Tuesday, September 22, 2015

New campaign emphasizes support for people with thyroid cancer

September 19, 2015

An interactive, educational campaign designed to help dispel myths that thyroid cancer is a “good cancer,” was recently launched by The Light of Life Foundation, ThyCa: Thyroid Cancer Survivors’ Association Inc. and Eisai Inc., according to a press release.  

“As a thyroid cancer survivor, I urge people to stop referring to thyroid cancer as the ‘good cancer,’ as I believe it downplays patients’ experiences,” Joan Shey, founder of the Light of Life Foundation, said in the release. “I hear time and time again from patients how difficult their diagnosis and treatment were and that their scars are more than skin deep. My hope is that this campaign can educate about the many types of thyroid cancer and change the thyroid cancer conversation.”
The campaign, “Myths and Truths About Thyroid Cancer,” is aimed at informing people about the realities of thyroid cancer. Most thyroid cancers can be successfully treated and many falsely believe that this makes thyroid cancer “a good cancer.”

“Being part of a community of survivors is very important for people coping with thyroid cancer,” Gary Bloom, thyroid cancer survivor and cofounder and execuative director of ThyCa, said in the release. “ThyCa takes this to the heart, which is why we are proud to provide support and resources to the thyroid cancer community. We also know more needs to be done to elevate awareness of thyroid cancer and what patients need in terms of support for the rest of our lives.”

People diagnosed with thyroid cancer may often feel misunderstood by their family and friends, but the campaign emphasizes the need for support and resources specific to their thyroid cancer experience, even after their diagnosis.

“I see patients with advanced forms of thyroid cancer, which can be aggressive, difficult to treat and often require the involvement of an integrated health care team,” Marcia Brose, MD, PhD, associate professor and director of Rare Cancers and Personalized Therapy at the University of Pennsylvania’s Abramson Cancer Center, said in the release. “Not all thyroid cancers are the same, and it is important that people diagnosed with and treated for thyroid cancer understand their treatment. In addition, if initial treatment does not eradicate their disease, they should find a medical oncologist with experience in the treatment of advanced thyroid cancer.”

Tuesday, September 15, 2015

Share on facebook Share on twitter Share on email Share on print More Sharing Services 1 Tight Control of Type 2 Diabetes May Help Prevent Dementia


Tight Control of Type 2 Diabetes May Help Prevent Dementia

Conversely, poor blood sugar control appears to increase risk of brain troubles, study finds

TUESDAY, Sept. 15, 2015 (HealthDay News) -- Keeping blood sugar levels in check may have a protective effect against dementia in people who have type 2 diabetes, new Swedish research suggests.
"The positiv
e association between [average blood sugar levels] and risk of dementia in fairly young patients with type 2 diabetes indicates a potential for prevention of dementia with improved blood sugar control," study author Dr. Aidin Rawshani, from the National Diabetes Register and Institute of Medicine in Gothenburg, Sweden, and colleagues wrote.

However, the study wasn't able to definitively prove a cause-and-effect relationship between blood sugar levels and dementia; it was only able to show an association between these factors.
The study included almost 350,000 people with type 2 diabetes. They were all registered in the Swedish National Diabetes Registry between January 2004 and December 2012. They had no history of dementia when they were diagnosed with type 2 diabetes. The mean age was 67 years when the study began.

Study volunteers were tracked until the study ended in 2012 or they were hospitalized for dementia or died. Using a computer model, the researchers calculated the link between average blood sugar levels and dementia. Average blood sugar levels were based on the results of hemoglobin A1C tests (HbA1C). This test provides doctors with a several-month average of blood sugar levels, according to the American Diabetes Association (ADA). The ADA generally recommends an HbA1C level of 7 percent or less for people with diabetes.

Slightly more than 3 percent of those in the study -- 11,035 people -- were admitted to the hospital with dementia during the nearly five-year follow-up period.

After taking other variables into account, the study found that those with HbA1c levels of 10.5 percent or higher were 50 percent more likely to be diagnosed with dementia compared to people with HbA1c levels of 6.5 percent or less.

Study volunteers who'd had a previous stroke were 40 percent more likely to have declines in memory and thinking abilities, the researchers said.

