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    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265809510444"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_250"
                     title="Cancer Research &quot;Giant&quot; Lawrence Garfinkel Dies at 88"
                     score="0"
                     href="http://www.medpagetoday.com/Pulmonology/Smoking/tb/18108?impressionId=1265809510444"
                     
      &lt;p&gt;Epidemiologist Lawrence Garfinkel, MA, a legendary researcher for the American Cancer Society whose work helped establish a link between cancer and smoking and other activities, died of cardiovascular disease Thursday in Seattle, Washington at 88.&lt;/p&gt;
&lt;p&gt;&quot;The American Cancer Society today mourns the loss of one of its most important historical figures,&quot; said John R. Seffrin, PhD, the society&apos;s chief executive officer.&lt;/p&gt;
&lt;p&gt;&quot;Larry Garfinkel joined the American Cancer Society as a young scientist in 1947, and for more than four decades played an instrumental role in expanding knowledge of and reducing death from smoking.&quot;&lt;/p&gt;
&lt;p&gt;Garfinkel&apos;s 1982 Cancer Prevention Study-II (CPS-II) is the largest contemporary study of tobacco and mortality, with 1.2 million participants and 77,000 data-compiling volunteers across 50 states, the District of Columbia, and Puerto Rico.&lt;/p&gt;
&lt;p&gt;CPS-II uncovered the effects of lifestyle factors, such as obesity, alcohol consumption, medications, genetic elements, that affect cancer and other chronic diseases, the analysis of which still reveals important clues about cancer today.&lt;/p&gt;
&lt;p&gt;The study also found lung cancer mortality rates in women increased five-fold from data collected in the original Cancer Prevention Study, while cancer rates among non-smoking women remained the same. This information provided strong evidence that lung cancer was almost exclusively a disease found in smokers.&lt;/p&gt;
&lt;p&gt;Garfinkel was born on January 11, 1922 in Manhattan&apos;s Lower East Side and was raised in the South Bronx.&lt;/p&gt;
&lt;p&gt;He served in the army during World War II, where he was seriously injured in northern France in August, 1944.&lt;/p&gt;
&lt;p&gt;Ultimately, Garfinkel graduated from the City College of New York and received a Masters Degree from Columbia University. He also received several honorary doctorates.&lt;/p&gt;
&lt;p&gt;Garfinkel began work for the ACS in 1947.&lt;/p&gt;
&lt;p&gt;He assisted E. Cuyler Hammond, MD, and Daniel Horn, MD, in the first ACS prospective mortality study of 187,783 males in the late 1940&apos;s by coordinating much of the field work, including training thousands of ACS volunteers in data collection techniques.&lt;/p&gt;
&lt;p&gt;Garfinkel acted as the co-principal investigator of the larger Cancer Prevention Study I (CPS-I) in 1959. The study enrolled 1 million participants across 25 states and required over 68,000 volunteers to collect data.&lt;/p&gt;
&lt;p&gt;In the 1960s, he contributed to more than two dozen major papers on the relation between smoking and health. He was co-author of one of the first reports combining epidemiology with pathology and provided some of the first direct evidence of lung damage related to smoking.&lt;/p&gt;
&lt;p&gt;Garfinkel also contributed to issuance of the landmark 1964 Surgeon General&apos;s report on smoking and health.&lt;/p&gt;
&lt;p&gt;He was appointed director of ACS research in 1979 after Hammond&apos;s retirement.&lt;/p&gt;
&lt;p&gt;Garfinkel retired from the ACS in 1989. Over the course of his career, he had contributed to more than 100 journal articles.&lt;/p&gt;
&lt;p&gt;Richard D. Klausner, MD, then-director of the National Cancer Institute, said at the time: &quot;Few individuals have contributed as much to our present-day knowledge about the disease consequences of smoking.&lt;/p&gt;
&lt;p&gt;&quot;His remarkable achievement is an important reminder what a tremendous impact an individual can make, and inspires all of us to continue the fight against cancer.&quot;&lt;/p&gt;
&lt;p&gt;Garfinkel continued to volunteer with the ACS after his retirement and taught biostatistics at the New York University Dental School.&lt;/p&gt;
&lt;p&gt;He is survived by his brothers, Harold and Melvin; his sons, Martin and Herb; a daughter-in-law, Margaret Cary, and two grandchildren.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_154"
