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Progress in immunotherapy for melanoma?
SCIENCE AND MEDICINE
NEWS Screening unnecessary for women taking tamoxifen invasive and unpleasant tests. Barakat (J Clin Oncol 2000; 18: “Neither biopsy nor TVS is suffi3459–63). ciently reliable and accurate to detect In the second study Bernd Gerber endometrial cancer”, he concludes. (University of Rostock, Germany) Gerber agrees and stresses that studied a group of 247 tamoxifen“women taking tamoxifen have only a treated women and 98 controls by slightly increased risk of developing carrying out TVS for endometrial endometrial cancer. abnormalities every 6 The high rate of false months for up to 5 Rights were not positives and iatrogenic years. The mean granted to complications of endometrial thickness include this screening makes it was 3·5 (SD 1·1 mm) unfeasible and unecobefore treatment and image in nomic, bearing in mind increased to a maxielectronic the greater numbers of mum of 9·2 (SD 5·1 media. Please women likely to be mm) after 3 years of refer to the given tamoxifen in the tamoxifen therapy. The printed journal. future.” Laurie Elit endometrium of (Hamilton Regional patients taking tamoxCancer, ON, Canada) ifen was significantly suggests that “all thicker than that of controls. Although 52 Unfeasible and uneconomic? t a m o x i f e n - t r e a t e d patients with a uterus asymptomatic patients should have pap smear screening for underwent further investigation by cervical cancer prevention”, and dilation and curettage and hysagrees with Trevor Powles (Royal teroscopy after the TVS revealed Marsden Hospital, London, UK) that abnormalities, only one patient had any abnormal bleeding, spotting, or endometrial cancer. Worryingly, four bloodstained discharge should be patients had uterine perforations durassessed by a gynaecologist and invesing the procedures. “The study tigated by biopsy if clinically indirevealed that TVS produced a very cated. “Bleeding is usually the earliest high rate of false positives in women sign of endometrial cancer; if a taking tamoxifen”, comments Gerber woman is treated quickly, survival (J Clin Oncol 2000; 18: 3464–70). rates are high”, concludes Powles. Barakat says that the two studies show that women who take tamoxifen do not need to undergo a battery of Kathryn Senior Science Photo Library
omen with breast cancer who take tamoxifen on a long-term basis are at increased risk of developing endometrial cancer, but two studies published this week confirm unequivocally that routine screening using biopsy techniques or transvaginal sonography (TVS) is unnecessary. Richard Barakat and colleagues at the Memorial Sloan-Kettering Cancer Centre in New York (NY, USA) did a prospective study of 159 patients who had just started tamoxifen therapy for breast cancer that was confined to the breast and axilliary lymph nodes. Endometrial biopsy samples were taken at the start of treatment and at 6-month intervals for 2 years. Each patient then had three subsequent annual biopsies. Patients were excluded from the analysis if they had previously had a hysterectomy, had previously used oestrogen-replacement therapy, or if they could not tolerate the biopsy. The 111 women who were not excluded underwent a total of 635 endometrial biopsies. 86% of the biopsy samples revealed benign endometria; only nine samples were abnormal and were followed-up by a dilation and curettage with hysteroscopy. “In the group of women studied, extensive investigation resulted in only three hysterectomies; only one of these actually had pathology determined by the biopsy”, says
W
Progress in immunotherapy for melanoma?
T
he preliminary results of the largest ever phase III randomised trial for metastatic melanoma were presented at the 25th European Society of Medical Oncologists congress (Hamburg, Germany; Oct 13–17) this week. 363 patients with advanced metastatic melanoma were randomised to receive dacarbazine, cisplatin, and interferon-alpha with or without high-dose intravenous interleukin-2 (IL-2). The trial, conducted by the European Organization for Research and Treatment of Cancer, was designed to detect an increase in survival from 15%, which is
THE LANCET • Vol 356 • October 21, 2000
achievable with standard treatment, to 20% with the addition of IL-2. Ullrich Keilholz (Free University Berlin, Germany) told the congress that no overall survival difference was seen after a median patient follow up of 2·3 years. However, planned subgroup analyses showed that although 192 patients who were without symptoms had a median survival of 12 months, those 170 patients whose melanoma had spread to the extent that the patient had symptoms had a median survival of only 6·1 months. To date, 16 of 95 patients receiving IL-2 are alive, compared with nine
of 95 controls. “It is logical that patients with a poor performance status [an index of illness severity] did not respond to IL-2, as they were probably too ill to mount an immune response”, suggests Keilholz. “We know from previous studies that if patients survive for 2 years they have a good chance of a durable remission, so this would represent a real benefit”, he says. “These early results show that follow-up, to identify metastatic melanoma patients before they become symptomatic, may be very important.” Ezzie Hutchinson
1415
For personal use only. Not to be reproduced without permission of The Lancet.
