NEWS

In Brief

Linda Wang

Letrozole Decreases Risk of Breast Cancer Recurrence, Study Finds

A new study found that women who took the aromatase inhibitor letrozole after completing 5 years of tamoxifen therapy had a 43% reduction in risk of breast cancer recurrence compared with women who took a placebo. The 5-year study was stopped early because of the positive results so that women in the placebo arm of the trial would have the opportunity to take the active drug.

Tamoxifen substantially reduces the risk of breast cancer recurrence in postmenopausal women; however, it may stop being effective after 5 years. Paul E. Goss, M.D., Ph.D., of the Princess Margaret Hospital in Toronto, and colleagues compared rates of breast cancer recurrence among 5,187 postmenopausal women who had completed 4.5 to 6 years of tamoxifen therapy after being treated for early-stage breast cancer and who were randomly assigned to receive either letrozole or a placebo every day for 5 years.

After a median follow-up of 2.4 years, 132 women taking the placebo (5.1%) and 75 women on letrozole (2.9%) had a recurrence or developed a new primary tumor in the contralateral breast.

In a related editorial, John Bryant, Ph.D., and Norman Wolmark, M.D., representing the National Surgical Adjuvant Breast and Bowel Project, said that although the results demonstrate a meaningful biologic effect of letrozole therapy after tamoxifen therapy, they do not demonstrate a significant survival benefit, nor do they convey information about the optimal duration of treatment beyond 2 to 3 years.

The articles are available online and will be published in the November 6 issue of the New England Journal of Medicine.

Mononucleosis Associated with Risk of Hodgkin’s Lymphoma

A new study suggests that infection with mononucleosis is associated with an increased risk of a subgroup of Hodgkin’s lymphomas in young adults.

Because Epstein-Barr virus (EBV), the virus that causes mononucleosis, has been found in one-third of young adult patients with Hodgkin’s lymphoma, some researchers have speculated that EBV-related mononucleosis is associated with a particular subgroup of Hodgkin’s lymphomas.

In a study in the October 2 issue of the New England Journal of Medicine, Henrik Hjalgrim, M.D., of the Statens Serum Institut in Copenhagen, Denmark, and colleagues examined the incidence of Hodgkin’s lymphoma among 38,555 Danish and Swedish patients who had been clinically diagnosed with infectious mononucleosis and 24,614 Danish patients who tested negative for the disease.

Within the cohort of patients who had been diagnosed with infectious mononucleosis, there were 46 cases of Hodgkin’s lymphoma. This cohort had more than double the risk of Hodgkin’s lymphoma for up to two decades after testing. In contrast, patients who had mononucleosis but tested negative for EBV had an increased risk of Hodgkin’s lymphoma for only 2 years after testing. More than half (16 out of 29) of tumor samples from patients with infectious mononucleosis had evidence of EBV. The average time for Hodgkin’s lymphoma to appear in people who had EBV-related mononucleosis was 4.1 years.

Our results indicate that EBV infection in the form of infectious mononucleosis is causally associated with EBV-positive Hodgkin’s lymphoma in young adults, the researchers wrote. However, they caution that the risk of Hodgkin’s lymphoma after infectious mononucleosis is low—one in 1,000 people.

Equal Treatment Reduces Racial Disparities in Childhood Leukemia Outcomes

Black children with acute lymphoblastic leukemia (ALL) can expect to have similar outcomes as white children with the disease if they are offered equal access to treatments, a new study has shown.

Ching-Hon Pui, M.D., of the St. Jude Children’s Research Hospital in Memphis, Tenn., and colleagues examined disease-free and overall survival rates of 412 children and adolescents (68 black, 338 white, and 6 other race) who were treated for ALL in successive clinical trials conducted at St. Jude Children’s Research Hospital during the 1990s. The patients received the same intensive, remission-induction therapy followed by 120 weeks of post-remission therapy.

Black children were more likely than white children to have high-risk features, such as a high leukocyte count and an unfavorable genotype. However, black children appeared to benefit the same from treatment as white children. Five-year event-free and overall survival rates were 80.7% and 86.2%, respectively, for black children, compared with 79.4% and 85.0%, respectively, for white children. Five-year event-free survival rates were similar for black patients and white patients in both the lower- and high-risk groups, as well as in a very high-risk group.

This finding underscores the ability of effective therapy to abolish the prognostic impact of most clinical and biological risk factors identified to date, the researchers concluded. The study appears in the October 15 issue of the Journal of the American Medical Association.



             
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