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October 23, 2015
Animal Studies Reveal Clues about Human Cancers
Recent news about genetic discoveries in animals (none of which damaged the animals but rather involved blood draws and so on) have revealed some exciting prospects for discoveries about the genetic, biological, and immunological mechanisms that contribute to cancer's prevalence in people. I released an article today in Huffington Post on the topic. You can read it there by clicking on the link in the prior sentence, or keep reading below:
Animal Studies Offer Cancer Research Clues
Posted: 10/22/2015 7:43 pm EDT Updated: 10/22/2015 7:59 pm EDT
What do an elephant, a blind mole rat, and bowhead whales have in common that could help people? There are indications that all of them have different sorts of cancer resistance built into their DNA and body processes. The National Cancer Institute (NCI) describes such animal models as central to understanding how cancer works in the human body.
According to the American Cancer Society, roughly one of two men and one of three women will be diagnosed with cancer in their lifetimes. Over three quarters of those diagnoses come in people above the age of 55, but cancer can strike at any age.
Animals get cancer too, but many do so at radically lower rates than people. In the 1970s, epidemiologist Richard Peto of University of Oxford, UK, studied larger and especially long-lived animals, whose cells have divided many more times than those of smaller and younger animals. His opening hypothesis was that these larger and older animals should have more random mutations that could lead to cancer. Surprisingly, he discovered that they actually contracted cancer far less frequently, so he suspected that they might have some built-in biological mechanism that was protecting them from the disease.
More recently, the labs of Dr. J. D. Schiffman (from the Huntsman Cancer Center at the University of Utah) and Dr. Vincent Lynch (evolutionary biologist at the University of Chicago) have each independently identified a significant factor that may help explain the difference in cancer incidence rates between people and elephants. A gene common to people and elephants called TP53 helps suppress cancer. The p53 protein helps identify when a gene has been damaged and may stimulate repair of the gene, pause cell division, or cause the cell to kill itself.
Humans have two copies of this tumor suppressor gene and have a lifetime cancer risk ranging from 33 - 50% (one in two men, one in three women). In contrast, elephants have 20 or more copies of this tumor suppressor gene, and their lifetime cancer risk is dramatically lower: under 5%. It remains to be experimentally proven whether TP53 is responsible for this cross-species difference in cancer risk. Yet in rare human cases where a human TP53 gene is defective (a rare disorder called Li-Fraumeni syndrome), the person's lifetime cancer risk may rise as high as 90%.
Many research labs are examining cancer trends in a variety of animal species that have particularly low cancer incidence for possibly different reasons. Researchers don't fully understand (yet) the mechanisms responsible for reduced cancer incidence in certain species but are now exploring more species for potential human parallels. Particular targets of investigation in animals include two gene types [one that causes normal cells to turn cancerous (oncogenes) and one that suppresses cancer by repairing cell damage and stopping tumor growth] as well as a variety of proteins and enzymes.
For example, the naked mole rat, a subterranean rodent that lives over 30 years (in comparison with the typical four-year life span of more typical rats), is resistant to both cancer and aging. Researchers believe this phenomenon is a function of an enzyme, hyaluronidase (HA). Because cancer is more prevalent in older humans, learnings from long-lived animals with low cancer rates could be relevant. Other long-lived species like parrots, tortoises, and bowhead whales are subjects of Dr. Schiffman's interest, although their cancer suppression mechanisms (as-yet unknown) may be different from either TP53 or the HA enzyme.
Discoveries of how these genes and enzymes behave in animal models may decipher the biological mechanisms that cause, support, prevent, or suppress cancers in the human body. Researchers seek to discover mechanisms in animal models that may help control human cancer's incidence, growth, spread, and potential to kill.
The exploration of such models is only one facet in cancer research but offers an important lesson about why cancer research costs so much and takes so long. Cancer isn't just one disease. It's the name for over 200 related conditions in which unrestrained cell growth may overwhelm the body's normal organs and systems. Controlling cancer requires understanding for each type of cancer such factors as its causes, mechanisms that allow or even foster its spread (metastasis), how some cancers develop chemotherapy resistance, and what causes recurrences after a patient goes into remission.
The American Association for Cancer Research (AACR) describes four basic levels of research that are pivotal to breakthroughs for humans:
- Basic laboratory research studies normal cells and what transforms them into cancer cells.
- Translational research works to convert laboratory discoveries into potentially safe and effective patient treatments.
- Clinical research conducts trials with people to determine safe and effective dosages, on what types of patients, with what types and stages of cancers. Some trials also test whether effective treatments for one type of cancer may work for other types as well.
- Population research examines volumes of clinical data to understand risk, incidence, and survival patterns across large population groups to reveal prevention, detection, or control breakthroughs.
Animal models represent only one link in the cancer research chain. Cancer research is further complicated by the overlay of genetic patterns that make each person more or less susceptible to cancer and by biological "switches" that may trigger the body's own immune system to fight cancer. The resulting breadth of potential research targets makes cancer research both costly and time consuming.
While it's unclear what human applications such research might have, Dr. Ted Gansler of the American Cancer Society says that
"Studies of other species that are done . . . without any short term expectation of medical relevance often turn out to be very important in understanding cancer . . . . progress often comes from unexpected directions."
Despite rising survival rates, current human cancer incidence (one new case diagnosed every 30 seconds) poses an extreme financial and emotional toll for affected families. Animal studies are time consuming and costly but will continue to yield important clues about cancer in humans, clues that will be missed or delayed without substantially increased Federal research funding.
