Wednesday, May 30, 2012

New Strategy for Blood Cancers

Some encouraging news from the good folks at Dana-Farber: researchers there have developed a peptide that seems to help override blood cancer cells' resistance to chemotherapy.

D-F issued a press release yesterday describing the research. In a nutshell, this is how it works:

The body's cells do not last forever.  When they are too old, or damaged, they seem to be programmed to die -- to kill themselves, really. The body activates a protein that shuts down the cells' mitochondria (the little power houses within the cell that keeps them going). No mitochondria, no cell life. (Imagine disabling the motor in your freezer; everything melts and spoils.) Lots of cancer treatments work by triggering these proteins in cancer cells, trying to get the cells to shut down and kill themselves.

But, oh, those tricky cancer cells. They find a way to ignore that protein, or intercept it before it can shut down the mitochondria. (Imagine someone screaming, "No! My ice cream!" and holding on to your leg before you can get to the freezer's motor. Now imagine a whole bunch of people holding your leg, because cancer cells develop multiple strategies for survival. Or, better, a whole line of people waiting to grab you once you shake one of them off on your long walk to the freezer.)

This treatment involves "stapling" a chemical to the shut-down protein. The chemical deactivates the cancer cells' signals, allowing the protein to shut down the mitochondria.

(It's too late to turn back now with this ridiculous freezer metaphor, so: imagine, as you approach that line of people ready to grab your leg, you have an 8 year old with a nerf gun and really good aim, riding on your back. As you approach each person in line, the 8 year old shoots them with the nerf gun, distracting them just enough that you can get to the next person in line, who suffers the same fate, until eventually, they all get out of the way and you can disable that freezer motor and ruin all of the ice cream and bags of corn and frozen Swedish meatballs inside. Which, you will remember, is actually cancer in this comparison.)

Anyway, it's a very promising treatment, especially for relapsed blood cancers (including lymphoma), which tend to increase their ability to resist with each recurrence. Still a VERY long ay to go before anything actually happens with it, but it certainly holds a lot of promise.

(And, by the way, this is just the kind of awesome research that gets funded when you give to the Pan Mass Challenge, which, as you may know, my brother will be riding in later in the summer. Feel free to help fund more awesome research.)

Sunday, May 27, 2012

What Causes Lymphoma?

A few weeks ago, I mentioned an upcoming podcast called "What Causes Lymphoma?"  I was a little critical about it, because I think cancer patients can obsess about causes. That kind of thinking potentially leads to a lot of "What did I do to deserve this?" kind of guilt. And it's often misplaced guilt, because something like Follicular NHL has no definite, known cause. I don't see much point in beating yourself up about something you can't control.

That said, I also fully believe in the power of information, and if being informed about lymphoma empowers you, then learn all you can. (Clearly, it's something that I do myself.)

And, perhaps most importantly, finding answers to "what causes lymphoma?" really is important to researchers, even if it isn't something patients should dwell on.

Anyway, that podcast took place on May 15th, and it's available online now. The show lasts for about 100 minutes, and features interviews with some leading epidemiologists -- medical experts whose focus is on the cause of diseases (specifically lymphoma).

And it's a pretty interesting show. It takes a while to get to the meat of things, but it's worth waiting for. (And in fact, the opening info is worth listening to as well. It includes a plug for a symposium in September to mark World Lymphoma Day; it will focus on Follicular Lymphoma, and is co-sponsored by the excellent organization HOPE for Lymphoma, whose Facebook page is an absolute necessity if you are on FB.)

The show gets a little technical in spots, but the hosts, Charlene McMann-Seaman and Scott Seaman, are pretty good about bringing things back to earth and asking questions that clarify and simplify some issues.

I still think it's easy to let guilt creep in when you're thinking about causes, but if you're past that, it's a show worth listening to.

Friday, May 25, 2012

ASCO: All the Lymphoma News

I can comb through more abstracts from ASCO, but why do that when I can have a Certified Lymphoma Rock Star do it for me?

In a Medscape Today video, Dr. Bruce Cheson of Georgetown University Hospital gives a brief summary of all of the important lymphoma-related abstracts from the conference, including the couple that I have reviewed already. (And yes, he and I agree about some of the significance of some of the research).

