Breaking Research News from sources other than Breastcancer.org
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Promising HER2+ cancer research out of Turku, Finland, funded by our Pink Ribbon campaign. Inhibiting SORLA protein inhibits HER2+ cell growth. Only at the lab bench stage, but I'm excited about all new findings that can potentially help us!
https://www.nature.com/articles/s41467-019-10275-0
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Proposed legislation aims to boost patient access to data The Lower Health Care Costs Act of 2019, a proposal introduced by the Senate Health, Education, Labor, and Pensions Committee, aims to promote health information exchange, enhance the security and privacy of health data, and reduce health care costs. The bill, which is open for public comment until June 5, "ensures that patients have full, electronic access to their own health information and information on what the patient would pay out of pocket for specific care" and "emphasizes that all existing privacy and security protections for patient health data under HIPAA and state laws apply," according to a summary of the draft legislation.Health Data Management (free registration) (5/28)
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WHO urges members to publicly disclose drug price info
A World Health Organization committee agreed to a draft resolution that urges member states to share information on net drug prices with the public and support distribution of voluntarily provided or publicly available information about clinical trial costs. The resolution did not support requiring drugmakers to disclose research and development costs, as some activists had suggested.Reuters (5/28)
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Seniors' out-of-pocket spending on cancer drugs rises
Seniors now pay an average of $10,470 annually out of pocket for cancer drugs through Medicare Part D, up from $8,794 in 2010, according to a study in the Journal of the American Medical Association. Researchers said new cancer drugs have substantially higher starting price points while prices for older drugs have steadily increased.
Prices for 13 anticancer drugs available through Medicare Part D in 2010 rose an average 8% over inflation every year over the past decade...
"We're also seeing that the newer products are just starting out with higher price points,"
In 2018, 48 of the 54 medications had monthly prices exceeding $10,000 per prescription fill, and 21 cost more than $15,000 per fill...
"There is no major increase in the cost of manufacture of those drugs," Fishman said. "These quite substantial cumulative increases are just a result of the power of these drug manufacturers to set price and increase price."
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Grail, a deep-pocketed startup, shows 'impressive,' if early, results for cancer blood test
Could a blood test detect cancer in healthy people? Grail, a Menlo Park, Calif.-based company, has raised $1.6 billion in venture capital to prove the answer is yes. And at the world's largest meeting of cancer doctors, the company is unveiling data that seem designed to assuage the concerns and fears of its doubters and critics. But outside experts emphasize there is still a long way to go.
The data, from a pilot study that Grail is using to develop its diagnostic before running it through the gantlet of two much larger clinical trials, are being presented Saturday in several poster sessions at the annual meeting of the American Society of Clinical Oncology. The data show that the company's test can detect cancer in the blood with relatively few false positives and that it is fairly accurate at identifying where in the body the tumor was found. Another abstract seems to show that the test is more likely to identify tumors if they are more deadly. One big worry with a cancer blood test is that it would lead to large numbers of patients being diagnosed with mild tumors that would be better off untreated.
"The progress of the technology is impressive," said Dr. Len Lichtenfeld, the acting chief medical officer of the American Cancer Society. But he also urged caution. "Grail is one organization that is pursuing this goal. We will get there. But we still have to prove the technology, and we still have to learn how to apply the technology."
Dr. Eric Topol, the director and founder of the Scripps Research Translational Institute, called the results "encouraging" and commented that Grail is "trending toward credibility." He agreed that if these early results hold up, the blood test could be more predictive than existing screening tools, like prostate-specific antigen or mammography. But he, too, emphasized the need for much more research. "All of this requires a large, prospective assessment," he wrote via email.
Grail is running a preliminary study called the Circulating Cell-Free Genome Atlas (CCGA), which is being conducted in 15,000 patients. The goal from the beginning was to use this study to optimize a diagnostic test. This would then be tested in two more studies: one of 100,000 women enrolled at the time of their first mammogram, and a second of 50,000 men and women between the ages of 50 and 77 in London who have not been diagnosed with cancer. These huge studies are one reason Grail has raised so much money.
But the data being reported at the ASCO meeting are from a tiny sliver of that first study: an initial analysis of 2,301 participants from the training phase of the sub-study, including 1,422 people known to have cancer and 879 who have not been diagnosed. These data are being used to pick exactly what test Grail will run.
