'Fasting-mimicking diet' may promote health and longevity

A new study published in Cell Metabolism suggests following a calorie-restricted diet that mimics fasting for just 5 days a month for 3 months may promote longevity and reduce a number of risk factors for cancer, diabetes and cardiovascular disease.

Researchers found participants who followed a fasting-mimicking diet experienced a reduction in risk factors linked to aging, cardiovascular disease, diabetes and cancer.

Study co-author Valter D. Longo, of the FIRC Institute of Molecular Oncology in Italy and the University of Southern California, and colleagues say the research demonstrates the first anti-aging, healthspan-promoting intervention that doctors could feasibly recommend for patients.

Previous research from Longo in June last year suggested prolonged fasting - defined as consuming only water for 2-4 days - can "reboot" the human immune system. That is, fasting can help clear out damaged cells and regenerate new ones.

Another study published later that month also found periodic fasting may protect against diabetes among individuals at high risk for the condition.

However, Longo and colleagues note that humans find it psychologically challenging to engage in such extreme dieting, and it can also have adverse health effects - particularly for older individuals.

"These concerns point to the need for dietary interventions that induce prolonged fasting-like effects while minimizing the risk of adverse effects and the burden of complete food restriction," they note.

Fasting diet promoted cell regeneration, extending lifespan in mice

To address this need, the researchers developed a fasting-mimicking diet (FMD) - a low-protein, low-fat diet high in healthy fats. By activating markers associated with prolonged fasting, such as low glucose levels and high levels of ketone bodies, the diet was able to simulate the effects of fasting.

Firstly, the team tested the diet in middle-aged mice, feeding them the diet for 4 days, twice a month. Mice fed the FMD intervention were compared with mice fed a control diet.

The team found mice fed the FMD intervention had much higher numbers of stem cells, and they experienced regeneration of an array of other cell types, including bone, muscle, liver, brain and immune cells, compared with mice fed the control diet.

In addition, the FMD intervention appeared to extend the lifespan of mice and promote better overall health. They experienced better learning and memory, lower incidence of cancer and inflammatory diseases and fat loss without a reduction in lean body mass, compared with control mice.

Reduction in risk factors for aging, CVD, diabetes and cancer in humans

Next, the team tested a similar FMD intervention in a group of 19 generally healthy people aged 18-70. These participants were required to follow the diet for 5 days a month for 3 months. The diet provided them with between 34-54% of their normal caloric intake, as well as 11-14% proteins, 42-43% carbohydrates and 44-46% fat.

The 19 participants following the FMD intervention were compared with a group of 18 generally healthy aged-matched individuals who continued to follow their normal diet.

Compared with the participants who consumed their standard diet, those who followed the FMD intervention experienced a reduction in risk factors linked to aging, cardiovascular disease (CVD), diabetes and cancer, including lowered blood glucose, reduced markers of inflammation and weight loss.

The team notes that only 5% of FMD participants were disqualified from the study for failing to comply with the dietary regime.

Longo and colleagues say their findings indicate that following an FMD intervention periodically may promote longevity in humans and protect against risk factors for certain diseases. They add:

"Although the clinical results will require confirmation by a larger randomized trial, the effects of FMD cycles on biomarkers/risk factors for aging, cancer, diabetes, and CVD, coupled with the very high compliance to the diet and its safety, indicate that this periodic dietary strategy has high potential to be effective in promoting human healthspan."

The team says they are now putting the FMD intervention through a rigorous testing process in order to gain approval from the US Food and Drug Administration (FDA) for clinical use. This involves testing the efficacy of the diet in 60-70 participants, before moving to a clinical trial with 500-1,000 participants.

"This is arguably the first non-chronic preclinically and clinically tested anti-aging and healthspan-promoting intervention shown to work and to be very feasible as a doctor or dietitian-supervised intervention," says Longo.

The researchers stress that because the effects of the FMD intervention are potent, individuals should only follow such a diet under medical supervision.

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Mini-breasts grown in petri dishes New tool for cancer research

About 70,000 Women are diagnosed with breast cancer every year in Germany alone. Despite significant progress in the treatment of common types of breast cancer, some aggressive subtypes are poorly understood and remain incurable. A new experimental model opens new avenues for mammary gland biology and basic breast cancer research. Researchers are now able to create three-dimensional organoid-structures that recapitulate normal breast development and function from single patient-derived cells.

Detail of breast epithelial cells in culture undergoing ductal elongation and side-branching.

