I wish you all a healthy and blessed 2011.
Hope and help for triple-negative (TNBC) and other forms of hormone-negative breast cancer.
Friday, December 31, 2010
Monday, December 20, 2010
Healthy Eating: Fiber in Whole Wheat
I have been taught to avoid breads—they mean fat, right? But whole grains also mean high fiber, which translates to a healthy heart. Whole grains actually soak up cholesterol, especially LDL, or bad, cholesterol. It’s a strong image. For most of my life, I have imagined bread soaking up only the bad things on my plate—gravy, for example. So, when I try to eat healthy, I avoid it. Instead, I should have been imagining what bread was doing inside my body—soaking up bad cholesterol. And I should have been eating it.
Based on my age, I am supposed to have five ounces of grains a day, at least half of which should be whole grains, according to the food pyramid. What’s in an ounce? One slice of bread, a cup of ready-to-eat cereal, a half cup of cooked cereal, or a half cup of cooked rice.
So, in a day, I should have, something like:
A cup of ready-to-eat cereal (1 oz)
Two slices of bread (2 oz)
A cup of cooked rice (2 oz)
Of course, you have to eat your whole grains in a healthy way. Pass up the high-fat butter and margarine as a topping and go instead for heart-healthy olive oil. But keep that low as well. (A tablespoon has 119 calories, all from fat. While that is good fat—monounsaturated—it still can add up.)
I have discovered Sara Lee’s whole wheat bread with 45 calories a slice and five grams of dietary fiber, or 18 percent of your daily value. It’s good, healthy, and filling. Nice work, Sara.
Even knowing this, I recently ate a quick lunch-on-the-go with my family after a funeral. To keep my calories down, I skipped the bread and ate the cold cuts. Good grief. Seriously? Was my nutritional brain born yesterday? Apparently. I ate the unhealthy part of the meal—the cold cuts—and passed up the cholesterol sponges—whole wheat bread. Next time, if I screw my head on, I will do it the opposite.
Friday, December 17, 2010
Lumpectomy Better for Early-Stage Hormone-Negative
From the San Antonio Breast Cancer Symposium via WebMD
Women with early-stage hormone-negative breast cancer who undergo a lumpectomy—often called breast-conserving therapy—fare slightly better than those who undergo a mastectomy, according to research presented today. And women from both groups do well, with the great majority alive after four years.
Specifically, those under 50 with lumpectomies were 13 percent to 29 percent less likely to die from their cancer than women with mastectomies. Women over 50 with hormone-negative who underwent a lumpectomy were 17 percent less likely to die than those with a mastectomy. The variation in percentages relates to variations in tumor sizes.
Data on 114,277 women from the California Cancer Registry were evaluated; 62,770 of these had a lumpectomy followed by radiation and 51,507 had a mastectomy. Ninety-three percent of the lumpectomy group and 87 percent of the mastectomy group were alive four years after diagnosis.
Read Charlene Laino’s report on the study in WebMD.
Avastin and TNBC: Let's Refocus the Research
Thursday, December 16, 2010
FDA Removes Approval of Avastin As Breast Cancer Drug
FDA NEWS RELEASE
For Immediate Release: Dec. 16, 2010
Media Inquiries: Erica Jefferson, 301-796-4988, firstname.lastname@example.org
Consumer Inquiries: 888-INFO-FDA
FDA begins process to remove breast cancer indication from Avastin label
Drug not shown to be safe and effective in breast cancer patients
The U.S. Food and Drug Administration announced today that the agency is recommending removing the breast cancer indication from the label for Avastin (bevacizumab) because the drug has not been shown to be safe and effective for that use.
The agency is making this recommendation after reviewing the results of four clinical studies of Avastin in women with breast cancer and determining that the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients. These risks include severe high blood pressure; bleeding and hemorrhage; the development of perforations (or “holes”) in the body, including in the nose, stomach, and intestines; and heart attack or heart failure.
