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Combining Radiation and Surgery Significantly Improves Survival for Head and Neck Cancer Patients

  • 6/10/2008
  • Fairfax, VA
  • press release
  • NewsReleaseWire.com

Adding radiation therapy to surgery significantly improves overall survival in patients diagnosed with node-positive head and neck cancer when compared to treating with surgery alone, according to a study in the June issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.

Radiation therapy is commonly used after surgery to treat some head and neck cancers, but very few studies have been conducted to determine its impact on survival. Researchers at the Mount Sinai School of Medicine departments of Radiation Oncology and Otolaryngology and Head and Neck Surgery in New York sought to determine with this study the impact of radiation and surgery on a head and neck cancer patients’ overall survival.

Between 1988 and 2001, 5,297 patients with a median age of 59 who were diagnosed with node-positive head and neck squamous cell carcinoma were treated with surgery and/or adjuvant radiation therapy. The patients were surveyed approximately 4.4 years after treatment, and the researchers found that adding radiation to surgery improved patients’ chance of survival by 25 percent in all nodal stages (N1-N3), including N1 stage patients, even though radiation is typically recommended only for N2 and N3 stage patients.
“This study provides evidence that radiation should be considered after surgery for most head and neck cancer patients with positive lymph nodes,” said Johnny Kao, M.D., assistant professor of radiation oncology at the Mount Sinai School of Medicine and lead author of the study. “For these patients, adding radiation improves not only locoregional control but also greatly increases their chance for overall survival. The findings of this study should serve to enhance the use of adjuvant radiation as the most effective treatment method for these types of cancer.”

For more information radiation therapy treatments for head and neck cancers, visit www.rtanswers.org.

ASTRO is the largest radiation oncology society in the world, with more than 9,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy.

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June, 2008|Archive|

What to Know About Tonsil Cancer

  • 6/9/2008
  • Houston, TX
  • staff
  • CancerWise (www.cancerwise.org)

Whether people have had their tonsils removed or not, they still might develop tonsil cancer and should be educated about the disease.

Answering questions about tonsil cancer is Ann Gillenwater, M. D., associate professor in M. D. Anderson’s Department of Head and Neck Surgery and director of the cancer center’s Oral Cancer Prevention Clinic.

What are tonsils?
The tonsils are a collection of lymph tissue, or white blood cells, at the back of your mouth that gather there to help fight infection.

What raises the risk of tonsil cancer?
Traditionally, the known risk factors for tonsil cancer are tobacco and alcohol use, but now there seems to be an increased rate of tonsil cancer in patients who don’t smoke or drink. There is some evidence that it’s related to the human papillomavirus (HPV).

Can you have tonsil cancer and no tonsils?
Even if you have had your tonsils removed (tonsillectomy), you can still get tonsil cancer because during the procedure, some tonsil tissue is left behind.

What are the symptoms of tonsil cancer?
The number one symptom is asymmetrical tonsils, having one tonsil larger than the other. Another symptom is a persistent sore throat.

At later stages, there are enlarged lymph nodes or cysts in the neck and maybe ear pain. As a general rule, any time someone is thought to have a tonsil infection and antibiotics don’t work, doctors should consider tonsil cancer.

Many times tonsil cancer that has metastasized or spread to lymph nodes is mistaken for a benign cyst called a branchial cleft cyst, which sometimes develops in children. In adults, it’s more common that the cyst is really metastatic tonsil cancer.

How is it diagnosed?
An otolaryngologist (ear, nose and throat doctor) examines the area and determines if a biopsy is needed.

What is the standard treatment?
Radiation, because tonsil cancer responds well to it and it has less of an impact on swallowing and speaking than surgery. In advanced cases, we use chemotherapy with the radiation therapy.

