Cancer Research in Switzerland - Krebsliga Schweiz

in PHIV were shown for Hodgkin’s lymphoma (HL), nonmelanoma
skin cancer and cancers of the anus, liver, lip/
mouth/pharynx and trachea/lung.
2. Time trends and risk factors for cancer incidence within
the SHCS (Polesel, AIDS 2008; Franceschi, British Journal
of Cancer 2008; Clifford, Blood 2009): The incidence of
NHL (particularly primary brain lymphoma) and KS were
confirmed to have greatly decreased in the combination
antiretroviral therapy (cART) era. This beneficial effect remains
strong up to 10 years after cART initiation. HL risk,
on the other hand, does not appear to have changed over
time or to have been significantly affected by cART.
3. Nested case-control studies of cancer aetiology (Franceschi,
British Journal of Cancer 2006; Clifford, AIDS
2008): Frequent co-infection with HCV/HBV means that
the direct effect of HIV-related immunodeficiency on
hepatocellular carcinoma (HCC) has proven difficult to
elucidate. Nevertheless, we showed a significant association
between lower CD4 + cell counts and HCC risk, which
was particularly evident for HBV-related HCC arising in
non-intravenous drug users.
4. Sero-epidemiological studies (Sullivan, AIDS 2010):
cART increases KS herpesvirus-specific humoral immune
response and clearance of viremia among PHIV, consistent
with the dramatic protection offered against KS.
Recommendations
Improving survival means that PHIV live long enough for
the most severe long-term sequelae of carcinogenic viruses
to manifest as non-AIDS-defining cancers (NADCs).
Thus, NADCs can be expected to become an increasingly
important complication of long-term HIV infection, and
better cancer prevention strategies (control of immunosuppression,
cervical cancer screening, control of hepatitis
viral infections, smoking cessation) are a priority.
Project coordinator
Dr Silvia Franceschi
Infections and Cancer Epidemiology Group
International Agency for Research on Cancer (IARC)
150, cours Albert Thomas
F-69372 Lyon Cedex 08
France
Phone +33 472 73 84 02
Fax +33 472 73 8345
franceschi@iarc.fr
In collaboration with:
– Prof. Dr. Christine Bouchardy, Registre genevois
des tumeurs, Bd. de la Cluse 55, CH-1205 Genève
– Prof. Dr. Fabio Levi, Institut universitaire de médecine
sociale et préventive, Université de Lausanne,
rue du Bugnon 17, CH-1005 Lausanne
– Dr. Martin Rickenbach, Swiss HIV Cohort Study,
CHUV, Mont-Paisible 16, CH-1011 Lausanne
– Dr. Luigi Del Maso, Servizio di Epidemiologia e
Biostatistica, via Pedemontana Occ 12,
I-33081 Aviano, Italia
Maibach Rudolf | Academic research activity of
the International Breast Cancer Study Group (IBCSG)
ICP OCS 01688-03-2005
Duration: 01.07.2005 – 01.07.2009
CHF 791,510.–
The International Breast Cancer Study Group (IBCSG) is a
cooperative group that has conducted high quality and
important clinical trials of adjuvant therapy for patients
with operable breast cancer for the past 30 years. With its
network of investigators spanning five continents, the
IBCSG is dedicated to designing and conducting relevant
trials, evaluating primary and secondary study results and
presenting and publishing its findings in the best journals
and at scientific congresses.
IBCSG has been supported by Cancer Research Switzerland
(and formerly by Oncosuisse) in the conduct of a
series of studies, some of which have been completed
and evaluated. The following results are only a selection
of IBCSG’s research activities:
In two studies for pre- and postmenopausal patients conducted
in the 1990s, IBCSG evaluated breast cancer treatment
with chemotherapy and hormonal therapy. The
IBCSG Tissue Bank serves as repository for tumour material
from many of these patients. The IBCSG Pathology
Review Office has now evaluated in 2,754 patients the
role of peritumoural vascular invasion (PVI) for long-term
outcome. It could be shown that this invasion is associated
with larger and more aggressive tumours but does not
have a negative impact on the prognosis of the patient
if she has received adequate hormonal therapy. Nevertheless,
the determination of PVI should be done to inform
choice of the best therapy for the patient.
In two other studies with a median observation time of
13 years, we analyzed the influence of the extent of oestrogen
receptor expression on the efficacy of the chemotherapy
given in combination with the hormonal treatment.
High oestrogen receptor expression allows good
efficacy of the hormonal therapy, thus reducing the impact
of chemotherapy on the success of the treatment.
Therefore, oestrogen receptor expression is an important
factor in the choice of the optimal therapy.
Chemotherapy also has a direct influence on the hormonal
situation of the patient by reducing or completely
stopping the ovaries from producing hormones. In a study
of high-dose chemotherapy for patients with a high risk of
relapse, the highest treatment effect was observed in the
group of patients whose tumours carried oestrogen receptors.
This leads to the hypothesis that even high-risk
patients may benefit from hormonal therapy if the tumour
shows a sufficient quantity of receptors.
In the same study, the quality of life of the patients was
assessed repeatedly by questionnaires. The quality of life
indicators were combined with the relatively high toxicity
experienced by the patients and the long-term outcome
of the treatment to produce “quality-adjusted time without
symptoms and toxicity” (Q-TWiST). Although the
quality of life of the patients subjected to high-dose
chemotherapy was lower during the treatment, they had
a longer Q-TWiST. It may therefore be worthwhile to accept
a short-term reduction of the quality of life by a burdensome
chemotherapy if it is compensated by long-term
treatment success.
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