Hormone test predicts ovarian function after chemotherapy for breast cancer

ScienceDaily (June 5, 2011) — A test that shows how many eggs a woman has in her ovaries may help young women with breast cancer know what their reproductive function will be after chemotherapy, a new study finds.

See Also:Health & MedicineWomen's HealthBreast CancerLung CancerMenopauseOvarian CancerColon CancerReferenceMenopauseHysterectomyOvarian cancerInfertility

The results are being presented at The Endocrine Society's 93rd Annual Meeting in Boston.

Called the anti-Mullerian hormone (AMH) test, this blood test measures levels of an ovarian hormone that reflects the size of the ovarian reserve, or remaining egg supply. Currently, doctors use it to quantify a woman's ovarian reserve before in vitro fertilization treatments. Now researchers from Scotland have found that measurement of AMH indicates how likely it will be for a woman to still have eggs in her ovaries after chemotherapy, which can often damage a woman's eggs and cause infertility.

"Future reproductive function is a concern for many young women with cancer," said lead investigator Richard Anderson, MD, PhD, professor of clinical reproductive science at the University of Edinburgh. "This test will be of benefit to women with newly diagnosed cancer to help decide whether they need to take steps to preserve their fertility."

In the U.S. alone, breast cancer is diagnosed in more than 25,000 women younger than 45 each year, according to the American Cancer Society.

For this study, Anderson and his colleagues recruited 50 premenopausal women, ages 29 to 51, who had just received a diagnosis of early breast cancer. All women had normal menstrual cycles and were asked to keep a daily record of their menstrual cycle, as an index of ovarian activity, during the two years of the study. Before the women started chemotherapy, they gave blood samples for AMH testing. They again had AMH tests one and two years after starting treatment.

Before chemotherapy the median AMH level was 0.4 nanograms per milliliter (ng/mL). After cancer treatment the AMH level fell rapidly, becoming undetectable (below 0.16 ng/mL) in 68 percent of the women after one cycle of chemotherapy, the authors reported. By one-year follow-up, 11 women withdrew from the study, mostly because of cancer recurrence, Anderson said. Menstrual records were available for 39 women at one year and for 29 women at two years.

A low AMH measurement before treatment correlated well with amenorrhea, or absence of menstruation, after treatment. Women whose AMH before treatment was low (below 0.4 ng/mL) were 16 times likelier to have stopped menstruating after chemotherapy than women with a high pretreatment AMH value, Anderson said. The odds of losing ovarian function remained higher even after statistical analysis controlled for increasing age, which tends to lower AMH levels. Women whose AMH before chemotherapy exceeded 0.92 ng/mL were reportedly almost five times more likely to continue menstruating after treatment.

"Our data suggest that the AMH test, taken before cancer treatment, can help individualize a woman's infertility risk after chemotherapy for breast cancer," Anderson said.

He added that results of this study, which was funded by the U.K. Medical Research Council, are likely to apply to other types of cancer as well.

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Early transplants are no better than chemotherapy followed by transplant for non-Hodgkin lymphoma patients, study finds

ScienceDaily (June 3, 2011) — Patients with a very aggressive form of non-Hodgkin lymphoma who receive a stem cell transplant after standard chemotherapy during their first remission have comparable survival rates to those who receive the same standard therapy alone and, if needed, a transplant when they relapse.

See Also:Health & MedicineLymphomaWounds and HealingToday's HealthcareMultiple Sclerosis ResearchDiseases and ConditionsCancerReferenceBone marrow transplantTransplant rejectionLiver transplantationClinical trial

These findings from a U.S. and Canadian clinical trial of 370 patients conducted at 40 clinical institutions were presented by Patrick Stiff, MD, lead investigator and director, Loyola Cardinal Bernardin Cancer Center, at the annual meeting for the American Society of Clinical Oncology (ASCO).

"The trial was based on several preliminary studies that indicated a survival benefit to early stem cell transplants," Dr. Stiff said. "These findings may save some patients from undergoing a stem cell transplant unnecessarily."

However, a subset with all of the possible poor risk factors with this form of non-Hodgkin lymphoma did seem to have a higher chance of survival in a sub- analysis.

"Additional research is necessary to determine the best plan of care for the highest-risk patients," Dr. Stiff said. "In the meantime, these patients will have to consult with their physician to carefully determine their treatment plan."

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Tai chi could help overcome cognitive effects of chemotherapy, evidence suggests

ScienceDaily (June 7, 2011) — According to the American Cancer Society, more than 11.4 million Americans are currently living with cancer. While cancer treatments are plentiful, many have negative side effects. Previous studies have indicated that a significant number of patients who receive chemotherapy also experience cognitive declines, including decreases in verbal fluency and memory. Now, one University of Missouri health psychologist has found evidence that indicates Tai Chi, a Chinese martial art, might help overcome some of those problems.

