AACR update: Breast cancer studies offer more potential treatment options


Debu Tripathy blog image

Two studies announced at this year's annual meeting of the American Association for Clinical Research are targeting unique molecular features that drive breast cancer. One study is testing the drug palbociclib, which targets an abnormality in the cancer cell cycle. The drug is being tested in hormone-positive breast cancer in combination with the aromatase inhibitor, Femara (letrozone). The combination significantly delays the time it takes for the cancer to continue growing. At the current time, it's not showing a survival advantage, but a phase 3 trial in progress may be the deciding factor for the drug's approval.

Another study is looking at a drug called neratinib, specifically in HER2-positive breast cancers. It's part of the I-SPY2 study, which is testing multiple new therapies before surgery, as neoadjuvant therapy. The results show that neratinib can result in complete disappearance of the tumor. This may represent a new drug for patients with HER2-positive breast cancer, including patients who have progressed on other HER2-targeted therapies.

Debu Tripathy is an oncologist and editor-in-chief of CURE. He is the co-leader of the Women's Cancer Program at Norris Comprehensive Cancer Center and Professor of Medicine at the Keck School of Medicine at the University of Southern California.


AACR update: New immunotherapy drug shows benefit in lung cancer


Debu Tripathy blog image

One of the areas that has progressed quite a bit recently is that of tumor immunotherapy. At this year's annual meeting of the American Association for Clinical Research, several papers have been presented in this area.

One of the most exciting is advances in lung cancer, which has been a traditionally hard to treat cancer. Recently there have been newer targeted therapies that work against growth factor receptors that show benefit, particularly in non-smokers. And now we're seeing advances in immunotherapy.

Now, a fundamental breakthrough in immunology has come with understanding the controls of the immune cells that allows us augment the natural immune response that white cells have against tumors.

One of the proteins blocked is the PD-1 receptor and PD-1 ligand. These proteins are important because the cancer cells can use them to block the immune system from attacking the cancer. There are several drugs being tested that inhibit this blockade, the so-called immune checkpoint, in trials not only for lung cancer, but also melanoma and other solid tumors.

One of the potential benefits of one of these drugs called MK-3475 is that it may work in people who have a history of smoking, people who have traditionally not benefited from these targeted therapies.

There is also some new information that we may be able to identify patients who have the best chance of responding to these drugs. There will be a more formal comparison and information on how the drug works in smokers coming hopefully very soon. We expect to hear those results at the annual ASCO meeting this summer.

Debu Tripathy is an oncologist and editor-in-chief of CURE. He is the co-leader of the Women's Cancer Program at Norris Comprehensive Cancer Center and Professor of Medicine at the Keck School of Medicine at the University of Southern California.


The other option: Surrogacy after cancer


Jen Rachman

At age 26, I was on my own, self-sufficient, secure and independent. I was already a few years into building my career as an adolescent therapist; a job that well suited me. I had my own apartment, and was about to move in with my boyfriend of several years. I took care of myself physically and emotionally. Life was pretty perfect, until the routine trip to the gynecologist that wound up saving my life.

When you hear the words, "you have cancer," there is truly no way to be prepared to absorb all that comes with it. My now unstable life became filled with terms like prognosis, oncologist, surgery, treatment and chemo. My doctors overwhelmed me with choices about what course of action to take. Suddenly, my secure sense of self became unraveled and presented me with a new identity – cancer patient. My oncologists' (who are wonderful) main goal was to rid me of cancer as quickly as possible. The recommended course of action when diagnosed with ovarian cancer is to have a complete hysterectomy.

Being only 26, the idea of parenthood wasn't even on my radar yet. But suddenly I felt forced to think about my fertility and my options. I was then hit with a double whammy: the idea that my cancer might render me infertile. I stressed to my doctors that while clearly the primary focus is to rid myself of cancer; I wanted them to make every attempt at preserving my fertility.

