Monday, August 26, 2013

Changing Paths

Old paths are such comforts.  Losing them feels like losing the coziness of an old friendship.

Today we took a new path through the woods and got a bit lost.  The familiar markers were gone and their comfort and clarity gone with them. That’s often the way with forging a trail—you get easily disoriented.  But it is a bit more so for us right now.

The woods we walk through by our little Colorado cabin have been engulfed in a forest fire and are now just charred fields with black skeletal trees poking up from an ash floor.

So we don't actually need a path any more because all the old obstacles are gone, the gorgeous pine trees and aspen groves are burned.  We can walk pretty much where we want,  although what we want is for this fire to never have happened.  I didn't want this change, I didn't want this blasted new path. I want things the way they were.

My path through cancer was similar.  The old ways of doing things—enjoying my martinis and wine, eating fatty foods, taking exercise only sort of seriously, working too hard and taking on too much stress—had to be replaced by a healthier, cancer-fighting life. I am so much the better for it, but forging that new post-diagnosis trail was the pits.  And I resent having to do it.

I did visualization exercises as part of my cancer treatment, and the tree-lined path to our cabin is what usually came to my mind when I tried to envision beauty and hope, a place in the future where I could see myself after the chemo and radiation and endless doctor visits and tests were over. Visualization can be potent, getting you out of your current ordeal and helping you see that there can be life and fulfillment after all this.

Still, I have often wondered why I saw this simple, non-spectacular cabin path.  Why not the dramatic mountain just beyond it?  Or the verdant meadow with its little stream?  Or even the cabin itself, with its cozy, friendly interior?  Why the path?

I think it was because the calm that engulfs me at the cabin starts on that path, making the path itself a symbol of better things to come, of hope.  I always feel so positive on that path—I know it ends in comfort.

This year, though, a portion of that path is burned, some of the trees just black sticks, the ground a mixture of ash and charcoal. The cabin itself is fine—thanks to God and the firefighters. But much of our nearby forest is gone, and the paths that once snaked through the woods are just vague marks in the ashy ground. 

Still, more often than not, we look for those old trails and follow them as much as we can.

I think it’s because the paths are our link to life before the fire, our tie to normalcy.  If we stay on the path that gets us up the hill and over to the next meadow, maybe we can forget the destruction around us, the sad state of our forest.  A little part of things will be like they were before.

Same way with cancer—the old familiar faith in our health, security about our future, and clarity about our present is gone, replaced with a vague route through an unfamiliar and frightening landscape.  I retired from a job I loved because too much of it had turned to stress and worry and because I knew I would be too busy to exercise and eat well. 

People remind me that the forest will grow back and will likely be even better than before.   They are right, of course, but it’s hard to see right now.  And, more than seven years after my cancer diagnosis, I know that my overall health is better than it would have been had I not had that health scare.  I feel obliged to treat my body better.  And the new life I have forged, with a mixture of the old and new, is pretty amazing—I feel challenged by the writing and part-time teaching I do, but I can now relax and plan my days the way I want them.  And the world is full of people like me who have survived to live a strong and happy life that, in many ways, is better than before.

Yet I have lost so many friends to this disease, and I feel their presence and their absence as I walk on.  I think of the spouses, children, and siblings who have been left behind.   My heart especially breaks for parents who have lost their daughters and little children who have lost their mommies. Their lives have been altered beyond comprehension, and I hope we can all lend a hand to them, helping them find their way onto a new path of love, one that honors the beauty of our memories and the hope of the future.

[Read more about the forest fire here.]


Monday, August 19, 2013

Biological pathway offers less-toxic treatment potential for some cases of TNBC


The OGF-OGFr axis, a novel biological pathway, can be modulated in human triple-negative breast cancer cells to inhibit proliferation, according to research in the June 2013 issue of Experimental Biology and Medicine. 

Exposure of human breast cancer cell lines to OGF in lab tests repressed growth within 24 hours. (That's fast, folks.) Treatment with low dosages of the opioid antagonist naltrexone (LDN) boosted OGF with minimal or no side effects, with potentially stronger effects than paclitaxel.

"What is exciting about our findings," said Ian S. Zagon, M.D., senior author and Distinguished University Professor at the University of Pennsylvania, "is that women with triple-negative breast cancer have few options because their tumors lack the necessary hormonal receptors. [Pat's note:  I would say "different options" rather than "fewer."]


