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April 2010 Archives

By Mary Brolley, Staff Writer

JakeasSuperman.jpgTwo years after his son Jake's grueling but successful treatment for childhood cancer, powerful feelings are still close to the surface for Joe C. of McLean, Va.

Chief among them: shock, fear, gratitude and relief.

Just after Jake's third birthday in early 2008, the little boy was diagnosed with rhabdomyosarcoma, a soft tissue cancer in children.

Tests revealed that the tumor was attached to his bladder, which explained why urination had become so difficult for him.

The tumor's size and location -- and Jake's age -- made choosing an effective course of treatment especially complicated.

Composed of cells that normally develop into skeletal muscles, rhabdomyosarcomas occur most often in children and teens. They represent about 3% of all childhood cancers, and approximately 350 new cases of rhabdomyosarcoma occur each year in the United States.
    

Proton therapy offers 'remarkable chance'
After consulting with experts at a local hospital in Virginia and getting a second opinion from another team at Johns Hopkins Hospital in Baltimore, Md., Joe and his wife Amy elected to augment Jake's chemotherapy treatment with an emerging, though lesser-known, form of radiation called proton beam therapy.

Because their bodies are still developing, children may have more serious long-term side effects from radiation treatment -- intellectual impairment, decreased bone and soft tissue growth, hormonal deficiencies and the development of second tumors.

But with its capability to precisely deliver high doses of radiation to the tumor with little damage to surrounding normal tissue, proton beam therapy is increasingly being used to treat cancer in pediatric patients.

Joe and Amy were convinced that chemotherapy and proton therapy offered the best chance to cure this difficult cancer, whose location near Jake's developing organs made its removal tricky and dangerous.

"Our radiation oncologist at Johns Hopkins felt that the combination of chemotherapy and proton therapy offered Jake 'a remarkable chance' of eliminating the tumor," he recalls.

But where to go for this therapy?

"He told us proton beam therapy is available in just five places in the country (at the time). And due to its wealth of experience in treating children, he recommended MD Anderson," he says.

The couple met a number of physicians and medical professionals who would become their partners in returning Jake to health. Among them was Anita Mahajan, M.D., associate professor in MD Anderson's Department of Radiation Oncology. Because of her expertise in treating pediatric tumors, she led Jake's care team.

Cancer treatment for a young child requires special accommodations. This is especially true for proton therapy, whose precision is the key to its success in killing cancerous tissue while sparing healthy tissue. Children have a harder time holding still, so those under age 8 require sedation before treatment. 

Mahajan and Vivian Porche, M.D., professor in the Department of Anesthesiology and Perioperative Medicine, were determined to make it as easy and interactive as possible for Jake.

Porche taught him how to "put himself to sleep" for the treatments, allowing him to push the button that started the anesthesia. Then she and nurse anesthetist Cynthia Williams sang him lullabies until he fell asleep.

Joe, who usually accompanied Jake to his proton treatments because his wife was home in Virginia with their younger child, still gets choked up when he remembers Porche's promise to him: "I'm your baby's mama when your baby's mama isn't here."

During their five weeks in Houston, the family stayed in the Ronald McDonald House. This made it easy when Amy and baby Lucy visited Joe and Jake every weekend. "We were treated like royalty," he says.

A healthy, happy 5-year-old

Two years later, Jake is a healthy, happy 5-year-old. Of all his father's memories about the months of Jake's treatment, two stand out.

Once, after a day when Jake's chemotherapy caused him to vomit repeatedly, 3-year-old Jake looked thoughtfully at his mom as she tucked him in for a nap, and asked, "Mommy, are you proud of me?"

In the other, young Jake responded defiantly to an older child who teased him about having lost his hair. "Jake reached up and touched his remaining hair and said, 'I have hair!' Joe recalls. "The kid said he didn't, and Jake said, 'Yes, I do!.' Eventually, he wore the kid down, and he walked away.

"He's just a tough little kid -- as are all these kids."

Related article:
Q&A: Proton Therapy for Pediatric Patients

MD Anderson resources:
Children's Cancer Hospital at MD Anderson

Childhood rhabdomyosarcoma

MD Anderson Proton therapy center

Anita Mahajan, M.D.

Vivian Porsche, M.D.


Additional resources:
The National Association for Proton Therapy

Anita Mahajan, M.D., associate professor in MD Anderson's Department of my Radiation Oncology, answers questions about proton therapy for pediatric cancer patients.

What is proton therapy?

Proton therapy is an advanced form of radiation therapy that uses protons, which are charged particles from an atom. The advantage of proton therapy over traditional forms of radiation treatment is its ability to deliver a pencil-thin beam of radiation to the tumor area with remarkable precision -- within one millimeter -- that avoids the surrounding tissue, generates fewer side effects and improves tumor control.

Proton therapy requires a highly specialized machine to deliver treatment, as well as a highly trained staff to ensure the best planning and treatment.

How does it differ from traditional (photon) therapy?

Proton therapy is different from traditional X-ray or photon therapy because it aims high-energy protons very accurately at the area of concern. Once protons enter the body, they deposit their energy (dose) at a precise location and stop, allowing no dose of radiation to go farther into the body. With more common radiation treatments that use X-rays (also known as photons or gamma rays), radiation is aimed precisely at the tumor. However, some radiation continues through the body, radiating organs and tissues that may not require treatment. This dose is called the "exit dose" and is almost non-existent with proton therapy.

What are its advantages?