Over the course of seven months, I endured three surgeries and six rounds of chemotherapy. The treatment took my hair, put my body in menopause, and left me feeling twice my age. Unfortunately, the doctors weren't able to save my ovaries. I recovered and slowly acclimated to my new normal – survivor.

As I moved further away from my date of diagnosis, I became more accepting of my life as a survivor and it became less scary to invest in the idea of leading a longer, healthy life. My then boyfriend and I were married in 2005, and after several years were comfortable exploring the idea of having a family. I had come to terms with the loss of my fertility and began exploring my options to become a parent. I reached out to my oncologist and my supports in the cancer community about surrogacy and adoption.

I feared that with adoption, I might be discriminated against due to my cancer history and therefore it felt safer to me to explore the world of surrogacy. I also liked the idea that though our child might not be genetically mine; they could still be connected to my husband. As we researched, it quickly became apparent that there was a lack of information about surrogacy.

We met with a few agencies and decided on Circle Surrogacy in guiding us through this process. We signed our contract with them and moved on to the matching process. Within four months of meeting our surrogate, we were expecting our son. The entire experience felt "right," as I believe this is the way we were intended to become a family. Our surrogate is truly an amazing woman, who we felt connected to from the start. Going into the experience, I had some anxiety about feeling envious or jealousy toward our surrogate as she was able to bring our child into this world; something that I couldn't do. I remember feeling surprised that I didn't feel this way toward her at all. As we were awaiting the arrival of our son, I felt humbled and grateful that she was doing this for us.

The day our son was born was truly the most amazing day of my life. It was as if all the struggle, loss and upset caused by cancer had been undone, or perhaps more so, solidified the reason for the journey.

As I reflected on the experience, I remained troubled by the idea that there was little information in the cancer community about surrogacy. I began exploring ways to get information about this amazing way to become a parent after cancer to survivors. I am fortunate to have made this a career goal and work now as an outreach coordinator to educate others about surrogacy.

Though being a cancer survivor is membership to a club I never wanted; I wouldn't say that cancer was the worst thing that happened to me. How could that be when it has brought so much to my life both personally and professionally?

Jen Rachman is a social worker from New York City. She is a 10-year ovarian cancer survivor having been diagnosed at age 26 and a parent through surrogacy. She is currently working as an outreach coordinator for Circle Surrogacy to educate survivors about this family building option after cancer.


So much to celebrate


Rachel Baumgartner Lozano

Life has changed a lot for me since nominating my nurse, Tish Mullen, who became a finalist in the first Extraordinary Healer Award contest in 2007. From my essay, "My Own Fairy Godmother Nurse":

"...I was extremely sick and in the hospital for most of the second semester of my senior year of high school. Well, when prom came around, it was really touch-and-go whether I would be in the hospital or not. Because of Tish, I was not in the hospital, got to attend prom, stayed out late, and all of this without my ever-present I.V. backpack. This was quite a feat!

She came over right before I got ready and removed my I.V. and I.V. backpack as part of getting ready (sort of a substitute for doing my hair since there was none). I put on my flowing royal blue gown and was whisked off as a princess for the evening--putting the fact that I was going into an intense life-threatening stem cell transplant in a week in the back of my mind.

At about 4 in the morning, I arrived home from the after-festivities and called Tish, as I had been instructed to do. She came over and safely put the I.V. back in like it had never left.

This is a small example of the type of person Tish is--caring, selfless, and trying to help pediatric oncology patients with all of her resources..."

After the Extraordinary Healer contest, Tish did another overly generous thing for me. She transformed my mother's wedding dress into a custom dress for my wedding! This year, I am celebrating my six-year anniversary with Gabe Lozano, the man I took as my date to that awards ceremony in 2007.

I am also very excited to celebrate 10 years this May with no evidence of cancer. I'm still deciding how I may want to honor this milestone.

Last year, I completed a dual master's program in art therapy and counseling. I achieved my goal of becoming an art therapist, inspired by a woman who was my therapist during my cancer treatment. It was a long road as I had been in treatment on and off for so many years.

