Wednesday, April 29, 2009

Ixempra Research Offers Hope for Triple Negative Breast Cancer

Bristol-Myers Squibb Company presented research at the 2008 San Antonio Breast Cancer Symposium (SABCS) last December that offers some encouragement for women with triple negative breast cancer.  The company studied Ixempra  (ixabepilone) plus capecitabine compared to capectabine alone in clinical trials

• Of 443 patients with triple negative breast cancer, Ixempra plus capecitabine is the first combination regimen to demonstrate statistically significant progression-free-survival compared to capecitabine  alone.

• Triple negative patients who received Ixempra and capecitabine had an overall response rate of 31 percent compared to 15 percent for patients who received capecitabine alone . The progression-free survival of the combination group was a median of 4.2 months compared to a median of 1.7 months for the capecitabine-treated group.

An article in Medical News Today quotes one of the researchers:

"Patients with advanced, triple negative breast cancer have limited treatment options and a poor prognosis," said Hope S. Rugo, M.D., Clinical Professor of Medicine and Director, Breast Oncology Clinical Trials Program, University of California San Francisco Helen Diller Family Comprehensive Cancer Center. "For this reason, it is important to explore the potential of other current and developmental therapies to discover more and effective treatment options for patients with this specific type of breast cancer."

 


Natural Intervention Helps Chemo

Spending two hours a week in nature watching birds, tending to plants or gardens, sitting by a window with a view of trees or a garden can cut the fatigue that is often associated with cancer treatment. This comes from research in the journal Cancer Nursing.  Here's what I said about it in an article I wrote in Mamm on cancer anxiety:

Research published in 2003 in the journal Cancer Nursing suggests one way to overcome attention problems that’s as simple as, well, a walk in the park. Bernadine Cimprich, R.N., Ph.D., the study’s lead author, studied mental fatigue in a group of women with newly diagnosed breast cancer. They agreed to follow a structured program of “natural intervention,” spending two hours a week in nature—watching birds or trees, tending to plants or gardens. They were also instructed to give their full attention to their surroundings, rather than listening to an iPod or planning a work meeting. The women took standard cognitive tests before intervention began, after surgery, then three, six and twelve months afterward. As compared to patients treated without any nature therapy, participants showed better sustained recovery of their attention skills.

Cimprich, associate professor at the University of Michigan School of Nursing in Ann Arbor, says that the stress of dealing with breast cancer can lead to “attention fatigue,” and that nature therapy helps relax the parts of the brain that help to focus actively on tasks. Catherine Vincent, R.N., Ph.D., was diagnosed with breast cancer in 2003 while working on a postgraduate fellowship with Cimprich, so using natural intervention was a logical approach as she went on her daily walks. “I just inhaled the outdoors,” says Vincent, 59, assistant professor of maternal-child nursing at the University of Illinois at Chicago. Her cancer treatment—which included chemotherapy—went smoothly, which she attributes to the conscious rest she gave her brain. “I know part of it was really paying attention to what I needed,” she says. “Part of it was restoration through natural intervention.”  Read more here

Monday, April 27, 2009

How to Counter the Side Effects of Chemo

Toward the end of my chemo treatment, my husband and I decided to celebrate my progress (any excuse for a celebration), so we went to eat at Red Lobster. Their cheese biscuits are one of my favorite parts of a meal there. This time, though, the biscuits tasted like lard. No cheese, no yummy breast taste. Just lard.

Such were the wonders of chemo that nobody told me about.


I learned a great deal on my own, so to spare you that charm,
here are some of the side effects of the chemo I had—four rounds of dose-dense Adriamycin (Doxorubicin) and Cytoxan (cyclophosphamide) every two weeks—and some suggestions for how to deal with those effects. AC, as this regimen is called, is fairly common for hormone-negative cancers, including triple-negative,  that have not spread to the lymph nodes.

Chemo, in general, kills fast-growing cells, which are often cancer cells. That’s the good side of those toxins being pumped into you. However, your body has other fast-growing cells that are also affected—in your hair, the lining of your mouth, and digestive tract. Killing these changes your body. And I was not prepared for most of that.

I went through chemo fine, for the most part, given that I was going through chemo. I kept active, ate healthy, and spent marvelous time with my friends and family. But, as with all other aspects of this lovely journey, I could have been better informed.
Losing your hair. This chemo effect is the most understood and expected. My doctor told me it would happen in the third week of chemo and, sure enough, that’s when my hair literally began coming out in chunks. Some women prepare for this ahead of time by getting their head shaved before the hair falls out. I wanted to be normal and natural for as long as I could. So, one warm June day, my hair came out like dead grass in an abandoned lot, and I literally pulled the rest out. Yes,  I pulled my hair out, and I will never be able to use that metaphor again. My husband shaved the rest.