In July 2010, after reviewing all available data an independent advisory committee, composed primarily of oncologists, voted 12-1 to remove the breast cancer indication from Avastin’s label.
“After careful review of the clinical data, we are recommending that the breast cancer indication for Avastin be removed based on evidence from four independent studies,” Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “Subsequent studies failed to confirm the benefit observed in the original trial. None of the studies demonstrated that patients receiving Avastin lived longer and patients receiving Avastin experienced a significant increase in serious side effects. The limited effects of Avastin combined with the significant risks led us to this difficult decision. The results of these studies are disappointing. We encourage the company to conduct additional research to identify if there may be select groups of patients who might benefit from this drug.”
Removing the breast cancer indication from the Avastin label will be a process. This is the first step. The drug itself is not being removed from the market and today’s action will not have any immediate impact on its use in treating breast cancer. Today’s action will not affect the approvals for colon, kidney, brain, and lung cancers.
Oncologists currently treating patients with Avastin for metastatic breast cancer should use their medical judgment when deciding whether a patient should continue treatment with the drug or consider other therapeutic options.
The agency has informed Genentech, Avastin’s manufacturer, of its proposal to withdraw marketing approval of the drug for breast cancer. Genentech has not agreed to remove the breast cancer indication voluntarily, so the agency has issued a Notice of Opportunity for a Hearing, which permits Genentech to request a public hearing if it wishes to contest the agency’s determination. The company has 15 days to request a hearing; if it does not do so, the hearing will be waived, and FDA will begin proceedings to remove the breast cancer indication.
Avastin, in combination with chemotherapy (paclitaxel), was approved in February 2008 under the FDA’s accelerated approval program, based on the results of a clinical trial known as “E2100,” which evaluated the drug in patients who had not received chemotherapy for their metastatic HER2-negative breast cancer. Under the accelerated approval program, a drug may be approved based on clinical data that suggest the drug has a meaningful clinical benefit, with more information being needed to confirm this. The program provides earlier patient access to promising new drugs to treat serious or life-threatening conditions while confirmatory clinical trials are conducted.
After the accelerated approval of Avastin for breast cancer, Genentech completed additional clinical trials and submitted the data from those studies to the FDA. These data showed only a small effect on “progression-free survival” without evidence of an improvement in overall survival or a clinical benefit to patients sufficient to outweigh the risks. The small increase in “progression-free survival” reflects a small, temporary effect in slowing tumor growth.
Avastin has also been associated with several other serious and potentially life-threatening side effects including the risk of stroke, wound healing complications, organ damage or failure; and the development of a neurological condition called reversible posterior leukoencephalopathy syndrome (RPLS), characterized by high blood pressure, headaches, confusion, seizures, and vision loss from swelling of the brain.
On the basis of all available data relating to the use of Avastin to treat metastatic breast cancer, the agency has determined that the risks of the drug outweigh the benefits for this use.
FDA is open to working with Genentech on any proposals to conduct additional studies of Avastin in patients with metastatic breast cancer designed to identify a population of patients in which the drug’s benefits exceed the risks.
For more information:
FDA: Bevacizumab (marketed as Avastin) Information
NCI: Breast Cancer
Wednesday, December 15, 2010
A Young Man's Testimonial for Avastin
Dose Dense Chemo Better for Hormone-Negative
Abdominal Fat Related to Estrogen-Negative Risk in Premenopausal Women
Body fat distribution does not play an important role in the incidence of every subtype of premenopausal breast cancer, but is associated with an increased risk for estrogen receptor (ER)–negative breast cancer, according to a study published December 15 in The Journal of the National Cancer Institute.
Previous studies have shown that the association between body mass index (BMI) and the risk of breast cancer varies with menopausal status: a higher BMI is positively associated with risk of postmenopausal breast cancer but inversely associated with risk of premenopausal breast cancer. Intra-abdominal fat that surrounds organs has been associated with metabolic and hormonal changes that have been associated with premenopausal breast cancer risk, although prospective studies have produced conflicting results, and none have examined the role of hormone receptor status.