Are there new treatments for tonsil cancer?
M. D. Anderson has been using a combination of radiation and molecular targeting agents called EGFR (epidermal growth factor receptor) inhibitors, which I explain to my patients like this:

The receptor is like a docking station for EGF, a type of growth hormone. Cancer cells overproduce these docking stations, so they can absorb more of that growth factor. If we can block that docking station using the EGFR inhibitor, then the cancer will die or stop growing.

How can patients prepare for treatment?
Radiation makes the muscles in the neck tight and fibrous. It’s very important for patients to see a speech pathologist before they begin treatment to learn stretching and strengthening exercises to help them maintain their swallowing function.

It’s also really important before radiation for patients to see a dentist to get an assessment on whether any dental work needs to be done, such as having wisdom teeth pulled or decayed teeth extracted. Radiation causes a lot of side effects on the mouth and teeth, and dental work after treatment may not be possible.

Radiation can decrease the amount of saliva, which is important for fighting cavities.

Radiation also decreases the blood supply to the jaw bone, so the bone would have a hard time healing if there were dental procedures after radiation. If an abscess developed after radiation treatment, it also would be very difficult to heal, and may lead to loss of the jaw bone.

What should patients know about the recovery?
Sometimes patients need a feeding tube because the radiation can cause burning inside the mouth, and sometimes it can cause difficulty swallowing.

What is the recurrence rate for tonsil cancer survivors?
Recurrence of tonsil cancer caught at an early stage is very low, as it is with tonsil cancer caused by HPV.

Is there a screening for tonsil cancer?
Not presently. If you get a physical every year, ideally, your doctor can look in your mouth and see if you have one tonsil bigger than the other or any other symptoms. Many dentists detect tonsil cancer during a dental exam.

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June, 2008|Archive|

Laser Therapy A Safer, Faster Cure For Throat Cancer

  • 6/8/2008
  • Washington, D.C.
  • Windsor Genova
  • All Headline News (www.allheadlinenews.com)

Using laser light to destroy cancer cells has been found to be safer in treating throat cancers than surgery, radiation and chemotherapy.

Dr. H. Steven Sims, assistant professor of otolaryngology and director of University of Illinois-Chicago’s Chicago Institute for Voice Care, used photodynamic therapy to completely removed the cancer from around the vocal folds of patient Sammie Bush without affecting his voice. The procedure was done on May 15.

In photodynamic therapy, the patient is injected with a light-activate drug that makes all cells in the body very sensitive to light. After two days, normal cells will return to their original state but the cancerous cells will retain the drug. A laryngoscope is then used to beam laser light with a specific wavelength to the cancerous cells. A biochemical reaction disintegrates the cells in a few days.

According to Sim, the laser technique saves the patient the inconvenience and cost of the repeated traditional medical procedures. It is also fast, does not require surgery, minimally invasive and cures oral and laryngeal cancers at a rate of 90 to 94 percent after one treatment.

“Best of all, normal tissues around the malignancies are left undamaged,” Sims said, according to Newswise.com. He added that photodynamic therapy allows patients to quickly use their voice. In contrast, a radiation procedure requires longer treatment and may cause voice to temporarily deteriorate.

The only side effect of the laser technique is the skin’s sensitivity to light for up to six weeks following the procedure, so the patient must me properly protected from sunlight.

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June, 2008|Archive|

How doctors can catch cancers in the mouth

  • 6/8/2008
  • Chicago, IL
  • Jeremy Manier
  • Chicago Tribute (www.chicagotribune.com)

Dental exams are considered the first line of defense for many forms of oral cancer, but the usefulness of such screening is unclear for HPV-related throat cancer.

Such tumors usually appear in the upper throat, which can be too far back for routine oral inspections to find them, experts said.

“Often we’ll get a referral from a dentist, but to be honest most of these patients’ tumors are not detected that way,” said Dr. Ezra Cohen, an oncologist at the University of Chicago Medical Center.

One of the most common ways of catching such cancers is during a routine physical, when doctors feel the patient’s neck for enlarged lymph nodes. If a patient or doctor feels a growth on the upper neck, the next step is often referral to an ear-nose-throat specialist, who can examine the upper throat by using an optical scope that’s guided down through the nose.

