Health Rounds: New blood test finds early risk for ovarian cancer

By Nancy Lapid

Nov 10 (Reuters) - Hello Health Rounds readers! Today we highlight a diagnostic discovery that could transform preventive care for women at high risk of ovarian cancer. We also report on a promising pre-surgical dual-drug regimen for patients with bladder cancer, and the possible digestive benefits of regular coffee drinking.

Blood test detects ovarian cancer precursor

A molecular signal in the blood helps identify microscopic changes that precede development of ovarian cancer, researchers have found, a potential diagnostic breakthrough for a disease often discovered after it has already spread.

For decades, efforts to detect ovarian cancer earlier have focused on finding smaller tumors, the researchers noted in their report published on Tuesday in Nature Medicine.

“We asked a fundamentally different question: What if we could identify the earliest molecular warning signs before invasive cancer even develops?” study leader Rajan Gogna of the Hoag Family Cancer Institute in Newport Beach, California, said in a statement.

Ovarian cancer often begins with microscopic changes in the lining of the fallopian tubes. The precancerous lesions are known as serous tubal intraepithelial carcinoma.

The new study found that women with this precursor condition have elevated blood levels of an RNA molecule called Tu-Stroma.

When researchers measured Tu-Stroma in blood, they detected STIC in 92.3% of affected women and correctly identified 98.2% of healthy women.

In women with genetic risk factors for ovarian cancer, approximately 72% of positive results would be accurate, while negative results would be correct nearly 100% of the time, they reported.

“For women at high risk, this could transform how we approach prevention,” co-author Dr. Esha Madan, also of Hoag, said in a statement.

Many such women face difficult decisions about preventive surgery to remove their fallopian tubes and ovaries.

“Today, decisions about preventive surgery are largely guided by inherited risk, without knowing whether precancerous lesions are actually present,” Madan said. “Our discovery could eventually provide that missing biological information.”

An option for bladder cancer patients ineligible for chemo

A new approach showed promise for patients with bladder cancer in a large clinical trial, especially those unable to receive the chemotherapy that is usually given before surgery to reduce the risk of recurrence.

Patients who received AstraZeneca’s AZN.L immunotherapy Imfinzi and the targeted cancer drug Padcev from Astellas Pharma 4503.T and Pfizer PFE.N before bladder removal surgery, followed by immunotherapy, had a 42% lower risk of death than patients who underwent surgery alone.

The nearly 700 participants in the randomized trial had tumors extending into the muscular wall of the bladder. Chemotherapy is usually given to shrink such tumors before surgery and reduce the risk of recurrence.

But nearly half of such patients are unable to receive standard cisplatin-based chemotherapy, leaving them with limited treatment options, study leader Dr. Alexandra Drakaki of the David Geffen School of Medicine at UCLA said in a statement.

Roughly 45% of patients receiving the two-drug treatment had no detectable cancer in tissues removed during surgery, compared with roughly 10% of patients who underwent surgery without preoperative treatment, the researchers reported in The New England Journal of Medicine.

At two years, 78% of patients who received the two-drug combination were alive, compared with 69% of patients who underwent surgery alone.

Roughly 64% of those in the medicated group were free of cancer-related events at two years, compared with 45% of the straight-to-surgery patients.

Padcev, an antibody-drug conjugate, attaches itself to a protein on bladder cancer cells and delivers a cancer-killing drug directly to those cells, while Imfinzi helps the body attack cancer by blocking a protein tumors use to evade immune system detection.

Most patients were able to complete the preoperative treatment, despite a high incidence of severe adverse events, the researchers noted.

The findings give doctors an opportunity to offer an effective treatment before surgery to patients with muscle-invasive bladder cancer who cannot receive cisplatin, Drakaki said.

Coffee drinkers may have better digestive function

Regular coffee consumption not only affects populations of organisms in the small intestine but also the function of the digestive tract itself, research from Denmark suggests.

In this study as in previous studies, coffee drinkers had a greater diversity of microorganisms in their gut than those who drank coffee less often, researchers noted.

But frequent coffee drinkers also had more contractions in the colon, which can support healthy digestion, help prevent constipation and keep the intestinal muscles in good condition, study leader Francesca Bucci of the University of Copenhagen said in a statement.

Coffee drinkers also had significantly lower pH in the small intestine, researchers reported in Gut Microbiology.

They don’t know yet whether a lower pH is beneficial or harmful, but they note that pH level plays an important role in how food is broken down.

The 61 study participants swallowed small electronic capsules that traveled through the digestive tract, measuring temperature, pH levels and intestinal contractions, among other things.

Those deemed frequent coffee drinkers for the study consumed at least one cup a day on more than three of the eight study days.

The study cannot prove the differences are due to coffee consumption. Even so, the researchers point out, coffee is known to influence a range of processes in the digestive system, including acid secretion in the stomach.

"A great many people struggle with constipation and irregular bowel movements,” study co-author Henrik Munch Roager, of the University of Copenhagen, said in a statement.

“If we can understand how coffee affects digestion and intestinal contractions, it may be possible to use that knowledge to stimulate gut motility in a natural way.”