The biggest advantage of proton therapy for children is that it reduces the dose to the body outside of the tumor area. In addition, there tends to be less radiation deposited between the entry point on the surface of the patient's body to the target area, know as the "entrance dose." Proton therapy may allow more aggressive treatment of tumors near or within sensitive organs, such as the lungs. In children, there may be a reduction in side effects with proton therapy. There's convincing evidence that even low doses of traditional radiation can increase the risk of secondary tumors.

Why was it a good choice for Jake's rhabdomyosarcoma?

Jake (the patient featured in the profile above) had a relatively rare cancer of the soft tissue that originated in the skeletal muscle. He was an ideal candidate for proton therapy because he had a fairly large pelvic tumor, surrounded by sensitive organs, including the bowel, pelvic bone, femurs and testis.

We recommended proton therapy because we felt there would be an advantage with the reduction of dose to the intestines, pelvic bone and femurs. This dose reduction allowed less bone marrow suppression, less bowel irritation (which can cause diarrhea), and better nutrition and tolerance of chemotherapy. In addition, by lowering the dose to these areas, we hope that he has fewer side effects as he gets older.

Is proton therapy recommended for other pediatric cancers?

Proton therapy has been used for several different pediatric cancers, including brain tumors, sarcoma and lymphoma. It can and should be considered for any child who's receiving aggressive curative treatment where moderate to high doses of radiation are required.

Are there special considerations when working with pediatric patients?

Young children and some older patients require daily sedation to help them stay still for any radiation. Reliable anesthesia support is absolutely necessary to allow safe and efficient radiation delivery.

Treating children with radiation is very challenging and rewarding. We've made great strides in curing many more childhood cancers, but we also realize that these young patients have many side effects as they grow older from the therapies that have helped cure their cancers. When treating children, we realize that they require aggressive therapy including surgery, chemotherapy and radiation therapy. We have to be aware of their previous and ongoing therapies, and we must consider their age, growth potential and functional development to minimize side effects and maximize their future quality of life.   

What else should parents know about this therapy?

Proton radiation is an exciting technology that may help reduce side effects during and after therapy. It should be part of a multidisciplinary approach that's common for many childhood malignancies. So far, results indicate that the rate of successful treatments is identical to traditional radiation, with a potential added benefit of fewer side effects.  Proton therapy also requires daily sessions (five days a week) for up to six weeks, depending on the particular tumor type. Patients may still have side effects, in particular from the organs and tissues adjacent to the tumor since part of them will receive most, if not the full, dose of radiation.

Related article:
Pediatric Patient Benefits From Proton Therapy

MD Anderson resources:


Children's Cancer Hospital at MD Anderson

Childhood rhabdomyosarcoma

MD Anderson Proton therapy center


Additional resources:

The National Association for Proton Therapy


By Laura Prus, Staff Writer

pomegranate.jpgOften hailed for their heart-healthy benefits, pomegranates have recently shown potential anti-cancer properties. A recent study revealed that eating pomegranates may help prevent breast cancer.

Pomegranate seeds produce a chemical known as ellagic acid. This chemical inhibits the estrogen-producing enzyme, aromatase, which plays a key role in breast cancer growth.

According to the American Cancer Society, 194,280 breast cancer cases were expected to occur in 2009. It has been noted that 75% of breast cancer cases are fed by estrogen.

Conducting the study
Conducted at the Beckman Research Institute of the City of Hope in California and published in Cancer Prevention Research, the study is the first to investigate the effects of pomegranate juice and aromatase. Researchers conducted laboratory tests to examine how 10 ellagitannin-derived compounds from pomegranates impacted aromatase activity and breast cancer cell growth.

Of the 10 compounds studied, urolithin B most significantly inhibited breast cancer cell growth. It is not known how much of the chemical is required to have an effect in humans, and researchers say it might not be possible to gain enough from diet alone. However, they added that including pomegranates in your diet could prove beneficial.

Further research is needed
Although results were promising, further studies will be made to determine whether consuming pomegranates will have the same effect in humans.

"More research on the individual components and the combination of chemicals is needed to understand the potential risks and benefits of using pomegranate juice or isolated compounds for a health benefit or for cancer prevention," says Powel Brown, M.D., professor and chair of MD Anderson's Department of Clinical Cancer Prevention.


Resources
Pomegranate Ellagitannin-Derived Compounds Exhibit Antiproliferative and Antiaromatase Activity in Breast Cancer Cells In vitro (Cancer Prevention Research)

By Sandi Stromberg, Staff Writer

checkingformelanoma.jpgEveryone looks forward to summer, especially in northern climates when the snow and ice melt and we can spend more time outdoors. School's out. The children are home. There's time for swimming and barbecues, picnics and family reunions.

But it's also a time to pay attention to our bodies and the sun. While experts say we need 15 minutes of sun a day to absorb enough vitamin D, too much sun can have adverse consequences, like skin cancer, the most dangerous of which is melanoma.

A cancer that occurs in melanocytes, the cells that give skin its color, melanoma represents about 3% of all skin cancers. However, it has the highest death rate of all types and is more likely to metastasize (spread).

Be aware of the symptoms

The symptoms of skin cancer vary from person to person and may include a:

•    Change on the skin, such as a new spot or one that changes in size, shape or color
•    Sore that doesn't heal
•    Spot or sore that changes in sensation, itchiness, tenderness or pain
•    Small, smooth, shiny, pale or waxy lump
•    Firm red lump that bleeds or develops a crust
•    Flat, red spot that is rough, dry or scaly

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

Pay attention to risks

Certain characteristics may put you at risk if you:

•    Spend too much time in the sun or have a history of severe blistering sunburn. Artificial tanning beds carry the same risk for melanoma as natural sunlight.
•    Are fair haired with light skin and blue eyes and have a strong tendency to sunburn.
•    Have a history of melanoma. The risk for a second case is 3% to 7%, much higher than the general population.
•    Have a large number of benign moles.
•    Carry a specific gene or gene mutation that has been identified as playing a potential role in the development of melanoma.
•    Have an atypical mole and melanoma syndrome (AMS), which can indicate increased risk.