Although it’s difficult for dentists to catch HPV-positive throat cancers, a thorough dental exam can catch oral cancer at an early stage. A study presented in April at the meeting of the American Academy of Dental Research suggests that patients with HPV and swollen gums are at increased risk of tongue cancer.

Dr. Mine Tezal, a co-author of that paper, said dentists usually look for red or white discoloration of the gums, tongue or inside of the cheek.

“Anybody can have red and white lesions, but they usually heal in a couple of weeks,” said Tezal, a professor of oral diagnostic sciences at the Roswell Park Cancer Institute in Buffalo. She said if a lesion persists for longer than a couple of weeks, patients should consider having a dentist or doctor examine it.

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June, 2008|Archive|

HPV vaccine’s suspected side effects cause concern

  • 6/6/2008
  • Dallas, TX
  • Jessica Meyers
  • Dallas Morning News (www.dallasnews.com)

Katherine Kimzey started suffering debilitating headaches, fainting spells and arthritis-like stiffness last November.

Six weeks later, the 14-year-old Dallas resident became so dizzy she could barely walk. She was hospitalized and missed three weeks of school.

Then, she had a seizure. For weeks, she bounced back and forth between specialists and was eventually diagnosed with epilepsy.

Katherine’s mother, Michelle Kimzey, now believes her daughter’s symptoms were caused by a new vaccine that was supposed to protect her against cervical cancer.

The symptoms started not long after Katherine had her second shot late last year, she said. And they mirrored many of the 5,000 reports filed by the public through a national database that monitors the safety of vaccines after they are licensed.

“When you read everybody’s stories, they’re too similar not to be related,” Mrs. Kimzey said.

But officials with the Centers for Disease Control and Prevention and doctors nationwide said such concerns about the drug are unfounded and most significant side effects reported are unrelated to the vaccine.

“The safety of the vaccine is being very closely monitored,” said John Iskander, acting director for immunization safety at the CDC, which runs the database along with the Food and Drug Administration.

“There certainly have been high-profile suspected side effects, some reports of deaths,” he said, “but those have been investigated and they don’t appear to have been causally related.”

The recommendations have not changed and the vaccine will remain available, he said.

Jennifer Allen, a spokeswoman for New Jersey-based Merck & Co.’s vaccine division, which makes Gardasil, said Thursday that the company conducted clinical trials for 10 years and that it remains confident in its product.

But this hasn’t assuaged Mrs. Kimzey, 41. And Katherine has refused to get her third and final dose of the vaccine.

Approved 2 years ago

Gardasil was approved by the Food and Drug Administration two years ago for females between ages 9 and 26. It protects against sexually transmitted diseases caused by the human papillomavirus, or HPV, responsible for 70 percent of cervical cancers and 90 percent of genital warts. Females are encouraged to get the vaccine before they become sexually active.

Three shots are given over a six-month period. The company said 16 million doses have been administered since its approval. And it lists nausea, vomiting and pain following the shot among the side effects.

The HPV vaccine has generated debate across the country and in Texas. Gov. Rick Perry issued an executive order in February 2007 requiring that all sixth-grade girls get the HPV shot. But angry parents and conservative groups fought the mandate, fearing it condoned premarital sex and took away parental rights. The Legislature defeated the order last April.

The National Vaccine Information Center heralded the decision, saying that testing of the vaccine was not extensive enough in girls under 12. The nonprofit center had already started warning about the possibility of adverse reactions such as extreme fatigue, arthritis and loss of consciousness.

Barbara Loe Fisher, co-founder and president of the center, said she’s frustrated that the CDC has “assumed safety” for Gardasil, which has been tested only in conjunction with the vaccine for Hepatitis B.

Today, girls often receive the Gardasil shot at the same time as a meningitis vaccine and another new booster that immunizes against tetanus, diphtheria and pertussis.