Credit: Image by Haruko Miura; Copyright HMGU

The research group, led by Dr. Christina Scheel, developed an assay whereby cultured human breast epithelial cells rebuild the three-dimensional tissue architecture of the mammary gland. For this purpose, a transparent gel is used in which cells divide and spread, similar to the developing mammary gland during puberty. Specifically, cells divide and generate hollow ducts that form a network of branches and terminate in grape-like structures. Throughout the reproductive lifespan of a woman, the mammary gland is constantly remodeled and renewed in order to guarantee milk production even after multiple pregnancies. Although their exact identity remains elusive, this high cellular turnover requires the presence of cells with regenerative capacity, i.e. stem cells. Breast cancer cells can adopt properties of stem cells to acquire aggressive traits. To determine how aggressive traits arise in breast cancer cells, it is therefore crucial to first elucidate the functioning of normal breast stem cells. For this purpose, the Scheel group provides a new powerful experimental tool.

A technological break-through

Using their newly developed organoid assay, the researchers observed that the behaviour of cells with regenerative capacity is determined by the physical properties of their environment. Jelena Linnemann, first author of the study, explains: "We were able to demonstrate that increasing rigidity of the gel led to increased spreading of the cells, or, said differently, invasive growth. Similar behaviour was already observed in breast cancer cells. Our results suggest that invasive growth in response to physical rigidity represents a normal process during mammary gland development that is exploited during tumor progression." Co-author Lisa Meixner adds that "with our assay, we can elucidate how such processes are controlled at the molecular level, which provides the basis for developing therapeutic strategies to inhibit them in breast cancer."

Another reason the mini-mammary glands represent a particularly valuable tool is, because the cells that build these structure are directly isolated from patient tissue. In this case, healthy tissue from women undergoing aesthetic breast reduction is used. Co-author Haruko Miura explains: "After the operation, this tissue is normally discarded. For us, it is an experimental treasure chest that enables us to tease out individual difference in the behavior of stem and other cells in the human mammary gland."

Experimental models that are based on patient-derived tissue constitute a corner stone of basic and applied research. "This technological break-through provides the basis for many research projects, both those aimed to understand how breast cancer cells acquire aggressive traits, as well as to elucidate how adult stem cells function in normal regeneration," says Christina Scheel, head of the study.

Background

In Germany, one in eight women is going to be diagnosed with breast cancer throughout her lifetime. In the past 30 years, the rate of newly diagnosed breast cancer cases has doubled. The reasons for this increase are unclear. Despite this greatly increased rate, mortality is declining steadily due to improved early detection and therapeutic options. Nonetheless, some aggressive subtypes of breast cancer remain poorly understood and incurable.

The aggressive behaviour of these breast cancer cells most likely originates in how the mammary gland develops and functions. The mammary gland itself consists of a structure similar in form to a bunch of grapes: a number of branching hollow ducts terminate in tiny, milk-producing pouches on one end, and the nipple on the other. This network of ducts in embedded in fatty and connective tissue which lends the breast is overall form. The mammary gland is the name-giving characteristic of mammals and provides a massive evolutionary advantage for raising offspring.

From a developmental point-of-view it is therefore essential that the highly energy-intensive process of milk production kicks in after each pregnancy. It is thought that for this purpose, the mammary gland harbours stem cells that are able to regenerate the entire mammary gland. However, how exactly such stem cells contribute to the main developmental phase of the mammary gland during puberty is not entirely clear. Without doubt, aggressive breast cancer cells activate developmental processes in an uncontrolled manner, which impacts many aspects of tumor progression. In that sense, a tumor is like an uncontrolled, regenerating organ. Importantly, elucidating how these regenerative processes are normally controlled provide the basis for the development of new targeting strategies.

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Story Source:

The above story is based on materials provided by Helmholtz Zentrum München - German Research Center for Environmental Health. Note: Materials may be edited for content and length.

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Prostate Cancer: Causes, Symptoms and Treatments

Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate - a gland in the male reproductive system.

The word "prostate" comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means "one standing in front", from proistanai meaning "set before". The prostate is so called because of its position - it is at the base of the bladder.

Contents of this article:

1. What is the prostate?
2. Prostate cancer
3. Classification of prostate cancer
4. Signs and symptoms of prostate cancer
5. Causes of prostate cancer
6. Prostate cancer treatments
7. Possible complications

Fast facts on prostate cancer

Here are some key points about prostate cancer. More detail and supporting information is in the main article.

• After non-melanoma skin cancer, prostate cancer is the most common cancer among men in the US.
• Prostate cancer is one of the leading causes of cancer death among men of all races and Hispanic origin populations.
• In the US around 209,292 men are diagnosed with prostate cancer per year.
• Around 27,970 men die from prostate cancer in the US each year.
• According to the American Cancer Society about 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
• Prostate cancer mainly occurs in older men - about 6 cases in 10 are diagnosed in men 65 years or older.
• Almost all prostate cancers are adenocarcinomas - cancers that begin in cells that make and release mucus and other fluids.
• Prostate cancer often has no early symptoms.
• Advanced prostate cancer can cause men to urinate more often or have a weaker flow of urine.
• Most men diagnosed with prostate cancer do not die from it. More than 2.9 million men in the US diagnosed with prostate cancer at some point are still alive today.

