Friday, January 21, 2011

A Little Exercise is Better than None

A 57-year-old Wichita man lost 223 pounds in a year and, to maintain his loss, spends 1.5 hours at the gym in the morning and adds another walk at lunch. According to the USA Today story, he eats 1800 calories “or more” a day. He is 5-foot 8 and-inches and now weighs 170 pounds.

This story was meant to be inspiration, as part of USA Today’s Annual Weight-Loss Challenge.

I think it backfires.

I mean 1.5 hours a day at the gym? Who does that? Who CAN do that? He apparently is a mortgage banker with his own business, so he has latitude in his schedule. But so do I and I cannot imagine spending that amount of time a day at the gym.

Messages like this, which are supposed to inspire, just make readers sigh and say, “I can’t do that, so why even try?”

I suspect the writer got caught up in some Rah Rah Journalism and didn’t think through the fact that using somebody whose exercise is, frankly, a little excessive, sends the wrong message. What’s more, I would challenge this impressive man—I mean, losing 223 pounds in a year is remarkable no matter how you cut it—whether he really does spend 1.5 every day actually exercising at the gym. I suspect he does not, and that his real pattern might be more like 3-4 days for an hour a so. This is still a serious commitment, but a little more accessible for the average person.

No doubt he needed that level of exercise and low calorie counts to lose the weight to begin with, but not to maintain it.

At 5-foot-8, he could consume 2000 calories a day and still maintain his weight, with moderate exercise, according to Web MD’s online fitness planner. Moderate exercise is 30 minutes a day walking at 3 miles an hour.

I don’t want to discourage anybody who has the time, energy, and commitment to handle this level of exercise. I do want to make the point that you don’t need to do so much to actually make a difference.

You do need some activity, as studies regularly show that physical activity can be a cancer-fighter.

Twenty minutes a day will help a great deal. The more the better. And once you start, you might keep going and increase your level to an hour or more. But research shows that people get discouraged easily when they set their sights too high. Be honest with what you can do, and do at least something. One step at a time.

HRT, Lack of Activity Biggest Breast Cancer Risk Factors

What can postmenopausal women do to reduce their risk of breast cancer? Avoid hormone-replacement therapy and increase physical activity. Both are more important than weight loss and reducing alcohol consumption. And both have about as much influence as factors beyond our control, such as early menstruation and late menopause.

This is from a new study from Germany of 10,000 postmenopausal women, 3,074 with breast cancer and 6,386 in a control group. And while HRT and inactivity were risk factors across the board for all types of breast cancer, hormone-positive tumors were more strongly affected. According to a news release on the study:

Of the modifiable lifestyle factors, it is primarily hormone replacement therapy and a lack of physical activity which increase a woman's risk of developing breast cancer. Alcohol consumption and overweight were found to have less influence on breast cancer risk. Thus, 19.4 percent of invasive postmenopausal breast cancer are attributed to hormone replacement therapy; 12.8 percent to a lack of physical activity. Both factors together are responsible for 29.8 percent of breast cancer cases. When the investigators took a separate look at the group of patients whose tumors have receptors for sex hormones (hormone receptor-positive breast tumors), they determined an even higher value of 37.9 percent.

The study leaders emphasize that these results reflect the situation in Germany with our typical lifestyle and may differ in countries with other lifestyles.

Non-modifiable factors such as family history or age at first and last menstrual period account for 37.2 percent in total of all malignant postmenopausal breast cancers. "That means that two factors which each woman has in her own hands are responsible for a similar number of postmenopausal breast cancer cases as the non-modifiable factors," Karen Steindorf [researcher and associate professor at the German Cancer Research Center] says. "If behavioral changes in these two areas could be brought about, almost 30 percent of breast cancers after menopause could be prevented." Therefore, the DKFZ researchers recommend women to take more exercise and to refrain from hormone replacement therapy, unless it is absolutely necessary.

Monday, January 17, 2011

Could Vitamin C Infusions Work for TNBC?