Data from these studies open new doors for treatment of this population of women." Moreover, the OGF-OGFr axis is present in all types of breast cancer cells suggesting that this pathway provides additional avenues for treatment of this commonly diagnosed cancer.

Existing drugs kill TNBC drugs by targeting their own waste

Triple-negative breast cancers may be vulnerable to drugs that attack the proteasome, a cellular structure that acts as the cell's waste disposal, breaking down damaged or unneeded proteins, according to a new paper in Cancer Cell.

In lab tests, researchers selectively "turned off" genes throughout the genomes of triple-negative tumor cells. When turned off, the cells die.

These data suggest that triple-negative breast cancers may respond to treatment with drugs similar to bortezomib (Velcade), which is used in multiple myeloma.


• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

Thursday, August 1, 2013

Enzyme UBASH3B Linked to TNBC Progression and Growth


Scientists at  the Genome Institute of Singapore (GIS) have identified genes that are potential targets for therapeutic drugs against triple-negative breast cancer. These findings were reported in the July 2013 issue of PNAS.

In the research, they discovered that an enzyme, UBASH3B, was overexpressed in one third of TNBC patients. Deleting this gene expression inhibits TNBC growth and lung metastasis in a mouse model. They also showed that TNBC patients with high levels of UBASH3B tend to be more likely to have early recurrence and metastasis.

Lead author Dr Qiang Yu said, “It is heartening to know that UBASH3B is an important element of the pro-invasive gene network and targeting UBASH3B not only inhibits TNBC invasive growth, but also significantly reduces metastasis.”

Tan Tock Seng Hospital consultant surgeon Dr Tan Ern Yu, a collaborator and co-author of the study said, “Some TNBC patients relapse soon after standard treatment while others remain free of disease for a long time. Being able to predict which patients are more likely to relapse is important since these patients may benefit from more aggressive treatments. But currently, doctors are unable to reliably do so. Further validation will show whether UBASH3B can be developed into a means of identifying these high-risk patients as well as a new form of treatment.”

Dr Dave Hoon, Director, Department Molecular Oncology at the John Wayne Cancer Institute, USA, and co-author said, “Recent large-scale genomic analysis of breast cancer show that triple negative breast cancer are highly heterogeneous and patients tumors can have different molecular profiles.  The finding can help us develop new approaches for targeted therapy for this highly aggressive breast cancer.”

The original news release is here.


• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

Saturday, June 29, 2013

Androgen Drug to Be Tested for TNBC in Phase II Trial


A News Release from Medivation
Medivation, Inc.and Astellas Pharma Inc. today announced enrollment of the first patient in a global Phase 2 clinical trial evaluating enzalutamide as a single agent for the treatment of advanced, androgen receptor (AR)-positive, triple-negative breast cancer (TNBC). Medivation is conducting this study under its agreement with Astellas.
"The initiation of this Phase 2 study marks an important milestone as we expand our enzalutamide development program beyond prostate cancer to explore the clinical efficacy of enzalutamide in triple-negative breast cancer, where there is a significant unmet medical need," said David Hung, M.D., president and chief executive officer of Medivation, Inc. "We plan to present the results from the Phase 1 study in breast cancer at an upcoming scientific conference."
The Phase 2 open label, single-arm, multicenter trial plans to enroll approximately 80 patients with AR-positive, TNBC at sites in the United States, Canada and Europe. The primary endpoint of the trial is clinical benefit rate, defined as the proportion of patients with a best response of complete response, partial response or stable disease at ≥ 16 weeks. All patients will receive enzalutamide at a dose of 160 mg to be taken orally once daily. Information about patient eligibility and enrollment can be obtained by calling 800-888-7704 ext. 5473 or e-mailing clintrials.info@us.astellas.com.
TNBC is a type of cancer which does not express any of the three most commonly targeted receptors in breast cancer: estrogen, progesterone and HER2. TNBC remains an area of significant unmet medical need. Currently, there are no approved targeted therapies for these patients, who are typically treated with multiple regimens of chemotherapy. AR-positive breast cancer is a recently-identified subtype of TNBC that can express high levels of the androgen receptor.
Enzalutamide is an androgen receptor inhibitor that acts on different steps in the androgen receptor signaling pathway. Enzalutamide has been shown to competitively inhibit androgen binding to androgen receptors, and inhibit androgen receptor nuclear translocation and interaction with DNA.
NOTE: XTANDI(R) (enzalutamide) capsules is indicated for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) who have previously received docetaxel. It can cause fetal harm and is contraindicated in women who are or may become pregnant.