Losing your hair is so emblematic of having cancer that the more you can address this head-on (no pun honestly intended), the better. Some women paint their heads; others have friends who also shave theirs in a gesture of solidarity. I just got a couple of pretty cool wigs and simply smiled when people complimented me on my new ‘do.

Whatever makes sense for you.

A friend did tell me that, because I am tall, I would look elegant in long scarves and could make a great fashion statement. I wanted to tell her to make her own damn fashion statement, but I know she was honesty trying to be supportive, so I said nothing. (I found, though, that I could not keep scarves on; they just kept sliding off my stupid bald head.)
Changes in your mouth. I did not expect this in the least. Because the cells on the lining of my mouth were killed, I lost a good deal of my sense of taste, which is why those biscuits tasted like lard. My acupuncturist suggested buying some Japanese plum sauce, which has a tangy taste and sort of shook up what taste buds remained. (She also told me the other day that my tongue had looked like raw meat at the time. It did feel especially raw.) I also found that chocolate malts tasted quite good.

The bigger mouth problem, though, was mouth sores. Lots of them. Doctors call this oral mucositis and recommend
a variety of things to help it, including “miracle” or “oncology” mouthwashes and antibiotics. I found an over-the-counter version that had hydrogen peroxide. Other than making me foam at the mouth like Cujo, it worked fine. I suspect that a good salt-water rinse would work as well.Digestive tract pokiness. One result of the loss of some of the cells in your digestive tract is that your digestion slows down. This is for sure the nastiest side effect of chemo, and no doctor has ever talked to me about it, but chemo patients talk about it all the time. Serious constipation. Serious. I took a natural laxative, Senna Plus, which worked OK. I often had to overdose, plus I also resorted to plain old-fashioned charmers like Milk of Magnesia.  The Mayo Clinic offers some good information on laxatives here.

I started taking a green drink every morning, a healthy tonic I still take. Green drinks are generally high in fiber and rich in antioxidants and vitamins. So they’re good for getting your digestion going and fighting the cancer. Oprah’s medical guru, Dr. Oz (really, Oz?) has a recipe online for his green drink
here.

I actually do two green drinks. In the morning, I have a powdered version that has spirulina, sea grass, organic greens, plus vitamins and minerals, like
Barlean’s Green.  In the evening, my husband makes me a fresh juice of carrots, kale, cabbage, and parsley, with apples and lemon for taste. Full of antioxidants and heavy on cancer-fighting cruciferous veggies.

The green drinks together, I think, helped move my digestion along.

I also found that I needed to increase the amount of magnesium I took, which is often a cause of constipation in folks without chemo, especially if they are taking calcium.


And exercise is essential.  I walked two miles most days, and that helped.  The more I walked, the better.Digestion tract speediness. Nausea is another effect we expect, although one oncologist told me that anti-nausea drugs added to the chemo cocktail have eliminated this problem. As if. My husband and I believed this, and we went out for lunch after my first chemo—at the suggestion of a helpful nurse I could strangle. Like a couple of certifiable idiots, we went to a great Italian restaurant where I ate spaghetti with meat sauce. I was sick for hours until I threw up the entire meal. I did not want meat sauce for years after, nor did I want to even walk into that restaurant, as though it were at fault.

I learned to eat small meals on chemo days, usually bland things like soups and toast or crackers.  I had plenty of liquids, and I went to the acupuncturist beforehand. I usually had mild nausea for about 24 hours after chemo, but nothing serious.

My sense of smell, which has always been acute, remained lively, so the smell of even bland things like mashed potatoes often turned me off. We resorted to eating as many fresh foods as we could, which is also a highly healthy way to go.

Three years later, I still think about those lardy biscuits. My taste buds got back into shape within a month or two of chemo. Now, the biscuits taste as they should—creamy, crunchy, and cheesy. I know, though, that behind all those goodies, there is lard. And that is one lesson of chemo I am choosing to ignore.

I will do the green drinks, I will eat healthy most of the time, and I will keep my weight down. Occasionally, though, I want a cheese biscuit or six, lard and all.


Read more about chemotherapy for TNBC, plus my experience with the disease, in my book, Surviving Triple-Negative Breast Cancer.

Tuesday, April 21, 2009

Zometa: Not Proven for Hormone-Negative

Zometa (zoledronic acid) has been touted as a life-saving drug, based on research in the February New England Journal of Medicine.    And it looks like the drug has serious potential—for women with hormone-positive disease.  Some things for women with hormone-negative breast cancer, including triple negative, to consider:

• The women studied were all premenopausal who were hormone-positive and were given hormonal therapy—either tamoxifen or Arimidex—plus goserelin (Zoladex) to suppress ovarian function.

