December 17, 2007
Drug combination shrinks breast cancer metastases in brain
Nancy Lin, MD
A combination of a “targeted” therapy and chemotherapy shrank metastatic brain tumors by at least 50 percent in one-fifth of patients with aggressive HER2-positive breast cancer, according to data presented by Dana-Farber Cancer Institute investigators at the San Antonio Breast Cancer Symposium.
Lapatinib (Tykerb) and capecitabine (Xeloda) were paired in an extension of a Phase 2 clinical trial in which lapatinib given alone shrank brain metastases significantly in six percent of 241 patients.
In the extension trial, capecitabine was added to lapatinib in 49 patients whose metastases — cancerous colonies in the brain spread from their primary cancer — had progressed while on treatment. With the combination therapy, brain metastases shrank by 20 percent or more in 18 patients (37 percent) and shrank by at least 50 percent in 10 patients (20 percent), reported Nancy Lin, MD, of Dana-Farber’s Breast Oncology Center.
“Very few medications have shown activity in the treatment of brain metastases, particularly in HER-2-positive metastatic breast cancer patients,” said Lin, who led the study with Eric Winer, MD, director of the Dana-Farber Breast Oncology Center. “Therefore, these data are quite encouraging, and further studies are warranted.”
Lapatinib is an oral small-molecule drug from GlaxoSmithKline that is approved along with capecitabine for treating patients with advanced or metastatic breast cancer whose tumors are driven by the abnormal growth signal, HER-2, and who have already undergone therapy including trastuzumab (Herceptin), a taxane drug, and an anthracycline compound. Lapatinib, like trastuzumab, blocks the HER-2 signal.
Up to one-third of women with advanced, HER-2-positive breast cancer may develop metastases to the brain. “Although radiation treatment is often effective, as women live longer with metastatic cancer, some develop worsening of brain metastases despite radiation,” said Lin. “Because cancer in the brain can have a major impact on quality of life, it is important to have treatment options to address this problem.”
The study was sponsored in part by GlaxoSmithKline.
Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.
Nancy U. Lin, MD
44 Binney Street
Boston, MA 02115
Office phone: (617) 632-5269
Appointment phone: (617) 632-2175
Fax: (617) 632-1930
Preferred contact method: office phone
Biography
Dr. Lin received her MD from Harvard Medical School in 1999. She completed her residency in internal medicine at Brigham and Women’s Hospital and went on to complete fellowships in medical oncology and hematology at Dana-Farber. In 2005, she joined the staff of Brigham and Women’s and Dana-Farber, where she is a medical oncologist and clinical investigator in the Breast Oncology Center.
Background
Board Certification
Internal Medicine, 2002
Hematology, 2005
Medical Oncology, 2005
residency
Brigham and Women’s Hospital, Internal Medicine
Fellowship
Dana-Farber/Partners Cancer Care, Hematology & Oncology
Laws alone can not secure freedom of expression; in order that every man present his views without penalty there must be spirit of tolerance in the entire population.
As a direct result of The Beatles’ success, Dr Timmis claimed, the scanner’s inventor, Sir Godfrey Hounsfield, was able to devote about four years developing the scanner from its 1968 prototype, to something that could be used in a clinical setting. His work was done in the Central Research Laboratory, a facility near Heathrow airport that was part of the EMI Group. Having sold 200 million of the Fab Four’s singles, (at seven inches, almost enough vinyl to stretch the length of the equator) the Beatles’ record company, EMI, was able to fund Hounsfield to do his research and the CT scanner was ready be used in hospitals in the 1970’s.
Medtronic Navigation makes a bold move into medical imaging with its first RSNA in the history of our company
Q: What products, updates or innovations are you announcing or launching at RSNA?
Medtronic Navigation is thrilled to be participating at RSNA for the first time in the history of our company. As the world’s leader in medical devices, Medtronic has taken a bold move through its Navigation division into the intra-operative imaging field. We will be highlighting two flagship products, the PoleStar® System — the worlds leading intra-operative MRI(iMRI) product, andthe O-ARM® System – an intra-operative 3D X-Ray platform. Both of these imaging platforms will be fully integrated into Medtronic Navigation’s STEALTHSTATION® System – a computer assisted surgery platform.
