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DEAR NEW MOMS: BREASTFEEDING CAN REDUCE YOUR RISK FOR CANCER

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by Oncologic Advisors
It’s no secret that breastfeeding is beneficial to an infant’s health. The benefits of breastfeeding for babies are very well-documented:
  • It provides the perfect balance of nutrients that your baby needs to survive and thrive.
  • Breast milk contains hormones and antibodies than natural strengthen your infant’s developing immune system.
  • Less of a likelihood that your child will later experience gastrointestinal issues, type 2 diabetes, childhood obesity, respiratory and ear infections, and some childhood cancers.[Schanler, 2016]

The protective effect of breast milk is even shown to last after a child stops breastfeeding, contributing to a number of short and long-term pediatric health benefits.

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Can IMRT be the cure for a cancer that was thought to be incurable?

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by Oncologic Advisors

There is new hope for some patients with prostate cancer, thanks to a joint study by the Institute of Cancer Research in London and the UK’s leading cancer hospital, the Royal Marsden. The study found that a treatment option called IMRT could cure thousands of men whose disease was before thought to be incurable.

For patients with prostate cancer, the following treatment options are usually advised (depending on how far the cancer has spread and how aggressive it is):
– Hormonal treatment
– Surgery
– Radiotherapy
– A combination of the above treatments

When a patient’s cancer spreads too far (meaning it spreads to the lymph nodes near the pelvis) doctors typically advise against radiation therapy, since radiation in that area can cause damage to the bowel, which could then prove to be fatal. (Telegraph)

So What is IMRT?

IMRT stands for Intensity Modulated Radiation Therapy. It’s a highly targeted form of radiation therapy that the Royal Marsden’s study claims can successfully eliminate cancer without causing fatal damage to surrounding organs.

For the treatment, your doctor uses a computer to plan the exact dose of radiation that will be aimed at the cancer. The computer then uses information about the size, shape, and location of the tumor to determine how much radiation is needed to kill the cancer cells.

The treatment uses the high amounts of radiation that are necessary to completely kill prostate cancer cells while still protecting the healthy cells that surround them. (UCLA) So IMRT can potentially be a safe option for patients whose cancer has spread to the pelvis.

Some newer radiation machines also have imaging scanners built into them to allow the doctor to take pictures of the prostate and make minor adjustments in aiming just before giving the radiation. This is called “image guided radiation therapy” or IGRT. It can help deliver radiation even more precisely, which could result in fewer side effects from the radiation. (American Cancer Society)

If you are considering going through IMRT, be sure to ask your physician about whether or not these additional options can be available to you.

Potential Side Effects of IMRT

Short term side effects of radiation can include:
– Skin damage (like a severe sunburn)
– Temporary diarrhea
– Rectal pain

Some possible long-term side effects can include:
– Painful or frequent urination
– Loose bowels
– Impotence

These problems could develop six months or more after the treatment ends and may be permanent. (Genomic Health) Again, be sure to consult your physician about the likelihood of these side effects and if there are options to help prevent them.

About the Study:

In the study mentioned above by the Institute of Cancer Research in London and the Royal Marsden, 447 men were treated with IMRT and monitored for five years. When the trail began in 2000, many of the patients were considered incurable.

The object of the study was to look at the long term effects of IMRT treatment as well as whether or not it could be used to treat those patients who were considered incurable before.

Study leader David Dearnaley, a professor of uro-oncology at the ICR and consultant clinical oncologist at the Royal Marsden said, “Our trial was one of the first of this revolutionary radiotherapy technique, which was pioneered by colleagues here at the ICR and The Royal Marsden.”

71% of the patients were alive and completely cancer free at the end of the five years. Just between eight and 16% of the patients in the trial suffered from issues with their bladder or bowel.

Ultimately, the trial found that IMRT can in fact be safely given to cancer cells that have spread to the pelvis to help stop the disease from spreading further.

Dearnaley calls the technique a “game-changer” for men with prostate cancer and says, “The work done here has already been carried forward into later-stage phase II and phase III trials. I’m excited to see this treatment become available to every man with prostate cancer who could benefit from it.”