September 21, 2015
Children's Cancer Awareness? Empathy is Far From Enough
Earlier this month, I received a blog post from the Cancer Knowledge Network, a very good information source that's published by people who have lost children to cancer. Sue McKechnie released a post about her son Shawn, who died of brain cancer at age 3. It's compelling reading, and I've picked up on her story in an article that I posted today on Huffington Post. If I say so myself, it's compelling and well worth a look: http://www.huffingtonpost.com/deborah-j-cornwall/childhood-cancer-empathy-_b_8158070.html
Hopefully it will inspire some readers to speak out in support of more funding for pediatric cancer research.
September 10, 2015
Finally, Legislation Addressing the High Price of Prescription Drugs
The Wall Street Journal just released a story about a bill that Bernie Standers and Elijah Cummings are introducing to the Senate and House today the Prescription Drug Affordability Act at a press conference today (September 10). It's goals are to allow citizens to import less costly drugs from Canada, empower Medicare to negotiate drug prices with pharmaceutical manufacturers, and require manufacturers to disclose the prices at which they sell their products overseas.
Pay attention to this bill as more details are disclosed and as our legislators begin to take sides. On the surface, this bill would appear to have positive impact for a large share of the American population. Regardless of your political preferences, it's clear that as the bill proceeds through Congressional consideration in both houses, there will be opportunities for impassioned advocates to communicate their feelings about it to legislators.
August 28, 2015
Cancer Research Accelerators Worth Watching
My latest Huffington Post article offers addresses how pan-cancer studies and collaborative research are changing cancer research. Three particular initiatives are discussed that may give hope to those seeking breakthrough clinical trials. For those of us fighting back to see an end to cancer in our lifetimes, these trends and the accelerating understanding of cancer at the molecular level also build hope and remind us all of the need to speak out to urge Congress to sustain and increase cancer research funding. This year, advocates for cancer research had some success, but in the face of growing budgetary pressures that have shrunk research funding in real dollar terms, it takes prolonged pressure from thousands of advocates every year to protect cancer and other health research budgets.
For inspiration about the kind of progress that is taking place, just click on the link below:
August 20, 2015
Prolonged and "Complicated" Grief Can be Managed
When a loved one dies, grief is inevitable. It comes in unpredictable waves, and at times it feels like you don't have any resilience left. All gone. Used up. Drained. It feels like you have a hole in the center of your body that can never be filled.
For most people, the hole gradually evolves into a well of fond memories. That doesn't mean that the sadness goes away, but it does mean that you begin reaching out to fill the hole . . . to find ways of savoring old memories, or to fill the time that's been left vacant, or to build new relationships that may in some small way help bolster your resilience and let you move on. Despite occasional waves of sadness and tears that may recur periodically, most bereaved people manage to move on and to live a fulfilling life despite the huge loss.
For some, however, the grief can be overwhelming and can last for years. This situation is often called "complicated grief." If you are experiencing such grief, or if a friend is drowning in grief, you might want to refer to an important article on this topic, entitled "A Grief So Deep It Won't Die," which appeared in The New York Times on August 14, 2015.
Complicated grief is severe and prolonged grief that lasts for more than a year or so and gets in the way of normal living for someone who has experienced the death of someone who played an important role in their lives. It's a situation in which the person left behind actually avoids contact with former activities and friends, sometimes won't leave the house or answer the phone, and can't stop thinking about the deceased.
Often the condition is spurred by self-blame: "I should have been able to change the outcome," or "I should have been able to do more." One interviewee for Things I Wish I'd Known: Cancer Caregivers Speak Out was blaming herself for her husband's death to cancer more than seven years after his death; she was a professional who said she wanted to re-enter the workforce, but she couldn't bring herself to even brush off her professional resume, even when presented with job referrals.
Sometimes the condition is spurred by blame directed to the care team. They "should have" or "shouldn't have" or "could have" done something differently. In the mind of the bereaved person, they didn't treat the deceased properly, or caused additional suffering, or allowed an avoidable death. One interviewee was still distraught at the death of her nine-year-old daughter 16 years earlier. She had a family and other children now, but her child's room in the grandmother's house had not been changed in 16 years. That's a long time to be in such profound pain.
Psychiatrists and counselors are careful in the terminology they use, but they are inclined to call complicated grief (and the associated inability to accept and adapt to reality) a disorder. There is now a Center for Complicated Grief (associated with the Columbia University School of Social Work) which can offer help to people who are having trouble integrating their severe grief into their normal lives. If you, a relative, or a friend is experiencing prolonged grief that is impeding the ability to bounce back after a serious loss, you might want to check out these two resources.
August 10, 2015
When There's Cancer in the Household, Don't Forget the Siblings!
When cancer strikes in the household, and particularly if it’s a child who’s been diagnosed, the whole family instantly takes up battle stations. The focus becomes almost exclusively on what needs to happen to mobilize the right clinical team for the right treatment as quickly as possible. The stress on the family unit only intensifies as multiple doctor, hospital, clinic, laboratory, and other visits proliferate and the family’s normal routines disappear in their wake.