The study's findings were to be presented Sept. 14 at the annual meeting of the European Association for the Study of Diabetes, in Stockholm, Sweden. Findings presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information
The American Diabetes Association has more on blood sugar management for people with type 2 diabetes.
SOURCE: European Association for the Study of Diabetes, news release, Sept. 14, 2015
Last Updated:

Clinical Oncology News - Thyroid Carcinoma Suppression Therapy Ups Cardiovascular Risk

Clinical Oncology News - Thyroid Carcinoma Suppression Therapy Ups Cardiovascular Risk:

'via Blog this'

Walking Reduces Risk of Cancer, Diabetes and Cardiovascular Diseases

 Interesting article, but there are a lot of "pop-ups", so be warned if you go to the website.


Sep 14, 2015 10:57 AM EDT | By Veronica P. De Leon

Research says that walking offers many health along with healthy eating. United States authorities are now encouraging everyone to live an active life. Vivek Murthy, a surgeon general of the US has recently initiated a campaign that encourages citizens to walk frequently.
Murthy is aware that "an average of 22 minutes a day of physical activity-such as brisk walking-can significantly reduce the risk of heart disease and diabetes."
"The key is to get started because even a small first effort can make a big difference in improving the personal health of an individual and the public health of the nation," Murthy added.
Health authorities say that making walking part of the daily life can reduce the chance of acquiring diseases thus saving more money.
However, there are many obstacles that are hindering authorities to achieve their goal of motivating people to exercise regularly. Lack of facilities disable them to meet their goals.
In line with the "Step It Up" campaign of Murthy, he also promotes the development of walkable communities. The American physician believes that program and policy efforts should be implemented including funding to ensure public health.
Facilities and designs like curb cuts, sidewalks, safe crossings for the visually impaired and crosswalks should be made to provide opportunities to the people to live a more active life.
Physical activity can help prevent osteoporosis and can help individuals manage their weight. It can also lower stress, enhance mood and even reduce risks of cancer, cardiovascular diseases and type 2 diabetes.
Walking is the simplest, easiest and most cost-effective form of physical activity one can add to his lifestyle but it can offer many health benefits like improving blood sugar levels and blood pressure.
Inactive lifestyle on the other hand, can cause lung and heart disease including cancer and diabetes which receive 86% budget from the health care cost of the US.

Diabetes nation? Half of Americans have diabetes or pre-diabetes


About half of all Americans have either diabetes or pre-diabetes, according to a new report. And experts in the field say that's good news.
That's because the study finds that after two decades of linear growth, the prevalence of diabetes in the United States has finally started to plateau.
In a paper published Tuesday in JAMA, the authors write that their findings are consistent with other studies that show the percentage of people with diagnosed diabetes remained steady from 2008 to 2012.
"Although obesity and Type 2 diabetes remain major clinical and public health problems in the United States, the current data provide a glimmer of hope," wrote William Herman and Amy Rothberg of the University of Michigan in an article accompanying the paper.
Herman and Rothberg, who were not involved in the research, said the study suggests the implementation of food, nutrition and physical activity policies and regulations by federal, state and local governments as well as other efforts to curb obesity and diabetes have finally started to pay off.
"Progress has been made, but expanded and sustained efforts will be required," they wrote.
The study is based on data collected by the National Health and Nutrition Examination Survey. The researchers report that from 2011 to 2012 between 12% and 14% of Americans had diabetes, depending on what criteria were used to diagnose them. This percentage has remained stable since 2008.
The research team also found that the proportion of people who had diabetes without knowing it decreased from 40.3% in 1988-1994 to 31% in 2011-2012.

A previous version of this post incorrectly stated the beginning year in the period 1988-1994 as 1998.
This decrease, however, was not seen across all racial and ethnic groups.
The proportion of Mexican Americans who were undiagnosed was higher than their white and black counterparts, and this percentage had not decreased over time. The authors suggest this result may be due to a lower percentage of Mexican Americans with health insurance, leading to lower access to healthcare.
The authors also found that Asian people were more likely than any other racial group to have undiagnosed diabetes.
The prevalence of people with pre-diabetes has grown over time. Previous studies show that between 1990 and 2002, 29% of people had pre-diabetes. Between 2007 and 2010, that number grew to 36%. In 2011 and 2012, the authors report the number grew slightly to 37% to 38%.
Altogether, that means that in 2011-2012, 49% to 52% of the entire U.S. population is estimated to have diabetes or pre-diabetes.

Friday, September 11, 2015

14 Years Later, Here's What We Know About 9/11 and Cancer


The link has become increasingly clear—just as victim funding is set to expire.  by Aria Bendix

In late August, a New Jersey woman named Marcy Borders became one of the 8 million individuals worldwide to die from cancer each year. Borders was best known for standing among the rubble after the World Trade Center collapsed on September 11, an image that eventually landed her the nickname “Dust Lady.” The mass of grey dust covering her body from head to toe—covering, even, the string of pearls around her neck—catapulted Borders to instant recognition.