To determine the relation between body fat distribution and premenopausal breast cancer risk, Holly R. Harris, Sc.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues, conducted a prospective analysis among women in the Nurses' Health Study II, a cohort of 116,430 women who have been followed up since 1989. In 1993 the researchers sent women in that study a questionnaire in which the women were asked to measure and report their waist and hip circumference.
The researchers found no statistically significant associations between waist circumference, hip circumference, or the waist to hip ratio and overall risk of breast cancer. But they did find that abdominal adiposity, or waist circumference and the waist to hip ratio, was more strongly associated with risk of ER-negative breast cancer than with the risk of ER-positive breast cancer.
Furthermore, the fact that body fat distribution was more strongly associated with ER-negative breast cancer than with ER-positive breast cancer suggests that body fat may influence breast cancer risk through sex hormone–independent pathways. Specifically, the researchers note that abdominal fat is associated with hyperinsulinemia, or pre-diabetes, and that insulin receptors are expressed in most breast cancers and have been shown to stimulate the growth of breast cancer cells in vitro.
"These findings may suggest that an insulin-related pathway of abdominal adiposity is involved in the etiology of premenopausal breast cancer," the authors write.
Tuesday, December 14, 2010
New Research Links Obesity to HR+, but not HR-
Brazil Sees Nearly Twice the TNBC Cases as Ten Years Ago
"We have no idea why we are seeing more of these cases," said Maira Caleffi, MD, PhD, Associação Hospitalar Moinhos de Vento, Porto Alegre, Brazil, on December 10. "The increase in triple-negative and hormone-negative tumours in women older than 50 is worrisome and does not reflect the common sense that the large majority of cases in this age group are hormone sensible."
Monday, December 13, 2010
HRT Increases risk of TNBC
Combined hormonal replacement therapy—using estrogen plus progestin—is associated with a 78 percent increase in triple-negative cancers, a twofold increase in HER2-positive tumors, and a 37 percent increase in HER2-negative tumors, according to Women’s Health Initiative results presented at the San Antonia Breast Cancer Symposium. And it nearly doubles the risk of death from breast cancer. In the past, HRT was associated strongly with hormone-positive cancers, but not hormone-negative.
Data were from WHI randomized trials after 11 years of follow-up.
Read the entire story from Internal Medicine News.
More Good News on PARP Inhibitors for TNBC
A novel agent that inhibits DNA repair in cancer cells appears to be promising for safety and efficacy given along with chemotherapy using irinotecan (Camptosar), according to early-phase clinical trial results reported here.
The phase Ib trial conducted among 34 metastatic breast cancer patients found that the experimental drug iniparib yielded partial or complete responses in up to 31.8% of the patients when combined with irinotecan, Stacy Moulder, MD, MSCI, of MD Anderson Cancer Center in Houston, and colleagues found. Read more.
Mixed News on Avastin
Sunday, December 12, 2010
Memorial: Ruth Bressan
Ruth stood in her sunny kitchen cutting peaches and gesturing with the knife as she told us about the headless rattlesnake that had snapped at her. Her sons had captured it, beheaded it, and put it in the sink. Instinctively, the creature coiled and sprang at her, even though its head was long gone and its fangs with it.
She was making us dessert, cutting fresh Colorado peaches to put on vanilla ice cream. So far it had taken her 45 minutes to cut three peaches. They were beautiful minutes, though, full of stories of Ruth’s life as a young wife and mother, then a grandmother, and finally a great grandmother, all spent in the shadow of Colorado’s Spanish Peaks, twin mountains called Wahatoya, or breasts of the earth, by native Americans.
She laughed, a tinkling giggle, her bright blue eyes blinking with delight in her memories.
Ruth lived in a house built by her husband Arthur, a comfy 1950’s ranch with a picture window in the living room that framed a stunning scene of the peaks. They raised six kids there—Dave, Doug, Don, Daryl, Debbie, and Dana.
