A New Agent That Might Change the Lives of Many Cancer Patients

This is not only good news for all prostate cancer patients, but is also good news for all cancer patients. 

The investigational radiopharmaceutical radium-223 chloride (Alpharadin) has recently been shown to improve survival in patients with advanced prostate cancer and bone metastases.  This agent could potentially be used in other cancer patients to extend their lives. 

The beauty of this product is that it is highly targeted for bone metastases; so this product will be valuable for many different Stage IV cancers patients whose cancers have spread to bones. 

Radium-223 chloride works by releasing minute, highly charged, targeted doses of radiation (alpha particles) that are highly lethal to cancer cancers but have a short penetration.  This specific targeting delivers radiation to the bone metastases and minimizes the damage done elsewhere. 

New Personalized Medicine Increases Survival in Melanoma Patients

Metastatic melanoma is the deadliest and most aggressive from of skin cancer.  A person with metastatic melanoma typically has a short life expectancy that is measured in months.  

The mainstay treatments for metastatic melanoma are dacarbazine (DTIC), interleukin-2 (IL-2) and interferon (IFN).  However, efficacies of these agents are not very good. 

Less than one in four people are expected to be alive one year after diagnosis and every year there are an estimated 40,000 people worldwide die from this disease. 

Calcium and Vitamin D Reduce Melanoma Risk in High-Risk Women

Researchers at Stanford have previous shown that mice lacking vitamin D receptors have more skin cancer.  In vitro studies have also shown that adding vitamin D to skin cancer cells sometimes reduces their growth.  

Now, a new analysis suggests high-risk women who take Vitamin D and calcium supplements might have a lower risk of melanoma. 

The researchers analyzed data from the Women’s Health Initiative study, which randomized 36,282 postmenopausal women to 400IU of vitamin D and 1000mg of calcium supplements or placebo and followed them for 7 years. 

It is Better for Cancer Patients to Die at Home

Cancer patients who die at home do so more peacefully and their caregivers also end up doing better emotionally, reported in the September 13th issue in the Journal of Clinical Oncology 

Wright’s team studied 342 terminal cancer patients and their loved ones until the patients died, usually about 4 1/2 months later. 

Although most patients with cancer preferred to die at home, 36% die in a hospital and 8% die in an intensive care unit (ICU). 

When patients died in an ICU, their loved ones were five times more likely to be diagnosed with post-traumatic stress disorder (PTSD).  21% of caregivers of patients who died in an ICU developed PTSD, compared with 4.4% of those caring for patients who died with home hospice. 

Families and loved ones of patients who died in the hospital were also more likely to have prolonged grief disorder, an intense, disabling form of grief that lasts more than six months. 

Home-based hospice care is meant to relieve suffering, but at least one study last month showed it may also help cancer patients live a little longer. 

Source: J Clin Oncol. Posted online September 13, 2010. Abstract 

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Ipilimumab – new option for Metastatic Melanoma patients

At ASCO this past weekend, Dr. Steven O’Day reported that ipilimumab alone or in combination with vaccine increased overall survival (OS) in patients with unresectable stage III/IV melanoma for whom previous treatment had failed (Abstract 4). 

Metastatic (stage IV) melanoma is very difficult to treat with no new approved choices since IL-2 over a decade ago. Ipilimumab, a monoclonal antibody against cytotoxic T-lymphocyte antigen 4 (CTLA-4), is an immune therapy directed against T-cells. Blocking this antigen helps to stimulate the expansion of T-cell populations, potentially increasing tumor-directed immune responses. 

Study design
Two therapeutic approaches — ipilimumab and vaccine therapy with gp100 alone and in combination. 

• double-blind study randomly assigned patients to receive 1) ipilimumab (137 patients), 2) ipilimumab and gp100 (403 patients), or 3) gp100 alone (136 patients).
• All patients were required to be HLA-A2 positive.
• Primary endpoint:  overall survival (OS).

Result
 After 12 months, 46% of patients receiving ipilimumab alone, 44% receiving ipilimumab plus gp100, and 25% receiving gp100 were still alive. (p = 0.0026 for ipilimumab alone versus gp100; p = 0.0004 for the combination versus gp100) [See Fig.1] 

Figure 1 Ipilimumab

 

Adverse events
Adverse events were predominantly immune response–related and included rash, colitis, diarrhea, and hepatitis. More serious immune-related grade 3 or 4 toxicities occurred in 10% to 13% of patients receiving ipilimumab.  Physicians treating melanoma should be familiar with the side effects and its management.  “Even at 3mg/kg, there were potentially life-threatening complications.  Using ipilimumab requires a committed, multidisciplinary team at all times to address toxicity management.” Dr. V. Sondak said. 

