Sunday, May 30, 2010

New Numbers

Several weeks ago, I mentioned that I have recently lost a few pounds, but one of the sucky things about having cancer is that, when you succeed in losing some weight, no one says anything to you, because it would be kind of insensitive to say to a cancer patient, "Hey -- are you losing weight?"

As I said then, what prompted my healthier eating was my elevated cholesterol. I've always had decent cholesterol numbers, and it's always been a point a pride for me. When Isabel and I were first married, I hung the letter from the doctor with my 174 cholesterol reading from our dining room chandelier, so that when we had a party, all of our friends could see it and I could brag.

My cholesterol has stayed in the low- to -mid 180's since then. But after my physical in January, the doctor told me it had shot up to 206. I wasn't happy. I changed some habits.

Last week, I got it re-tested. The results came back yesterday. Five months of watching what I eat, and I'm back to 181.

As always, the lesson here is that I'm awesome.

Thursday, May 27, 2010

Lenalidomide

Next week, the American Society of Clinical Oncology will hold its annual meeting. I expect a flood of press releases soon, as researchers tout their breakthroughs. I always look forward to that kind of thing.

I've already seen a couple, and both are related to the drug Lenalidomide, also known as Revlimid. Lenalidomide has been an approved treatment for Multiple Myeloma (another blood cancer) for a few years, and is now being tested for its effectiveness in other cancers, including Follicular NHL. Lenalidomide is another one of those treatments that works well, but nobody is really exactly sure why. But it seems to kill some cancer cells directly, disrupt others' environments so they have trouble growing, and also serve as a immunomodulator (which means it messes with the immune system, which, in the case of blood cancers, is usually the problem).

The first study coming out of ASCO related to lenalidomide is called "Complete response rates with lenalidomide plus rituximab for untreated indolent B-cell non-Hodgkin's lymphoma." The researchers combined Revlimid (lenalidomide) with Rituxin. (This is another one of those combos that attack cancer cells from several different angles). This is a phase II clinical trial, so the numbers were limited: 30 patients. But 24 of them had a complete response, 2 had a partial response, and 4 had stable disease. 17 of the 30 had Follicular NHL and 16 of those achieved a complete response. Not bad. It will move to a pahse III trial now, with larger numbers of patients.

The other research report looks at how lenalidomide affects patients with transformed lymphoma -- one that has changed from a slow-growing, indolent type like Follicular to a more aggressive type. The article is called "Study Identifies Promising Treatment for Agressive Lymphoma," and it describes the "remarkable" (as they say) results for transformed patients. This is important for Follicular patients, since about 30% of us will transform. Right now, R-CHOP is the standard first attempt at treatment; after that, stem cell transplants are usually the next step, and then some other possibilities if that doesn't work. Lenalidomide would provide another option.

There seem to be relatively few side effects for lenalidomide, at least compared to some other treatments. Still no walk in the park -- anything that messes with the immune system is something to be dealt with carefully. But it seems to hold some real promise.

More from ASCO soon, I'm sure....

Monday, May 24, 2010

Dancin' Girl

I can't only highlight my talented boys:

Catherine had her dance recital last Saturday night, and I have some video from the rehearsal (no cameras allowed during the actual performance).

I don't know how other dance schools do their recitals, but for Catherine's, the recital is built around 5 or 6 clusters of performances, each cluster based on a musical or a film, with different classes from the school dancing to songs from that film. This year, Catherine danced to songs from Pebble and the Penguin (ballet), Jungle Book (jazz), and Cats (tap).

The videos are from the rehearsal, so you can hear the teacher in some spots. For the Pebble and the Penguin dance (see more about the movie here, plus a link to watch it online for free, if you're so inclined), Catherine is in the group of girls on the left at the strat of the video. She's the one standing up on the left in that group. You can try to follow her from there.

video

For the Jungle Book piece, Catherine begins in the front row (the one that comes out from the left). She's the second one from the left (hard to tell in that costume).

video

Finally, for the Cats piece, she's in the front row, all the way on the right.

video

I think she did awesome, and even better during the actual performance the next night.

********************************

Watching Catherine dance always gets me misty, because when she first started taking dance classes, she was four, and the lessons were on a Tuesday morning, and I wasn't teaching at that time of day, so I took her to class. I remember her chubby legs not moving very well. Two years ago, I was in tears watching her dance ballet -- she was suddenly so graceful.

As much as I loved watching her dance, another of my favorite parts of the night came later in the performance, when the older students performed to scenes from Victor/Victoria, the film in which Julie Andrews shed her Mary Poppins image (and her shirt). In case you've never seen it, it's about a woman who can't get a job singing in a Paris club, so she pretends to be Victor, a female impersonator.