• None received adjuvant (after surgery) chemotherapy;

The study found a 98 percent chance of survival in young women who were given ovarian suppression and hormone therapy drugs but did receive any chemotherapy.

So this could be great news for a narrow group of women.  Unfortunately, this does not include those of us with hormone-negative disease.

The Dr. Susan Love Research Foundation has a great analysis of this

Back to the drawing board, docs.  Find us a cure.

(My thanks to the talented Deb Lattimore for sending me Dr. Love’s link.  You can read about Deb’s fight against triple negative, and enjoy her excellent photography, here. )

 

Hidden Sources of Caffeine

Caffeine has been linked to hormone-negative breast cancer, including triple negative. And it can lurk unseen in your diet.

I have been having heart palpitations, so I immediately decided that either 1) the chemo had caused heart failure or 2) I have lung cancer, putting pressure on my heart. After an X-ray showed both lungs and heart normal, I decided to get a clue and start looking at my diet to see what I was doing to cause the palpitations. If I could not find an answer, I would go to the doctor, but I suspected I could take care of this by finding culprits in my diet.

I did.

I discovered caffeine all over the place, which is bad news, because I have been avoiding caffeine, as I noted in an earlier post. Caffeine has been linked to increased risk of hormone-negative breast cancer, including triple negative.

What I learned from honestly assessing my diet:

• I had been adding green tea to my morning smoothie, thinking I was adding a jolt of health. I was, but it also came with a jolt of caffeine. I often link green tea to herbal teas and assume it is caffeine-free. In fact, it has less caffeine than black tea and much less than coffee, but it still has caffeine. Thumpety.

• I had been making some nice, strong decaf coffee daily in my French press. That’s OK, right? Wrong. Decaf has less caffeine, but it is not caffeine free. Researchers at the University of Florida compared caffeine in decaf coffee and found that different brands had from 8.6 mg to 13.9 mg, compared to an average of 85 mg for caffeinated coffee. So, the super-strong stuff I was making—and I was making a good 16 ounces of it—no doubt had the caffeine of one or two cups of regular. Add that to the green tea caffeine and I was getting quite a start to my day. Thumpety thump.

• My beloved Diet Coke still hooks me, and when I fall off the wagon, I do a great job. Restaurants give you free refills, right? Sometimes I embarrass myself with the number of times my glass is refilled. There’s about 47 mg, of caffeine in an 12-ounce serving of Diet Coke. Heaven only knows how many I have at a simple lunch. Thumpety thump thump.

• Dark chocolate is considered by some a cancer fighter because of its high levels of antioxidants and phytochemicals. And it has plenty of caffeine: 31 mg in a 1.45 oz, bar. I used to have a tiny square as a treat after a meal. That gradually expanded to 3,4,5 squares. Thumpety thump thump thump.

So, I reminded myself that I am not a bonehead, that I am supposed to be eating healthy, and that I am supposed to know these things. I cut the hidden caffeine from my diet for three days and, guess, what? No palpitations.

I am frankly a bit embarrassed about this, but I am fairly sure I am not the only person who gets caught in the unhealthy caffeine trap. My heart told me to stop. That is way better than a cancer recurrence.

And searching my own diet was far cheaper, easier, and more successful than going in for heart tests.


Friday, April 10, 2009

Laughing at Triple Negative Breast Cancer

Here's a great story from the Tulsa World:

Trudy Runnels is a 44-year-old mother from Waxahachie, Texas. She has a rare form of metastatic breast cancer (triple- negative). It is not funny. Trudy is.

On a recent afternoon, at Cancer Treatment Centers of America, Runnels and a handful of other cancer patients gathered in a group therapy session. Together, their laughter became medicine.
After all, a funny story can do the most amazing things for a cancer patient, according to Dr. Gerald Ellison, a psychologist who leads the Centers' weekly humor therapy class.

"Laughter stimulates the immune system to produce cells that are very powerful in fighting cancer," Ellison explained. " There are many medical benefits to laughter." Read more
here.

University of Alabama to Search for Triple Negative Therapy

One of the reasons triple negative breast cancer is so lethal is because it does not respond to standard follow-up treatment, like tamoxifen or Arimedex, which is a highly successful therapy for hormone-negative cancer, although chemotherapy has been found to be effective for all hormone negative cancers.

Now, Komen for the Cure and the Triple Negative Breast Cancer Foundation have awarded $6.4 million to the University of Alabama at Birmingham to study the development of a drug to be used with chemotherapy to treating triple negative breast cancer.

Researchers will also study ways to predict the therapies that will be most effective against triple negative breast cancer.

More good news--evidence that this cancer has caught researchers' eye. Yea.