It was also, just maybe, what ultimately killed her.

After the Twin Towers fell, a layer of dust and debris coated Manhattan. Hidden among that cloudy air, inhaled by survivors and first responders alike, were carcinogenic particles and chemicals—asbestos, fiberglass, mercury, and benzene, among others. The Natural Resources Defense Council estimates that 300 to 400 tons of asbestos fibers were used to construct the World Trade Center.
Still, just a week after the attack, the U.S. Environmental Protection Agency told the public there was no long-term danger to their health. “I am glad to reassure the people of New York and Washington, D.C., that their air is safe to breath[e],” EPA Administrator Christie Whitman said at the time. But then people began to fall ill.

In 2002, Dr. David Prezant of the New York City Fire Department, a pulmonary disease specialist, coined the term “World Trade Center cough” after 9/11 firefighters started to develop chronic respiratory illnesses. From 2001 to 2004, the federal government established a Victim Compensation Fund for all those physically harmed or killed as a result of the tragedy. In 2011, 10 years after the attacks, Congress reactivated the fund via the James Zadroga 9/11 Health and Compensation Act—named after an NYPD officer and first responder who died of respiratory disease—in addition to establishing a new World Trade Center Health Program. Two years later, officials finally added 50 different types of cancer to the list of diseases eligible for compensation.
The WTC Health Program is set to expire next month, and the Victim Compensation Fund is set to expire in October 2016, unless Congress decides to pledge more money. Not only would an end to funding mean an end to 9/11-related cancer treatment and compensation, but it would discontinue research as well—just as scientists and doctors are on the verge of finding a definitive empirical link between the incident and the illness.

The difficulty of finding a connection

In one of the most comprehensive studies of its kind to date, the New York City Health Department found no clear association between cancer and the debris at the World Trade Center site. The study, published in 2012 in the Journal of American Medical Association, observed 55,778 New York residents who were present at the World Trade Center on the day of the attacks and had enrolled in the World Trade Center Health Registry. Among those observed, 1,187 had been diagnosed with cancer by the time of the study. When comparing this number to all New York state residents, the study found an increased risk of prostate cancer, thyroid cancer, and myeloma, but ultimately could not connect the diagnoses to 9/11 due to a lack of statistical significance.

Still, the work did not rule out an association. “The presence of carcinogenic agents raises the possibility that exposure to the WTC environment could eventually lead to cancers,” the researchers wrote.

One of the study’s major caveats was it couldn’t account for the latency period of certain cancers—the time it takes for the illness to develop following exposure. According to the WTC Health Program, strains of cancer like thyroid cancer have about a 2.5-year minimum latency period. But a cancer like mesothelioma, whose main known cause is asbestos exposure, can have an 11-year minimum latency period before a patient starts exhibiting symptoms.

In all likelihood, this is a conservative estimate. It’s difficult to determine the latency period of mesothelioma due to a number of confounding factors, such as gender or intensity of exposure. But Mary Hessdorfer, executive director of the Mesothelioma Applied Research Foundation (where I am an unpaid volunteer), has known patients to go 20 or even 50 years without showing symptoms.
This long gap between onset and detection was the driving logic behind the initial decision to add cancer to the 9/11 Health and Compensation Act in June 2012. The person responsible for this recommendation, public health administrator Dr. John Howard, was appointed by George W. Bush as special coordinator for 9/11-related medical issues following the attacks. “You don’t want to wait 20 to 30 years to get a definitive answer,” Howard told The New York Times back in 2012.

As evidence mounts, compensation has lingered

Fourteen years after the attacks, researchers are closer than ever to arriving at that answer.

In 2013, Environmental Health Perspectives published a study that found more conclusive evidence of a link between cancer and 9/11. Of the 20,984 participants—all World Trade Center rescue and recovery workers—552 were diagnosed with cancer between 9/11 and December 2008. Those who had been highly exposed to carcinogens and pollutants were more likely to be diagnosed. In addition, the study’s authors were surprised to find higher levels of thyroid and prostate cancer than they had originally anticipated.

Dr. Raja Flores, chief of thoracic surgery at Mount Sinai Medical Center, one of seven sites affiliated with the WTC Health Program, insists that researchers are just scratching the surface with these findings. There’s no doubt in his mind that we will see a sharp increase in 9/11-related cancers over the next 30 years.