Drugs to Block CD73 Successfully Target Chemo-Resistant TNBC


A news release from Centre hospitalier de l'Université de Montréal (edited by Pat to eliminate fearful language]:
MONTREAL, June 26, 2013 /CNW Telbec/ - An international research team of Canadian and Australian scientists have found that an enzyme in triple-negative breast cancer makes patients less responsive to chemotherapy. 
Triple negative breast cancer accounts for 15% of all breast cancers and is characterized by the absence of three key receptors (oestrogen receptor, progesterone receptor and the human epidermal growth factor receptor 2). Standard treatment, such as hormone therapy, cannot be used for triple negative breast cancer.
In a study published in the online version of the Proceedings of the National Academy of Sciences of the United States, the team found that CD73 made the breast cancer more resistant to chemotherapy with anthracyclines. This drug works not only by killing the tumour cells, but also by activating the body's anti-tumour immune response.
The research revealed that the overexpression of CD73 inhibits the body's immune response to cancer. Moreover, the heightened presence of CD73 is associated with a higher risk of distant metastases, the principal cause of death in breast cancer.
"These results are quite encouraging," says John Stagg, M.D,  assistant professor in the Faculty of Pharmacy at the University of Montreal and a researcher affiliated with Montreal Cancer Institute. "Because they suggest that therapies specifically designed to block the action of CD73 could make it possible to enhance the beneficial effects of anthracycline-based therapies." Indeed, in experiments with laboratory animals, Stagg's team showed that combining standard anthracycline treatment with anti-CD73 therapy prolonged survival by over 50%. More research is required to determine whether anti CD73 therapies can also be effective with other chemotherapeutic agents.
Human trials of inhibitors of CD73 could begin within five years, meaning that there is hope on the horizon for triple negative breast cancer patients.

Thursday, June 13, 2013

Looking for a Clinical Trial for TNBC?

Are you looking for the TNBC clinical trial that most suits your needs and for which you are eligible?  A researcher at Harvard, Maytal Bivas-Benita, is currently designing a portal that patients can use in their search for trials, but she would like your help.
What challenges are you encountering on your search?  Maytal would love to talk with you, help you with your research, and use this to help others.  As she says, she would be your personal scientific consultant.
Here’s how she explains it:
My aim is to provide the patient with a basic understanding of the drug that is being tested, the possible mechanism of action, the relevance to TNBC, outcome in other indications (if available) and potential side effects (if previously identified). This information will give patients a better idea of what they are getting into. 
Different patients will have different considerations in selecting a trial (such as distance from home, reputation of the clinical site, potential benefits, potential toxicity, etc). It is up to each patient to make the right decision by carefully considering all their options. 
I am in the early stages of developing this approach and I would like to work together with patients who are looking for clinical trials. This will help me learn and understand the decision-making process. I am not a medical doctor, I am a scientist with a broad pharmaceutical background and extensive research experience. You can think of me as your personal (free) scientific consultant.
If you are interested in talking with Maytal, you can email her at maytalb@mac.com

Saturday, June 1, 2013

Today's Goal

Worry less, appreciate more.

Thursday, May 30, 2013

This Beautiful Day

I hesitated over my morning prayer today: Thank you for this beautiful day; help me to use it well.   I looked out the window at the unending Iowa rain  and thought, "How can I say this is beautiful?" This is dreary and a little scary. I am not thankful for it. Not. At. All.   But then I realized that the beauty for which I give thanks is in the day itself—the people I cherish, the meaning of the work I do, the amazing resilience of my body, the fact that I am healthy right now.  This is a prayer, after all, and not a weather report.  So, I said it: Thank you for this beautiful day; help me to use it well.

Saturday, May 25, 2013

Protein may be path to targeted TNBC treatment


A protein called Numb (seriously) may  promote the death of cancer cells by binding to and stabilizing the tumor suppressor protein p53, which is implicated in many cases of triple-negative breast cancer, according to research published in the May 23rd issue of Molecular Cell.   When Numb is reduced by the Set8 enzyme , it will no longer protect p53.  

“If you don’t have Numb in a cell, then the p53 can be degraded very quickly, and these cells become resistant to chemotherapy,” said Shawn Li, PhD, a professor of Biochemistry and Canada Research Chair in Cellular Proteomics and Functional Genomics at Western Ontario University.  

