Battling Cancer

What’s going on in cancer clinical trials?

For a refresher on what clinical trials are see the Battling Cancer archives on the topic.

The SUN Program: Studies to Understand Sunititrib Malate. While the there are numerous Sun Trials including five enrolling for breast cancer, this one is of particular interest. Check out the site for a video of the study on Sutent.

SUTENT is indicated for the treatment of

• Advanced renal cell carcinoma (RCC)
• Gastrointestinal stromal tumor (GIST) after disease progression on or intolerance to imatinib mesylate

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Chronic Illness is a journal that focuses on multi-disciplinary approaches to disease treatment and management.  This month, the journal focuses on childhood cancer.

Articles are available to the public for free viewing until May. I’ve listed links to them below, and I’ve found them to be a good mix of original scientific research, clinical observation, and the often forgotten patient / caregiver perspective. Definitely the best multi-disciplinary “round up” of current articles that I’ve seen on childhood cancer recently — check them out if you get a chance!

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Today’s guest commentary is by Amanda, a cancer research scientist, on the high cost of anti-cancer drugs.

Can you put a price on life? What a complex and interesting question, and one that I have never really thought much of before. But this is the question that many cancer patients face when considering the coming months of costly treatment options after their initial diagnosis.

While many insurance companies cover a percentage of the drug treatment costs, the price of new cutting-edge treatments are astronomical. For example, herceptin is a drug that prescribed to women who have breast cancers that overexpress a receptor called HER2. This type of cancer is very aggressive, and tends to grow and spread more quickly than HER2-negative tumors. Treatment with herceptin is the only option for women having this type of cancer. However, the drug is by no means cheap. Months of treatment can reach $25,000-$50,000 a year. The approximate cost of a three week infusion of herceptin is about $5,000. If the insurance company covers 70% of the cost, you will still be left with $1,500 that is not covered.

This figure only takes into account type of treatment. Depending on the type of cancer, combinational therapy may be the only option for patient survival, with two to three different types of drugs that the patient must pay for or face certain death. After a few months, this adds up, and most working class families cannot afford it. And the question once again returns: can you put a price on life?

Why are these treatments so expensive? More →

New studies reveal a promising new ways to keep prescription drug costs down for cancer patients — and it could be just as easy as taking pills on a full stomach rather than an empty one as prescribed.

In general, patients who are advised to take drugs on an empty stomach are done so because it helps physicians better predict effects without having to worry about multiple variables. However, new clinical studies have revealed that certain drugs that are taken with food could be found at much higher blood levels than they are when taken on an empty stomach. Also, some drugs may be more effective at lower doses when taken with grapefruit juice by taking advantage of changes in blood composition. Changes like these can help save patients $1700 or more on their costly cancer drug costs.

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The problem with excising cancerous cells from the body through surgery or radiation is that cells can be left behind to act as a seed to a new tumor.  In school, we learned that it can take even as little as 30 cells left behind to do exactly that.  Recently, physicians and scientists have found ways to make some cancerous cells glow in the dark, making them easier to spot within the human body and thus, easier to take right out in the hands of oncologists.

Scientists at the National Cancer Institute (NCI) are developing new ways to detect “silent” tumor masses, including ovarian cancer and pancreatic cancer. The problem with these types of cancer is that there are normally very few symptoms that arise until the cancers have progressed and metastasized, making early detection and treatment very difficult. In order to address these detection problems, researchers at the NCI, lead by Dr. Hisataka Kobayashi, M.D., Ph.D., are using fluorescent imaging techniques to detect small tumor growths in mice that would not be detected using the cuurent practices.

The first study uses the fluorescent compound called Av-3ROX, which consists of the protein avidin bound to three molecules of rhodamine X, a fluorescent dye that emits a detectable signal when hit with the correct wavelength of light. The joining of avidin to rhodamine X results in the inability of rhodamine X to fluoresce. The genius of this approach is that avidin binds specifically to another protein that is found only on cancer cells. The cancer cells then “digest” the Av-3ROX, which is then broken down inside the cell to the base parts.

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A new study out this week aims to put a more individual spin on the mathematics behind tumor progression.

Niko Beerenwinkel and colleagues used a colon cancer case study to analyze how much particular gene mutations affect an individual’s tumor development. They found that current tumor progression models, which only looked at a few genes of interest, lacked the accuracy that a model based on a larger selection of gene mutations could provide.

Previously, doctors have relied heavily on standard mathematical formulas to derive predictions on how large individual tumors will grow in a particular amount of time. The article, which was published on November 9 in the Public Library of Science journal Computational Biology, may help explain the huge variation between individual tumors.

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Here’s a quick glance at a few interesting cancer research studies that have come out recently, edited here for your weekend reading pleasure — enjoy!

Transplanting killer cells into cancer patients: Apparently, there are some people just aren’t prone to getting cancer due to a higher than normal healthy stock of immune system soldiers called granulocytes. Wake Forest University-based Dr. Zheng Cuit and his colleagues are looking to see if they can transplant some of those natural born killer cells into cancer patients — um, as long as it’s not flu season.