The FDA has approved all the vaccines separately, but studies on administering them together are still ongoing.

“Not only was Gardasil put on the fast track and licensed quickly,” said Ms. Fisher, “but to say safety is assumed and you can give any vaccine with it is even more shocking.”

Enough evidence

Joseph Bocchini, chairman of the Committee on Infectious Diseases for the American Academy of Pediatrics, says there’s enough evidence to support mixing the drugs and not enough adverse reactions to stop it.

“From the data, we already know [the vaccines] would not be expected to interfere with each other in terms of antibody or safety,” said Dr. Bocchini. “If we look at the number of doses given vs. the reports, it’s very clear that there are significant benefits that far outweigh potential risks at this time.”

Dr. Bocchini cautioned that reactions that do not occur immediately, like seizures, may actually be caused by something else. So far, he said, there have not been enough verifiable reports of extreme side effects through the Vaccine Adverse Event Reporting System, or VAERS, to generate a study.

Dallas County’s Health and Human Services officials said they have received no reports of severe reactions to the vaccine.

The Texas Department of Health and Human Services said it had 210 reports of reactions to Gardasil last year, eight of which required hospitalization.

But officials said this is not an uncommon number for a vaccine. Dr. Jennifer Walsh said she will continue to encourage use of the vaccine where she works, the Adolescent Medical Clinic at Children’s Medical Center Dallas.

“I’m still following the standard guidelines,” Dr. Walsh said. “I don’t have any worries at this point.”

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June, 2008|Archive|

New treatment combination proves safe, effective for head and neck cancer patients

  • 6/3/2008
  • Chicago, IL
  • press release
  • EurekAlert.com

Patients treated for locally advanced head and neck cancer may respond better to treatment with the addition of cetuximab to chemotherapy, according to a University of Pittsburgh Cancer Institute (UPCI) phase II study. The results will be presented at the 44th annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago as an oral presentation.

In the study, 39 patients with stages 3 or 4 head and neck cancer were treated initially with a combination of docetaxel, cisplatin and cetuximab, after which they received radiation therapy and additional cisplatin and cetuximab. Cetuximab, approved by the U.S. Food and Drug Administration in March 2006 and also known as Erbitux, is often prescribed for metastatic colorectal cancer and is used in conjunction with radiation therapy to treat squamous cell carcinomas of the head and neck. This is the first time it has been used in combination with docetaxel and cisplatin as induction therapy.

“We found that adding cetuximab to standard chemotherapy helped head and neck cancer patients respond better to treatment. Out of 37 patients, 32 responded to induction treatment for an 86 percent response rate, and all patients had their tumors reduced, either partially or completely, after radiation was completed,” said Ethan Argiris, M.D., lead investigator and medical director of the aerodigestive cancers program and co-leader of the head and neck cancer program of UPCI.

Further evaluation of this treatment shows that the complete disappearance of the primary tumor occurred in about 80 percent of patients. More importantly, after two years the same percentage of patients remained cancer-free. “Given that the majority of our patients had stage 4 disease, our efficacy results are thus far very encouraging,” said Dr. Argiris. In addition, the UPCI investigators noted that treatment-related toxicities were expected and manageable.

Dr. Argiris and his colleagues are planning more clinical studies using this regimen.

“While longer follow-up will be needed to assess long-term efficacy and side effects, the addition of cetuximab to chemotherapy and radiotherapy is very promising and could become the standard of care in the next few years,” said Dr. Argiris. “The results from this trial, and the possibilities we are witnessing with novel agents, are allowing us to be optimistic about the future of patients with head and neck cancers,” he added.

Head and neck cancers are a group of biologically similar cancers originating from the upper aerodigestive tract, including the lip, mouth, nasal cavity, paranasal sinuses, pharynx and larynx that affect more than 45,000 individuals in the U.S. each year. Most head and neck cancers are classified as squamous cell carcinomas. Head and neck cancers are strongly associated with environmental and lifestyle risk factors, including tobacco smoking, alcohol consumption and certain strains of the sexually transmitted human papilloma virus.