The Windsor (Ontario) Star has a thorough piece on Vitamin C infusions in the treatment of triple-negative breast cancer. Forty-four-year old Sandra Quattrin, diagnosed last year with TNBC, has chosen the infusions over the chemo that was making her ill. Local doctors have mixed reactions, with some completely disregarding the treatments as quackery while others say they are a valid option. Treatments are available at the Canadian Clinic for Integrative Medicine in Windsor. Read the entire story here.

As part of my research for the book I am writing, I interviewed a six-year survivor who chose vitamin C infusions rather than chemo. She is going strong, driving around the country with her husband in their new RV.

Monday, January 10, 2011

Four rounds of chemo just as good as six for early-stage breast cancer

For tumors with zero to three affected lymph nodes, regardless of hormone receptor status, four cycles of chemotherapy are as effective as six, according to results from the Cancer and Leukemia Group B 40101 trial of 3,173 patients. Relapse-free survival at 4.6 years for those with four rounds was 91.8 percent. For those with six rounds, it was 91.6 percent. For just two-tenths of a percentage point improvement, women might endure four more weeks of chemo and all its side effects. Those studied were either treated with Adriamycin and Cytoxan or paclitaxel. Results so far cover only the duration of treatment, not the effectiveness of specific regimens. Researchers say six rounds might eventually pay off in the longer run. Internal Medicine News has the story.

Receptor status can change in breast cancer recurrence or metastases

Receptor status in breast cancer that has recurred or metastasized may be different from the original tumor, according to research presented at the 2010 ASCO meeting in San Antonio. Estrogen-receptor status changed in 33 percent of breast cancer patients; Her2 status changed in ten percent, in a study of 459 patients by Swedish researchers. Twenty-six percent of tumors changed from positive to negative and seven percent changed from negative to positive. In previous research, published in the journal Breast Cancer Research, ten percent of all tumors changed receptor status. Internal Medicine News has the story.

Saturday, January 8, 2011

Geneva, Illinois, Coach Returns to Bench After TNBC Treatment

The Chicago Tribune has run a profile of 42-year old Gina Nolan, a Spanish teacher and basketball coach, who spent this summer and fall in treatment for triple-negative breast cancer. It is a good piece on what sounds like an amazing woman. Of course, the writer defines TNBC as "aggressive," which has become shorthand for this disease. While it can be aggressive, it is not always so, and it is absolutely survivable--most women do survive it. That qualifier, however, seldom makes it into stories.

Nolan told her students: "This is what happened to me over the summer. It can take away my hair. It can wear me down physically, but it won't change my mind, it won't change my heart and it won't change who I am as a teacher." Read more here.

Wednesday, January 5, 2011

PARP inhibitor Iniparib decreases tumors, increases survival time

The PARP inhibitor iniparib (BSI-201) boosted overall survival by nearly five months when used with chemotherapy for metastatic triple-negative breast cancer compared with chemotherapy alone, according to results from a phase II trial of 123 patients published online in the New England Journal of Medicine. The median overall survival was 12.3 months for those on the PARP inhibitor-plus-chemo regimen and 7.7 for chemo alone. The drug combination shrank tumors and increased the time they took to progress.

Below is a news release from Sanofi-Aventis, maker of iniparib:
BRIDGEWATER, N.J., Jan. 5, 2011 /PRNewswire/ -- Sanofi-aventis (EURONEXT: SAN and NYSE: SNY) and its wholly-owned subsidiary, BiPar Sciences, today announced that The New England Journal of Medicine (NEJM) published the final phase II data for the investigational drug iniparib* (BSI-201) demonstrating significant clinical benefit in women with metastatic triple negative breast cancer (mTNBC) when iniparib was administered in combination with chemotherapy agents gemcitabine/carboplatin. Although not a pre-specified endpoint, overall survival also was significantly increased in women who received iniparib. The study, "Iniparib plus Chemotherapy in Metastatic Triple-Negative Breast Cancer," was published in the January 5, 2011, online version of the NEJM and will be published in the January 20, 2011, print edition. These findings were presented at the 35th European Society for Medical Oncology (ESMO) Congress in Milan, Italy.