Learn how to reduce your risk

To reduce your risk, MD Anderson experts suggest that you:

•    Use sunscreen. Choose an SPF 15 or higher, put it on 30 minutes before going outside and follow product directions for reapplication.
•    Find shade. Look for shady areas under an umbrella or tarp. Better yet, stay indoors between 10:00 a.m. and 4:00 p.m.
•    Cover up. Wear a shirt or other cover-up to protect your skin from the sun.
•    Wear a hat. Pick one with a large brim to protect the ears and neck.
•    Put on sunglasses. Buy sunglasses to protect your eyes from harmful UV rays.
•    Protect your children. Babies under 6 months of age should be completely shielded from direct sun exposure. Apply sunscreen to infants over 6 months of age, and teach older children to make applying sunscreen a regular habit before they go out to play.
•    Avoid the use of tanning beds or other artificial sunlight sources. Tanning beds are not safe alternatives to the sun.

The ABCs of early melanoma detection

Melanoma appears most frequently on the trunk area in fair-skinned men and on the lower leg in fair-skinned women. In dark-skinned people, melanoma appears most frequently on the palms, the soles of the feet and the skin under nails. If caught early, melanoma is potentially curable.

Be aware of change and new growths on your body. The ABCs of melanoma provide a good guideline:

•    Asymmetry of lesion: Are the sides of the lesion different?
•    Border irregularity: Are the edges notched as opposed to smooth?
•    Color variation: Is the lesion a mixture of black, blue, red and white?
•    Diameter: Is the diameter greater than six millimeters? (Most melanomas are larger than the head of a pencil.)
•    Evolution: Is the lesion growing in width or height?
•    Feeling: Has the sensation around a mole or spot changed?

These recommendations serve as a guide. Promptly show your doctor any suspicious skin area, non-healing sore or change in a mole or freckle. If exam results suggest cancer, more extensive diagnostic tests should be conducted.


MD Anderson resources:

Skin cancer Q&A


Just the Facts: Skin Cancer (PDF)


Melanoma: A Pathfinder


Advances in the treatment of melanoma (Patient Power Audio Podcast)


Sun safety, skin cancer and teens (Cancer Newsline Audio Podcast)


Melanoma and skin cancer with Dr. Patrick Hwu (Video)


Melanoma and Dr. Patrick Hwu with his patient, David (video)


Melanoma survivor David Ess (Video)



Wolf_photo.jpgWhen Judith Wolf, M.D., started running to and from the hospital as a healthy response to grueling 36-hour days as a gynecologic oncology fellow, little did she realize that two of her greatest passions later would come together for the benefit of so many.

Now a noted ovarian cancer specialist and a senior member of M. D. Anderson's renowned Department of Gynecologic Oncology who still pulls long hours, Wolf will be one of the first out of the blocks on Saturday, May 1, at the 13th annual Sprint for Life Run/Walk and Sprint for Sprouts Kids' Run.  

A seasoned runner, Wolf founded the race in 1998 to raise funds for M. D. Anderson's Blanton-Davis Ovarian Cancer Research Program. Wolf continues to chair the annual event which, to date, has brought in more than $2.3 million for basic science and translational research.  

Wolf fondly remembers her patient Laura Lee Scurlock Blanton - one of the two women for whom the Blanton-Davis Program is named - and runs the annual event not only in memory of her but other women who have lost the fight with ovarian cancer.  Wolf remains steadfast in her commitment to the cause and the annual event, inspired by the women who are patients and survivors - and for their daughters and granddaughters. Today, Eddy and Kelli Scurlock Blanton, Laura Lee's son and daughter-in-law, work alongside Wolf and her substantial team of M. D. Anderson staff and volunteers to grow the event each year.

"I remember when Mrs. Blanton came out to watch me run my first marathon. It was the day before she was scheduled for surgery, but she was running up and down the course with her camera cheering me on," Wolf says. "We had a unique bond and it's important for me to do this in her memory and for the others fighting ovarian cancer.  This race is about celebrating survivors, raising awareness and supporting research to find better therapies and ultimately, a cure."

To register for the May 1 Sprint for Life 5K Run/Walk and Sprint for Sprouts Kids' Run, click on http://www.mdanderson.org/how-you-can-help/community-events/sprint-for-life/index.html


As we acknowledge National Minority Cancer Awareness Week, it's an appropriate time to pause to look at why race and ethnicity might be risk factors for cancer.


According to the American Cancer Society, the incidence of cancer (those who are diagnosed with the disease) in the United States is highest in African-Americans followed by Caucasians, Hispanics, Asian-Americans and American Natives, and deaths (those who die from the disease) are highest in African-Americans followed by Caucasians, American Natives, Hispanics and Asian-Americans.
 
The chart below includes data from the National Cancer Institute and the American Cancer Society on the three most common types of cancer: lung, prostate and breast.

