Breast cancer patients can use antiperspirants during radiotherapy

Women undergoing daily radiation therapy for breast cancer are commonly told they should not use antiperspirant for fear that it could cause greater radiation damage to the skin, but a new study from the Perelman School of Medicine at the University of Pennsylvania shows that advice is not based on sound science.

While they found that about eight out of every 10 patients reported their doctors told them not to use antiperspirants and roughly the same number of doctors say they routinely make that recommendation, their study also showed there was no difference in the radiation skin dose absorbed by these patients with or without these deodorants. They published their findings in Radiotherapy and Oncology this month.

Going without antiperspirants entirely for a 3-6 week course of radiotherapy can have a negative impact on a patient’s quality-of-life,” said the study’s lead author Brian C. Baumann, MD, who recently completed his residency in Radiation Oncology at Penn and is a member of Penn’s Leonard Davis Institute of Health Economics. He is also currently an assistant professor of Radiation Oncology at Washington University in St. Louis. “Our study suggests that antiperspirants can be safely used during breast radiotherapy without risking increased skin side effects.”

The study tackled two key areas. First, it established that it’s still common practice for physicians to advise breast cancer patients to avoid antiperspirants during radiotherapy. Second, it debunked the myth that the use of these antiperspirants increases the amount of radiation the skin receives, thus causing more damage to the skin.

For the first part of the study, researchers utilized OncoLink, an online cancer service dedicated to patient and provider education that is run by Penn’s Radiation Oncology unit. They developed a survey to find out what percentage of providers still tell their patients not to use antiperspirants, and what percentage of patients say they received that advice. Of the 105 doctors and nurses who responded and said they regularly manage radiation dermatitis for their patients, 86 of them (82 percent) said they regularly tell patients not to use antiperspirants during their course of radiation treatment. On the patient side, 92 women responded who said they have received radiotherapy for breast cancer, 73 of whom (79 percent) say their healthcare providers advised them to avoid using deodorant for the duration of their treatment.

While the sample size of the survey is relatively small, the percentage of patients who received the advice to avoid antiperspirants and the percentage of providers who routinely offer this advice was very similar. We cannot make any conclusions about the exact prevalence of this recommendation, but we think the results strongly suggest that the recommendation remains popular,” Baumann said.

The advice persists despite a lack of scientific evidence. Trials have not shown antiperspirant use leads to higher skin side effects during breast radiation therapy, but those trials do not appear to have changed clinical practice. Baumann says that shows providers either do not know about these studies or they are skeptical of the results.

There can be a discrepancy between the ways we measure skin toxicity in clinical trials versus the problems patients report to their healthcare providers,” Baumann said. “The current skin toxicity scoring system has important limitations. It does not take pain or itching into account, for example, so it is possible that the studies may have missed a clinically meaningful effect because of the limitations of the measurement tool.” Researchers addressed that discrepancy in the second part of this study as they sought to find out if antiperspirants really do increase the surface dose of radiation on the skin. For this portion, researchers used optically stimulated luminescent dosimeters (OSLDs) – a common device for measuring the amount of surface radiation absorbed with each dose. They used three squares of paper: one with nothing on it, one with a thick coating of standard antiperspirant, and one with a thick coating of extra-strength antiperspirant. They placed the squares of paper in the beam’s path and measured the absorbed radiation dose with OSLDs.

We found no significant difference in surface dose with or without antiperspirant,” Baumann said.
Baumann’s team also moved the beam to four different angles, but found it did not lead to different results.
These antiperspirants also contain aluminum zirconium tetrachlorohydrex glycine, a common metal found in antiperspirants. The standard deodorants contain 15 percent of it, while the extra strength contains 25 percent.

We specifically wanted to know if the radiation could hit that metal and scatter, sending radiation off target and into other, healthy parts of the skin, but any difference in surface dose we found was within the margin of error,” Baumann said.

This study shows providers should be more liberal in letting patients use antiperspirants during radiation treatment, which may improve patient quality-of-life.”

Baumann et al. Avoiding antiperspirants during breast radiation therapy: Myth or sound advice? Radiother Oncol. 2017;S0167-8140(17)30432-2. doi: 10.1016/j.radonc.2017.06.021 [Abstract]

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Anti-androgen therapy improves survival for men with cancer recurrence after prostatectomy

Men with prostate cancer who have prostate-specific antigen recurrence following radical prostatectomy have improved survival with radiotherapy and a long-term course of anti androgen therapy.