As of last year, there have been more than 2,500 reported cancer cases among World Trade Center rescuers and responders. These cancers span the full gamut—thyroid, prostate, lung, pancreatic, leukemia, multiple myeloma. The list goes on, though Flores thinks it wise to focus on the big three: esophageal cancer, lung cancer, and mesothelioma.

By 2014, the Victim Compensation Fund had awarded a sum of $50.5 million to a mere 115 cancer claimants (though case reviews are ongoing). Only 17 of the claimants were downtown New Yorkers, and five were visitors at the time of the attacks. While the lack of typical citizens among these claimants may point to their reduced exposure compared to first responders, it might also suggest a limited awareness by the victims themselves that they could have a health problem related to 9/11.
Then there are those like Marcy Borders. Last fall she told The Jersey Journal she suspected her stomach cancer was related to 9/11. But she also said she was struggling to pay her bills for chemotherapy treatment—suggesting that Borders might not have been awarded victim compensation during her lifetime, and that even if she did receive some, it clearly wasn’t enough.

Victim compensation funding is set to expire

Though much attention has been given to the firefighters and first responders afflicted with cancer, the claims of common citizens are more difficult to address. Despite being exposed to the same toxic chemicals and particles, these citizens are likely to be at a reduced risk, given that they did not work directly among the rubble following the attacks. But even New Yorkers who were peripherally exposed to the debris have cause for concern.

These distressing questions bear further scrutiny, and further screening. Unfortunately, says Flores, testing for 9/11-related cancers like mesothelioma or lung cancer is not as common as screening for respiratory illness or sinus or GI issues, which have more immediate symptoms. Moreover, for 9/11 survivors and first responders to qualify for coverage under the WTC Health Program, they must already have demonstrated symptoms. That puts potential 9/11-related cancer victims in a tragic bind: either they foot the bill themselves for early cancer detection (which is a critical component to survival), or hope they don’t develop symptoms 10, 20, or even 30 years down the line.
As funding for the program reaches its expiration date, many lawmakers are pushing for extended, long-term compensation for victims. This April a number of federal lawmakers called for a permanent reauthorization of the James Zadroga Act. Despite reluctance by some members of Congress to fund the reauthorization, which will cost around $400 million annually, Senator Kirsten Gillibrand told Jon Stewart in July that she expects a vote sometime around September 11. Both Gillibrand and Stewart are passionate supporters of the act, with Stewart calling any resistance to it “the most galling example of a legislature removed from the purpose of their job.” 

But while the government can vote to extend compensation, its willingness to channel more money toward early cancer detection is likely contingent on researchers confirming a link to 9/11. In the end, New Yorkers exposed to the World Trade Center debris are faced with an awful predicament: Only time will tell if certain cancers manifest as a result of 9/11, but if there is indeed a link, time for these survivors to catch their cancer early is running out.

Marcy Borders is a fitting example of a cancer patient whose fate came too quickly, but the unfortunate reality is that Borders may be an exception. The real mass of 9/11-related cancer deaths is probably yet to come.


Thursday, September 10, 2015

A few words, wryly spoken… My unlucky cancer journey, as told in The Washington Post

Follow up to the previous post.  I plan to check out his book. - JHH


Given all this, I was delighted to see today’s article in the Washington Post: “Is thyroid cancer the good cancer? It doesn’t feel that way when you get it.” The article quotes me (among other survivors) and describes how my cancer journey—my years of surgery, chemo and clinical trials—contradicts the medical notion that thyroid cancer is one of the most curable around.

The reporter, Emily Mullin, who interviewed me over the phone, has written a sensitive and informative piece that also gives her personal connection to thyroid cancer (her mom has it).

As a former reporter for The Associated Press, I always appreciate when a news organization gives coverage to an urgent subject that gets far too little public attention. (Aptly, September happens to be Thyroid Cancer Awareness Month). The article mentions how my struggle led me to write a novel, The Opposite of Everything. The book is a comedic twist on what I went through, and writing it helped me work through the disruptive changes that cancer brought to my health and relationships.

As Emily writes in the Washington Post, my story began in spring 1994, when my family doctor felt a small lump in my throat during a routine checkup. Diagnosed with thyroid cancer, I underwent an operation to remove my thyroid, dozens of lymph nodes, part of my trachea, and a nerve that controls one of my vocal chords. The procedure left me permanently hoarse. A year later, I had another surgery to take out more cancerous lymph nodes. And in 1999 I had a third surgery to remove a tumor that had wrapped itself around my remaining laryngeal nerve, threatening my ability to speak.

