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June 2010 Archives

By Lana Maciel, Staff Writer, MD Anderson

MarkWood_july2010.jpgThere's a reason why some of the cardiologists at MD Anderson treat Mark Wood like a rock star. Not only did he beat the deadliest form of skin cancer, but he also overcame obstacle after obstacle, including the "widow maker," a coronary artery that threatened to shut down.

It was an experience that occurred in the short time span of two years, and it's one that Wood says has left him thankful for every minute of every day.

A string of complications

Wood's health problems surfaced in 2007, when he was diagnosed with melanoma. For nearly nine years, the Sherman, Texas, police officer was concerned about a mole on his back that was constantly being irritated from rubbing against his police vest.

For a while, Wood says, his physicians didn't think anything of it. But after having the abscessed mole removed, he became a patient of Patrick Hwu, M.D., professor and chair of MD Anderson's Department of Melanoma Medical Oncology, who diagnosed him with melanoma. In less than a year, the disease had spread.

"I had actually been on interferon for six months, but Dr. Hwu noticed the disease was starting to affect another part of my body," Wood says. "It had gone to my right lung, and a tumor the size of a nickel had formed."

In early October 2008, Wood underwent surgery to remove the lung tumor. However, he had a seizure mid-surgery, forcing doctors to stop the procedure.

Another surgery was scheduled, and the tumor was removed on Oct. 15. Wood began recovering from the surgery, but two days later, he aspirated and went into flash pulmonary edema when fluid began accumulating in his lungs. The condition prompted doctors to put Wood into an induced coma.

The next day, Wood had a second episode of pulmonary edema as doctors removed his breathing tube. This series of complications placed a lot of pressure on his heart. When he showed no sign of improvement after three weeks, Cezar Iliescu, M.D., assistant professor in MD Anderson's Department of Cardiology, decided a coronary angiography was needed.

Treating a second diagnosis

For the procedure, Wood was taken into a cardiac catheterization lab, where doctors could insert a catheter into his arteries and examine the heart's condition.

A cardiac catheterization laboratory contains specialized technology that benefits cancer patients when they need more thorough cardiac evaluations and certain procedures. (For more information, see link to Q&A at the end of this story, where Iliescu answers questions about this technology and why it's an important asset in a cancer center.)

Wood's cath lab results showed severe left main coronary artery disease. Given his condition, bypass surgery was too much of a risk. And because he was still in a coma, doctors decided to place a stent in his artery to keep it open.

"Having a stent put in was the best decision the doctors could have made for me," Wood says. "The problem was in my upper left main artery, which they call 'the widow maker.' If that shuts down, you have a massive heart attack and die. So if I hadn't gotten that stent, I probably wouldn't be here today."

The road to full recovery

Wood immediately recovered after having the stent placed and came out of the coma on Dec. 6, 2008. But after spending nearly two months in bed, he had to learn to walk again through extensive physical therapy. Seven months later, by Father's Day in 2009, Wood returned to duty with the Sherman Police Department, where he has served for 13 years.

Today, he is free of melanoma and the tumor. He has fully recovered from his heart condition, and the lesions that developed on his liver from the melanoma continue to shrink.

Wood continues to share his experience by speaking at churches, and he credits the prayers and presence of his support team, including the Sherman Police Department, his mother, his siblings and three young daughters, Brittany, Katherine and Courtney, for getting him through the most difficult time of his life.

"My mom was so faithful through it all," Wood says. "She's my rock and my strength. She prayed by my side every day, and she prayed over the doctor's hands before he put in the stent. I think it was her actions that gave the doctors the hope and strength they needed to take care of me."

If you ask Wood about his experience at MD Anderson, he can't say enough about the doctors and staff who took care of him.

"They're my family," Wood says of his team of health care providers. "They were with me at the lowest point of my life. I think I crashed 11 times, and they brought me back each time. To this day, my chest still hurts once in a while from the compressions they performed on me. It's a daily reminder of how blessed I am to be here."

Related story:
Q&A: Cardiac Catheterization for Cancer Patients
Cezar Iliescu, M.D., assistant professor in MD Anderson's Department of Cardiology, answers questions about this technology and why it's an important asset in a cancer center.
Read More


MD Anderson resources:

Melanoma

Department of Cardiology

Department of Melanoma Medical Oncology

Additional resources:

National Heart Lung and Blood Institute


Cathlab_staff.JPGA cardiac catheterization laboratory contains specialized technology that benefits cancer patients when they need more thorough cardiac evaluations and certain procedures. Cezar Iliescu, M.D., assistant professor in MD Anderson's Department of Cardiology, answers questions about this technology and why it's an important asset in a cancer center.

What is a cardiac catheterization?

Cardiac catheterization is a minimally invasive procedure that allows physicians to evaluate blood circulation and the condition of the heart's chambers. A thin, flexible tube, the catheter is inserted into an artery or vein in the patient's arm or groin, then gently moved farther into the arteries of the heart. Contrast agents are then injected and pictures (coronary angiograms) in various angulations are projected on a computer screen.

Is it strictly for diagnostic purposes?

No, it can be used for both diagnostic purposes and treatment. It helps recognize heart failure, pulmonary hypertension and valve disease, among other heart problems. It can also be used to implant pacemakers, defibrillators and intra-aortic balloon pumps, as well as perform pericardiocentesis (a procedure that uses a needle to remove fluid surrounding the heart) and endomyocardial biopsies (a procedure for patients with possible heart failure after chemotherapy, where a minimal piece of heart muscle is analyzed under the microscope).  


Why is it important to have a cath lab in a cancer center?

As a result of their disease and the treatments they receive, cancer patients are different from regular cardiovascular patients. With the cath lab at MD Anderson, we can care for our patients and tailor their treatments using state-of-the-art cardiovascular equipment. We can judge the appropriate time to do an intervention, which creates a lower risk of complications surrounding chemotherapy or surgery.


CathLab_screens.JPG
What is a specific example of the use of a cath lab?

With the equipment in a cath lab we can assess and treat cancer patients for heart failure (related to the chemotherapy). We can evaluate their volume status (right heart catheterization) and the coronary artery anatomy (left heart catheterization and selective coronary angiogram). If needed, in a nonischemic cardiomyopathy patient (one with a disease of the heart muscle) with decreased ejection fraction (not pumping enough blood), we can implant an automatic implantable cardioverter defibrillator (AICD). If a patient starts to have life-threatening arrhythmia or an abnormally high heart rate, the AICD gives the heart a shock that helps it start beating normally again.

For patient Mark Wood, who developed heart complications during surgery for melanoma, the cath lab proved to be life-saving technology. His results showed severe left main coronary artery disease. Given his condition, bypass surgery was too much of a risk. And because he was still in a coma, doctors decided to place a stent in his artery to keep it open. Today, he is free of melanoma and the tumor. He has fully recovered from his heart condition.

What types of research can you carry out?

Our first goal is to make sure that the research project is safe for our patients.

•    In one research project, we're following patients with thrombocytopenia (low platelet count), and we evaluate the safety of procedures in this high-risk subgroup.

•    In another research project, to decide the best time for valve surgery (tricuspid valve and sometimes pulmonic), we're looking at patients with carcinoid heart disease and measuring the pressure parameters in heart chambers and echocardiographic parameters (ultrasound waves to create an image of the heart muscle).