The video is called "Blood Cancers: Lymphoma, Myeloma Preview," and in it, Dr. Cheson gives his take on some of the abstracts. (The link also includes a written transcript of what he has to say, if you'd rather read than watch.)

Among the abstracts that he addresses are a study comparing R-CHOP and CHOP + Bexxar (the RadioImmunoTherapy treatment). He promises this one will be controversial.

There will also be an update on the RESORT trial, which recently found that Rituxan Maintenance did not offer significant improvement over watching and waiting after initial treatment.

Another I'll be very interested in: an update on the STIL (Study group of Indolent Lymphomas) trial that compared CHOP and Bendamustine, and which in previous years has gone a long way toward Bendamustine elbowing out CHOP as a preferred fontline treatment for indolent lymphomas like Follicular. We'll get updated information on the trial.

Should be very interesting. As we inch closer to the dates of the conference, we'll start to see some press releases from the sponsors of various studies. We'll see then which studies seem most significant, at least in the sponsors' eyes -- those things that are most worth bragging about.

Wednesday, May 23, 2012

How Doctors Should Treat Us

We interrupt this discussion of ASCO abstracts to bring you an article from the always excellent Mary Elizabeth Williams, cancer patient and Salon writer, called "Listen up, doctors: Here’s how to talk to your patients."

I've linked to Williams before -- I think she is probably the best writer out there is terms of describing what it feels like to be a cancer patient. (And did I mention that I emailed her to tell her how much I liked her work, and she emailed me back? Imagine -- being a groupie at my age.)

This article offers some advice to doctors for how they should talk to patients. All of us -- cancer patients or not -- have dealt with doctors with nasty bedside manners; it gets worse when the situation involves cancer, or some other dire (or seemingly dire) situation. Williams' practical advice for doctors would help all of them, whatever their specialty, and whatever their patients' situation.

It's blunt, too: the first piece of advice is "Get your hand off the goddamn doorknob already." As in: we know you're in a hurry. We can see how crowded the waiting room is. But if you're already focused on the next patient, you aren't paying attention to us. Plus, it makes us feel less than valued, as if our problems don't matter. So have a seat and hear what I have to say.

There's other good advice, too. And the comments from readers are also worth reading.

Tuesday, May 22, 2012

ASCO: Transformation

Another abstract from the ASCO conference to be held in a couple of weeks.

This one is called "Transformation of follicular lymphoma in the era of immunochemotherapy: A population-based study from British Columbia."

 There was some encouraging news from it (though, of course with the usual "yeah, but..."). The study aimed to find out whether Rituxan, which has had such a positive impact on fNHL in general, has had any impact on transformation -- when Follicular turns into a more aggressive form of lymphoma.

As the abstract notes, most studies put transformation risk at about 3%. In other words, about 3% of Follicular patients will transform every year, and about 15-20% will transform over 5 years. (This abstract doesn't say it, but depending on who you ask, the risk is anywhere from 30-50% over 15 years, and the risk seems to disappear after that time.) The researchers looked at 261 patients with Follicular NHL from the Lymphoid Cancer Database of the British Columbia Cancer Agency. All had been treated with either CVP + Rituxan or Fludarabine + Rituxan. Some also received Rituxan Maintenance (infusions of Rituxan every 6 months after the initial treatment).

According to the study, the risk of transformation for the entire group was 2% per year -- lower than the 3% from other studies. This suggests that Immunochemotherapy (that is, combining chemo and Rituxan) lowers the risk of transformation.

The study also found, though, that the rate of transformation for patients who received R-Maintenance was  even lower: about 1.5% per year.

They seem careful not to make too many promises in their abstract. It's a relatively small study of a very geographically limited population. (I have no idea if geography, or environment, has anything to do with transformation, but it seems like a broader study would be more trustworthy.) But it's significant enough to justify further exploration. Some kind of relief for transformation would certainly make Follicular patients happy.

Sunday, May 20, 2012

ASCO: Follicular Treatment Options

And so it begins: the abstracts and press releases for papers at the upcoming ASCO conference. ASCO is the American Society of Clinical Oncology, and their annual conference takes place in Chicago June 1-4. There are a whole bunch of lymphoma-related conferences throughout the year, but one reason I like ASCO so much is that it's devoted to clinical oncology -- the doctors who work directly with patients. All lymphoma research is valuable; there's no question about that. But the clinical stuff appeals to my pragmatic nature.

