News in brief: Call to step up latent infection screening; Genetic clue to oesophageal cancer; Obesity paradox in breast cancer

8 Apr 2021

Multicultural community requires better ID screening  

Researchers have called for universal screening for latent and undiagnosed infections among overseas-born patients with cancer.

An audit of 952 overseas-born patients presenting at the Peter MacCallum Cancer Centre in 2019 found only about half were screened for hepatitis B (58.9%) and hepatitis C infections (50.7%). Fewer patients were screened for HIV (30.5%) and latent TB (18.3%) infections.

The study found that even among epidemiologically high-risk patients, 35% were not screened for any infection before commencing cancer therapy.

“If patients were screened according to epidemiological risk, 10% (N = 8) of HBV positive patients would have been missed, and 11% (N = 4) of patients with LTBI,” the study said.

Patients with haematological malignancies were more likely to be screened than those with solid cancers.

“Our data demonstrate the need for a comprehensive and accessible screening protocol for latent infections prior to cancer therapy, especially for cancer patients born outside of Australia,” the researchers said.

Supportive Care in Cancer

Genetic drivers for EAC explored 

Loss of the tumour suppressor gene SMAD4 promotes progression of high-grade Barrett’s oesophagus towards oesophageal adenocarcinoma (EAC).

Melbourne-led research, published in Cellular and Molecular Gastroenterology and Hepatology, found up-regulation of oncogenes such as CDC6 and silencing of tumour suppressor genes following SMAD4 loss in a high-grade dysplastic Barrett’s oesophageal cell line.

The researchers said there is other evidence that SMAD4 loss is present in about 44% of patients with loco-regional and distant metastasis – suggesting an important role of SMAD4 loss in driving the invasive and metastatic potential of EAC.

“Given the replication stress and increased genomic instability, it may be possible to utilise vulnerabilities in cells with SMAD4 loss as a therapeutic advantage.”

They said incorporating SMAD4 loss as a clinically relevant biomarker of dysplastic Barrett’s progression towards EAC, might be of utmost benefit for early intervention and prevention.

Obesity paradox in HER2+ breast cancer 

High BMI is associated with worse survival in early HER2-positive breast cancer and improved survival in advanced HER2-positive breast cancer.

A post hoc analysis of data from thousands of women enrolled in several phase 3 RCTs found worse overall survival in early breast cancer for overweight (HR 1.30) and obese women (HR 1.37).

However in advanced breast cancer cohorts, overweight (HR 0.85) and obesity (HR 0.82) were significantly associated with improved overall survival.

“The results of this study describe the presence of a marked obesity paradox in HER2 positive BC, which was consistent regardless of the use of contemporary therapy or the line of therapy,” the study said.

The results were also consistent with evidence of the obesity paradox in other cancer types.

“Hypotheses for the obesity paradox in advanced cancers include an association between the nutritional reserve and cancer-related cachexia which is characterised by low body weight, anorexia, high ECOG PS, and low albumin.”

Breast Cancer 


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