Q: What are the benefits of using your product?
PoleStar® System: during brain surgery, the brain shifts from its original location on the preoperative diagnostic scan. This makes localization of the area of interest with the degree of accuracy neededdifficult. The PoleStar® enables surgeons to acquire images as needed to confirm accurate anatomical position as well as critical tumor resection verification. This low field iMRI is an economically feasible alternative to high field options. It can be installed in an existing OR with minimal modifications, allowing the OR to be used as an all purpose room when iMRI is not needed.
This is what has driven our world market share leader position in intra-operative MRI. The O-ARM® System: high resolution intra-operative images provide surgeons with a 3D view of the patient in the operative position. This allows surgeons to view anatomy and confirm hardware placement in the axial, coronal, and sagittal views prior to closing the patient. Because it is a mobile platform, it does not require a dedicated room and can be used during multiple surgeries across different specialties.
Q: Please explain what the customer, whether clinician organization, individual clinician or patient stands to gain from using your products and why?
Whether they are removing a brain tumor or correcting a spinal deformity, surgeons can close with confidence when using intra-operative imaging. They can confirm the extent of the tumor removal or the hardware placement before closing the patient rather than waiting for a post-op scan. For patients, this may mean shorter recovery time and a decreased need for repeat surgeries.
Q: What are you hoping to achieve from this year’s RSNA?
We intend to become thepreferred intra-operative navigation andimaging company worldwide. While the field of diagnostic imaging is quite crowded with world class companies, we believe that Medtronic stands out as the imaging company committed to surgery in every way and is uniquely positioned to provide clinical solutions to our surgeon and radiology customers. Looking at a procedure from aholistic perspective that includes planning, navigation and therapy delivery drives our unique imaging solutions.
Q: What key messages do you have for RSNA attendees?
Medtronic is a world class company committed to solutions in the OR. Our imaging business will become the gold standard surgical imaging business around the world. We are at RSNA to develop trust with the radiology community and to showcase the most exciting, practical imaging solutions in the surgical environment.
Q: What will you be trying to communicate to potential customers that will help you stand out from the crowd?
Our relationships with the surgical community give us a powerful window through which we gather the needs of end user customers. We have applied this knowledge to product development and surgical work flow in a way that adds real clinical value. We will maintain this strategic advantage because of who Medtronic is relative to diagnostic imaging companies.
Q: How do you see the year ahead in clinical and business terms?
The intra-operative MRI market will continue to grow and be fueled by interest in High Field use in the OR. This market growth will add to ourworld market leading position in the iMRI space when cost benefit analysis and realistic assessments of OR work flow are taken into serious purchase consideration.The O-ARM® System has captured the imagination of the surgical community who now for the first time are able to acquire 3D volumetric imaging with the convenience ofa C-arm but with CT-like image quality.
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Company profile
Since its inception, Medtronic Navigation has been on the forefront of surgical navigation solutions, guiding the industry to a higher standard of care for several clinical specialties, including functional neurosurgery, spinal, ENT, joint replacement and orthopaedic trauma surgeries.
As the leading provider of integrated navigation and intra-operative imaging solutions, we pride ourselves on the technology, service and support we provide to more than 2300 StealthStation® System and intra-operative imaging customers worldwide.
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Contact details
Name: Medtronic Navigation
Interviewee: Rich Grant
Phone: +1-978-698-6010
Website: Click here for the Medtronic site.
At the 93rd Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) Siemens is profiling its new 3 Tesla MRI system with a wide bore entrance for people directly embroiled in the obesity epidemic:
The MAGNETOM Verio offers greater patient access and comfort made possible by the 70 cm Open Bore resulting in higher throughput and more referrals. Patients of all shapes and sizes feel less discomfort and anxiety, reducing the need for sedation and minimizing claustrophobic rejections. In addition, Tim™ technology also increases throughput thanks to shorter scan time, which creates an opportunity to increase your procedure volume…MAGNETOM Verio is the shortest 3T system available today, with an ultra-light magnet. You spend less from the start because the system’s size, weight, and stray field minimize siting requirements and costs without compromising performance.