Dr. Steven Joffe, the chief of the division of medical ethics at the University of Pennsylvania Perelman School of Medicine, called it "important and necessary work, but very different from the envisioned use as a screening tool."
The first big surprise is exactly what test the company is using. When it was spun out of DNA sequencing giant Illumina in 2016, Grail was focused on genes. The idea was that little bits of DNA shed by cancer cells could be detected in the blood. But Grail is now not looking at the genes themselves, but patterns called methylation, which is used by the body to change how the genetic code is read.
"You start out with a few cells, but then they become tremendously differentiated into brain cells, heart cells, skin cells, all of those things," said Dr. Alex Aravanis, Grail's head of research and development. "Methylation is the fundamental signal that determines those cell identities and cell fates."
Grail had previously presented strategies of using DNA in the blood to detect cancer: sequencing the entire genetic code, or a targeted panel of genes, or using methylation. Aravanis said that methylation was not only the most accurate method, but the best at telling where the tumor originated — whether it was breast cancer, lung cancer, or pancreatic cancer, for instance, that the patient had.
The test was set up so that it would have a 99% specificity — meaning that for every 100 people told they had cancer, 1% would actually not have the disease. The test could detect 34% of cancers at stage 1, when the cancer is least risky, 77% at stage 2, and 84% at stage 3. For 94% of patients, the diagnostic gave the tissue of origin of the test, and it was right nine times out of 10.
Ability to correctly identify where the cancer was varied by tumor type. At 99% specificity, the test identified 59% of early-stage lung cancers, 74% of colorectal cancers, and 78% of pancreatic cancers. The test got better when later-stage cancers were included: identifying location for 92% of lung cancers, 97% of colorectal cancers, and 79% of pancreatic cancers.
With these data, it's possible to start to imagine what the use of a Grail cancer blood test would look like in the real world. Dr. Anne-Renee Hartman, Grail's vice president of clinical development, said that between 1% and 1.5% of people older than 50 develop cancer each year. So a test that looked at 100,000 individuals and detected cancer in 70% of them would find 700 cancers. If it had a 99% specificity, it would tell 1,000 people who do not have cancer that they had the disease. The test would tell doctors where to look, and they would have to calm those whose tumors could not be found and treat those whose tumors were findable.
This may not sound great. The test would still be scaring more people unnecessarily than it's helping. But Hartman and Aravanis pointed out that that's far better than existing tests like mammography, CT screening, or PSA. Those, Aravanis said, have false positive rates that are 10 times higher.
Still, while the Grail executives said they envision the company's test used to screen large numbers of people, they also pointed out that their big studies contain plenty of people at higher risk, like heavy smokers or people with mutations known to increase their risk of cancer. Anirban Maitra, a pancreatic cancer researcher at MD Anderson Cancer Center, said that if you look just at pancreatic cancer, not all cancers, it's likely almost 1,000 people who don't have cancer would be identified for every 15 that are diagnosed. "It may be better to apply tests of this nature in a pre-selected high risk population (mutation carriers, or cohorts being followed for cancer surveillance due to some concurrent high risk features) before going all in on a general population," he said.
Dr. Charu Aggarwal, an assistant professor of medicine at the University of Pennsylvania, said she, too, would like to see the test tried in patients at higher risk. But she also was surprised and impressed by the data. "I'm really intrigued," she said.
Aravanis also argued that Grail has another advantage here: that it appears to be detecting deadlier early-stage tumors, no matter where they are in the body. "All cancers are not the same. We really want to find those cancers that are dangerous that grow, progress and cause clinical harm," he said.
Grail is taking the next steps. Hartman, its head of clinical development, said that the company plans to soon start experiments where it will return results back to patients and their doctors, so they can understand what patients do with the information. Until now, Grail has been taking patients' blood and watching, but not telling them about the results of its still-experimental tests.
Dr. Otis Brawley, a professor of oncology and epidemiology at Johns Hopkins University, said he was impressed by the data.
"This is truly exciting in that it's a company that has consistently tried to do the right thing in developing a screening test," he said. "Many companies have tried to cut corners."
Aravanis also said that the company is cognizant that its final test can't be too expensive, and that it is targeting small enough areas of the genome that it can make the test affordable. "We want this to be broadly accessible when deployed," he said. "Being able to price it in a way that's compatible with that is very important to us." He gave a range from $600 to a few thousand dollars, and said that it would get to the low end of that range if possible.