  Lung Cancer - Men and Women Prostate Cancer - Men Breast Cancer - Women
Highest Incidence Rate African-American males African- American White, non-Hispanic
Lowest Incidence Rate Hispanic females American Indian/Natives Korean American
Highest Death Rate African-American males African- American African-American
Lowest Death Rate Hispanic females Asian / Pacific Islander Chinese American


Recent research indicates that there are many factors, including ethnicity, that may contribute to the development and survival rates for some cancers.

Some of the factors are:

•    Lifestyle behaviors encompassing diet, physical exercise, sun exposure, smoking, and alcohol use and sexual practice behaviors
•    Socioeconomic factors including education and income level, access to health insurance, and routine medical screening and services 
•    Genetic factors involving inherited genes and a family  history of certain diseases
•    Cultural factors involving practices, beliefs and in some instances mistrust of the health care system, which may prevent some from seeking preventive screening services 
•    Age, which supports the concept that cancer is a disease largely associated with aging; so the longer one lives, the greater that person's risk for developing the disease

The question is often asked, "Why can't we cure cancer?" One reason is that there isn't just "one" cancer. There are more than 200 types of cancer and treatment for one type might not work for another. With the existence of so many different cancers it's evident that many risk factors, including extenuating factors associated with the different racial and ethnic groups, play a role in the development and survival of some cancers.

It's also evident that cancer is not an inevitable fact of life. In many cases, it can be prevented or detected at its earliest and most curable stage. People could protect themselves by following these simple steps:

•    Know the risks and ask questions
•    Make healthy lifestyle choices
•    Access health care services, including preventative screenings and health care events

By Will Fitzgerald, Staff Writer

carrington.jpgToday, college scholarships come in a variety of forms, including recognition for academic achievement, athletic prowess or even membership in a community organization. However, scholarships are also awarded for students demonstrating the will to survive and a bit of artistic expression to boot.

The Children's Art Project at M. D. Anderson (CAP) awards tuition assistance to more than 80 kids each year who are involved with the program during and after their cancer treatment. Funds supporting scholarships come from the sale of each patient's unique artwork.

I got the inside scoop about the program from Carrington Marzett, 20, of Midland Texas, who's the recipient of a CAP scholarship.  After being diagnosed with lymphoblastic leukemia at age 15, Carrington is just one of the healthy kids now pursuing big dreams.

"It's been amazing," she said of her involvement with the project. "I have enjoyed every minute of it."

Carrington currently attends Baylor University and is majoring in sociology with an emphasis on medical humanities. I, of course, know her as the creative genius behind many of CAP's designs, so I was surprised to learn she wasn't an art history major.

"I'm thinking of becoming a professor of American literature, or possibly joining Teach for America after I graduate," she told me.

Unfortunately, while in school, the reality of cancer surfaced once more. One of Carrington's favorite professors was diagnosed with breast cancer, but it was clear this wasn't a moment of pity, rather one of friendship and hope.

"When I first heard, I felt really bad because we had formed a bond," she says. "I decided to give her one of my CAP designs."
Bunny Note padThat design turned out to be the Bunny Note Pad, one of this spring's best-selling products. It features a festive colored bunny complete with yellow swirls, and an important personal story that Carrington laughed about when I asked her. 

"It wasn't hard to create the Bunny Note Pad because when I was a kid I had a rabbit, that served as my inspiration," she said.  "It was completely white with red eyes; I think it was an albino."

As with each CAP artist, the real story lies somewhere in between their courage, optimism and unique ability to remind us all of what's really important in life.

For more information on CAP programs or to purchase artwork please visit

Related Stories

Young Leukemia Patient Finds Joy in Art

By: Alex De Alvarado, Peiying Yang, Ph.D., Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

vitamin d in sunshineVitamin D is a fat-soluble nutrient well known to be essential for the absorption of calcium and maintaining bone health. Health benefits may include improvement of immune function, muscle strength and reducing inflammation. In addition, ongoing research is examining the role of vitamin D in cancer prevention and treatment.

While vitamin D may be obtained through diet, there are few foods that naturally contain adequate amounts. The best sources include the flesh of fatty fish such as salmon, mackerel, tuna and fish liver oil. Secondary sources include fortified foods such as milk, juices, yogurt, bread and supplements.

The body can also make vitamin D through direct sun exposure, although recommended guidelines have not been established. Researchers have suggested that 5-30 minutes of sun exposure between 10:00 a.m. and 3:00 p.m. at least twice a week to the face, arms and legs is sufficient to gain a benefit. Caution should be used during exposure, as increased levels of sun exposure may lead to an increased risk for skin cancers. 

The Institute of Medicine, Food and Nutrition Board recommends the following daily intake of Vitamin D depending on age:

•    For 0-50 years, 5mcg or 200 IU
•    For 51-70, 10 mcg or 400 IU
•    For 71+, 15mcg or 600 IU

The current recommendations are regarded by many health professionals as being too low. The new guidelines set to be released later this year will likely recommend a substantially higher level. The U.S. Food and Nutrition Board, as well as the European Union's Scientific Committee on Food, list the upper intake level of Vitamin D at 2,000 IU (the maximum daily intake unlikely to cause adverse health effects).

The link between vitamin D and cancer
Ecological studies have examined the association between cancer incidence and survival with vitamin D through sun exposure. Findings suggest that individuals living in northern latitudes have an increased risk of cancer as compared to those in southern latitudes where sun exposure is more accessible for production of vitamin D in the body.

Research has shown that vitamin D may have a role in reducing the risk for more than 16 types of cancer including bladder, breast, colon, endometrial, esophageal, gallbladder, gastric, lung, ovarian, pancreatic, prostate, rectal, renal, vulvar cancer, and Hodgkin's and non-Hodgkin's lymphoma.