Her kitchen has corner windows that looked the opposite direction, toward one of the dikes—volcanic walls—that are unique to this neck of the Southern Colorado woods, south of Walsenburg and east of La Veta. Outside those windows, dogs, horses, cows, and who knows what other unknown beasts roamed the high dessert.
And rattlesnakes. As Ruth told it the Bressan family had a close relationship with these snakes, which liked to nest in the rocks of the dikes.
Still gesturing with her knife, still cutting the peaches, Ruth tells us about the time she and her dog went for a walk in the autumn and heard hissing all around them. Both froze—smart dog—until the snakes lost interest and moved.
We were her neighbors and were at her house on one of the two or three visits we made every year. Although our land adjoined hers, it took us about half an hour to drive to her house. So we did not visit as much as we wanted. Each visit, though, was a treat.
This time, my brother Ed, his wife Gwyn, and my husband Joe were all visiting. Finally, Ed got up and helped Ruth finish the peaches. We sat down and had our tasty dessert. But the real luxury was time with Ruth.
Usually, Gwyn and I visited without our husbands. Two years ago, we went driving around the nearby Boy Scout camp her family helped build. I drove my Toyota 4Runner and Ruth encouraged me up one steep hill after another, as though we were driving to the mall. At one point, we ended up on the narrow ridge we often hiked. She suggested that I drive along the ridge but I suggested otherwise. Each time I hike that ridge I chuckle at Ruth, so glibly telling me how I could just turn and keep driving on a cow path. She would have.
The year before that, we had hiked close to Ruth’s home, to a formation she called the Birdbath. It is probably a 20X20-foot flat rock with a pool at one corner into which water puddles. It was a hidden wonder, a little mountain treasure we would never have known without Ruth.
Afterward, we shared peanut butter and jelly sandwiches.
The last meal I shared with Ruth was in her cozy dining room with her son Dave. We brought part of the meal and Ruth and Dave added fabulous cheese plus strawberries with melted chocolate. And wine. Ruth loved Yellow Tail. We talked about gas drilling in the area, we heard more stories of the Bressan family, we laughed, we talked politics. We were kindred political souls—Ruth and Dave even had a fish named Obama.
And we left. I hugged Ruth and told her I would see her next year. We are fair weather neighbors, in the mountains only in the summer. Ruth waved goodbye, her grey hair in its perky little ponytail, her tiny frame tucked into her jeans.
That was my last view of her. She died last Friday, of a cancer that came on ferociously—adenocarcinoma, which affects the lining of the internal organs— and stole her right from under us in a matter of weeks.
I only met Ruth eight years ago—ironically, we got to know one another over a lawsuit with a troublesome common neighbor. And I only saw her a few times a year. Yet I am as bereft as if I had seen her every day. Partly it’s because I did not get to spend as much time as I wanted with her—it’s like our friendship was just getting started. There was so much I wanted to know, so many stories I wanted to hear.
Largely, though, it’s because she was an American original—the kind of person whose life stories belong in a book, whose world was larger than the rest of us can even imagine. And who made us larger by sharing it.
Wednesday, December 8, 2010
The Pill and Cancer: Correction
Our Role in Elizabeth Edwards’ Deadly Hesitation
When Elizabeth Edwards felt a lump in her breast in 2004, she waited until after the election to get the treatment she needed. She knew her health would become the story rather than the issues she felt passionate about, the issues that fueled her support for her husband as a vice-presidential candidate.
This is more than the usual wife who puts her wellbeing on hold to care for her husband. It was a woman living her life under a magnifying glass who knew that, should she shine light on that glass, it would scorch her and her family.
So the cancer grew and spread and by the time she got treatment, it was already stage III.
There are already people saying God killed her in retribution for her husband’s infidelity. Somebody has even blamed it on Obama. In the words of Pogo, "We have met the enemy, and he is us."
Most of us who discover a lump can head to the doctor, get tested, possibly get the bad news, and then figure out how to tell our family and friends. No so Elizabeth Edwards. She could not quietly take time off the campaign and discreetly go to the doctor. Some reporter, blogger, or unpaid busybody would have leaked the story and the woman’s pain would become the country’s gossip.
