Darolutamide in Nonmetastatic, Castration-Resistant Prostate Cancer. BACKGROUND: Darolutamide is a structurally unique androgen-receptor antagonist that is under development for the treatment of prostate cancer. We evaluated the efficacy of darolutamide for delaying metastasis and death in men with nonmetastatic, castration-resistant prostate cancer. METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial involving men with nonmetastatic, castration-resistant (...) prostate cancer and a prostate-specific antigen doubling time of 10 months or less. Patients were randomly assigned in a 2:1 ratio to receive darolutamide (600 mg [two 300-mg tablets] twice daily) or placebo while continuing androgen-deprivation therapy. The primary end point was metastasis-free survival, with the presence of metastasis determined by independent central review of radiographic imaging every 16 weeks. RESULTS: In total, 1509 patients underwent randomization (955 to the darolutamide group

Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. BACKGROUND: Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. METHODS: To clarify the relative benefits and risks (...) of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule

Supervised exercise sessions increase physical activity and fitness of cancer survivors Supervised exercise sessions increase physical activity and fitness of cancer survivors Dissemination Centre Discover Portal NIHR DC Discover Supervised exercise sessions increase physical activity and fitness of cancer survivors Published on 11 December 2018 doi: Aerobic exercise and resistance sessions that include supervision help people living with cancer to meet guideline physical activity levels (...) . Common behaviour change techniques that were shown to increase physical activity are goal setting, graded tasks (e.g. increasing exercise duration or intensity over time), and instruction on how to perform particular exercises. This review update looked at the most effective ways to increase and sustain physical activity for 1,372 sedentary adults living with and beyond cancer. Most trials used exercise machines in a gym. The findings suggest exercise was generally safe in this group

Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications Stomach cancer surgery and enhanced recovery programmes (ERAS) Dissemination Centre Discover Portal NIHR DC Discover Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications Published on 18 July 2018 doi: Enhanced recovery programmes reduce length of hospital stay and associated healthcare costs after stomach cancer surgery (...) established practice for many types of surgery, including for stomach cancer, in many UK hospitals. This review included trials from Asia, but these followed internationally accepted protocols. Its findings support programmes already in place and add evidence for hospitals that have not yet implemented them. Share your views on the research. Why was this study needed? Each year around there are around 7,000 people in the UK with stomach cancer, making it the 16 th most common cancer. Survival rates

Common osteoporosis drugs may prevent breast cancer spreading to bone Signal - Common osteoporosis drugs may prevent breast cancer spreading to bone Dissemination Centre Discover Portal NIHR DC Discover Common osteoporosis drugs may prevent breast cancer spreading to bone Published on 13 March 2018 Drugs commonly prescribed to prevent bone thinning probably help prevent the spread of early breast cancer to the bones in a few women, when taken in addition to standard cancer therapies. However (...) , the overall benefits may be small, for example preventing spread to bone or death in about one extra woman in every 100 treated for about five years. This is a complex area because many of the treatments for breast cancer are known to worsen bone thinning, but there are other bone strengthening benefits to these drugs. This large review of 44 studies with more than 37,000 participants looked at women with either early breast cancer or advanced breast cancer with or without bone involvement. The reviewers

Large ten-year trial on treatment of localised prostate cancer will aid management decisions Signal - Large ten-year trial on treatment of localised prostate cancer will aid management decisions Dissemination Centre Discover Portal NIHR DC Discover Large ten-year trial on treatment of localised prostate cancer will aid management decisions Published on 15 September 2016 New, long-term research indicates that active monitoring, with prompt treatment if needed, may be a better option than radical (...) surgery or radiotherapy for many men who have prostate cancer if it’s confined to the prostate gland. In the ProtecT trial, after an average of ten years, few men died of prostate cancer and there was no difference in survival between men receiving active monitoring and those who had radical treatments (which caused unpleasant side effects). But active monitoring did increase the risk of cancer progressing or spreading to other parts of the body. Longer follow-up will help to fully understand

Bone-targeting drugs improve quality of life, but not survival in prostate cancer that has spread to bone Signal - Bone-targeting drugs improve quality of life, but not survival in prostate cancer that has spread to bone Dissemination Centre Discover Portal NIHR DC Discover Bone-targeting drugs improve quality of life, but not survival in prostate cancer that has spread to bone Published on 27 September 2016 The drug zoledronic acid delayed the onset of bone complications by two months in men (...) with prostate cancer that had spread to the bone. Though it did not increase overall survival, it improved quality of life by reducing important complications such as fractures and spinal cord compression. The radioactive drug strontium-89 was also tested and delayed the combined outcome of bone-related complications, pain or death by about one month. It also had no effect on overall survival or the number of bone complications. Both treatments were compared with chemotherapy alone. Current NICE guidance