A large four-year trial involving 1,179 postmenopausal women found vitamin D plus calcium supplementation significantly reduced the all-cancer risk. However, conflicting research such as the Third National Health and Nutrition Examination Survey found no association between vitamin D and cancer mortality with the exception of colorectal cancer. It reported a 72% lower risk of colorectal cancer death for those participants in the study with higher vitamin D blood levels, as compared to those with lower blood levels.

In addition to colon cancer, promising research has found correlations between reduced breast cancer risk and vitamin D obtained through both diet and sun exposure (6) (7).

More research is needed to assess the benefits of vitamin D for cancer and other illnesses. The National Institutes of Health is currently sponsoring a major study involving 20,000 participants called the VITamin D and OmegA-3 TriaL, or VITAL, investigating whether dietary supplements of vitamin D (about 2000 IU) or fish oil (about 1 gram of omega-3 fatty acids) reduces the risk of developing cancer, heart disease and stroke in those without prior history of these illnesses.

Because vitamin D deficiencies are prevalent in our society, it is recommended that all individuals, with or without cancer, have their vitamin D levels checked and ensure they are maintained at the recommended levels to obtain health benefits.

Further Reading
1.  Office of Dietary Supplements Fact Sheet

2.  Vitamin D deficiency.New England Journal of Medicine

3.  Solar ultraviolet-B exposure and cancer incidence and mortality in the United States, 1993-2000 BMC Cancer 2006

4.   Vitamin D and calcium supplementation reduces cancer risk: Results of a randomized trial. American Journal of Clinical Nutrition 2007

5. Prospective study of serum vitamin D and cancer mortality in the United States. JNCI 2007

6.  Vitamin D From Dietary Intake and Sunlight Exposure and the Risk of Hormone-Receptor-Defined Breast Cancer Am J Epidemiol 2008 Aug 27

7.   Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women's health study. Cancer Causes Control

A trail-blazing lung cancer clinical trial that matched drugs to patients based on a molecular analysis of their tumors took center stage today at the opening session of the American Association for Cancer Research 101st Annual Meeting 2010

The Phase II clinical trial known as BATTLE demonstrates the potential of using drugs that target specific genetic networks or other molecular defects to tailor personal therapy for patients. That's not done now in lung cancer, as it can be to the benefit of some breast and colon cancer patients, because there are no established molecular signatures to predict who would benefit from each drug, says clinical trial leader Edward Kim, M.D., associate professor in M. D. Anderson's Department of Thoracic/Head and Neck Medical Oncology.

BATTLE -- short for Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination -- evaluated four drugs in 255 stage IV non-small cell lung cancer patients who had received between one and nine previous treatments.

"We know that new targeted therapies help a fraction of lung cancer patients, but we haven't been able to identify who those people are," Kim says. "BATTLE demonstrates the feasibility of a more personalized approach by taking a new biopsy of each patient's tumor, swiftly evaluating that tumor tissue for specific biomarkers, then assigning drugs to patients based on that analysis." 

For example, the researchers found one of the four drugs in the trial, sorafenib, didn't work at all against tumors with one common, more easily treated mutation. However, sorafenib had good effect controlling tumors that featured a KRAS mutation, which has no proven treatment.

By using an innovative statistical approach to identify patients in Phase II clinical trials who are most likely to benefit from a targeted drug, BATTLE points the way toward focused Phase III trials that will require fewer patients, take less time and will be more likely to succeed.

Lung cancer research, Kim says, is littered with large Phase III trials that enrolled hundreds or thousands of patients, then showed no or only minor effects. Many failed to enroll enough patients to finish.


The BATTLE abstract at AACR can be viewed here.

Read the news release from M. D. Anderson - BATTLE Links Potential Biomarkers to Drugs for Lung Cancer

By Mary Brolley, Staff Writer

health insuranceExcerpted from Network Newsletter Spring 2010

Ricki Hasou has seen the health insurance game from both sides. After a long career with a major insurance company, she joined M. D. Anderson in 2007 as a senior managed care analyst in the Department of Managed Care.

Since then, she's helped M. D. Anderson patients figure out how to deal with their managed care plans.

For cancer patients who have insurance coverage, keeping up with the paperwork from their insurance carriers and health care providers is daunting.



Organization, record keeping essential

As many patients have discovered when they're dealing with an onslaught of mailings and e-mails from providers -- especially during a long or protracted illness -- it's nearly impossible to remember whom you called, what you discussed and exactly when.

Yet, because these details may help build or support a case, it's crucial to track them in a notebook or maintain notes in a file.

Knowing your policy means reading the materials sent or provided when you enrolled. Take your time, read through it, figure out what type of coverage you have.

Define the terms
Many patients consider traveling to Houston to be treated at M. D. Anderson, so in- and out-of-network benefits are one of the largest areas of concern. Every day, Hasou's colleagues in Managed Care and in the Department of Patient Access Services go to bat for those who want to be treated at M. D. Anderson. Physicians and their staffs are also accustomed to stepping in to help assure coverage.

Your insurance card yields insights
Though this may seem simple, your insurance card provides a good deal of information and is essential to getting anywhere.

The card contains identifying information about the cardholder and the policy, including co-payment amounts.

Customer service personnel: your allies
Hasou insists that the staff of the insurance company's customer service department is or should be the patient's or caregiver's friend. "The person who answers the phone is your advocate," she says. "He or she is there to help you."

Hasou's advice? Take a deep breath. You'll likely have plenty of time to do so while you're on hold. Then, she advises, be polite but persistent.