Often other siblings in the family put up the stiff upper lip—the “I’m OK” front—as they recognize the need to sublimate their own needs and concerns to those of their brother or sister who is in treatment. Shortly thereafter her mother was also diagnosed with a treatable cancer, and given the dual stress on the family, the parents took her at her work that she was doing fine. Often adolescent children in similar situations may actually think they’re OK, but over time the lack of normalcy and the stresses of the unknown eat away at their sense of calm and control.
You’ll recognize when this happens:
- Michael’s older sister was able to cope for the first seven months of cancer turmoil ordeal . . . until she had a meltdown in school one day. Thereafter her parents arranged with a favorite teacher, the guidance counselor, and her chorus and band directors to keep their eyes on her and watch for unusual emotions or behaviors. They also arranged for her to touch base with the counselor several times a week, so she’d have a predictable pressure release valve and a safety net in case she needed it.
- Jeff’s sister, also in her closing years of high school, took a more direct approach to the issue. One day she approached her mother with the gripping question, “Don’t I matter any more? It’s like I’m invisible.” For her, the issue was getting private time with her mother, Jeff’s primary caregiver. In response, her mom started to plan a night out with her daughter once a week, a time when they could have private conversations or take in a movie—escaping from the 24/7 cancer onslaught.
These strategies were enormously helpful after the fact for both families, but a more effective approach is to plan ahead by recognizing that the entire family is affected by a cancer diagnosis and arranging mechanisms to address healthy children’s emotional needs. For example, some cancer centers and Cancer Support Community divisions are now offering support groups that allow children to interact with similar-aged peers who are experiencing cancer in the family. Such support groups generally offer both conversation and distracting physical or creative activities that give the kids cancer-free time while at the same time legitimizing their emotions and reducing the fear and anxiety that cancer in the household is bound to generate.
When there's cancer in the household, children's concerns are bound to come out. Handling them proactively can be an important part of the "new normal" that they're craving.
July 29, 2015
Connection between Body Clock Disruption and Breast Cancer?
A Dutch study was just released that showed a link between circadian rhythm disturbances (CRD) and early stage breast cancer. This study has implications for the kinds of light-dark disruptions that are experienced by people who work on night shifts over the long term. The authors carefully emphsize that they have identified--in mice only--the correlation between these disruptions and breast cancer prevalence, but identificaition of causes for that correlation will require more study. Current hypotheses suggest that this situation may arise from decreased natural tumor suppression by the immune system, as well as changes in body temperature and hormone levels that accompany chronic CRD for night workers.
Earlier studies (such as the large 10-year Nurses Health Study released in 2001 and a World Health Organization Report released in 2007) have revealed increased risk for this population. The Nurses Health Study hypothesizes that the light-dark inversion reduces melatonin release and deregulates other hormones, potentially increasing breast cancer risk. According to the Memorial Sloan-Kettering Cacner Center, laboratory and animal studies have shown that melatonin applied directly to breast cancer cells can inhibit tumor growth, but the connection has yet to be proven in humans.
Suffice it to say that regular breast cancer screening may be especially important for people who work at night or who rotate between day and night work schedules, such as nurses, flight attendants, hospitality and industrial workers, public safety personnel, and so on.
July 11, 2015
Pancreatic Cancer: Hope on the Horizon?
Pancreatic cancer is one of the most challenging forms of cancer to diagnose and to treat. It shows few if any symptoms before it has spread, and it tends to be chemotherapy-resistant.
In the wake of losing my long-time (34-year) business partner to the disease less than three weeks ago, I've done some research about developments in the therapeutic pipeline that may generate hope for patients in the future. I posted an article in Huffington Post this week that may prove of interest if you're one of the thousands of people who has faced pancreatic cancer as a patient or caregiver and struggled with its dire prognosis.
Sustained funding may help some of these research initiatives pay off in our lifetimes. If you're interested or curious, click on the Huffington Post link in this paragraph, and let's be hopeful together.
June 18, 2015
6 Caregiver Tips for Turning a Slow Death Into a Slow Dance
When cancer is winning, you can often expect death to come slowly, but the uncertainties associated with it challenge both patient and caregivers. Huffington Post released my article on this topic today. It draws on experiences from my caregiver research and may be helpful to those who are dealing with this unsettling issue. Click here to read the article.
May 20, 2015
Fraud in Cancer Fund-Raising? Really?
The New York Times today disclosed that the Federal Trade Commission, in conjunction with the secretaries of state for all 50 states, has filed suit against four cancer charities (The Cancer Fund of America, Children's Cancer Fund of America, Cancer Support Services, and the Breast Cancer Society) for falsifying financial documents and spending the majority of their donations on fund-raising and personal salaries, bonuses, trips, and so on. The article says that only about 3% of the donations were used for their stated purposes. Two of the charities have been closed down, and the other two are being sued for restitution for the nearly $187 million in donations.
The illegalities and abuse of fiduciary trust are bad enough, but the funds that were siphoned off could have legitimately funded important cancer research projects that are starving for resources today.
Readers who are eager to donate to cancer-related causes should take a minute to look at rating lists that will tell you whether a charity bearing a seemingly credible name is actually reputable. The New York Times article said that "The Cancer Fund of America placed second on a list of America’s worst charities published by The Tampa Bay Times and the Center for Investigative Reporting. . . . Charity Navigator, a rating site, gave two of the organizations a low rating, one out of four stars, for the 2013 fiscal year. And three of the four charities had been named to South Carolina’s Scrooge list, which notes charities that spend a lot on fund-raising and comparatively little on charitable programs."