Whole brain radiotherapy provides little benefit for lung cancer that has spread Signal - Whole brain radiotherapy provides little benefit for lung cancer that has spread Dissemination Centre Discover Portal NIHR DC Discover Whole brain radiotherapy provides little benefit for lung cancer that has spread Published on 10 January 2017 Radiotherapy to the whole brain makes little difference to people with the commonest type of lung cancer that has spread to the brain and cannot be operated (...) on. This mainly UK-based trial found no difference in overall survival and quality of life among people who had whole brain radiotherapy plus usual supportive care compared with people who received supportive care alone. This is the largest trial to assess the effect of this treatment in people with non-small cell lung cancer and multiple brain metastases (cancer deposits in the brain). Practice has been changing since early results of the trial were released. The final results reinforce the message

Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival Signal - Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival Dissemination Centre Discover Portal NIHR DC Discover Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival Published on 28 February 2017 Intensive follow-up (...) of patients who have been successfully treated for bowel cancer does not improve survival outcomes compared to less intensive follow-up. This systematic review included 15 randomised controlled trials comparing different intensities of follow-up. Protocols varied in terms of the number of tests, appointments or their setting (e.g. GP or hospital) - none of them affected survival. More intensive follow-up did however detect recurrent cancers sooner, and patients were twice as likely to undergo surgery

Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer Signal - Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer Dissemination Centre Discover Portal NIHR DC Discover Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer Published on 28 February 2017 Postoperative radiotherapy increases the risk of death by 18% for patients with non-small cell lung cancer that has been (...) on survival and cancer recurrence rates. Most of the trials are from over 30 years ago, so there is the possibility that newer radiotherapy techniques may be less harmful. Nevertheless, this review provides the best evidence to date that postoperative radiotherapy may not be appropriate as a routine treatment for non-small cell lung cancer. Share your views on the research. Why was this study needed? Lung cancer is the second most common cancer in the UK with 37,453 new cases registered in 2014

Suction drainage after rectal cancer surgery does not reduce infection Signal - Suction drainage after rectal cancer surgery does not reduce infection Dissemination Centre Discover Portal NIHR DC Discover Suction drainage after rectal cancer surgery does not reduce infection Published on 28 February 2017 Placing a suction drain in the pelvic cavity does not reduce the risk of pelvic infection after commonly-used surgery for rectal cancer. A French trial comparing results of surgery (...) with and without pelvic drainage showed no difference in risk of infection within 30 days. The risk of infection was about 17%. The drainage technique is less commonly used in the UK. The study was carried out in several hospitals and included 469 people having total mesorectal excision of rectal cancer. Half the patients were randomised to suction drainage. Surgical techniques included laparoscopic and open surgery, with staples or stitches. Patients were followed up for signs of pelvic infection, leakage

MRI scan before biopsy could detect more prostate cancer Signal - MRI scan before biopsy could detect more prostate cancer Dissemination Centre Discover Portal NIHR DC Discover MRI scan before biopsy could detect more prostate cancer Published on 7 March 2017 In men with a raised prostate specific antigen (PSA) blood test, which can be a sign of prostate cancer, MRI scanning before standard biopsy could allow more targeted biopsies and increase diagnosis of medium and high-risk prostate cancer (...) . In this NIHR-funded study, 576 men with suspected prostate cancer received a multi-parametric (MP)-MRI scan in addition to transrectal ultrasound-guided (TRUS) biopsy. They also had template mapping (TPM) biopsy of the entire prostate to reliably diagnose cancer. Neither MP-MRI scan nor TRUS-biopsy were entirely accurate. However, if MP-MRI is used as an initial test, followed by TRUS-biopsy targeted at areas identified on the scan, 18% more cancers could be detected than by TRUS biopsy alone. It may also

Delaying chemotherapy after breast cancer surgery may reduce survival chances Signal - Delaying chemotherapy after breast cancer surgery may reduce survival chances Dissemination Centre Discover Portal NIHR DC Discover Delaying chemotherapy after breast cancer surgery may reduce survival chances Published on 31 January 2017 Delaying chemotherapy after breast cancer surgery may slightly decrease a woman’s chances of survival. A review found about a 5% increase in the relative risk of death. Many (...) women are offered chemotherapy soon after breast cancer surgery, called adjuvant chemotherapy. Chemotherapy is usually started after the surgical wounds have healed but the effect of any delay to this was unclear. These researchers calculated the risk from outcomes for almost 30,000 women treated with adjuvant chemotherapy, from studies in Europe and North America. The absolute risk of death for any woman will depend on her individual cancer stage and characteristics. A four week delay could add