After all that, my battle with thyroid cancer wasn’t over. By 2000, my cancer had metastasized to my lungs. I underwent three years of traditional chemotherapy, but the cancer continued to spread.
In 2008 I signed up for a clinical trial at the University of Vermont Medical Center that tests a novel treatment targeting the enzymes that tell cancer cells to grow. My cancer has stopped spreading, although some spots remain in my lungs.

Throughout my battle, the doctors’ words two decades ago have come back to haunt me: “You have the good kind of cancer.”

I beg to differ, though I do feel lucky in a backwards sort of way. I live in a time when medical technology has led to new novel treatments that have given me hope. I have a great family and my disease helped kick-start my career as a novelist. I start each day seeking meaning in everything I do, and sometimes succeed. My life is not the one I once imagined. But lumps and all, so far it’s a pretty good deal.

David Kalish is the author of The Opposite of Everything, a romantic comedy and cancer story rolled into one, inspired by the author’s simultaneous struggle to mend his heart, by finding new love, and his health, by finding new treatment.

Health & Science Is thyroid cancer the ‘good’ cancer? It doesn’t feel that way when you get it.

The answer, of course, is a resounding "NO"!  Interesting article.  -  JHH


My mother wouldn’t have known she had thyroid cancer had it not been for a routine checkup two years ago. She felt fine, but her doctor found a lump in her neck, and after several tests she got the diagnosis. I was worried, of course, but the research seemed encouraging: Thyroid cancer has one of the highest survival rates of all cancers — 97.9 percent five years after diagnosis, according to the National Cancer Institute.
This gives thyroid cancer a reputation as being a “good” cancer. But as I have learned, cancer survival statistics don’t tell the whole story.
These estimates are based on data from thousands of people, and as with all statistics they can’t gauge the actual risk for a particular individual. What the rosy survival outlook glosses over is the impact of thyroid cancer on a person’s quality of life, which studies have shown can be significant. For my mom, an outwardly healthy 51-year-old at the time of her diagnosis, thyroid cancer has been an emotional and physical challenge, though you wouldn’t know it by looking at her or talking to her.
Robert Smallridge, deputy director of the Mayo Clinic Cancer Center in Jacksonville, Fla., says patients often come to him very worried even though they’ve been told that thyroid cancer is the “good” cancer. This dichotomy often makes them feel that they’re not entitled to complain or even feel bad. “They’re told they’re supposed to feel lucky, but they don’t. They have cancer,” says Smallridge, who is president of the American Thyroid Association.
About 63,000 new cases of thyroid cancer are diagnosed in this country each year. Most of the tumors are slow-growing and small; they originate from cells that produce hormones in the thyroid, a tiny, butterfly-shape gland located in the front of the neck, near the Adam’s apple. Many people have no symptoms other than an enlarged gland, but some have pain in the front of the neck, trouble swallowing, persistent hoarseness or other voice changes, or constant coughing.
But other cases can be much more aggressive and are associated with worse outcomes, says endocrinologist Leonard Wartofsky,chairman of the Department of Medicine at the Washington Hospital Center. “Like all things in medicine, it depends on the individual case,” he says.
Surgery, then hormones
The first-line treatment is surgical removal of all or part of the thyroid, called a thyroidectomy. My mother had a total thyroidectomy, as well as removal of several cancerous lymph nodes, to prevent her cancer from spreading. The thyroid regulates a number of essential functions, including blood pressure, body temperature, heart rate and metabolism, so when the entire thyroid is removed, patients must take hormone replacement medication. This daily treatment replaces the organ’s vital role of producing and releasing necessary hormones.
The dosing of thyroid replacement hormones varies widely depending on the individual. Too much or too little can produce side effects including fatigue, chest pain, increased heart rate or pulse rate, sweating, nervousness and anxiety, headache, insomnia, diarrhea, vomiting, weight loss and fever.
“The biggest long-term adjustment that I went through — and most people with thyroid cancer go through — is modulating the medication,” says Cherry Wunderlich, 71, of Bethesda, director of outreach for ThyCa, a thyroid cancer survivors’ association.
Wunderlich was diagnosed in 1999 after noticing a hard protrusion on her neck, and she soon had her thyroid removed. But it took much longer to get her medication right, and for the first few years, Wunderlich experienced extreme fatigue.She needed to nap for two to three hours most afternoons during the first year. Eventually, after doctors fine-tuned her dosage, her health began to improve.
My mother also has experienced severe fatigue since going on thyroid replacement medication. She often has to rest after work, and she goes to bed early.
After a thyroidectomy, remnants of thyroid tissue or cancerous cells may be left behind. When this happens — as it did to my mother and Wunderlich — patients have to undergo radioactive iodine treatment to destroy these remaining cells.
After taking the isotope in liquid or pill form, patients are typically isolated at home for up to a week, while the body gives off low amounts of radiation. Patients must avoid close contact with people and pets, sleep alone, clean their dishes by hand, and wash their towels, sheets and clothes separately.
A further cancer risk
Although the radioiodine kills the thyroid cancer cells, it increases the risk of a secondary cancer because it exposes the kidney, bladder and pelvic organs to radiation, Smallridge says. The treatment also can cause short-term side effects including painful swelling of salivary glands, headache, nausea and appetite loss. The worst of my mom’s side effects was the metallic taste, which lingered long after her treatment. An avid cook, she didn’t enjoy food for months.
Even after thyroid cancer is gone, there’s a risk that it will come back: Ten to 30 percent of patients deemed disease-free after initial treatment will develop recurrence or metastases 10 to 20 years after treatment, according to the National Cancer Society.