Average cancer-killing ability appeared to be lower in adults over the age of 50 and even lower in people with cancer. It also fell when people were stressed, and at certain times of the year.

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I just got some really exciting news from some old labmates of mine: Judah Folkman, the father of angiogenesis therapy in cancer, has agreed to speak at my alma mater!

Who is Judah Folkman and Why Should I Care?

To understand the significance of this event, please allow me to give you a brief cell biology lesson: The body’s cells are surrounded by capillaries, or tiny blood vessels, which nourish the cells and carry off their waste. These capillaries are made up of endothelial cells, and because these endothelial cells generally never divide, the blood vasculature pretty much stays the same. Angiogenesis refers to the few times (like during wound healing or menstruation) when these sleepy endothelial cells actually do decide to wake up and start dividing. Like anything that has to go to work after a long nap, the cells get everything they need to get done in a short, controlled burst, and then tune right back out again.

Back in the 1960’s, it was generally thought that the living cells that comprise tumors were just feeding off the blood supply of normal tissue. Dr. Folkman was the first to hypothesize that perhaps these unwanted tumor cells were surviving due to angiogenic activity. Turns out that he was right, and a new way to approach cancer treatment was born.

A flurry of anti-angiogenic approaches have found success not just in cancer, but in but heart disease, obesity, and infertility as well. Researchers in Dr. Folkman’s laboratory have been in the forefront of the “stop ‘em where it starts” approach to management and treatment, and both the man and his research have been highlighted in books both by him and others, a documentary, several news stories, and most recently, new business development.

The Judah Folkman Lunchbox

Because he was not afraid to try new approaches when almost everyone in his field thought he was wrong, I’ve considered Dr. Folkman to be a Rock Star Scientist in my eyes for years. Both my husband and I had done our graduate work in an cancer angiogenesis laboratory, so we used to joke that getting the thumbs-up approval from Dr. Folkman would trump even a Nobel Prize in Medicine.

Fast forward a few years to this past April when I presented my work at the American Association of Cancer Research Annual Meeting for the first time. Until my labmates and I got our conference programs in the Los Angeles Conference Center, I had no idea that it was the 100th anniversary of AACR and that Dr. Folkman had been invited to be a keynote speaker. After briefly hyperventilating, I planned my entire schedule around seeing him speak. When I saw him at his sunrise session talk, he was both humble and instantly likeable as he spoke not just about his recent work but that of his collaborators.

Since I figured I’d never get the chance to see him in person again, I hung around afterwards with a small crowd of scientists. As I eavesdropped on the other people talking to him, I realized that each person he was talking to was asking for his expert opinion on research approaches or clinical practices. They were all dressed up and from big-name institutions. I was some scruffy kid who came from an cancer center no one’s ever heard of — and I had nothing brilliant to say! When it came to my turn in line, I said, in true Lesly-fashion, the first thing that came to mind: “Dr. Folkman, I’m Lesly, and me and my husband think that you’re so great that we would buy a lunchbox with your face on it!”

And there it was for all to see: my pedicured foot inserted neatly in my mouth. More →

When looking for quality information about medical or scientific breakthroughs, like most everything else in life, you have to sift through a lot of crap in order to find the good stuff. Unfortunately, for every good source on the internet about cancer like the American Cancer Society or WebMD, you have tons of sites and blogs with weak content or even misinformation.

Because physicians and scientists don’t often spend the time marketing their big ideas a la Benjamin Franklin or Thomas Edison, it’s often up to science writers, journalists, and bloggers to interpret their work and broadcast it for them. It is here where many roadblocks to good science communication can come up, including a lack of familiarity with a hyper-specialized vocabulary (be honest: do you recognize this?) or even a misintepretation of a data set’s significance (helpful hint for everyone who reports on medical breakthroughs in cancer research: correlation does not imply causation!)

Martin Fenner points out the difficulty of writing about cancer research science to a general audience in an interesting article entitled “Poor Media Coverage of Cancer Research: Are Blogs one Answer?” An excerpt:

For those of us working in cancer research, it is important to remember to communicate our research findings not only in journal articles and scientific meetings. We probably have to do a much better job in talking to the media and the public. One example would be to start a blog about a particular area of cancer research or cancer patient care. The number of quality blogs in this area could be much higher, and some blogs even had to close down.

I agree with Martin that there aren’t nearly enough high-quality news outlets for cancer research, and we’re not alone. This past year, one of the biggest powerhouses in scientific publications, the Nature Publishing Group, has made some pretty bold steps in making strong, evidence-based information about science easily accessible through their development of the Nature Network, an open-access social network and blogging platform geared directly to scientists and other professionals (including Martin).

In the spirit of promoting strong content in the world of cancer research, I’d like to point you to a few recent posts on some of my favorite blogs: More →