Being overweight or having diabetes are both linked to cancer Signal - Being overweight or having diabetes are both linked to cancer Dissemination Centre Discover Portal NIHR DC Discover Being overweight or having diabetes are both linked to cancer Published on 6 February 2018 For western high-income countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a Body Mass Index [BMI] greater than 25). A high BMI was (...) responsible for almost twice as many cancers as diabetes. Around 5.6% of cancers globally in 2012 were attributable to diabetes or high BMI. Because obesity is increasing globally, this number may rise by 25% by 2035. Although the links between high BMI, diabetes and cancer have been known for some time, this study presents the first calculations of attributable risk for 175 countries. This represents the proportion of cancers that could be prevented if the risk factors were eliminated. The researchers

Chemotherapy for people with recurrent stomach and oesophageal cancers can prolong survival by two to three months Signal - Chemotherapy for people with recurrent stomach and oesophageal cancers can prolong survival by two to three months Dissemination Centre Discover Portal NIHR DC Discover Chemotherapy for people with recurrent stomach and oesophageal cancers can prolong survival by two to three months Published on 17 May 2016 This meta-analysis provides high quality evidence that second-line (...) chemotherapy with supportive care can boost survival by about two months. In the three trials included, two types of chemotherapy were investigated for people with recurrent gastric cancers and compared to supportive care alone. Not all patients benefited from chemotherapy – over a third did not live longer or suffered side effects. A number of predictive factors were assessed that could be used for deciding which patients are most likely to benefit from second-line chemotherapy. These included the time

A scan may help decide if surgery is required as follow-on treatment for head and neck cancer Signal - A scan may help decide if surgery is required as follow-on treatment for head and neck cancer Dissemination Centre Discover Portal NIHR DC Discover A scan may help decide if surgery is required as follow-on treatment for head and neck cancer Published on 7 June 2016 People with head and neck cancer in the UK usually receive chemotherapy and radiotherapy followed by surgery. Using a scan (...) to assess cancer status after this first line chemoradiotherapy and only suggesting surgery to those with a clear indication led to similar survival rates, complications and fewer operations compared with planned cancer surgery for everyone. After receiving similar initial treatment, this trial compared routine neck dissection surgery to surgery only if the scan showed residual cancer 12 weeks after chemoradiotherapy. Head and neck surgery can be invasive and disfiguring, so doctors and patients alike

Physical activity in the community improves mobility for cancer survivors Signal - Physical activity in the community improves mobility for cancer survivors Dissemination Centre Discover Portal NIHR DC Discover Physical activity in the community improves mobility for cancer survivors Published on 25 July 2017 Programmes to encourage physical activity for people with cancer at home or in local communities have a positive impact on physical function. The changes were generally small to moderate (...) , for example those receiving rehabilitation could walk on average 28 metres further in six minutes. The studies mostly included older people with breast cancer, in whom these small improvements may be important. Cancer survivors experience changes to their physical function resulting from cancer and its treatments. Restoring function can help people maintain independence. This review looked at a range of interventions. Those delivered in people’s homes or nearby community settings may be more convenient

New evidence confirms three-yearly surveillance interval for people at intermediate risk of bowel cancer Signal - New evidence confirms three-yearly surveillance interval for people at intermediate risk of bowel cancer Dissemination Centre Discover Portal NIHR DC Discover New evidence confirms three-yearly surveillance interval for people at intermediate risk of bowel cancer Published on 3 October 2017 People with benign growths (adenomas), who are at intermediate risk of bowel cancer, benefit (...) from follow-up colonoscopy. However, some of the patients at the lower end of risk in this intermediate category may not benefit from more than one follow-up. This NIHR-funded cohort study reviewed data for 11,944 intermediate-risk patients from UK hospitals. Within this group, particular features were identified which placed them at higher risk, such as the presence of larger or highly abnormal adenomas or incomplete colonoscopy. These patients had half the risk of developing cancer

Men feel physically and psychologically ill-prepared for prostate cancer surgery Signal - Men feel physically and psychologically ill-prepared for prostate cancer surgery Dissemination Centre Discover Portal NIHR DC Discover Men feel physically and psychologically ill-prepared for prostate cancer surgery Published on 28 November 2017 Following prostate cancer surgery men often experience physical changes, such as urinary incontinence and erectile dysfunction, causing negative emotions (...) and distress. This review found that men felt poorly prepared – psychologically and physically – for the changes they might experience after surgery. Surgery was often described as "life-changing", and men described worrying about their future. NICE recommend that men and their partners/carers are fully informed about prostate cancer treatment options and their possible complications, and are supported in decision-making. This includes having access to psychosexual support at any time. This global review

Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery Dissemination Centre Discover Portal NIHR DC Discover Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery Published on 12 June 2018 A three-month course of chemotherapy after surgery for bowel cancer seems no less effective than the standard six-month course, and half (...) as many people suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment. This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowel cancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatment after surgery is usually six months of an oxaliplatin-containing regimen. This study evaluated a shorter course. Oxaliplatin is known