Notes:

1. Co-investigators of the study include M. Gibson, M.D.; D.E. Heron, M.D.; R. Smith, M.D.; R.L. Ferris, M.D., Ph.D.; S.Y. Lai, M.D., Ph.D.; S. Kim, Ph.D.; B.F. Branstetter, M.D.; J.T. Johnson, M.D.; and J.R. Grandis, M.D., all of the University of Pittsburgh. The study was partially supported by Bristol-Meyers Squibb, cetuximab’s manufacturer.

2. The study is published as abstract number 6002 in the 2008 ASCO Annual Meeting Proceedings and will be accompanied by an oral presentation given by Dr. Argiris at 3:30 p.m. CT, June 2.

3. Founded in 1984, the University of Pittsburgh Cancer Institute became a National Cancer Institute (NCI)-designated Comprehensive Cancer Center in record time (by 1990). UPCI, the only cancer center in western Pennsylvania with this elite designation, serves the region’s population of more than six million. Presently, UPCI receives a total of $154 million in research grants and is ranked 10th in funding from the NCI.

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June, 2008|Archive|

Avant brain cancer vaccine has wider promise

  • 6/3/2008
  • New York, NY
  • edited by Andre Grenon
  • Reuters News (www.reuters.com)

A promising vaccine to treat brain cancer developed by Avant Immunotherapeutics Inc may also hold promise against numerous other types of cancer, Interim Chief Executive Anthony Marucci said in an interview.

Researchers said on Monday that Avant’s vaccine, licensed by Pfizer Inc in April, more than doubled the survival time in patients with the most common and deadly type of brain tumor in a clinical trial.

Marucci, whose company is guaranteed an undisclosed double- digit royalty on Pfizer’s future sales of the product, said the world’s largest drugmaker has the money and could have the desire to greatly widen the scope of research on the vaccine.

“My guess is they would want to do larger studies in different indications, like head and neck cancer, ovarian and prostate cancer,” Marucci said in a recent interview, noting that such studies could cost hundreds of millions of dollars.

The vaccine works by targeting a receptor to a type of protein called epidermal growth factor that has a mutation only found in cancer cells.

In the recently completed trial, the vaccine was used in combination with Temodar, a brain cancer drug sold by Schering- Plough Corp.

“The only side effect you have with the vaccine is that it gives you a little redness around the site where it is injected, so the safety profile is an added bonus,” Marucci said. “In oncology, any time you have a mild side effect profile, you’re grateful.”

Marucci said the price of Avant’s vaccine will likely be in line with Temodar, which he said costs about $35,000 for a year of treatment.

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June, 2008|Archive|

New research offers insight into oral cancer

  • 6/2/2008
  • Alexandria, VA
  • staff
  • Genetic Engineering and Biotechnology News (www.genengnews.com)

A new study published in the June 2008 edition of Otolaryngology Head and Neck Surgery focus on what role gender plays in the prognosis of oral tongue cancer.

This study is a prime examples of the wide variety of critical research being undertaken every day by otolaryngologist-head and neck surgeons; research that will improve physicians ability to provide the best patient care for the ear, nose, throat, head and neck, said journal editor Richard M. Rosenfeld, MD.

Researchers at the University of Milano-Bicocca, Italy, found that although oral cancer is more prevalent in men, in their study group of 71 women and 142 men diagnosed with tongue cancer, gender did not influence prognosis. Based on this, the researchers concluded that employing a less aggressive course of treatment in female patients due to their gender was not justified.

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When Thumbs Up Is No Comfort

  • 6/2/2008
  • New York, NY
  • Jan Hoffman
  • New York Times (nytimes.com)

Over the Memorial Day weekend, the actor Patrick Swayze, who is being treated for pancreatic cancer, made a pointedly public appearance at a Los Angeles Lakers game, looking strong-jawed and bright-eyed. He released a statement about his lively schedule and good response to therapy. Meanwhile, Senator Ted Kennedy, who had recently left Massachusetts General Hospital with a diagnosis of brain cancer, flashing crowds a thumbs up, competed in a sailing race. International headlines cheered, “Fight, Ted, Fight!”