I'll try to review as many of the Follicular NHL abstracts as possible over the next few weeks. This first one is from a group of researchers in Italy. Their aim was to try to establish a standard for treating advanced fNHL. This represents a serious problem: there are lots of treatments available, but no real agreement over which one should be used, or which should be preferred, or in which order they should be given.

The presentation is called "R-CVP versus R-CHOP versus R-FM as first-line therapy for advanced-stage follicular lymphoma: Final results of FOLL05 trial from the Fondazione Italiana Linfomi (FIL)," and, as the named implies, they attempted to compare three widely-used treatments: CHOP, CVP, and Fludarabine (with Rituxan added to all of them). The study took place over 5 years, and involved 504 patients, divided between the three treatments. The patients were measured for Time to Treatment Failure (evidence that the treatment didn't work, or evidence that the disease had returned or gotten worse).

Overall, 91% of patients responded to the treatment they were given. (Which is very good -- and further evidence of why it's so hard to establish one treatment as the best). After 3 years, Time to treatment Failure (that is, the percentage of patients who had no progression) for the three treatments were 46% for R-CVP, 64% for R-CHOP, and 61% for R-FM. But while CVP seemed less effective than the others, R-FM also resulted in a greater number of secondary cancers (probably leukemias, from what I've read of Fludarabine when Dr. R mentioned it to me as a possibility long ago).

That would seem to make CHOP the winner, but, interestingly, the abstract does not some right out and say so.

My guess, then, is that clinicians will continue to choose whichever of the three has been most appealing to them up until now.

Of course, the study didn't include Bendamustine, which might have come out as successful as CHOP, but with less toxicity. Which doesn't do anything to clear things up.

Two ways to look at this: 1) There's still lots of confusion, and no one knows what the best thing to do is. Or 2) We have lots of options, and they all seem very good, so if one doesn't work, we can try another.

I choose the latter.

Thursday, May 17, 2012

Antibodies for Follicular Lymphoma

The May 2012 issue of Hematologic Malignancies reports on results of a phase II clinical trial comparing Rituxan with Obinutuzumab, and Obinutuzumab wins!

This seems like a pretty big deal. It's the first time the two monoclonal antibodies went head-to-head in a clinical trial. Both antibodies target the CD20 protein on the surface of B-cell lymphocytes, but there are some key differences. Obinutuzumab (also known as GA101) is a humanized antibody, unlike Rituxan, which was derived from mice. It is also glyco-engineered. (Which is apparently important, but honestly, I've read a dozen different explanations of what glyco-engineering is, and I can't get a handle on it. Sorry. We'll just say it's a good thing and leave it at that.) Obinutuzumab also seems to bring on death of cancer cells more directly.

As for results: 149 Follicular Lymphoma patients took part in the study. Of those given Obinutuzumab, 44.6% had a response, compared to 33.3% who were given Rituxan. That seems like a pretty good improvement.

We need to step back a little bit, though.

First of all, these results aren't new; they were presented at the 2011 ASH conference. Even then, they were seen as exciting, but not earth-shattering; in a sample of 149 patients, which is fairly small, an 11 percentage point difference is not statistically significant (which means it can't actually be attributed to Obinutuzumab). 

But what is encouraging is that we have enough data to justify a phase III trial, which will mean a larger sample. 

Rituxan has been a miracle for so many people -- I'll include myself -- but despite a dozen or more attempts at improving on it, there has yet to be a monoclonal antibody that can do much better. Maybe Obinutuzumab will prove to be the one, and the trial will show that. Like Rituxan, it won't be a cure. At best, it might prove to be an alternative for patients who are sensitive to Rituxan, or who become Rituxan-resistant.

At worst, it's another arrow in the quiver. Not too bad.

Tuesday, May 15, 2012

Visit with Dr. R

I'm happy to report on a really boring visit with the oncologist.

About the most exciting thing about it was the compliments I got on my Piggly Wiggly t-shirt.

As I wrote four months ago, the practice has changed a little -- same doctors and staff, but the management of the practice has been taken over by Yale's Smilow Cancer Hospital. So everything is kind of a big production  now. I have to wear an ID bracelet and give my name and date of birth every time I talk to someone, even though I've known all of these people for four years. And everyone seems a little harried, like they were last time.

