- Email: [email protected]
Imatinib helps elderly patients with leukaemia
Newsdesk
Imatinib helps elderly patients with leukaemia In the Group for Research on Adult Acute Lymphoblastic Leukemia study, 30 elderly patients with Ph+ALL were treated with chemotherapy alternated with imatinib and steroids. After treatment, 90% of patients achieved complete remission (95% CI 73–98), versus 48% (26–70) of 21 historical controls who were given chemotherapy only. The new treatment also increased median relapse-free survival from 4·2 to 20·1 months (p<0·0003). “This paper extends accumulating evidence for the clinical value of imatinib in the treatment of Ph+ALL in elderly patients”, says Oliver Ottmann (Johann Wolfgang Goethe University, Frankfurt, Germany), who has previously shown that concurrent use of imatinib with chemotherapy improves outcomes in such patients. Deborah Thomas (MD Anderson Cancer Center, Houston, TX, USA) agrees that the study supports imatinib use, but adds
that some outcome improvements could be due to changes in supportive care. Future trials will address this issue and test new tyrosine-kinase inhibitors in elderly patients with Ph+ALL.
Jane Bradbury
Professor Aaron Pollack/Science Photo Library
New results suggest that the addition of imatinib to chemotherapy regimens might improve outcome in elderly patients with Philadelphia-positive (Ph+) acute lymphoblastic leukaemia (ALL; Leukemia 2006; 20: 1526–32). But lead researcher André Delannoy (Jolimont Hospital, Haine-Saint-Paul, Belgium) warns, “although our findings are encouraging, it seems unlikely, given the relapse-free survival curve, that a substantial number of patients will be cured by this treatment strategy”. In elderly people, Ph+ALL has a poor prognosis—few survive longer than a few months. Imatinib, which inhibits the BCR/ABL protein kinase encoded by the Philadelphia chromosome, has good activity in young adults with Ph+ALL, but “treatments that are used in these patients cannot simply be transposed to the elderly who often cannot tolerate intensive chemotherapy”, notes Delannoy.
Treatment for ALL extended to elderly patients
Breast reconstruction compromises radiotherapy planning A US study has shown that radiotherapy planning is compromised in more than half of women undergoing breast reconstruction immediately after mastectomy for breast cancer, compared with fewer than one in ten matched controls with delayed reconstruction (Int J Radiat Oncol Biol Phys 2006; 66: 76–82). Researchers assessed the effect of immediate reconstruction of the breast on radiotherapy planning in 110 women (112 treatment plans) who had mastectomy with immediate transverse rectus abdominis muscle (TRAM) flap reconstruction at the University of Texas MD Anderson Cancer Center (Houston, TX, USA) in 1989–2003, compared with stagematched controls who underwent mastectomy without intervening reconstruction. Radiotherapy planning was assessed by four variables: breadth of chest-wall http://oncology.thelancet.com Vol 7 October 2006
coverage, treatment of the ipsilateral internal mammary chain, reduction of lung irradiation, and avoidance of the heart. 52% of plans for women with immediate reconstruction were compromised, compared with 7% for controls (p<0·0001). 33% of radiotherapy plans after breast reconstruction were moderately compromised, and 19% involved a major compromise. Optimum chest-wall coverage was achieved in 79% of women with immediate reconstruction compared with 100% in controls (p<0·0001). Likewise, the ipsilateral internal mammary chain was treated in 45% and 93% (p<0·0001); irradiation of the lung was kept to a minimum in 84% and 97% (p=0·0015); and the heart was avoided in 84% and 92% (p=0·1435). The researchers, led by Sabin Motwani, say: “for patients with locally
advanced breast cancer, the potential for compromised radiotherapy planning after mastectomy should be considered when deciding between immediate and delayed reconstruction”. The results, although unsurprising, raise important issues about this procedure. But they do not show the effect on recurrence or survival, says Hugh Bishop (Royal Bolton Hospital, UK, and president of the Association of Breast Surgery, London, UK). “If patients got less radiotherapy than they should have done, we need to know if this leads to increased local recurrence and reduced survival.” Bishop also cautions that patients had transverse rectus abdominis muscle-flap reconstruction, which uses abdominal fat that does not react well to radiotherapy, and that other reconstructive techniques might have less of an effect.
