Thursday, September 30, 2010

Healthcare reform good news for cancer patients

Cure Today has an excellent article on healthcare reform and its effects on cancer patients. One paragraph sums it up.

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

From a news release from the American Association for Cancer Research:

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.

Tuesday, September 21, 2010

Two-time TNBC Survivor Honored

NEW YORK, Sept. 14 /PRNewswire/ -- Everlast, the premier fight sports and fitness brand in the world, today announced Kim Brylow as the winner of their global 'What Do You Fight For?' philanthropic social movement and contest. For her brave story of twice fighting and overcoming triple negative breast cancer, Kim will receive $5,000, which she is donating to the Triple Negative Breast Cancer Foundation, and a VIP trip for her and one guest to the Sergio Mora - Shane Mosley fight at the Staples Center in Los Angeles, CA. on September 18th.

The contest, which ran in conjunction with Everlast's 100 year anniversary, received more than four-hundred entrants who shared the motivations that drive their fight in life. Entries were voted on by the public through a platform on the Everlast page on Facebook. Brylow, a 43-year old mother of one, inspired thousands of voters through her fight and survival with two separate bouts of triple negative breast cancer.

"Kim's story of strength and determination is at the heart of our 'What Do You Fight For?' campaign," said Everlast President Adam Geisler. "If she is able to affect just one individual and empower them to be better, to do better, then we have achieved our goal."

On the eve of celebrating 1-year of being cancer free, Brylow has turned her fight to help those who face a similar challenge. In turn, she has committed to donate 100% of the $5,000 grand prize to the Triple Negative Breast Cancer Foundation, who is dedicated to supporting research so that effective detection, diagnosis, prevention and treatment of triple negative breast cancer can be pursued and achieved.

In honor of Brylow's story, former WBC Champion Sergio Mora is going to dedicate Saturday nights fight against Shane Mosley to her and also wear a pink ribbon patch on his trunks to honor her and those affected by breast cancer.

"As somebody who fights for a living, I understand the dedication and strength it takes to overcome a difficult opponent," explains Sergio Mora, former WBC Light Middleweight Champion. "Though no opponent I will ever face as a fighter compares to the fight against cancer, Kim's strength to overcome and fight to help others inspires me and dedicating Saturday's fight to her is my way of saying thanks."

Everlast's long standing partnership with Teddy Atlas and the Dr. Theodore A. Atlas Foundation was the inspiration behind 'What Do You Fight For?'. For each contest entry received, Everlast pledged $1 to support the foundations mission of improving the lives of those in need in our communities. With the support of countless athletes and celebrities like Sergio Mora and Mario Lopez, Randy Couture, Andre Berto, Gray Maynard, Miguel Cotto, and Teddy Atlas, who joined the fight to inspire others by sharing their personal motivations, Everlast was able to make a $10,000 donation to the Dr. Theodore A. Atlas Foundation.

For information or to pledge your support, please visit, Dr. Theodore A. Atlas Foundation or Triple Negative Breast Cancer Foundation.

Genetic Connection to TNBC is Complex, Researchers Say

We know that triple-negative breast cancer is connected to the mutation of the BRCA gene. What we don’t know is why do some women with the BRCA1 mutation get breast cancer while others don’t.

Research in the journal Nature Genetics, published online this week, helps explain the genetic links to TNBC.

Those women who have the BRCA mutation and get TNBC are likely to also likely to have other genetic variants, specifically rs8170 and rs48-8611, all on chromosome 19p13.

Researchers studied 1,193 women with BRCA1 mutations diagnosed with cancer before the age of 40 and compared their genetic composition to a control group of 1900 women without breast cancer. They ten replicated their results with a new sample of 2,974 women with breast cancer and the BRCA1 mutation and 3012 without breast cancer. The results were the same.

The research

Antoniou AC, Wang X, Fredericksen ZS et al. A locus on 19p13 modifies risk of breast cancer in BRCA1 mutation carriers and is associated with hormone receptor–negative breast cancer in the general population. Nature Genetics, September 19 2010 (published online)

Monday, September 20, 2010

Linda Tauber, 45, September 11, 2010

I never actually met Linda Tauber, but briefly corresponded with her husband John when her triple-negative breast cancer did not respond to chemotherapy. Her husband wrote a loving goodbye to her on Caring Bridge. And, from reading Linda’s own posts, she lived a full—although far too short—life. Her obituary in the St. Petersburg Times encourages friends to donate to the Susan G. Komen for the Cure 3-Day for the Cure in Linda's memory.

I wish I’d had a chance to meet Linda. She sounds like a beautiful woman in all ways. Let's hope that current research on TNBC ultimately yields successful treatment and prevention for this mean disease.

Friday, September 3, 2010

Research Hints At Source of TNBC

Triple-negative breast cancer may begin, not in stem cells as previously thought, but in cells called intermediaries or progenitors. Research by British scientists published today in the journal Cell Stem Cell may provide new insight into what causes this disease, which is not fueled by hormones. The study—laboratory research on mice—may lead to therapies targeted at faulty cell signals. Medical News Today did a thorough article on the research, quoting head researcher Matt Smalley, from the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research, London:

These results represent a major advance in our understanding of breast cancer. It means we can now look very closely at where the disease forms and which genes are involved in that process. This knowledge will greatly improve the chance of finding effective new targeted treatments for breast cancer patients in the future.

Source: "BRCA1 Basal-like Breast Cancers Originate from Luminal Epithelial Progenitors and Not from Basal Stem Cells" Gemma Molyneux, Felipe C. Geyer, Fiona-Ann Magnay, Afshan McCarthy, Howard Kendrick, Rachael Natrajan, Alan MacKay, Anita Grigoriadis, Andrew Tutt, Alan Ashworth, Jorge S. Reis-Filho, Matthew J. Smalley
Cell Stem Cell, Volume 7, Issue 3, 403-417, 3 September 2010. 10.1016/j.stem.2010.07.010

Wednesday, September 1, 2010

Clinical Trials

I added a section to the right on clinical trials for TNBC. Let me know if it works for you. It is powered by Google, and so far they seem to be doing a decent job of finding appropriate articles. If there are any glitches, please let me know.