Aggressive, 'just-in-case' treatments unnecessary

New test can shield breast cancer patients from unneeded treatments, study indicates

A new tumor test can help identify which breast cancers don't need extra treatment.

According to a recent KQED morning edition piece by Joe Neal and Patti Neighmond, "more and more studies are showing many small, early tumors don't present a danger."

The public-radio report, under the rubric "Shots: health news from NPR," indicated that a study published in JAMA Oncology suggested that it's possible "to distinguish fairly precisely between 'ultralow-risk' tumors that are unlikely to cause problems and those that are more aggressive and likely to spread."

Which translates into some patients being able to, according to the piece, "avoid unnecessary treatments."

The MammaPrint diagnostic test, used by researchers in the United States and Sweden, apparently can measure a tumor's genomic "fingerprint" and compare it with survival time after a tumor is removed.

The NPR story reported that the researchers said "they were able to pinpoint patients who had a very low risk of death from breast cancer — even up to 20 years after the first diagnosis."

Dr. Laura Esserman

The piece quoted Dr. Laura Esserman of the University of California, San Francisco, the lead author of the study, as saying what it means is that "we don't have to be aggressive upfront and treat you with everything, just in case."

The test results, it continued, "build on findings of a 2016 report using the same test that  showed 46 percent of women with certain genetic profiles could actually skip chemotherapy with little consequence to their long-term survival."

According to Esserman, it appears that about 20 to 25 percent of tumors being diagnosed today may be ultralow-risk and not require treatment after surgery.

The tumor test, which isn't covered by all insurance companies, is not cheap. It costs $4,200.

Many more details about much more research on breast cancer can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, geared to caregivers.

Smaller studies can mean missed side effects

Pharmaceutical companies can't find patients for trials of experimental cancer drugs 

Dr. Peter Bach

Too few patients are available to cover all the clinical cancer drug trials being conducted.

That, at least, is the conclusion of a recent story by Gina Kolata in The New York Times.

Her article notes that the problem "is caused partly by companies hoping to rush profitable new cancer drugs to market, and partly by the nature of these therapies, which can be spectacularly effective but only in select patients."

There currently are more than 1,000 immunology trials underway, for example.

But Kolata says "immunotherapy trials have proliferated so quickly that major medical centers are declining to furnish patients to them. The Yale Cancer Center participates in fewer than 10 percent of [those] it is asked to join." 

The writer cites words of Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center: "I think there is a lot of exuberant rush to market. And we are squandering our most precious resource — patients."

Dr. Roy Herbst

She also quotes Dr. Roy Herbst, the Yale center's chief of medical oncology, to the effect that the companies sponsoring the trials aren't addressing new research questions but are merely "trying to get proprietary drugs approved."

Some companies are working on experimental drugs that attack and block mutations that tumors need to grow and thrive. The mutations sought by those targeted therapies, however, are extremely rare so pharmaceutical companies "may be forced to undertake a worldwide search for subjects that can last for years."

It took Pfizer three years, for example, "to locate 50 lung cancer patients who carried a rare aberration called ROS1, found in just 1 percent of patients."

Many new trials involve a limited number of patients, which can be risky.

Bach, according to Kolata, maintains that "the smaller the study and the shorter its duration, the more likely that what looks like an effect in a trial might simply be the result of chance" — which "leaves some of us evidence geeks wondering if it works."

Dr. Scott Ramsey

The writer also quotes Dr. Scott Ramsey, an oncologist at the Fred Hutchinson Cancer Research Center, that "in tiny studies, serious side effects can be missed."

Details of many clinical trials can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Can 40 percent of cancers be prevented?

Vast majority of cancer-causing mutations due to random DNA errors, new study indicates

"Two-thirds of cancer mutations are due to random DNA copying errors, study says."

That's the bulk of a slightly scary headline at the top of a recent "To Your Health" section of The Washington Post website.

In a story by Laurie McKinley, the study — published in "Science" magazine — cancer-causing mutations occur when normal cells divide. 

Humans, according to the piece, "have trillions of cells, which are constantly regenerating by dividing and making new cells. But each time DNA is copied, the scientists said, an average of three random mistakes will occur. While most are harmless, a small number affect genes that will promote cancer."

Bert Vogelstein

The Post article indicates that two Johns Hopkins University researchers — Bert Vogelstein, a cancer geneticist, and Cristian Tomaetti, a mathematician — were able in their study to separate the randomness factor from the other main contributors to cancer: inherited genes and environmental factors such as smoking and obesity.

Cristian Tomasetti

Results, after analyzing  "genome sequencing and epidemiological data for 32 types of cancer," assigned the mutations thusly: 66 percent, DNA-replication mistakes; 29 percent, environmental factors; 5 percent, heredity.

Variations depended on what kind of cancer they were talking about. According to the story, for example, "random DNA-replication mistakes account for about 77 percent of critical mutations in pancreatic cancer, and virtually all childhood cancer."

But "more than two-thirds of the mutations in lung cancer were due to environmental factors, mostly smoking."

