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Satraplatin for hormone-refractory prostate cancer
Newsdesk
Satraplatin for hormone-refractory prostate cancer Satraplatin, which is currently awaiting approval by the US Food and Drug Adminstration, significantly decreased the risk for disease progression in a phase III trial in hormone-refractory prostate cancer (HRPC), according to a study presented at the 3rd Prostate Cancer Symposium (Orlando, FL, USA; Feb 22–24, 2007). 950 patients who had failed treatment with at least one previous regimen were randomised to receive prednisone plus satraplatin, or placebo. Patients treated with satraplatin had a 40% decrease in the risk of disease progression compared with those in the placebo group. The improvement in progression-free survival (PFS) increased over time. At the median time, PFS was 11 weeks and 10 weeks in the satraplatin and placebo groups, respectively. At the 75th percentile, PFS improved by 89% (36 vs 19 weeks). After 6 months,
30% of the satraplatin and 17% of the placebo group had not progressed; and at 12 months, nonprogression was 16% and 7%, respectively. Study author Cora Sternberg (San Camillo Forlanini Hospital, Rome, Italy) says, “satraplatin will be an important addition to the limited treatment options available today to treat HRPC. There are currently no approved treatment options for HRPC patients who have failed chemotherapy. We have now seen compelling results with satraplatin in two randomised trials, in which it has shown statistically significant delays in disease progression. The efficacy of satraplatin is not affected by the type of prior chemotherapy: patients treated with docetaxel do as well as those who are treated with other chemotherapy regimens”. Winston Tan (Mayo Clinic, Jacksonville, FL, USA) comments, “this study
addresses a very important question that has remained unanswered for many years: what is the best secondline treatment for HRPC? The 1·5-week improvement in survival is small but significant. Whether this would translate into a true clinical benefit remains to be answered. The true benefit of satraplatin as a potential prostate-cancer drug needs to be studied further. Also, other drugs with reasonable toxicity should be tested”. The most common adverse effects of satraplatin were thrombocytopenia, neutropenia, nausea, vomiting, and diarrhoea, which were generally mild to moderate. However, Sternberg believes that this is a manageable sideeffect profile, even in older patients. She added that satraplatin can be taken at home, giving patients added convenience and a sense of control.
Cathel Kerr
Inflammatory polyarthritis increases death risk Rheumatoid arthritis substantially increases mortality in patients with cancer, a British study suggests (Arthritis Rheum 2007; 56: 790–98). Jarrod Franklin (University of Manchester, UK) and co-workers recruited 2105 patients in 1990–1999 with newonset inflammatory polyarthritis (IP),
Research could benefit patients with inflammatory arthritis and cancer
290
a condition that often develops into rheumatoid arthritis. “Approximately 75% of our cohort would go on to satisfy the criteria for rheumatoid arthritis”, says co-author Deborah Symmons (University of Manchester, UK). The researchers compared these patients with the general population of Norfolk, UK, in terms of overall cancer incidence and survival. The overall cancer incidence in patients with IP was not increased compared with the general population. But after adjusting for age, sex, and cancer-site, those with IP who had cancer had a substantially increased risk of death compared with the general population with cancer (hazard ratio 1·4 [95% CI 1·1–1·7]). “Compared with an increased incidence of cancer, reduced cancer survival might be a greater contributor to the increased cancer mortality observed in some rheumatoid arthritis populations”, the researchers conclude.
This association might be because cancers in patients with IP are treated less aggressively since such patients are frail, says Symmons. “It may be that the patients with IP are given the same therapy as the general population but develop more complications of treatment and die from it”, she adds. “[Sometimes,] patients with IP and cancer present late”, and, “[there should be] a close liaison between the rheumatologist and the oncologist when choosing the appropriate treatment for the patient and in deciding what to do about the treatment for IP”, she says. “This study will inspire further research to design better treatment for cancer patients with rheumatoid arthritis, thus helping to reduce mortality in these patients”, says Basudeb Bhar (Calcutta Medical Research Institute, India).