Before the recital started, Peter, seated on my left, asked me what Victor/Victoria was about. I gave him the quick explanation: "It's about a woman who pretends to be a man who pretends to be a woman." His 13-year-old mind grasped the concept. "That's weird," he pronounced.

John was seated on my right. His 11-year-old mind could not quite handle the deconstruction of gender categories. During the performance, he turned to me.

John: "I don't get this. What's Victor/Victoria about?"

Me: "It's about a woman who pretends to be a man who pretends to be a woman."

John [after a few seconds of blank staring]: "Wait...what?"

Me: "A woman pretends to be a man and then pretends to be a woman."

John [more blank staring]: "So is she a man or a woman?"

Me [fully aware that the performance is still going on]: "I'll explain later."

John watched the performance for two or three more minutes and then turned to me again.

John: "This actually looks pretty funny. Can we rent the video sometime?"

Me [without hesitation]: "I don' t think so."


(Sitting next to John is almst as much fun as watching Catherine dance.....)

Thursday, May 20, 2010

R Maintenance

Good news this morning from the manufacturer of Rituxan: maintenance therapy with Rituxan cuts the chances of recurrance in half -- after two years, anyway.

According the article, Follicular NHL patients who had chemo and Rituxan, and who were then given Rituxan every six months after that, were twice as likely to be disease-free as those who didn't do the maintenance. According to the article ("Roche's Rituxan halves risk of lymphoma recurrence"), this was the case regardless of the patient's age, stage of disease, or any other factor.

The results came from a phase III clinical trial with a pretty significant number of subjects (1,000). As the article says, lots of people with NHL already use R maintenance; it's nice to get the results of a trial that will help this to become an officially FDA-approved practice.

Two things strike me as being worthy of caution: The title is a little misleading. The study measured progress over 2 years, so "halving the risk of recurrence" really doesn't tell the whole story. Lots of folks I know have had the disease return after 2 years of maintenance. So let's not get too crazy here -- we're not talking about a cure or anything.

The other thing that stands out for me still is the question of R maintenance for someone like me, who did not have chemo, but just Rituxan. There hasn't been any big trial for folks like us to determine if maintenance is useful. Dr. R and I had this conversation the last time we met. There isn't a lot of clinical evidence to determine whether or not continuing R maintenance for me would be useful. (Though there isn't any to say it won't be, either.)

Of course, I say there's never any guarantee of a treatment's success anyway, so why not go with the easiest, least toxic option anyway?

I see him a month or so. We'll fight it out then, I suppose....

Tuesday, May 18, 2010

Musical Kids

Last night, the boys participated in their school band's spring concert. They did an awesome job. Below are some clips.

This first one is "Hogan's Heroes March." Peter played drums, which he has been doing a lot for the school band this year. John plays clarinet, of course -- you can see him in the foreground behind the flute player -- and said this one was his favorite piece of the night.

video

This piece is one of the night's ensembles -- small groups of the more advanced students. Peter and his friend Nicole play a saxophone duet of "Misty," with Nicole on tenor and Peter on alto. About six or seven parents came up to us afterwards to tell us how great Peter sounded. We agreed, but we're biased.


video

This last piece was the night's finale: "Super Heroes R Us," a medley of movie theme songs (Superman, James Bond, Batman, and Austin Powers). John does some fun clarinet work on this one.

video

We're very proud of our boys. They'll both be doing some advanced work this summer on their music, and we look forward to even better things next year (though it will be hard to get better than last night).

Saturday, May 15, 2010

Improved RIT?

Someone posted this article to the support group. It's actually almost two years old, but I think only recently became available to the public. It's called "Improved Therapy by Pretargeted Radioimmunotherapy of Non-Hodgkin Lymphoma with a New Recombinant, Trivalent, Anti-
CD20, Bispecific Antibody
," and it was published in July 2008 in Cancer Research. The article describes an improved way of administering RIT (RadioImmunoTherapy). It's only been tried on mice in a lab, but it sounds very promising.

First, a reminder: RadioImmunoTherapy involves taking a monoclonal antibody (like my pal Rituxan), which finds and latches on to the protein CD20 on lymphoma cells, and adding to it a dose of raditation. So when the antibody attaches to the lymphoma cell, it is zapped with that radiation payload. RIT has been a very effective treatment for a lot of people.

Now, this article describes a change in the way the radiation is delivered. If I'm reading it correctly, instead of delivering the antibody with the radiation attached to it, the two are sent in separate parts. The antibody attaches to the lymphoma cells, and a day later, the raditon is delivered separately. The radioactive particles are constructed so they seek out the antibody and attach to them.