The changes in use of IMRT have caused a “complete revolution” in the way it is delivered, with doses now delivered in only two minutes.

Professor Paul Workman, chief executive of the ICR says, “Radiotherapy is often seen as perhaps old-fashioned and crude compared with other cancer treatments — but nothing could be further from the truth.” With new advances in IMRT and the findings from this study, radiotherapy is now considered a highly precise and sophisticated treatment.

“It’s great to see this long-term evidence of the degree to which precision radiotherapy has transformed outcomes for men with prostate cancer,” Workman says.

How Big of An Impact Does This Study Have?

Prostate cancer affects tens of thousands of men in the U.S. each year, and those rates are rising. In 2017 there were about 161,360 new cases of prostate cancer and about 26,730 deaths from the disease.

Most men diagnosed with prostate cancer don’t die from it. When the disease is caught early, treatment is often successful. More than 2.9 million men in the U.S. who have been diagnosed with prostate cancer at some point in their lives are still alive today.

Still, about 1 man in 7 will be diagnosed with prostate cancer in his lifetime. And often, the cancer is not caught early enough.

Prostate cancer is the third leading cause of cancer death in American men, behind lung cancer and colorectal cancer. The American Cancer Society estimates that 1 man in 39 will die of prostate cancer. (American Cancer Society)

In Conclusion:

Still, even with the new findings from this study it is important to consider your options and decide whether or not IMRT is the right treatment for you.

Dr. Matthew Hobbs, Deputy Director of Research at Prostate Cancer UK said that the findings were promising, but also called for larger randomized trials to confirm definitive answers about the benefits of IMRT and its suitability for different cases. (Telegraph)

IMRT still may not be for every patient, but this new study does provide hope for a number of men who were once considered incurable.

Sources:

http://www.telegraph.co.uk/news/2017/09/26/prostate-cancer-treatment-could-cure-men-no-hope/

http://urology.ucla.edu/body.cfm?id=523

https://www.cancer.org/cancer/prostate-cancer/treating/radiation-therapy.html

https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

http://www.myprostatecancertreatment.org/en-US/Home/Prostate-Cancer-Treatment-Options/Radiation-For-Prostate-Cancer

http://www.express.co.uk/life-style/health/858891/prostate-cancer-symptoms-treatment-uk

 

Virtual Navigational Services for Cancer Patients in the United States

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by Oncologic Advisors
FOR IMMEDIATE RELEASE
September 2017
Media Contact: Alexia Chalita, Marketing Director, North America
Virtual Navigational Services for Cancer Patients in the United States

A virtual service that allows cancer patients to get fast second opinions and receive navigational services from board-certified oncologists through the comfort of their own home.  

Oxnard, CA. Cancer patients who need a second opinion, help finding a clinical trial, assistance choosing an optimal treatment plan, or need to have questions answered fast have a new readily available service. Oncologic Advisors has a wide-variety of services to help cancer patients, ranging from just diagnosed patients to a stage 4 cancer patient.  

Oncologic Advisors has a staff of board-certified oncologists ready to service second opinions, connect patients to clinical trials within the United States, provide patients with research to help them make educated decisions based on their treatment course, and answer any time-sensitive questions patients may have. Oncologic Advisors is designed to be time-effective and objective. What sets Oncologic Advisors apart is that they are not linked to any cancer center, making treatment decisions solely based on the patient’s best interest, and considering all treatment options within the country. Oncologic Advisor’s group of independent, board-certified oncologists understand that time is of the essence for cancer patients and have quick turn-around rates for second opinions and navigational services.

“Through my years of practice as a radiation oncologist, I’ve noticed the lack of guidance cancer patients have access to,” says Robert Lum, CEO and Founder of Oncologic Advisors. “When I created Oncologic Advisors, it was my priority to give cancer patients and their families ease of mind. Cancer patients and their families are already so overwhelmed with the everyday difficulties the disease brings that they often choose the first treatment option that is offered to them, without fully researching or understanding. In addition, when patients try to research clinical trials or other cancer treatments, there is so much information and controversy on the web that they are often misinformed or get discouraged. Since I know personally how much work and stress accompanies having a cancer diagnosis, we created Oncologic Advisors to help ease the mind of cancer patients so they can focus on getting better.”