•    Another research project being conducted with cath lab technology is using biopsies to identify toxicities from chemotherapy and create pathways to prevent heart damage.

•    There are other tools available in the cath lab that help us gain knowledge about the simultaneous management of cancer and heart disease.

Related story:
Miracle Patient Beats Two Deadly Diseases
There's a reason why some of the cardiologists at MD Anderson treat Mark Wood like a rock star. Not only did he beat the deadliest form of skin cancer, but he also overcame obstacle after obstacle, including the "widow maker," a coronary artery that threatened to shut down.
Read More

MD Anderson resources

MD Anderson Cardiopulmonary Center

MD Anderson Department of Cardiology


 
Additional resources:

National Heart Lung and Blood Institute

New Methods Needed to ID Cardiac Catheterization Candidates


 

shark cartilage extractThe occurrence of cancer in sharks may be rare, but contrary to long-held beliefs, shark cartilage extract provides no therapeutic benefits for non-small cell lung cancer patients.

A recent study indicated that lung cancer patients who took shark cartilage extract (Neovastat or AE-941) in conjunction with chemotherapy and radiation treatments gained no additional survival benefits.

The results of this study were published in the Journal of the National Cancer Institute and presented at the 43rd annual meeting of the American Society of Clinical Oncology in June.

Studying the effects of shark cartilage

The absence of blood vessels in cartilage has long contributed to the idea that it may contain properties that stop angiogenesis, the stimulation of blood vessel growth. If a tumor is present and angiogenesis is blocked, there are no blood vessels to feed the tumor, causing it to stop growing.

For years, researchers believed that sharks, fish with a cartilaginous skeleton, rarely develop cancer due to the nature and biological properties of cartilage. Early Phase I and II studies in lung and renal cancer patients showed that high doses of extract suggested some benefits. A larger Phase III study proved otherwise.

In this international trial, 379 patients with newly diagnosed, untreated stage III non-small cell lung cancer, including 60 participants from MD Anderson, received standard chemotherapy and radiation treatment. In addition, some patients drank four ounces of shark cartilage extract twice daily, while others received a placebo.

Results negate previous beliefs
With a median follow-up of 3.7 years, researchers did not find a statistical difference in survival between patients who received the cartilage extract, 14.4 months, and those who took the placebo, 15.6 months.

Charles Lu, M.D., associate professor in MD Anderson's Department of Thoracic/Head and Neck Medical Oncology, says the results indicate that shark cartilage extract is not an effective therapeutic agent for lung cancer, the leading cancer killer in men and women.

"We have absolutely no data showing improvements in survival, tumor shrinkage and/or clinical benefits to patients," Lu says. "Now, when patients ask their oncologists about shark cartilage, physicians can point to this large NCI-sponsored Phase III trial and tell patients that, at this point, the only studies that have been done with cartilage-derived products have been negative."

Adapted by Lana Maciel from an MD Anderson news release
Shark Cartilage show no benefit as a therapeutic agent for lung cancer



MD Anderson resources:

Lung Cancer

Department of Thoracic Head and Neck Medical Oncology

Additional resources:

Questions and Answers About Cartilage (National Cancer Institute)


By: Alex De Alvarado and Lorenzo Cohen, Ph.D.

green teaTea is the second most consumed beverage in the world after water. Its origins are in Southeast Asia, where tea has been consumed for thousands of years.


All teas come from the same species of plant, Camellia sinensis. The differences lie in the way the teas are processed through oxidation (also called fermentation). Unlike black and oolong teas, green tea leaves are steamed to prevent oxidation and, therefore, retain higher catechin polyphenol levels such as epigallocatechin gallate (ECGC).

In China, tea has long been part of cultural practices and incorporated within traditional Chinese medicine. Recently, there has been a dramatic increase in scientific research examining the health benefits of green tea, including epidemiological studies, preclinical research and clinical trials.  

Of particular interest is the examination of ECGC -- a powerful antioxidant that is thought to be one of the main components of the health benefits of tea.  

Several epidemiologic studies in East Asia have found associations between green tea and lower cancer incidence. For example, in 1994 the Journal of the National Cancer Institute published the results of a study indicating that drinking green tea reduced the risk of esophageal cancer in Chinese men and women by nearly 60%.  

The research on green tea
In a recent study, MD Anderson researchers examined the effects of green tea extract on people with a precancerous condition called oral leukoplakia. Results were encouraging, showing less progression towards development of cancer in more than half of those who took the extract. 

Vassiliki Papadimitrakopoulou, M.D., professor in the Department of Thoracic/Head and Neck Medical Oncology and the study's senior author, cautions that this initial trial enrolled few participants and still warrants more research. "While still very early, and not definitive proof that green tea is an effective preventive agent, these results certainly encourage more study for patients at highest risk for oral cancer," he says.

A study presented at the 2010 annual meeting of the American Society of Clinical Oncology showed preliminary evidence that the ECGC component of green tea may reduce the number of leukemia cells in patients with chronic lymphocytic leukemia (CLL). The Mayo Clinic researchers are looking forward to more controlled clinical trials to confirm these benefits as well.

Ask your doctor
Although drinking green tea is generally considered safe, patients with cancer should discuss possible contraindications or side effects with their physician, especially if consuming green tea as a supplement versus as a drink. Green tea contains caffeine, which could have different stimulatory effects on individuals. In addition, green tea may interact with certain anticancer drugs and supplements.

The initial promising research on the benefits of green tea warrants further investigation to conclusively determine its role in the prevention and treatment of cancer. In the meantime, tea will continue to be a source of refreshment, relaxation and ritual.  

MD Anderson Resources:

News Release - Green Tea Shows Promise as Chemoprevention Agent for Oral Cancer, M. D. Anderson Study Finds

Integrative Medicine Program

Place ... of wellness

Additional Resources:

Reduced risk of esophageal cancer associated with green tea consumption. Gao YT, McLaughlin JK, Blot WJ, Ji BT, Dai Q, Fraumeni JF Jr.J Natl Cancer Inst. 1994 Jun 1;86(11):855-8.

Phase II randomized, placebo-controlled trial of green tea extract in patients with high-risk oral premalignant lesions.Tsao AS, Liu D, Martin J, Tang XM, Lee JJ, El-Naggar AK, Wistuba I, Culotta KS, Mao L, Gillenwater A, Sagesaka YM, Hong WK, Papadimitrakopoulou V.Cancer Prev Res (Phila Pa). 2009 Nov;2(11):931-41.

Phase II trial of daily, oral green tea extract in patients with asymptomatic, Rai stage 0-II chronic lymphocytic leukemia (CLL). T. D. Shanafelt, T. Call, C. S. Zent, B. LaPlant, J. F. Leis, D. Bowen, M. Roos, D. F. Jelinek, C. Erlichman, N. E. Kay  J Clin Oncol 28:7s, 2010 (suppl; abstr 6522)

National Cancer Institute Fact Sheet

start_trails_campers.jpgBy Will Fitzgerald, Staff Writer, MD Anderson Cancer Center

Summer is here. For kids, this means freedom -- a chance to run wild and prepare for the annual ritual of summer camp. But for kids with cancer, a trek to summer camp can often be a difficult experience due to health concerns.   

