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Hormone therapy can safely be reduced to 18 months in high-risk prostate cancer patients

MD-FM Thursday February 21, 2013





GENERIQUE
Carillon
 
Sarah:
MD FM — Medical News from around the world with Peter Goodwin.

P1

PETER:
Hello, and with me is Sarah Maxwell. To begin with, for patients with localized high-risk prostate cancer, halving the duration of androgen blockade therapy is safe and doesn’t affect survival. That’s from a study presented at the American Society of Clinical Oncology’s Symposium on Genito-Urinary Cancers in Orlando last week….

SARAH:
Yes, patients who had 18 months of hormone therapy lived just as long as those treated for 36 months — the current standard. At a median follow-up of 77 months, a comparable number of patients were still alive in both treatment groups and at five and 10 years, overall survival was still similar. Lead author Abdenour Nabid:

Bob-Nabid-1: “Androgen blockade is a source of many side effects, especially the castration syndrome that makes most of our patients’ life miserable. So for the patients in the duration of side effects --it’s fabulous! and it’s also a reduction in cost of treatments”

SARAH:
Abdenour Nabid told us at the ASCO meeting that the study did not include patients who have node-positive disease — so these results don’t apply to them — but for patients with localized high-risk prostate cancer, he urged doctors to start shortening treatment duration as soon as possible:

Bob-Nabid-2: “Before we publish all this data, and it will be published, just start to lower the duration of androgen blockade to at least 24 months. And when the data will be published, then the doctors will make their decisions”

SARAH:
That was doctor Abdenour Nabid, from Sherbrooke University Hospital, in Quebec, Canada talking to Peter Goodwin at ASCO last week.

P2

PETER:
Some of the cancers associated with human papillomavirus infection, incidence rates have increased in the United States over the past 35 years, despite a decline in overall deaths from cancer. These findings — published in the Journal of the National Cancer Institute — are part of an annual report that called for additional prevention efforts for HPV-associated cancers, including increasing vaccination coverage, which was low among adolescents.

VIRGULE MUSICALE

P3

PETER:
For the extended treatment of patients with unprovoked venous thrombo-embolism, two anti-coagulants have shown promising results according to data published in the New England Journal of Medicine...
 
SARAH:
Yes. Firstly, two double-blinded randomized trials looked at the direct thrombin inhibitor Dabigatran: comparing it with placebo, and also head-to-head with warfarin. Lead study author Sam Schulman:
 
Bob Schulman: “There is a reduction in the risk of new thrombosis by 92% compared to placebo. Against warfarin, it has a similar effect in the long run and the bleeding is reduced --significantly less bleeding overall.”
 
SARAH:
That was Doctor Sam Schulman, from McMaster University in Hamilton, Ontario.

And in the other publication –  from Italy – the direct factor Xa inhibitor Apixaban — was found to be more effective than placebo and to have very low bleeding rates. So, for selected patients at high-risk of recurrence, these two agents could become attractive alternatives to warfarin. Jean Connors, wrote an editorial in the New England Journal:
 
Bob- Connors: “These new drugs are fantastic in that they have significantly less drug-drug and drug-food interaction, so there is no need to monitor --so these patients can take them and not have to worry about going to get their blood drawn or having a home test machine and testing for warfarin, and that makes taking them a lot simpler. However, because they have such a short half-life, if you forget to take these medication their effects wear off very rapidly. So for the conscientious patient without big bleeding risk these medications are great. For patients who may have a higher bleeding risk they may not be the best drugs because with warfarin we can reverse the effects of anticoagulation immediately if someone starts to bleed, whereas with these new agents, we do not have a very good tested strategy to immediately stop the bleeding.”

SARAH:
That was doctor Jean Connors from Boston, Massachusetts, and she underlined that these new anticoagulants do have some contra-indications like renal insufficiency.


VIRGULE MUSICALE
 
P4

PETER:  
Deaths caused by drug overdose in the USA  increased for the 11th consecutive year in 2010; and prescription pharmaceuticals — especially  opioid analgesics — drove the increase — according to data released by the National Centre for Health Statistics…
 
SARAH:
Yes, in 2010, pharmaceuticals were involved in 60% of deaths from overdose in the US and three-quarters of these were unintentional. The two most common drugs involved were: opioids and benzodiazepines:

Bob-Jones-1: “The middle age group -45 to 54 --have the highest overdose death rate for opioids, and then the 35 to 44 year old age group have the second highest. So these are people who either have sort of chronic substance abuse histories or maybe are taking opioids for medical conditions. But when we look at who’s most at risk, it’s people who have substance use disorders histories or mental health disorder histories, people who live in rural areas, and then people who are in increased poverty have a higher risk for opioid overdose death”
 
SARAH:
That was Christopher Jones, who wrote a letter in JAMA and had this recommendation:

Bob-Jones-2: “It’s really important to use data sources like electronic health records or prescription monitoring programs to identify what drugs a patient may already be taking before prescribing new drugs that have abuse potential. And also conducting screening to identify mental health issues or substance use disorders prior to prescribing an abusable drug like an opioid or a benzodiazepine, I think this is really important because we do see in the deaths of opioids and benzodiazepines an involvement of antidepressants and other mental health medication.”

SARAH:
Doctor Christopher Jones from the Centers for Disease Control in Atlanta, Georgia.


VIRGULE MUSICALE

P5

PETER:
Throughout the menstrual cycle, women’s respiratory symptoms can vary significantly according to a study reported in the American Journal of Respiratory and Critical Care Medicine…

SARAH:
Yes, a questionnaire was mailed to nearly 4000 women, asking them about: recent respiratory symptoms, their last cycle, their BMI and smoking status. Researchers found that for each symptom — wheezing, shortness of breath, and coughing — there were significant rhythmic variations throughout the different stages of the menstrual cycle…

Bob-Macsali: “We investigated this with a chronobiological methodology --just trying to see if there are variations through the cycle. Most of the other studies compare maybe menstruation to ovulation or to any other period, a predefined subset of the menstruation. We kind of leave it open and we just look at the patterns. But the weakness maybe of our study is that each women answered only about one period in their cycle, so they don’t give information about their whole cycle, so I don’t think we should overestimate the value of the figures  in my article --I think the most important thing is to be aware that there might be a connection between their menstrual cycle and their respiratory symptoms --women with asthma should be aware of this possible connection. So measure them, write them down, and maybe change their medication according to the pattern that they might have.”
 
SARAH:
That was lead study author doctor Ferenc Macsali, from the University of Bergen in Norway.


BREVE 1  Sur fond musical
 
PETER:
Finally, in brief:

Smoking bans in Belgium — which were implemented in three phases — were associated with successive reductions in the risk of preterm delivery, according to a study published in the British Medical Journal. Over 600,000 live, single-born deliveries were analysed over nine years and there was no decreasing trend in the years or months prior to the bans.

And...
 
BREVE 2


A systematic review in JAMA has found that hydroxyethyl starch — a fluid currently being use intravenously in critically ill patients who need an increase in their blood fluid volume — was associated with a significant risk of death and acute kidney injury. The review excluded data found to be fabricated by research misconduct documented and discredited in the 1990s! When these data were removed the mortality excess became clear! The accompanying editorial highlights the importance of revising recommendations and guidelines.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye!
 
JINGLE FIN     

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