- Email: [email protected]
NICE: opioids should be first-line for cancer pain
News
Chromosome 8q gain in clear-cell renal-cell carcinoma Gain of chromosome 8q is an independent prognostic factor and is associated with increased risk of metastases and death from clear-cell renal-cell carcinoma (RCC) according to a new study. Chromosome 8q harbours the proto-oncogene c-MYC that might be upregulated by a gain in chromosome 8q, which activates the MAPK pathway. One of the study’s authors, Arie S Belldegrun (David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA), explained that “[The idea of] ‘one size fits them all’ does not work in renal cancers as there are different types of kidney cancers each with different biology, progression pattern, and varying controlling genes. Recognising the subtype of the tumour will direct best personalised therapy for the disease. Kidney cancer is becoming the paradigm for tailored cancer therapy.”
He added that: “we hope that defining patients by 8q gain may assist in personalising therapy [for patients] who might benefit from specific c-MYC inhibitors or agents that target the MAPK pathway”. Researchers assessed 336 patients with clear-cell RCC for cytogenetic analysis. 28 (8·3%) patients had 8q chromosomal gain, which was associated with a raised risk of regional lymph node metastases (21·4% of patients with gain vs 6·2% of those without; p=0·011) and distant metastases (50·0% vs 24·4%; p=0·006) and increased tumour sizes (7·4 cm vs 5·2 cm; p=0·030). Similarly, patients with 8q gain had a risk of death from clear-cell RCC 3·22 times higher than did those without such a gain (p<0·001). Multivariate analysis established that 8q chromosomal gain is an independent prognostic factor (hazard ratio 2·37, p=0·006).
Paul Russo (Memorial Sloan Kettering Cancer Center, New York, NY, USA) comments that “the identification of another potential pathway to target [clear-cell RCC] with new systemic agents and the early identification of a poor prognostic renal cancer creates an exciting potential for the rational design of adjuvant systemic therapy clinical trials”. He further adds that: “The day may come in the not-too-distant future when a resected kidney cancer will be subjected to cytogenetic analysis and an individual and specific adjuvant therapy based on that analysis will then be prescribed with the aim of improving the chance for longterm survival and sparing patients unnecessary treatment when they are not destined to profit”.
Published Online June 1, 2012 DOI:10.1016/S14702045(12)70255-3 For more on the clear-cell renal-cell carcinoma study see Cancer 2012; published online May 17. DOI:10.1002/cncr.27607
Sharan Prakash Sharma
NICE: opioids should be first-line for cancer pain
www.thelancet.com/oncology Vol 13 July 2012
adequate knowledge and skills with which to educate patients and dispel their fears and to prevent or treat sideeffects; a tall order for professionals new to using opioids”. Andrew Davies (The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK) also has reservations. “Unfortunately, some sections of the NICE guideline contradict similar sections in other guidelines and this creates a risk that non-specialists will be unsure about the best course of action. The general principles remain the same though, so most oncologists will not need to modify their normal practice”, he comments. UK patients with advanced cancer are often given doses of strong opioids that are insufficient. Refining of guidelines will help to address this issue, but Given believes that improved education about pain management should be introduced for health professionals
in the long term. “There have been some improvements in nursing and medical training but pain management education should be given a higher priority. The next generation of health professionals needs to have sufficient skills and knowledge of pain management in clinical practice to be able to give cancer patients with pain a better quality of life”, he recommends.
Published Online June 1, 2012 DOI:10.1016/S14702045(12)70256-5 For more on the NICE guidelines see http://publications.nice.org. uk/opioids-in-palliative-caresafe-and-effective-prescribingof-strong-opioids-for-pain-inpalliative-cg140
Kathryn Senior
Bsip, Platriez/Science Photo Library
The newly released recommendations for opioids in palliative care from the UK’s National Institute of Health and Clinical Excellence (NICE) is the latest in a series of guidelines about the management of severe cancer pain. It is aimed at non-specialist health-care professionals who are initiating strong opioids for adults with advanced and progressive disease. The guidance aims to overcome reluctance from health professionals and patients who are concerned about side-effects of opioids, risk of toxic effects, whether long-term use will lead to tolerance and therefore unmanageable pain, and whether use of opioids will be taken as a signal of end-of-life care. Jamie Given (The London Clinic, London, UK) welcomes the guidelines, which he says “have been a long time coming”. Given warns, however, that “the onus will still be on health professionals to ensure they have
e289
Chromosome 8q gain in clear-cell renal-cell carcinoma Gain of chromosome 8q is an independent prognostic factor and is associated with increased risk of metastases and death from clear-cell renal-cell carcinoma (RCC) according to a new study. Chromosome 8q harbours the proto-oncogene c-MYC that might be upregulated by a gain in chromosome 8q, which activates the MAPK pathway. One of the study’s authors, Arie S Belldegrun (David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA), explained that “[The idea of] ‘one size fits them all’ does not work in renal cancers as there are different types of kidney cancers each with different biology, progression pattern, and varying controlling genes. Recognising the subtype of the tumour will direct best personalised therapy for the disease. Kidney cancer is becoming the paradigm for tailored cancer therapy.”