It is well established that a rising serum prostate-specific antigen (PSA) level is an indication of cancer progression in men diagnosed with prostate cancer and treated with radical prostatectomy (RP). For these patients, adding 24 months of anti-androgen therapy (AAT) during and after salvage radiotherapy (RT) improves overall survival statistically compared with salvage RT alone, according to the long-term results of a clinical trial conducted by the Radiation Therapy Oncology Group (RTOG), now conducting research as NRG Oncology. The RTOG 9601 study results presented today at the plenary session of the 57th Annual Meeting of the American Society for Radiation Oncology (ASTRO) also reveal that the addition of ATT to salvage RT reduces prostate cancer death and the development of metastatic prostate cancer without increasing radiation toxicity.

Over the last 25 years, many men with intermediate-risk prostate cancer have undergone RP, yet many will face recurrence subsequently with a rising PSA,” says lead study author William U. Shipley, M.D., FACR, FASTRO, who is the Andres Soriano Distinguished Professor of Radiation Oncology at the Massachusetts General Hospital and the Harvard Medical School, both in Boston. “Our results show that salvage RT plus peripheral androgen blockade (AAT with bicalutamide), when compared with RT plus a placebo, improved long-term overall survival and reduced death from prostate cancer without adding significantly to radiation toxicity. Because prostate cancer progresses slowly, follow-up of over 12 years was necessary to demonstrate a statistically better patient survival with combined AAT and RT.

With a median follow-up now of 12.6 years, the study results showed the actuarial overall survival at 10 years was 82 percent for the RT plus AAT arm and 78 percent for the RT plus placebo arm (P = 0.036). The 12-year incidence of prostate cancer-related deaths was 2.3 percent for the RT plus AAT arm, compared with 7.5 percent for the RT plus placebo arm. At 12 years, the cancer had metastasized in 51 patients (14 percent) in the RT plus AAT arm, compared with in 83 patients (23 percent) in the RT plus placebo arm. Additionally, late bladder and bowel toxicity were low and similar in both groups, whereas 70 percent of men in the RT plus AAT arm reported swelling of the breasts, compared with 11 percent in the RT plus placebo arm.

Conducted at sites across the United States and Canada from 1998 to 2003, the RTOG 9601 trial enrolled 761 men with prostate cancer who had undergone RP and subsequently developed elevated PSA levels. The patients were randomized to receive either salvage RT plus placebo (377 patients) or salvage RT plus AAT (384 patients).

Further statistical analyses, which are underway, may identify subgroups of patients who may not benefit from hormone therapy added to salvage RT and other subgroups for whom it may be especially beneficial. Also, because anti-androgen therapy, which suppresses testosterone production, is now used more commonly than peripheral androgen blockade with AAT, its use should be evaluated,” says Shipley in regard to next research steps for the population of post-RP patients referred for salvage RT. Shipley also emphasizes the clinical researchers’ gratitude for the willingness of the patients to participate on this and other randomized trials and for the essential role they play in advancing cancer care.

The results of this trial are testament to the importance of phase III randomized controlled trials for determining significant benefits. Congratulations to the trial team for their commitment to obtaining the quality of research data necessary for impacting the clinical care of patients with prostate cancer,” says Walter J. Curran Jr., M.D., an NRG Oncology Group Chairman and Executive Director of the Winship Cancer Institute of Emory University in Atlanta.

57th Annual Meeting of the American Society for Radiation Oncology (ASTRO) 2015 San Antonio, Texas, USA

Cancer scan could remove the need for radiotherapy in some patients

A UK National Cancer Research Institute trial led from The University of Manchester and the Christie NHS Foundation Trust has suggested that in patients with early stage Hodgkin lymphoma the late effects of radiotherapy could be reduced by using a scan to determine those who actually need it.

In a paper published in the New England Journal of Medicine, the researchers show that a positron-emission tomography (PET) scan immediately after treatment with chemotherapy can identify patients who have a very good outcome without additional radiotherapy.

Hodgkin lymphoma is a cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout the body. Around 1,900 people a year, many of whom are teenagers and young adults, are diagnosed in the UK.

