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People across the world are mourning the death of Apple co-founder Steve Jobs, who passed away Wednesday, Oct 5, following a battle with pancreatic cancer. Jobs' death has turned attention to rare form of cancer, for which the U.S. Food and Drug Administration this May approved a new drug - the first new option in nearly 30 years. Learn more about the drug, everolimus, and how it's helping patients with pancreatic neuroendocrine tumors

By Lori Baker, MD Anderson Staff Writer

Not many emails make you cry. But tears of joy rolled down Carmen Jacobs' face when she read that the drug everolimus had been approved by the U.S. Food and Drug Administration (FDA) for patients with pancreatic neuroendocrine tumors (pNET).

She considers this treatment one of her biggest efforts as a research nurse, and this news meant it had just been delivered to patients everywhere. It's a much-anticipated arrival, since this is the first new treatment option for these patients in nearly 30 years.

"I was there when Dr. Yao treated the first patient in the very first clinical trial about six years ago," says Jacobs, research nurse supervisor, Gastrointestinal (GI) Medical Oncology, who also worked on each subsequent trial. "I was so happy when I got his message saying it was approved. Now all of these patients have access to a new treatment that provides more hope for a longer and better life."

By Katrina Burton, MD Anderson Staff Writer

A prostate cancer diagnosis has the ability to strike fear in the hearts of many men. The fear is a normal reaction as men diagnosed with the disease consider the potential side effects from treatment and how it may affect their sexual relationships.

Depression, negative body image and performance anxiety are some of the symptoms prostate cancer survivors face that can lead to a lack of intimacy and, ultimately, to sexual dysfunction.
 
The ability to have a satisfying sexual experience after treatment may vary, depending on the patient and treatment dynamics. The reality is that men are not the only ones affected by the diagnosis and treatment of prostate cancer.

Positive future
Leslie Schover, Ph.D. a behavioral scientist at MD Anderson, was lead investigator on the CAREss (Counseling About Regaining Erections and Sexual Satisfaction) trial that focused on determining whether couples counseling after prostate cancer treatment had a positive effect on sexual outcomes.

brontoyounes.jpgThis year, approximately 11,000 patients combined will be diagnosed with Hodgkin lymphoma (HL) and anaplastic large cell lymphoma (ALCL). Compared to other cancers, such as breast and lung, these two lymphomas are considered relatively rare cancers. So, chances are, you didn't hear the news about brentuximab vedotin (SGN-35), which is now called Adcetris.  

HL and ALCL are potentially highly curable types of lymphoma when conventional chemotherapy regimens and radiation therapy are used. For this reason, no new drugs have been approved by the U.S. Food and Drug Administration for Hodgkin lymphoma since 1977.

But if you are one of the unlucky ones who aren't cured with these conventional regimens, today is a good day for you. Indeed, it's a good day for all of us. A good day for humanity.

A new drug has been approved

Today, the Oncologic Drugs Advisory Committee/ODAC, an FDA advisory panel, voted 10-0 to recommend accelerated approval for Adcetris to treat patients with relapsed Hodgkin lymphoma after having a stem cell transplant, and for patients with relapsed or resistant systemic ALCL.
 

younesJune11.jpgUp until now, the role of intensified therapy for newly diagnosed lymphoma in the rituximab era remained unknown. 

This week at ASCO, four independent randomized trials, looking at different strategies, reported that more intensive front-line therapy offers no added advantage over standard chemotherapy regimens in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). 

If you don't have the time to read this full report, all you need to know is that RCHOP-21 remains the standard of care.

By Jennifer Litton, M.D., assistant professor, Department of Breast Medical Oncology, MD Anderson Cancer Center

Litton1a.jpgAt ASCO, Canada's NCIC Clinical Trials Group released three-year results from a large randomized double-blind Phase III trial comparing Exemestane (Aromasin), an aromatase inhibitor, to placebo for postmenopausal women at high risk of developing breast cancer.

The study showed a 65% decrease in developing breast cancer when compared to placebo in high-risk, postmenopausal women.

Given how this drug works, it is only effective in women who are postmenopausal without ovarian estrogen production. Exemestane is a drug that has been used for years when treating women with early breast cancer and metastatic disease. Now, it may have another indication in preventing breast cancer.

This is not surprising, as we saw a decrease in second breast cancers that developed in the opposite breast in the early breast cancer trials from this class of drugs. Tamoxifen, which has been used in prevention for years, is a well-tolerated and very effective drug. However, only a small percentage of women choose to take the drug.

By Scott Merville and Laura Sussman, MD Anderson Staff Writers

Customized treatment that matches specialized cancer drugs to their targets on each patient's tumor has been found to increase survival of people with late-stage disease in a Phase I clinical trial at MD Anderson.

Researchers presented results today at the annual meeting of the American Society for Clinical Oncology in Chicago. ASCO also chose to highlight this project to the news media from among thousands submitted to the meeting.

Patients who enroll in Phase I clinical trials have no regular treatment options left and have advanced disease that has spread to other organs or can't be surgically removed. 


 

How this research was done
In this trial, patients' tumors were analyzed for genetic flaws and when there were drugs available to attack that defect, patients received those drugs rather than those thought to target their type of cancer, such as breast or lung. Patients with just about every type of solid tumor -- lung, breast, colorectal, prostate, brain, pancreas, liver, kidney, melanoma, thyroid and many others -- participated.

A new study published May 31 in the Journal of Clinical Oncology reports that beta-blocker use is associated with improved relapse-free survival in all patients with breast cancer, including those with triple-negative breast cancer (TNBC), a particularly aggressive form of the disease.