Cancer patients looking to receive services from the board-certified oncologists at Oncologic Advisors, should request a consultation via the website:  http://www.oncologicadvisors.com/request-a-consultation/. Our Oncologic Liaison will contact patients within a couple of hours and evaluate the patient’s case. From there, the Oncologic liaison will connect patients with one of our board-certified oncologists, who will then review a patient’s case and personally connect with them.

About Oncologic Advisors

Headquartered in Southern California, Oncologic Advisors works virtually to serve cancer patients across the United States and internationally. Oncologic Advisors offers navigational services to cancer patients: second opinions, connections to clinical trials, answering questions, and helping patients make important treatment decisions. Patients and their families feel more at ease by having an Oncologic Advisor holding their hand and answering their questions along the cancer journey. More at www.oncologicadvisors.com.

What Is Precision Cancer Medicine? How Targeted Therapies Are Changing The Way We Think About Treatment

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President Jimmy Carter and Precision Cancer Medicine: In December 2015, former President Jimmy Carter announced that he no longer displayed any signs of cancer following his diagnosis and treatment for metastatic melanoma that had spread to his liver and brain. Carter had undergone a regimen of surgery, radiation, and targeted immunotherapy, crediting a drug called pembrolizumab (Keytruda) for playing a significant role in his apparent early remission. (The Carter Center).

For patients battling cancer, Carter’s story was inspiring: an older patient with a metastasized disease had achieved remarkable results with the aid of a promising new drug. His high-profile case put a new spotlight on a phenomenon commonly known as “precision cancer medicine”: a targeted approach to cancer treatment that’s providing hope and an expanded range of options for doctors and their patients. What is precision cancer medicine and if you or someone you love is fighting the disease, how might new advancements in targeted cancer therapy affect your options for treatment?

PRECISION CANCER MEDICINE DEFINED: DECODING THE BUZZWORD

According to UpToDate.com, precision (sometimes called “personalized”) medicine “refers to the application of patient-specific profiles, incorporating genetic and genomic data as well as clinical and environmental factors, to assess individual risks and tailor prevention and disease-management strategies” ([1] UpToDate). Put more simply: doctors are learning more about the human genome all the time, and are using that knowledge to develop new ways to treat disease. Combined with information about a patient’s lifestyle, environment, and history, doctors may then use that knowledge to decide which treatments might be most effective for each individual patient.

The somewhat broad umbrella of “precision medicine” includes (but is not limited to) oncology.

Oncologists have long sought an alternative to the “spray and pray” approach of traditional chemotherapy, which destroys healthy cells as well as malignant ones and overwhelms the body with a battery of harmful side-effects (such as hair loss, anemia, and even an increased risk of secondary cancers). Certain modern techniques now permit doctors to be more precise and less invasive in their approach, isolating and destroying cancer cells with reduced toxicity and fewer side-effects for the patient. Examples of these techniques include targeted radiation therapies (like stereotatctic radio surgery) ([2] UpToDate), and targeted pharmaceuticals (such as the pembrolizumab that doctors chose to treat Jimmy Carter).

GENOMICS: FROM SCREENING TO TREATMENT

So, how do doctors choose which precision treatments to use? You may have heard your doctor talk about something called genomic testing: that is, the analysis of an individual’s DNA to identify certain traits that may place him or her at increased risk for cancer or other diseases, and that may determine the particular type of cancer a person has. By referencing your genetic data prior to treatment, doctors may be able to make more informed decisions about which course of therapy to pursue. In theory, this strategy should help minimize side-effects, keep costs down, and save valuable time that might be lost through a trial-and-error approach to treatment. (National Foundation for Cancer Research)

Even if you don’t currently have cancer, you may wish to utilize genetic profiling to gain a better picture of your overall health and facilitate the prevention, diagnoses, and treatment of certain cancers in the future. For example, a woman with a family history of breast or ovarian cancer may choose to utilize genetic profiling in order to determine whether she carries a mutation in the BRCA1 and BRCA2 genes, which is associated with an increased risk for the disease. If testing reveals that she does carry a mutated copy of the gene, she may choose to undergo more frequent screening measures (such as regular mammograms) in a effort to detect cancer early; she may also elect to undergo a prophylactic mastectomy or oophorectomy to decrease her risk of developing the disease. If she does ultimately develop breast or ovarian cancer, her genetic status may help her doctors determine a more specific (and ideally, more effective) course of treatment: for example, her oncologist may choose to prescribe a PARP inhibitor after an initial regimen of chemotherapy, which research suggests may be particularly effective in women with BRCA-mutated ovarian cancers.

