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Pazopanib or sunitinib for metastatic renal-cell carcinoma?
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Women who drink alcohol between their first period and their first pregnancy are at an increased risk of developing breast cancer, results of recent research suggests. Alcohol is well known to be a risk factor for cancer, but few studies have explored whether the timing of alcohol consumption can influence the development of cancer. US researchers analysed the medical histories of 91 005 women aged 25–44 years and data on lifestyle factors including alcohol consumption during four different periods of age. Among these women were 1609 cases of breast cancer and 970 cases of proliferative benign breast disease (BBD)—when presenting with atypia is associated with risk of breast cancer. Overall, the researchers concluded that drinking alcohol between the
ages of the first period and first pregnancy increased the risk of breast cancer (RR=1·13 per 10 g per day intake, 95% CI 1·03–1·24) compared with women who did not consume alcohol before their first pregnancy. Drinking before first pregnancy also increased the risk of proliferative BBD (RR=1·16 per 10 g per day intake, 1·02–1·32). The researchers also noted that the risk of breast cancer increased with the length of time between first period and first pregnancy. Lead researcher Graham Colditz (Washington University School of Medicine, St Louis, MO, USA) said, “The age at which women are having their first child is continuing to rise in high-income countries, so the adverse effect of alcohol consumption through these years becomes even
more evident and more important for prevention.” Richard Francis, Head of Research at Breakthrough Breast Cancer (London, UK), said, “This study confirms that alcohol intake increases the risk of developing breast cancer, particularly between the ages of a woman’s first period and her first pregnancy. This could be caused by breast tissue being particularly susceptible to developing cancer between these key ages.” Claire Knight, from Cancer Research UK (London, UK) added that although the study supported the theory that drinking before a first pregnancy could increase the risk of breast cancer, a lot more evidence is needed before we can be certain.
Ian Hooton/Science Photo Library
Drinking alcohol before first pregnancy ups breast cancer risk
Published Online August 31, 2013 http://dx.doi.org/10.1016/ S1470-2045(13)70408-X For the study see J Natl Cancer Inst 2013; published online Aug 28. DOI:10.1093/jnci/djt213
Sanjay Tanday
Pazopanib or sunitinib for metastatic renal-cell carcinoma? Pazopanib is non-inferior to sunitinib for the first-line treatment of metastatic renal-cell carcinoma and has a favourable safety and quality-oflife profile, according to the results of a phase 3 trial. The investigators randomly assigned 1110 patients and compared efficacy, safety, and quality-of-life results. The primary endpoint was progressionfree survival, and the investigators reported a hazard ratio for progression of disease or death from any cause for pazopanib of 1·05 (95% CI 0·90–1·22), which was within the predefined noninferiority margin. “The COMPARZ trial is the largest study comparing two approved therapies for the treatment of metastatic renal-cell carcinoma”, said study coauthor Robert Motzer (Memorial Sloan-Kettering Cancer Center, New York, NY, USA). Discussing the results, he added, “Pazopanib had similar efficacy to sunitinib, but a differentiated safety profile. While www.thelancet.com/oncology Vol 14 October 2013
mild and moderate adverse events were associated with both drugs, the adverse events occurring more frequently with sunitinib are more troublesome to patients in their dayto-day activities.” Commenting on the study, Martin Gore (Royal Marsden Hospital, London, UK) told The Lancet Oncology, “There is little doubt from this study that pazopanib is better tolerated by patients than sunitinib.” However, he also noted that the trial “was designed to allow an increase in the risk of disease progression or death of up to 25%, which is higher than differences that would often be considered clinically significant in trials where superiority between two interventions is sought”. Although Gore noted that the actual results showed little difference in efficacy, he drew attention to the issue of interpreting non-inferiority trials and communicating their results to patients to enable informed
choices. “Patients may wish to trade a potential loss of efficacy for a relative improvement in quality of life, and this is at the heart of many non-inferiority trials. In such circumstances physicians must explain to patients that ‘non-inferiority’ is not synonymous with ‘as effective’”. Brian Rini (Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA) suggested that the findings “allow the clinician to choose the most appropriate therapy for each patient based on the risk-to-benefit ratio for that patient, which is influenced by factors such as comorbidities and how a specific toxicity would affect the quality of life of that individual”. However, he added, “given that the benefit of either drug is ultimately limited and requires chronic therapy, investigation of novel therapeutics remains a priority in metastatic renalcell carcinoma”.