What is the prostate?

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.

Diagram of the location of the prostate gland and nearby organs

The urethra - a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body - goes through the prostate.

There are thousands of tiny glands in the prostate - they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.

Urine control

As the urethra goes through the prostate: the prostate gland is also involved in urine control (continence) with the use of prostate muscle fibers. These muscle fibers in the prostate contract and release, controlling the flow of urine flowing through the urethra.

The Prostate Produces Prostate-specific antigen (PSA)

The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man's PSA levels by checking his blood. If a man's levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition.

It is a myth to think that a high blood-PSA level is harmful to you - it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.

Male hormones affect the growth of the prostate, and also how much PSA the prostate produces. Medications aimed at altering male hormone levels may affect PSA blood levels. If male hormones are low during a male's growth and during his adulthood, his prostate gland will not grow to full size.

In some older men the prostate may continue to grow, especially the part that is around the urethra. This can make it more difficult for the man to pass urine as the growing prostate gland may be causing the urethra to collapse. When the prostate gland becomes too big in this way, the condition is called Benign Prostatic Hyperplasia (BPH). BPH is not cancer, but must be treated.

Prostate cancer

In the vast majority of cases, the prostate cancer starts in the gland cells - this is called adenocarcinoma. In this article, prostate cancer refers just to adenocarcinoma.

Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer - it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.

Experts say that prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells - Prostatic intraepithelial neoplasia (PIN).

Doctors say that nearly 50% of all 50-year-old men have PIN. The cells are still in place - they do not seem to have moved elsewhere - but the changes can be seen under a microscope. Cancer cells would have moved into other parts of the prostate. Doctors describe these prostate gland cell changes as low-grade or high-grade; high grade is abnormal while low-grade is more-or-less normal.

Any patient who was found to have high-grade PIN after a prostate biopsy is at a significantly greater risk of having cancer cells in his prostate. Because of this, doctors will monitor him carefully and possibly carry out another biopsy later on.

Classification of prostate cancer

It is important to know the stage of the cancer, or how far it has spread. Knowing the cancer stage helps the doctor define prognosis - it also helps when selecting which therapies to use. The most common system today for determining this is the TNM (Tumor/Nodes/Metastases). This involves defining the size of the tumor, how many lymph nodes are involved, and whether there are any other metastases.

When defining with the TNM system, it is crucial to distinguish between cancers that are still restricted just to the prostate, and those that have spread elsewhere. Clinical T1 and T2 cancers are found only in the prostate, and nowhere else, while T3 and T4 have spread outside the prostate.

There are many ways to find out whether the cancer has spread. Computer tomography will check for spread inside the pelvis, bone scans will decide whether the cancer has spread to the bones, and endorectal coil magnetic resonance imaging will evaluate the prostatic capsule and the seminal vesicles.

The Gleason Score

A pathologist will look at the biopsy samples under a microscope. If cancer tissue is detected, the pathologist then grades the tumor. The Gleason System of grading goes from 2 to 10. The higher the number, the more abnormal the tissues are compared to normal prostate tissue.

Two numbers are added up to get a Gleason score:

1. A number from 1 to 5 for the most common pattern observed under the microscope. This is the predominant grade and must be more than 51% of the sample.
2. A number from 1 to 5 for the second most common pattern. This is the secondary grade and must make up more than 5% but less than 50% of the sample.

A Gleason score of 7 can have two meanings. Look at these two examples below:

1. If the predominant grade is 3 and the secondary grade is 4, the Gleason score is 7.
2. If the predominant grade is 4 and the secondary grade is 3, the Gleason score is also 7.

However, the first example, with a predominant score of 3, has a less aggressive cancer than the second example, with a predominant score of 4.

It is crucial that the tumor is graded properly, as this decides what treatments should be recommended.

Signs and symptoms of prostate cancer

During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:

• The patient urinates more often
• The patient gets up at night more often to urinate
• He may find it hard to start urinating
• He may find it hard to keep urinating once he has started
• There may be blood in the urine
• Urination might be painful
• Ejaculation may be painful (less common)
• Achieving or maintaining an erection may be difficult (less common).

If the prostate cancer is advanced the following symptoms are also possible:

• Bone pain, often in the spine (vertebrae), pelvis, or ribs
• The proximal part of the femur can be painful
• Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
• Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
• Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord).