He added that: “we hope that defining patients by 8q gain may assist in personalising therapy [for patients] who might benefit from specific c-MYC inhibitors or agents that target the MAPK pathway”. Researchers assessed 336 patients with clear-cell RCC for cytogenetic analysis. 28 (8·3%) patients had 8q chromosomal gain, which was associated with a raised risk of regional lymph node metastases (21·4% of patients with gain vs 6·2% of those without; p=0·011) and distant metastases (50·0% vs 24·4%; p=0·006) and increased tumour sizes (7·4 cm vs 5·2 cm; p=0·030). Similarly, patients with 8q gain had a risk of death from clear-cell RCC 3·22 times higher than did those without such a gain (p<0·001). Multivariate analysis established that 8q chromosomal gain is an independent prognostic factor (hazard ratio 2·37, p=0·006).
Paul Russo (Memorial Sloan Kettering Cancer Center, New York, NY, USA) comments that “the identification of another potential pathway to target [clear-cell RCC] with new systemic agents and the early identification of a poor prognostic renal cancer creates an exciting potential for the rational design of adjuvant systemic therapy clinical trials”. He further adds that: “The day may come in the not-too-distant future when a resected kidney cancer will be subjected to cytogenetic analysis and an individual and specific adjuvant therapy based on that analysis will then be prescribed with the aim of improving the chance for longterm survival and sparing patients unnecessary treatment when they are not destined to profit”.
Published Online June 1, 2012 DOI:10.1016/S14702045(12)70255-3 For more on the clear-cell renal-cell carcinoma study see Cancer 2012; published online May 17. DOI:10.1002/cncr.27607
Sharan Prakash Sharma
NICE: opioids should be first-line for cancer pain
www.thelancet.com/oncology Vol 13 July 2012
adequate knowledge and skills with which to educate patients and dispel their fears and to prevent or treat sideeffects; a tall order for professionals new to using opioids”. Andrew Davies (The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK) also has reservations. “Unfortunately, some sections of the NICE guideline contradict similar sections in other guidelines and this creates a risk that non-specialists will be unsure about the best course of action. The general principles remain the same though, so most oncologists will not need to modify their normal practice”, he comments. UK patients with advanced cancer are often given doses of strong opioids that are insufficient. Refining of guidelines will help to address this issue, but Given believes that improved education about pain management should be introduced for health professionals
in the long term. “There have been some improvements in nursing and medical training but pain management education should be given a higher priority. The next generation of health professionals needs to have sufficient skills and knowledge of pain management in clinical practice to be able to give cancer patients with pain a better quality of life”, he recommends.
Published Online June 1, 2012 DOI:10.1016/S14702045(12)70256-5 For more on the NICE guidelines see http://publications.nice.org. uk/opioids-in-palliative-caresafe-and-effective-prescribingof-strong-opioids-for-pain-inpalliative-cg140
Kathryn Senior
Bsip, Platriez/Science Photo Library
The newly released recommendations for opioids in palliative care from the UK’s National Institute of Health and Clinical Excellence (NICE) is the latest in a series of guidelines about the management of severe cancer pain. It is aimed at non-specialist health-care professionals who are initiating strong opioids for adults with advanced and progressive disease. The guidance aims to overcome reluctance from health professionals and patients who are concerned about side-effects of opioids, risk of toxic effects, whether long-term use will lead to tolerance and therefore unmanageable pain, and whether use of opioids will be taken as a signal of end-of-life care. Jamie Given (The London Clinic, London, UK) welcomes the guidelines, which he says “have been a long time coming”. Given warns, however, that “the onus will still be on health professionals to ensure they have
e289