Each year, profits generated from the Children's Art Project (CAP) and the sale of items featuring the artwork of young MD Anderson patients support special camps that cater to kids with cancer. Camp Star Trails, an overnight summer camp in Washington County, Texas, emphasizes normal childhood experiences plus a whole lot of fun.

I got a chance to speak with Megan Evans, 17, who was diagnosed with Ewing's sarcoma in early 2000 and is not only one of CAP's famous designers, but a seven-year camp veteran. This year, Megan is looking forward to attending Camp Star Trails as a new counselor. "I got involved because I love helping kids," Megan says. "I understand the camper's point of view because everything at camp is made for kids with cancer."

Camp_Star_trails_Megan.jpgMegan is quick to point out that her new role is subject to a bit more responsibility. She says if the campers create too much noise in the cabin, it's her duty to be adult-like and quiet everyone down. Jokingly, she adds, that if the campers are anything like her brothers, she may be doing a lot of that.

One of the great benefits to the younger campers is that Megan knows first-hand how they feel and where many have been. Cancer is tough, but the friendships and support formed by a simple understanding, between camper and counselor, create a unique environment.
"I think it helps to meet someone who has also gone through what I went through," Megan says.

Still, at the end of the day, fun is the name of the game. If smiles were a currency, camp would be the Federal Reserve.

"I love horseback riding and rock climbing," Megan says. "This year, I'm determined to get on the trapeze and the zip-line."

If you thought a zip-line might be difficult for a camper with bone cancer, Megan reassures that it's not. If someone can't get to the top of the zip-line, the camp has a special hoist to easily bring them up so they can enjoy the activity.

This year, 150 kids from across the country, including many from Texas, will get to experience this special place. It's through the Children's Art Project and its commitment that allows each camper to enjoy the moment. In Megan's words, "Camp makes my summer. I'm counting down the days."

Related Stories:

My Fox Houston -  Children with Cancer Enjoy 'Normal' Life at Camp

By François Pouliot, Ph.D., M.D., assistant professor and clinical ethicist, Department of Critical Care

The recent European Oncology Nursing Society meeting in The Hague, Netherlands, and the 6th International Conference on Clinical Ethics Consultation in Portland, Ore., were great opportunities to share experiences, build networks and receive good ideas on important issues in the field of bioethics.
 
International partnerships
The importance of international partnerships between institutions of the western world and emerging economies was underlined in both meetings.

The presence and contribution of Turkish nurses in The Hague was great. No surprise that MD Anderson has already developed partnerships in Turkey.

In Portland, there were more than 25 countries represented, and a large portion of the conference was allotted to international perspectives on ethics consultation in Brazil, Columbia, Chile and India. Ethics consultation was always offered in those countries on an individual basis, but currently, well-structured clinical ethics services are emerging at the clinical setting almost everywhere.

Dr. Jessica Moore and I, as representatives of MD Anderson, shared our own experiences of restructuring an ethics service. We are looking forward to upgrading our practice according to the highest standards.

Because bioethics was a creation of the West, a leadership that it continues to assume, we are called on to share what we have learned with the whole world. Access to postgraduate or fellowship programs and the organization of international conferences are examples of contributions made at the international level.
 
Moral distress
Moral distress among patients and caregivers is a serious issue for individuals and institutions because of its many important consequences. It is currently a hot topic.

When individuals make moral judgments as to the right course of action in a particular situation, but are unable to carry it out, they may experience moral distress and its psychosocial consequences: anxiety, anger, depression, cognitive impairment, absenteeism. To deal with the problem, emphasis must be placed on distress screening, counseling and support.

The clinical ethicist has an important role to help clarify the issues and make sure the right people are involved, while at the same time respect the boundaries between ethics consultation and therapy.
 
Survivorship
A survivorship program offers comprehensive cancer care where the physical and psychosocial impacts caused by the cancer, and/or by the aggressive therapies used to treat cancer, are addressed. With a large increase of survivors, survivorship programs are emerging in almost all major cancer centers.

In Europe, survivorship programs are still being managed in the regular clinics, but more and more patients are being transferred to specialized caregivers and teams. One of the issues is to make sure that patients do not feel abandoned by their cancer doctor or nurse.

In public-funded health care systems such as Europe, survivorship programs will impact resource allocation. The goal should then be to allow highly specialized doctors and teams to serve the patients who can benefit the most, and to make sure that other services are provided by the appropriate resources (survivorship doctors and teams).


Proceedings:
The proceedings of the EONS Conference can be found in
The European Journal of Oncology Nursing, Vol. 14 Suppl. 1 April 2010.


Upcoming events:
Anderson Network Cancer Survivorship Conference, Omni Houston Westside, Sept. 24-25.
Moral Distress in Health Care Symposium, Coast Plaza Hotel and Suites, Vancouver, Sept. 18-19.


MD Anderson's Clinical Ethics Service (CES) helps patients, families and health professionals make difficult decisions about medical treatments and patient care. Any patient, family member or guardian, health professional or others with a legitimate interest in a patient may request a consultation. All consultations are confidential , and services are free. ECS representatives are on call 24 hours a day, 7 days a week. Call (713) 792-8775
 

by Laura Nathan-Garner

Family health. It sounds like a contradiction. After all, who's got time to exercise and cook healthy meals when you've got a family?

But we learn many of our diet and exercise habits from our parents. Close to two-thirds of adults and one-third of kids in the United States are overweight or obese. That's a lot of kids learning unhealthy habits and missing the chance to prevent cancer by eating healthy and exercising regularly.

ElitCrisGavin.jpgThis is why the story of MD Anderson employee Elit Gonzalez is so impressive: After her Type-2 diabetes got out-of-control, Elit made exercise and healthy eating her top priorities. Nine months later, she's lost 50 pounds, her husband and mother have both lost 30 pounds, and her two young sons read nutrition labels. You can find out how to follow the Gonzalez family's lead in this month's issue of Focused on Health.

You'll also find tips on how to make your next road trip healthy and how to help your parents prevent cancer, along with insight on new sunscreen worries and a video featuring proven advice on the Power of Sustainable Changes in Diet & Lifestyle from Dean Ornish, M.D.

What are you doing to boost your family's health this summer?


By Angela Rankin

Since October 2005 MD Anderson has been my second home. Starting with ovarian cancer in 2005, breast cancer in 2006, followed by melanoma in 2009, I have been blessed with the best doctors for whom I have waited many hours. And whom I would wait for again and again! 


I've had countless MRIs, PET scans and CAT scans. I've had my collapsed veins aided by a port surgically inserted in my chest, and my vein needled for blood samples to get my "cancer numbers."

Waiting is part of the cancer process, too. Waiting in the areas to be called for a doctor's appointment or a test could become stressful. I used this time for reflection and prayer, while trying to calm myself and hum a song in my head.

I went through it all with the Celebration Singers by my side. We met at MD Anderson every Tuesday evening and sang. This experience gave me a sense of healing on the inside of my physical body and in my heart and spirit, too.



Video by Deborah Thomas

This video depicts my history at MD Anderson and the major forces that helped me know remission. Music was such a healing force for me. Whether it was the Gregorian chant during chemotherapy, rehearsing at my church for Sunday Mass or singing with the Celebration Singers, music helped to push me through the years and continually lifted my spirits.