As it did. I am writing this in the middle of the night in the middle of Iowa, and you are reading it. My opinion is already out there, swirling around cyberspace. I think it is a fairly well reasoned opinion, but even if it weren’t, it still has legs.
Lucky for us, Elizabeth was a thoughtful, articulate woman who turned her negative into our positive, educating us on the ferocity of this disease and on how to deal with it under pressure. She wrote two books, advocated for better treatment for others with cancer, and was a gifted spokeswoman and role model for women throughout the world dealing with a similar diagnosis.
And with that came public support and affection. And criticism. When her cancer returned in the 2008 presidential campaign, critics said John should pull out of the race, that he and Elizabeth were putting politics ahead of her health. And when John’s affair was made public, some blamed Elizabeth for a laundry list of reasons that were nobody else’s business.
The adulation itself can be oppressive, of course. I met Elizabeth—see how I call her by her first name because we’re so close?—once during the 2008 campaign. Politics are retail in Iowa, where we get to meet candidates personally. I introduced myself and told her I’d also had breast cancer. She smiled wearily—it was the end of the day and she was no doubt exhausted and had been dealing with God-only-knows-what. I suspect she thought, “Oh my, another one.”
She could not get away from cancer, or from us.
And the misinformation lingers. In discussion boards, women say she had triple negative breast cancer—negative for estrogen and progesterone receptors, and for the human epidermal growth factor receptor, Her2. This probably grew from the fact that TNBC can be an aggressive form of cancer, and Elizabeth’s certainly seemed aggressive. But hers was estrogen and progesterone positive—the most common kind. While statistically less deadly, it still kills.
A 24/7 news cycle means that public figures never have a minute off, never a second of downtime. Add to that the option of Internet anonymity that allows us to spit even our most evil thoughts into the public well, plus commentators who make things up for a living, and public scrutiny can make even the most thoughtful person second-guess basic decisions—like when to go to the doctor.
That is the environment in which Elizabeth Edwards faced the reality of her illness. No wonder she avoided initial treatment for that lump. And shame on us for making her hesitate for fear of what we might do.
But good for her for becoming the face of reason against an unreasonable disease and unfathomable public scrutiny. If she whined, she did so in what little privacy she had left.
Tuesday, December 7, 2010
Elizabeth Edwards: A Good Life
Elizabeth Edwards Has Hormone-Responsive Breast Cancer
Monday, December 6, 2010
Elizabeth Edwards Losing Her Cancer Battle
Elizabeth Edwards announced today that her cancer is now incurable and that doctors have stopped medication. She is now resting at her home in Chapel Hill, North Carolina. On her Facebook page, she wrote:
The days of our lives, for all of us, are numbered,” she wrote. “We know that. And yes, there are certainly times when we aren’t able to muster as much strength and patience as we would like. It’s called being human. But I have found that in the simple act of living with hope, and in the daily effort to have a positive impact in the world, the days I do have are made all the more meaningful and precious. And for that I am grateful.”
The Associated Press covered the family’s announcement today.
Elizabeth did a great deal to improve out understanding of the reality of breast cancer. Her story is worth a whole basketful of pink ribbons.
Sunday, November 21, 2010
Two Views of Breast Cancer
Wednesday, November 17, 2010
Review of Triple-Negative
Thursday, November 11, 2010
Online Discussion on Triple-Negative
Don't Define Me By My Cancer
Some of us do it with less complaint than others, but that is not courage. It is just good luck—a positive attitude, perhaps a better diagnosis, smoother response to treatment, or a support system that keeps us grounded.
Updates from the San Antonio Breast Cancer Symposium
Think Pink, Live Green
Everything is on the table: what we eat, drink, breathe, take, and use from the kitchen, pantry, cleaning shelf, and medicine chest; how we handle stress, sleep at night, make reproductive choices, treat ourselves, and interact with others. All of these factors affect how our outside environment affects the inside environment within our bodies.
