[NICE Consultation] Brain tumours (primary) and brain metastases in adults

NICE |  March 2020 | Brain tumours (primary) and brain metastases in adults |In development [GID-QS10092]

NICE has released a consultation for the 5 key areas for quality improvement which you consider as having the greatest potential to improve the quality of care in this area. 

Closing date for comments: Monday 20 April 2020 at 5pm

Full details from NICE

NICE Neutropenic sepsis: prevention and management in people with cancer

NICE | February 2020 | Neutropenic sepsis: prevention and management in people with cancer

NICE has published its surveillance decision on Neutropenic sepsis: prevention and management in people with cancer;  NICE will not update its  guideline on neutropenic sepsis.

NICE will amend recommendation 1.2.1.1 about fluoroquinolones for prophylaxis of neutropenic sepsis to add a link to the Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update on fluoroquinolone antibiotics.

Full details available from NICE

 

Testicular cancer: study finds one cycle of chemo just as effective

Cullen, M., et al |2020|The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis|European Urology|

European Urology has published a paper based on a study that looked at the efficacy of one cycle of chemotherapy for patients with testicular cancer rather than two.  While standard treatment in Europe involves two cycles of chemotherapy the researchers of this trial  show that one cycle has few adverse effects and comparable outcomes
to those seen with two cycles. 

Abstract
Background: Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2 ), and cisplatin (BE360P) chemotherapy, or surveillance.
Objective: To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P.
Design, setting, and participants: A total of 246 patients with vascular invasion–positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study.
Intervention: One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1–3, and cisplatin 50 mg/m2 on days 1–2, plus antibacterial and granulocyte colony stimulating factor prophylaxis.
Outcome measurements and statistical analysis: The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of 5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr.
Results and limitations: The median follow-up was 49 mo (interquartile range 37–60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3–
3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3–4 febrile neutropenia occurred in 6.8% of participants.
Conclusions: BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population.
Patient summary: Removing the testicle fails to cure many patients with high-risk primary testicular cancer  since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes
to those seen with two cycles

The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of  Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in 
High-risk, Stage 1 Nonseminomatous or Combined Germ Cell
Tumours of the Testis

In the news:

BBC News Testicular cancer: ‘Kinder’ chemotherapy is ‘just as effective’

Cancer survivors have raised heart risk, reports a US population-based study of cardiovascular disease mortality risk patients with cancer

Sturgeon, K.M , et al | 2019| A population-based study of cardiovascular disease mortality risk in US cancer patients| European Heart Journal| ehz766| https://doi.org/10.1093/eurheartj/ehz766

The European Heart Journal has published research that looked at three million US patients, across 28  types of  cancers, over a period of  40 years, the experts behind this analysis found that more than one-tenth of patients died from cardiovascular diseases. The research highlights the incidence of cardiovascular disease (CVD)  in patients diagnosed with breast, prostate, or bladder cancer.  The team also observed that from the point of cancer diagnosis onward patients with cancer (all sites) are at elevated risk of dying from CVDs compared to the general US population (Source: Sturgeon, et al. 2019).

 

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The journal article is available in full from The European Heart Journal

Abstract

Aims

 

This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis.

 

Methods and results

The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3 234 256 US cancer survivors (1973–2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1 228 328 patients (38.0%) died from cancer and 365 689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at less than 35 years of age. Further, CVD mortality risk is highest within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population.

Conclusion

The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.

 

In the news:

BBC News Cancer survivors ‘have higher heart risk’

A quarter of cancer patients experience avoidable delay to diagnosis

One in four cancer patients experienced a delay to their diagnosis that could have been avoided, according to a new study | via Cancer Research UK

A new study, published in Cancer Epidemiology, looked at data the national cancer registry of around 14,300 people diagnosed with cancer in England in one year.

It found that nearly 3,400 patients experienced a delay that could have been avoided. Half of these patients waited around two months longer to be diagnosed compared with those who didn’t have an avoidable delay.

The reasons for delays are complex but researchers on this study attempted to identify what could go wrong. The study authors asked GPs to identify when the delay happened – before the patient saw their GP, while they were still being assessed by the GP practice or after they had referred them.

The data showed 13% of all avoidable delays happened before the patient saw their GP and 38% after the GP referred them to hospital. The other half (49%) happened while the patient was being assessed by the GP surgery including waiting for tests to be done and results to be sent back.

Full story at Cancer Research UK

Research article: Swann et al. | The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients | Cancer Epidemiology | published online 3 December 2019.

NICE impact report: lung cancer

NICE impact reports review how NICE recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system, helping to improve outcomes where this is needed most. This report considers how NICE’s evidence based guidance can contribute to improvements in the care of people with lung cancer.

lung
Image source: https://www.nice.org.uk/

Lung cancer is the third most common cancer in England and is the leading cause of  cancer death. In 2017, there were almost 39,000 new cases of lung cancer and just over 28,000 related deaths.

Since 2005 and the publication of NICE’s first guideline on lung cancer, NICE has produced a suite of lung cancer related guidance, which aim to improve outcomes by focusing on survival rates and ensuring the most effective tests and treatments are used.

In England, overall survival rates for cancers are improving but there is still a marked difference between lung cancer and other cancers. Between 2012 and 2016 more than 95% of people with breast or prostate cancer survived more than 1 year after their diagnosis, compared to less than 40% of people with lung cancer.

There is an even greater difference between 5-year survival rates. More than 85% of people with breast or prostate cancer survived more than 5 years but just over 15% of people with lung cancer survived this long. When comparing with other countries in Europe, England’s long-term survival for people with lung cancer is poor, ranking 26th out of 29 countries.

Further detail at NICE

Full report: NICEimpact Lung Cancer