My Catholic faith is a power I cannot deny. Prayers of others helped me to heal. As a teacher at St. Laurence Catholic School, their mentioning my name over the PA system during morning prayers and the thought of so many people praying for me, gave me a positive motivation to focus on remission. I prayed to the cancer saint, St. Peregrine, daily and envisioned myself doing what he did.

Dealing with cancer is hard on the family, too. My husband, and loving and devoted caregiver, was adamant from the beginning that we were going to beat the cancer! He loved me even when I had no hair ... both times! He came to every treatment, every appointment and every test. He was and is always there for me and he'd wait for me without complaint.

My song tells of the impact that music and my family has had in my healing, and how it helped me through the pain and rough roads of cancer through the years.

Music plays a great part in my life, my healing and my future!

KatePhoto_small.jpgHolly McRae is the mother of 6-year-old Kate, who was diagnosed last June with a malignant, very aggressive brain tumor called a supratentorial primitive neuroectodermal tumor or sPNET. Kate underwent a craniotomy with tumor resection on July 3, 2009, in Phoenix, but surgeons were only able to remove 50% of the tumor due to its location in the left temporal lobe of her brain. Since that time, Kate has received other treatments, most recently here at the MD Anderson Proton Therapy Center under the care of Anita Mahajan, M.D.

Holly and Kate recently returned to Phoenix after a two-month stay in Houston for proton therapy treatment. Here, Holly shares both the pain and the hope that her family has experienced as they move day by day through Kate's cancer journey.



By: Holly McRae

Brain radiation. It is the one thing we had so desperately hoped to avoid in Kate's journey. The thought made me tremble. The potential side effects were seemingly more than we were willing to put our precious 6-year-old through. And yet, our choices were few.

We had already gone through a subtotal resection of the aggressive tumor that was invading her brain. We had completed five rounds of intense and debilitating chemotherapy, along with another round of high-dose chemo and a stem cell transplant. And there it still remained. A little bit of unwelcome, life-changing cancer still lingering in Kate's brain.

Devastating doesn't cover it. So we knew she needed radiation if we were going to keep fighting. And not fighting - well that was nowhere in the equation.

After many tears, much prayer, talking with Kate's doctors and doing a little digging of our own, we decided to temporarily move to Houston to seek out a potentially much-improved and more targeted form of radiation called proton therapy. We knew it came with a little risk, for there was far less long-term data in relation to this treatment in children compared with traditional radiation. However, we also knew that if the long-term studies proved what doctors were hoping, the long-term side effects could be dramatically reduced.

So we took the plunge. We moved to a city we knew nothing about and where we knew no one, and started proton beam radiation to Kate's brain.

I will never forget the first few times we left her on the treatment table, asleep, knowing everyone else would need to leave the potentially hazardous room as the proton radiation poured into her still-developing brain. I wanted to run back in and rescue her. But me saving her from radiation wouldn't save her from cancer. And so with many tears, the proton radiation began.

It is weird how something you dread with everything in you can be something you also learn to cherish. Each day we would whisper a prayer in our daughter's ear before the proton treatment would begin. Many times the prayers were tearful pleas that God would use this treatment to save our daughter's life.

I will never forget looking into the kind faces of the Proton Therapy Center staff who had learned to love our daughter. There is an enormous difference between those who take care of your child as a job and those who use it as a ministry. We were so deeply grateful that we experienced the latter. We felt a bit of comfort in a journey that provides very little room to be comforted.

Another blessing amidst the deep pain was the families of other children we met during treatment at the Proton Therapy Center. There was no need to hide the deep anguish with them. They most likely felt the sting of cancer just as deeply. They were strangers who became friends, somehow united by tragedy. All praying that proton therapy would be part of the healing that would take place in our children's bodies.

The cancer had different names for all of us, slightly different courses of treatment and different prognoses. But we all had one thing in common: We were all fighting to get a chance to see our children grow up.



We were fortunate to be able to celebrate Kate's last day of proton treatment with three other families that had journeyed through proton therapy with us. The kids all hit the gong as they celebrated their graduation. One year earlier we thought Kate would be graduating from kindergarten, instead it was from proton radiation to her brain.

Life is uncertain. However, we are learning to count each day as a blessing and each milestone in our journey as a gift. This was a milestone and well worth celebrating. Our Kate was still fighting. And we believe she's winning.

For us, proton treatment was the end of Kate's treatment. However, we are far from the end of our journey. When cancer has touched your family, the journey doesn't just end with treatment. It just changes. We felt elated and terrified. No more long hospitalizations. No more debilitating treatments. We could live at home as a family again, all under one roof. The thought was overwhelming.

And yet, we are still waiting to receive a clean scan. We are waiting to see what the proton treatment has done. Some days the waiting feels just as hard as the treatments. It can be terrifying. No more thinking the next round of chemo or the next proton radiation treatment will get what was left behind. Those treatments are done. So we wait.

We wait and plead with God to heal our daughter, and we thank Him for the many people He has placed in our journey, those who have cared for our Kate and those who have cared for us, too. The joy intermingled in the sorrow.



Kate's first MRI since completion of proton therapy will take place on June 29, a year to the day that she was diagnosed with cancer.

Resources
www.prayforkate.com
MD Anderson Proton Therapy Center
Patient Power: Proton Therapy for Pediatric Cancer (Audio)


Talking Poop

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Adelea Ibsen was just 30 when diagnosed with late-stage breast cancer. At the time of diagnosis, she was living in Germany with her husband and two young daughters. Because of her illness, the family immediately moved back to Texas so she could be treated at MD Anderson.

Ibsen now commutes from her Austin home weekly to participate in a Phase I clinical trial under the direction of Richard Theriault, D.O., professor in the Department of Breast Medical Oncology.

Today's post continues an occasional series on her experiences with cancer and treatment.

Post by: Adelea Ibsen

ladiesroom.JPGOK, let's begin with this: I'm a Southern girl at heart.

I say ya'll, I love grits, I know what a katydid sounds like. I schvitz, not sweat, and I do not do poop talk. Just ask my husband, my best friend or my kids.

But lately, it's the only thing on my mind. I talk about it to my husband Kent, to my best friend, my kids, friends I haven't seen in ages, a girl today at Victoria's Secret, all nursing staff and most doctors.

It's all about the poop!

How often. Consistency. Changing consistency. Color. Morning or night. Middle of the night. Does it hurt. Do I cramp. Loose or rabbit pellets. The list goes on and on.

Here's the thing, though. I am the one offering up before they even ask. I think my South Alabama grandmother is rolling in her grave.

I even have others talking on my behalf in chart-speak, word-of-mouth or to their own mothers to help with my "issues." This must be how babies feel when their poop is discussed incessantly and with genuine emotion.  

The only other time I have poop talked this much is when I lived on a commune in East Africa one summer in college. Same questions as above, but the word "frothy" got tossed around more, due to giardia outbreaks.

It's a good thing I've had lots of practice on forgetting my dignity. College, childbirth, hanging out with naked-loving Germans, cancer, and that time I peed in my best friend's ex-boyfriend's garden.

It was all practice for my mind being so poop-centered right now.