There will definitely be competition. Yesterday, Thrive, a Cambridge., Mass.-based company, announced that it had raised $110 million to develop a competing test developed by researchers at Johns Hopkins University. That test combines DNA and protein data to tell where in the body tumors are. Thrive says its test will cost hundreds of dollars. The race is on.
Matthew Herper, Senior Writer, Medicine, STAT News
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Brain Metastases From HER2-Positive Breast Cancer
- This retrospective study was designed to evaluate the impact of local and systemic therapies for patients with brain metastases related to HER2+ breast cancer.
- Patients treated with surgery or stereotactic radiosurgery and HER2-targeted therapy experienced the best outcomes, whereas patients with a low performance status and neurologic symptoms experienced worse outcomes.
BACKGROUND
There is no sufficient evidence to establish a standard of care for patients with brain metastases (BM) from HER2-positive (HER2+) breast cancer (BC). The aim of this study was to assess the impact of local and systemic treatments on the outcome of patients diagnosed with BM from HER2+BC over a period of 10 years, from 2005 to 2014.
METHODS
Data of 154 patients were retrospectively collected at 14 Italian institutions through a specifically designed database
CONCLUSIONS
Patients with BM from HER2+BC treated with surgery/SRS as local treatment and HER2-targeted therapy as systemic treatment achieved the best outcomes. Patients with low Karnofsky performance score (KPS) and neurological symptoms had poor survival.
Commentary on study provided by Lillie D Shockney RN, BS, MAS
https://www.practiceupdate.com/C/84183/56?elsca1=emc_enews_topic-alert
https://www.clinical-breast-cancer.com/article/S1526-8209(19)30011-4/abstract
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I was a 31-year-old kid in a way': How a cancer diagnosis changed a health care reporter
Rebecca Robbins and Damian Garde and Adam Feuerstein, STAT News • May 24, 2019
All health care reporters deal with the medical system outside of work. But not many of them have dealt with it like Alexandra Glorioso has in recent months.
Glorioso is a reporter for Politico. She's based in Tallahassee, Fla., and she writes about health care, insurance, and the state legislature. She covers stories like the push to expand Medicaid in Florida and legislative proposals to rein in drug costs.
Last summer, at age 31, Glorioso was diagnosed with stage 2 breast cancer. She underwent chemotherapy, participated in a clinical trial with an experimental drug, and had surgery. Then, in March, she announced she was in remission, with no evidence of disease. This week, Glorioso talked with STAT about what the whole experience has been like — and how it shaped her thinking as a health care reporter.
Go to:
https://news.yahoo.com/31-old-kid-way-cancer-084540348.html
for coverage of the interview.
{Story originally published by STAT news. Lightly edited version published at Yahoo News. Free access at Yahoo or subscribe to STAT.}
Alexandra Glorioso's article
I'm Coping With Cancer by Reporting On It. This is what it's like to go from journalist to patient.
Can be accessed here:
https://www.politico.com/magazine/story/2018/08/19/im-coping-with-cancer-by-reporting-on-it-219372
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Health spending and life expectancy, 1970-2017
The Economist
It is difficult to argue with this chart showing America is getting a much lower return on investment of our health care dollars than other countries. There are obviously no easy answers, but this seems quite simply unsustainable.{check out the great chart!}
"THE REPUBLICAN PARTY will soon be known as the party of health care—you watch," President Donald Trump declared in March. "We're coming up with plans." Alas, like many of Mr Trump's claims, this one proved untrue. Days later, following conversations with Mitch McConnell, the Republican Senate majority leader, Mr Trump admitted via tweet that his much-touted health-care proposal would in fact be delayed until at least 2021 after "Republicans hold the Senate & win back the House".
Republican reluctance to embrace health care, despite the president's best efforts, is understandable. On the one hand, America's health-care system is woefully dysfunctional: the country spends about twice as much on health care as other rich countries but has the highest infant-mortality rate and the lowest life expectancy (see chart). Some 30m people, including 6m non-citizens, remain uninsured. And yet, though costs remain a major concern—out-of-pocket spending on insurance continues to rise—Americans say they are generally satisfied with their own health care. Eight in ten rate the quality of their care as "good" or "excellent". Few are in favour of dramatic reform.