As public figures are stricken with harrowing illness, the images of them as upbeat — think of the former White House spokesman Tony Snow, Elizabeth Edwards, the actress Farrah Fawcett — accompanied by stirring martial language, have almost become routine.

“Whether you’re a celebrity or an ordinary person, it’s obligatory, no matter how badly you’re feeling about it, to display optimism publicly,” said Dr. Barron H. Lerner, the author of “When Illness Goes Public.”

That optimism reassures anxious relatives, the public and doctors, regardless of whether it accurately reflects the patient’s emotional state. “If Ted Kennedy wanted to stick up his middle finger,” Dr. Lerner added, “that would be the more appropriate finger, but he’s doing what he is supposed to.”

Whether such images inspire patients, or reinforce unrealistic expectations that they, too, should maintain a game face, remains an open question, say doctors, social workers, family members and patients themselves.

Adam Lichtenstein, a founder of Voices Against Brain Cancer, a fund-raising and support organization, sees no down side to Mr. Kennedy’s composure. “It gives everyone else with his diagnosis a glimmer of hope,” said Mr. Lichtenstein, whose ebullient brother, Gary, was 24 when he died from a glioblastoma. “Patients think, ‘He’s fighting it, why can’t I?’ ”

But Rachel M. Schneider, a clinical social worker at Memorial Sloan-Kettering Cancer Center, said that while many patients are inspired by celebrities, others feel guilty for not being as upbeat as the celebrities appear, and angry that the gravity of the disease may be misrepresented. By being constantly reminded that they should keep their chin up, patients implicitly believe that emotional wobbliness will adversely affect their outcome.

“Hopefulness is real,” Ms. Schneider said. “But patients say, ‘I have to be positive, I can’t cry, I can’t let myself fall apart.’ And that is a burden.”

Certainly maintaining a game face is how many patients cap the eruption of terror and anxiety, in an effort to protect their loved ones and themselves. But not everyone is going to be brave, said Dr. Joseph J. Fins, chief of medical ethics at Weill Medical College of Cornell University. “We only hear about those who handle it well,” he said. “As a society we value the stoic but we don’t know what the stoicism hides.”

Although public figures promote enduring impressions of the stalwart, pumped-up spirit, he added, patients themselves often describe a more nuanced, evolving journey. When Robert Kosinski was told he had a tumor on top of his brain stem, entwined with his optic nerve, “Everything went dark, went blank,” he recalled. “I was overwhelmed by the idea that I had a brain tumor stuck inside me. The train ride home lasted so long and I just kept wondering, ‘How long do I have to live?’ ”

Faced with potentially harrowing repercussions from a biopsy, Mr. Kosinski, a husband and father in Jersey City, said he felt depressed and ultimately alone with his decisions.

He chose not to have the biopsy, and went through chemotherapy. He would endure a dozen blood transfusions. Optimism, or even stoicism, were not part of his emotional makeup during those grueling months. “I never felt brave or courageous,” Mr. Kosinski said. “I don’t know what that means. I was scared. I was the furthest you could be from courageous.”

That was 15 years ago. Mr. Kosinski, now 61, paints and attends a monthly support group, where he ascribes his odds-defying survival to luck and medical expertise, rather than personal will. “Some people in my group don’t want to hear the upbeat scenario,” he said. “The way they’re coping is completely the opposite because they feel they may not make it.”

It’s important for patients to realize that “there’s no scripted way to handle this,” Dr. Fins said. “They can write their own script based on their own narrative.

“If we fail to meet patients where their grief has taken them, we have sequestered them off,” he added. “Then patients and families talk about platitudes rather than what they’re really thinking.”

