Breaking Research News from sources other than Breastcancer.org
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Hi April1964,
It was from an article that Lumpie posted on the previous page:
Mixed Results for Profiling in Predicting Late Recurrence in ER+ Breast Cancer Tools may, however, help select patients for extended treatment https://www.medpagetoday.com/reading-room/asco/breast-cancer/80812?xid=nl_mpt_DHE_2019-07-03&eun=g1237212d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-07-03&utm_term=NL_Daily_DHE_Active
I looked again and it was a measure of "Circulating Tumor Cells". If a person's count was 2 or more CTCs per 7.5ml of blood, they had an 83% recurrence rate. (It mentioned that the doctors didn't know if the CTC count was predicting the recurrence or showing that a recurrence had already started and was not otherwise detectable).
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thank you salamandra! it’s sometimes hard to understand this stuff
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This was an interesting article that I read about resistance to AIs, and relates to the question talked about above related to survival statistics.
https://erc.bioscientifica.com/view/journals/erc/2...
In particular, in talking about why studies are not showing an increased survival pattern despite the development of new drugs, the article (from 2018) had this to say:
In fact, AIs therapy presents higher clinical efficacy, prolonged disease-free survival and time to recurrence, and significantly less severe side effects than tamoxifen. Nevertheless, clinical trials generally suggest that AIs therapy does not significantly improve overall survival when compared to tamoxifen therapy (Bonneterre et al. 2001, Mouridsen et al. 2001, 2003, Milla-Santos et al. 2003, Paridaens et al. 2004, 2008, Howell et al. 2005, Chumsri 2015, Early Breast Cancer Trialists' Collaborative Group 2015). This unintended effect on overall survival may be associated with immature data from many studies, which report an increase in the number of non-cancer deaths in patients with prolonged AI therapy, and, consequently, this increase attenuates the contribution of the treatment in reducing the number of breast cancer deaths (Goldvaser et al. 2018).
Not sure if I am reading this correctly (I am not a scientist) but it certainly offers some hope.
Bev
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I wonder how many have their circulating tumor cells tested. Now I want mine tested. I bet it's not routine.
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Hi Jessie,
I think you are right--not many MOs do test CTCs. I had mine done in April, ordered by my naturopathic oncologist. My former MO told me years ago that the test had too many false positives and that she doesn't rely on them, but my NO told me that the test has become much more accurate in the past years and she recommended it for me. Thankfully, it was zero. Amazingly my insurance company paid for it--I guess they did because I never got a bill.
Claire in AZ
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Claire -- that's good to know. Although I'm not sure I want to know I think I'll go ahead and request the test when I see my MO in September. Did you ever find out what that lump was or is? Kind of the same thing happened to me --- just relaxed in bed one night watching TV and felt a quick sharp pain which made me put my hand to that area. My internist couldn't even feel it. I would have never known since it didn't show on mammogram.
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I think this article is important especially if you are having a problem with drugs you are taking. A large percentage of our generic drugs are made in China.
July 10, 2019
Should U.S. Health Care Depend on China?
Two new books expose the health dangers posed by the import of pharmaceuticals from the People's Republic of China. The dependence of America's medical system on products of questionable quality does not just endanger patients today, but risks long-term problems as the push for "Medicare for All" or some similar national health insurance scheme grows in popularity. The enormous costs of such a government-run program will pressure bureaucrats and politicians to embrace the continued outsourcing of drug production to low-cost foreign sites to keep budgets down. China Rx: Exposing the Risks of America's Dependence on China for Medicine by Rosemary Gibson and Janardan Prasad Singh is the latest work by two authors with a long record of pushing for improved safety protocols. Gibson is senior advisor at the Hastings Center Bioethics Research Institute and Singh is an economic advisor at the World Bank. Bottle of Lies: The Inside Story of the Generic Drug Boom is by...(Read Full Article)
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Hi Jessie, I sent you a PM...
Claire in AZ
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FDA 'Satisfies' FOIA Request on Hidden Database
The FDA has closed out its file on the Kaiser Health News Freedom of Information Act request that exposed a hidden database of reported problems with medical devices.
KHN posted its correspondence with the FDA, which said that releasing the information online should satisfy the news outlet's request. The agency published the "alternative summary reporting" database on June 21 --it can be found here.
The program bypassed a public database known as MAUDE that is used by doctors, researchers, and patients to report and signal problems with devices. It included 5.7 million incidents of malfunctions and injuries linked to medical devices over 2 decades.