Read the Full Article in Network, Spring 2010

eatinghealthy.jpgExperts at the American Institute for Cancer Research estimate about one-third of the 1.4 million cancers that occur every year in the United States could be prevented, in part, by eating a healthy diet. The food you put in your body plays a vital role in beating this disease.

The April issue of Focused on Health, M. D. Anderson's online healthy living newsletter, shares tips on how to outsmart restaurant menus, talks about the best cancer-fighting foods, and provides recipe and menu ideas to jump-start your cancer prevention diet.


Fight Cancer With Food
What do grapes and broccoli have in common? They both play a "starring role" on our list of cancer-fighting foods. Learn how to fight cancer with fruits and veggies

A Healthy Plan for Dining Out
Boost your restaurant IQ with smart tips to help you steer clear of diet-sabotaging menu items. Get six healthy ideas to outsmart the menu

Easy Ideas to Makeover Lunch
Make healthier choices one meal at a time. Try our five-day lunch menu to give your midday meal extra protective power against cancer. Get healthy lunch ideas.

Fit Food From Many Cultures
Get ready to say "Olé!" Learn about the health benefits found in many cultural dishes. Get low-fat cultural food recipes.

Featured videos include:
Video: Cooking Healthy (1:04:10)
Watch as Scott Uehlein, corporate chef at the world famous Canyon Ranch, demonstrates how to make flavorful healthy meals.

Dubois_CIPRIT GrantRepresentatives of the second-largest funding source for cancer research in the country visited Houston Wednesday to pass out some large checks to area researchers.

Jimmy Mansour, chairman of the oversight board of the Cancer Prevention and Research Institute of Texas (CPRIT), and board member Charles Tate distributed huge checks of the non-negotiable, symbolic variety representing $35 million in CPRIT funding to five research institutions and two biotech companies.

"This is a wonderful day, not only for the City of Houston and the Texas Medical Center, but also for would-be victims of cancer across the country and even the world," Mansour said. CPRIT awarded funding for its first round of research grants and prevention programs earlier this year.

Research projects will focus on areas such as new cancer inhibitors, early detection efforts, stem cell studies, screening techniques, and all types of cancers including colorectal, breast, lung, pancreatic, colon, cervical, prostate, leukemia and lymphoma.

Created by a constitutional amendment passed by the Texas Legislature and approved by voters in 2007, CPRIT will invest $3 billion in cancer research over the next 10 years. "We expect to be back in Houston many more times in the next ten years," Mansour said.

Recipients Wednesday were M. D. Anderson; Baylor College of Medicine; Ingeneron Inc.; Methodist Hospital Research Institute; Rice University; The University of Texas Health Science Center at Houston; and Visualase Inc.

Former CPRIT board member, current agency ambassador and past Rice University President Malcolm Gillis, Ph.D., presented M. D. Anderson's $12.7 million "check" to Provost and Executive Vice President Raymond DuBois, M.D., Ph.D., who praised the speed and efficiency of the new state agency. "CPRIT assembled an executive team, pulled together research committees and then got funding out in record time," DuBois said.

Executive Director William "Bill" Gimson and Chief Scientific Officer Al Gillman, M.D., Ph.D., were appointed in March and April of 2009.

"Texas' bold and decisive action is unparalleled by any other state in the country," Mansour said, noting CPRIT is second only to the National Cancer Institute in the funding of cancer research. The agency has kept overhead costs to 3% of its budget, a number that will continue to drop, Mansour said. CPRIT also assembled a group of 105 scientists to review grant applications, all of whom are from out of state.

The CPRIT web site has a complete list of all grants awarded.


M. D. Anderson awardees are:

Individual Investigator Awards

Christopher Amos, Ph.D., professor, Department of Epidemiology, "Effects from nicotinic receptor variations on smoking behaviors and lung cancer risk," $1,441,155.

Richard Davis, M.D., associate professor, Department of Lymphoma/Myeloma, "Self-antigen dependence of chronic active B-cell receptor signaling in the activated B-cell type of diffuse large B-cell lymphoma," $971,675.

Sharon Dent, Ph.D., professor, Department of Biochemistry and Molecular Biology, "Regulation of Ash2L and MLL oncoproteins by PRMT-mediated methylation in normal cells and acute leukemias," $949,549.

Raymond DuBois, M.D., Ph.D., professor, Department of Gastrointestinal Medical Oncology, "Prostaglandins and inflammation in colorectal cancer," $1,198,243.

Guillermo Garcia-Manero, M.D., associate professor, Department of Leukemia, "Analysis of histone code alterations and the role of histone demethylase JMJD3 using CHIP-seq in myelodysplastic syndromes," $771,451.

Peter Gascoyne, Ph.D., professor, Department of Imaging Physics, "Antibody-free microfluidic isolation and molecular analysis of circulating cancer cells," $913,709.

Georg Halder, Ph.D., associate professor, Department of Biochemistry and Molecular Biology, "Discovery and validation of novel cancer drug targets through synthetic lethal screening," $963,854.

Vicki Huff, Ph.D., professor, Department of Genetics, "Next generation genomic sequence identification of the 19q familial Wilms' tumor predisposition gene,"  $558,951.

Larry Kwak, M.D., Ph.D., professor and chair, Department of Lymphoma/Myeloma, "Translational development of novel lymphoma vaccine therapy," $842,104.

Guillermina Lozano, Ph.D., professor and chair, Department of Genetics, "A single nucleotide polymorphism in Mdm2 regulates p53 activity," $805,546.