The radioactive particles are somehow able to (I'm not sure how) find their target quckly, do their job, and then leave the bloodstream quickly -- much more quickly than RIT currently is able to be cleared out. Less radiation in the bloodstream is a good thing. The quick clearing from the blood means that more radition is allowed to be given, increasing the chances that all of the lymphoma cells will get hit.

So it seems like this method means less toxicity with better results. That's the one-two punch we're all looking for with future treatments.

One downside is that this kind of method adds a step to an already complex process, and that complexity (it has to be done by a nuclear medicine specialist, not by a regular old oncologist) might deter some people.

On the other hand, lots of docs have already been put off by the complexity of administering RIT (among other reasons), but very positive results from clinical trials seem to be changing some minds. So maybe as this method moves through trials, the (we assume) excellent results will change more minds.

Thursday, May 13, 2010

Pan-Mass Challenge

Once again, my brother Mike will be riding in the Pan-Mass Challenge this year, on August 7th and 8th. The PMC is a two-day (obviously) bike ride across half of Massachusetts, fom Wellesley to Provincetown. He and many others will raise money for cancer research and treatment at the Dana-Farber Cancer Institute in Boston.


Last year, Mike raised $5600, exceeding his goal. This year, his goal is $5000.


I'm making an appeal to you all to support Mike on his ride.


As I have done in the past, I'll make this personal: As you know, I am vitally interested in lymphoma research -- and I mean "vitally" in the most literal way possible. Lymphoma research saves lives, and the treatment I have received and am in line to receive is available because of research like the kind now being done at Dana-Farber.


As I write this, researchers at Dana-Farber are involved in 23 trials involving Non-Hodgkin's Lymphoma -- 3 involving treatments for Follicular NHL in particular. These resarch projects involve some of the treatments I've written about: RIT, the next generation of monoclonal antibodies, stem cell transplants, and some new targeted therapies that I haven't even heard of yet.


Please consider giving to Mike's ride. The easiest way to do it is to donate online. You can do so at his secure PMC web page:

http://www.pmc.org/profile/MM0386


If you don't want to donate online, let me know, and I'll forward you Mike's mailing address.


Thanks for considering this.

(Yeah, sure, there's plenty of time to donate. But if you don't do it right now, are you really going to remember when July rolls around?)

Tuesday, May 11, 2010

CD47

The American Association for Cancer Research's annual conference took place a couple of weeks ago in Washington, DC, and one particular presentation really stood out.


It's available online -- audio and a slideshow -- and it's called "Targeting CD47 with Blocking Monoclonal Antibodies in Human Hematologic Malignancies," by Ravindra Majeti of Stanford University. It's pretty heavy in terms of its science, but I can give you a quick summary.


As you know from reading the blog, much of the reserch being done on NHL is focused on Monoclonal Antibodies like Rituxan. These antibodies target specific proteins that are typically found on lymphoma cells; Rituxan targets one called CD20.


The researchers in this presentation are focused on a protein called CD47. They believe CD47 is significant because it sends a "Don't Eat Me!" signal (as they put it in the presentation) to immne system. In other words, cancer cells can develop into tumors because they can somehow fool the body into thinking they are not harmful. the researchers have found that CD47 may be the protein responsible for sending that signal when it binds with something else.


These researchers have developed a monoclonal antibody that targets CD47. Wipe out that signal, and it tells the immune system that these cells are harmful, and that they should be destroyed (in a process called "phagocytosis," which they mention a lot in the presentation, just in case you were planning on listening).


In one experiment, they combined the anti-CD47 antibody with Rituxan, and found that the combination was pretty potent, since it acts on lymphoma cells in two different ways.


The research has so far only involved mice, but it looks pretty good: 8 of the 9 mice were actually cured by the 20/47 combination. Nice numbers.


It makes sense: Rituxan + chemotherapy is effective because it targets cancer cells in two different ways. Add a third way, through RadioImmunoTherapy, and the numbers get even better. The research here seems to suggest that the anti-CD20/anti-CD47 combo can potentially cure NHL with minimal toxicity, targeting only lymphoma cells and leaving healthy cells alone.


I've been wondering for a while how all of these various monoclonal antobodies were going to be used. This seems like maybe the start of some of that research, combining them in ways that will make them more effective than they are by themselves.


Or maybe it's not the start, but the happy end?

Sunday, May 9, 2010

Happy Mother's Day

A happy day to all you moms.

You all do so much. I think you could use a smile today. So enjoy this video.

Hope it brings back happy memories for you.