But that's fine. I still like them all anyway.

So, the upshot is: everything is stable. Blood work is "perfect," he said. The physical exam didn't reveal anything drastic -- maybe a tiny bit of "fullness" in the area that I've had problems in. But nothing that worries him; he still doesn't want to see me for 4 or 5 months, which is the schedule I've been on for about a year.

He brought up the issue of a scan -- I didn't mention it.  He said my last one was in August, but he doesn't feel the need to make it an exactly annual thing, so we'll see how things look in September and decide from there.

It was a fairly brief visit, with no real concerns from either me or the doctor. Just the way I like it.

I will just continue living my life, I guess. I can handle that.

Sunday, May 13, 2012

Happy Mother's Day

I was fortunate enough to have the privilege of making a Mother's Day brunch for my wife and mom today. I thought I'd cap it off with a classic video for two classic moms: "Treat Your Mother Right," by lymphoma survivor Mr. T.

It's not the video's first appearance in Lympho Bob, but it's great reminder for some great moms.

Happy Mother's Day to all of you moms. Hope it was a good day for you.

Friday, May 11, 2012

Follicular NHL: CHOP+ Variations

We're getting close to one of those times of the year when a whole bunch of research on lymphoma is going to be reported: a big conference in early June. More as it becomes available (that is, when researchers and especially drug companies start sending out enthusiastic press releases about clinical trial results).

For now, though, we can get into the swing of it with some research results from Clinical Oncology News: CHOP (the chemo-combo gold standard for some aggressive NHLs, and an option for Follicular NHL) gets similar results when combined with either Rituxan or RadioImmunoTherapy (RIT), the radiation-enhanced version of Rituxan.

The study actually took place from 2001-2008, but needed three additional years of follow-up before results could be confirmed.

Just under 500 patients were enrolled in the study, with about half being given CHOP with Rituxan, and the other half, CHOP with RIT.  The CHOP-R group had an 85% response rate, with 41% receiving a Complete Response. The CHOP-RIT group had an 86% response rate, with 46% getting a complete response.

Here's the strange thing: in some ways, the study is already out of date. There have been so many new treatments developed since 1999 that, really, the debate about which version of CHOP+ to give doesn't really matter anymore -- at least for Follicular NHL patients.

What is significant, though, is the success that patients had with RIT.

The article quotes Dr. Rebecca Elstrom, from Weill-Cornell (and who's slowly becoming a Lymphoma Rock Star -- let's call her an opening act for now), who says that the study shows that RIT "has a role in up-front therapy."

I think whatever love the NHL community had for RIT has cooled off again, but it's great to see that another study has given it a little boost, and kept it in people's minds. We'll see if it stays there.

As usual, it's just always good to know there's another option.

Wednesday, May 9, 2012

"Stronger" Video

I saw this yesterday, and I think it's awesome.

A 22 year old leukemia patient at the Seattle Children's Hospital made a video of his fellow patients -- all of them young kids -- lip-synching Kelly Clarkson's song "Stronger."

If you're not familiar with the song, it's about someone who just broke up with her significant other, making it clear that she's doing just fine. The chorus goes:

What doesn't kill you makes you stronger
Stand a little taller
Doesn't mean I'm lonely when I'm alone
What doesn't kill you makes a fighter
Footsteps even lighter
Doesn't mean I'm over cause you're gone

It's a fighter's song, no doubt -- very upbeat in music and lyrics. Except for the whole "breaking up" thing, it's a pretty good song for kids who are fighters.

The young man who put the video together spent last Saturday filming his fellow patients (he's much older than most of them, and they saw him as a big brother), plus nurses and other staff, and then put edited all night, posting the video on YouTube on Sunday. As of this morning, it had over 250,000 views.

There's a lesson, and to me it's pretty obvious: kids are fighters, they find ways to push through the darkness, and they have a lot to teach the rest of us.

An MSNBC story about the video is here, and the video itself is embedded below. It's tough to watch kids with cancer sometimes -- though if you're reading this, I'm guessing you can handle it. Plus, these are special kids worth watching.

Tuesday, May 8, 2012

More on Immunotherapy

This is a nice piece from Fox News. It focuses on how Barack Obama causes cancer.

No, no, that's political humor in an election year. The Fox News piece actually focuses on advances in Immunotherapy -- treatments that use the body's natural defenses to fight cancer.