When David Kalish, of Albany, N.Y., was diagnosed with a rare, aggressive type of thyroid cancer in 1994 at age 32, he had surgery to remove his thyroid, dozens of lymph nodes, part of his trachea, and one of his laryngeal nerves. That procedure has left Kalish permanently hoarse. A year later, he had another surgery to take out more cancerous lymph nodes. And in 1999 he had a third surgery to remove a tumor that had wrapped itself around his remaining laryngeal nerve, threatening his ability to speak.

After all that, Kalish’s battle with thyroid cancer wasn’t over.

“When I was diagnosed in 1994, all the literature said there was a 95 percent cure rate. What I was going through was definitely not in sync with that information,” says Kalish, whose type of thyroid cancer is more aggressive and more deadly than most.

By 2000, Kalish’s cancer had metastasized to his lungs. He underwent three years of traditional chemotherapy, but the cancer continued to spread.

In 2008 Kalish signed up for a clinical trial testing a novel treatment targeting the enzymes that tell cancer cells to grow. The cancer has stopped spreading, although some spots remain in his lungs.
Kalish wrote a comedic novel about his experience with cancer, “The Opposite of Everything,” and is hopeful that science will keep churning out drugs to keep him alive.

No ‘good’ cancer
What I’ve learned from my mother’s diagnosis is that while some other cancers are certainly more deadly, there is no such thing as a “good” cancer.

Or as my mother puts it: “Cancer diagnosis of any kind is still cancer.”

While she is relieved she doesn’t have a more serious type of cancer, it will be years before she’ll know whether she’s truly cancer-free. She needs regular tests to make sure the cancer hasn’t come back. When I ask her about the cancer, she almost always has a positive outlook, but she still regularly experiences fatigue and mood swings from her hormone medication.

Smallridge says patients’ quality of life tends to improve over time as they learn how to cope with what is essentially a chronic disease, the lack of thyroid hormones.

“It’s going to take a while for patients to get through the initial therapy,” Smallridge says. “It’s going to take several years before they can appreciate that they’re going to do well.”

Mullin is a freelance science writer living in the Washington area.

Friday, September 4, 2015

Aspirin could help boost cancer treatment, experts find

'Exciting' study results show anti-inflammatory pain killer suppresses cancer molecule that allows tumours to evade body's immune defences

By , Health Editor
5:00PM BST 03 Sep 2015

Cancer treatment could be more effective when it is combined with aspirin, new research suggests.
The anti-inflammatory pain killer suppresses a cancer molecule that allows tumours to evade the body's immune defences, a study has found.
Experts said the research findings were “exciting”, suggesting that drugs that cost just a few pence could make “a huge difference” helping to save lives.
But they cautioned that the findings would need to be confirmed by further trials before aspirin was routinely given as part of cancer treatment.
Laboratory tests show that skin, breast and bowel cancer cells often generate large amounts of a molecule called prostaglandin E2 (PGE2).
The study found aspirin and other members of the "Cox inhibitor" drug family block its production so that tumours have nowhere to hide. In mice, combining immunotherapy with drugs such as aspirin substantially slowed the growth of bowel and malignant skin cancer.
Professor Caetano Reis e Sousa, who led the team from the Francis Crick Institute in London, said: "We've added to the growing evidence that some cancers produce PGE2 as a way of escaping the immune system.
"If you can take away cancer cells' ability to make PGE2 you effectively lift this protective barrier and unleash the full power of the immune system.
"Giving patients COX inhibitors like aspirin at the same time as immunotherapy could potentially make a huge difference to the benefit they get from treatment.
"It's still early work but this could help make cancer immunotherapy even more effective, delivering life-changing results for patients."
The ability of cancers to manufacture PGE2 may be one reason why some experimental immunotherapy treatments have not lived up to expectations.
Professor Peter Johnson, chief clinician at Cancer Research UK, which funded the study published in the journal Cell, said: "PGE2 acts on many different cells in our body, and this study suggests that one of these actions is to tell our immune system to ignore cancer cells.
"Once you stop the cancer cells from producing it, the immune system switches back to 'kill mode' and attacks the tumour."