Now that he’s identified the Set8-Numb-p53 pathway, Li is investigating various drugs to find a Set8 inhibitor which could be used as a novel breast cancer therapy alone, or in  combination with other chemotherapy regiments. View this video to see Li explain his findings.


• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

Progesterone metabolites linked to hormone-negative breast cancer


Progesterone metabolites, often considered waste products by endocrinologists, may be potent hormones that can fight against hormone-negative breast cancer, according to a new study published in Breast Cancer Research.
A research team at Western Ontario University team discovered that the progesterone metabolites 5α-dihydroprogesterone (5αP) and 3α-dihydroprogesterone (3αHP), respectively, exhibit pro-cancer and anti-cancer effects on receptor-negative human breast cells.
“We’ve found that they are potent hormones that can play a vital role in the fight against breast cancer,” said lead author and biology professor John P. Wiebe.  He will share the findings at the Endocrine (ENDO) Society Annual Meeting and Expo in San Francisco in June.
“Our findings provide unequivocal evidence that 5αP and 3αHP deserve to be considered as active hormones in their own right, rather than inactive waste products, and that they need to be considered in the development of new approaches to prevention, detection and treatment of breast cancers,” Wiebe said.
The study may also lead to an understanding of the cause and potential regulation of receptor-negative breast cancers.


• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

Wednesday, May 15, 2013

Does Angelina Jolie's Story Help or Hurt?


I've been traveling and have had little time to post about—or even process—Angelina Jolie's opinion piece, “My Medical Choice,” in the NY Times. 

I am not sure I have anything to add to the discussion, but I have had so many people ask me about it that I felt I should respond.  I am doing so in a highly equivocal way, as  I have mixed emotions on the piece. (The more I learn about breast cancer and its treatment, the fuzzier my opinions.  Things used to be clearer when I knew less.)

I do think Jolie does an exceptional job explaining her specific case, providing great details for those who are unsure what might be ahead of them. She certainly makes it real and true—and doesn't glamorize it.  This is a hard decision and the treatment is hard on your body.  She makes that clear—and good for her for taking the risk of going public with a decision that some might trivialize, with insensitive and uninformed comments.

I do worry, though, about how we approach celebrity information.  Too often we want to do what they do, be who they are.  It concerns me, then, that women who do not have the risk factors Jolie faced—she had an 87 percent risk of breast cancer—might also think they need a double mastectomy.  This could be much more aggressive treatment than makes sense for them—more aggressive than might be good for them.  In fact, there has been an increase in the number of double mastectomies in recent years, sometimes in cases of DCIS.

I hope we keep the risks—of cancer as well as of the effects of it treatment— in perspective.  It is a fine line—I want us to be informed, proactive, and in control.  But I do not want us unnecessarily fearful.  I think Jolie helps us with the former but also puts us at risk of the latter.

As I said, the more I learn, the less I truly understand.


• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

Saturday, May 11, 2013

My Mom and the Golden Shoes


I just bought a pair of shoes in a color that reminds me of rocks in a mountain stream.  The manufacturer calls it “pewter,” but I think it looks more gold. It shimmers and takes on the hue of whatever I wear.  As I tried them on in the store, I loved them immediately.  They are excellent shoes, made even more so because they are dead ringers for my favorite pair from more than 50 years ago.

I was in the eighth grade when my mom worked as a sales clerk at Sweetbriar’s dress shop in Pueblo, Colorado.  It was a pretty fancy place for Pueblo in the early 1960s, with central air and a sunken dressing room area surrounded by mirrors.  One Christmas, Mom brought me home a special outfit from the store.  The dress had a velvet top and a full brown chiffon bottom with taffeta underneath.  With it came the dark gold shoes, with black lace anklets.

Now, very few little girls had dark gold shoes and black lace anklets, I have to tell you.  That was one classy fashion statement.

I was a tall, skinny kid without a lot of grace. (After dance class once, one of the nuns asked me how I could be so graceful on the dance floor and so clumsy everywhere else.  Yes, she did.)  But in the outfit Mom brought home, I was Grace Kelly. 

I wore in on Christmas, feeling like my own sort of ornament, and I did not want to ever take it off, because I knew I had nowhere else special enough to wear it. 

So it hung in the closet for a few months and then I could stand it no more. I decided I should wear it to school on one of the days we got to wear something other than our navy blue serge uniforms. Mom said it might be a little too fancy, but I insisted and she ultimately gave in.  Drama was involved.