Sanjit Bagchi http://oncology.thelancet.com Vol 8 April 2007
Satraplatin for hormone-refractory prostate cancer Satraplatin, which is currently awaiting approval by the US Food and Drug Adminstration, significantly decreased the risk for disease progression in a phase III trial in hormone-refractory prostate cancer (HRPC), according to a study presented at the 3rd Prostate Cancer Symposium (Orlando, FL, USA; Feb 22–24, 2007). 950 patients who had failed treatment with at least one previous regimen were randomised to receive prednisone plus satraplatin, or placebo. Patients treated with satraplatin had a 40% decrease in the risk of disease progression compared with those in the placebo group. The improvement in progression-free survival (PFS) increased over time. At the median time, PFS was 11 weeks and 10 weeks in the satraplatin and placebo groups, respectively. At the 75th percentile, PFS improved by 89% (36 vs 19 weeks). After 6 months,
30% of the satraplatin and 17% of the placebo group had not progressed; and at 12 months, nonprogression was 16% and 7%, respectively. Study author Cora Sternberg (San Camillo Forlanini Hospital, Rome, Italy) says, “satraplatin will be an important addition to the limited treatment options available today to treat HRPC. There are currently no approved treatment options for HRPC patients who have failed chemotherapy. We have now seen compelling results with satraplatin in two randomised trials, in which it has shown statistically significant delays in disease progression. The efficacy of satraplatin is not affected by the type of prior chemotherapy: patients treated with docetaxel do as well as those who are treated with other chemotherapy regimens”. Winston Tan (Mayo Clinic, Jacksonville, FL, USA) comments, “this study
addresses a very important question that has remained unanswered for many years: what is the best secondline treatment for HRPC? The 1·5-week improvement in survival is small but significant. Whether this would translate into a true clinical benefit remains to be answered. The true benefit of satraplatin as a potential prostate-cancer drug needs to be studied further. Also, other drugs with reasonable toxicity should be tested”. The most common adverse effects of satraplatin were thrombocytopenia, neutropenia, nausea, vomiting, and diarrhoea, which were generally mild to moderate. However, Sternberg believes that this is a manageable sideeffect profile, even in older patients. She added that satraplatin can be taken at home, giving patients added convenience and a sense of control.
Cathel Kerr
Inflammatory polyarthritis increases death risk Rheumatoid arthritis substantially increases mortality in patients with cancer, a British study suggests (Arthritis Rheum 2007; 56: 790–98). Jarrod Franklin (University of Manchester, UK) and co-workers recruited 2105 patients in 1990–1999 with newonset inflammatory polyarthritis (IP),
Research could benefit patients with inflammatory arthritis and cancer
290
a condition that often develops into rheumatoid arthritis. “Approximately 75% of our cohort would go on to satisfy the criteria for rheumatoid arthritis”, says co-author Deborah Symmons (University of Manchester, UK). The researchers compared these patients with the general population of Norfolk, UK, in terms of overall cancer incidence and survival. The overall cancer incidence in patients with IP was not increased compared with the general population. But after adjusting for age, sex, and cancer-site, those with IP who had cancer had a substantially increased risk of death compared with the general population with cancer (hazard ratio 1·4 [95% CI 1·1–1·7]). “Compared with an increased incidence of cancer, reduced cancer survival might be a greater contributor to the increased cancer mortality observed in some rheumatoid arthritis populations”, the researchers conclude.
This association might be because cancers in patients with IP are treated less aggressively since such patients are frail, says Symmons. “It may be that the patients with IP are given the same therapy as the general population but develop more complications of treatment and die from it”, she adds. “[Sometimes,] patients with IP and cancer present late”, and, “[there should be] a close liaison between the rheumatologist and the oncologist when choosing the appropriate treatment for the patient and in deciding what to do about the treatment for IP”, she says. “This study will inspire further research to design better treatment for cancer patients with rheumatoid arthritis, thus helping to reduce mortality in these patients”, says Basudeb Bhar (Calcutta Medical Research Institute, India).
Sanjit Bagchi http://oncology.thelancet.com Vol 8 April 2007