Causes of prostate cancer

Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.

1) Age

Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50.

2) Genetics

Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups - in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men.

Studies indicate that the two faulty genes - BRCA 1 and BRCA 2 - which are important risk factors for breast cancer and ovarian cancer, have also been implicated in prostate cancer risk.

In a study scientists found seven new sites in the human genome that are linked to men's risk of developing prostate cancer.

Faulty BRCA2 gene linked to aggressive form of prostate cancer - researchers at the The Institute of Cancer Research, UK, reported in the Journal of Clinical Oncology (April 2013 issue) that men who have inherited the faulty BRCA2 gene are more likely to have the faster-spreading type of prostate cancer. The scientists say these men should receive treatment immediately after diagnosis with surgery or radiation therapy, rather than receive the "watchful waiting" approach.

Senior author Ros Eeles wrote that experts have already known that those with the faulty BRCA2 gene have a higher risk of developing prostate cancer. This is the first large study to demonstrate that the faulty gene is also linked to a faster spread of the disease and poorer survival.

This new discovery will make some health authorities around the world rethink their policies and procedures. In the United Kingdom, the National Health Service offers the same prostate cancer treatment for both carriers and non-carriers of the faulty BRCA2 gene.

Prof. Eeles said "It must make sense to start offering affected men immediate surgery or radiotherapy, even for early-stage cases that would otherwise be classified as low-risk. We won't be able to tell for certain that earlier treatment can benefit men with inherited cancer genes until we've tested it in a clinical trial, but the hope is that our study will ultimately save lives by directing treatment at those who most need it."

3) Diet

A review of diets indicated that the Mediterranean diet mayreduce a person's chances of developing prostate cancer.Another study indicates that soy, selenium and green tea, offer additional possibilities for disease prevention - however, a more recent study indicated that combination therapy of vitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.

A US pilot study on men with low risk prostate cancer found that following an intensive healthy diet and lifestyle regime focusing on low meat and high vegetable and fruit intake, regular exercise, yoga stretching, meditation and support group participation, can alter the way that genes behave and change the progress of cancer, for instance by switching on tumor killers and turning down tumor promoters.

Other studies have indicated that lack of vitamin D, a diet high in red meat may raise a person's chances of developing prostate cancer.

A study published in the journal Clinical Cancer Research suggests vitamin D deficiency may predict aggressive prostate cancer.

4) Medication

Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk. A study found that statins, which are used to lower cholesterol levels, may lower a person's risk of developing prostate cancer.

5) Obesity

A study found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer.

6) Sexually transmitted diseases (STDs)

Men who have had gonorrhea have a higher chance of developing prostate cancer, according to research from the University of Michigan Health System.

7) Agent Orange

Veterans exposed to Agent Orange have a 48% higher risk of prostate cancer recurrence following surgery than their unexposed peers, and when the disease comes back, it seems more aggressive, researchers say. Another study found that Vietnam War veterans who had been exposed to Agent Orange have significantly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.

8) Enzyme PRSS3 linked to aggressive prostate cancer

Scientists from the Mayo Clinic, Florida, reported in Molecular Cancer Research that PRSS3, an enzyme, changes the environment of prostate cancer cells, making the cancer much more likely to metastasize.

Senior researcher, Evette Radisky, Ph.D., said "This molecule is a protease, which means it digests other molecules. Our data suggests PRSS3 activity changes the environment around prostate cancer cells - perhaps by freeing them from surrounding tissue - to promote malignancy and invasiveness. I don't think PRSS3 is the only factor involved in driving aggressive prostate cancer, but it may be significant for a certain subset of this cancer - the kind that is potentially lethal."

Recent developments on prostate cancer causes from MNT news

Chronic prostate inflammation tied to nearly double risk of prostate cancer - a study reported in the journal Cancer Epidemiology, Biomarkers & Prevention, finds that compared to men with no such signs, men with chronic inflammationin non-cancerous prostate tissue may have nearly double the risk of developing prostate cancer.

Vasectomy linked with aggressive prostate cancer risk - In the largest and most comprehensive study of its kind, researchers from Harvard School of Public Health in Boston, MA, find that vasectomy is associated with a small increased risk of prostate cancer, and a larger increased risk for advanced or lethal prostate cancer.

Prostate cancer: high cholesterol, triglyceride levels may raise risk of recurrence - Among men who have surgery for prostate cancer, those who have high total cholesterol and triglyceride levels - two types of fat found in blood - may be at increased risk of disease recurrence. This is according to a study published in the journal Cancer Epidemiology, Biomarkers & Prevention.