McGinley's piece noted that "the new research builds on a 2015 study that highlighted the role of 'bad luck' — random DNA errors — in developing cancer. That study drew vehement protests from some cancer physicians and researchers who worried it would encourage people to take a fatalistic approach to cancer rather than trying to reduce their cancer risk by maintaining a healthy weight, exercising regularly, eating a good diet and avoiding cigarettes."

The Hopkins researchers have claimed "their earlier work was widely misinterpreted," the article continued — and emphasized that the new study "was consistent with estimates that 40 percent of cancers can be prevented."

Vogelstein insisted said that "science needs to find better ways to detect cancer early, when there is a good chance of curing it."

According to the story, critics of the 2015 study "disliked the 'bad luck' explanation and complained that the study was limited to the United States and didn't include the most common cancers — breast and prostate."

Insights into cancer mutations — especially BRCA1 and BRCA2 genes — can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Are 16 unregulated chemicals putting you at risk?

Contaminants in drinking water may cause cancer, pregnancy problems and other risks

A new study shows that 16 cancer-causing chemical contaminants are filling California's water supply.

According to a Patch.com article by Autumn Johnson, hundreds of harmful contaminants have been found across the American water supply that also can cause "developmental issues in children, problems in pregnancy and other serious health conditions."

The subhead of the website piece warns, "What's legal isn't necessarily safe when it comes to your drinking water."

In California as well as other states, it says, the following contaminants have been detected above health limits or guidelines in some water districts:

Chromium (hexavalent), which is linked to cancer and liver damage; total trihalomethanes (TTHMs), which are connected with bladder and skin cancers plus fetal development issues; bromodichloromethane and dibromochloromethane, both of which are linked to cancer and harm to fetuses; chloroform, connected to cancer risks and fetal development issues; dicloroacetic and trichloroacetic acids, both of which are linked to cancer as well as reproductive or pregnancy difficulties; uranium, arsenic and radium-228, all of which have cancer links; nitrate and nitrite, which are linked to cancer and fetal development issues; haloacetic acids (HAA5) and fluoride, which may cause cancer; selenium, which can decrease thyroid hormone production; 1,2-dibromo-3-chlororopane (DBCP), which can cause sterility in men and well as cancer; and tetrachloroethylene (perchlorothylene), which can cause cancer and pollute soil and groundwater.

Nneka Leiba

The Patch story adds that the study, which was released today, contends that chemicals "above health-based lists, or health guidelines, [can be found] in the water of more than 250 million Americans, said Nneka Leiba, director of Healthy Living Science at the Environmental Working Group, or EWG, and independent nonprofit organization that release a detailed account of the contaminants."

Laws often permit utilities "to allow these dangerous chemicals to pollute our waters," Johnson's story continues.

The story quotes Leiba as saying that about 160 contaminants out of the 250 in the nation's drinking water are unregulated, "a big concern because…that means [they] can be present in our water at any level — and be legal."

In many cases, however, a simple water filter — although not 100 percent effective — can help protect consumers.

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

'Transformative" treatments deemed possible

Race underway to create gene therapies for breast, prostate, ovary, lung, pancreas cancers

Pharmaceutical companies and universities are in a race to develop "utterly transformative" gene therapies, according to a recent article by Denise Grady in The New York Times.

The story says "one of the big goals now is to get them to work for many [cancers other than leukemia, for which approval is expected soon], including those of the breast, prostate, ovary, lung and pancreas."

The radically new class of treatments, it also says, may "re-engineer and turbocharge millions of patient's own immune cells, turning them into cancer killers that researchers call a 'living drug.'"

Dr. Stephan Grupp

The Times piece contends that the new leukemia drug, called CAR-T therapy, "has been utterly transformative in blood cancers," according to Dr. Stephan Grupp, director of the cancer immunotherapy program at the Children's Hospital of Philadelphia, a professor of pediatrics at the University of Pennsylvania, "and a leader of major studies."

Although Grupp cautions that it will take at least five years to make an accurate determination, he maintains that if the treatment "can start to work in solid tumors, it will be utterly transformative for the whole field."

The treatment apparently is also being studied in conjunction with "glioblastoma, the aggressive brain tumor that Sen. John McCain was found to have."

Grupp says one particularly encouraging potential avenue of research with children involves earlier stages of disease "instead of very late, as rules now require," the Times story indicates. 

Earlier treatment, it reports him as believing, "might help some patients avoid bone-marrow transplant, a grueling, last-ditch treatment. Children with less advanced disease also tend to have milder side effects."

Other studies are underway to combine the new therapy "with immunotherapy drugs called checkpoint inhibitors, which help unleash the cancer killing power of T-cells" — which the story describes as the white blood cells "often referred to as the soldiers of the immune system."

One of the big problems with the new treatment — which "involves removing millions of…T cells…from the patient's bloodstream, genetically engineering them to recognize and kill cancer, multiplying them and then infusing them back into the patient" — is its cost factor.

The process, the story explains, is very expensive (at least $300,000 per treatment, other articles have said)  "because each treatment has to be made separately for each person."