Hopefully in the future potential donors will ensure that their funds are going to an organization that is reputable and fulfills its public trust on behalf of the patients it claims to serve.
May 13, 2015
Remember Watson, IBM's Artificial Intelligence? It's Learning to Diagnose Cancer!
Cancers often travel in disguise, with no visible symptoms or symptoms that look like everyday benign conditions (sniffles, sore throats, swollen glands, persistent coughs, and so on). Many of the individuals I interviewed for Things I Wish I'd Known: Cancer Caregivers Speak Out described their struggles during and after delayed diagnoses.
Now information technology is coming to the fore to help. IBM (the creator of the Watson supercomputer) is partnering with Memorial Sloan Kettering (MSK) Cancer Center to train Watson Oncology, a cognitive computing system that is targeted to "interpret patients' clinical information and identify evidence-based treatment options that leverage . . . decades of experience and research " in clinical oncology. The goal is to accelerate how quickly the latest research and evidence can spread throughout the oncology community and improve patient care nationwide.
By integrating data about large volumes of cancer patients, the results of many clinical trials, and the latest developments in correlations between particular cancer markers in the patient's blood and tumors and responsiveness to particular treatments, a team of subspecialized oncologists is literally training Watson to both identify cancers earlier and to guide physician choices toward the most appropriate treatments for the patient's particular condition.
An April 2014 article in Business Insider online quoted Andrew McAfee, co-author of The Second Machine Age, as saying that "Dr. Watson" will be a gamechanger because:
- "It's based on all available medical knowledge . . . .
- It's accurate. . . .
- It's consistent. . . .
- It has very low marginal cost . . . .
- It can be offered anywhere in the world."
McAfee continued (in an interview with Smart Planet) to cite an April study estimating that as many as 5% of US adults are misdiagnosed by human doctors each year.
This article goes on to cite a Forbes' 2013 article saying that Watson had analyzed, by that time, 605,000 pieces of medical evidence, 2 million pages of text, and 25,000 training cases, with the assistance of 14,700 clinical hours dedicated to refining its decision accuracy. In the ensuing two years, Watson has assimilated even more information on which to base its recommendations.
IBM's own descriptive information is available online, describing how it is being used at MSK, MD Anderson Cancer Center, Wellpoint, and many other leading healthcare institutions nationwide. Over time, Watson will get better and better at leveraging these huge volumes of information to match and even surpass the speed and accuracy of our best human diagnosticians.
So stay tuned: Dr. Watson may be coming to a cancer center near you, and in doing so it is likely to brighten the prospects for all of us who are seeking rapid diagnosis and treatment for suspected cancers.
May 2, 2015
It's Hard When Saying Goodbye and Planning Ahead Aren't In Sync
We will all die. That statement may be the only certainty in life. Yet accepting an early death is unbelievably hard, regardless of whether you're the patient, the caregiver, or a close "significant other" (family friend, neighbor, business partner, old schoolmate, and so on).
When cancer intrudes in someone's life, future visions get dashed. The rude ups and downs of treatment keep us on a roller coaster of expectations and emotions. At some point, for some patients, no matter their age, both proven and experimental curative treatments can no longer hold back the disease; active treatment stops, with only palliative actions taken to relieve pain, nausea, and anxiety. The end of the road is in sight.
For many of us, the question then is: I know I have some time, but I don't know how long, so what now?
At this moment, some patients take the time to say goodbye to those they love. They get their "affairs in order," and they help others who will be affected by their death begin transitioning. For some this means documenting and transitioning both perosnal and business records and processes and discussing past good memories with loved ones. For most, it even means talking about how much they've meant to each other.
Not all patients can make the transition so gracefully. If a dying patient is in denial, or pushing back, caregivers may face their most challenging moments. Sometimes the patient will claim confidentiality and declare annoyance at being pressured to take action. At other times, he or she will assert that there's plenty of time, even when he is too weak to walk down the stairs unaided, or he'll avoid asking for help in tasks that require more energy, persistence, or muscular strength and adrenaline than he could possibly muster.
It's important to interpret these behaviors in context: From the moment of diagnosis, both patients and caregivers lose any sense of control. It's like a rug has been pulled out from under their feet and the earth is shaking daily. Over time, they may be struggling to restore some sense of control over at least a part of their lives, to maintain even a vestige of hope, and to sustain feelings of normalcy that for moments at least may resemble fragments of pre-cancer life.
They may say they'll tell you when they need help, but even as they weaken, they don't ask for it, and so are able to put off the inevitable conversations or transitions. Caregivers, friends, and associates may see the future looking more and more murky and grow more concerned lest the patient die and the transition leave them in limbo in gaining access to needed information, guidance, and resources. The longer the patient deflects action, the more complex the transition begins to look to everyone, especially if faced with the prospect of having to figure things out after the patient's death.
If and when this phenomenon arises, caregivers are powerless to intervene. Their options are limited and are mostly unattractive. If you force the issue, you may be undermining the illusion of control that is keeping the patient going.You'll be eroding their sense of hope and even brutalizing their sense of self if you push too hard and too soon for action that will make your own life easier after he dies. You know what needs to be done, but you can't make it happen. It is what it is, and the sooner you confront the fact that you can't change the process or the outcome, the less stressed you'll be.
If you're a terminal patient reading this, I can only urge you to think of those who will be left behind, and to find ways to streamline transitioning information and transferring knowledge sooner rather than later. If you have many months left ahead of you, bravo for creating something you and your significant other can laugh about. If you don't, taking the needed actions is an expression of caring for those around you and will keep them from having to sort things out in the dark of their grief after you're gone.
