By Evelyn Griggs (Contributing Author)
A new study published in medical journal,PLoS One, has revealed that the use of human insulin is not associated with an increased risk for bladdercancer. The study, carried out by Chin-Hsiao Tseng and colleagues at the National Taiwan University College of Medicine, involvedan analysisof health insurance reimbursements of 785, 234 patients suffering from Type 2 diabetes (T2DM), from the years 1996 to 2009. Within this group, some 88,000 patients (called the ?ever group?), had been treated human insulin; the rest (697, 294 patients, called the ?never group?), had never received human insulin.
Incident bladder cancer was 0.52% in the ever-user group and 0.48% in the never-users group, leading authors to conclude that there is no significant risk associated with the use of human insulin. [1]
Ensuring Accurate Statistics
According to its authors, the study ?relieves the concern? of those who have received and are currently receiving human insulin to treat their diabetes condition. The study took into account various ?confounders? which could have pointed to a link between human insulin and an increased risk of bladder cancer. These include patients on pioglitazone (Actos?; Takeda Pharmaceuticals), used in particular with Type 2 diabetes (T2DM) patients whose blood sugar cannot be sufficiently controlled throughnutritionand exercise. Pioglitazone, in addition to being associate, albeit at an?uncommon?level with bladder cancer, has been found to haveadditional side-effects, including weight gain, hematuria and erectile dysfunction. It should be noted, however, that the latter condition is common in patients with diabetes (about 35%-75% of men with diabetes experience this condition). Additional confounders which were removed from the study were patients on insulin glargine (a human insulin analogue). Researchers pointed out that study limitations included a lack of actual measurement for confounders such as smoking, alcohol consumption, water intake, family history, diet, smoking and even hair ye use. Occupational exposure and genetic parameters were also difficult to assess.
The strengths of the study include the fact that the databases studies included absolutely all claims on outpatient and emergency visits, and all claims for hospital admission, thus enabling researchers to obtain valuable data from all possible sources. The use of official medical records likewise reduced the risk of relying on data that has been skewed by self-reporting. Moreover, although there were different risks for bladder cancer dependent on the ages of subject and the amount of human insulin they received, these differences were rendered insignificant by the adjustment of all risk factors.
The aim …. is that [these] discoveries will lead to the discovery of specific pathways that can be targeted to improve the efficacy of bladder cancer treatment…
Two Intrinsic Subtypes of Bladder Cancer Discovered
Elsewhere in bladder cancer news, researchers from the University of North Carolina(UNC) Lineberger Comprehensive Cancer Centerhave identifiedtwo intrinsic subtypes of high-grade bladder cancer. Some 262 bladder tumors were analyzed, and researchers found that invasive bladder cancer can be divided into two subtypes (basal-like and luminal), owing to their difference at both the molecular and clinical levels. The findings likewise indicated that women had a significantly higher rate of basal-like tumors, which cause greater mortality rates than the luminal type. William Y. Kim, MD, who led the study, noted that the identification of different subtypes, as occurs in breast cancer, may be useful when it comes to stratification for therapy. Thus far, approved therapies for bladder cancer do not comprise targeted therapies; the aim of Kim and his team is that their discoveries will lead to the discovery of specific pathways that can be targeted to improve the efficacy of bladder cancer treatment. [2]
HER2 Use Proposed for Bladder Cancer Patients
A third advance in the treatment of bladder cancer involves the discovery that amplification of Human Epidermal Growth factor receptor 2 (HER2) ? which drives some types of breast cancer ? also occurs in a specific type of bladder cancer known as Micropapillary Urothelial Carcinoma (MPUC). As is the case with breast cancer, HER2 amplification in MPUC causes cancer to grow faster, spread quicker and have a higher incidence of recurrence. Since the administration of trastuzumab (Herceptin?; Genentech) to patients with these breast cancers has been found to improve outcomes, the hope is that it will do the same for patients with MPUC.
The study found HER2 amplification in 15% of patients with MPUC, and in 9% of patients with more common bladder cancers. Those with HER2-amplified MPUC were more likely to have aggressive tumors than other patients. The hope is that the study will enable scientists to identify prognostic and therapeutic biomarkers, to enable them to select the right drug for each type of tumor, rather than aiming treatment merely at the part of the body the tumor is located in. Individualized therapy is the future of cancer care, and the good news is, that in 2013, some 12 molecular/genomic markers were identified, representing great hope for the diagnosis, treatment and prognosis of a plethora of cancers.
For more information
[1] Chin-Hsiao Tseng Human Insulin Does Not Increase Bladder Cancer Risk PLOS One, January 20, 2014 DOI: 10.1371/journal.pone.0086517 [Article]
[2] Damrauer JS1, Hoadley KA, Chism DD, Fan C, Tiganelli CJ, Wobker SE, et al. Intrinsic subtypes of high-grade bladder cancer reflect the hallmarks of breast cancer biology. Proc Natl Acad Sci U S A. 2014 Feb 25;111(8):3110-5. doi: 10.1073/pnas.1318376111. Epub 2014 Feb 11. [Article][PubMed]
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