Recently by Dawn Dorsey

120821katie.JPGWhen Katie Meacham was diagnosed with Hodgkin lymphoma in early 2008, she was 25 years old and enjoying a tasty bite of the Big Apple.

She had a good job with a large marketing firm in New York and a promising future in front of her. Then, during a trip to Buenos Aires, she noticed her feet were itching.

"It went away in a few days, but I started to realize I had been itching for a while," she says. "My arm had broken out in hives, my head had been itching and I itched when I got out of the shower."

Then she noticed a lump in her throat. Her mother was visiting and insisted on taking her to the doctor, which led to a CT scan and diagnosis of Hodgkin lymphoma. She opted to be treated at a New York hospital, but two months into treatment, the cancer was found in another lymph node.

Big Apple to Lone Star
"The doctor said he had seen this happen only one other time," she says. "He said I would need a stem cell or bone marrow transplant."

120724_Janice_.JPGSeven years after successful treatment at MD Anderson, Janice thought she had closed the book on breast cancer. Her life was back to normal and she was busy helping others, volunteering for the American Cancer Society, the Komen Foundation and MD Anderson.

Then, on a fun weekend in New Orleans, she noticed some subtle changes.

"I love Mardi Gras," says Janice, a native of Louisiana who lives in Houston. "In 2007, I was checking out a few parades with my sisters when I noticed my balance was off and my attention span was short."

An unwelcome diagnosis
When her husband noticed the changes, too, Janice decided she should investigate. Not too concerned, she visited her primary care physician, who ordered an immediate MRI.

The test showed a lesion in Janice's brain, and she was admitted to MD Anderson.

Doctors told her that her breast cancer cells had spread, or metastasized, to her brain.

"When I heard the diagnosis, it was hard," she remembers. "The first thing I thought was, 'I'm not going to be here much longer.' But I've proved myself wrong. The second thing was that I needed to talk to someone. I didn't know anything about metastatic breast cancer, and suddenly I was in the learning process again."

brainandspineChristy.JPGIn 2007, brain cancer survivor Christine Butterfield added two new words to her vocabulary. Words she wishes she didn't know so much about.

"Anaplastic astrocytoma of the right frontal lobe. That was my diagnosis when I came to MD Anderson," she says. "Big words I never wanted to learn - even how to spell!"

Snowed in
In 2007, Christine and her extended family - including her husband and 18-month-old daughter -- were having a great time in Breckenridge, Colo., about 80 miles from Denver. Then, she started to have severe headaches and nausea. The local hospital didn't have imaging equipment, so they took her by ambulance to the closest larger town for a CT scan.

"The doctor came into my room and said, 'There is a large mass on your right frontal lobe. We don't know what it is, so we have to get you to Denver,'" she remembers. "The problem was the chopper was grounded, and the highway was closed because of the weather."

To make matters worse, it was New Year's Eve. Finally, the doctor found a neurosurgeon in Denver who would see Christine, and they tracked down an ambulance willing to make the drive.

"The doctor in Denver said it really looked like cancer, but that I needed a biopsy to find out for sure," Christine says. "He recommended that I find a place where I had support. My family lives in Houston, and MD Anderson was the first hospital I thought of."

braincancersurvivorGBG.JPGChances are you've worked with someone like Gail Goodwin, a program manager in MD Anderson's External Communications office. She's the one in the office who cheers everyone up with her easy smile and sunny disposition, likely to break into song at a moment's notice.

Goodwin is also a brain cancer survivor.

April Fool's to remember

On April 1, 2009, a co-worker stopped by Goodwin's office to ask several questions, but got no response. She knew something was very wrong when she noticed Goodwin was not talking, which Goodwin points out is a rarity for her.

"My brain was playing a really bad April Fool's joke on me," Goodwin says with her signature sense of humor.

Immediately, Goodwin's office mates called 911. Since her symptoms pointed to a possible stroke, the paramedics took her to the emergency room of a nearby hospital. But over the next couple of days, she was diagnosed with a stage III oligodendroglioma, a rare malignant brain tumor.

"Once I found out I had cancer, I got back to MD Anderson as quickly as I could," Gail says.

mohs.jpgMore than 20 years ago, Florence Beck's bridge partner looked across the table at her and played a card that may well have saved Beck's life.

"She said, 'You have a skin cancer on your cheek. Go see a dermatologist,'" Beck recalls. "Since she was a registered nurse, I paid attention to her advice."

Beck did, indeed, have a skin cancer -- the first of many over the coming years. As a matter of fact, she has had so many removed that she's not sure of the exact number. Her best guess is 12: two squamous cell cancers and 10 basal cell cancers. The majority of them have been removed with Mohs surgery by Deborah Mac Farlane, M.D., professor in the departments of Dermatology and Plastic Surgery at MD Anderson.