April 23, 2015
Personalized Chemotherapy Implantable Device: Amazing Idea!
“Personalized” and “precision” medicine are simple terms used to describe the very complex process of figuring out just which of many available chemotherapy treatments will give the best response to a particular tumor in a particular patient. One of the exciting research developments has been the ability to determine, based on the presence of certain biomarkers in a patient’s blood sample, what chemotherapy treatment(s) might be most appropriate.
Now researchers at Massachusetts Institute of Technology's Koch Institute for Integrative Cancer Research are developing an implantable device that’s as small as a grain of rice and has the potential for determining this with greater certainty. This device can carry 30 (and eventually up to 100) micro-doses of single chemotherapies or combined drugs that can subject the tumor to varied types and dosages of treatment. The response of the tumor to each drug can be measured independently before the patient’s entire body is subjected to the rigors of systemic treatment. In other words, the implant can help determine which drug or drugs are most likely to cause the desired response from the tumor, and patients wouldn't be subjected to the suffering that trial and error inflicts on their bodies.
According to Dr. Jose Baselga, chief medical officer at Memorial Sloan Kettering Cancer Center in New York, the device would be removed 24-48 hours after implantation, and within a week the treatment plan would be devised, based on the results. Tests are underway in mice for prostate, breast, and melanoma tumors, with human trials likely later this year.
This development was written up in the journal Science Translational Medicine (April 2015) and was summarized in the Boston Herald on April 23, 2015. Science fiction is coming to life with the possibility of nearly real-time matching of tumors with treatments. Stay tuned!
April 20, 2015
Future Perfect: Liquid Biopsies are Coming!
When I first encountered the circulating tumor cell (CTC) research at Massachusetts General Hospital’s (MGH's) Cancer Center in 2007, I was left nearly speechless. The possibilities I encountered there left my non-scientific head spinning with hopeful prospects.
The premise underlying the MGH CTC work was that primary cancer tumors “shed” cells into the blood stream and that if they can be captured and their density in a blood sample can be measured, diagnosis and treatment of many cancers could be accelerated. CTCs have been known for well over 100 years, according to the MGH website, but only recently has technology allowed them to be differentiated from normal blood cells. These circulating tumor cells are so tiny that they couldn't be detected until a new technology of microscopic matter emerged, called nanotechnology.
The Mass General CTC team, under the direction of Drs. Daniel Haber and Mehmet Toner, assembled bioengineers, molecular biologists, and clinicians to use microscopic fluid dynamics to construct a “chip” and accompanying assay devices that would be over 100 times more sensitive to the presence of cancer cells than existing technologies.
Flowing a small blood sample through specially coated channels in the chip would allow capture of any CTCs (to indicate whether cancer is present) and measuring their density in the blood sample. Think of this like flowing the blood through a tunnel that is lined with coated columns, each of which attracts the CTCs that flow nearby. After the blood has flowed all the way through the chip's channels, the CTCs can be removed from the columns, measured in density, and assessed for their genetic composition.
Findings from such tests could serve as a liquid biopsy, avoiding the need for surgical biopsies for tumors deep in the body. Such biopsies could reveal early stage cancer, characterize the DNA composition of those cells (what kind of cancer, with what kinds of genetic characteristics), and determine the treatment to which the individual patient’s cancer cells were most likely to respond. In addition, the technology offers the opportunity to determine later whether prescribed chemotherapy and other treatments are working in real time (reducing the density of those cancer cells many weeks before tumor shrinkage would show up on a CT or other scan and eliminating the need for repeated biopsies). It would also allow metastases to be identified and treated in their earliest stages.
In 2009, after competition among 237 submissions for funding from Stand Up to Cancer (SU2C), this team won $15 million to advance its technology on the condition that MGH collaborate with other institutions to accelerate bringing it to market. The chip was refined in conjunction with Massachusetts Institute of Technology (MIT) bioengineers to increase its sensitivity.
Pilot testing of the CTC system is now underway with patients at Mass General, Memorial Sloan-Kettering Cancer center in New York, Dana-Farber Cancer Institute (Boston), and M.D. Anderson Cancer Center (Houston) to determine its applicability for different types of cancers. In clinical studies conducted over the past two years, the CTC-chip has been used to identify circulating cancer cells in the blood of patients with metastatic cancers of the prostate, lung, pancreas, colon and breast.
Now another angle on this idea has reached the public stage. On April 19, 2015, Gina Kolata of The New York Times described another blood test with the potential to serve as a liquid biopsy. This one is earlier in the research and development pipeline and was devised by two Australian scientists in collaboration with Johns Hopkins researchers. This test extracts “shards” of DNA in a patient's blood after tomor removal surgery, with initial applicability to Stage 2 colon cancer. Their goal is to identify which patients have remaining cancer DNA in their bloodstreams after and should be treated with chemotherapy to prevent metastasis.
Both of these research studies are capitalizing on emerging technologies both in molecular biology—understanding the genetic composition of a patient’s cancer cells and the indicators of change in disease progression—and in applying nanotechnology to understand and change the course of the disease. Bringing their potential developments to fruition will require time and sustained funding, but their potential to save lives and improve the quality of life for cancer patients and their families is encouraging.