Thursday, September 3, 2015

Combination Therapies Continue to Advance in Melanoma with BRAF Inhibitor


Laura Martin @OncEditorLaura
Published Online: Monday, August 31, 2015
Both targeted therapy and immunotherapy regimens, as combinations, have shown significant benefit in the treatment of melanoma.

Combination treatment with the BRAF inhibitor vemurafenib (Zelboraf) and the MEK inhibitor cobimetinib showed promise in patients with BRAFV600-positive advanced melanoma in both the BRIM7 and coBRIM studies.

Follow-up data for BRIM7 presented at the 2015 ASCO Annual Meeting continued to show a response rate of 87% in patients who had not previously received a BRAF inhibitor; however, investigators reported 4 additional complete responses (CRs), raising the CR rate from 10% (n = 6) to 16% (n = 10). Median progression-free survival (PFS) was unchanged at 13.8 months. With extended follow-up, median overall survival (OS) was reached at 28.5 months and 2-year OS was 61%. Despite these additional benefits after extended follow-up, the adverse event frequency and severity remained stable.

Updated results were also presented at ASCO for the phase III coBRIM study, showing a median PFS with the vemurafenib/cobimetinib combination of 12.25 months versus 7.20 months with vemurafenib plus placebo (HR = 0.58; 95% CI, 0.46-0.72). The overall response rate (ORR) was 69.6% versus 50%, respectively. Based on the coBRIM results, the FDA is currently reviewing an application for cobimetinib/vemurafenib for patients with BRAFV600-positive advanced melanoma, with a decision deadline of November 11, 2015.

The frontline checkpoint combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) has also shown promise for patients with advanced melanoma. In data from the phase II CheckMate-069 trial presented at ASCO 2015, ORR was 60% with the combination compared with 11% with ipilimumab alone in patients with BRAF–wild-type disease (P <.0001). There were 12 CRs with nivolumab/ipilimumab versus none with single-agent ipilimumab. Median PFS was 8.9 versus 4.7 months, respectively (= .0012). Similar ORR and PFS results were reported in the BRAF-positive subgroup.

Toxicities were increased with the checkpoint combination, with grade 3/4 adverse events of 51% versus 20% in the control arm.

OncLive sat down with Anna Pavlick, DO, associate professor, Department of Medicine, Ronald O. Perelman Department of Dermatology, assistant director for Clinical Research Education, and co-director of the Melanoma Program at NYU Langone Medical Center, to discuss the future outlook of combination therapies in advanced melanoma and the challenges oncologists should consider regarding them moving forward.

What were the goals of the extended follow-up study of BRIM7?

Dr Pavlick: We looked at the 2-year OS of patients who participated in the BRIM7 study. The BRIM7 study examined vemurafenib, which is a BRAF inhibitor, in combination with the MEK
inhibitor cobimetinib. We knew the correct dose of vemurafenib, but we dose escalated the cobimetinib.

We also investigated scheduling. The outcome was that it was safe to administer vemurafenib at a full dose of 960 mg twice daily in combination with 60 mg daily, 21 days on with a 7-day drug-free break during every 28-cycle.

The longer we followed these patients, the more complete responses we were able to see. The time to progression was also extended and the patients were alive for much longer than we had predicted. The toxicities were also very tolerable.

What do you think the impact of these findings will be for patients?

The combination studies have clearly shown that the excitement we had about single-agent BRAF inhibitors was very much quelled when saw all these patients starting to progress after 9 months. However, we are more confident now that we are starting to understand that you can treat patients with combination therapy if they have very aggressive disease; immunotherapy might not be the right choice for them. There is a clear subset of patients who are going to go on and have durable responses from inhibitor therapy, without ever having to receive immunotherapy.

What questions still remain after this analysis?