The current standard treatment is for all Hodgkin lymphoma patients to receive chemotherapy, followed by radiotherapy. However, this radiotherapy comes with undesirable late effects, such as cardiovascular disease and other cancers – despite the fact that they have already been cured of Hodgkin lymphoma.

The 602 patients who agreed to take part in the ‘RAPID’ trial had a PET scan performed after their chemotherapy. Patients who tested positive received radiotherapy. Those who tested negative were divided into two groups – one group of 211 patients received no further treatment, while the other group of 209 had the standard radiotherapy.

After three years of regular check-ups, the proportion of patients who were alive and free of disease was 94.6% in the radiotherapy group, and 90.8% in the group which hadn’t received further treatment.

Lead researcher, Professor John Radford, is based at The University of Manchester’s Institute of Cancer Sciences and the Christie NHS Foundation Trust. He said: “This research is an important step forward. The results of RAPID show that in early stage Hodgkin lymphoma radiotherapy after initial chemotherapy marginally reduces the recurrence rate, but this is bought at the expense of exposing to radiation all patients with negative PET findings, most of whom are already cured.”

Despite the findings from this study the researchers stress that a longer follow-up period is needed in order to determine whether this approach will ultimately lead to fewer late side-effects and improved overall survival.

The research was funded by Leukaemia & Lymphoma Research. Dr Matt Kaiser, Head of Research at the charity, said: “This ground breaking clinical trial shows that, by using scans to predict an individual’s risk of relapse, many patients can remain disease-free with just chemotherapy alone. Radiotherapy can cause a range of long-term problems like heart disease and hard-to-treat second cancers. As many Hodgkin lymphoma patients are relatively young, it is particularly important to avoid using intensive treatment when it is unnecessary.”

Radford et al. Results of a Trial of PET-Directed Therapy for Early-Stage Hodgkin’s Lymphoma. N Engl J Med. 2015; 372:1598-1607, DOI:10.1056/NEJMoa1408648 [Article]

Many cancer survivors have unmet physical and mental needs related to their disease and its treatment

Even decades after being cured, many cancer survivors face physical and mental challenges resulting from their disease and its treatment. That’s the conclusion of a new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The findings could help clinicians and other experts develop interventions that are tailored to the specific types of problems and concerns that cancer survivors may experience.

Increasingly, cancer patients are living many years after cancer treatment, with the number of US survivors expected to top 19 million by 2024. While many survivors do well after treatment, some experience continuing problems that can significantly impair their quality of life well beyond the magical 5-year survival milestone. These problems and challenges can vary by the type of cancer patients had and the treatments they received.

To assess the unmet needs of cancer survivors, Mary Ann Burg, PhD, LCSW, of the University of Central Florida in Orlando, and her colleagues looked at the responses from an American Cancer Society survey, wherein 1514 cancer survivors responded to the open-ended question, ‘Please tell us about any needs you have now as a cancer survivor that ARE NOT being met to your satisfaction.’ “This study was unique in that it gave a very large sample of cancer survivors a real voice to express their needs and concerns,” said Dr. Burg.

Survivors most frequently expressed physical problems, with 38 percent saying they were an issue. (Problems related to sexuality and incontinence among prostate cancer survivors were especially common.) Financial problems related to the costs of treatment also persisted long after treatment for 20 percent of respondents, with Black and Hispanic survivors being especially hard-hit. Anxiety about recurrence was a common theme expressed by survivors regardless of the type of cancer they had or how many years they had survived cancer. The number and type of unmet needs were not associated with time since cancer treatment.

Overall, we found that cancer survivors are often caught off guard by the lingering problems they experience after cancer treatment. In the wake of cancer, many survivors feel they have lost a sense of personal control, have reduced quality of life, and are frustrated that these problems are not sufficiently addressed within the medical care system,” said Dr. Burg. She noted that improvements are needed concerning public awareness of cancer survivors’ problems, honest professional communication about the side effects of cancer, and the coordination of medical care resources to help survivors and their families cope with their lingering challenges.

Burg et al. Current unmet needs of cancer survivors: Analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. Cancer. 2015;EPub Ahead of Print [Abstract]

Scientists pinpoint bladder cancer patients who could benefit from ‘tumor-softening’ treatment

Scientists in Manchester have identified a protein that could help doctors decide which bladder cancer patients would benefit from a treatment that makes radiotherapy more effective.

