A team at the University of Kentucky (UoK) Markey Cancer Center has identified a key molecular mechanism in BC that enables tumour cells to metastasise, while a separate study has uncovered five new regions of the genome that increase a woman's risk of developing the disease by between 6 and 16 per cent.

The work conducted by the UoK could lead to new lines of research aimed at developing treatments for metastatic BC (MBC). The research, published in the 13th April online issue of The EMBO Journal (10.1038/emboj.2010.63), focused on the process by which tumour cells stop clinging to other cells and become motile. The increased motility of tumour cells at the initial step of metastasis is similar to epithelial-mesenchymal transition (EMT). In all EMT processes, cells lose the expression of E-cadherin, which functions as a "molecular glue" that attaches cells to one another. The team explained that when E-cadherin is broken down, tumour cells start to migrate and spread throughout the body.

A protein called Snail acts as a master switch in the cell's nucleus to suppress E-cadherin expression and induce EMT in the cell. Agents that can disrupt the interaction of Snail are thought to have great therapeutic potential for treating MBC. Leading on from these findings, the scientists at the UoK are keen to develop drugs that can treat metastatic cancer.

Separately, a study funded by Cancer Research UK (CRUK) and the Wellcome Trust has found five new regions of the genome that increase a woman's risk of developing BC by between 6 and 16 per cent. As more of these low-risk sites are found, scientists believe that it may be possible to create tests for a combination of them that together significantly increase risk, which could ultimately help doctors to make decisions about prevention, diagnosis and treatment for women who are more likely to get BC.

The scientists scanned the entire genetic code of over 4,000 women with BC and a family history of the disease for genetic variations that appeared more often compared to healthy women. They then tested the most promising regions in over 12,000 women with BC and 12,000 women without the disease in an international collaboration. Although the results now take the total number of gene regions linked to the risk of BC to 18, scientists are still unsure which genes are causing this increased risk. Lead author, Professor Doug Easton, director of CRUK's Genetic Epidemiology Unit at the University of Cambridge, commented: "While each of these sites have a small impact on breast cancer risk, by finding more of these genes, we may be able to develop a test that can predict more reliably a woman's risk of developing breast cancer."

Alice Rossiter - Editor, Cancer Drug News

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

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

HRT linked to LC risk

Women who take hormone replacement therapy (HRT) are at an increased risk of developing lung cancer (LC), new research by the Oregon Health and Science University suggests. As published in the 16th February online edition of the Journal of Clinical Oncology (10.1200/JCO.2009.25.9739), women aged 50 to 76 years who take oestrogen plus progestin (O+P) may have an increased risk of the disease.

According to the researchers, although the risk is duration-dependent, with women taking HRT for ten or more years at greatest risk of developing LC, an acceptable length of HRT has yet to be determined. However, it was noted that while the risk of developing LC for women using O+P for ten years or longer was approximately 50 per cent more than women not using HRT, this risk is small compared to the risk from smoking.

The scientists reviewed data collected from 2000 to 2002, and identified 36,588 peri- and postmenopausal participants aged 50 to 76 years who met their study criteria and followed them for six years. At the end of the observation period, December 2007, 344 of the participants had developed LC. After adjusting for smoking, age and other factors that affect the risk of the disease, the researchers determined that the use of O+P for ten or more years was associated with an increased risk for LC, compared with no use of HRT. They also found that the duration of use was associated with an advanced stage of cancer at diagnosis.

This research is not the first to highlight the risk of HRT use with LC. Scientists from the University of California, Los Angeles Medical Center previously reported that HRT using O+P increases the risk of death from LC. After the eight-year total follow-up from the study, published in the 20th September 2009 online edition of The Lancet (10.1016/S0140-6736(09)61526-9), the researchers found that more women died from LC in the combined HRT group than in the placebo group (73 compared to 40 deaths). In other words, women in the HRT group were 71 per cent more likely to die.

Further, it is not just an increased risk of LC that has been linked with HRT. According to results from a Stanford University study, published in the 5th February 2009 edition of the NEJM (2009;360:573-587), postmenopausal women who take combined O+P menopausal hormone therapy for at least five years double their annual risk of breast cancer. This multi-centre study also found that women on HRT can quickly reduce their risks of cancer simply by stopping the therapy.

Research such as this suggests that postmenopausal women, especially current smokers or long-term past smokers, should carefully consider these risks before initiating or continuing combined O+P use.

Alice Rossiter
Editor, Cancer Drug News