Information on clinical trials on ipilimumab 

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Melanoma Cases on the Rise – Latest Incidence, Prevention and Detection

Incidence

While the incidence of other cancer such as prostate cancer has leveled off, the incidence of melanoma in US is on the rise, according a presentation at the 68^th Annual Meeting of the American Academy of Dermatology. 

In his presentation at Annual Meeting of the American Academy of Dermatology, Dr. Rigel pointed out that the average American’s risk of developing melanoma in his or her lifetime increased from one in 1,500 in 1930, to one in 250 in 1980 and one in 74 in 2000.  By 2004, the risk of getting this deadly skin cancer increased to one in 65 and by today, the risk is 58.

If this rate continues, he predicted the risk will be one in 50 by 2015!

He did not believe the risk in melanoma is due to increase in the number of skin cancer screenings.  If that was true, we should see a sudden rise in melanoma cases and then leveled off.

Prevention

Melanoma is caused by too much exposure to ultraviolet (UV) radiation, whether from the sun or indoor tanning beds and lamps. To prevent yourself from getting melanoma, make sure you have put on sunscreen before going under the sun.  Also, avoid using the tanning beds, which is known to increase your risk of melanoma and serious eye problems.

Detection

Monitor your mole regularly.  Make sure you mole does not have any of the following characteristics.

• Asymmetry: one half unlike the other half.
• Border: irregular, scalloped or poorly defined.
• Color: varies from one area to another; shades of tan and brown, black; sometimes white, red or blue.
• Diameter: the size of a pencil eraser or larger.
• Evolving: changing in size, shape or color.

If you see a mole with any of the above characteristics, you should see a dermatologist immediately.  Also, mole that grows bleeds, crusts, or changes also required immediately doctor’s attention.

Presentation at the 68^th Annual Meeting of the American Academy of Dermatology. 

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Psoriasis Is Associated With an Increased Risk of Cancer

If you have psoriasis, you might have an increased risk of cancer, including melanoma, prostate cancer and non-Hodgkin’s lymphoma, according to a new research presented at the 68th annual meeting of the American Academy of Dermatology (AAD 2010). 

The researchers evaluated the incidence of psoriasis and cancers in 37,159 patients and 111,473 controls from a large insurance claims database.

Their analysis found that patients with psoriasis had a 56% higher risk for any type of cancer, 76% higher risk for melanoma, 12% higher risk for breast cancer, 75% higher risk for non-Hodgkin’s disease, 87% higher risk for lymphoma and 22% higher risk for prostate cancer.

The results might not be too surprising since patients with psoriasis are known to have defected immune system and defected immune system is associated with cancer. 

However, the results of this study indicated that patients who have psoriasis will need to monitor not only their skin symptoms, but also for their overall health, co morbidities, and well-being.

Presented at the 68th annual meeting of the American Academy of Dermatology (AAD 2010). 

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Immune response and stage 4 melanoma

Stage 4 (Stage IV) melanoma is very difficult to treat.  Even though stage I melanoma has an excellent prognosis; response rate for stage 4 melanoma with palliative biotherapies and chemotherapies is only approximately 10%.

Clinicians and researchers are working hard to find treatment options for patients with stage 4 disease.  Despite treatment failure of radiotherapy and chemotherapy in melanoma, they repeatedly note anti-tumor immune responses with regression of metastases or disease stabilization.  These findings imply that melanoma is immune-related.

I found the article by Dr. Michael Erdmann in the February issue of The Lancet Oncology very interesting.  He discussed findings from recent trials on two anti-CTLA-4 agents, ipilimumab and tremelimumab.  They are both immunomodulating antibodies targeting CTLA-4.  While phase 2 study of ipilimumab has shown some clinical responses with best overall response rate of 11.1%, phase 3 study of tremelimumab was terminated due to lack of superiority compared to chemotherapy (dacarbazine or temozololomide).  Note that response rate of ipilimumab is comparable to chemotherapy.  However, it is important that prolonged disease stabilization in the selected subset of responsive patients is different.  The author explained activation of immune system by blocking CTLA-4 is a double-edged sword.  Ipilimumab has been associated with dose-dependent immune-related adverse events like enterocolitis and hypophysitis with irreversible disability.

Researchers’ next challenge is to prove ipilimumab’s superiority to chemo in phase 3 trials and hopefully they can identify biomarkers to identify or predict melanoma patients whom will respond to these CTLA-4 agents.