"These published data show that the addition of iniparib to gemcitabine and carboplatin provided a significant improvement in clinical benefit in women with metastatic triple negative breast cancer, an aggressive form of breast cancer with no approved standard treatments that target this particular tumor subtype," said Joyce O'Shaughnessy, M.D., lead investigator of the study and co-chair of the Breast Cancer Research Program, Baylor-Charles A. Sammons Cancer Center, Texas Oncology, US Oncology in Dallas.

According to the study results, 56 percent of patients in the iniparib (BSI-201) group showed a clinical benefit – defined as a complete or partial response or stable disease of at least six months – compared with 34 percent (P=0.01) of patients in the chemotherapy group alone. Median progression-free survival in the iniparib (BSI-201) group was 5.9 months compared with 3.6 months in the chemotherapy group (95% CI (0.39-0.90) HR=0.59, P=0.01). The overall response rate was 52 percent in the iniparib (BSI-201) group versus 32 percent (P=0.02) in the chemotherapy group alone. Although it was not a pre-specified endpoint of the trial, median overall survival among women who received iniparib (BSI-201) was 12.3 months, compared with 7.7 months among women who received chemotherapy alone – translating to a 43 percent reduction in the risk of death (95% CI, (0.36-0.90) HR=0.57, P=0.01).

In the phase II iniparib (BSI-201) study, the most common any grade adverse events in the iniparib (BSI-201) arm were neutropenia, anemia, thrombocytopenia, fatigue/asthenia, nausea and constipation. The most common grade 3/4 adverse events in the iniparib treatment arm were neutropenia, anemia, thrombocytopenia, leukopenia and fatigue/asthenia. There were two fatal adverse events (3.4%) in the chemotherapy-alone group and three (5.3%) in the iniparib (BSI-201) group, all attributed to disease progression within 30 days of receiving study treatment. A large phase III study is ongoing and results are expected in 2011.

"The positive iniparib phase II data in this difficult to treat form of breast cancer is encouraging and underscores the innovative science and approach we have taken as we continue to investigate iniparib's potential to address this unmet medical need," said Atul Dhir M.D., CEO, BiPar Sciences, a wholly- owned subsidiary of sanofi-aventis.

About the Phase II Iniparib Study

This multicenter, open-label, randomized study included 123 women with mTNBC. The primary endpoints were safety and tolerability and clinical benefit rate of iniparib (BSI-201) defined as a complete or partial response or stable disease of at least six months. Secondary endpoints included overall response rate and progression-free survival. Overall survival also was assessed, although it was not a pre-specified endpoint of the trial. Patients received gemcitabine/carboplatin alone (chemotherapy group) or in combination with iniparib (BSI-201) until disease progression or unacceptable toxicity. Patients in the chemotherapy group whose disease progressed were allowed to cross over to the iniparib (BSI-201) plus chemotherapy group. Efficacy analyses were conducted on the intent-to-treat (ITT) population.

About Iniparib

Iniparib (BSI-201) is a novel investigational anti-tumor agent with poly (ADP-ribose) polymerase (PARP) inhibitory activity in preclinical models. Iniparib (BSI-201) is in phase III trials for patients with mTNBC and squamous non-small cell lung cancer, as well as in phase II trials for patients with ovarian, uterine and brain cancers.

The U.S. Food and Drug Administration (FDA) granted Fast Track designation to iniparib (BSI-201) for mTNBC. The regulatory submissions are planned for Q1 2011 in the United States and Q2 2011 in the European Union.

About Triple-Negative Breast Cancer (TNBC)

When patients are diagnosed with breast cancer, their tumors are routinely tested for the presence of estrogen and progesterone receptors and for the over-expression of HER2. However, 15 to 20 percent of all breast cancers lack over-expression of all three proteins – giving rise to the term "triple negative breast cancer" or TNBC. Research has shown TNBC can be difficult to treat, leading the disease to be associated with poorer outcomes than other types of breast cancer. Women with TNBC are not candidates for hormonal therapy such as tamoxifen or the targeted therapy Herceptin, leaving chemotherapy as the standard treatment.