See Also:Health & MedicineAlternative MedicineLung CancerColon CancerMind & BrainIntelligenceMental HealthBehaviorLiving WellReferencePilatesMenopauseNanomedicineMemory bias

"Scientists have known for years that Tai Chi positively impacts physical and emotional health, but this small study also uncovered evidence that it might help cognitive functioning as well," said Stephanie Reid-Arndt, assistant professor and chair of the Department of Health Psychology in the School of Health Professions. "We know this activity can help people with their quality of life in general, and with this new study, we are encouraged about how Tai Chi could also help those who have received chemotherapy. I also hope this encourages more people to think about Tai Chi positively on a broader scale in their lives."

Tai Chi involves practicing slow motion routines and is based on several principles, including mindfulness, breathing awareness, active relaxation and slow movements. The emphasis on slow movement makes Tai Chi particularly suited to a wide range of fitness levels, which makes it very relevant for those who have had chemotherapy and might be experiencing physical limitations as a result, Reid-Arndt said.

The MU pilot study followed a group of women with a history of chemotherapy. The women participated in a 60-minute Tai Chi class two times a week for 10 weeks. The women were tested on memory, language, attention, stress, mood and fatigue before and after the 10-week sessions. According to Reid-Arndt, the results of the tests indicated that the women had made significant improvements in their psychological health and cognitive abilities.

"Tai Chi really helps individuals focus their attention, and this study also demonstrates how good Tai Chi could be for anyone, whether or not they have undergone treatment for cancer," Reid-Arndt said. "Due to the small size of this study, we really need to test a larger group of individuals to gain a better understanding of the specific benefits of this activity for patients who have been treated with chemotherapy and how significant these improvements might be."

The study was published recently in Complementary Therapies in Clinical Practice.

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Gene-modified stem cells help protect bone marrow from toxic side effects of chemotherapy

ScienceDaily (May 21, 2011) — Although chemotherapy is used to kill cancer cells, it can also have a strong toxic effect on normal cells such as bone marrow and blood cells, often limiting the ability to use and manage the chemotherapy treatment. Researchers at Fred Hutchinson Cancer Research Center reported at the annual meeting of the American Society of Gene and Cell Therapy in Seattle that one possible approach to reduce this toxic effect on bone marrow cells is to modify the cells with a gene that makes them resistant to chemotherapy.

See Also:Health & MedicineLeukemiaBrain TumorStem CellsLung CancerColon CancerLymphomaReferenceGliomaMetastasisStem cell treatmentsTumor suppressor gene

Hans-Peter Kiem, M.D., a member of the Hutchinson Center's Clinical Research Division, and colleagues Jennifer Adair, Ph.D., a research associate in the Clinical Research Division, and Maciej Mrugala, M.D., Ph.D., M.P.H., a neuro-oncololgist at the Seattle Cancer Care Alliance and the University of Washington, presented data from a clinical trial in which bone marrow stem cells from patients with brain tumors were removed and modified with a retrovirus vector to introduce the chemotherapy-resistant gene. The cells were then re-infused into the patients. In the trial, which was designed to evaluate safety and feasibility, patients were safely administered gene-modified blood stem cells that persisted for more than one year and did not show any apparent harmful effects.

This approach was first attempted in patients with a terminal form of brain cancer called glioblastoma. Currently, median survival for glioblastoma patients is just 12 to 15 months. The prognosis for glioblastoma patients is poor not only because no curative treatment is available but because doctors cannot effectively use the treatment that does exist. Glioblastoma cells make a large amount of a protein called MGMT that makes them resistant to chemotherapy, so doctors use a second drug, called benzylguanine, to knock down MGMT and make the tumor cells susceptible to the chemotherapy. However, this potent one-two punch is not limited to the brain tumor cells. Benzylguanine also disables MGMT in normal blood and bone marrow cells, leaving them also susceptible to the effects of chemotherapy. The effects on patients' blood and bone marrow can be pronounced and often limit the ability to effectively administer the chemotherapy.

"Our initial results are encouraging because our first patient is still alive and without evidence of disease progression almost two years after diagnosis," Kiem said.

The results of the trial suggest the administration of the modified cells represent a safe method for protecting marrow and blood cells from the harmful effects of chemotherapy in brain tumor patients. Future clinical trials will be done to determine whether this combination chemotherapy will also improve the survival of patients with glioblastoma.

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