In the last 15 years, as patients have become more outspoken, a mushrooming amount of cancer narratives has legitimized a soulful range of responses to illness. The Internet teems with patients’ voices: communities gather to weep and wisecrack on sites like the uppity ChemoChicks or MyCancer, a National Public Radio blog by Leroy Sievers, a former television news producer .

Dr. Gary M. Reisfield, a palliative care specialist at the University of Florida, Jacksonville, believes that the language used by cancer patients and their supporters can galvanize or constrain them. Over the last 40 years, war has become the most common metaphor, with patients girding themselves against the enemy, doctors as generals, medicines as weapons. When the news broke about Senator Kennedy, he was ubiquitously described as a fighter. While the metaphor may be apt for some, said Dr. Reisfield, who has written about cancer metaphors, it may be a poor choice for others.

“Metaphors don’t just describe reality, they create reality,” he said. “You think you have to fight this war, and people expect you to fight.” But many patients must balance arduous, often ineffective therapy with quality-of-life issues. The war metaphor, he said, places them in retreat, or as losing a battle, when, in fact, they may have made peace with their decisions.

To describe a patient’s process through illness, he prefers the more richly ambiguous metaphor of a journey: its byways, crossroads, U-turns; its changing destinations; its absence of win, lose or fail.

Richard Haimowitz, 62, a lawyer in Queens who was found to have pancreatic cancer in January 2007, thought of himself as a warrior, fighting with all available ammunition.

“The day of my last treatment, people congratulated me, but I felt blindsided by my reaction,” Mr. Haimowitz said. “I thought, ‘Oh my God, I have nothing left to fight with,’ and I felt angry that there was nothing left for me to do.” Statistics to the contrary, Mr. Haimowitz has had two clean scans, is back at work and takes spinning classes. As he soldiered through treatment, Mr. Haimowitz recalled, he did not fear death, even though he did not want to die. Many studies published in oncology and mental health journals have looked at whether attitude is a factor in survival or recurrence rates, a core belief in many cultures and faiths. Some studies say yes, others no. They all have their critics.

“The thumbs-up attitude is very important,” said Darren Latimer, 33, a banker in Chicago who had surgery for a malignant brain tumor in May 2005, and still receives chemotherapy. “You can be in the dumps very quickly in our business, the business of being sick. But can you fight your disease and not yourself?”

Certainly patients need psychic resolve to make difficult decisions, prepare for stark regimens and to push back against bleak prognoses. The evolutionary biologist at Harvard, Stephen Jay Gould, whose doctors told him that eight months was the median survival rate of patients with his diagnosis, abdominal mesothelioma, wrote: “Attitude clearly matters in fighting cancer.” In his 1985 essay, “The Median Isn’t the Message,” he described how he then closely studied those grim statistics to optimize his chances. He died from another form of cancer 20 years after the initial diagnosis.

Uneasy well-wishers, steeped in near-superstitious belief about positive mental attitude, can exacerbate anxiety. On Cancerblog.com and ChemoChick’s “Excuse Me?” sites, lists of tone-deaf remarks include, “If anyone can beat it, it’s you,” “You gotta think positively” and “Just look at Lance,” a reference to Lance Armstrong, the champion cyclist and a cancer survivor.

Brian Wickman, a manager at a luxury hotel in Manhattan, needed to reframe his loved ones’ language. Two years ago, an oncologist told him there was little published data about the aggressive tumor on Mr. Wickman’s ankle because it was so rare and because, “no one wants to publish when all the subjects die.” A month later, Mr. Wickman, then 30, a skier and a rock climber, had his left leg amputated. He was also found to have thyroid cancer. He reacted severely to chemotherapy, and spent two months in intensive care.

His awestruck friends would say, “ ‘You’re so brave, I don’t know how you do it, you’re my inspiration.’ They would put me on a pedestal,” Mr. Wickman said. “That doesn’t allow me to be human and in pain, angry or depressed.”