Riding for Survivors

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Post and Video by:  Deborah Thomas

On Saturday, June 5, 178 motorcycle enthusiasts with big hearts came together to support MD Anderson and Anderson Network's Cancer Survivorship Conference.

The 11th Annual Ride for Life was organized and sponsored by Riders for the Cure, a group of MD Anderson employees/motorcycle riders committed to raising awareness of various types of cancer and ways to find a cure through research and education. Anderson Network also provided support in organizing the event.

Riders left Stubbs Harley Davidson for a one-hour ride then returned for lunch, door prizes, music, and a presentation by patients and family.

More than $4,000 in registration fees and donations were collected at the event and presented to Anderson Network for support of its programs.



This year's Anderson Network Survivorship Conference will be held Sept. 24-25. All cancer survivors and caregivers are welcome and encouraged to attend.

This week at MD Anderson, we took time to celebrate cancer survivors and their caregivers. There were decorations, lapel pins and all types of activities in common areas all over the hospital. But the atmosphere of celebration and hope truly resonated from the survivors who joined us for the festivities.

We asked a few who joined us for one of the art sessions, "what does cancer survivorship mean to you?"

Recent cancer research has led to an increased understanding that there are gene changes in cancers that could be the key to effectively killing the tumor.


Such strategies have provided significant gains in several tumor types, as exemplified by chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). In these tumors, the gene mutations are present in almost all of the patients' tumors and use of targeted chemotherapy treatments have provided meaningful benefits. 

 

Kopetz2.jpg In contrast to these "rare disease, common mutation" examples, results presented at this year's ASCO meeting addressed the similar problem in more common tumor types such as breast, lung and colon cancers.

In lung cancer, treatment with a new drug was very successful in the small percent of patients with a particular genetic change in their tumor (awkwardly denoted the "ELM4-ALK trans-location"). In contrast to the uniform genetic change seen in almost all CML patients, this ELM4-ALK trans-location is only present in less than 5% of lung cancer patients. Similarly, mutations in the BRAF gene in colon cancer (in 5% of tumors) is associated with some sensitivity to a novel BRAF inhibitor, according to the research I presented at the meeting. 

Also at ASCO, MD Anderson investigators reported on mutations in a gene called PIK3CA (present in 2% to 20% of patients), which appears to identify patients sensitive to experimental inhibitors of this pathway. 

 

While the treatment results in these patients are impressive, the requirement to screen 20 patients to identify one patient who may benefit is a significant logistical challenge. Such efforts require the development of new tests and validation steps to make sure that these molecular changes are accurately identified in patients' tumors. In addition, there are unique problems that arise in this "common disease, rare mutation" scenario. 


Patients are commonly choosing between immediate treatment with standard chemotherapy or waiting several weeks without therapy to see if their tumor is one of the rare ones that may benefit from these novel therapies. At other times, there may not be a sufficient amount of tumor available for testing, requiring patients to undergo additional biopsies to obtain enough material for these increasingly important tests.


In addition, the state of oncology commonly changes faster than insurance companies can keep up. As these molecular tests become part of routine cancer care, reimbursement problems can occur. Even small, preliminary clinical trials require coordination between multiple institutions to successfully identify enough patients. 


At MD Anderson, these challenges are being met through a new Institute of Personalized Medicine, which is developing these new tools necessary for the "common disease, rare mutation" research, and working to minimize these roadblocks to implementation. The goal of such Herculean efforts is to have patients' tumors undergoing screening for many of these genetic changes prior to determining therapies. It is hoped that as such testing becomes commonplace for clinical care, many of these barriers will be reduced.


Ultimately, we believe that surmounting the "common tumor, rare mutation" problems will be the best path forward for improving the collective outcomes of cancer patients.

Matthew Ballo, M.D., is a radiation oncologist at the MD Anderson Regional Care Center in the Bay Area. His passion for survivorship and post-treatment care led to the creation of the Road to Wellness program in 2007. Today the program is open to breast cancer and prostate cancer patients treated at the MD Anderson Regional Care Center in the Bay Area. MD Anderson's main campus offers a number of programs and clinics for survivors, but the Bay Area location is the first of the institution's regional care centers to offer this service.By

By: Matthew Ballo, M.D.


When I began training at MD Anderson I observed that fatigue was a common problem in patients receiving radiation. Since there were few active interventions to address the issue at the time, I pledged that when I moved my practice to the Bay Area, I would work to find diet and exercise solutions to relieve fatigue.

As the idea of the program began to grow, it became apparent that fatigue was only one of several quality of life issues that patients faced. I started thinking more globally about issues such as stress management and smoking cessation and soon realized this program fit under the emerging discipline of survivorship.

In 2007 we began the Road to Wellness program, which offers lifestyle rehabilitation programs to transition patients from active cancer care to survivors who are preparing for life post-treatment.

Cancer survivors have unrecognized and untreated aftereffects of cancer treatment, so we put two and two together and created a program that addresses fatigue and the global issues of quality of life in cancer patients undergoing treatment. This program prepares patients for survivorship by equipping them with the tools necessary to be healthy cancer survivors.

The Road to Wellness is a five-step program:

  1. Initial consultation. Studies show that the majority of patients prefer to undergo lifestyle counseling at the time of diagnosis rather than after treatment.
  2. Consultation with an exercise physiologist. A tailored exercise regimen is created for each patient based on cardiovascular and resistance testing.
  3. Nutritional consultation. Patients meet with an MD Anderson registered dietician and undergo counseling regarding specific diet modifications endorsed by the World Cancer Research Fund for reducing cancer risks.
  4. Meeting with a social worker. A social worker performs a needs assessment and teaches stress management skills. Patients may be directed to support groups or other resources in the community that they can attend.
  5. Smoking cessation, if needed. MD Anderson's Tobacco Treatment Program is a comprehensive tobacco-cessation program that may consist of face-to-face and telephone behavioral counseling, nicotine replacement therapies and tobacco-treatment prescription medications.

Holding My Own

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Stable! That's what the doctor said and so it sounds good to me. Maybe it's not quite as good as shrinking, but it's definitely better than growing!

After 13 rounds of chemo, I'm doing well and feeling fine. Still, it's disconcerting to walk in the doors of MD Anderson without the "protection" of one's employee badge. It kinda feels like I'm not wearing clothes - and for some reason, I get the impression that people are staring at me.

GailOffice.jpgVulnerable frame of mind
In my rational mind, I know that isn't the case, but I still feel the eyes on me. Suddenly, I'm in a more vulnerable frame of mind. What will he say this time? What did my blood test report? And, most important of all, what did the MRI have to show the radiologist who read it?

Then there's the cognitive testing. I have to admit that I always hate this part - it's been a long time since I was in school. This time, my "teacher" is a Ph.D. and an instructor in neuro-oncology and I don't like it that she's the one with all the answers.

I can recall a list of seven or eight numbers, but I have a hard time saying them backwards. I go through the dictionary in my mind to come up with every word I can remember that begins with a designated letter. I sort a long list of words into categories so that I can repeat them all. I fit little metal pegs into their slots. I truly struggle to match images with three-dimensional blocks - I've never been good at this task.

There's more, but I begin wondering how I'm doing - if I'm as sharp as I was before this all began. I don't like not knowing if I'm making the grade.