A better understanding of how your particular type of cancer functions on a molecular level may guide your doctor in choosing certain drug treatments over others. In the case of Jimmy Carter, doctors utilized a type of pharmaceutical called an immune checkpoint inhibitor to treat his melanoma in conjunction with surgery and focused radiation. Immune checkpoint inhibitors help activate the human body’s natural immune responses to attack abnormal cancer cells but leave normal, healthy cells unharmed. In addition to melanoma of the skin, this type of immunotherapy has shown promise in treating non-small cell lung cancer, kidney cancer, bladder cancer, head and neck cancers, and Hodgkin lymphoma ([1] American Cancer Society).

PRECISION CANCER MEDICINE: WHAT’S THE CATCH?

It’s important to remember that we still have much to learn about cancer. Doctors are still learning about the benefits and limitations of genomic medicine, and our understanding of how precision cancer medicine might compliment more traditional therapies is still unfolding.

As some doctors were quick to note, it may be premature to label any one factor as the “most significant” element in former President Carter’s remission: in addition to targeted immunotherapy, traditional surgery and focused radiation also played important roles in his treatment (MedPage Today). Others postulated that early detection may have improved his prognosis, giving him an overall advantage no matter what treatment strategy his doctors chose (CNN). And above all, the longterm efficacy of Carter’s treatment has yet to be determined: after all, cancer may still recur in the future even after a patient goes into remission and shows no signs of the disease ([2] American Cancer Society).

In addition, the new age of precision cancer medicine and genomic profiling has brought with it the inevitable array of enterprising corporate entities (some more reputable than others), all claiming to offer genetic testing services to directly to the public. These direct-to-consumer testing (or DTC) services have come under increased scrutiny by the FDA, and their efficacy at predicting genetic risk for disease appears unreliable ([1] UpToDate). If you decide to pursue DTC genetic testing, always get a second opinion from your doctor before using the results to embark on a new course of treatment.

IN CONCLUSION

As we enter this new era of medical understanding and discovery, we must remain hopeful but cautious. While modern targeted therapies provide more choices and greater agency for doctors and patients alike, we should be careful not to mislabel the advent of precision cancer medicine as an all-encompassing “miracle cure.” That said, our understanding of the human genome continues to expand by the day, as does our arsenal of promising resources for detecting and treating various forms of cancer – and that’s exciting news! For people like former President Carter, precision medicine may indeed pave the way for a longer, healthier life.

Learn more about Oncologic Advisors

REFERENCES

The Carter Center: Statement From Former President Jimmy Carter. December 5, 2015.

https://www.cartercenter.org/news/pr/carter-center-statement-120615.html

[1] UpToDate: Personalized Medicine. Benjamin A Raby, MD, MPH. Topic last updated: April 16, 2016.

https://www.uptodate.com/contents/personalized-medicine?source=search_result&search=precision%20medicine&selectedTitle=1~150

[2] UpToDate: Radiation therapy in the management of melanoma. Arnand Mahadevan, MD. Topic last updated: January 16, 2017.

https://www.uptodate.com/contents/radiation-therapy-in-the-management-of-melanoma?source=search_result&search=focused%20radiation%20therapy&selectedTitle=5~150

National Foundation for Cancer Research: Cancer Genomics.

http://nfcr.org/genomics/

[1] American Cancer Society: Immune Checkpoint Inhibitors to Treat Cancer. Last Revised: March 23, 2017.

https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/immune-checkpoint-inhibitors.html

MedPage Today: Most Experts Not Surprised By Carter’s Status. Charles Bankhead, December 8, 2015.