About sanofi-aventis Oncology

Sanofi-aventis Oncology is targeting cancer on many fronts in an effort to address unmet medical needs for a broad range of patients. Starting with a deep understanding of the mechanisms by which cancer develops, grows and spreads, as well as identifying the right science early in the discovery process, the company employs innovative approaches to bring the right medicines to the right patients. There are currently more than 10 investigational compounds in development across a broad scientific platform, including cytotoxic, antimitotic, anti-angiogenic agents, antivascular agents as well as supportive care therapies. Three of these compounds are now being investigated in phase III clinical studies aimed at multiple solid and hematologic tumors.

About sanofi-aventis

Sanofi-aventis U.S. is an affiliate of sanofi-aventis, a leading global pharmaceutical company that discovers, develops and distributes therapeutic solutions to help improve the lives of patients. Sanofi-aventis is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY).

For more information, or

About BiPar Sciences

BiPar Sciences is a biopharmaceutical organization dedicated to pioneering novel tumor-selective therapies designed to address urgent unmet needs of cancer patients. Located in South San Francisco, California, BiPar is a wholly-owned subsidiary of sanofi-aventis. For more information, please visit

Medpage Today has an article on the findings, as does Internal Medicine News, and Medscape Today.

Sunday, January 2, 2011

Giving Thanks in My Seventh Decade

I turned 65 last week and I am not sure what to make of it. Yes, getting older is better than the alternative, as my bout with cancer made extremely clear. Still, that’s old. Medicare old. If I got robbed, the news story could very well describe me as elderly.

I was diagnosed with cancer when I was 60, and that certainly stopped my whining about getting old. I need no reruns of that scenario, so I am embracing my advancing age.

Not that I have a choice.

Seriously, I am embracing it. I am fortunate enough to have everything that matters, plus the perspective to appreciate all these gifts. So, in this new year of my life, as I welcome expanded wrinkles and joint pain, I am stopping to celebrate what I have with humility and gratitude.

I have love. Not just received, which is beautiful, but love given. I love my husband, son, daughter, grandson, son-in-law, brothers, sisters, nieces, nephews, and friends. The other night I started counting all the people in my life who truly matter to me. Not Facebook-level friends, but friends with whom I regularly share long talks, friends who were with me when I was sick and would be with me again. Not acquaintances. Friends. I reached 74 before I fell asleep. Nice.

I have my health. Sure, I still worry that every bump and pain means cancer is back, but it’s been 4.5 years since I was diagnosed, and with hormone-negative, the rate of recurrence falls off the cliff after three years. What’s more, since that diagnosis, I have eaten far more healthily, exercised more, and taken up yoga and meditation. Getting sick forced me to get healthy.

I have meaningful work. I was blessed with a talent for writing and have been given the opportunity to nourish and share that talent. And I was doubly blessed that this turned into an academic career that was way beyond fulfilling and that I have been able to continue after retirement. I see no need to retire from writing. I love that I can use that talent to help many beautiful women when they are struggling with a new diagnosis.

I have home. My house is sunny and warm and big enough for me and my husband but small enough to make sense. We are comfortable here.

I have happiness. I often wake up with a smile on my face.

Five years ago, I would not have made the same list. Five years ago, I would not have thought of making a list at all. I was too busy, too consumed with where I was going and what I was doing to see where I actually was, what I was actually doing, what actually mattered.

Cancer stopped my in my tracks and made me pay attention. As did hearing the stories of other women who have faced problems accessing and paying for proper healthcare, who have had husbands and partners leave them in their illness, who have lost jobs and security because of their illness, whose response to treatment was harsh, who don't know where to go next, who are terrified and confused.

I am lucky. Sixty-five, eighty-five, thirty-five, whatever the age, I am blessed. Yeah, I have those aching bones, and graying hair, and wrinkles, and a growing list of friends who are sick or who I have already lost to death. That comes with the benefit of age.

Sure, the Big C lurks in my consciousness like a cobra hiding in my brain, with worry that strikes whenever I let my guard down. But I am living a great life. And I am enormously thankful for it.