Sound like a big job? In fact, it’s going to take a movement, called Think Pink, Live Green, which is based in science, grounded in medicine, and will be delivered in clear terms with easy-to-follow strategies. We’re certainly not starting from scratch. Think Pink, Live Green represents the results of a research project I’ve been working on for two years with Dr. Joan Ruderman of Harvard Medical School, identifying emerging environmental factors that can potentially contribute to the risk of breast cancer.
The first educational program of Think Pink, Live Green is this expert column on Breastcancer.org, with effective and practical information and tips on things like choosing the safest sunscreens and cosmetics, buying organic at the grocery store, and what cleaning and household products are safe to use. We know far from everything – but we know enough to have serious concerns about using various products and making different lifestyle choices.
For more, go to breastcancer.org.
Tuesday, November 2, 2010
Exercise cuts BC risk for postmenopausal women
Wednesday, October 27, 2010
Watch TNBC Special on the Discovery Channel
Tuesday, October 19, 2010
Correcting Information About TNBC
I have seen two news stories in the past three days that misrepresent triple-negative breast cancer. One said TNBC does not respond to chemotherapy; the other said that most women die of TNBC within two years. Both are wrong.
Here's what research tells us:
1. The majority of women with triple-negative survive.
2. Risk of death significantly drops three years after diagnosis.
3. Chemotherapy is successful in reducing TNBC tumors and their risk of recurrence.
According to research at Women’s College Hospital in Toronto on 1,601 patients with breast cancer diagnosed between 1987 and 1997, published in 2007:
• The majority of the TNBC women—57.8 percent—were alive after ten years
• The risk of recurrence significantly dropped after three years
• No recurrences occurred after eight years.
Eric Weiner, M.D., and Erica Mayers, M.D., M.P.H., of Dana Farber say this about chemotherapy and TNBC:
Triple-negative tumors do not respond to endocrine agents or trastuzumab and can only be treated with chemotherapy. Fortunately, increasing evidence suggests that the triple-negative subgroup derives substantial and preferential benefit from chemotherapy. Read more here.
Monday, October 18, 2010
NOS2 Connected to Worse Outcome for ER-
Wednesday, October 13, 2010
Vegetables Reduce ER- Risk Among African-American Women
African-American women who eat their veggies have a reduced risk of estrogen-negative breast cancer, according to a new study from Boston University. This is good news because estrogen-negative—especially triple-negative‚ disproportionately affects African-American women, who also face higher fatality rates from the disease than white women. Researchers from the Slone Epidemiology Center at Boston University School of Medicine studied 51,928 women for 12 years who participated in the Black Women’s Health Study. Among the women, all of whom were African-American, Hormone receptor cancer (ER-/PR-) cases were 43 percent lower for those women who ate at least two vegetables a day compared to those who ate fewer than four a week. (Really? Fewer than four veggies a week? OK, never mind. I used to eat like that.)
Researchers said cruciferous veggies—cabbage, kale, broccoli, cauliflower, mustard greens—were especially beneficial, as were carrots.
The study used the National Cancer Institute’s Surveillance and Epidemiology End Results (SEER) data. It was published in the American Journal of Epidemiology, published online October 11, 2010.
As I write this, I am drinking the fresh vegetable juice my dear hubby makes me every night—it contains carrots, kale, and cabbage, plus apples and lemon for taste. Such an easy way to get the goodies, especially cruciferous vegetables.
Tuesday, October 12, 2010
Three new treatments for metastatic TNBC studied
News from the 35th annual ESMO (European Society of Medical Oncology) Congress in Milan:
• Adding the PARP inhibitor iniparib to chemotherapy added five months to overall survival of patients with metastatic triple-negative breast cancer. What’s even better is that complete or partial response or stable disease was achieved in 55.7 percent of the women, compared with chemotherapy alone. (Complete response: the disease has completely disappeared—no disease is evident on examination, scans or other tests; Partial response: some disease remains in the body, but it has decreased by 30 percent or more in size or number of lesions. Stable disease: the disease has remained unchanged in size and number of lesions.A less than 50 percent decrease or a slight increase in size is generally considered stable disease.) Two phase III studies on iniparib and triple-negative are ongoing. The study was presented by John Pippen, MD, of Texas Oncology, Dallas.