http://www.medpagetoday.com/HematologyOncology/SkinCancer/55076

CNN: Jimmy Carter is ‘cancer free’: Miracle or just science? Sandee LaMotte, December 7, 2015

http://www.cnn.com/2015/12/06/health/jimmy-carter-cancer-doctor-interview/index.html

[2] American Cancer Society: Understanding Recurrance.

https://www.cancer.org/treatment/survivorship-during-and-after-treatment/understanding-recurrence.html

Olaparib Ovarian Cancer Treatments: How Oncologists Use Parp Inhibitors As a Maintenance Therapy

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by Oncologic Advisors

OLAPARIB OVARIAN CANCER TREATMENTS

A promising new treatment option for ovarian cancer patients made news this week when the FDA approved a New Drug Application (NDA) for olaparib (Lynparza) tablets, “for use in platinum-sensitive, relapsed ovarian cancers in the maintenance setting” – that is, for people with advanced cancer who have already completed an initial regimen of surgery and chemotherapy, and who have responded positively to platinum-based cancer treatment agents (Oncology Times/FDA). Olaparib ovarian cancer therapies produced some exciting results in clinical trials, delaying tumor growth and increasing survival rates in women fighting an advanced disease.

But how exactly does olaparib ovarian cancer therapies work? And – if you’re battling ovarian cancer – how do you know if olaparib ovarian cancer therapies might be a good option for you? Navigating the landscape of new drug therapies can be overwhelming, so let’s break it down from the beginning.

OVARIAN CANCER BASICS

Ovarian cancer is the second-most common reproductive cancer in American women following endometrial (or uterine) cancer, but it is also the deadliest as it is exceedingly difficult to detect early. Caucasian women, women who have never given birth, post-menopausal women, and women with a family history of breast, ovarian, or uterine cancer tend to be at greater risk of developing ovarian cancer. According to the American Cancer Society, ovarian cancer is rare in women under the age of 40 and half of all ovarian cancers are diagnosed in patients over 63 (ACA).

Certain inherited traits, such as a mutation in the BRCA1 and BRCA2 genes, may also put a woman at increased risk of developing breast and ovarian cancers (you may have heard of the BRCA-mutation by way of Angelina Jolie, who underwent a preventative double mastectomy in 2013 after losing her mother to ovarian cancer and learning she carried an abnormal copy of the gene). When functioning normally in most people, these genes tell cells “to make a protein that helps repair damage to DNA. So people who inherit a faulty copy are less able to repair damage that accumulates in their DNA over time. And so they’re at higher risk of cancer” (Cancer Research UK).

Doctors will typically recommend surgery followed by a course of chemotherapy for most ovarian cancer patients. The specific type of chemotherapy you will receive should be determined by your oncologist after diagnosis and staging, as there are are a number of chemotherapy drugs in wide use today and the most appropriate course varies from woman to woman. The most common agents for treating ovarian cancer are taxanes (paclitaxel or docetaxel) and platinum agents (carboplatin or cisplatin), as “studies have demonstrated that platinum- and taxane-containing chemotherapy improves the survival of women with ovarian cancer over other types of regimens” (UpToDate).

So how does olaparib ovarian cancer therapies fit into this traditional treatment plan?

PARP INHIBITORS AS A MAINTENANCE THERAPY

Olaparib (Lynparza) is part of a class of pharmaceuticals called PARP inhibitors. PARPs – or, Poly (ADP-ribose) polymerases – are enzymes that help repair damaged DNA. As a targeted cancer therapy against malignant cells, PARP inhibitors “may help keep cancer cells from repairing their [own] damaged DNA, causing them to die.” (NIH/National Cancer Institute).

Recent studies have shown that PARP inhibitors hold significant promise as a maintenance therapy, particularly by increasing progression-free survival (PFS) rates in those patients with BRCA-mutated cancers. Olaparib ovarian cancer therapies itself has been around since 2014, when the FDA approved the drug in a 400mg capsule formulation for use in patients with BRCA-mutated advanced ovarian cancers (Oncology Times/FDA). More recently, olaparib’s phase II and III trials suggested that even patients without BRCA cancers may see positive results from treatment with the drug, even though people with the mutation still saw the greatest benefit (MedPage Today). And Olaparib ovarian cancer therapies is not the only PARP inhibitor in the game, or to make headlines in recent weeks: niraparib (Zejula) was approved by the FDA on March 27 to treat recurrent epithelial ovarian, fallopian tube, and primary peritoneal cancers regardless of the patient’s genetic status (FDA).