That's how, one warm March day, I trotted down Spruce Street in velvet, chiffon, taffeta, gold shoes, and black lace anklets, headed to a normal day of eighth grade.  I was a sight, I just knew it.  OK, I am now sure of it.

I was by far the fanciest little girl at St. Francis Xavier School that day.  Maybe that year.   I did not know what “overdressed” meant and certainly would not have thought that I was capable of it.  I just thought I was pretty doggone special.

The nuns kindly commented on my pretty dress and reminded me that I should be a little careful on the playground.  (Was I trying to play baseball?  Perhaps.  I honestly don't remember, but I would not put that past me.)  The other kids just sort of shrugged it off, as far as I know.  I don't remember anybody teasing me for wearing dance recital duds on a plain old Friday. 

Were we kinder back then, or was I just oblivious?  I am pretty sure the second is true, and I hope the first is as well.  Maybe, though, they just saw how happy I was and left me alone.

And now, as I look at my new shoes, I miss my mom, like I have missed her since she died 20 years ago.  She was a great mom.  Like all of us, though, she often focused on what she didn't do, what she wished she could have given me. She wanted to splurge on these kinds of gifts all the time and was sad that her extravagance was so unusual.  We didn't have much money, so this dress and shoes were an  unexpected treat for me. But that is why they are such an important memory.

And when I remember my Christmas outfit,  I don't wish I’d had more like it.  Instead, I treasure that one warm memory and, as I do, I think of the love that came with those clothes. I know Mom sacrificed something else, no doubt for herself, to buy it for me.  Her main focus at that moment of time was making me happy.

That was my mom.  Loving, generous, and dear, but worried that she was just not doing enough.

If I could talk to her, I would tell her that love was always more than enough.  And always will be.

That she'll be with me whenever I wear my new shoes.

And when I don't.


• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!

Thursday, May 9, 2013

I've been fiddling with the paint brushes and am about 75 percent finished with this. I am not sure when—and if—it will be at 100 percent, but at least I no longer feel like throwing it away. Creating is good for my soul, even when the result isn't what I expect.  As with many things, it is all about the journey.

Wednesday, May 8, 2013

Rudeness, Social Media, and Cancer


Mary says Robin Roberts is “more concerned about her 'star ness' than her health.”  When Kathy and Michele object, calling Mary “rude,” Mary responds.  “If she wasn't a celebrity, you wouldn't care, admit it. She wouldn't care about me. So, I just treat them as regular folk. Can't be PC all the time. I work in the real world.” 

That was the discussion one morning last week on wxyz.com.

Mary sounds like a royal pain in the asterisk.  And she naturally has to share it because we share every blasted thing because we can in our 24/7 wired world.

Roberts had posted on Facebook that she had to stay home from her job as cohost of Good Morning America due to an infection that could be related to treatment for myelodysplastic syndrome brought on by chemotherapy treatment for breast cancer.

So WXYZ.com ran the story, encouraging comments, which, in the way of comments went their own way from unnatural coziness to unnatural nastiness. 

Mary says she lives in some “real world” somewhere. But in what world is it OK to be rude to people who are sick?  (Or, for that matter, who aren’t sick?)  Robin did not ask for this media scrutiny and, I suspect, wishes it would go away.  Imagine people following your prognosis and posting/printing/tweeting it over and over and over? You’re trying to beat the beast of cancer while also fighting constant reports about your fight—many of which are inaccurate and most of which are invasive.  That seems at least one fight too many.  

And Robin didn't ask for strangers like me to blog about her using her first name as though we were buddies.  Hey, Robin, whazzup?

But, Robin’s "star-ness aside" (that's not a word, Mary), what’s with being rude? Mary appears pretty unapologetic—  she used her full name, after all.   Does that signal the fact that she thinks it is just fine to be so critical of a fellow human being fighting a deadly disease?   Worse, does she think she is somehow right?  That because she thinks it, it is therefore good and worth sharing?  

That seems to be a mentality right now.  We think it therefore we say it.  I wish this tendency  would go away—this sharing of our deepest misunderstandings and darkest thoughts.  But it is truly sad that it has infected the cancer world, which already has enough infections to fight.



• Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

• Please consider a donation to Positives About Negative to keep this site going.  This work is entirely supported by readers.  Just click on the Donate button in the right of the page.  Thank you!