The phase III study of vemurafenib and cobimetinib [coBRIM] has already been published. Our follow-up analysis confirms the data from almost 7 years ago. However, a few questions remain to be answered. How do we identify the patients that will be the complete responders? How do we better integrate immunotherapy into the inhibitor platform, so that we can give the patients who progress the ability to have longer responses?

Were there any concerning or new toxicities determined in this follow-up?

Toxicities were what we expected for the most part. We actually had fewer toxicities than we predicted. We were very nervous about giving two different targeted therapies at that point, because we did not know what the overlapping toxicity might cause. Our biggest concern was rash, as there were a significant amount of rashes with vemurafenib as well as with cobimetinib. However, the level of rash was actually very tolerable. Interestingly, the combination did not diminish the photosensitivity side effect we had with vemurafenib. However, it did decrease the rate of invasive squamous cell skin cancers that patients might develop.

The CheckMate-069 study also examined a significant combination regimen for patients with previously untreated advanced melanoma. What are your thoughts on the impact of these findings?

Clearly, we have taken a huge stride in combining two immunotherapies. Ipilimumab has a more dynamic toxicity profile than nivolumab, and so we had to tread lightly when we combined the two to make sure we could administer them safely. We found out we can give them safely if we adjust the dose of nivolumab when we combine it with ipilimumab.

Even with this adjustment, we still ran into challenges with managing toxicities. Giving the two drugs together gave at least 50%-60% toxicities that we needed to manage. Most of those toxicities did not preclude us from continuing therapy; however, there were a good number of patients who did need to come off the study right in the beginning of the trial because of toxicity.

The interesting thing about that is, even when patients were never able to get any more combination therapy due to toxicities, many still went on to have strong, durable responses. Because of this, many of us feel very comfortable stating that, if a patient has a toxicity that causes them to discontinue treatment, they may still go on to have a durable response if they received at least 50% of the combination regimen before discontinuing.

What were the most common toxicities found in this trial?

Toxicities include rash, itching, and diarrhea. What we were not expecting to see that we did was an early unset of endocrinopathies, which normally occur with ipilimumab 16 to 20 weeks after starting therapy. In the combination, the endocrinopathies occurred much earlier, at about 6 to 8 weeks after starting therapy. When using these treatments together, we now know to be prepared for that.

What role do you believe this combination will have in the future?

Although the response rate was clearly outstanding, this should not become the standard of care for everyone due to the toxicities. The toxicities can be serious, and they need to be managed promptly and effectively so that patients do not end up in the hospital. Deciding who gets this treatment is really where the art of medicine is going to come into play. Doctors need to look at the patients’ comorbidities, their overall performance status, and the bulk of their disease, and decide if they will be able to withstand the toxicities. The benefit is there, but doctors really need to select the right patients and have the right staff in place to handle this combination.
- See more at: http://www.onclive.com/web-exclusives/combination-therapies-continue-to-advance-in-melanoma#sthash.eJGTwxPn.dpuf

Wednesday, September 2, 2015

How Google looks to change the management of diabetes


 Updated Ron Leuty Reporter San Francisco Business Times

Google Inc. and drug developer Sanofi are joining forces to develop and streamline tools for managing diabetes.
The end game: reducing the risk of complications and ultimately lowering the cost of managing type 1 and type 2 diabetes for nearly 30 million patients in the United States and nearly 400 million worldwide.
The move comes as questions swirl about Google's future in health care, following the Mountain View-based company's (NASDAQ: GOOG) decision to move its life sciences unit from the Google X R&D division into a standalone company under the control of its new overarching Alphabet company.
Sanofi (NYSE: SNY), based in Paris, is one of the leading diabetes drug and device sellers.
There is a huge opportunity in diabetes, Google said in a statement. Patients use devices, apps and pieces of paper all try to keep track of food intake, but those methods are largely unintegrated and only a third of patients with type 1 diabetes meet their target blood sugar levels. That can lead to long-term complications, such as heart disease, stroke and nerve damage.
"With new technologies emerging to provide a more continuous and real-time view of a patient's health, we can see the promise for more proactive and effective ways to control diabetes," Andy Conrad, CEO of Google's life sciences team, said in a press release.
Google's highest-profile moonshot to date has come in the aging-related company Calico Life Sciences LLC, led by former Genentech Inc. CEO Art Levinson. But it also is working with Novartis AG on a "smart" contact lens with a miniaturized glucose sensor, a Star Trek-like Tricorder for early detection of disease and Liftware for Parkinson's disease patients who have trouble lifting and controlling utensils.