To be clear, PARP inhibitors like olaparib and niraparib do not replace a conventional strategy of surgery and chemotherapy, but rather expand the arsenal of options available to doctors and their patients during the following maintenance phase of treatment. It’s important to remember that there is no set standard or single solution for maintenance therapy: some doctors, for example, may advocate simple clinical observation. Other methods (such as maintenance chemotherapy) remain under consideration and research, and new information continues to emerge by the day. However, maintenance chemotherapy performed rather poorly in another recent study, having a negligible effect on overall survival rates and possibly even encouraging chemoresistance in some people (Medpage Today). For patients who wish to avoid additional lines of chemotherapy (along with its associated toxicity), the trend towards PARP inhibitors may come as somewhat encouraging news.

PARP inhibitors, however, are not side-effect free: anemia, nausea, and abdominal pain are just some of the adverse effects associated with both olaparib and niraparib, though some of these symptoms were also common in control groups taking placebo. And for some people, PARP inhibitors may come with some “serious risks”: the FDA notes that niraparib may cause “hypertension, severe increase in blood pressure (hypertensive crisis), bone marrow problems (myelodysplastic syndrome), a type of cancer of the blood called acute myeloid leukemia and low levels of blood cells in the bone marrow (bone marrow suppression)” (FDA). As with any course of therapy, only you and your doctor can determine if the potential benefits of trying a PARP inhibitor outweigh the risks.

CONCLUSION

So, what’s the bottom line? PARP inhibitors may be an exciting prospect for more people than we previously believed, not just those with BRCA-mutated cancers. If PARP inhibitors are news to you, or if you previously thought you couldn’t benefit from one because of your BRCA status, you may wish to to talk to your doctor as your options may have changed with the emergence and approval of these new drug therapies. And for women who do have BRCA-related ovarian cancer, the expanded acceptance of PARP inhibitors is excellent news indeed.

As with any new therapy, we continue to learn new things about PARP inhibitors every day. So keep reading. Don’t be afraid to ask questions. And always remember: it’s up to you to work with your doctor to choose the specific treatment strategy that’s best for you.

Suffering from ovarian cancer? Contact Oncologic Advisors for a second opinion and navigational advice.

 

REFERENCES

Oncology Times, FDA Actions & Updates – New Drug Action Approved for Olaparib in Ovarian Cancer Use. March 28, 2017.

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm548948.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery

American Cancer Society (ACA) – About Ovarian Cancer.

https://www.cancer.org/cancer/ovarian-cancer/about.html

Cancer Research UK – Angelina Jolie, inherited breast cancer and the BRCA1 gene. Henry Scowcroft, May 14, 2013.

http://scienceblog.cancerresearchuk.org/2013/05/14/angelina-jolie-inherited-breast-cancer-and-the-brca1-gene/

UpToDate – Patient Education: First-line medical treatment of epithelial ovarian cancer (Beyond the Basics). Thomas J. Herzog, MD, Vincent E. Herrin MD, last updated February 9, 2017.

https://www.uptodate.com/contents/first-line-medical-treatment-of-epithelial-ovarian-cancer-beyond-the-basics?source=search_result&search=%E2%80%9Cstudies%20have%20demonstrated%20that%20platinum-%20and%20taxane-containing%20chemotherapy%20improves%20the%20survival%20of%20women%20with%20ovarian%20cancer%20over%20other%20types%20of%20regimens%E2%80%9D&selectedTitle=1~1

NIH/National Cancer Institute – NCI Dictionary of Cancer Terms.

https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=660869

MedPage Today – PARP Inhibitor Extends PFS in Ovarian Cancer. Charles Bankhead, March 15, 2017.

https://www.medpagetoday.com/meetingcoverage/sgo/63854

FDA News Release – FDA approves maintenance treatment for recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancers. March 27, 2017.

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm548948.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery