From OncoLog, May 2013, Vol. 58,
Beta-Blocker Use Associated With Higher Survival Rates in Lung Cancer Patients Receiving Radiation Therapy
Using beta-adrenergic receptor antagonists (beta-blockers) prolongs
survival in patients with non–small cell lung cancer (NSCLC) undergoing
definitive radiation therapy, findings from a study at The University
of Texas MD Anderson Cancer Center suggest.
The analysis, led by Daniel Gomez, M.D., an assistant professor in the
Department of Radiation Oncology, found that the incidental use of
beta-blockers in this population was associated with longer distant
metastasis–free, disease-free, and overall survival.
Of the 722 patients included in the retrospective study, 155 had
received beta-blocker treatment during radiation therapy. About
two-thirds of those patients received beta-blockers to treat
hypertension, and most of the remaining third received them to treat
coronary heart disease.
A univariate analysis comparing outcomes for patients who received
beta-blockers with those who did not revealed that the use of
beta-blockers was associated with longer distant metastasis–free,
disease-free, and overall survival. After adjustment for age, Karnofsky
performance score, disease stage, tumor histology, use of concurrent
chemotherapy, radiation dose, gross tumor volume, hypertension, chronic
obstructive pulmonary disease, and aspirin use, a multivariate analysis
revealed that the use of beta-blockers was still associated with longer
distant metastasis–free, disease-free, and overall survival.
Several factors other than beta-blocker use also were significantly
associated with survival. Concurrent chemotherapy was associated with
longer overall survival; age younger than 65 years was associated with
longer disease-free survival; a Karnofsky score greater than 80 was
associated with longer distant metastasis–free survival, disease-free
survival, and overall survival; and stage III disease was associated
with shorter distant metastasis–free survival, disease-free survival,
and overall survival.
The study was reported in Annals of Oncology in January. Dr. Gomez and
his co-authors recommended prospective trials to determine whether the
length and timing of beta-blocker use influence survival for cancer
Selumetinib Shows Promise for Patients With Recurrent Low-Grade Ovarian Cancer
Selumetinib, a MEK1/2 inhibitor, benefits some patients with recurrent
low-grade serous ovarian cancer, according to the results of a recent
phase II clinical trial.
The open-label, single-arm study—the first to evaluate targeted therapy
for low-grade serous ovarian cancer—enrolled 52 patients with recurrent
disease who had undergone at least one prior therapy. Patients were
given 50 mg of oral selumetinib twice daily for a median of 4.5 4-week
cycles; individual patients’ doses were adjusted on the basis of the
hematological, dermatological, and/or gastrointestinal adverse events
Selumetinib elicited a complete or partial response in 8 patients (15%)
and stabilized disease for at least 6 months in 34 patients (65%). The
median progression-free survival duration was 11 months, and the 2-year
overall survival rate was 55%. There were no treatment-related deaths.
“These are remarkably encouraging results for what can ultimately be a
devastating disease,” said David Gershenson, M.D., a professor in the
Department of Gynecological Oncology and Reproductive Medicine at The
University of Texas MD Anderson Cancer Center and the senior author of
the study’s report.
The grade 4 adverse events experienced in the study were pain (1
patient) and cardiac and pulmonary events (1 patient each). Grade 3
adverse events included cardiotoxicity, gastrointestinal events, pain,
fatigue, and anemia. Owing to these adverse events, the selumetinib
dose was reduced in 22 patients, and 13 patients ultimately left the
Although low-grade serous ovarian cancer is less aggressive than its
high-grade counterpart, it is extremely difficult to treat if initial
therapy fails—and the cancer will persist or recur in more than 80% of
patients. Recurrent or relapsed low-grade serous ovarian cancer is less
susceptible to standard therapies than is high-grade disease, and
response rates for recurrent or relapsed low-grade disease are usually
“After surgery with or without pre-surgical chemotherapy, when
low-grade serous ovarian cancer persists or returns, chemotherapy and
hormonal therapy are relatively ineffective,” Dr. Gershenson said.
Selumetinib inhibits MEK1/2, a critical molecule in the MAPK signaling
pathway, which includes BRAF and KRAS. BRAF and KRAS mutations are
common in low-grade serous ovarian cancers. In the study, 14 patients
had KRAS mutations, and 2 had BRAF mutations; but a patient’s having
either mutation was not connected to her selumetinib response.
The study was conducted by the National Cancer Institute’s Gynecologic
Oncology Group, and the report was published in the February edition of The Lancet Oncology.
Varenicline Improves Smokers’ Chances of Stopping Smoking
Smokers in a smoking cessation study who took varenicline had a higher
probability of quitting smoking and a better overall cessation
experience than did those who took bupropion or placebo, a team of
researchers at The University of Texas MD Anderson Cancer Center has
The team, led by Paul Cinciripini, Ph.D., a professor in the Department
of Behavioral Science and the director of the Tobacco Treatment Program
at MD Anderson, investigated the relative efficacy of varenicline and
bupropion, two popular smoking cessation drugs, in nearly 300 people
who were trying to quit smoking. Participants were randomly assigned to
receive varenicline, bupropion, or placebo; they also underwent
extensive smoking cessation counseling. Participants were assessed for
nicotine withdrawal and emotional functioning every week during
The researchers found that, compared with placebo, only varenicline
significantly improved smoking abstinence rates by all measures at all
time points—a finding that is consistent with the results of phase III
clinical trials of varenicline. Compared with placebo, both varenicline
and bupropion reduced participants’ nicotine cravings, but people
taking varenicline had less intense cravings for nicotine, even if they
did not quit smoking.
“When smokers try to quit, many are likely to experience a range of
nicotine withdrawal symptoms—including negative mood, difficulty
concentrating, irritability, and even depressive symptoms—making
quitting difficult and increasing the chances of relapse,” Dr.
Cinciripini said. “Our findings suggest that smokers trying to quit
will have a better experience with varenicline as opposed to trying to
quit on their own or taking bupropion.”
Dr. Cinciripini and his colleagues also found that regardless of
whether varenicline or bupropion was received, people who were able to
abstain from smoking not only showed lower negative affect, less
anxiety, and less sadness but also showed higher positive affect than
those who were not able to abstain from smoking.
“This is a very interesting finding in that it suggests smoking itself
may not be a very good antidepressant,” Dr. Cinciripini said. “It also
suggests that those who are able to abstain from smoking will
ultimately feel better than those who continue to smoke.”
The study was published online by JAMA Psychiatry in March.
information, talk to your physician, visit www.mdanderson.org, or call askMDAnderson at 877-632-6789.
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