Recently, I began working in a residential facility for children and teens dealing with emotional and behavioral issues. The children inspire me so much every day, and I feel blessed to be there.

Combining my love for art therapy with helping others with cancer has led me to the opportunity of facilitating workshops for adults and children with cancer using art as the means of expression. I'm now helping plan a local young adult conference for people living with cancer this summer and will lead a session on art therapy.

I have continued to do inspirational speaking, which has taken me around the country and even to Europe. I have enjoyed meeting amazing people through all these experiences.

Although I still deal with many long-term side effects, I make the most of it, as I'd rather deal with them than the alternative. I'm even challenging myself to train with a program called Cancer to 5K to see how much I can push my body. It seems that if I'm busy with life, then I don't have much time to think about the lingering side effects.

As I reflect back on my experiences with CURE's Extraordinary Healer contest, getting the chance to honor such an amazing nurse who did so much for me has definitely been a highlight in my journey. I continue to see Tish occasionally, and she continues making the lives of children with cancer better and brighter. I hope to be more like her!

Rachel Lozano is an art therapist, artist and inspirational speaker. She is a three-time young adult survivor of Askin's tumor. Statistically, she had a 0 percent chance of survival the third time, but in May will celebrate 10 years of no sign of cancer. Feel free to contact her through her Facebook page, Rachel Lozano: Inspirational Speaker.

Editor's note: Nominate your nurse for CURE's 2014 Extraordinary Healer Award at Deadline March 28, 2014.


Adding surgery in metastatic kidney cancer could improve survival


Elizabeth whittington blog image
One of the stories out of the ASCO Genitourinary Cancers Symposium earlier this year was that patients with metastatic kidney cancer may benefit from surgery in addition to biological treatments.

Before targeted therapies, patients with metastatic renal cell carcinoma were treated with surgery and interferon. With the advent of targeted therapy, it's unknown whether surgery is still beneficial. The retrospective study examined patients treated with a targeted agent--most patients were treated with Sutent (sunitinib) or Nexavar (sorafenib). Because the study was not a randomized prospective study, patients chose whether to proceed with surgery, and about 60 percent elected to undergo a nephrectomy (surgical removal of the kidney). You can read the abstract here.

Patients who had surgery lived longer than patients who did not have surgery (20.6 months versus 9.5 months). However, because those who elected to have surgery were in better health, researchers had to adjust the data, which ultimately came out to a 40 percent survival benefit. This effect was apparent in patients who had longer life expectancy and good prognostic factors. Researchers noted that patients who had poor prognostic factors, such as low blood counts, did not appear to benefit from surgery.

Daniel Yick Chin Heng, presenting author of the study, said these results confirm a previous, but much smaller, study. "Cytoreductive nephrectomy may extend overall survival; however, not all patients should have it," he said. "Patients with a longer estimated survival can potentially stand to gain a lot more benefit from cytoreductive nephrectomy." Two phase 3 randomized studies will, hopefully, answer more questions in which patients would benefit from surgery.


Inflammation and fatigue


Kathy LaTour blog image

We now have another clue about why we are so tired during chemotherapy and for months afterward.

It's one of those "Dem Bones" issues. You know the old spiritual that says, "Toe bone connected to the foot bone, foot bone connected to the heel bone, heel bone connected to the ankle bone," and so on.

In this case, according to researchers at the Winship Cancer Institute at Emory University in Atlanta, Georgia, chemotherapy is connected to an epigenetic imprint in the DNA of breast cancer patients' blood and the imprint is connected to inflammation and inflammation is connected to fatigue.

The changes to the DNA are very complex, which I don't want to explain to you when I don't understand them. Suffice it to say that they are finding that these changes are in the DNA at six months post chemotherapy.

