Happy St. Patrick's Day

A Happy St. Patrick's Day to you all. 

We're off to a corned beef and cabbage dinner in a little while, but I thought I'd at write a quick entry before we left.

I try not to stray too far from the general topic of cancer in the blog, at least not for two posts in a row, so I'll offer you this joke, from an Irish humor website, in the spirit of the day. (It's actually one I posted on the blog way back in February 2008, not long after i was diagnosed, and looking for something to laugh at, but it's worth repeating):

An Irishman named O'Malley went to his doctor after a long illness.  The doctor, after a lengthy examination, sighed and looked O'Malley in the eye and said, "I've some bad news for you. You have cancer, and it can't be cured, you'd best put your affairs in order."

O'Malley was shocked and saddened. But of solid character, he managed to compose himself and walk from the doctor's office into the waiting room.

To his son who had been waiting, O'Malley said, "Well son, we Irish celebrate when things are good, and we celebrate when things don't go so well. In this case, things aren't so well. I have cancer. Let's head for the pub and have a few pints."

After 3 or 4 pints, the two were feeling a little less somber. There were some laughs and more beers. They were eventually approached by some of O'Malley's old friends who asked what the two were celebrating.

O'Malley told them that the Irish celebrate the good and the bad. He went on to tell them that they were drinking to his impending end. He told his friends "I have been diagnosed with AIDS." The friends gave O'Malley their condolences, and they had a couple more beers.

After his friends left, O'Malley's son whispered his confusion. "Dad, I thought you said that you were dying from cancer? You just told your friends that you were dying from AIDS!"

O'Malley said, "I don't want any of them sleeping with your mother after I'm gone!"





Have a good one!

Jazz

Been a while since I did any bragging about one of the kids, so here it is:

Peter's band played their spring concert last night. Actually, I should say bands, since he played clarinet in the Concert Band, and soprano sax in a Jazz ensemble. I may post a video of the Concert Band at some point, but the Jazz piece was a highlight for us.

Here's Peter on Duke Ellington's "Riding on a Blue Note"; his soprano sax improv solo comes just past two minutes into the video.



We're very proud of our boy.

Take a Nap

Apparently, yesterday was National Napping Day, and I want to make known my disappointment at not getting a nap in at all yesterday. Today, either. A day full of errands, grading, and driving kids around. And it isn't even close to being over.

National Napping Day was created by a Boston University professor who wanted to highlight the importance of getting enough sleep. It comes, appropriately, just after we change our clocks and lose an hour. 

I don't think I've had regular naps since I had my Rituxan -- six weeks of Benadryl-induced snoozing. It was awesome. I've been tired since then.

Huffington Post ran a story asking people for the strangest place they've ever napped. I can't remember the strangest place I've ever napped, but I remember the strangest place one of my kids napped: Peter, about 8 years old, in the dentist chair during a cleaning. They gave the kids sunglasses so the light wouldn't shine in their eyes. The dentist asked Peter to open wider, and when he didn't respond, they checked under the sunglasses and saw him snoozing away. John, on the other hand, announced when he was four that "now I'm four, I don't need westess." Oh, well.

So take a nap. Do it for me.

Ofatumumab

The medical journal Blood, which focuses on research on diseases of the blood (duh), published the results of a recent study on a Rituxan alternative. The article is called  "Ofatumumab Monotherapy in Rituximab-Refractory Follicular Lymphoma: Results from a Multicenter Study." The titular results were, well, not all that exciting.

Ofatumumab is a second-generation monoclonal antibody -- one of several that were developed as alternatives to Rituxan. Like Rituxan, it attaches to the CD20 protein that is present on B cells (both lymphoma and normal cells). The big difference is that, while Rituxan was derived from mouse cells, Ofatumumab is derived from human cells. Researchers thought this might result in fewer side effects, and better attachment.

So far (like many second-generation monoclonal antibodies), it hasn't proven to be a huge improvement over Rituxan. This study doesn't seem much different, unfortunately.

The focus, as the title indicated, is on fNHL patients who are refractory to Rituxan -- that is, patients who have had Rituxan, but are not getting results from it. The hope was that Ofatumumab would be different enough from Rituxan to override whatever resistance the body had built up.

And that was the case for a portion of the patients in this study. The abstract says it was "well-tolerated and modestly active in this heavily pretreated, rituximab-refractory population." The term "modestly active" doesn't really get anyone up and cheering. But it did show at least some results for some patients.

Maybe more importantly, Ofatumumab "is being studied in less refractory FL and in combination with other agents in various B-cell neoplasms." In other words, maybe using it as a monotherapy -- all by itself -- isn't the best way to use it. Much like Rituxan, maybe its greatest strength will be in making other treatments better. There are a whole bunch of trials going on that are attempting to find some good combinations.

One more to keep an eye on.

Personalization? Not Yet

Some troubling (or, potentially troubling) news from the world of cancer research, as reported in USA Today and other outlets: personalized treatments based on genetic profiling might not be as easy as we think.