Most of the time, I can forget that I'm a brain cancer patient. It's the sticks in the arm that remind me. I don't get frightened, but I do always wonder what the report will be this month. I guess that as long as it's stable, it's OK with me.

Celebrating milestones
However, in spite of these pokes and prods and the anxieties that go along with them, the fact remains that I am a survivor. In fact, this is a special week at MD Anderson because it's a week to honor cancer survivors. Special activities are being held to observe survival milestones reached by every patient. You can go to a baseball game, videotape your own story (and even your cancer journey, if you'd like), calm yourself with yoga, and try your hand at drumming.

I'm celebrating each new day with every survivor and you can, too. Visit the survivorship section of the MD Anderson website for a list of all that's planned to celebrate life - to celebrate YOU!

Two new targeted agents, panobinostat and PCI32765, were presented at ASCO and demonstrated promising clinical activity for the treatment of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL).

In one study, A. Surrreda presented results from an ongoing large Phase II study of the oral pan histone deacetylase inhibitor (HDACi) in patients with relapsed HL. Remarkably, despite the relative rarity of the patient population, this international trial has completed enrollment with 129 patients at 45 sites in 13 countries.

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Oral panobinostat was administered at a dose of 40 mg three times per week, every week, in 21-day cycles. Dose delays and reductions were allowed for management of toxicity. Patients had a median age of 32 years, with a median prior treatment regimens of four. Importantly, 37% had no response on last therapy and 80% had a prior autologous stem cell transplant. 

Based on objective response assessment, 17 patients achieved major responses and 71% of the patients had tumor reductions. Common grade 1 and 2 toxicity included nausea, vomiting, and diarrhea. The most common grade 3 and 4 toxicity were thrombocytopenia and anemia. Thus, this study confirms the clinical activity of HDACi in HL.

However, this study is the largest single agent Phase II study to be conducted in patients with relapsed HL, after receiving ASCT, which represents a population of unmet medical need. The final analysis of this study is expected to be available by the end of this year.

While the single agent activity looks very promising, panobinostat-based combination clinical trials are currently enrolling patients with relapsed HL. One interesting study is a combination of everolimus plus panobinostat, which is currently enrolling patients at MD Anderson.

In a second study, N. Fowler presented very exciting data from an ongoing Phase I study using the oral Bruton's tyrosine Kinase (Btk) inhibitor PCI32765 in patients with relapsed B cell lymphoma. Btk is an important component of B-cell receptor signaling pathway, downstream of Syk.

The first study to target this activated pathway was recently published using the oral Syk inhibitor fostamatinib, which demonstrated promising clinical activity in a variety of B-cell lymphoma, especially chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Based on promising preclinical data in B-cell NHL, a study was conducted to test the safety, pharmacokinetics, pharmaco-dynamics, and efficacy of PCI-32765, a potent, selective oral inhibitor of Btk.

At the time of the report, 47 patients were enrolled using a dose escalation Phase I design, with a starting dose of 1.25 mg/kg/day. The study included patients with a variety of histologies: 16 follicular, 15 CLL/SLL, seven DLBCL, four mantle, four marginal and one waldenstrom macroglobulinemia. Patients had a median of three prior regimens.

Therapy was well tolerated. Clinical responses were observed in 23% of the patients with FL, 69% with CLL/SLL, 75% of patients with mantle cell lymphoma and in 1/7 patients with DLBCL. Because the MTS has not been reached, dose escalation continues. Thus, PCI-32765 has a favorable safety profile with a promising antitumor activity. This activity will be confirmed in future Phase II studies.

By: Lakshmi Naik and Stephen Collazo, Department of Social Work

What comes to mind when you hear the words social worker?

Some people associate the profession with the "Good Samaritan" who advocates for the downtrodden and needy. Others might think of things like "social welfare" for the poor. Many associate social work with "protection" for the abused.


Early pioneers
While all of these are true, it's also important to note that social workers were among the earliest pioneers in providing the first psychosocial services to patients with cancer, addressing their "emotional pain" and integrating psychological, socio-economic and existential dimensions of adapting to and coping with a cancer diagnosis.

When a patient is diagnosed with cancer, it has both psychological and existential implications. Faced with the prospect of a life-threatening disease, patients and families embark upon an unpredictable roller coaster journey that takes its toll on them physically, emotionally, financially and spiritually.

Over the past 25 years the psychosocial dimensions of patient care in oncology settings have gained immense momentum, bringing together multiple disciplines: medicine, nursing, social work, psychiatry, chaplaincy, pharmacology, rehabilitation and palliative care. These multidisciplinary teams become equal partners in caring for the whole patient.

In fact, a 2007 Institute of Medicine report titled "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs" proposed new evidence-based models and standards for addressing these various patient needs and recommendations for the coordination of care between the aforementioned variety of service providers.

Helping patients navigate
Social workers hold a unique position in this multidisciplinary team. Because they understand the psychosocial impact of cancer and its treatments, they have the ability to help the patient navigate in a carefully and strategically planned manner throughout the cancer experience. This guidance helps patients manage distress, comply with treatments, enhance recovery, obtain support and regain control. 

Social Work counselors initially assess patients to determine if any help with coping is needed and then prepare patients and families for any possible changes in mood, behavior, relationships and lifestyle. The primary techniques for addressing these potential patient issues are a variety of counseling techniques (problem solving, brief psychotherapy, cognitive-behavioral and other supportive interventions), as well as services like relaxation, meditation, guided imagery, hypnosis and support groups.

The psychosocial impact of cancer on patients, families, health care professionals and society at large is so immense that a multi-pronged, multidisciplinary approach that is well orchestrated and streamlined throughout the course of the cancer experience is imperative.

Social workers will continue to provide a very integral form of care within this approach, both at MD Anderson and in the oncology field as a whole. If any of the services mentioned are of interest to you, feel free to contact the Department of Social Work at 713-792-6195.

By Jennifer Litton, M.D.

In today's oral abstract session for local and adjuvant treatment of breast cancer at ASCO, several studies were reported, and two are highlighted below.

Dr. Giuliano reported the results from ACOSOG study Z0011. This study evaluated the need for further axillary lymph node dissection in women who had up to three sentinel lymph nodes removed during surgery, had a positive lymph node, but did not go on to have further lymph node surgery. The researchers reported no significant differences in local disease recurrence or in overall survival.

This may be the beginning of a major shift in how we address and treat lymph nodes during surgery for women who have biologically low-risk tumors and are treated with whole-breast radiation that also encompass the lymph node area.

LittonSmall.jpg

Additionally, Dr. Albain reported on potential causes of racial survival disparities in the SWOG 8814 study. Historically, African-American women have been reported to have worse breast cancer outcomes and overall survival after a diagnosis of breast cancer. This analysis tried to evaluate if there was a biological difference in the tumors by race when evaluated in a controlled clinical trial setting.

The researchers looked at postmenopausal women with ER-positive tumors. Nine percent of the women involved in the above trial were African-American. All trial participants had the same treatment and scheduled follow-ups. Additionally, the researchers used the Oncotype DX test to estimate risk of recurrence by using recurrence scores (RS). There was no significant difference in the distribution of recurrence scores, although there was a trend to higher recurrence scores in African-American women. 