{Access to full article requires subscription. This article noted by NCCS.}
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Researchers are hoping any positive outcomes can be appliedhumans in the future.
https://news.wisc.edu/clinical-trial-begins-to-test-universal-vaccine-against-canine-cancer/
The trial is slated to run over five years. Cancer-free, healthy dogs between the ages of six to 10 will be randomized to receive either a series of the investigational vaccine or placebo vaccines.
Two sets of vaccines will be given every two weeks, for a total of four treatments, and then annually. Researchers have not observed any side effects other than those typical to any vaccine, such as moderate local pain or swelling at the site of injection, in mice or dogs to date, but the study will characterize any unanticipated adverse reactions in the larger study population.
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I thought I would post links to a couple of research studies that may be of interest. Both seek stool samples.
This one actually pays you for them! And its stated mission is to make cancer treatment more effective.
This one is "citizen funded" which means you pay to participate.
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Breast Cancer Histologic Subtypes Cluster in Families
- Using a large, population-based database, the authors sought to investigate familial clustering of breast cancer by histologic subtype. The authors identified 23,629 individuals who had more than three generations of genealogy and more than one primary breast cancer; 2883 had specific histologic subtypes other than invasive ductal carcinoma (eg, inflammatory, lobular, and mucinous). The relative risk (RR) for breast cancer was increased among second-degree relatives of patients with inflammatory (RR, 1.32), lobular (RR, 1.36), and mucinous (RR, 1.27) subtypes.
- The lobular, mucinous, and inflammatory histologic subtypes of breast carcinomas appear to cluster within families, but the genetic variants responsible for increased risk and inheritance need to be identified.
- CONCLUSIONS: These findings provide evidence for significant familial clustering within histological subtypes for lobular, mucinous, and inflammatory breast carcinomas. Further research is required to identify the underlying genetic variants responsible for the increased risk. Studies of high-risk pedigrees segregating a specific histologic subtype could be a powerful design for predisposition gene identification.
DOI: 10.1002/cncr.321980 -
Resistance Mechanisms to Anti-HER2 Therapies in HER2-Positive Breast Cancer
- The authors of this review highlight current knowledge regarding the mechanisms involved in the development of anti-HER2 therapy resistance in HER2-positive breast cancer.
- The authors provide detail on mechanisms such as impaired drug binding to HER2, constitutive and self-sufficient signaling in HER-related signaling pathways, metabolic reprograming, and attenuation of the immune system activation state.
HER2-positive breast cancer (HER2 + BC) represents 15-20% of all BCs. In the last two decades, the introduction of monoclonal antibodies (MoAbs), tyrosine kinase inhibitors (TKIs) and antibody-drug conjugates (ADCs) directed against HER2 impressively improved patient prognosis in all disease stages.
Yet, not all patients with limited-stage disease are cured, and HER2+ metastatic BC (mBC) remains an almost invariably deadly disease. Primary or acquired resistance to anti-HER2 therapies is responsible for most treatment failures. In recent years, several resistance mechanisms have been identified, such as impaired drug binding to HER2, constitutive activation of signaling pathways parallel or downstream of HER2, metabolic reprogramming or reduced immune system activation. However, only a few of them have been validated in clinical series; moreover, in the era of standard-of-care dual HER2 blockade, these mechanisms should be re-assessed and, in case, confirmed with anti-HER2 combinations.
Defining the best strategies to delay or revert resistance to anti-HER2 treatments will be crucial to improve their clinical efficacy.
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On a roll Lumpie, thank you
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Drugs make headway against lung, breast, prostate cancers
Kisqali...best
https://apnews.com/4c83cc7cc92a430b8c026691e77815c...0 -
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AKT Inhibitor Doubles PFS in Advanced Breast Cancer
Early randomized trial of capivasertib shows promise in ER-positive disease
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Heart Meds Help in HER2+ Breast Cancer Patients
-ACE inhibitor or beta-blocker cuts cardiotoxicity in patients treated with trastuzumab and anthracyclines
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New Principle for Eradicating Cancer: Leave No Dead Cells Behind
Killing cancer cells is the fundamental objective of chemotherapy, radiation and targeted cancer therapies. However, these treatments often fail to eradicate tumors, and cancer often recurs.
So, is killing the problem?
Dr. Sui Huang (pictured above), professor and cancer biologist at Institute for Systems Biology, along with former mentee and longtime collaborator Dr. Dipak Panigrahy at Beth Isreal Deaconess Medical Center in Boston and colleagues at Harvard Medical School, show that dead cells, or cell debris, generated by treatments intended to eradicate tumor cells, actually act as strong stimulators of tumor progression. Their findings were published in The Journal of Experimental Medicine on November 30 {2017}.