Published Online August 31, 2013 http://dx.doi.org/10.1016/ S1470-2045(13)70409-1 For the study see http://www. nejm.org/doi/full/10.1056/ NEJMoa1303989
Neil Bennet e442
Women who drink alcohol between their first period and their first pregnancy are at an increased risk of developing breast cancer, results of recent research suggests. Alcohol is well known to be a risk factor for cancer, but few studies have explored whether the timing of alcohol consumption can influence the development of cancer. US researchers analysed the medical histories of 91 005 women aged 25–44 years and data on lifestyle factors including alcohol consumption during four different periods of age. Among these women were 1609 cases of breast cancer and 970 cases of proliferative benign breast disease (BBD)—when presenting with atypia is associated with risk of breast cancer. Overall, the researchers concluded that drinking alcohol between the
ages of the first period and first pregnancy increased the risk of breast cancer (RR=1·13 per 10 g per day intake, 95% CI 1·03–1·24) compared with women who did not consume alcohol before their first pregnancy. Drinking before first pregnancy also increased the risk of proliferative BBD (RR=1·16 per 10 g per day intake, 1·02–1·32). The researchers also noted that the risk of breast cancer increased with the length of time between first period and first pregnancy. Lead researcher Graham Colditz (Washington University School of Medicine, St Louis, MO, USA) said, “The age at which women are having their first child is continuing to rise in high-income countries, so the adverse effect of alcohol consumption through these years becomes even
more evident and more important for prevention.” Richard Francis, Head of Research at Breakthrough Breast Cancer (London, UK), said, “This study confirms that alcohol intake increases the risk of developing breast cancer, particularly between the ages of a woman’s first period and her first pregnancy. This could be caused by breast tissue being particularly susceptible to developing cancer between these key ages.” Claire Knight, from Cancer Research UK (London, UK) added that although the study supported the theory that drinking before a first pregnancy could increase the risk of breast cancer, a lot more evidence is needed before we can be certain.
Ian Hooton/Science Photo Library
Drinking alcohol before first pregnancy ups breast cancer risk
Published Online August 31, 2013 http://dx.doi.org/10.1016/ S1470-2045(13)70408-X For the study see J Natl Cancer Inst 2013; published online Aug 28. DOI:10.1093/jnci/djt213
Sanjay Tanday
Pazopanib or sunitinib for metastatic renal-cell carcinoma? Pazopanib is non-inferior to sunitinib for the first-line treatment of metastatic renal-cell carcinoma and has a favourable safety and quality-oflife profile, according to the results of a phase 3 trial. The investigators randomly assigned 1110 patients and compared efficacy, safety, and quality-of-life results. The primary endpoint was progressionfree survival, and the investigators reported a hazard ratio for progression of disease or death from any cause for pazopanib of 1·05 (95% CI 0·90–1·22), which was within the predefined noninferiority margin. “The COMPARZ trial is the largest study comparing two approved therapies for the treatment of metastatic renal-cell carcinoma”, said study coauthor Robert Motzer (Memorial Sloan-Kettering Cancer Center, New York, NY, USA). Discussing the results, he added, “Pazopanib had similar efficacy to sunitinib, but a differentiated safety profile. While www.thelancet.com/oncology Vol 14 October 2013
mild and moderate adverse events were associated with both drugs, the adverse events occurring more frequently with sunitinib are more troublesome to patients in their dayto-day activities.” Commenting on the study, Martin Gore (Royal Marsden Hospital, London, UK) told The Lancet Oncology, “There is little doubt from this study that pazopanib is better tolerated by patients than sunitinib.” However, he also noted that the trial “was designed to allow an increase in the risk of disease progression or death of up to 25%, which is higher than differences that would often be considered clinically significant in trials where superiority between two interventions is sought”. Although Gore noted that the actual results showed little difference in efficacy, he drew attention to the issue of interpreting non-inferiority trials and communicating their results to patients to enable informed
choices. “Patients may wish to trade a potential loss of efficacy for a relative improvement in quality of life, and this is at the heart of many non-inferiority trials. In such circumstances physicians must explain to patients that ‘non-inferiority’ is not synonymous with ‘as effective’”. Brian Rini (Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA) suggested that the findings “allow the clinician to choose the most appropriate therapy for each patient based on the risk-to-benefit ratio for that patient, which is influenced by factors such as comorbidities and how a specific toxicity would affect the quality of life of that individual”. However, he added, “given that the benefit of either drug is ultimately limited and requires chronic therapy, investigation of novel therapeutics remains a priority in metastatic renalcell carcinoma”.
Published Online August 31, 2013 http://dx.doi.org/10.1016/ S1470-2045(13)70409-1 For the study see http://www. nejm.org/doi/full/10.1056/ NEJMoa1303989
Neil Bennet e442