If you want to read the details you can find them in the journal Brain, Behavior, and Immunity. More researchers than ever are focusing on inflammation and its relationship to cancer. Ironically, this study appeared just when we were preparing the spring issue to go to press, and in it you will find a feature on inflammation as it relates to cancer and recurrence of cancer.

In the article we add another line to Dem Bones as we look at the impact of sress on inflammation. Stress does lots of nasty stuff in the body, including, perhaps, suppressing the immune system and encouraging inflammation.

So what does this all mean for those who cannot get off the couch because they are so fatigued, which, in turn, causes stress because we need to get off the couch to live. Well, it's time to take some control and find ways to fit exercise into our lives. I know, I know, you are tired of hearing it, but you will have to plug your ears if you want it to go away.

I am not talking about getting up and doing a 5 k. Just lie there and do leg lifts or get small weights and use those to get your oxygen level up. Get your blood pumping, which you can also do by raising and lowering your arms. Yoga has evidence that it helps. Exercise and other stress reducing activities also impact your chances of recurrence.

There are also inflammation reducing foods, spices and movement just as there are those foods that increase inflammation.

Check out what survivor and healthy living guru Kris Carr says about inflammation. Her response to a cancer diagnosis was to become a nutritionist.

No one thing is the answer to fatigue, but even small changes show our body we love it. So to wrap up . . .

Chemotherapy is connected to epigenetic changes in the DNA and they are connected to inflammation and it is connected to fatigue/ conversely less stress is connected to less inflammation and exercise is connected to less inflammation because it reduces stress.

No one said it would be easy.


The Little Couple has cancer


Kathy LaTour blog image

OK, I admit that I like a reality show called The Little Couple. I happened on it one night last year and was struck by how authentic Bill Klein and Jen Arnold came across. The premise of the show is to take part in the lives of a husband, Bill Klein, and wife, Jen Arnold, MD, as they marry, build their dream home in Houston and grow their family with two adopted children from abroad. And they happen to be little people, the polite term for those who suffer from some form of dwarfism.

I was impressed with Bill and Jen and their efforts to show the world that little people are just like everyone else. I don't know their goals for allowing cameras in their lives, as it has to be incredibly intrusive, but with this show it works. As a neonatologist, Jen Arnold is a working physician, and Bill Klein is a businessman. Then, as anyone who follows the show knows, while in India to pick up their adopted daughter, Zoey, Jen begins to bleed. A call home to her gyn results in a speedy trip back to the states where she is met by her mom and dad at the airport and then begins a series of tests to understand what is going on.

It's cancer. And quickly, the reality TV show became almost too real for those of us who have been there. As the build up to the show where we learn the details of Jen's cancer, I am sure most cancer survivors were saying, "It's cancer. We know the signs." Jen was diagnosed with gestational trophoblastic neoplasm, a very rare cancer that occurs in the tissue remaining after a failed pregnancy.

There were details not on the show but in the news about her treatment that I am not sure have yet occurred. For example, according to news accounts, chemo didn't seem to work at first, so they did a complete hysterectomy. Since, on this week's episode we saw Jen getting chemo, I don't know if the surgery is to come or if they already completed it and have moved on. At any rate, I am glad that Jen continues to affirm many details of the cancer experience.

For example, when she said the side effects of chemo seemed to be cumulative, it bothered me that even now, for a professional in the medical field, she still was not told that one fact. Chemo side effects are bad and they get worse with more treatment.

She has addressed the fatigue, which no one can tell you about until you experience it. I am glad we got to go with her to look for a wig and saw the quality she found at a shop that caters to those going through chemotherapy. We have such a shop here and it makes such a difference. Boy have wigs gotten better since the nasty things I wore in 1986.

Mostly, I am glad they decided to take the camera into chemotherapy with her and not gloss over it in the story line. I am sure the producers have had some serious talks about how much is too much when the other story line at home is the beautiful little Zoey with her big eyes, seriously smart and tender big brother Will – and a father who is clearly terrified. I applaud them for keeping the reality in reality television. Those who are newly diagnosed will find a friend in Jen as they struggle with the same issues. I just hope they let her continue to talk about the changes cancer has made in her new family – like living with the fear of recurrence -- and then celebrating when the cancer stays gone.