Chemotherapy worked equally well in African-American women compared with the rest of the women who participated in the study. The outcomes did, however, show differences in recurrence and survival when controlled for all other factors. The researchers noted a difference with higher ki-67 - a marker of proliferation, or how fast a tumor divides - in the tumors of African-American breast cancer patients. Therefore, further evaluations of these differences in a controlled clinical trial setting need to be done.

Several important studies were presented at the ASCO lymphoma oral session.

In the first presentation, G. Salles from France presented the long-awaited data from the Primary Rituximab and Maintenance (PRIMA) study in newly diagnosed patients with advanced stage follicular lymphoma (FL) requiring therapy. This GELA-sponsored international Phase III study investigated two years of rituximab (R) maintenance in FL patients responding to first-line immuno-chemotherapy consisting of either eight cycles of R-CVP, or six cycles of R-CHOP or R-FCM (plus two additional rituximab infusions). The study was initiated in 2004 and enrolled 1,217 patients from 25 countries at 223 centers. It completed enrollment in April 2007. 


Younes Small.jpgPRIMA results

There were 1,207 evaluable patients treated with RCHOP (n=885), RCVP (n=272) or RFCM (n=45), and 1,018 responding patients were randomized to either rituximab or observation (513 observation, 505 rituximab maintenance). Median follow-up was 25 months from randomization (31 months from study entry).

There was a significant (stratified log-rank, P<.0001) improvement in the primary endpoint PFS, for R-maintenance (hazard ratio [HR]=0.50; 95% CI [0.39-0.64]; two-year PFS 82%; 95% CI [78-86%] vs. 66% [61-70%] for observation). An independent response review committee confirmed the significant improvement in PFS in the R-maintenance arm (HR=0.53 [0.41-0.68]). Time to next anti-lymphoma treatment, as well as response rate at the end of maintenance or observation, were significantly improved in the R-maintenance arm. Remarkably, the benefit of rituximab maintenance was observed in all subgroups, regardless of type of induction therapy, age, FLIPI score, or quality of response (CR vs PR).

The authors concluded that the PRIMA study provided evidence for a new standard of care for FL patients in need of treatment.


More promising news

In a different study, R. Pettengell examined the role or rituximab for in vivo purging and as maintenance after autologous stem cell transplant (ASCT). From October 1999 to April 2006, 280 of a planned 420 patients with rFL in first (n=16), second (n= 222) or third remission (n=41) who achieved either a complete remission (n=83) or a very good partial remission (n=196) to induction chemotherapy, with limited bone marrow infiltration (<25% B-lymphocytes), underwent a single randomization in a 2x2 design to RP and RM, n = 69; RP, n = 72; RM, n = 69; No R n = 70.


The findings

PFS at five years was 54.3% versus 47.8% for in vivo purging versus none (logrank PFS; p=0.20; HR 1.23, 95%CI: 0.89 - 1.72). PFS at five years was 58.8% versus 42.6% in patients receiving R maintenance versus none (logrank PFS; p=0.02; HR 1.50, 95%CI: 1.07 - 2.09). PFS at five years was 54.8% versus 37.6% in patients receiving R purging and maintenance versus none (logrank PFS; p=0.05; HR 1.44, 95%CI: 1.004 - 2.05). The success of salvage therapy is reflected in an overall survival at five years of 80.8% (95% CI: 75.5 - 85.0). Conclusions: This study shows that peri-autograft, R in vivo purging and two years maintenance post-autograft gives a superior PFS compared to no rituximab.

 

Collectively these data demonstrate:

• Rituximab maintenance after induction with R-chemo in patients with advanced stage FL improved PFS


• Rituximab maintenance after ASCT in rituximab-naive FL patients in second or third remission also improves PFS


However, it's important to keep in mind that:

• This data is applicable for patients with FL. Previous randomized study failed to show benefit for rituximab maintenance after induction with RCHOP in patients with newly diagnosed diffuse large cell lymphoma

• We still do not know if giving rituximab maintenance for longer than two years would produce better outcomes or more toxic effects. So for now, if one wants to use rituximab maintenance, one should give it for two years, unless on clinical trials.

 

 

Yesterday was National Cancer Survivors Day, though for many of our survivors and their loved ones, every day is a celebration of life.

The National Cancer Survivors Day Foundation defines a "survivor" as anyone living with a history of cancer, from the moment of diagnosis through the remainder of life.


As a dedicated day, we celebrate our cancer survivors' journeys and raise public awareness that for many, there is life after a cancer diagnosis that is meaningful and productive. At MD Anderson, we have planned a Cancer Survivors Week of events open to everyone. 

This week is a great time for everyone to stop and think about the survivors they know and love. I reflect on the cancer survivors and caregivers that I have had the honor to care for over the last 30 years. I see a collage of your faces and remember your stories. 

One such survivor story happened early in my nursing career. When I was 26 years old, I met Anna, who was 22 and single. She had been diagnosed with an ovarian germ cell tumor and came to my unit for treatment. Over the next 12 months, Anna's tumor was successfully treated with chemotherapy and surgery. She fought hard and her cancer was gone, but the treatment left her unable to have children. 

Over the next 15 years, Anna would occasionally call or, at the least, return yearly to our clinic and we would "catch up." Anna earned a college degree in education and teaching third graders became her passion. She began dating and called me once to ask my thoughts of when she should divulge that she was a cancer survivor. Eventually, she met and married a wonderful man and we continued to celebrate her health and prosperity. The world seemed only to have open doors with a promising future.  

On one visit to our clinic she emotionally shared that she felt guilty (because she also felt so lucky to be alive), yet still grieved that she would never be a mother. We talked at length, I listened, reassuring her that her feelings were normal, encouraging her to discuss options with her doctor. She did and also visited with social work services to get information and resources for adoption agencies. Eventually, Anna was able to adopt a beautiful baby girl. Today, advances in medicine include minimally-invasive surgery that preserves fertility, egg harvesting and more. 

Anna is one of the many survivors who have taught me about courage, determination, faith, hope, love and living with gusto. 

I recently read that it takes a minute to find a special person, an hour to appreciate them, a day to love them, but an entire life to forget them. This is how I see the women and men who I have had the honor to provide nursing care for. They will forever survive in my heart. 

By Jennifer Litton, M.D.

Today at the 2010 ASCO Annual Meeting, a number of studies were presented regarding metastatic breast cancer. Several looked at new drugs showing promise in women with HER2 positive breast cancer who have already had trastuzumab and/or lapatinib therapy.

Trastuzumab DM-1 is a new therapy combining trastuzumab with another toxin that now gets taken up by the metastatic tumor and releases a toxin that kills the tumor cell. The biggest side effect of this therapy appears to be low platelets. Additionally, studies presented look at pairing it with pertuzumab, another anti-HER-2 agent that may also target resistance to trastuzumab. Two other studies looked at adding everolimus, an mTOR inhibitor to trastuzumab. The idea is to block a mechanism of resistance to trastuzumab.

  Litton2.jpgIn the research presented by Morrow and Esteva, et al., this combination of everolimus and trastuzumab had 47 patients. Fifteen percent of patients had a partial response and 19% had stable disease for >/= 24 weeks in women who had already received trastuzumab showing biological activity of this combination.