The idea behind this kind of treatment is that cancer cells have a genetic footprint. If we can find the genetic problem with a particular type of cancer, then maybe we can base a treatment on it and find a cure. Follicular NHL, for example, has two chromosomes that are out of order (14 and 18, I think. I forget -- I can't see them, anyway, so who cares). Something made them switch positions. So researchers can look for treatments that can switch them back (if that's even possible), or target cells that have those genes switched.

This approach assumes that there is a genetic basis for cancer; this is the dominant assumption about cancer these days. Every type of cancer has its own genetic footprint.

So here's the problem: researchers found that, on some tumors, there are different cancer cells, with completely different genetic profiles, and if the cancer shows up someplace else, those cells can have different profiles as well. So a Follicular NHL  in one patient might have that 14, 18 switch going on in some cells, but 3, 16 in others, and a 9, 12 in still others.  So what happens is, a treatment is developed that targets one genetic problem, but it misses the others, because they weren't known about. So a bunch of cancer cells survive.

The articles I've read on this study present this as the death of personalized medicine.

Hardly.

It's a set back, to be sure. As least a potential set back. But here are a few things to remember:

First, this study involved on a very small number of patients, with one specific kind of cancer. What we know for sure is that these patients have several different genetic profiles in their tumors. But not everyone with their cancer will have the same genetic issues, let alone everyone with every type of cancer. That's the curse of genetic profiling -- it's shown us just how complex cancer is.

Of course, that makes it even more of a blessing, too -- we're getting a  better idea of just how complex cancer is. Isn't is just as likely that, now that we know about these multiple genetic abnormalities, we can start devising tests that look for them, and then corresponding treatments? I see this this as more blessing than curse. We're actually a step closer to understanding cancer. How can that be bad news?

Look, it's been 40 years since we declared war on cancer, and the fight still goes on. Anyone naive enough to believe that personalization would mean an immediate end to cancer should appreciate the wake up call. For the rest of us, we take our good news incrementally, and this is one more small piece to celebrate.

So start celebrating.

Getting Physical

I had my annual physical today. No cancer doctors involved, just a friendly internal medicine specialist.

Everything seems fine. No cancer-related issues (swollen legs, swollen nodes, chills, fevers, or night sweats). My EKG is normal. Even got a tetanus shot a few years early so they could add a vaccine for Pertussis (Whooping Cough, which is apparently making a come back, thanks to people not vaccinating their kids. So I'm covered -- whoopie for Whooping Cough!). Blood pressure is normal. She's pleased that I'm still running.

I'll do a blood test next week. Complete blood panel, plus tests for Vitamin D and PSA. I expect everything to be fine. I'll share results, because I expect to be bragging again this year.

So, once again, I retain my title as the healthiest cancer patient around.

This comes on the heels of a sad day, though -- the 30th anniversary of the death of John Belushi. As I celebrate my good health, I can't help but think of how a great talent was wasted because of an open lack of concern for health. It resulted in some great comedy, for sure, but at a huge expense.

So, of all the clips I could use to celebrate Belushi's life, I'm going with this one, which seems oddly appropriate.

powered by ifood.tv

Thanks, Bluto...

Immunotherapy Trials

The National Cancer Institute announced recently that it will fund an initiative to encourage research in immunotherapy. It's a promising approach to treating cancer, one that's been around for a little while, and includes treatments like my old pal Rituxan, as well as the very successful drug Herceptin, used most often to treat breast cancer. Both are examples of monoclonal antibodies, which work in several ways, including stimulating the immune system.

The NCI initiative will involve 27 cancer research centers across the country (including, in my own backyard, Yale), and will focus on developing and running clinical trials. In addition to studying the overall effectiveness of the selected immunotherapies, the study will also look at other things like biomarkers, clues to determine if certain patients have more success because of the genetic makeup of their cancer. (While patients might outwardly have the same kind of cancer, they may not have come to it the same way. Biomarkers let researchers know which path the cancer took to get to where it is, and thus, potentially, which treatment to use to get rid of it. This is what personalized medicine is all about.)

The first NCI trials will focus on two particular immunotherapies.  One of the two chosen is called CP-870, 893. Like Rituxan, which targets cells that have the protein CD20 on their surface, this one targets the protein CD40, which is present on some B-cell malignancies (that is, some types of lymphoma) as well as some solid tumors. The other is called Inter-leukin 15, which mimics a naturally-occurring substance that is secreted by cells when they are attacking a virus. It is hoped that this copy of the natural substance will do the same job, stimulating T cells -- immune cells that attack invaders -- as well as work to cause bad cells to kill themselves in lots of neat ways.

Very encouraging to see immunotherapy get some love. Seems like a very promising approach overall, as shown by the success of Rituxan and Herceptin.

I know I get very excited about any new approach that's being touted in the news. I have no idea what the future holds, and whether, say, immunotherpay holds the key to wiping out cancer, or if  nanotechnology will be it. Maybe it will be some combination. But I am, I will freely admit, a Cancer Whore: I will go with any potential treatments, any place, any time, as long as they can pay the price -- a successful phase III clinical trial.