Once again cancer reminds us that it doesn't matter who you are and what you are doing. Jen, there are many who are with you and we send you our collective strength for the journey ahead.



Increased screening leads to decrease in colorectal cancer


Elizabeth whittington blog image

A new report reveals that incidence and mortality rates of colorectal cancer have been drastically reduced in the past 10 years. The article, "Colorectal Cancer Statistics, 2014" was published in CA earlier this month and reveals that there has been a steady drop in incidence rates over the past decade, most notably in individuals age 65 and older.

In the late 40s and early 50s, colorectal cancer was the number one cause of cancer death in the United States. Lung cancer would eventually surpass it, but many other factors over the past several decades have helped drive down colorectal cancer rates and deaths, including improvements in diet and lifestyle, increased aspirin use, the widespread adoption of routine colorectal cancer screening and advances in treatment. Experts predict that mortality rates could drop by 50 percent by 2020.

While there is much good news regarding the drop in incidence and mortality, as we dive a little deeper into the data, there is still much that needs focus.

Racial and socioeconomic disparities still persist. Death from colorectal cancer in black men is still 50 percent higher than in whites. What's interesting is that this wasn't always the story: In the 1960s, risk of death from colorectal cancer was actually lower in blacks than whites. Around the 1970s and 80s, incidence of colorectal cancer in black men began increasing while rates in whites began to drop. This can be traced to adoption of routine screening, stage at diagnosis, social and environmental factors and possibly diet.

Colorectal cancer increased in adults younger than 50. Experts believe that changes in diet and lifestyle may be a contributing factor. Focusing on reducing obesity in this group could be key.

Understanding cancer statistics helps researchers track patterns, which in turn can help identify strategies to reduce cancer incidence and deaths. With these new numbers, we learn that while we're making progress, there is certainly reason to celebrate. However, we also discover that we have much work to do, including continuing to build on improving colorectal cancer screening rates, engaging individuals who are at risk, including racial and socioeconomic groups and those who are underinsured and uninsured. We also have to examine why those under 50 appear to be developing colorectal cancer at increasing rates. Do we lower the age of routine screening, focus on diet and lifestyle changes or promote awareness of other risk factors, such as Lynch Syndrome?


Fight Colorectal Cancer calls on Congress


suzanne lindley blog image

The depths of my senses are on edge. I hear the whipping wind outside my door while the sunshine pours through the window at my back. I have only to turn around in my seat to see the dust dancing in small clouds of gray across the yard while the blue sky kisses the back edge of the pasture. The horses are kicking up their hooves; enjoying a day of play in not hot weather, but just right temperatures. They circle the trees; first trotting then loping beyond my sight. Within this day filled with blue skies and sunshine there is more normalcy than I could have ever imagined this time 15 years ago, in great part due to the efforts of Fight Colorectal Cancer.

Back then, I was only months into a diagnosis of stage 4 colon cancer and the world seemed to be falling apart at the seams. I don't even remember if there was such a Colorectal Cancer Awareness Month. Those were the days when coping with colon cancer was new, and I cried much more than I laughed. There was despair, anguish, anger and frustration. Questions and doubts hung heavily in the air. All that had seemed perfect just months before felt dangerously close to disappearing. I looked at my children and fell to pieces; not knowing how to hold on from one minute to the next. I would grab Ronnie's hand and cry with the realization that in old age it would probably not be me that was sharing his golden years. It took the help of old friends, my family and new friends to help me struggle through the fear and loneliness to slowly accepting the new normal that crept in and quickly encompassed every minute of each day.