Western diet could be fatal for prostate cancer patients - A new study has suggested that following a Western diet - high in red and processed meats, refined grains and high-fat dairy products - could increase the risk of death for people with prostate cancer from both prostate cancer and all causes.

Prostate cancer treatments

The following treatments are separated into early stage and advanced stage prostate cancers.

Early stage prostate cancer

If the cancer is small and contained - localized - it is usually managed by one of the following treatments:

• Watchful waiting - not immediate treatment is carried out. PSA blood levels are regularly monitored.
• Radical prostatectomy - the prostate is surgically removed.
• Brachytherapy - radioactive seeds are implanted into the prostate.
• Conformal radiotherapy - the radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment, thus minimizing healthy tissue exposure to radiation.
• Intensity modulated radiotherapy - beams with variable intensity are used. An advanced form of conformal radiotherapy usually delivered by a computer-controlled linear accelerator.
  Treatment recommendations really depend on individual cases. In general, if there is a good prognosis and the cancer is in its early stages, all options can be considered. However, they all have their advantages and disadvantages. The patient should discuss available options thoroughly with his doctor.

More advanced prostate cancer

If the cancer is more aggressive, or advanced, the patient may require a combination of radiotherapy and hormone therapy. Radiotherapy requires treatment on an everyday basis for up to about eight weeks. Radical surgery is also an option - the prostate is removed. Traditional surgery requires a hospital stay of up to ten days, with a recovery time that can last up to three months. Robotic keyhole surgery has the advantage just a couple of days in hospital, followed by a much shorter recover period. However, even robotic keyhole surgery may not be ideal for very elderly patients.

In advanced prostate cancer hormone therapy is very effective in slowing down, and even stopping the growth of cancer cells. Even if the hormone therapy stops working after a while, there are still other options the patient will be able to discuss with his doctor, such as participating in clinical trials.

Radioactive injection helps advanced prostate cancer patients live longer - scientists at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, UK, reported in NEJM (New England Journal of Medicine) that radium-233, a radiation injection, directly targets tumors in the bone delivering short range radiation, causing minimal damage to healthy tissue. Radium, like calcium, is absorbed by the bone.

Delivering estrogen through skin patches may be an easier and safer way to treat prostate cancer than the hormone therapies that are currently used, British researchers explained in Lancet Oncology (March 2013 issue).

In May 2013, the US FDA approved Xofigo (radium Ra 223 dichloride) for metastatic castration-resistant prostate cancer that has reached bones but not other organs. Enzalutamide is taken in combination with docetaxel, another cancer medication.

Richard Pazdur, M.D., from the FDA, said "Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues. Xofigo is the second prostate cancer drug approved by the FDA in the past year that demonstrates an ability to extend the survival of men with metastatic prostate cancer."

Xtandi (enzalutamide) was approved by the FDA in August 2012 for patients with metastatic castration-resistant prostate cancer that has spread or recurred.

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Immunotherapy heralds 'new era' for cancer treatment

A "whole new era" for cancer treatment is upon us, according to experts. Two new studies published in the New England Journal of Medicine provide further evidence that immunotherapy - the use of drugs to stimulate immune response - is highly effective against the disease.

Immunotherapy involves the use of drugs to boost patients' immune system response, increasing the attack on cancer cells.

Recently presented at the 2015 American Society for Clinical Oncology annual meeting, one study revealed that a drug combination of ipilimumab and nivolumab (an immune therapy drug) reduced tumor size in almost 60% of individuals with advanced melanoma - the deadliest form of skin cancer - compared with ipilimumab alone, while another study found nivolumab reduced the risk of lung cancer death by more than 40%.

Nivolumab is a drug already approved by the Food and Drug Administration (FDA) for the treatment of metastatic melanoma in patients who have not responded to ipilimumab or other medications. It is also approved for the treatment of non-small cell lung cancer (NSCLC) that has metastasized during or after chemotherapy.

According to cancer experts, however, the results of these latest studies indicate that nivolumab and other immune therapy drugs could one day become standard treatment for cancer, replacing chemotherapy.

Prof. Roy Herbst, chief of medical oncology at Yale Cancer Center in New Haven, CT, believes this could happen in the next 5 years. "I think we are seeing a paradigm shift in the way oncology is being treated," he told The Guardian. "The potential for long-term survival, effective cure, is definitely there."

Nivolumab plus ipilimumab reduced tumor size by at least a third for almost 1 year

Nivolumab belongs to a class of drugs known as "checkpoint inhibitors." It works by blocking the activation of PD-L1 and PD-1 - proteins that help cancer cells hide from immune cells, avoiding attack.

