Monthly Archives: October 2016

Immunotherapy as a cancer treatment

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Immunotherapy as a cancer treatment was addressed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

Dr. Mohammed Milhelm, Holden Chair of Experimental Therapeutics at the University of Iowa, said “Sarcoma doctors aren’t happy with the current treatments available. I’m trying to move immunotherapy into sarcoma treatment.”

Historically, immunotherapy is used to stimulate the immune system, yet if our immune systems are always accelerated, we would not live. “We have a good brake system in our bodies,” he said.

Immunotherapy is using the body to target the tumors. “A lot of people are thinking about immunotherapy in combination with other treatments,” he said. “We are still trying to understand how the immune system works. It’s tricky and complicated.”

A lot of questions are coming up about how to do immunotherapy. Sometimes imaging months after treatment ends might show significant improvements. Combining immunotherapy with radiation might help the immune drug work better.

Newer, more powerful drugs are on the horizon. “We’re learning a lot from the melanoma world and trying to transfer it to other cancers. There haven’t been enough immunotherapy treatments with LMS to know if it is effective.”

Swelling can be a big problem, especially in the bones and the brain, and is a concern researchers still don’t know how to address.

There is a lot of promise right now, but researchers don’t yet know how to translate it into treatments for LMS.

Chemotherapy Clinical Trials

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Chemotherapy clinical trials for leiomyosarcoma (LMS) were discussed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

There are 70 different types of sarcoma, and treatment is moving toward individual types of sarcoma using genetically specific molecular therapy, said Dr. Scott Okuno, Chief Medical Officer in Sarcoma Alliance for Research Through Collaboration, a non-profit research cooperative,  and professor of oncology at Mayo Clinic.

“As we get deeper into LMS, we find molecular subtypes of LMS,” he said.

He explained that adjuvant treatment is preventative. Typically a tumor is removed and the patient is given additional treatment to eradicate microscopic metastatic cells.

Neoadjuvant treatment is given prior to removal/ablation of a tumor, and is used to shrink the tumor and eradicate any microscopic metastatic cells.

In determining which path to follow, the physician will look at outcomes. For neoadjuvant treatment, for example, perhaps 33 percent (about three of 10 patients) will have a recurrence.

With adjuvant treatment, there might be another 33 percent reduction in recurrence—which means instead of three out of 10 patients with recurrence, there will be two out of ten patients with recurrence.

Chemotherapy is given when a tumor cannot be surgically removed.

In clinical trials, a tumor has to decrease in size by 30 percent to be considered a partial response.

Progression has to be a greater than a 20 percent increase for the treatment to be considered no longer working.

Sometimes the lump might get bigger but the tumor is dying, so the percent increase in size is allowed. One needs a sarcoma specialist to determine if the growth is from dying cells or from a growing tumor.

Dr. Mohammed Milhelm, director of the Melanoma Program at the University of Iowa, added, “We really don’t know what’s going on inside the tumor.”

Dr. Okuno said Gemzar and Taxotere together aren’t showing much difference beyond just what Gemzar can do. Dacarbazine alone doesn’t make much difference. Yet when Gemzar and dacarbazine are combined, patients tend to have better outcomes. A difference in outcomes also was found in the rate of infusion—for example, infusing the same amount of chemotherapy over a longer period of time can result in better outcomes.

Clinical Trials and Leiomyosarcoma

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nlmsf-logo

Clinical trials for leiomyosarcoma (LMS) were discussed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I will be reporting about during the coming weeks.

Dr. Peter Oppeli, assistant professor of medicine at the Washington University School of Medicine, said LMS is one of the more common types of soft-tissue sarcoma. It is found in smooth muscle cells that naturally occur in the intestines, blood vessels, and the uterus, all of which are in charge of involuntary action in the body. For pregnant women, these muscles play a key role in labor and delivery.

LMS can originate anywhere smooth muscles are found. In almost half of all new LMS diagnoses, it is found in the uterus. It also occurs in the body’s extremities and in the abdominal cavity, especially in the back part of the abdomen.

There are about 2,000 new diagnoses each year. Compare that to another type of cancer, such as colon, which has about 135,000 new diagnoses each year.

Because LMS is rare, it is more challenging to come up with treatments. Any new drug for a rare disease is cause for a lot of excitement. Trabectadine, for example, was approved by the FDA in October 2015.

New drugs are approved when they show proven benefit from a clinical trial.

Clinical trials are research studies for understanding cancer and how to treat it. Trials can look at new drugs, combinations of drugs, ways to ease side effects, new forms of radiation, and new surgical methods.

A Phase 1 clinical trial is for finding the right dose and finding out the treatment’s side effects.

A Phase 2 trial involves larger groups of patients. In a Phase 3 trial, large number of patients are treated to confirm effectiveness.

The vast majority of clinical trials do not have a placebo-only option. Placebos usually are combined with standard effective treatment, so every patient gets what is determined to be the best treatment.

What is research protocol? It is the rule book for each clinical trial. Each trial will have a unique/specific protocol that describes inclusion and exclusion criteria for potential treatment.

Is a clinical trial going to help a particular patient? “We hope so, but cannot say with certainty that enrolling is going to be beneficial,” Dr. Oppeli said.

Almost every standard treatment has first been proven effective in clinical trials.

After his talk there was a 10-minute time period for questions.

A lot of clinical trials have interim times to see if a trial is helpful or not. Then if not shown effective, the trial is stopped. If the results look promising, the trial continues.

Thriver Soup Ingredient:

For more information on clinical trials, go to www.cancer.net for a large video library.

Sometimes We Need to Sweat the Small Stuff

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I am responsible for his death. I never paid any attention to Black Gold’s lameness; he always black-gold-copyseemed to work out of it.

H. Webb, trainer, in the fiction book Black Gold

 

A hairline crack developed in the hoof wall of the Thoroughbred Black Gold as he raced through the spring of his three-year-old season. Despite the soreness this created, he won the 1924 Kentucky Derby. His trainer kept pushing the stallion anyway, and the jockey, Jaydee Mooney, stopped riding the lame horse in protest. The injury was left untreated and worsened. Eventually the brave racehorse broke that limb during a race, finishing on three legs. The beloved racehorse was put down.

I read his story, by Marguerite Henry, when I was in grade school. While very sad, I loved the tale. This year I found the same hardback book for $1 and brought it home to reread.

The parallels with my life were too obvious. I didn’t give much heed to the “benign” fibroid in my gut that grew unreasonably large. Two good friends found it frightening and urged me to get to a doctor as soon as possible.

By this time I was out of town. Through a long process, I finally decided to go to the emergency room. A small problem, like Black Gold’s hoof crack, left unattended, became deadly–a stage 4 uterine sarcoma.

It’s easy in our culture, with our “grin-and-bear-it,” “no pain, no gain” athletic mentality, to ignore our bodies’ warning signs. Yet our bodies give these signals because something is out of balance and needs our attention. Small problems, if attended to quickly, can stay small and be fixed, or at least controlled. Left on their own, they can become insurmountable issues.

Thriver Soup Ingredient

One fallout from a cancer diagnosis is that every headache, skin bump, or new pain brings up anxiety around the idea that it could be cancerous. If the symptom persists, it might be a good idea to get it checked by a doctor.

Sources:

https://en.wikipedia.org/wiki/File:Hof9.gif

Marguerite Henry, (Author), Wesley Dennis (Illustrator), Black Gold (Rand McNally, 1975)