April 12, 2015
A Big Dose of Inspiration Can't Hurt Anyone
When you or a loved one are facing cancer, you can never get enough inspiration. Today's dose of inspiration comes courtesy of James and his wife, who together faced down a terminal multiple myeloma diagnosis in 1992, when he was only 44 years old. They persevered through some very difficult times, have outlived his original prognosis by almost 7-fold, and have so far beaten James' cancer into remission. His good health today is thanks to the right treatment (Dana Farber Cancer Institute), aggressively seeking out three bone marrow transplants and two clinical trials, and a combination of perseverence and good luck. James is so strong today that he's in training for his ninth Pan-Ohio 328 mile bicycle ride to benefit the American Cancer Society. His story is inspiring and worth reading if you need a combination of information and inspiration about multiple myeloma or the value of clinical trials. Kathleen, his caregiver, is a role model for caregivers in her blend of persistent monitoring of his condition, aggressive research, and sheer determination to seek out every possible new development that could be helpful. Thanks to both of them for sharing their story to inspire others.
April 8, 2015
Scorpion Venom Makes Cancer Cells Glow?
Recent cancer research developments have been mind-boggling, and this one is no exception. Clinical trials are underway for a substance derived from scorpion venom that can be injected into a patient's bloodstream and will attach itself to brain cancer cells to make them glow.
Many cancer cells are shaped almost like spiders, with strands that extend into and around adjacent tissues. This is a particular problem in the brain because surgeons simply can't see all of the strands to remove them all without damaging normal tissues.
Dr. James Olson, a pediatric neuro-oncologist at Fred Hutchinson Cancer Center in Seattle, has been working for 15 years on a substance called chlorotoxin that comes from a type of scorpion. When he couldn't get traditional research funding sources to support his idea, he used crowd funding to accelerate progress. Now the idea is in clinical trial for its ability to cause brain cancer cells to glow, making them easier to excise. Olson has founded a company, Blaze Bioscience, which is now making the substance in the laboratory.
Olson is now exploring a new class of substances called "optides" that may have therapeutic benefits for a variety of cancers. His team is also seeking to understand why some tumors become resistant to therapies after first responding to treatment.
Meanwhile other major cancer centers are exploring therapeutic applications of chlorotoxin. For example, at New York-Presbyterian Hospital (the teaching hospital for Columbia and Cornell medical schools), Dr. Stephen Rosenfeld and his team are exploring the effects of radioactive and non-radioactive chlorotoxin on malignant gliomas, which are especially aggressive and have a poor prognosis. Their clinical trials are studying whether such substances can help cut off the blood supply to the cancer cells, at least inhibiting their spread and potentially killing them without harm to normal cells.
Other research laboratories and biotech companies around the world are exporing whether other animal and plant toxins may also yield therapeutic benefits. Such potential treatments are controversial and as-yet unproven, but they illustrate the breadth of research initiatives targeted toward understanding the complexities of cancer diagnosis and treatment. In that regard, they offer hope that new ways of approaching cancer research may find new techniques for improving outcomes while reducing the suffering traditionally associated with cancer treatments.
April 6, 2015
Cancer Research Progress Spotlights Cruel Irony
This article was published online by Huffington Post on April 7, 2015:
To hear the words "cancer" and "cure" in the same sentence from experienced cancer researchers is both breathtaking and unexpected. Researchers and top oncologists are usually cautious to a fault.
To hear that Congress is again trying to squeeze cancer research budgets is breathtaking but predictable. They've become frugal, also to a fault.
Such is the cruel irony facing cancer patients and researchers today.
Building on over 50 years of scientific progress, research leaders from cancer centers across the country are achieving stunning results that have led even the most guarded of them to use such formerly forbidden words as "breakthrough," "miracle," and "cure" in describing patient reactions and the potential outcomes of their virology and immunology cancer work. Much of this work has been supported by federal grants (National Institutes of Health, National Cancer Institute). Along the way, the continuance of many promising ventures has been jeopardized by Congressional refusal to sustain funding, even for breakthrough projects whose outcomes are already exceeding clinical expectations.
Virology and immunology research sounds mysterious but can be described in simple terms. Most cancers have mechanisms that make them invisible to the body's immune system. In other words, the immune system can't recognize them as dangerous and so doesn't attack them.
Researchers are now genetically modifying viruses that -- if left unchanged -- would have had the power to paralyze or kill their hosts. The genetic modifications turn formerly harmful and even lethal viruses (such as measles, polio, rabies, and HIV) into therapeutic agents. Rather than harming normal cells and spreading disease throughout the body, modified virus particles or virus-infected cells (in the case of HIV) are injected into solid tumors or delivered intravenously into the blood stream.
William C. Phelps, PhD, Director of Preclinical and Translational Cancer Research at the American Cancer Society, describes recent research developments as "one of those scientific situations where two fields (virology and immunology) collide to provide a breakthrough. Fifty years of studying viruses in excruciating detail has allowed us to understand how to engineer viruses in clever and useful ways to accomplish what immunotherapy needs to create cancer-fighting weapons."
Some of these therapies inject direct cancer-killing "oncolytic viruses" directly into tumors while others stimulate the immune system to recognize and attack the cancer cells. Dramatic clinical trials of such new combination therapies are underway at leading cancer centers nationwide with patients who have exhausted traditional therapies for recurrences of potentially lethal cancers. A sampling of these include:
Similar work is also underway at other cancer centers across the country but may have received less visible press coverage. Many of the resulting therapies could--if current outcome trends continue--be eligible for "fast track" or "breakthrough" designation by the Food and Drug Administration (FDA). Both of these FDA programs offer a framework for accelerating broad market approvals.