Gordon Mills, M.D., Ph.D., professor and chair, Department of Systems Biology, "Mechanisms underlying delayed recurrence of ER positive breast cancer: a critical step in the development of effective biomarkers and therapies," $978,679.

Samuel Mok, Ph.D., professor, Department of Gynecologic Oncology, "Novel angiogenic factor in ovarian cancer microenvironment," $939,821.

Dihua Yu, M.D., Ph.D., professor, Department of Molecular and Cellular Oncology, "14-3-3zeta-induced microRNA deregulation in early stage breast cancer progression," $776,401


High-Impact, High-Risk Awards


Zhen Fan, M.D., associate professor, Department of Experimental Therapeutics, "Development of a novel anti-EGFR antibody-protamine recombinant protein for in vivo delivery of small interfering RNAs for cancer therapy," $200,000.

Garth Powis, D.Phil., professor and chair, Department of Experimental Therapeutics, "New treatments for mutant K-Ras: the elephant in the room of cancer therapy," $200,000.

Elizabeth Shpall, M.D., professor, Department of Stem Cell Transplantation and Cellular Therapy, "Cord blood natural killer cells for patients with cancer," $200,000.

You hear many people say that cancer is a marathon, not a sprint.

That's certainly true for patients with ovarian cancer who may face a year of treatment to fight back against one of the most deadly diseases in women. But while many of us can only walk alongside and support loved ones through the long journey, we'd like you to consider a "Sprint" in which everyone can help advance research in ovarian cancer, celebrate survivors and remember those who lost their lives.

SFL_Webbanner_10.jpgIt's the 13th annual Sprint for Life 5K Run/Walk and Sprint for Sprouts Kids' Run, which will be held on Saturday, May 1, with proceeds going to the Blanton-Davis Ovarian Cancer Research Program at M. D. Anderson. 

The event begins at 7:30 a.m. on the M. D. Anderson campus with the non-competitive races for children 12 years and younger beginning at 9:15 a.m. The family-friendly, post-race party will feature a presentation and awards ceremony, music, food and beverages, and special recognition of survivors.

Corporate teams, organized groups, individuals and advocates for ovarian cancer research may get additional information or register online at http://www.mdanderson.org/how-you-can-help/community-events/sprint-for-life/index.html. Early registration continues through April 28, though participants also may sign up at the event. 

Event organizers hope to raise $400,000 this year with the participation of 2,500 runners and walkers, says Judith Wolf, M.D., professor in the Department of Gynecologic Oncology, event co-founder and avid runner.

Since 1998, Sprint for Life has raised more than $2.3 million for ovarian cancer research at M. D. Anderson.




AYA Workgroup_edit_small.jpgThere never is a good time to be diagnosed with cancer, especially when you're a teen or young adult.

Adolescent and young adult (AYA) patients fall in the gap of cancer care at most facilities. They're too old to pass time in the pediatric playroom and too young to relate with a waiting room filled with much older patients. April 4-10 marks National Young Adult Cancer Awareness Week®, a week recently recognized and proclaimed by Houston's Mayor Annise Parker.

AYA Resources at M. D. Anderson

For the more than 70,000 young adults who are diagnosed with cancer each year, M. D. Anderson is paving the way to improve care for these patients. Most recently, M. D. Anderson established an AYA Advisory Council of patients and staff. The council meets monthly to discuss ways to improve the programs and services for young patients at M. D. Anderson.

Cancer180_pinball.jpgIn addition, the Children's Cancer Hospital at M. D. Anderson has an AYA program that focuses on the specific medical, educational and emotional needs of this patient population. To provide a social outlet for young adult patients to connect with one another, Anderson Network's Cancer180 program was created. On March 26, Cancer180 kicked off the young adult awareness week by hosting an evening at Joystix, where AYA patients competed against each other on their favorite arcade games.

facebook_icon_15.jpgStay in touch with Cancer 180 events, join Young Cancer Connection on Facebook


Where to Find Information

If you happen to be at M. D. Anderson during the first week of April, resource tables will be set up throughout M. D. Anderson with information about the various programs and services for AYA patients. Tables will be located at:

•    Wednesday, April 7, Clark Clinic lobby (The Aquarium), 9 a.m.-noon
•    Friday, April 9, skybridge entrance on Floor 3 of Main Building, 9 a.m.-noon

Resource information also will be available at the Robin Bush Child and Adolescent Clinic, Stem Cell Transplant Clinic, Leukemia Center and Lymphoma and Myeloma Center throughout the week.

Rise to Action Conference for Young Adults

Wrapping up the week will be Houston's first Rise to Action Conference on April 10, hosted by M. D. Anderson, the Leukemia and Lymphoma Society and Children's Cause for Cancer Advocacy.

The free, all-day conference will feature experts and young adult survivors from M. D. Anderson and other area organizations. Breakout sessions will cover topics such as advocacy, employment, family and peer relationships and education.

Although the need is still great for providing more access to care and support for the AYA population, conferences such as Rise to Action and organizations such as M. D. Anderson and other non-profits are leading the way to close the gap and provide the best care to these patients.

By Tomise Martin, Staff Writer

LisaRichardson.jpgIn 1987, Lisa Richardson, then 14, was like many teenagers. She had a busy social life in her hometown of Metairie, La., enjoyed volleyball and cheerleading, and had a strong relationship with her older brother.

However, that spring, she began experiencing a sporadic pain in her left hip that would change her life. First, she and her parents thought it was a complication from playing multiple sports, and they treated it with Ibuprofen and a heating pad that alleviated the pain.