In a phase 3 trial, Dr. Rene Gonzalez, of the University of Colorado Cancer Center, and colleagues tested the effectiveness of nivolumab combined with ipilimumab - a drug that stimulates immune cells to help fight cancer - or ipilimumab alone in 945 patients with advanced melanoma (stage III or stage IV) who had received no prior treatment.

While 19% of patients who received ipilimumab alone experienced a reduction in tumor size for a period of 2.5 months, the tumors of 58% of patients who received nivolumab plus ipilimumab reduced by at least a third for almost a year.

Commenting on these findings, study co-leader Dr. James Larkin, of the Royal Marsden Hospital in the UK, told BBC News:

"By giving these drugs together you are effectively taking two brakes off the immune system rather than one, so the immune system is able to recognize tumors it wasn't previously recognizing and react to that and destroy them.

For immunotherapies, we've never seen tumor shrinkage rates over 50% so that's very significant to see. This is a treatment modality that I think is going to have a big future for the treatment of cancer."

Dr. Gonzalez and colleagues also demonstrated the effectiveness of another immune therapy drug called pembrolizumab in patients with advanced melanoma.

While 16% of 179 patients treated with chemotherapy alone experienced no disease progression after 6 months, the team found that disease progression was halted for 36% of 361 patients treated with pembrolizumab after 6 months.

Dr. Gonzalez notes that while a combination of nivolumab and ipilimumab shows greater efficacy against advanced melanoma than pembrolizumab, it also presents greater toxicity. Around 55% of patients treated with nivolumab plus ipilimumab had severe side effects, such as fatigue and colitis, with around 36% of these patients discontinuing treatment.

Dr. Gonzalez says such treatment may be better for patients whose cancer does not involve overexpression of the PD-L1 protein.

"Maybe PDL1-negative patients will benefit most from the combination, whereas PDL1-positive patients could use a drug targeting that protein with equal efficacy and less toxicity," he adds. "In metastatic melanoma, all patients and not just those who are PD-L1-positive may benefit from pembrolizumab."

Nivolumab almost doubled patient survival from NSCLC

In another study, Dr. Julie Brahmer, director of the Thoracic Oncology Program at the Johns Hopkins Kimmel Cancer Center, and colleagues tested the effectiveness of nivolumab against standard chemotherapy with the drug docetaxel among 260 patients with NSCLC.

All patients had been treated for the disease previously, but the cancer had returned and spread.

The team found that patients who received nivolumab had longer overall survival than those treated with standard chemotherapy, at 9.2 months versus 6 months.

At 1 year after treatment, the researchers found nivolumab almost doubled patient survival. Around 42% of patients who received nivolumab were alive after 1 year, compared with only 24% of patients who received chemotherapy.

The study results also demonstrated a longer period of halted disease progression for patients who received nivolumab compared with those who had chemotherapy, at 3.5 months versus 2.8 months.

Overall, the researchers estimated that, compared with patients who received chemotherapy, those who received nivolumab were at 41% lower risk of death from NSCLC.

Commenting on these findings, Dr. Brahmer says:

"This solidifies immunotherapy as a treatment option in lung cancer. In the 20 years that I've been in practice, I consider this a major milestone."

While both studies show promise for the use of immunotherapy in cancer treatment, experts note that such treatment would be expensive. The use of nivolumab plus ipilimumab for the treatment of advanced melanoma, for example, would cost at least $200,000 per patient.

As such, researchers say it is important that future research determines which cancer patients would be most likely to benefit from immunotherapy.

Medical News Today recently reported on a study conducted by investigators from Cancer Research UK, which reveals a class of drugs called AKT inhibitors may boost the effect of radiotherapy against various cancers, including breast, kidney, melanoma and brain cancers.

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Sun safety: how to protect your child from the greatest cause of skin cancer

It is well known that exposure to UV radiation from the sun or indoor tanning devices is a primary cause of skin cancer - the most common form of cancer in the US. What appears to be less well known is the risk UV radiation can pose to children, with a recent survey revealing that 1 in 5 parents are unaware that their children's skin is sensitive to the sun.

Sun protection is a key factor for reducing skin cancer risk.

According to Dr. Lisa Chipps, assistant clinical professor of the David Geffen School of Medicine at the University of California-Los Angeles (UCLA), director of dermatologic surgery at Harbor-UCLA Medical Center, skin cancer is primarily viewed as a disease of adulthood, meaning many parents may not consider their child is at risk.

"However," Dr. Chipps told, "melanoma accounts for up to 3% of pediatric cancers and 6% of cancer cases in teens 15-19 years old."

There is currently no registry or database that tracks cases of skin cancer among children in the US, but a 2013 study published in the journal Pediatrics found the rate of melanoma - the deadliest form of skin cancer - rose 2% annually among children aged 0-19 between 1973 and 2009.