The article is called "Training Immune System to Fight Cancer Comes of Age," and it's focus is really about which Immunotherapy companies to invest in, but it gives  a nice summary of some of the treatments currently in use, and others in development.

Yervoy, for example, is used in treating melanoma, and has been successful for many patients. The article points out that a few are in use now, that "at least a dozen therapies are set to have key late- or mid-stage trial data over the next 12 months," and that "scores" more are in earlier stages of development.

There isn't any specific mention of NHL treatments, but we know they're out there.

Saturday, May 5, 2012

Legs or Lungs?

If I've learned anything after six years of running, it's that sometimes you need to worry that your legs aren't up to it, and sometimes it's your lungs.  Lately, with my asthma, it's been the lungs. Today, it was the legs.

I had planned on running about 6 miles this morning. About a half mile in, my feet started hurting. Not good. The same thing cut short my run on Tuesday. I skipped Thursday all together, hoping a little rest would help. It didn't. The pain in my feet radiated up to my calves, and I  hobbled on for another mile. I've had plantar fasciitis in the past, and it sort of feels like that, but not exactly. I stopped and retied my shoes and walked for a minute or two, and that seemed to help. Or maybe my feel were just numbed from pain at that point.

I decided to cut the run short at 5 miles -- 5 slow, uncomfortable miles. Still pretty good, though I sure would have liked to have gone six. But I'm smart enough to know a mile less today gives me a better chance at running at all next week. No sense in pushing it and getting hurt. I'm old and fat, but I'm smart.

And it's all worth it, because runners live longer than non-runners -- so said the European Society of  Cardiology on Thursday.

Of course, that's not to say that my lungs were entirely happy this morning. Every now and then, you pick up speed during a run, and end up breathing a little heavier. Like, say, when a pack of college-aged women runners comes running toward you. Move to the side, give a polite nod, and the next thing you know, you're breathing heavier. And you need to slow down again. It happens.

And I need my lungs. Also on Thursday, researchers from the University of Georgia announced that they believe it is not genetic mutations, but rather low oxygen levels in cells, that drive cancer. This certainly goes against current thinking. And it also gives me yet another reason to run -- more oxygen in my body means less chance of a low-oxygen environment in my cells?

Probably not -- cancer is always more complicated than that. (And if it was the case, that two years of running before I was diagnosed would have done me more good than it apparently did.)

But don't tell my lungs that. They're already pissed off about the whole asthma thing, and maybe the cancer/oxygen connection will make them feel better about it all.

(Sitting and typing for a half hour was not good....Legs stiffened up again....ouch.....)

Wednesday, May 2, 2012

Pan Mass Challenge

Once again, my brother Mike will be riding in this year's Pan Mass Challenge, a bike riding event that raises money for cancer research. H's leaner and meaner this year than ever before. Mike sent this letter out recently, asking previous donors to consider donating again.
I'm asking you to please consider donating to this worthy cause.
 May 1, 2012
 This year on August 4th, I will be joining over 5,000 cyclists riding for my 5th year in the Pan Mass Challenge to raise research funds for the Dana Farber Cancer Institute in Boston. 
As many of you may know from sponsoring me in the past, this cause is especially personal to me as I have had several immediate family members and close friends that have been diagnosed and treated successfully for many different types of cancers.  Some, like my mother, Jean are currently patients at Dana Farber, and others, like my brother Bob, have been beneficiaries of the breakthrough research that has been conducted at the DFMC.
Since 1980, the PMC has raised $338 million for cancer research and treatment at Dana-Farber. The majority of this impressive total is considered unrestricted support-critical, flexible funding that can be directed where and when it is needed most. As the PMC generates nearly half of the Jimmy Fund's annual revenue, every rider supports the efforts of more than 3,000 DFCI faculty and staff members as they make countless advances that have become the standard of cancer care and research.
I’m asking you to join me in the fight against cancer by sponsoring me in my ride with the 2012 Pan Mass Challenge.  The doctors and researchers at the Dana Farber Cancer Institute in Boston are making tremendous progress in finding a cure for this terrible disease, but we need to continue to fund the fight and bring this to an end.
The easiest way to donate is to give on-line.  The PMC site is a secure site. 

To give on-line, you can go to the following link to my personal fundraising site:
Many thanks,