MAGNETOM Verio brings new benefits:
A unique combination of 3T and 70 cm Open Bore
The shortest 3T system on the market today
Ultra-light magnet with zero helium boil-off
Large field of view, support a full range of clinical applications
TrueForm™ magnet design offers enhanced image quality by optimizing the homogeneity
Higher speed and superb image quality powered by the VQ-engine gradient
Diffusion weighted imaging is becoming a must have tool in the arsenal of the MRI technologist. This is a great look at how DWI can be used in pelvic imaging to determine if a tumor is cancerous or not. By using the b-1000 snd the ADC maps from the DWI images the Radiologist can determine this.
MR keeps breaking ground in pelvic imaging
By: H. A. Abella
Diffusion-weighted MR imaging could one day become a routine exam for noninvasive characterization and staging of uterine tumors, replacing unnecessary catheter or surgical biopsies, according to several studies released Sunday at the RSNA meeting.
Endometrial cancer is the most common gynecologic malignancy and the fourth most common cancer among U.S. women. Incidence of the disease is higher among white women, but it kills almost twice as many black women. About a fifth of the approximately 40,000 new cases diagnosed in 2007 will be lethal.
Carcinoma of the cervix is less common and carries low mortality rates in the U.S. compared with those in the rest of the world, mostly thanks to Pap smear screening. It hits minorities in disproportionately high numbers, though.
Both cancer types are hard to characterize, thus making biopsies necessary in many patients.
DWI will help physicians to distinguish benign from malignant lesions and reduce the number of patients who undergo these invasive procedures, said Dr. Nagaraj S. Holalkere, a radiologist at Massachusetts General Hospital.
Holalkere and colleagues retrospectively evaluated 65 women with 80 lesions who underwent DWI on a 1.5T scanner with a phased-array coil between August 2006 and March 2007. Two independent radiologists, reading blindly, characterized lesions using qualitative and quantitative parameters.
Qualitative analysis entailed comparing lesions to myometrium. Lesions were considered malignant if they appeared hyperintense on DWI and hypo- or isointense on apparent diffusion coefficient maps. Quantitative analysis involved measuring lesions’ ADC values on axial and sagittal maps. ADC values below 1 were considered an indicator of malignancy.
The investigators found qualitative and quantitative analyses were reproducible tests that accurately differentiated benign from malignant lesions. Qualitative analysis yielded sensitivity, specificity, and accuracy rates of 79%, 94%, and 91%, respectively. The quantitative analysis produced mean ADC values of 0.6 for malignant lesions and 1 for benign ones. The correlation between axial and sagittal maps was statistically significant (r = 0.98, <i.p</i.p<0.0001).
MR-based characterization of benign and malignant pelvic masses should include both qualitative and quantitative DWI assessments, Holalkere said. He is using the technique routinely to gather a larger population sample and more conclusive data.
“A lower number of patients would be subjected to surgical biopsies if this technique is proven useful,” he said.
Another study by Italian investigators weighed DWI’s value in the assessment of myometrial tumor invasion. Dr. Sandro Sironi and colleagues at the University of Milan enrolled 37 consecutive patients with early-stage endometrial carcinoma and compared DWI data against conventional MRI and biopsy. They found the combination of conventional and diffusion-weighted MR imaging yielded diagnostic information.
Korean investigators tested DWI to characterize metastatic from nonmetastatic lymph nodes in patients with cervical cancer. The team was led by Dr Kyoung Ah Kim, a radiologist at the Pochon University College of Medicine in Sungnam. The investigators evaluated DWI data from 108 patients who underwent radical hysterectomy and lymph node dissection for uterine cervical cancer. They found DWI useful for differentiating metastatic from nonmetastatic lymph nodes in these patient populations.
cervical lesion with restricted diffusion suggestive of malignancy on DWI. (Provided by N. S. Holalkere)
December 17, 2007
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