How thankful I am for the army of goodwill that surrounded me...both from the spirit and warmth of organizations to the endless list of names that were rarely farther than a phone call away. Today, many of those angels are marching on Capitol Hill with Fight Colorectal Cancer. I'm usually there but spending time this year with my bubbly 6 year old who has just finished up her Spring Break. Although I'm not physically walking the Halls of Congress or personally knocking on the doors of my elected officials (Representative Hensarling, Senator Cruse and Senator Cornyn), I am making phone calls and sending letters.

This year, I'm proud to say that Fight Colorectal Cancer has made an even bigger impact than ever before at Call on Congress! The first two days advocates were briefed on important issues in colorectal cancer and learned how to communicate with legislators as well as hearing from experts across the United States who discussed research funding, emerging science and the current state of policies that impact colorectal cancer. Advocates around the country also helped to create Blue Star States across the nation!

Today is the biggest day of all, where advocates go to the Hill and visit their elected officials. They share their voices and empowering stories; ensuring the importance of colorectal cancer and establishing it as a national priority. It is here that my voice, your voice and the voices of those who may not even know about colorectal cancer are represented. It is because of these very special advocates that my children and your children may soon live in a world where colon cancer is a cancer of the past. To learn more about what advocates are accomplishing or to be a part of Call on Congress next year, visit

Preventable, Treatable, Beatable!!

Suzanne Lindley has been living with metastatic colorectal cancer since 1998. She is the founder of YES! Beat Liver Tumors, an organization for individuals living with metastatic liver tumors, and an advocate for Fight Colorectal Cancer.


Lynch Syndrome Awareness Day: March 22


Elizabeth whittington blog image

On March 22, communities around the world will recognize Lynch Syndrome Awareness Day. While some may scoff at the multitude of "awareness" events throughout the year, this may be one that could have wide-ranging benefits.

We've learned that this hereditary genetic mutation (LS), also known as hereditary nonpolyposis colorectal cancer (HNPCC), may be the cause of a higher percentage of colorectal and other cancers than previously thought. Approximately 3 to 5 percent of all colorectal cancer cases can be traced back to LS. And it's estimated that 600,000 to 800,000 people in the U.S. may have LS, but only 5 percent are ultimately tested and diagnosed with the syndrome.

This year it seems especially fitting to recognize LS Awareness Day as the National Comprehensive Cancer Network, a group of 25 of the world's leading cancer centers, announced a recommendation at their annual meeting that nearly all patients diagnosed with colorectal cancer should be screened for LS. (There is an option to forego testing on patients older than 70 who do not have other risk factors.) The recommendation is included in the latest set of clinical guidelines issues by the NCCN. You can view the guidelines here, but access requires site registration, which is free.

Because people diagnosed with LS have an 83 percent chance of colorectal cancer, it's important that testing be done early so they can take advantage of preventive measures to reduce their risk of cancer, such as increased screening, surgery or chemoprevention drugs. LS can also greatly increase the risk of bladder, pancreatic, gastric, ovarian and other cancers. For patients who have been diagnosed with cancer, a confirmation of LS can help guide treatment, follow-up and surveillance for other cancers.

Lynch Syndrome International is keeping a running track of events around the world and the U.S. on its Facebook page to help spread the word. In response, the awareness of LS has brought about a conversation that could have as much impact as the "Katie Couric Effect" had on colorectal cancer screening.

A friend's husband was recently diagnosed with colorectal cancer. Barely 40 and a family history of the disease, my immediate thought was Lynch Syndrome. It's disappointing that LS screening wasn't a priority for all patients with CRC earlier, as he could have been more closely monitored for the disease and preventive actions could have been taken. But screening for LS may still benefit him through treatment and survivorship, as well as his children and other family members.

To help learn more about LS, several studies are underway, including this one from the Ohio Colorectal Cancer Prevention Initiative. All patients diagnosed with colorectal cancer in Ohio will be screened for LS to help provide recommendations for high-risk individuals, as well as genetic counseling.

With a recent report out that routine screening and advances in treatment have significantly reduced colorectal cancer incidence and mortality, it seems that awareness and action for those with LS may be the next frontier.


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