The team from The University of Manchester, funded by the Medical Research Council, found that patients whose bladder tumour had high levels of a protein, called ‘HIF-1α’, were more likely to benefit from having carbogen – oxygen mixed with carbon dioxide gas – and nicotinamide tablets at the same time as their radiotherapy. The treatment, called ‘CON’, makes radiotherapy more effective.

By comparing levels of HIF-1α in tissue samples from 137 patients who had radiotherapy on its own or with CON, the researchers found the protein predicted which patients benefited from having CON. High levels of the protein were linked to better survival from the disease when patients had radiotherapy and CON. Patients with low protein levels did not benefit from having CON with their radiotherapy.

The HIF-1α protein indicates low oxygen levels in tumour cells – a state known as ‘hypoxia’. The CON treatment works by adding oxygen to the oxygen-deprived tumour cells which makes them more sensitive to the radiotherapy. The study is published in the British Journal of Cancer (BJC).

Study author, Professor Catharine West, a Cancer Research UK scientist at The University of Manchester, said: “Although we have another biomarker that can predict responsiveness to CON and radiotherapy in bladder cancer patients, our findings tell us a bit more about the characteristics of bladder cancer tumours and how they may respond to this treatment.”

But we desperately need to do more work to find ways to treat those patients who won’t see as much benefit from this. And it’s exactly this type of vital research that we and other scientists will be doing at the Manchester Cancer Research Centre – bringing together a wide range of expertise to revolutionise cancer treatment.

Around 65 people are diagnosed with bladder cancer in Manchester every year. There are around 25 deaths from the disease every year.

Nell Barrie, senior science communications manager at Cancer Research UK, said: “This fascinating new finding could help doctors adapt their treatments to patients with bladder cancer as well as shedding more light on the disease. Deaths from bladder cancer are falling in the UK, but more work needs to be done so that this trend continues. More research is needed to helps us find new and better ways to fight bladder cancer.”

Hunter et al., (2014). Expression hypoxia-inducible factor-1α predicts benefit from hypoxia modification in invasive bladder cancer. Brit. J. Cancer111: 437-443  doi: 10.1038/bjc.2014.315. [Abstract]

Survey sheds light on common clinical practice for incompletely resected lung cancer

A landmark survey of more than 700 specialists provides crucial real-world insight into the treatments most oncologists choose for lung cancer patients whose tumour has been incompletely resected, an expert from the European Society for Medical Oncology (ESMO) says.

Jean Yves Douillard, from the ICO Institut de Cancerologie de l’Ouest René Gauducheau, France, Chair of the ESMO Educational Committee, was commenting on a paper published in the journal Lung Cancer. In the study, researchers led by Raffaele Califano of The Christie NHS Foundation Trust, Manchester, UK, surveyed 768 oncologists from 41 European countries about the treatments they offered patients who had “R1 resected” non-small-cell lung cancer.

R1 resection is a term used by oncologists to indicate that it is possible to find microscopic evidence of cancer cells remaining after a cancer has been surgically removed.

We know that incomplete resection, or R1 resection, is associated with a higher risk of relapse but there are currently no strong evidence-based recommendations on how to treat these patients after surgery,” Douillard says.

This study is important since it provides a good overview on how the problem is handled in clinical practice all over Europe by practitioners who treat lung cancer.”

Overall, 83% of experts surveyed were medical oncologists –specialists trained to treat cancer using chemotherapy, targeted therapies, immunotherapy and other medications.

Of the respondents, 91.4% prescribed chemotherapy, mostly cisplatin/vinorelbine or cisplatin/gemcitabine. The survey showed that the majority of doctors (85%) discussed with the patient the fact that there was limited clinical evidence to guide treatment options. Almost 50% of participants prescribed radiotherapy, with radiation oncologists most likely to offer this treatment approach.

Treating physicians clearly believe in what they do, and try to provide the best for their patients,” says Douillard. “According to the survey, however, practice is heterogeneous and varies according to the specialty of the treating physician—whether they are radiation oncologists or medical oncologists. This is why treatment decisions are best made by multidisciplinary teams.”