• Adding cetuximab to cisplatin chemotherapy doubled the response rate in women with metastatic triple-negative. Cetuximab targets the epidermal growth factor receptor (EGFR). The results come from a phase II randomized trial of 173 women and included researchers from Spain, Belgium, Austria, Portugal, the UK and Israel. Cetuximab is marketed by Merck under the brand name Erbitux. Merck tried last year to market the drug for lung cancer but failed to win approval.
• Eribulin, a microtubule inhibitor, improved outcomes of all metastatic breast cancer patients, but was most effective against hormone-negative. Estrogen receptor/progesterone receptor negative patients receiving eribulin rather than the physician’s standard choice of chemotherapy had a 34 percent decreased risk of death. The results were part of the EMBRACE (Eisai Metastatic Breast Cancer Study Assessing Physician's Choice versus Eribulin E7389) study, a phase III clinical trial.
Thursday, September 30, 2010
Healthcare reform good news for cancer patients
Health care reform stands to affect almost all people with cancer, both those who lack insurance and those who already have it. Some will be affected profoundly, as they will be spared from financial ruin because of their treatment. The bill also addresses cancer screenings, out-of-pocket expenses, clinical trials, the Medicare “doughnut hole,” and even creates new taxes on cancer-unfriendly industries—such as tanning salons—to help pay for it. Opinions vary on reform, from those who think it goes too far, to those who think it didn’t go far enough. But patient advocates say the changes will generally be good news for anyone with cancer.
Wednesday, September 29, 2010
Patients with TNBC Fare Better If They Have the BRCA Mutation
Here’s a shocker—having TNBC plus the BRCA mutation is actually better than not having the mutation. That’s certainly contrary to contemporary wisdom. Here’s the story:
• Of 77 women with triple-negative breast cancer treated at the M.D. Anderson Cancer Center, 15 had BRCA mutations—12 with BRCA1 and three with BRCA2.
• All were treated between 1987 and 2006.
• The five-year relapse-free rate for patients with the mutation was 86.2 percent. For patients without the mutation, it was 51.7 percent.
• The five-year overall survival rate for patients with the mutation was 73.3 percent. For patients without the mutation, it was 52.8 percent.
Many of the patients did not know they had the mutation because they had not done genetic testing.
Ana M. Gonzalez-Angulo, M.D., associate professor in MD Anderson's Departments of Breast Medical Oncology and Systems Biology presented the findings in advance of the 2010 Breast Cancer Symposium. A news release from M.D. Anderson provides additional perspective.
Tuesday, September 28, 2010
Insulin Growth Factor Receptor Tied To Better Odds for TNBC; May Lead to New Drugs
DENVER — Patients with triple-negative breast cancer, one of the hardest subtypes to treat, may have a unique biomarker that would enable them to receive more targeted therapy, according to data presented at the Fourth AACR International Conference on Molecular Diagnostics in Cancer Therapeutic Development.
Triple-negative breast cancers are breast cancers that have tested negative for estrogen receptors, progesterone receptors and HER2. Because of this biology, these cancers do not respond to endocrine therapies or trastuzumab.
“In other subsets of breast cancer, you can use these drugs with some success. However, triple-negative breast cancers currently lack therapeutic targets and are managed with conventional chemotherapy,” said Agnieszka K. Witkiewicz, M.D., an associate professor of pathology at Thomas Jefferson University Hospital in Philadelphia.
Witkiewicz examined 97 patients with triple-negative breast cancer, of whom 73 were white and 24 were African-American. Insulin-like growth factor 1 receptor (IGF-1R) protein expression was evaluated by immunohistochemistry and IGF-1R gene copy number was assessed by chromogenic in situ hybridization.
