'Virtual' cancer patient can help real ones [p. 6]

By JUDY SIEGEL-ITZKOVICH
A computer-generated "virtual cancer patient" developed by Israeli researchers can predict how patients with advanced breast cancer will respond to treatment with 70 percent accuracy, according to scientists who lectured at the NCRI Cancer Conference in Birmingham, England. Cancer UK announced the results of the study, which showed that Israeli technology - invented by Prof. Zvia Agur of the Israel Institute of Medical BioMathematics and developed by Optimata in Ramat Gan - is much more accurate than the best guesses of oncologists (who are right only about 25% of the time). The team from Nottingham City Hospital, in collaboration with researchers at the biomathematics institute, undertook a pilot study on 33 patients with breast cancer that had spread to the liver, lymph nodes or lungs. They used the cyberpatient, based on advanced mathematical models, to find out which of two drugs would work best in each patient, based on certain characteristics of their cancer, such as the size of the tumors and how fast they were growing. In this retrospective study, part funded by Cancer Research UK, the Optimata "virtual cancer patient" (OVP) model accurately predicted how patients would respond in more than two-thirds of cases. In the future, technology like this could help doctors tailor treatment more accurately to ensure every patient receives the most appropriate therapy, the team said. The two chemotherapy drugs they compared were docetaxel and doxorubicin, which can be used on their own to treat a number of cancers but can have different effects in different people. Looking at drugs that work best on their own rather than in combination with other drugs provided researchers with the most clear-cut data. Patients with advanced cancer were chosen for this pilot study because they are most likely to experience serious side effects, such as fatigue and sickness, due to the volume of anti-cancer drugs they receive. Dr. Abhik Mukherjee from Nottingham City Hospital, who worked on the study, said: "Every cancer is slightly different, and every patient will respond to treatment differently. We wanted to find a way to predict how patients would respond to a particular drug in order to limit side effects and give them the best chance of beating the disease." The OVP was "trained" using clinical data from real patients. The team programmed the model to see how the drugs affected cancer growth and behaved in the body, and how the cancer cells responded to the drugs. Once the model had been fully "trained," they compared the predictions of the OVP program with the actual response of patients. Dr. Stephen Chan, who also worked on the study, added: "We found the computer program accurately predicted how patients responded to treatment in around 70% of cases. However this was a pilot study in a small number of patients, so now we want to fine-tune the model by testing it in a larger study. We also want to see how it works when we use combinations of drugs, and whether the model can predict if a patient will suffer other side effects." Kate Law, clinical trials director at Cancer Research UK, said it was "a very interesting early study that could potentially have a big impact on how cancer patients are treated. Tailoring treatments to individual patients will ensure the best possible outcome for each. This is a hugely important area of cancer research, so we look forward to seeing how this technology performs in a larger trial." GUM INFECTIONS LINKED TO GESTATIONAL DIABETES Nearly half of all pregnant women with gestational diabetes also have periodontal disease, compared to one in 10 pregnant women without gestational diabetes. This was discovered by researchers at Tulane University in Louisiana. The study, available in the October issue of the American Journal of Obstetrics and Gynecology, is the first to demonstrate a link between poor oral health and diabetes during pregnancy. Periodontal disease is a chronic infection of the gums and mouth. Gestational diabetes is an inability to process dietary sugars normally during pregnancy. Gestational diabetes puts women and their babies at increased risk of injury and illness. The researchers analyzed health data from 256 pregnant women who participated in the National Health and Nutrition Examination Study III. Based on their analysis, the researchers recommend that dental care during pregnancy be considered as a way to help prevent gestational diabetes. Veteran Jerusalem dentist Dr. Steve Sattler explains that pregnant women are at higher risk of chronic periodontal disease and acute infections because of the increased hormonal influence during pregnancy. Any form of diabetes, he says, will influence one's periodontal condition, and even well-controlled diabetes will cause some negative changes in the periodontal condition. Therefore all pregnant women should have several dental exams, preferably one before the start of pregnancy, another at three months (without X-rays), a third three months later, and a fourth six weeks after delivery. TWO ARE BETTER THAN ONE "Cocktails" of drugs can sometimes have a synergistic effect against disease. An international study headed by Dr. Bella Kaufman of Sheba Medical Center has shown that combining the drug Herceptin with hormonal therapy increases the length of time certain women with advanced breast cancer live without the disease progressing. Postmenopausal women whose breast cancer is positive for hormone receptors and HER2 live an average of 4.8 months longer without cancer when they take both Roche's Herceptin and AstraZeneca's Arimidex, Kausman reported at the recent European Society for Medical Oncology Congress in Istanbul. In patients taking only Arimidex, the cancer spread again after an average of just 2.4 months. In patients taking the drug "cocktail," overall survival was prolonged to an average 28.5 months compared to 23.9 months for those on Arimidex alone - but this difference was not statistically significant. Around 65% of postmenopausal women with breast cancer have hormone-sensitive disease, and up to a quarter of them will also be HER2-positive, which means they have a particularly aggressive form of cancer with a higher risk of relapse. "The results are very positive," Kaufman said at the Istanbul meeting. "In breast cancer, there are not many trials that show double progression-free survival." Roche will apply to national drug registration authorities around the world to win approval for using both drugs together.