Though a diagnosis of skin cancer is rare during childhood, excessive sun exposure at a young age can increase the risk of skin cancer later in life. Last year, MNT reported on a study revealing that multiple sunburns during adolescence can raise the risk of melanoma by 80%.

"Overexposure to the sun and sunburns that happen during childhood are important and preventable risk factors for developing skin cancer as an adult," says Dawn Holman, a behavioral scientist in the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC), told MNT. "This is why it's so important for us all to use sun protection at every age."

However, as the aforementioned survey revealed, many parents seem to be unaware that the sun poses a risk to their child's skin. That same survey - conducted by Nivea Sun - also found that more than half of parents are unaware that multiple sunburns cause long-lasting damage to their child's skin, while 77% do not think pink or sore skin necessarily indicates sun damage.

In this Spotlight, we look at the best ways to protect children of all ages against the damaging effects of UV (ultraviolet) radiation and look at ways to overcome some of the major challenges that threaten children's sun safety.

Shade is the best sun protection for infants

According to the Skin Cancer Foundation, infants aged 6 months and under should be kept out of direct sunlight. This is because they have low levels of melanin in their skin - the substance that gives pigment to the skin, hair and eyes and protects against the sun - meaning they are very sensitive to UV radiation.

As such, the Skin Cancer Foundation recommend that parents take their infant for walks in a stroller with a sun-protective cover before 10 am and after 4 pm - when UV radiation is lowest.

"The best protection is to keep your baby in the shade," says Dr. Hari Cheryl Sachs.

Infants should be dressed in lightweight clothing that covers the arms and legs, and their face neck and ears should be protected with a wide-brimmed hat or bonnet.

When an infant is traveling in a vehicle, it is wise to cover the windows with removable mesh window shields or UV window film to reduce sun exposure.

While sunscreen is regarded as a key form of sun protection, it is not recommended for use on infants under the age of 6 months.

"Babies' skin is less mature compared to adults, and infants have a higher surface-area to body-weight ratio compared to older children and adults," explains Dr. Hari Cheryl Sachs, a pediatrician at the Food and Drug Administration (FDA). "Both these factors mean that an infant's exposure to the chemicals in sunscreens may be much greater, increasing the risk of side effects from the sunscreen."

"The best protection is to keep your baby in the shade, if possible," she adds. "If there's no natural shade, create your own with an umbrella or the canopy of the stroller."

If it is not possible to protect an infant from the sun with protective clothing or shade, sunscreen may be applied on the advice if a pediatrician.

It is safe to use sunscreen in babies aged 6-12 months, according to the Skin Cancer Foundation, who note that a broad-spectrum sunscreen with a minimum sun protection factor (SPF) of 15 should be applied.

Wearing protective clothing and seeking shade are still key factors for protecting a baby against the sun; sunscreen should be applied on areas that are not covered - such as the hands and face - 30 minutes before sun exposure and reapplied every 2 hours after swimming or sweating.

Children aged 6 months and older should also wear wraparound sunglasses that block 99-100% of UV radiation.

The challenges of sun protection in toddlers

As a child grows, protecting them against the sun can become more difficult. They are more likely to be exposed to sunlight by playing outdoors, and they are also more likely to disobey requests to wear a hat or sunglasses.

In 2004, Dr. Lori Steinberg Benjes, a dermatologist in Cambridge, MA, led a study published in JAMA Dermatology that looked at rates of sun protection among children aged 6 and 18 months.

The results revealed that while 22% of children experienced tanned or sunburnt skin at the age of 6 months, this figure rose to 54% at 18 months. The researchers claim one reason for this is due to the difficulties parents face in controlling their children as they reach toddler age.

"Keeping babies out of the sun is often manageable, but consistent, effective sun protection of toddlers requires more effort and is more challenging," Dr. Benjes notes.

The study also revealed that while there was a higher incidence of tanned and sunburnt skin among children aged 18 months, the use of sunscreen increased. This, the team says, indicates that parents fail to action other sun-protection methods.

"Parents need to understand that sunscreen is only one vital line of defense in sun protection," says Dr. Perry Robins, president of the Skin Cancer Foundation, adding:

"Strategies such as seeking shade and dressing children in sun-protective clothing are just as important and can't be abandoned in the second year, since sunscreen cannot keep all of the sun's rays away from the skin. Teaching these techniques early to children can leave them with sun safety habits that will help prevent skin cancer later in life."

Schools: a help or hindrance to sun safety?

For school-age children, the rules for sun protection remain the same; they should use sunscreen, wear protective clothing and seek shade when UV radiation is at its strongest, which is normally around midday.

