35th ESMO Congress

News

In 2009, Cuba’s centre for immunoassays began manufacturing its own PSA test with microanalysis technology: “we are now able to produce and analyse the PSA test for a mere fraction of the previous cost, making its widespread use possible”, says Celia Alonso—a clinical laboratory specialist from Hospital Hermanos Ameijeiras. Early last year, PSA testing was approved by the NCCU in primarycare settings for early detection and diagnosis of prostate cancer in all men with signs or symptoms of prostate cancer and asymptomatic men older than 50 years of age who request testing or have a family history of prostate cancer; a pilot programme studying the feasibility of annual PSA screening for all men between 50 and 75 years is underway. Although the PSA test might detect prostate cancer at an earlier stage, the appropriateness of widespread population-based screening has been questioned. Importantly, PSA is not a specific marker for prostate

cancer—eg, an increased PSA is often noted in benign conditions and PSA could remain within normal ranges in patients with clinically significant disease. Therefore, men with increased PSA must have invasive ultrasound-guided needle biopsies to confirm the diagnosis. In Cuba, ultrasound machines and biopsy needles are in short supply and increased use of such tests and subsequent demand for curative treatment is likely to put a substantial—if not overwhelming— strain on the health-care system. Furthermore, the PSA test cannot differentiate between aggressive cancers and harmless, slow-growing tumours, which are detected frequently by screening. Therefore, screening with PSA increases the chance of diagnosing and treating indolent cancers that might not have affected the patient during their lifetime. Patients are then potentially exposed to the adverse effects associated with invasive procedures

and the health-care system wastes money and resources. The national oncology group determined that at present “[PSA screening] is the best chance we have to alter the trajectory of prostate cancer mortality in Cuba”, explains Soriano. “Our primary objective is to cure the disease with what resources we have available, while doing our best to avoid overtreatment and the subsequent adverse effects which impair the patient’s quality of life”, adds García. Cancer-specific, cost-effective screening strategies with proven mortality benefit remain elusive for many cancers. While a defined mission, unified organisation, and coordinated management are important, effective reduction of the cancer burden is hampered by scarce funding and resources, suboptimal interventions, and adverse effects of cancer screening. Whether or not Cuba’s public-health system can overcome these obstacles remains to be seen.

with erlotinib than in the control arm; no patients had unexpected adverse events or showed signs of interstitial lung disease.

preliminary analysis, 4 months after the completion of enrolment, showed comparable response rates in the two arms—29 (41%) patients in the control group had an objective response versus 32 (48%) in the trastuzumabDM1 group—with substantially fewer grade 3 or worse adverse events being reported with the experimental treatment (51 [75%] of 68 analysable patients in the control group vs 25 [37%] of 67 in the trastuzumab group).

David Johnson

35th ESMO Congress OPTIMAL Erlotinib could be a new option for the first-line treatment of nonsmall-cell lung cancer (NSCLC) according to data presented by C Zhou (Shanghai, China) and colleagues. In this phase 3 trial, 165 patients with epidermal growth factor receptor activating mutations were randomly assigned to treatment with either erlotinib alone or carboplatin plus gemcitabine. 154 of these patients were included in the presented analyses: 82 in the erlotinib group and 72 in the carboplatin and gemcitabine group. Progression-free survival [PFS] was significantly improved with erlotinib compared with the control group (median PFS 13·1 vs 4·6 months; hazard ratio [HR] 0·16, 95% CI 0·10–0·26; p