Further studies regarding improving existing agents and pairing with other agents that circumvent resistance continue to show promise and progress in this field.

Imatinib, better known as Gleevec, has been one of the most successful cancer drugs ever developed. The targeted therapy has increased the five-year survival rate among those with chronic myeloid leukemia from 50% to 90%.


Second-generation drugs that block even more variations of the CML-causing protein have been approved as second-line therapy for those whose disease grows resistant to Gleevec.

Two new studies published in the New England Journal of Medicine and presented at the 46th Annual Meeting of the American Society of Clinical Oncology show that the newer drugs, nilotinib and dasatinib, provide faster, better remissions and do a better job blocking disease progression to more advanced stages when they are given to new CML patients instead of Gleevec.

"The second-generation CML drugs are more effective than imatinib and less toxic overall," says Hagop Kantarjian, M.D., professor and chair of MD Anderson's Department of Leukemia. Kantarjian is the corresponding author of the dasatinib study and co-author of the nilotinib study.

The large, Phase III clinical trials compared the drugs using two measures of high-quality remission: complete cytogenetic response and major molecular response after a year of treatment. Achieving either has been shown to extend survival. The studies also looked at disease progression. Nilotinib and dasatinib were superior to Gleevec in all areas.

"We've learned in cancer therapy that it's important to use your big guns up front," Kantarjian says. "Using these second-generation drugs first will likely improve outcomes for patients with chronic myeloid leukemia."

An accompanying editorial in the New England Journal puts the findings in perspective and touches on medical and economic reasons that might favor one of the three drugs over the others.

MD Anderson has been extensively involved in planning and operating clinical trials for all three drugs. The two new studies confirm results from single-arm clinical trials conducted at MD Anderson comparing the performance of the drugs in new patients to historical results from earlier trials of Gleevec.



MD Anderson News Release: Second-line CML Drugs Evoke Faster, Better Front-line Remissions

I cohen_yoga post_edit.jpgn chronically ill people, yoga helps improve biological parameters, lessen the severity of symptoms, and improve quality of life at a physical and psychological level.


The growing body of scientific research on yoga in medical populations has documented the psychological and health benefits of these ancient practices. The few studies of yoga in people with cancer suggest that yoga helps improve sleep quality, physical functioning, mood, and social well being, as well as symptom control and immune outcomes for patients undergoing treatment. 

A new study presented at the 2010 American Society of Clinical Oncology Annual Meeting provides further support for the benefits of yoga in an oncology setting

The study, conducted by Dr. Karen Mustian at the University of Rochester within the Community Clinical Oncology Program, randomly assigned 410 people who had been treated for early-stage cancer who were having sleep problems two to 24 months after the end of treatment. The participants were mainly breast cancer survivors and were assigned to either the yoga group - who had yoga classes two days a week for four weeks - or a comparison control group who were simply monitored.

By the end of the four-week program, the participants in the yoga group reported improvements in sleep outcomes, less fatigue and better quality of life compared to the control population. That such a brief yoga program led to improvements in sleep quality and fatigue is quite remarkable.

Sleep disturbances and fatigue are two of the most common long-term side effects experienced by people after cancer treatment. Conventional treatments for sleep disturbances and fatigue are of limited benefit and usually have unwanted side effects. Longer follow-up from this unprecedentedly large study is needed to determine the long-term benefits of the yoga program.     

Our own research at MD Anderson suggests that yoga helps improve sleep outcomes, decreases the side effects of treatment, improves physical functioning aspects of quality of life, and leads to an increase in finding meaning from the illness experience as patients transition from active treatment to cancer survivorship.

Yoga will benefit people when they are practicing on a regular basis. However it is a challenge to get people to continue to engage in these healthful practices after the initial instruction phase. Although some changes may be permanent, in the absence of practicing the improvements will likely be short lived without consistent follow-up. 

Mind-body practices are many and varied; yoga is especially useful as it is a quintessential mind-body practice that combines movement, breathing practices and meditation all with the purpose of creating a life with unity and complete awareness. The key is to find a practice that resonates with you and make it a daily practice. 

U.S. News & World Report's "America's Best Children's Hospitals survey has ranked the MD Anderson Children's Cancer Hospital as the No. 12 hospital in the nation for pediatric cancer care.

The annual rankings are based upon a survey of board-certified physicians around the country, patient survival data and a mix of care-related factors such as nurse-to-patient ratio, infection control and services for patients and the community. MD Anderson Children's Cancer Hospital has been included in the survey for the last three years and was ranked No. 13 last year.

"To be ranked in the top 15 among the nation's best children's cancer hospitals is a testament to the compassionate, expert care that we extend to our children, teens, young adults and their families," says Eugenie Kleinerman, M.D., head of the Children's Cancer Hospital. "Every day, we leverage all of our clinical, educational and social resources available on behalf of each patient and their family. It's what they expect from us, and it's what they deserve."

At the forefront of care is a family-centered approach adopted by faculty and staff. Within the past year, the hospital has enhanced its family-centered culture with the formation of a patient-led Adolescent and Young Adult Advisory Council and Supportive Care Committee and the addition of more parents and staff to the Family Advisory Council.

 

Parents now participate in the interview and hiring process for potential employees, and patient and family educational materials are developed with input from parents. In addition, the Children's Cancer Hospital recently adopted a new mission and vision that was written by its staff, faculty and Family Advisory Council.

The Children's Cancer Hospital continues to listen to families, develop new programs and refine current practices to make each patient's experience better. Whether it's the robust research program bringing new therapies to patients or the advanced technologies and support programs that improve quality of life for patients - the faculty and staff look to their patients to guide them in making the Children's Cancer Hospital one of the best in the nation.

Intro by: Mary Brolley, Staff Writer

Adelea Ibsen was just 30 when diagnosed with late-stage breast cancer. At the time of diagnosis, she was living in Germany with her husband and two young daughters. Because of her illness, the family immediately moved back to Texas so she could be treated at MD Anderson.

Ibsen now commutes from her Austin home weekly to participate in a Phase I clinical trial under the direction of Richard Theriault, D.O., professor in the Department of Breast Medical Oncology.

Today's post continues an occasional series on her experiences with cancer and treatment.



Post by: Adelea Ibsen

Adelea_kidsroom.jpgHere come the tears again.

Did I mention I haven't worn contacts in three months due to the spontaneous crying? It dries them out and I have to peel them off my eyeballs.

This is not my first time around the "trial block" on my tricycle. I've done all kinds of trials and mainstream therapies.

I even did the trials where everyone in the study has had some rate of response. Nope, not me.

It sucks, it sucks, it sucks.

I would like a break. God, did you hear me? A break.

There is nothing like the moment when I look into the doctors' eyes and tell them, "I need to be here. No, really. I know we all need to be here, but I HAVE to be here. For my girls."

For my sweet, funny, sassy, smart, creative, snuggle-cuddle girls.

My heart, my soul, the true loves of my life. The thing that drives me like a madwoman.

The day after "The News," I sat at the computer and looked at pictures of them when they were born and growing up. Thinking about how it would be for them, without me. It was a way to cry with them without them being here.

So we start again with a new trial.

This time, we will attempt again the emotional tightrope of having immense hope but no expectations.

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