Of course, parents have a lot to think about when they are getting their child ready for school, which means they may be less likely to focus on sun protection.

"Getting a few kids ready for school in the morning involves making breakfasts, packing lunches, choosing outfits, finding shoes/homework/backpacks, so yes, sometimes parents slack on the sunscreen," Dr. Chipps told.

The Skin Cancer Foundation say schools can be a hindrance to sun safety, but they can also play an important role in increasing sun safety.

She does, however, provide a useful tip to help combat this problem: "As a parent, I advise making sunscreen part of the childrens' daily morning routine. I keep the sunscreen on the bathroom counter so my kids can apply it when they brush their teeth and comb their hair."

But how can parents ensure their children receive adequate sun protection when they are at school and out of their sight?

According to the Skin Cancer Foundation, sometimes schools can be the "biggest block" to children's sun safety. "Many schools see sunscreen as a medicine, and require either written permission to use it, or require that the school nurse apply it," they note. "Many schools also ban the wearing of hats and sunglasses during school hours, including recess."

The Foundation recommend parents talk to their child's school to find out what their policy is on sun safety. If the school is not doing enough to protect children, they recommend alerting other parents and getting them involved in encouraging the school to take action.

Schools, however, can also play an important role in increasing children's sun safety. "Evidence suggests that sun-safety interventions in child care centers, elementary schools and middle schools are effective in increasing children's use of sun protection," says Holman.

Such interventions - detailed in The Community Guide from the Community Preventive Services Task Force - include educating children about the risks of UV radiation and what can be done to protect against them, as well as implementing activities designed to influence children's, teachers' and parents' behaviors and attitudes toward sun safety.

"In addition," added Holman, "the public health community can work with partners to ensure parents have the information they need to keep their families sun-safe and that other community sectors - such as those working at schools and outdoor recreational settings - have the tools they need to support sun-safety."

Teens and tanning

We all know what it's like to be a teenager. It is a time when you may feel pressured to look a certain way and conform to common perceptions of what is attractive. For many teens - particularly girls - attractiveness means having tanned skin.

What many people - both teenagers and adults - fail to realize is that any form of tan is a reflection of skin damage. The skin turns brown because of an increase in melanin production in an attempt to protect it from further damage.

But many individuals - particularly teens - put their desire for a tan over the associated health risks. In a Spotlight investigating the dangers of UV exposure last year, Tim Turnham, executive director of the Melanoma Research Foundation, told us:

"Despite elevated awareness of the dangers of UV radiation, people still choose to ignore the dangers in the pursuit of what they consider to be a 'healthy tan.' This is particularly an issue among young people who tend to ignore health risks in favor of enhancing their social status and popularity. We know that tanning appeals to people who are interested in being included, and this is a primary driver for teens - being part of the 'in' crowd."

Unfortunately, the desire for being part of the "in" crowd pushes many teenagers toward indoor tanning. According to the American Academy of Dermatology, around 17% of teenagers have reported using a tanning bed at some point in their lives.

Indoor tanning can dramatically raise the risk of skin cancer - with the rays that tanning devices emit being around 10-15 times stronger than those given off by the midday sun.

A 2014 study estimated that each year, around 400,000 cases of skin cancer in the US may be related to indoor tanning, while a study reported by MNT last year linked the use of tanning beds in teenagers to greater risk of basal cell carcinoma (BCC) - the most common skin cancer in the US.

The dangers of indoor tanning have hit the headlines recently after a 29-year-old woman shared a picture of wounds caused by treatment for skin cancer. Tawny Willoughby, from Kentucky, was first diagnosed with BCC aged 21 - a diagnosis she puts down to her excessive sunbed use as a teenager.

"If anyone needs a little motivation to not lay in the tanning bed and sun here ya go! This is what skin cancer treatment can look like," she wrote alongside her posted picture. "Wear sunscreen and get a spray tan. You only get one skin and you should take care of it."

A spray tan is certainly a healthier alternative to using indoor tanning devices for those who yearn for a golden glow, though it should be noted that a spray tan does not protect the skin against the sun. The use of sunscreen is still required. Another alternative is tanning lotions, some of which have an SPF of 15 and above.

As well as the use of sunscreen, it is recommended that teenagers also seek shade during midday hours and wear sun-protective clothing. If your teen complains that such clothing isn't fashionable, try to find items that are more stylish that still cover them up - like a pretty sarong for a teenage girl, for example.

But of course, one of the best ways to encourage sun safety in children - no matter what their age - is to lead by example. As the Skin Cancer Foundation say:

"The most important thing to remember when thinking about sun protection is this: you are your children's role model. Be sure to let them see you protecting yourself from the sun. If you have great skin, so will they."

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