Thursday, May 6, 2010

Nodes of Gold

Every now and then, I highlight a well-known person who has been diagnosed with or overcome some type of lymphoma. Politicians, actors, athletes -- even the rich and famous can get lymphoma. Two of my Nodes of Gold Heroes are Boston-area athletes, John Lester of the Red Sox and Joe Andruzzi of the Patriots (and SCSU). Unfortunately, we need to add another hero to their ranks.

Dave Roberts.

He was diagnosed recently with Hodgkin's Lymphoma, and went public with it a couple of days ago, when his appearance started to change because of the chemo. He's doing well, is very upbeat, and, as Sox Manager Terry Francona says, he's likely to be able to unrun pretty much anything, including cancer.

***********************

Roberts had a fairly average big league career: 10 years with five different teams, a .266 career batting average, .342 on-base percentage, 243 stolen bases. He was fast, which is why the Sox got him halfway through the 2004 season. He played in 45 games for the Sox that half season, got to the plate 101 times, and stole 5 bases.

But he's most famous for one play, one stolen base, against the Yankees.

The Sox were down in the playoff series, 3-0. One more loss and the Yankees would go to the World Series, and the Sox would go home for the winter. In the ninth inning of game 4, the Sox were down 4-3 when Roberts was put in to pinch run. Francona didn't even bother to give him a steal sign -- he just winked at Roberts as he trotted out to first base, and Roberts knew what to do. He stole second, then scored to tie the game, the Sox won in 12 innings, won the next three games, and then their first World Series in 86 years.

Some call Roberts' steal the greatest play in Red Sox history. Tough to argue; not many single moments were better than that.

The next season, he left the Sox as a free agent, but came back to Boston for the ceremony to get his World Series ring. He got a lot of criticism for wearing a Sox jersey that day, despite playing for someone else. I say, too damn bad. He made his career with the Sox. He hasn't had to buy a meal or a beer in Boston since then.

There's a really nice entry from the blog Newhan on Baseball that gets at what a great guy Roberts is.

Obviously, I wish him well. Sorry he had to join this particular club, but he seems like he has the attitude to make it easier. May we all.

Tuesday, May 4, 2010

Denial

There's a disturbing discussion going on in the support group.


A woman wrote about her husband, who was diagnosed with Follicular NHL, stage 4 (it had moved from the nodes to the bone marrow) in 2002 when he was 49. He had two rounds of chemotherapy, and didn't like that it made him feel so weak and so sick, and so he stopped treatment. He's gone untreated since then, and now he's having B symptoms -- night sweats, chest tightness, back pains. He refuses to see a doctor. His wife basically wants to know from the group how much more time he has, what she can expect to happen, and when she should call hospice.


My fellow group members have tried to offer advice. Treatments are much different now than they were even 8 years ago, and he has non-chemo options like RIT available to him that won't make him feel so bad.


I just don't understand. I mean, part of me understands, I guess. Follicular is so slow-growing, there are times when it seems like you'll live forever. And I haven't had chemo, but I know how people feel going through it, and how horrible that can be for some people.


But this guys seems to be giving up, and that's what I don't understand. Can someone be that stubborn? That fearful? That misinformed? Or just that depressed?

I can't be any of those things. I won't let myself. And Isabel wouldn't let me.

But I also know that you can never say "suck it up" to a cancer patient, because it's just not that easy. Depression is a horrible, sometimes uncontrollable thing, and as much as someone might want to just stop being depressed, sometimes it's just not something they have a choice about.

Anyway, I guess this is one of those things that kind of pulls you back to reality. I've been feeling good since I had the treatment, and I've been busy enough lately to not think much about cancer, and then you read about something like this. Makes you want to get in a car and drive to where he is and do something, anything, to help him.

Sunday, May 2, 2010

Nano Nano

A couple of interesting recent articles on nanotechnology and cancer. Nanotechnology describes a very broad group of approaches to cancer treatment that involve tiny, tiny particles that can be manipulated to treat cancer by more easily targeting cancer cells specifically while avoiding healthy cells.

One article focuses on carbon nanotubes. It describes research by some folks at Yale (hey! just down the street!) who have discovered that carbon nanotubes can stimulate the body's natural defenses to attack cancer cells. Researchers can remove T cells (immune cells that should be able to attack cencer cells, but usually get fooled by them) from the body and increase their numbers more effectively in a lab than they would be produced naturally in the body. The carbon nanotubes somehow help increase production. The T cells can then be put back into the body and their numbers will overwhelm the tumor. Or so it is hoped.

There's another article that I can't get to link. It's from the Northeastern University alumni magazine, and it describes nanotech in general. Appartently, NU has a great nanotechnology program. Can't let those Yalies get all the love -- gotta give some to my old school. I'll work on getting the link.