Previous epidemiological research has shown that breast cancer is potentially more likely to recur in the context of chronic stress and that beta-blockers -- a class of drugs that help in diminishing the effects of the stress pathway by blocking adrenergic stimulation -- may improve breast cancer relapse. These drugs are often used for cardioprotection after heart attacks and to control cardiac arrhythmias and hypertension.

This collaborative study led by Amal Melhem-Bertrandt, M.D., an assistant professor in the Department of Breast Medical Oncology at MD Anderson, found that the use of beta-blockers in patients with breast cancer was associated with an approximately 50% reduction in breast cancer relapse after three years when compared to patients who were not on beta-blockers. The associated improvement in three-year overall survival in the beta-blocker group, although not significant, was approximately 35%..

By Milind Javle, M.D., associate professor, Department of Gastrointestinal (GI) Medical Oncology, MD Anderson
Cancer Center

Recently, a clinical trial published in the New England Journal of Medicine has offered new hope for patients suffering from pancreatic cancer.

This trial enrolled over 300 patients with advanced cancer of the pancreas, who were treated with either the standard chemotherapy with gemcitabine or with a four-drug chemotherapy combination called FOLFIRINOX.

A five-month improvement in survival was noted with FOLFIRINOX; this regimen also delayed cancer progression. This study is important because for the first time a drug combination has been shown to extend survival of pancreatic cancer patients by a significant degree over that offered by gemcitabine, alone.

Scott Evans, M.D., turned his frustration into a finding.

All too often, Evans, an assistant professor in the Department of Pulmonary Medicine at MD Anderson, has seen leukemia patients experience pneumonia in their initial treatments. This is the case in at least 40% of leukemia patients he sees, and a large number of them don't survive it.

One patient, in particular, comes to mind.

A young East Texas man in his early 30s was responding well to his treatments, until he contracted pneumonia. Before long, he was in intensive care, where he died.

Identifying, removing and analyzing a few select lymph nodes often tells the tale

newer.jpgA 38-year-old woman comes to her dermatologist with a mole on her right upper back that has begun to itch and bleed. Examination shows that the mole has irregular borders and varied coloration. A biopsy reveals that it's a melanoma, 2.8 mm deep and with ulceration. There were no clinical signs or symptoms indicating that the melanoma had metastasized. A surgical oncologist recommends wide excision of the primary tumor site and a sentinel lymph node biopsy.

This case, paraphrased, opens an invited article in the May 5 issue of the New England Journal of Medicine by two MD Anderson surgeons. It provides a clinical update on a surgical lymph node biopsy technique that facilitates evaluation of possible microscopic spread of melanoma and indicates who needs further treatment.

MD Anderson was one of the first institutions to use sentinel lymph node biopsy, 20 years ago for melanoma and expanding into other cancer types.

"Sentinel lymph node biopsy allows us to obtain more information in the setting of less invasive surgery than our historical approach," says Jeffrey Gershenwald, M.D., co-author with Merrick Ross, M.D., both professors in the Department of Surgical Oncology. "And this allows a more personalized approach to surgery for our patients."

After years of failure in the treatment of advanced melanoma, two new drugs have emerged that help patients with one of the most deadly and difficult-to-treat cancers.

The experimental drug PLX4032 targets a specific genetic mutation found in the tumors of about half of all patients.  Ipilimumab,  an antibody that stimulates an immune system attack on melanoma, recently was approved by the U.S. Food and Drug Administration for treatment of the disease.

MD Anderson researchers followed a surprising clue to discover that a known cancer-fighting protein also limits the growth of cells damaged by reactive oxygen species, one type of the highly reactive molecules known as free radicals.

Their groundbreaking paper in the Proceedings of the National Academy of the Sciences won the Cozzarelli Prize Tuesday as the best paper in the Biological Sciences category published in the Proceedings during 2010. The prizes are given to the top paper in six categories out of more than 3,700 studies published by the journal each year.

blog pic.jpgCheryl Walker's research team was studying one tumor-suppressing protein when they found another protective protein known to work inside the cell nucleus moonlighting in another part of the cell.

Following up on this surprise, they found the cancer-blocking nuclear protein ATM has a second job controlling and killing damaged cells out in the area between the nucleus and the cell membrane called the cytoplasm. ATM recognizes damage caused by reactive oxygen species and tells the injured cells to stop growing or orders them to devour themselves, a process called autophagy.  

Elevated ROS has been linked to more than 150 diseases, including diabetes, cancer, neurodegenerative diseases and atherosclerosis. ATM is commonly mutated in cancer.

Previously, ATM was known to monitor DNA damage in the nucleus, halt cell division and order the cell to repair the damage. If repair fails, ATM sets off apoptosis -- programmed cell death.

"The Cozzarelli Prize is wonderful recognition of research that brought to light a brand new aspect of cell biology and marked a new direction for our lab," says Walker, a Ph.D. and professor in the Department of Molecular Carcinogenesis, located at MD Anderson's Virginia Harris Cockrell Cancer Research Center, Science Park, near Smithville, Texas.

"Discovery of ATM's additional anti-tumor role is the type of basic science research that heightens our understanding of cancer and paves the way for improved prevention and treatment," says Raymond DuBois, M.D., Ph.D., MD Anderson provost and executive vice president. "The Cozzarelli Prize is a great honor for Cheryl, her lab and MD Anderson.

"The award also highlights the opportunities available for graduate students at MD Anderson," DuBois says. Co-first author Angela Alexander is a doctoral student in The University of Texas Graduate School of Biomedical Sciences, which is operated jointly by MD Anderson and The University of Texas Health Science Center at Houston (UTHealth).

The PNAS paper can be read here.

MD Anderson news release about the paper: Researchers Discover Second Protective Role for Tumor-Suppressor



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