The evidence gathered in this survey is supported by the recommendations of the 2nd ESMO Consensus Conference on Lung Cancer held in 2013, Douillard notes. That group of worldwide recognised experts recommended adjuvant chemotherapy and adjuvant radiation in R1 resected patients.

The authors of the latest paper call for prospective trials to be undertaken to provide stronger evidence to guide post-surgery treatment in this situation. Douillard agrees that such trials would be informative.

However, trials of adjuvant treatment in R1 resected lung cancer would be very difficult to design and perform, as this is fortunately an infrequent occurrence. R1 resection would also need to be clearly defined in such studies, as it actually represents a quite heterogeneous group.”

Based on evidence from clinical trials in resected patients in whom all tumour cells have been completely removed, there is a rationale for using both chemotherapy and radiotherapy in R1-resected non-small-cell lung cancer,” Douillard says.

As the authors of this survey state, definitive proof would come from a randomised clinical trial, although such studies would be difficult to perform.”

Additional Information:

Califano et al., (2014). Use of adjuvant chemotherapy (CT) and radiotherapy (RT) in incompletely resected (R1) early stage Non-Small Cell Lung Cancer (NSCLC): A European survey conducted by the European Society for Medical Oncology (ESMO) Young Oncologists Committee. Lung Cancer85(1):74–80 [Abstract][pdf]

Chemotherapy before radiotherapy for testicular cancer could reduce long-term side-effects

Giving men with testicular cancer a single dose of chemotherapy alongside radiotherapy could improve the effectiveness of treatment and reduce the risk of long-term side-effects, a new study reports.

As many as 96% of men with testicular cancer now survive at least ten years from diagnosis, but more advanced forms need to be treated with combination chemotherapy – which can have serious long-term complications. Researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust have therefore been searching for new treatments that would reduce the risk of relapse after initial treatment and so spare as many men as possible from needing combination chemotherapy.

The new pilot study, published in the August issue of prestigious journal the Annals of Oncology, tested a new treatment in a pilot study of men with stage IIA and IIB testicular seminoma – where the cancer has spread to the lymph nodes in the abdomen.

The researchers showed that giving chemotherapy drug carboplatin before radiotherapy could reduce relapse rates compared with radiotherapy alone – cutting the numbers of men who would need follow-up treatment. It also allowed radiation doses to be reduced. The study was funded by The Institute of Cancer Research (ICR), the Bob Champion Cancer Trust and Cancer Research UK, as well as through the NIHR Biomedical Research Centre at The Royal Marsden and the ICR.

Researchers gave 51 men with stage IIA and IIB testicular seminoma a single cycle of carboplatin – a low toxicity form of chemotherapy – followed three to four weeks later by radiotherapy. Most of the men were aged below 50, over a range of 18-73 years.

Adding carboplatin to patients’ treatment plans allowed doctors to give a lower dose of radiation over a smaller area of the body for most of the men in the study. Some 39 of the men in the study had their prescription of radiation reduced from the standard 35 Grays (Gy) of radiation to 30 Gy, delivered to a smaller area of the abdomen.

After an average of 4.5 years of follow-up, there were no relapses of the cancer compared with a relapse risk of 5-11% after radiotherapy alone. The side-effects from treatment were mild and only lasted a short time.

Dr Robert Huddart, Team Leader in the Division of Radiation and Imaging at the Institute of Cancer Research, London, and Consultant at The Royal Marsden, who led the study, said:

“The results of this study show great promise. Men who have this stage of testicular seminoma are normally treated with just radiotherapy, or in some countries with intensive combination chemotherapy, where several anticancer drugs are given at once. Relapse occurs in 5-11% of men after radiotherapy alone, and these recurrences have to be treated with combination chemotherapy, which is associated with a risk of serious long-term complications such as cardiovascular disease or second cancers.

“The aim of the study was to develop an effective non-toxic treatment with low risk of long-term treatment complications, and our findings suggest that a single cycle of carboplatin before radiotherapy may reduce the chances of cancer reappearing compared with radiotherapy alone. This will reduce the risk that these patients would need combination chemotherapy. Not only that, but by adding carboplatin to the therapy, the radiation dose and volume can be lowered.”

As this was a small, single-centre study, the researchers are recommending the approach is evaluated more widely.

Horwich et al., (2013). Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann. Oncol., 24 : 2104-2107 doi:10.1093/annonc/mdt148 [Abstract]