"So what?," you might ask. "Doesn't this show that we're winning this war?"
On the contrary, much of this breakthrough work is still in the research pipeline and not widely available. Statistics from the American Cancer Society show that the need for such treatments is still greatly outstripping theor availability.
In this country, over 1.7 million people are diagnosed with cancer and almost 600,000 will die each year. There are currently almost 15 million survivors, many of whom worry about whether their cancers will return. Millions more, both patients and family caregivers, are in the midst of prolonged treatments and unpredictable disruptions of their work and family lives. The costs to the economy in health care expenses and lost work time are massive.
You don't have to use the word "cure" to appreciate the possibilities. Evidence exists that the dramatic life-saving impact of the newest cancer care treatments can generate massive cost savings if the nation would commit to making "cancer-free" a more common outcome of cancer therapies that are available to an ever-increasing number of patients.
As a nation, we've proven our willingness to defend our homeland against external threats through military defense spending. Perhaps comparable medical defense spending could advance our internal war against cancer. By "piling on" and intensifying research funding now, through increased Congressional support of NIH cancer research budgets, we could finally break the cruel irony of under-funding potential cancer breakthroughs.
March 24, 2015
Public Television Highlights the Cancer Treatment Revolution
Jane Brody's March 23 New York Times article, "The Road to Cancer Treatment Through Clinical Trials," highlights the fact that a higher proportion of pediatric cancer patients than adults have the opportunity to participate in clinical trials. For adults, the proportion is only around 5%. The article highlights the potential dramatic impact of the right trial and details resources for finding appropriate clinical trials (most of which are listed on the Resources tab of this website). Brody also details several cases where new treatments have changed the course of the disease for trial participants.
Unfortunately the availability of trials is often a function of a medical center's size and location in a major metropolitan area, where larger numbers of trials are conducted. Nevertheless, it's important to know where appropriate trials might be available in case a patient from a rural area is able to travel to such a location for treatment. American Cancer Society Hope Lodges (31 nationwide) may be available to help with free lodging in these circumstances.
Brody's article also previews Ken Burns' eagerly awaiting six-hour series, "Cancer: The Emperor of All Maladies," which will be broadcast on PBS in two-hour chunks on March 30, 31, and April 1. Featured as a commentator throughout will be Dr. Siddhartha Mukherjee, author of the Pulitzer Prize winning book, The Emperor of All Maladies: A Biography of Cancer. Given the quality of Burns' and Mukherjee's past work, the series should be well worth watching for anyone facing the uncertainty or stress of a cancer diagnosis and anyone who is advocating on behalf of a cancer patient. Thanks to Jane Brody for calling attention to the issue of clinical trials and to this important piece of broadcast journalism.
March 19, 2015
Most cancer pain is controllable
Experts say that 95% of cancer pain is controllable, but you need to be dealing with pain management or palliative car experts as part of your care team. If you're looking for pain management resources, check the tab above labelled Resources and scroll down. Three good resources are now listed there to find information that will greatly improve the quality of life for those suffering pain during treatment.
March 12, 2015
When Cancer Hits, Engage the Kids
The drive to protect our children ― to help prevent falls, ease cuts and scrapes, and deflect nasty experiences ― is at the core of parenthood. It’s baked in to the classic parental desire to “kiss it and make it better.” Yet if carried too far, to the point where we don’t level with children after a family member or the child himself is diagnosed with cancer, this drive can actually inflict lasting pain.
Today the Cancer Knowledge Network published my article on this topic, based on Things I Wish I'd Known: Cancer and Kids, my new book focused specifically on how to communicate about cancer with children affected by a personal or family cancer diagnosis and key lessons about how to manage a child's cancer. For more information, click on the CKN link or go to the "Cancer and Kids" tab of this website.
March 11, 2015
A Hair-Saving Chemotherapy Development!
It's not just women who lament losing their hair when faced with chemotherapy treatments, most of which are hostile to hair. Even four-year-old Eric was upset to have to shave his head in advance of his aggressive treatment for a rare lymphoma.
Well, the New York Times (Tara Parker-Pope) wrote on March 9, 2015 of a new treatment that applies a cold cap to the scalp before, during, and for two hours after a chemotherapy infusion. Apparently the concept has been in practice for over 20 years, but new and improved technology has just gone through its first clinical trial and isn't yet available in most hospitals. It's a good sign of a new development that offers both the opportunity for those in treatments to boost their self-esteem during chemo and increased privacy for those who don't want to walk around virtually advertising, through their baldness, that they're in cancer treatment.
For more information about the concept, history, and alternative types of caps that are being introduced to medical centers for rental, you may want to visit The Rapunzel Project. This site also offers information about Cold Caps Assistance Projects, which helps patients to cover around half of the $600 per month rental expense, depending on need. For access to the supporting research, information about how to get a "starter kit," tips for hair care during chemotherapy using the caps, and a list of the hospitals currently either offering cold cap therapies or with the needed freezer equipment to do so, see the CCAPS site.
Also, you may want to see The Cancer Knowledge Network's blog (April 17, 2015) on this topic.