When it persisted, Richardson's dad took her to a local chiropractor, who found an abnormality in an X-ray. Further tests revealed a fist-sized tumor at the base of her spine. Richardson was referred to a New Orleans hospital for a biopsy.

"That night was a blur of emotions. First, I refused to believe what my parents were telling me," Richardson says. "The pain felt like strained muscles. Now, there was a possibility of cancer. I thought it was some cruel joke. I was too young for this."

'You have cancer'

The next day the biopsy confirmed the tumor was advanced-stage bone cancer called dedifferentiated chondroblastic osteogenic sarcoma. Her parents, Lee and Betsy, were told their daughter had three to six months to live without treatment and maybe two years with an aggressive, experimental regimen. The next step was telling her that she had cancer.

"I knew the result was either 'yes,' I had cancer or, 'no,' I did not," Richardson says. "My dad told me that the tumor was malignant, but we would move forward and focus on getting the best treatment."

The three decided Richardson would be a part of every decision, as long as she felt comfortable. When doctors explained the only alternative was chemotherapy that might extend her life by two years, she and her family opted for a second opinion.

Choosing the right hospital and treatment

Her dad called hospitals around the world in search of other treatment options. One week later, Richardson was admitted for treatment to the Children's Cancer Hospital at M. D. Anderson.

Led by Norman Jaffe, M.D., now professor emeritus at the Children's Cancer Hospital, a team of doctors planned to shrink the tumor with chemotherapy, then perform a hemipelvectomy, a surgery to amputate her left leg.

After months of flying between New Orleans and Houston for therapy, Richardson and her parents received good news. The tumor was finally operable. Before the surgery, Lee gave clear directions to the surgeons: if they could save his daughter's leg, do it.

Hours into the procedure, the surgeons found that opportunity. Lee and Betsy had two options: to leave the leg intact and risk keeping some cancer; or to amputate the leg and any undetected disease. They chose to save their daughter's leg.
Managing side effects and recovery

The following months were challenging for Richardson, but her parents supported her in every way.

"My parents helped me physically, mentally and emotionally," Richardson says. "When it was painful for a sheet to touch my toes, they tied it away from my feet. Most important, they encouraged me to concentrate on plans after my recovery, which helped me tremendously."

Lee and Betsy also helped Richardson readjust to life after her cancer. While she was still recovering from surgery, they turned their home into a teenage-friendly place. They also allowed her friends to ask questions and showed them how to collapse and open the wheelchair so Richardson could go out with them.

Life after recovery

Since building her strength, Richardson can walk for extended periods of time with assistance but uses her wheelchair for longer distances. At 36, she is living out her childhood dream as an elementary school teacher in North Carolina. She maintains that her diagnosis, treatment and wheelchair help her be a better teacher.

"It has taken me a while to get to this point, but I can honestly say that cancer has given more than it has taken away," Richardson says. "In my wheelchair, I'm at eye level with my students and can help them learn to be comfortable around those with disabilities."

Now engaged, Richardson looks forward to planning her wedding and starting a life with her fiancé, Russell Nelson. They plan to marry late this summer.

Related articles:

Q&A: Advice on caring for a child with cancer

M. D. Anderson resources:

Bone cancer (Sarcoma)


Additional resources:
Chondrosarcoma

Bone cancer(National Cancer Institute)

All About Bone Cancer (American Cancer Society)


By Laura Prus, Staff Writer

Regardless of the stage of their cancer, many patients experience moderate to severe pain. For physicians in M. D. Anderson's Pain Management Center, alleviating the pain caused by cancer is an imperative and integral part of care.

"In the past, cancer pain wasn't always recognized as a priority," says Allen Burton, M.D., professor and chair of the Department of Pain Medicine and clinical medical director of the center. "Killing or arresting the cancer and treating the side effects of therapy, such as nausea, took precedence. Pain was something patients had to live with."

"Our message is that cancer pain is treatable," Burton says. "Maybe we can't take the pain away, but we can control it and improve a patient's quality of life. The depth and breadth of our experience, combined with our multidisciplinary approach and dedicated staff, offers cancer patients real hope in relieving their pain."
PainAwardLarger.jpg
Managing pain at all levels

The Pain Management Center seeks to treat acute and chronic pain.

"The more effectively you treat someone's acute pain, the less likely the odds they're going to develop a long-term chronic pain syndrome," Burton says.

Patients with chronic pain are treated through medication and procedural interventions, physical rehabilitation and psychological counseling. Medications may include acetaminophen, non-steroidal anti-inflammatories, opioids, antidepressants, antiepileptic drugs and steroids.

The Cancer Pain Service, which works with inpatients and outpatients, and the Postoperative Pain Service, which assists patients after surgery, also are available for patients without advanced-stage cancer or those who are in remission.

An award-winning team

A team of anesthesiologists, physical medicine and rehabilitation practitioners, neurologists, nurses, psychologists, social workers and chaplains provides patients with a full spectrum of care to reduce the burden of pain and improve their quality of life.

The Pain Management Center is staffed with clinicians who are trained and experienced in palliative care (symptom management), and who collaborate closely with the Supportive Care (Palliative Care) Center. They believe this background provides them with a better understanding of pain and makes them better clinicians.

In 2009, their work earned the American Pain Society Center of Excellence Award. It was the first time a cancer pain management center had been chosen.

Related story:
Cancer pain (podcast)


M. D. Anderson resource:

Pain management

Pain Management Center



Additional resources:

Pain (American Cancer Society)


Pain control (NCI)



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