Medical Bulletin 05/ July/ 2024

Here are the top medical news for the day:

Trial Demonstrates High Efficacy of Antibody-Drug Conjugate in Preventing Early-Stage Breast Cancer Recurrence

A year of treatment with a medicine made of an antibody and chemotherapy drug has proven highly effective in preventing stage 1 HER2-positive breast cancer from recurring in patients, a team led by Dana-Farber Cancer Institute researchers has found.

The findings were published in the Journal of Clinical Oncology.

Trastuzumab Emtansine (T-DM1), known as an antibody-drug conjugate, is currently approved for post-surgical, or adjuvant, treatment of patients with HER2-positive breast cancer which remains after pre-surgical treatment and is also approved for patients with metastatic HER2-positive breast cancer.

The new study, a randomized phase II trial dubbed ATEMPT, involved patients with a stage 1 HER2-positive cancer, meaning it was small and without lymph node involvement.

Researchers also investigated biomarkers to predict cancer recurrence despite T-DM1 treatment. They utilised the HER2DX test, which evaluates clinical factors and the activity of four genes within tumour tissue. The findings indicated that patients with high scores on the HER2DX test had a greater risk of cancer recurrence.

The trial enrolled 512 patients across cancer centers with 384 participants receiving T-DM1 and 128 receiving chemotherapy and trastuzumab. Five years post-treatment, the T-DM1 group showed a 97% rate of no cancer recurrence. Additionally, the study highlighted that the rate of clinically relevant toxicities was similar in both groups. However, patient-reported outcomes revealed that those treated with T-DM1 experienced a better quality of life, reporting less neuropathy, less hair loss, and improved work productivity compared to those who received chemotherapy and trastuzumab.

Overall, the study underscored the potential of T-DM1 as an effective and well-tolerated treatment option for patients with early-stage HER2-positive breast cancer, particularly those at higher risk of recurrence.

“The ATEMPT trial has taught us that one year of T-DM1 after surgery for patients with a stage 1 HER2-positive cancer leads to outstanding long-term outcomes, making it a reasonable treatment approach for select patients,” says senior author Sara Tolaney.

Reference: Paolo Tarantino et al., Adjuvant Trastuzumab Emtansine Versus Paclitaxel Plus Trastuzumab for Stage I Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: 5-Year Results and Correlative Analyses From ATEMPT. JCO 0, JCO.23.02170; DOI:10.1200/JCO.23.02170

Limiting Ultra-Processed Foods Alone Doesn't Ensure a Healthy Diet, Study Reveals

A new study, presented at NUTRITION 2024, the flagship annual meeting of the American Society for Nutrition, demonstrated that eating primarily minimally processed foods, as they are defined by the NOVA classification system, does not automatically make for a healthy diet, suggesting that the types of foods we eat may matter more than the level of processing used to make them.

Comparing two menus reflecting a typical Western diet — one emphasizing minimally processed foods and the other emphasizing ultra-processed foods, as categorized by the NOVA classification system — the researchers found that the less processed menu reached its expiration date over three times faster without delivering any additional nutritional value.

In the study, researchers constructed two menus: a less-processed menu deriving 20% of its calories from ultra-processed foods and a more-processed menu deriving 67% of its calories from ultra-processed foods. The level of processing in each menu was determined using the NOVA system of classification.

Both menus were calculated to have a Healthy Eating Index score of about 43-44 out of 100, indicating poor adherence to the Dietary Guidelines for Americans. The researchers calculated that the median time to expiration for less-processed menu items was 35 days, versus 120 days for the more-processed menu items.

The study highlighted the disconnect between food processing and nutritional value. Notably, some nutrient-dense packaged foods can be classified as ultra-processed, such as unsweetened applesauce, ultrafiltered milk, liquid egg whites, and certain brands of raisins and canned tomatoes.

“This study indicates that it is possible to eat a low-quality diet even when choosing mostly minimally processed foods. The results indicated that building a nutritious diet involves more than a consideration of food processing as defined by NOVA. The concepts of ‘ultra-processed’ foods and ‘less-processed’ foods need to be better characterized by the nutrition research community,” said Julie Hess, PhD, a research nutritionist at the USDA-ARS Grand Forks Human Nutrition Research Center, who led the study.

Reference: Mark Messina, PhD, Soy Nutrition Institute Global, NUTRITION 2024, The flagship annual meeting of the American Society for Nutrition; AMERICAN SOCIETY FOR NUTRITION

Higher Isoflavone Intake Linked to Enhanced Thinking Skills in Children: Study

A new study, presented at NUTRITION 2024, the flagship annual meeting of the American Society for Nutrition, found that school-aged children who consumed more isoflavones from soy foods exhibited better thinking abilities and attention. These findings pave the way for future research aimed at exploring how soy foods can positively impact children's cognitive abilities.

Isoflavones are naturally occurring compounds predominantly found in soybeans and soy-based products. These phytoestrogens, which mimic the action of estrogen in the body, are known for their antioxidant properties and potential health benefits. In adults, studies have shown that isoflavones can enhance cognitive functions such as memory and attention. They are also linked to various other health benefits, including reduced risk of heart disease, improved bone health, and alleviation of menopausal symptoms.

To investigate the potential benefits of soy isoflavones, researchers analysed data from a previous cross-sectional study involving 128 children aged 7 to 13. They used 7-day diet records to determine each child's average intake of various nutrients, including macronutrients, micronutrients, vitamins, and isoflavones. The children's general intellectual abilities were assessed using grade-level adjusted tests. Additionally, their attentional abilities were evaluated using a computerized task, while electroencephalographic (EEG) activity was recorded to measure information processing speed and attention.

The analysis showed that, overall, the children consumed low amounts of soy foods containing isoflavones. However, those who did consume more soy foods demonstrated faster responses during the attentional tasks and quicker processing speeds. No significant link was found between soy isoflavone intake and general intellectual ability.

“In the study, children consumed an average of 1.33 mg of isoflavones per day, ranging from 0 to 35 mg/day. For context, an 8 oz serving of soy milk has about 28 mg of isoflavones, tofu provides about 35 mg, and half a cup of steamed edamame offers about 18 mg. Soy snacks like soy nuts, soymilk, and tofu or soy-based nuggets can help increase intake. To further investigate the effects of soy foods on cognitive abilities, sex hormones, metabolic health, and gut health, the researchers have started a clinical trial,” said Ajla Bristina, a neuroscience doctoral student, University of Illinois.

Reference: Ajla Bristina, et al.; University of Illinois Urbana-Champaign; Soy Isoflavone Consumption Is Associated With Greater Attentional Inhibition Among School- Aged Children; NUTRITION 2024, The flagship annual meeting of the American Society for Nutrition; American Society for Nutrition