February 27, 2015
Precision Medicine is Changing Clinical Trials
Cancer patients for whom standard treatments haven't worked often feel desperate to find a clinical trial that can extend their window of hope. Yet many either can't qualify for or can't get into an appropriate trial. Often this happens because the controlled-experiment nature of the trials poses such stringent requirements and precludes the sickest patients from participating.
The good news is that precision medicine (see my blog posts of December 31, 2014, and February 3, 2015, below) is now staging a new and unconventional type of clinical trial that may convince the Food and Drug Administration to accelerate approval of new, genetically targeted cancer treatments.
The concept, described in Gina Colata's February 25 The New York Times article, "A Faster Way to Try Many Drugs on Many Cancers," is based on genomic analysis of an individual patient's tumor for known mutations that may contribute to the growth of cancers that strike may different body parts. In the past, potential therapies were tested and then approved to address cancers of particular organs or body systems. The new "basket trial" approach uses drugs already approved for specific genetic mutations in cancer of a given organ or system to treat patients whose cancers (regardless of where they appear in the body) are characterized by the same genetic mutations. In other words, the treatment is governed by the genetic mutation that is causing the cancer, rather than by the particular kind of cancer or body part where it appears. This is why these trials are called "basket studies" (because they lump together different kinds of cancer).
This kind of trial isn't saving every patient who is enrolled, but when results for a number of patients with different kinds of cancer are dramatic enough, a new therapy may be approved far faster than in traditional clinical trials. Each trial will be smaller than traditional clinical trials and will be conducted without a traditional control group (a group of patients who don't receive the new medication that's being tested). As a result, the FDA's office that approves new cancer drugs will be looking not at the relative efficacy of the new treatment in comparison with standard treatments, as in the past, but rather at whether the population of cancer patients will benefit significantly from access to the drug.
The National Cancer Institute is coordinating such basket studies nationwide to amass data quickly enough to identify and accelerate apprpoval for those drugs that appear to change the treatment "game" for cancer patients. The potential impact of such trials is breathtaking.
February 20, 2015
On February 19, The New York Times ran an OpEd entitled "My Own Life: Oliver Sacks on Learning He Has Terminal Cancer." It's worth reading on its own, as a commentary on how life looks when it's lived under the shadow of knowing that cancer is winning.
In addition, one of the people who commented on his article, Elizabeth Fuller from Peterborough, New Hampshire, offers remarks that are at least as compelling as Dr. Sacks piece. She wrote, in response to Dr. Sacks editorial, that she attended a friend's funeral in recent months where she heard a moving quote about immortality, "that we do live forever, and not just as memories. What we have done, said, and written lives on in ways big and small, often subconsciously, in those whose lives we have touched."
Both Dr. Sacks OpEd and Ms. Fuller's commentary offer words of solace to anyone who has lost a loved one to cancer, to think about how that person touched others in a lasting way. Second, they offer a reminder to all of us who care about cancer and are committed to ending its rampage that every time we reach out to touch someone else through our caregiving, advocacy, or active support of cancer research, we're doing lasting good that matters long after we're gone.
If we could all touch others' lives as she suggests, wouldn't the world be a better place?
February 3, 2015
The Time for Precision Medicine has Come
The time has come to recognize that just because two people may carry the same diagnosis for a seemingly similar medical condition, the most appropriate treatment may well differ for each, based on individual patients' unique genetic make-up. The President announced this week that his proposed budget will not only seek to restore some of the cuts in health research funding that sequestration inflicted in the budgets of the National Institutes of Health and the National Cancer Institute, but will alaso propose a new "precision medicine" initiative.
This terminology may be new to the layman reader. Two resources that may help explain the term "precision medicine" are:
While the total budget for the new initiative is small ($215 million) in relation to the opportunity, it's a beginning. Hopefully public pressure will move this initiative forward and make it more robust over time, regardless of what happens to other budget line items. One or both of these articles is worth a read if the topic is new to you.
While cancer and diabetes are cited in the articles as potential targets for precision medicine, this combination of technologies (genomics, immunomics, proteomics, and "big data") has potential to help the thousands of people who are afflicted by less known conditions like dysautonomia that are both hard to diagnose and harder to treat. The future is before us. The only question is whether we, as a nation, will have the will to realize its potential.
January 26, 2015
National Clinical Trials Network (NCTN) Increases Trial Access, Efficiency, Speed
The National Cancer Institute (NCI) of the National Institutes of Health has reorganized its National Clinical Trials Network (NCTN) to consolidate nine cooperative networks of medical and research centers that conduct multi-site cancer clinical trials into four groups. According to Cancer Today Magazine's Winter 2014 issue [published by the American Association for Cancer Research (AACR) in December 2014], this action will centralize the ethical and scientific review of trial protocols for multi-site trials and impose stricter timelines for their execution. The intent is to accelerate participant enrollment, shorten trial timeframes, and improve patients' access.
In addition, the community-based health program, the network of community hospitals which enrolls around 40% of trial participants, is being wrapped into a new NCI Community Oncology Research Program (NCORP) with 46 sites nationwide. Twelve of these sites have been designated to draw least 30% of their trial participants from racial or ethnic minorities or from rural areas. NCORP will also study which treatments offer the best return for their investment, generating important resource allocation insights for use by the government, organizations, health systems, and practitioners.
Total cancer research and clinical trials funding is still meager, but these initiatives offer the potential for existing spending to have greater efficiency faster than in the past and to broaden patients' access to appropriate trials.
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