They found that IGF-1R was overexpressed in 25 percent of the cases. The IGF-1R protein overexpression correlated with gene amplification.
Moreover, low expression of the receptor was associated with greater risk of lymph node metastasis and high expression showed borderline association with lower tumor size. Among patients younger than 55 years, IGF-1R overexpression was associated with longer survival.
Since IGF-1R blockade has been a successful therapeutic approach in sarcomas, Witkiewicz suggested that there may be potential to target this receptor in this breast cancer subtype as well.
“For now, we know that it is there and we know it is a marker of better prognosis,” said Witkiewicz. “The next step is to learn if triple-negative breast cancer patients benefit from targeting IGF-1R.
Saturday, September 25, 2010
Docs: Listen to yourselves
A doctor once tried to convince me to take tamoxifen, saying that, even though I was hormone-negative, it would keep hormone-positive from forming. That might be true, I said, so shouldn’t all women be on the drug? They probably should, he said. Aurghhhh. The clincher to his argument, though, came after I objected to the potential side effects of the drug, including uterine cancer. No big deal, he said. “You’re postmenopausal, so you’ll start bleeding and we can catch it, then take your uterus out, and you’ll go back on the drug.”
Oh, is that all? Whatever could have been my objection to such a simple process? Deal with cancer again, go through surgery, take forever to recover. And then get on with my life forever changed again. No big deal. I did it once, why not just plan to do it again sometime down the road?
This is wrong on so many levels that, four years after the fact, I am still sputtering.
First, of course, is that his medical advice was weak. Research shows that tamoxifen does little for hormone-negative and that it can, in fact, increase the risk of hormone-negative forming. In cases like mine, with a weakly positive reading for progesterone, it might have done a few ounces of good, but the risks far outweighed the benefits, in my mind.
But the science here is not the biggest issue. What continues to roil me royally is his callous lack of understanding of how cancer feels to the patient.
I was reminded of this incident recently when a friend was worried about a mammogram that showed small spots on the breast that had been affected by triple-negative breast cancer three years before. The doctor told her she expected good news from the biopsy. The doctor clarified this with: “Good news does include if it's cancer it is in the same breast and we can just take care of it with a mastectomy."
Again, no big deal, just major surgery and the trauma of another cancer diagnosis.
The spots were benign and she was physically fine, but the experience left her tired and depressed.
So docs, before you speak to your patients about the possibility of cancer recurring remember:
• Cancer is a life-altering experience for the patient and her loved ones. We don’t just deal with it and pick up our lives where we left off. We are forever terrified of its return. We fight to go back to being just us, not the Person with Cancer. And, once we have faced the disease that might be our killer, we can never look at cancer—any kind, any stage, any prognosis—with anything short of terror.
If a patient successfully fought off an armed intruder would you shrug off the possibility of another intrusion with “Oh, if it happens again, you’ll just knock him off the deck again and go on with your life.” Cancer to us is that armed intruder and, even if we think we can win, we are not up to another fight. And, by the way, we’re not sure we would win.
• Cancer treatment is traumatic and leaves lasting effects. We forever carry the physical and mental scars of surgery, radiation, and chemotherapy: exhaustion, pain, dark memories of dark days. Surgery hurts, chemotherapy makes you sick in multiple ways, radiation leaves neuropathy that, to some women is as painful as surgery. My lumpectomy incision still hurts, my underarm is painful from lymph node removal, I remain worried about the effects of chemo on my heart, and I was tired for more than a year after all of this. And I had it fairly easy. Some women lose their fingernails, others dip into a deep depression, many cannot work through treatment and lose their jobs.
Oncologists, radiologists, surgeons, cancer nurses, and all healthcare professionals: Remember that these are real and very worried people in front of you and that they cling to everything you say. So watch your words. Don’ shrug off a cancer recurrence as though it were a trip to the mall. Always ask yourself, “How would I want to be treated if I were my patient?”
We’re people, not tumors. You treat the tumor, but you’re talking to the person. And, boy are we listening.