Susan Mayor 803
Imatinib helps elderly patients with leukaemia In the Group for Research on Adult Acute Lymphoblastic Leukemia study, 30 elderly patients with Ph+ALL were treated with chemotherapy alternated with imatinib and steroids. After treatment, 90% of patients achieved complete remission (95% CI 73–98), versus 48% (26–70) of 21 historical controls who were given chemotherapy only. The new treatment also increased median relapse-free survival from 4·2 to 20·1 months (p<0·0003). “This paper extends accumulating evidence for the clinical value of imatinib in the treatment of Ph+ALL in elderly patients”, says Oliver Ottmann (Johann Wolfgang Goethe University, Frankfurt, Germany), who has previously shown that concurrent use of imatinib with chemotherapy improves outcomes in such patients. Deborah Thomas (MD Anderson Cancer Center, Houston, TX, USA) agrees that the study supports imatinib use, but adds
that some outcome improvements could be due to changes in supportive care. Future trials will address this issue and test new tyrosine-kinase inhibitors in elderly patients with Ph+ALL.
Jane Bradbury
Professor Aaron Pollack/Science Photo Library
New results suggest that the addition of imatinib to chemotherapy regimens might improve outcome in elderly patients with Philadelphia-positive (Ph+) acute lymphoblastic leukaemia (ALL; Leukemia 2006; 20: 1526–32). But lead researcher André Delannoy (Jolimont Hospital, Haine-Saint-Paul, Belgium) warns, “although our findings are encouraging, it seems unlikely, given the relapse-free survival curve, that a substantial number of patients will be cured by this treatment strategy”. In elderly people, Ph+ALL has a poor prognosis—few survive longer than a few months. Imatinib, which inhibits the BCR/ABL protein kinase encoded by the Philadelphia chromosome, has good activity in young adults with Ph+ALL, but “treatments that are used in these patients cannot simply be transposed to the elderly who often cannot tolerate intensive chemotherapy”, notes Delannoy.
Treatment for ALL extended to elderly patients
Breast reconstruction compromises radiotherapy planning A US study has shown that radiotherapy planning is compromised in more than half of women undergoing breast reconstruction immediately after mastectomy for breast cancer, compared with fewer than one in ten matched controls with delayed reconstruction (Int J Radiat Oncol Biol Phys 2006; 66: 76–82). Researchers assessed the effect of immediate reconstruction of the breast on radiotherapy planning in 110 women (112 treatment plans) who had mastectomy with immediate transverse rectus abdominis muscle (TRAM) flap reconstruction at the University of Texas MD Anderson Cancer Center (Houston, TX, USA) in 1989–2003, compared with stagematched controls who underwent mastectomy without intervening reconstruction. Radiotherapy planning was assessed by four variables: breadth of chest-wall http://oncology.thelancet.com Vol 7 October 2006
coverage, treatment of the ipsilateral internal mammary chain, reduction of lung irradiation, and avoidance of the heart. 52% of plans for women with immediate reconstruction were compromised, compared with 7% for controls (p<0·0001). 33% of radiotherapy plans after breast reconstruction were moderately compromised, and 19% involved a major compromise. Optimum chest-wall coverage was achieved in 79% of women with immediate reconstruction compared with 100% in controls (p<0·0001). Likewise, the ipsilateral internal mammary chain was treated in 45% and 93% (p<0·0001); irradiation of the lung was kept to a minimum in 84% and 97% (p=0·0015); and the heart was avoided in 84% and 92% (p=0·1435). The researchers, led by Sabin Motwani, say: “for patients with locally
advanced breast cancer, the potential for compromised radiotherapy planning after mastectomy should be considered when deciding between immediate and delayed reconstruction”. The results, although unsurprising, raise important issues about this procedure. But they do not show the effect on recurrence or survival, says Hugh Bishop (Royal Bolton Hospital, UK, and president of the Association of Breast Surgery, London, UK). “If patients got less radiotherapy than they should have done, we need to know if this leads to increased local recurrence and reduced survival.” Bishop also cautions that patients had transverse rectus abdominis muscle-flap reconstruction, which uses abdominal fat that does not react well to radiotherapy, and that other reconstructive techniques might have less of an effect.
Susan Mayor 803