The treatment was developed at the University of Pennsylvania and licensed to Novartis.

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

'Mismatch repair-deficient' genetic flaws studied

Tumor cell testing might show if new immunotherapy could target your particular cancer

The more gene mutations hidden inside your cancerous tumor, "the better chance your immune system has to fight back."

That's what Lauren Neergaard, an Associated Press medical writer, wrote recently after a newly approved landmark drug became "the first cancer therapy ever cleared [by the Food and Drug Administration] based on a tumor's genetics instead of the body part it struck first."

Keytruda, an immunotherapy, apparently might help those whose disease is among those with a common genetic flaw — called a mismatch repair defect — carried by seemingly unrelated cancers.

Genetic testing can show if a patient is a candidate for the precision immunotherapy.

Neergaard's story indicates that Johns Hopkins researchers estimate "about 4 percent of cancers are mismatch repair-deficient, potentially adding up to 60,000 patients a year."

Widely available tests to tell who's eligible for the immunotherapy cost between $300 and $600.

The flaw, Neergaard's article says, "is more common in colon, endometrial and gastrointestinal cancers but occasionally in a list of others." 

Dr. Bert Vogelstein

According to Dr. Bert Vogelstein, a cancer geneticist at Johns Hopkins, where the new use for the immunotherapy was discovered, the more mutations in a tumor, the greater the chance that at least one of them produces a foreign-looking protein that is a beacon for immune cells." 

More information on cancer research is contained in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Gene-changing leukemia therapy nears approval

Feds open door to okaying cancer-fighting treatment that genetically alters patient's cells

An FDA panel has given a unanimous vote of confidence to a gene-altering leukemia therapy.

According to a story by Denise Grady in The New York Times today, the Food and Drug Administration panel has unanimously recommended, following successful clinical trials, that "the agency approve the first-ever treatment that genetically alters a patient's own cells to fight [lethal] leukemia, transforming them into what scientists call 'a living drug' that powerfully bolsters the immune system to shut down the disease."

The agency is likely to accept the recommendation, Grady's story indicates, an action that would make Novartis' experimental treatment the first gene therapy to reach the market — ending in September a decades-long competition by researchers and drug companies.

"To use the treatment," the article continues, "a separate treatment must be created for each patient" — at enormous cost: between $300,000 and $600,000 for the requisite single infusion, according to analysts.

The CAR T-cell technique has multiple steps: Cells removed from the patient must be frozen, thawed and processed at a plant run by the manufacturer, frozen again and shipped back to the treatment center.

Severe side effects — including "fever, crashing blood pressure, lung congestion" — can potentially be life-threatening, but scores of patients have experienced long remissions and, in some cases, possible cures, the Times story maintained.

On the other hand, "re-engineering cells for treatment sometimes take four months," it noted, leaving some patients "so sick that they died before their cells came back."

Dr. Carl H. June

Dr. Carl H. June, an immunology professor and leader of the University of Pennsylvania research team that developed the treatment and licensed it to Novartis, has labeled the altered cells "serial killers."

One cell purportedly can destroy up to 100,000 cancer cells.

The panel's recommendation specifically dealt with leukemia "that has resisted treatment, or relapsed, in children and young adults ages 3 to 25" — for patients who typically had a bleak prognosis.

The clinical trials, according to a story by Laurie McKinley in The Washington Post yesterday, took place "in almost a dozen countries," with results of 83 percent of patients going into remission.

That story also indicated that "researchers are exploring CAR T-cell therapy's use for multiple myeloma and chronic lymphocytic leukemia [and] are also tackling a far more difficult challenge — using the therapy for solid tumors in the lungs or brain."

Meanwhile, Dr. Stephen Schuster, a Penn oncologist and leader of a lymphoma study, is quoted by the Post as saying, "We're saving patients who three or four years ago we were at our wit's end trying to keep alive."

Details on a variety of cancer therapies can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Cell experiment shows 'extraordinary' promise

Can new gene therapy change patient's own blood into a cancer killer? Quite possibly

Turning your own blood into cancer killers may now be possible.

According to a new study reported recently by the Associated Press, more than a third of very sick lymphoma patients showed no sign of the blood cancer six months after a single treatment of an experimental gene therapy.

Findings of the study, the story by Marilynn Marchione indicated, were made by the treatment's maker, California-based Kite Pharma, which purportedly "is racing Novartis AG to become the first to win approval of the treatment, called CAR-T cell therapy," in the United States.

The treatment could become the nation's first approved gene therapy, the AP article indicated.

Side effects appear to be manageable.

There are risks involved, of course. "Three of the 101 patients in the study died of causes unrelated to worsening of their cancer," the story said, "and two of those deaths were deemed due to the treatment," which was developed at the National Cancer Institute and licensed to Kite.

Dr. Roy Herbst

One independent expert, Dr. Roy Herbst, cancer medicines chief at the Yale Cancer Center, was quoted as calling the results "extraordinary" and "extremely encouraging."

He suggested, though, that follow-up studies were needed to make sure the benefit doesn't wane over a longer period of time.

New research and treatments are an integral part of "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.