                     title="AACR-IASLC: Smoking Boosts Tolerance for EGFR Drug (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AACR-IASLC/tb/17981?impressionId=1265809510444"
                     
      &lt;p&gt;CORONADO, Calif.  --  Current smokers can tolerate significantly higher doses of the epidermal growth factor receptor (EGFR)-targeted tyrosine kinase inhibitors, according to preliminary trial results.&lt;/p&gt;
&lt;p&gt;Smokers&apos; maximum tolerated erlotinib (Tarceva) doses reached up to 525 mg  --  far above the standard 150 mg  --  with a median of 300 mg, found Lynsay Waller, MD, of Wake Forest University in Winston-Salem, N.C., and colleagues.&lt;/p&gt;
&lt;p&gt;Former and nonsmokers in the trial topped out at 225 mg, which was also the median dose (&lt;em&gt;P&lt;/em&gt;=0.03 versus current smokers).&lt;/p&gt;
&lt;p&gt;The key question is whether escalating the dose will improve outcomes for smokers, Waller said.&lt;/p&gt;
&lt;p&gt;That&apos;s something the phase II study aims to eventually determine  --  progression-free survival is the primary endpoint.&lt;/p&gt;
&lt;p&gt;But those results weren&apos;t available for the interim analysis presented here at the Joint Conference on Molecular Origins of Lung Cancer sponsored by the American Association for Cancer Research and the International Association for the Study of Lung Cancer.&lt;/p&gt;
&lt;p&gt;While it&apos;s tempting to consider upping the dose for smokers, in the absence of any data showing a benefit, physicians should focus their efforts on getting smokers to quit the habit, commented Paul A. Bunn, Jr., MD, of the University of Colorado Denver.&lt;/p&gt;
&lt;p&gt;Nevertheless, the findings should come as little surprise based on prior studies, he and Waller agreed.&lt;/p&gt;
&lt;p&gt;&quot;Smokers metabolize erlotinib at a faster rate than nonsmokers and require a higher dose to achieve equivalent plasma levels,&quot; she told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Smoking appears to elevate levels of a liver enzyme involved in metabolizing the drug, she explained.&lt;/p&gt;
&lt;p&gt;Early studies with erlotinib suggested greater toxicity at higher doses but whether it was accompanied by greater efficacy wasn&apos;t certain, Bunn said.&lt;/p&gt;
&lt;p&gt;Waller&apos;s group designed a rapid dose escalation schema for individualizing erlotinib doses, a task that has proven challenging &quot;due to the frequent progression of cancer prior to achieving each patient&apos;s maximal tolerated dose.&quot;&lt;/p&gt;
&lt;p&gt;Their phase II study included 25 patients with metastatic non-small cell lung cancer given four cycles of dose-dense chemotherapy (75 mg/m&lt;sup&gt;2&lt;/sup&gt; of both docetaxel [Taxotere] and cisplatin [Platinol] on day one of an every two week cycle) with growth factor support.&lt;/p&gt;
&lt;p&gt;Patients then got erlotinib at an initial dose of 150 mg per day for nonsmokers and former smokers or 300 mg daily for current smokers (21% of the cohort). The dose was escalated by 75 mg every two weeks until a grade 2 or higher nonhematologic adverse event occurred.&lt;/p&gt;
&lt;p&gt;Grade 3 or 4 toxicity prompted a hold on dosing until resolution, then dose de-escalation by 75 mg per day.&lt;/p&gt;
&lt;p&gt;This strategy appeared safe, with no grade 4 or 5 toxicity related to erlotinib, the researchers said.&lt;/p&gt;
&lt;p&gt;Maximum tolerated daily erlotinib doses ranged from 300 to 525 mg among smokers and 150 to 225 mg among nonsmokers. Medians didn&apos;t differ by gender.&lt;/p&gt;
&lt;p&gt;The two most common dose-limiting toxicities were grade 2 rash and grade 2 diarrhea (23.5% for each), followed by less severe rash and/or diarrhea (17.6% for each), and finally dehydration (5.9%). Disease progression occurred in 11.8% of cases. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;These findings would likely generalize to gefitinib (Iressa), which is a similar compound, though not FDA approved, Bunn said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was sponsored by OSI Pharmaceuticals.&lt;/p&gt;&lt;p&gt;Waller reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Bunn reported having consulted for OSI Pharmaceuticals and Genentech.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_9_746"
                     title="Smokers and Drinkers Get Head Start on Colorectal Cancer"
                     score="-0.005"
                     href="