By Nancy Lapid
Oct 30 (Reuters) – Today we report on a troubling cancer trend among US adults of all ages. We also report on impressive survival data from a two-drug regimen that could be an alternative to more expensive immunotherapies for some patients with a type of advanced kidney cancer.
COLORECTAL CANCER RATES ON THE RISE IN ALL US ADULTS
Medical groups have been sounding the alarm about the recent rise of colorectal cancers among younger adults in the United States, but a new analysis found that the increased incidence extends to nearly all age groups.
Colorectal cancer incidence rates among adults aged 20-49 years increased by 3% annually between 2013 and 2022, and by 2026 the disease was the leading cause of cancer deaths in that age group, according to data from the American Cancer Society.
The new analysis of National Cancer Institute data looked at all ages up to 70. Researchers found the incidence fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, but then rose to 38.3 in 2023.
“This is the first time that we have seen an increase in the overall rate in more than 20 years,” study leader Caitlin Murphy of the University of Chicago said in a statement.
The sharpest increase — 12.76% annually from 2019-2023 — was seen in 45- to 49-year-olds, likely driven by more people undergoing colorectal cancer screening after US recommendations lowered the recommended age for the testing to 45 from 50, the researchers reported in NEJM Evidence.
“That means that screening is doing as we intend it to do. It’s catching cancer earlier,” Murphy said.
But screening increases do not explain the rise in incidence overall or in other age groups, which suggests unknown risk factors, including environmental, may be offsetting the gains made by screening, the researchers said.
A separate team of researchers has identified new clues to help explain why colorectal cancer is often more aggressive in younger patients.
They analyzed 189 tumors from adults of all ages, looking for factors that changed gradually with age.
Among tumors of the most common colorectal cancer subtype, younger patients’ tumors had significantly more connective and supporting cells than cancer cells, a finding that has been linked to chemotherapy resistance in several types of solid cancer, the researchers reported in Nature Medicine.
Younger patients also had higher activity of long non-coding RNAs, molecules that can regulate genes without making proteins. Many are “dark” RNAs, whose functions remain largely unknown.
The researchers also saw gene activity suggesting stronger signaling between cells that can help cancer cells move and invade nearby tissue in younger patients.
“While we’re still at the beginning of understanding what these differences mean, our work gives researchers a new direction to pursue in tackling this urgent problem in human disease,” study co-author Ana Anderson of Harvard Medical School said in a statement.
DRUG COMBO IMPROVES SURVIVAL FOR SOME KIDNEY CANCER PATIENTS
A combination of two targeted therapy drugs can dramatically improve survival for certain patients with newly diagnosed advanced kidney cancer, data from a midstage trial suggests.
The trial testing the two drugs was launched before therapies known as immune-checkpoint inhibitors became the preferred treatment for such patients.
But checkpoint inhibitors such as Merck’s Keytruda and Bristol Myers Squibb’s Opdivo cannot be used by patients with autoimmune diseases, and their cost can be prohibitive, especially in low-resource settings.
The 51 patients in the trial — all with clear cell renal carcinoma that had spread throughout the body by the time it was first detected — received Votrient from Novartis and Roche’s Avastin on an alternating basis.
Both drugs block the action of a protein called vascular endothelial growth factor, or VEGF, that promotes the growth of new blood vessels that can supply the tumor with oxygen and nutrients. Votrient’s effect on VEGF weakens over time, while Avastin actually removes VEGF from circulation.
The patients survived for a median of 63.2 months, including 24.8 months during which their disease did not worsen, researchers reported in The Lancet Oncology.
By comparison, when Votrient is given alone as the first-line treatment for patients with previously untreated metastatic clear cell renal cell carcinoma, overall survival ranges from 28.4 to 29.3 months, and median progression-free survival is just 9.2 months.
A particularly strong benefit was seen in the 33 trial participants who were considered “favorable-risk” based on their underlying health status. In this group, median progression-free survival, the time before the cancer began to worsen, reached 28.5 months and overall survival was 76.9 months, the researchers found.
In the favorable-risk patients, “the benefit from this novel regimen of (Votrient and Avastin) was comparable to or better than that of the contemporary immunotherapy combinations,” study leader Dr. Saby George of the Roswell Park Comprehensive Cancer Center in Buffalo, New York, said in a statement. “This is significant due to the lower cost of this regimen compared to the immunotherapy combinations.”
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(Reporting by Nancy Lapid; Editing by Bill Berkrot)
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