NEWS Screening unnecessary for women taking tamoxifen invasive and unpleasant tests. Barakat (J Clin Oncol 2000; 18: “Neither biopsy nor TVS is suffi3459–63). ciently reliable and accurate to detect In the second study Bernd Gerber endometrial cancer”, he concludes. (University of Rostock, Germany) Gerber agrees and stresses that studied a group of 247 tamoxifen“women taking tamoxifen have only a treated women and 98 controls by slightly increased risk of developing carrying out TVS for endometrial endometrial cancer. abnormalities every 6 The high rate of false months for up to 5 Rights were not positives and iatrogenic years. The mean granted to complications of endometrial thickness include this screening makes it was 3·5 (SD 1·1 mm) unfeasible and unecobefore treatment and image in nomic, bearing in mind increased to a maxielectronic the greater numbers of mum of 9·2 (SD 5·1 media. Please women likely to be mm) after 3 years of refer to the given tamoxifen in the tamoxifen therapy. The printed journal. future.” Laurie Elit endometrium of (Hamilton Regional patients taking tamoxCancer, ON, Canada) ifen was significantly suggests that “all thicker than that of controls. Although 52 Unfeasible and uneconomic? t a m o x i f e n - t r e a t e d patients with a uterus asymptomatic patients should have pap smear screening for underwent further investigation by cervical cancer prevention”, and dilation and curettage and hysagrees with Trevor Powles (Royal teroscopy after the TVS revealed Marsden Hospital, London, UK) that abnormalities, only one patient had any abnormal bleeding, spotting, or endometrial cancer. Worryingly, four bloodstained discharge should be patients had uterine perforations durassessed by a gynaecologist and invesing the procedures. “The study tigated by biopsy if clinically indirevealed that TVS produced a very cated. “Bleeding is usually the earliest high rate of false positives in women sign of endometrial cancer; if a taking tamoxifen”, comments Gerber woman is treated quickly, survival (J Clin Oncol 2000; 18: 3464–70). rates are high”, concludes Powles. Barakat says that the two studies show that women who take tamoxifen do not need to undergo a battery of Kathryn Senior Science Photo Library
omen with breast cancer who take tamoxifen on a long-term basis are at increased risk of developing endometrial cancer, but two studies published this week confirm unequivocally that routine screening using biopsy techniques or transvaginal sonography (TVS) is unnecessary. Richard Barakat and colleagues at the Memorial Sloan-Kettering Cancer Centre in New York (NY, USA) did a prospective study of 159 patients who had just started tamoxifen therapy for breast cancer that was confined to the breast and axilliary lymph nodes. Endometrial biopsy samples were taken at the start of treatment and at 6-month intervals for 2 years. Each patient then had three subsequent annual biopsies. Patients were excluded from the analysis if they had previously had a hysterectomy, had previously used oestrogen-replacement therapy, or if they could not tolerate the biopsy. The 111 women who were not excluded underwent a total of 635 endometrial biopsies. 86% of the biopsy samples revealed benign endometria; only nine samples were abnormal and were followed-up by a dilation and curettage with hysteroscopy. “In the group of women studied, extensive investigation resulted in only three hysterectomies; only one of these actually had pathology determined by the biopsy”, says
W
Progress in immunotherapy for melanoma?
T
he preliminary results of the largest ever phase III randomised trial for metastatic melanoma were presented at the 25th European Society of Medical Oncologists congress (Hamburg, Germany; Oct 13–17) this week. 363 patients with advanced metastatic melanoma were randomised to receive dacarbazine, cisplatin, and interferon-alpha with or without high-dose intravenous interleukin-2 (IL-2). The trial, conducted by the European Organization for Research and Treatment of Cancer, was designed to detect an increase in survival from 15%, which is
THE LANCET • Vol 356 • October 21, 2000
achievable with standard treatment, to 20% with the addition of IL-2. Ullrich Keilholz (Free University Berlin, Germany) told the congress that no overall survival difference was seen after a median patient follow up of 2·3 years. However, planned subgroup analyses showed that although 192 patients who were without symptoms had a median survival of 12 months, those 170 patients whose melanoma had spread to the extent that the patient had symptoms had a median survival of only 6·1 months. To date, 16 of 95 patients receiving IL-2 are alive, compared with nine
of 95 controls. “It is logical that patients with a poor performance status [an index of illness severity] did not respond to IL-2, as they were probably too ill to mount an immune response”, suggests Keilholz. “We know from previous studies that if patients survive for 2 years they have a good chance of a durable remission, so this would represent a real benefit”, he says. “These early results show that follow-up, to identify metastatic melanoma patients before they become symptomatic, may be very important.” Ezzie Hutchinson
1415
For personal use only. Not to be reproduced without permission of The Lancet.