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Using two anti-HER2 agents together boosts survival in patients with HER2-positive metastatic breast cancer

 MD-FM Thursday May 16, 2013


BREAST CANCER: anti-HER2 combination extends survival in patients with HER2-positive metastatic tumours

C-reactive protein levels accurately identify high risk of heart disease

Bisphosphonates greatly reduced the risk of heart attacks in patients with rheumatoid arthritis

Hidden salts in processed and restaurant foods are still a threat and can only be countered through government regulations

Agent with novel mechanism of action alleviates symptoms of acute schizophrenia

Patients with diarrhea-predominant irritable bowel syndrome can benefit from a gluten-free diet

The new coronavirus could be passed between individuals in close contact




MD FM, Medical News from around the world with Peter Goodwin.




Hello, and with me is Sarah Maxwell. To begin with, in patients with HER2-positive metastatic breast cancer, chemotherapy combined with two monoclonal antibodies greatly improved survival. That was in a study published in The Lancet Oncology


Yes, progression-free survival was on average six months longer for patients on a triple-drug combination of pertuzumab, trastuzumab plus docetaxel, than for those on trastuzumab plus chemotherapy alone — the standard approach — which had a median progression-free survival of two years. That’s according to final results of the phase-3 CLEOPATRA trial and lead study author Sandra Swain, said overall survival was also extended…


Swain-1: The median overall survival for the placebo was about 3 years, its 37.6 months, whereas it hasn’t been reached yet for pertuzumab, so we don’t know how much it’s increased at this point.



Dr. Sandra Swain, from Washington, DC said pertuzumab and trastuzumab have complementary mechanisms of action. They bind to different epitopes of the HER2 receptor, so the combination has greater antitumor activity than either agent given alone. Also, there was no disease worsening or death with pertuzumab, however, patients receiving the drug did experience more side effects


Swain-2: They included things like having a fever when their blood counts were low, which we call febrile neutropenia, there was more diarrhea and there was more mucositis. So we think that the diarrhea and the mouth sores are what contributed to having this fever when the blood counts were low



Nonetheless, Dr. Swain recommends using the triple combination first-line, now that pertuzumab is approved in the USA and in Europe.




Measuring circulating levels of C-reactive proteins, CRPs, could help spot patients at high-risk of heart disease among those currently considered at intermediate risk using traditional criteria



Yes, patients with CRP over two and LDL cholesterol lower than 3.4 mg/L below the threshold at which patients are currently considered high-risk, had significantly HIGHER rates of cardiovascular events than those with CRP levels under two, regardless of their LDL-cholesterol. That’s from a study in the European Heart Journal that concluded: measuring CRP levels helped identify an extra 18% of patients who could benefit from statin therapy…

Ray-1: One of the things that this biomarker picks up are people with a bit more abdominal adiposity and fat, and that’s one of the things that traditional equations haven’t picked up so it might be picking up essentially a lifestyle issue, social deprivation and other factors, and where it is potentially helpful is for people who are at intermediate risk in the short term, at ten years, this helps you to take a decision to start that preventive treatment earlier



That was Kausik Ray, from London, who did not participate in the study. He said lifestyle changes are the first line of action…


Ray-2: Instead of just medicalizing people, we perhaps need to think about the causes of heart disease much earlier. I think you have to do lifestyle for anybody anyway and then what most of us would probably do is reassess. So for example if you lose weight, you stop smoking and you change your lifestyle, CRP will come down. If despite doing all of those things CRP is high, it’s a marker of a sick person who is at higher risk of dying, in particular of heart disease. In that situation, we know that statins reduce your risk. The flipside from a health-economic point of view is the cost of doing the test and the incremental cost of giving those additional people a statin



Professor Kausik Ray, from St George’s University of London.





PETER: In patients with rheumatoid arthritis, the risk of heart attacks was lower by 30 to 50 per cent among those receiving the bone-building drugs bisphosphonates. The concomitant use of vitamin D was associated with an even further reduction in myocardial infarction rates. These are the findings of a new study published in the Journal of Bone and Mineral Research, based on data from over 19,000 patients with RA.





Despite evidence linking high sodium levels and cardiovascular risks, the amount of salt present in processed foods and restaurant meals has barely changed over the past decade in the United States…


Yes and this is despite recommendations to reduce salt levels by 50 to 75%. A study in JAMA Internal Medicine reports that between 2005 and 2011, the sodium content in 400 processed foods declined by 3.5% but increased by 2.6% in 78 fast-food restaurant products in the US. Although some products showed decreases of at least 30%, most showed at least 30 per cent increases


Havas-1: For years many physicians have been tell their patients to use less salt at the table, the problem is 80% comes from processed and restaurant foods, so that doesn’t make a dent on the problem



That was co-author Stephen Havas, from Chicago, who said the only way to reach healthy sodium levels, that are below 1500 mg per day, is through regulations:


Havas-2: In the US so far there’s been no effort by the government to reduce the amount of sodium that food processors and the restaurant industry put in --absolutely none. A few countries such as the United Kingdom, France, Finland, Australia and Canada are all making efforts to try and convince at least food processors to reduce the amount of sodium in processed food. So you need public pressure and you need government regulation. It doesn’t have to be done overnight but over a ten year period this should be done and people wouldn’t even notice that sodium was being reduced



Dr. Stephen Havas, from Northwestern University in Chicago.




Psychotic patients’ symptoms improved rapidly after being given an infusion of sodium nitro-prusside, a vasodilator that’s been used to treat severe hypertension for more than 80 years



Yes, most psychotic symptoms diminished within four hours, according to two commonly used psychiatric symptom rating scales, while symptoms in patients who got a matching placebo didn’t improve. This is according to a study published in JAMA Psychiatry, which included 20 patients hospitalized for an acute phase of schizophrenia. The improvements are said to have lasted for up to four weeks without any apparent adverse effects.


Hmm, interesting. But weren’t the patients already on medications?



Yes, all patients were already on standard antipsychotics. But sodium nitro-prusside is hypothesized to affect schizophrenia through a novel pathway: by normalizing the function of N-methyl-D-aspartate glutamate receptors. Serdar Dursun, senior author of the study, said more research is needed to investigate the use of this agent.


Dursun: This is preliminary data, it’s a proof of concept study and we are very cautious because we know that it is a very heterogenous illness, very difficult to treat, so any such dramatic results should be treated with caution, because of the past failures of similar preliminary results not being repeated. We are very keen to do larger scale clinical trials, which might confirm our current data



Dr Serdar Dursun, from the University of Alberta in Edmonton, Canada.

BREVE 1 Sur fond musical  



Finally, in brief:


Patients with diarrhea-predominant irritable bowel syndrome who were given a gluten-free diet had fewer bowel movements per day than those whose diet contained gluten, in a small randomized trial published in the latest issue of Gastroenterology. In addition, the authors found that gluten alters bowel barrier functions in these patients, particularly for those who are HLA-DQ2/8-positive.






A few days ago the World Health Organization announced that the new coronavirus could be passed between individuals in close contact. This was after French health workers confirmed a second man had contracted the virus, in a possible case of human-to-human transmission: the patient had shared a hospital room with the first laboratory-confirmed patient. 120 persons were identified as contacts of the first case, laboratory tests were conducted on five suspected of being ill, of which only one proved positive..


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!


Previous editions


Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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