His e-mail messages reveal a spirit of great equanimity and eloquence: Mr. Wickman, who now wears a prosthesis and has resumed athletic activities, will attend graduate school in the fall for a joint degree in social work and divinity.

But in his darker moments, he refused to construct a front. He would write bluntly about feeling grumpy, frustrated and afraid nobody would date him. “This is not a call for pity responses,” he would add. “Just let me be where I am.”

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June, 2008|Archive|

Anemia Drugs May Speed Tumor Growth in Some Cancer Patients

  • 6/2/2008
  • web-based article
  • Amanda Gardner
  • U.S. News Health (health.usnews.com)

Widely prescribed blood-boosters might stimulate malignant cells, hasten death, study says.

Drugs used widely to treat anemia in cancer patients may actually speed progression of the cancer in certain individuals, but researchers report they may found a way to determine who those individuals are.

“We may have a test to predict whether a patient is susceptible to having their tumor progress if treated with erythropoietin and, alternatively, we may be able to predict patients it would be safe to treat with erythropoietin,” study author Dr. Tony Blau, of the University of Washington in Seattle, said during a Sunday news conference at the American Society of Clinical Oncology annual meeting in Chicago.

Recent controversy over erythropoiesis-stimulating agents (ESAs) such as Procrit, Epogen and Aranesp has centered around whether the blood-boosting drugs should be withdrawn from the market because of troubling side effects.

In March, a U.S. Food and Drug Administration advisory panel voted to recommend continued use of the drugs for patients on chemotherapy, unless the patient is likely to be cured. They also voted to recommend against the drugs’ use in patients with breast or head and neck cancer.

Eight clinical trials now suggest these medications actually speed the growth of tumors and shorten the lives of cancer victims.

The drugs’ manufacturers added a “black box” warning to the medications last November.

“There has been lots of controversy over these stimulating agents, and we have an FDA advisory committee to act on this as we speak,” said Dr. Julie Gralow, director of breast oncology at the University of Washington and Fred Hutchinson Cancer Center in Seattle and moderator of the Sunday news conference. “The drugs offer benefits in terms of reducing anemia and reducing transfusions, but several large trials in a variety of tumor types suggest that . . . these agents may have some stimulatory effects on tumor cells, faster progression in some cases, and more death in others.”

Until recently, Blau added, these drugs represented the biggest U.S. federal expenditures for oncology patients.

The results of the current study were based on analyses of tumor samples from 101 patients diagnosed with head and neck cancer who had participated in a previous phase III trial of erythropoietin.

Scientists measured levels of erythropoietin receptor (EpoR) messenger RNA (mRNA).

High levels of EpoR mRNA in patients who had undergone radiation but not surgery tended to signal a worse prognosis. There was a similar effect with Janus Kinase 2 (Jak2), the main intermediary of EpoR signaling, Blau added.

“These are preliminary findings, but they’re very exciting,” Gralow said. “If they hold up, they may mean that we may be able to use ESAs in targeted ways.”

“These findings must be considered preliminary until confirmed,” added Blau. “We believe that the definitive answer to this question lies locked in the filing cabinets of pathologists’ offices that contain tumors of patients who participated in already completed phase III studies.” That, of course, would be much easier than initiating entirely new studies.

A second study found the multiple drugs elderly cancer patients may already be taking could interact significantly with chemotherapy.

In particular, patients taking drugs that interfered with protein binding such as Norvasc for high blood pressure, Prilosec for heartburn, and the pain reliever Celebrex were more likely to experience hematologic side effects such as low white blood cell counts.

Patients taking drugs that act on a group of enzymes known as cytochrome p450 were more likely to experience effects such as fatigue or diarrhea. Examples of these drugs include the heart medications such as Pacerone and Cordarone.

“We found that all drugs patients are taking besides chemotherapy are likely to affect their tolerance to chemotherapy,” said study author Dr. Mihaela Popa, of the H. Lee Moffitt Cancer Center in Tampa, Fla.

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June, 2008|Archive|