In Mohs surgery, thin layers of tissue are shaved off and examined immediately under a microscope. If the tissue is cancer free, the procedure is complete. If cancer cells remain, the process continues until the sample is cancer free.

bike.jpgFor Scott Goodman, halfway is never enough. His intensity bursts through into everything he does -- his way of speaking, his job, his love of life and family -- even his exercise regimen.

So, when he was diagnosed with squamous cell cancer of the ear canal, Goodman knew he wanted his treatment to be as aggressive as possible.

Squamous cell cancer that begins inside the ear is extremely rare. So rare, in fact, that it's not clear how many cases occur each year. However, Paul Gidley, M.D., associate professor in MD Anderson's departments of Head and Neck Surgery and Neurosurgery, estimates that only some 300 cases are diagnosed every year in the United States.

A type of drug that blocks the binding of cancer-promoting proteins may be suitable for treatment-resistant non-small cell lung cancer (NSCLC), especially if a specific growth factor is activated, according to a case study published today in the Clinical Therapeutics section of The New England Journal of Medicine.


The article, written by a team of researchers while they were fellows at The University of Texas MD Anderson Cancer Center, outlines the available data about use of these drugs, known as oral tyrosine kinase inhibitors, in the treatment of lung cancer patients. 

It is based on the case of a 64-year-old woman with Stage I adenocarcinoma (cancer) of the lung who had a right upper lobectomy, or surgical removal of part of her lung. She had never smoked. A year after treatment, the cancer had spread to the bone and liver. Although she then was treated with carboplatin, paclitaxel and bevacizumab, more bone metastases were found six weeks later.

"NSCLC is a deadly disease that is incurable once it has metastasized," said Don Gibbons, M.D., Ph.D., assistant professor in the Departments of Thoracic/Head and Neck Medical Oncology, and Molecular and Cellular Oncology at MD Anderson. "New approaches like erlotinib and gefitinib have proven benefit in a subset of patients, even with widely metastatic disease, and frequently these are less toxic than cytotoxic chemotherapy."

Erlotinib and gefitinib, known commercially as Tarceva and Iressa, are tyrosine kinase inhibitors, which block the binding of epidermal growth factor (EGF) with the epidermal growth factor receptor (EGFR) to stop cancer growth.

Co-authors were first author Vince D. Cataldo, M.D., Louisiana State University Health Sciences Center; Roman Perez-Soler, M.D., Albert Einstein College of Medicine; and Alfonso Quintas-Cardama, M.D., assistant professor, Department of Leukemia, MD Anderson Cancer Center.

Agents block growth factor binding

According to the American Cancer Society, lung cancer is the leading cause of cancer-related death in the United States, and each year it accounts for more than 157,000 deaths. About 90% of lung cancers are NSCLC. Even with new drugs, such as bevacizumab, the median five-year survival rate is 3.5%.

The dismal outlook for NSCLC has prompted researchers to look for new treatment approaches, including some - like erlotinib and gefitinib - that act on the epidermal growth factor receptor, which is activated in more than half of patients with NSCLC. This is the same protein targeted by the monoclonal antibody cetuximab, that was developed under the pioneering leadership of MD Anderson Cancer Center President John Mendelsohn, M.D.

Binding of epidermal growth factor (EGF) and other EGF-like growth factors to their receptors triggers cancer-promoting  processes such as cell proliferation, protection from cell death, activation of new blood vessel formation and development of metastasis.

Research shows success in certain patients

In clinical trials, these agents have shown some success in NSCLC. Research suggests they may be as effective as standard chemotherapy for second- or third-line treatment in patients with advanced NSCLC. As first-line therapy, tyrosine kinase inhibitors appear to be less effective than standard chemotherapy in general but more effective for some patients, especially those with activating EGFR mutations. Some initial clinical trials have shown that women, patients of East Asian descent, patients who have never smoked and patients with adenocarcinomas who received erlotinib or gefitinib had higher rates of response and overall survival.

Because EGFR tyrosine kinase inhibitors are expensive and have shown relatively low response rates overall, a method is needed to identify the specific patient group that will benefit from them. EGFR mutational status is the most reliable predictor of response and benefit now. However, assessment of all patients with advanced NSCLC and subsequent treatment with an EGFR tyrosine kinase inhibitor for those with EGFR mutations has not shown to have an overall positive effect on survival. However, if a patient is known to have an EGFR mutation, therapy with an EGFR tyrosine kinase inhibitor is advisable.

Erlotinib is recommended in this case

Gibbons says their review of data suggests EGFR tyrosine kinase inhibitors should be considered in this case. Since erlotinib has been shown to be beneficial as second-line therapy in unselected patients, treatment without assessment of the EGFR mutational status is acceptable. Restaging studies should be conducted before therapy begins and six to eight weeks after to evaluate response. Therapy should continue until the cancer progresses.


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