News & Notes

Abstract

AbstractPCTs limit HPV vaccine to national programmeAs many as half of PCTs may be pressuring GPs to limit prescribing of the HPV vaccine to those patients covered by the national immunisation programme, according to reports in the newspaper GP.The programme is funded centrally, but PCTs pay for additional prescribing of the vaccine. A full course of Cervarix or Gardasil costs £241.50.The newspaper's survey of 101 GPs revealed that one‐third of respondents were prescribing outside the immunisation programme; a majority considered that vaccination is appropriate for a patient not yet sexually active who requests it.Survival with non‐hormonal treatments for breast cancerImprovements in chemotherapy have resulted in major gains in survival for patients with advanced breast cancer, according to an exhaustive meta‐analysis of 148 comparative randomised trials (J Natl Cancer Inst 2008; 100: 1780‐91).Compared with monotherapy with non‐anthracyclines, regimens containing an anthracycline reduced mortality by 22–33 per cent. Treatment with a taxane, alone or with an anthracycline, was similarly effective. Combining a taxane with gemcitabine or capecitabine approximately halved the risk of death.Overall, whereas older agents offered increased survival of around one year, these data suggest that newer treatments offer a further 4.2–12.5 months.Degarelix approved in EuropeGnRH receptor antagonist degarelix has received European approval for treatment of advanced hormone dependent prostate cancer. Ferring Pharmaceuticals says degarelix suppresses testosterone levels to below 0.5ng/ml in 96 per cent of patients within 3 days, and in all patients after 14 days, compared with 18 per cent with leuprorelin. This was associated with a median decline in PSA levels of 64 per cent compared with 18 per cent with leuprorelin. The adverse effect profiles were similar.Fertility drugs raise cancer riskIsraeli investigators have published new evidence that treatment to induce ovulation may increase risk of cancer (Am J Epidemiol 2008; published online doi:10.1093/aje/kwn318).Their cohort study identified 15030 women in Jerusalem who gave birth between 1974 and 1976. Among the 567 who used drugs to induce ovulation, overall risk of cancer was increased by 36 per cent compared with controls. Risk of uterine cancer was increased more than fourfold by clomiphene. Risks of malignant melanoma and non‐Hodgkin's lymphoma were also raised; a 40 per cent increased risk of breast cancer was of borderline statistical significance. Risk of ovarian cancer was not increased. The findings are based on relatively few cases, but are supported by evidence of a dose‐response relationship: women who took longer to conceive were at higher risk.Radiotherapy enhances endocrine therapy in prostate cancerCombining radiotherapy with endocrine therapy reduces mortality in men with locally advanced prostate cancer, a Scandinavian study suggests (Lancet 2008; published online doi:10.1016/S0140‐6736(08)61815‐2).After a median follow‐up of 7.6 years in 875 men, the cumulative 10‐year incidence of prostate‐cancer specific death was 24 per cent with endocrine therapy alone and 12 per cent with endocrine therapy plus radiotherapy – a relative risk of 0.44. Overall mortality was 39 and 30 per cent respectively. PSA recurrence was less frequent with radiotherapy (26 vs 75 per cent), but adverse urinary, rectal and sexual effects were more common. Copyright © 2009 Wiley Interface Ltd