Erdmann MK, Immunity unleashed in melanoma; Lancet Oncol 2010, 11; 108-109

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How to live longer with Stage 4 Melanoma?

Would you and your loved ones like to fight cancer and fulfill your dreams?  Have you reached your milestones yet?  Here are some suggestions offered by Nekar Lo, a terminal cancer patient who is in his eighth year after his melanoma diagnosis.

Mental changes

1) Don’t believe everything you heard especially on how long you are going to live. Nekar was told to have 6 months to live, but he chose to fight the cancer and is still living today, 5 years after his diagnosis of Stage 4 melanoma.  “I told myself I need to live on because I want to attend my son primary graduation, high school graduation and then university graduation…”, Nekar said.

2) Don’t fight the cancer alone but get the support from friends and family members. Encouragement, support and compassion will be the key source of energy to fight the cancer.

3) Be happy and grateful. The best medicine to fight cancer is not chemo- or targeted therapy, but be joyful and grateful.  “After the initial shocks wear off, I did not continue to ask why I have this disease.  I understand God want me to send the messages to people around me to treasure their lives and love their family and neighbors”, Nekar added.

Diet Changes

1) Drink oxygenated water. Dr. Otto Warburg, a two-time Nobel Prize winner for research, found results that suggest oxygen deprived cells are more likely to become cancerous.  Therefore, having cells with enough oxygen is important to prevent cancer.

2)  Eat organic food to avoid pesticides and chemical residues.

 

3) Dink freshly squeezed juices such as apple, tomatoes, carrots and red beets juice. These fruits contain loads of minerals and vitamins and will boost your immune system to fight cancer.

4) Eat raw vegetables to get antioxidants and enzymes to get rid of toxin and free radicals.

5) Consume allalkine food and drinks such as eggplant, lemon-tea, prune juice and “vegetable soup”. Chinese herbalists believe that cancer arise because our body is overly acidic.  Eating alkaline food can neutralize the acidity in the body and fortify our immune system to fight the cancer cells.

The “Vegetable Soup” is a coolant invented in Japan during the late 60s. The product contains 5 ingredients: burdoch turnip, carrot, turnip keaf and mushroom and has been shown to strengthen the immunity.  www.vegetable-soup.com

 

Lifestyle Changes

1) Go to bed before 11:00pm every night. Liver is most active around 11 to 12 pm in detoxification.

 

2) Turn your light off when you go to sleep.

3)  Get involved in making decisions about your future medical therapies and lifestyle changes, but be ready to make compromise with your caregivers. Getting involved in decision making will make you feel empowered, but “going it alone” will create stress with your caregivers.

*Please note the above suggestions are not supported by any clinical study.

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A wish before going to heaven

“Let’s do it tomorrow!”…but not everyone has the luxury of tomorrow.  For our good friend Nekar, “today is a gift and tomorrow is a bonus”.

Nekar was diagnosed with melanoma five years ago when he was just 41 years old and at the peak of his career.  When the doctor confirmed the diagnosis, the tumor has already spread to the spinal cord and pressing the nerves.

The doctor said he only had 3 months left, but Nekar remained cheerful and believed he need to stay alive to take care of his family and to spread God’s words.  Since then, he had undergone 3 spinal surgeries, 3 rounds of radiotherapy, one cycle of chemotherapy and one cycle of targeted therapy. The tumor continued to grow and killed the nerves leading to his limbs, causing him to be paralyzed from his neck downwards.

Despite his doctor’s dire prediction and all these traumas, Nekar has survived the last 5 winters.  His goal for the remaining days is to live happily with his family (his wife who has to work night shift as a nurse to support the family and his 8-year-old son who is in Grade 3)

Nekar regretted he did not spend enough time with family prior to his melanoma diagnosis.  If he can start all over again, he would spend more time with his family and not at work.  Previously, he travelled all the time on business and rarely spending more than 2 weeks per month at home.  “I barely saw my son before he turned two” he said.

He is not afraid of dying, but felt lonely at times.  ‘Staring at the ceiling in the hospital bed, I feel so lonely.  I want to cry but no tears would come out.  Even if there are tears, I can’t wipe my tears?’ Nekar added.

Hope is very important to cancer patients.  His next dream is to move into a small apartment closer to home so that he doesn’t have to bother his wife, but help his son on homework in the evening.  “This one of the simple things that I can do now”, said Nekar.

We sincerely hope that Nekar can move to his new home in the near future instead of staying in the rehab center.  Fortunately, Nekar is loved by his friends and his church community in Hong Kong.