Wednesday, November 30, 2022

Clinical trial of new drug for metastatic breast cancer patient shows 'unheard of' survival rates

A new clinical breast cancer drug trial has resulted in "unheard of" survival rates.

According to a recent story by Gina Kolata in The New York Times, for some patients with metastatic tumors that were not significantly affected by other forms of chemotherapy, the treatment halted their cancer's growth.

The findings of a new study, published in the New England Journal of Medicine, might "change how medicine [is] practiced," the article indicates.

Dr. Eric Winer, who was not involved in the study but who is director of the Yale Cancer Center and head of the American Society of Clinical Oncology, is quoted as saying that "this is a new standard of care. It affects a huge number of patients."

The Times piece notes that the new treatment, using an experimental drug (trastuzumab deruxtecan, sold as Enhehru) "that targeted cancer cells with laser like precision" was "stunningly successful, slowing tumor growth and extending life to an extent rarely seen with advanced cancers."

The trial, which focused on a mutant protein known as HER2, involved 557 patients. Tumors in those who took the experimental drug stopped growing for about 10 months, twice the length of those who took only standard chemotherapy. Those patients survived for almost two years, compared to less than a year and a half for those who received standard chemo.

Dr. Halle Moore
"It is unheard of for chemotherapy trials in metastatic breast cancer to improve survival in patients by six months," the story quotes Dr. Halle Moore, director of breast cancer oncology at the Cleveland Clinic, as saying.

Dr. Susan Domchek, a breast cancer specialist at the University of Pennsylvania's Abramson Cancer Center, also is quoted to the effect that she plans to see — even before the Food and Drug Administration approves the drug, which has a wholesale price of about $14,000 every three weeks — if the data from the study will be sufficient to convince insurers to approve it.

More information about successful clinical trials can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Friday, November 25, 2022

Expert contends that collective voices could cut socio-economic disparities hiking cancer deaths

The ability of cancer patients to overcome inequities in insurance coverage and acquire access to the appropriate clinical care has grown quite a bit lately.

In a recent op ed by Elizabeth Helms in the Marin Independent Journal, the cancer care expert promotes advocate and collective voices to achieve those and other results for patients and their families who "live daily with chronic conditions"

Elizabeth Helms
Helms, president and CEO of the California Chronic Care Coalition, an alliance of nonprofit, social consumer and provider organizations, writes that "access to innovative, clinically appropriate cancer treatments will not only improve survival outcomes for cancer patients, but actualize a future where many cancer types can be viewed as a chronic condition to be managed in consultation with a care team."

Noting that "our collective voices are always stronger than just one advocate, " she quotes an African proverb that says, "If you want to go fast, go alone. If you want to go far, go together."

For Helms, "together" — at least in California — means supporting the mission of the Cancer Patients Bill of Rights, a resolution unanimously passed by the state's legislature in 2021. 

California, it should be noted, is the first state to adopt such a bill of rights, one that lays out six rights that every cancer patient should be entitled, including access to promising innovations and experts specializing in various cancer types.

In her op ed, Helms maintains that while biomedical research has produced life-saving innovations, cancer patients still face socioeconomic disparities that if eliminated could prevent "34% of cancer deaths among all U.S. adults ages 25 to 74."

The bottom line, she contends, is that "when patients receive early access to the treatments and expertise tailored to treat their cancer subtype, lives are saved and the quality of life remains higher during and after treatment."

In California, she write, patients insured through the Medical program "often must navigate confusing layers of subcontracted care, who managed-care plans…outsource responsibility for patients. In many cases, the heavy use of subcontracted care adds a knot of red tape on top of an already stressful time for Medical patients trying to access specialized cancer care."

She adds that cancer patients in that program "who have breast, colon, lung and rectal cancer are more likely to be diagnosed at an advanced stage of disease and have less favorable five-year survival rates."

"Our current one-size-fits-most system prevents many California cancer patients from accessing optimal care," she insists, "and the lack of access has translated into needless suffering and lives lost."

The cancer community, Helms says, "has a moral imperative to break down these barriers to access." 

Access that eliminates disparities can make a difference for the more than 187,000 Californians who are diagnosed with cancer every year and the thousands who "will be misdiagnosed or placed on inappropriate or ineffective treatment."

More information about care can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers. 

Monday, November 7, 2022

Despite Katie Couric's advice, doctors repudiate some ultrasound breast cancer screenings

Many doctors are questioning Katie Couric's new call for ultrasound screenings beyond annual mammograms to detect breast cancer.

A recent online Kaiser Health News story by Michelle Andrews notes that the 65-year-old former co-host of NBC's "Today" show is now pushing those sonograms because they "can sometimes identify malignancies that are hard to spot on a mammogram in women whose breasts are dense — that is, having a high proportion of fibrous tissue and glands vs. fatty tissue."

Dr. Carol Mangione
The KHN article, however, quotes Dr. Carol Mangione, professor of medicine and public health at UCLA who chairs the U.S. Preventive Services Task Force, a group of medical experts who make recommendations for preventive services after weighing their benefits and harm, as being in doubt. She says clearly, "We don't have evidence that auxiliary screening reduces breast cancer mortality or improves quality of life."

Dr. Sharon Mass, an OB-GYN in Morristown, New Jersey, and the former chair of the American College of Obstetricians and Gynecologists' New Jersey section, echoes that sentiment. "On the one hand," Andrews' piece quotes her as saying, "we want to do everything we can to improve detection. But on the other hand, there are lots of costs and emotional distress" associated with false-positive results.

Couric first shared the news of her own breast cancer diagnosis in September.

In addition to regular mammograms, many women are getting 3D mammograms, sonograms or MRIs as supplemental testings. That imaging in those who aren't at high risk for breast cancer, the KHN story says, "may identify potential trouble spots, which can lead to follow-up testing such as breast biopsies that are invasive and raise cancer fears for many patients. But research has found that very often these results turn out to be false alarms."

And that doesn't count the possible extra cost. "An ultrasound screening might cost $250 out-of-pocket while a breast MRI could run $1,084," according to the Brem Foundation to Defeat Breast Cancer," Andrews' story says. 

Meanwhile, Rep. Rosa DeLauro (D-Conn.) recently tweeted that she's working in conjunction with Couric on a bill to cover MRIs and ultrasounds for women with dense breasts "without any out-of-pocet costs," the article reports.

What are the real results of added screenings? Studies show, the KHN piece notes, that "if 1,000 women with dense breasts get an ultrasound after a negative mammogram, the ultrasound will identify two to three cancers. But the extra imaging will also identify up to 117 potential problems that lead to recall visits and test but are ultimately determined to be false positives."

Mass' group doesn't recommend supplemental screening for women with dense breasts who don't have any additional risk factors for cancer, the article reports. "Many other professional groups take a similar position."

Dense breasts, the story says, "are relatively common. In the United States, an estimated 43% of women 40 and older have breasts that are considered dense or extremely dense…Women with dense breasts are up to twice as likely to develop breast cancer as women with average-density breasts, research shows."

Other steps instead of extra screening could be helpful, according to Dr. Karla Kerlikowske, a professor of medicine and epidemiology/biostatistics at the University of California, San Francisco. "If you really want to help yourself, lose weight," she's quoted as saying. "Moderate your alcohol intake and avoid long-term hormone replacement. Those are things you can control."

Additional information on mammograms, sonograms and other screenings can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.