Traditional cancer therapies, then, become a double-edged sword: Too much and too fast, yet incomplete, killing of the tumor cell population will generate so much debris that the tumor stimulatory effect overpowers the decimation of tumor cells. The dead cells trigger a reaction that strengthens the cancer cells that have just escaped death by drugs: These become more like stem cells, which are resilient and robust, and eventually cause recurrence of the tumor.
This phenomenon of cancer drugs as a double-edged sword may be considered discouraging. (Will cancer drugs then ever work?) However, knowing about new mechanisms offers new strategies for new drugs.
"As with wars, focusing solely on killing thy enemy may not be productive and can backfire," Huang said. "A broad assessment of the enemy's culture, the danger of empowering them by attacks and parallel diplomacy help. What politicians and military leaders have long learned, cancer research is now realizing: Look beyond just making killing more efficient. This new vista may open ample new opportunities for gentler, less toxic non-killing – but effective – anti-cancer drugs."
https://systemsbiology.org/news/2017/11/30/cancer-debris/
http://jem.rupress.org/content/215/1/115
DOI: 10.1084/jem.20170681
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High-Deductible Plans and Breast Cancer: Not What You Want to See
Diagnosis made nearly 7 months later than for women in low-deductible plans
High-deductible health plans (HDHPs) were linked to delays in diagnosis and treatment for breast cancer among low-income women, J. Frank Wharam, MD, said here at the AcademyHealth Annual Research Meeting.
High-deductible health plans -- in which patients pay lower premiums than traditional health plans but pay deductibles ranging anywhere from $1,000 to $7,000 before coverage kicks in -- are becoming an increasingly larger part of the health insurance landscape, Wharam noted. "Between 2006 and 2018, HDHPs grew to [cover] almost 60% of workers...
"Rural women in HDHPs experienced substantial delays across the arc of cancer care, from diagnostic testing to treatment," said Wharam. "Adding high out-of-pocket costs to preexisting barriers might cause especially pronounced 'financial toxicity' among rural women."
"We believe further research is needed to determine if these delays cause adverse health outcomes; we're trying to work on that now,"
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05026
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Lumpie--if you take requests, I think you should make a new thread about that persephone biome study. I bet there would be lots of takers.
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Ingerp: I take requests! That's a great idea! I'll do that.
And in case anyone needs a link immediately... here you go:
Poop for the Cure
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Apparently they don't want Canadian poop!. I was so ready!
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My BS is absolutely convinced that low Vit D levels are a big contributor to BC so it was interesting to read that article. My levels were horribly low at diagnosis and that's despite having an outdoor job. He says it's because we use so much sunscreen.
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hahahaha Greek Ninja!
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Sorry, Greek. Hope you’re not personally insulted. I hear it smells like maple syrup.
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Yes it smells like maple syrup and looks like poutine.
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<like!>
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Shetland ...I've been following the MSH6 studies. I had Myriad testing prior to diagnosis (where they told me I had a very low chance of getting breast cancer) and then got diagnosed within months. I have the MSH6 variant which, at the time, was noted as a "variant of unknown significance". The genetic counselor told me to keep checking in because as they collect more data, they tie more genes besides BRCA to breast cancer. And sure enough....
The study reads that a normal woman has a 15% chance of getting breast cancer while a woman with an MSH6 variant has a 30-38% chance of getting breast cancer.
I just don't understand why they can't move faster with this research. It's frustrating.
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Drug to Replace Chemotherapy May Reshape Cancer Care
http://www.bnnbloomberg.ca/drug-to-replace-chemoth...0 -
lala1: regarding the vitamin D levels.... I have done some reading about this because my D levels are sometimes low. My impression is that there seems to still be a good deal of uncertainty around any consequence of vitamin D produced by your body vs vitamin D taken in table/capsule form. I know that they have identified at least one, and quite possibly more, genetic mutations that can be related to vitamin D synthesis. But even people with homozygous (two) mutated genes sometimes do ok so there is obviously more to the story than just the gene pair I have read about. It is possible to be tested but I think that most physicians feel it is not worth it. If you have done a genealogy DNA test, you can run your results thru an analyzer at https://promethease.com/.
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