References:
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HHS Inspector General Finds Serious Flaws In 20% Of U.S. Hospice Programs
There's no easy way for consumers to distinguish the good hospices from the bad. Two new government studies are the government's first to look at hospice deficiencies nationwide. The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health inspectors cited 87% of hospices for deficiencies. And 20% of hospices had lapses serious enough to endanger patients. The Centers for Medicare & Medicaid Services (CMS), doesn't make information on hospices previously cited for deficiencies available on Hospice Compare, its website for consumers, even though the agency has the authority to post at least some of that data.
https://www.npr.org/sections/health-shots/2019/07/09/739471717/hospice-oig-reports
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New discovery targets stem cells of claudin-low BC.
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when they test the tumor after surgery do they also test it for stem cells?
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April1964:
To the best of my knowledge, there is no test for stems cells. I believe that they are presumed to be present in all tumors and are the mechanism by which cancer spreads. Also, as the article notes, "At present, there are no drugs that can kill cancer stem cells, but people are looking for them..." So even if it were possible to test for them, the test would probably not be done routinely if it were not "actionable" - in other words, it didn't indicate some specific treatment. I hope we will 'get there' - sooner rather than later!
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Wow lumpie, does that mean chemo, radiation and aromatase inhibitors don’t kill stem cells?
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thanks so much lumpie for explaining that!
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How Long Is This Going to Take?
{In this memoir-esque piece, an oncologist reflects on his multi-year odyssey with a quirky stage 4 cancer patient.}
"There are times when I wished I might capture Leroy's spirit in a bottle to be passed around so that I and others might take a healthy swig of it from time to time.... {It} helps encourage us to "keep on keepin' on" at what we do."
https://ascopubs.org/doi/full/10.1200/JCO.19.01102
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Effects of marital status on breast cancer survival by age, race, and hormone receptor status: A population‐based Study
First published: 02 July 2019
It remains unclear whether marital status could affect the breast cancer‐caused special survival (BCSS) of patients with breast cancer. Therefore, we sought to explore the influence of demographic and pathological factors on prognosis of patients with breast cancer.
Our findings demonstrated that married and single patients with breast cancer had better prognosis than their DSW (divorced/separated/widowed) counterparts. Age, race, and HRs could affect the correlation between marital status and BCSS.
we used SEER*Stat 8.3.4 software to extract eligible patients included in the database.
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marijen I believe that chemo is reasonably effective at killing them systemically; radiation kills them locally; and aromatase inhibitors cut off their food supply if they are hormone driven. But there is still no good test for them.... especially if they are "hiding" somewhere in the body. Perhaps research on CTC (circulating tumor cells) will eventually allow an assessment of whether they are present in the sampled blood specimen....and, therefore, likely to be lurking elsewhere....
{Note: Upon rereading, I note that the article says "At present, there are no drugs that can kill cancer stem cells, but people are looking for them" so maybe chemo's systemic effect is limited to less potent cells that have broken off and are circulating. Still lots to figure out about this disease process.}
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Sports playbook helps doctors predict cancer patient outcomes
Using in-game win probability techniques, Stanford researchers devised a way to predict a cancer patient's outcome at any point during treatment. The approach could also inform treatment decisions.
...researchers at the Stanford University School of Medicine have taken a page from this playbook to generate more accurate prognoses for cancer patients. They've done so by designing a computer algorithm that can integrate many different types of predictive data — including a tumor's response to treatment and the amount of cancer DNA circulating in a patient's blood during therapy — to generate a single, dynamic risk assessment at any point in time during a patient's course of treatment. Such an advance could be deeply meaningful for patients and their doctors.
"Our standard methods of predicting prognoses in these patients are not that accurate," Kurtz said. "Using standard baseline variables it becomes almost a crystal ball exercise. If a perfectly accurate test has a score of 1, and a test that assigns patients randomly to one of two groups has a score of 0.5 — essentially a coin toss — our current methods score at about 0.6. But CIRI's score was around 0.8. Not perfect, but markedly better than we've done in the past."
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My parents were on hospice in my home for 6 years -- I know that's unusual since hospice was developed as a 6 month program ---- but I kept them on medicare only --- no supplement or HMO type program. Medicare is so large they don't monitor as well as private business. Anyway, our hospice was very good -- however the R.N. told me that they go into many very bad situations -- even some involving neglect --- but they never report the neglect. When I asked them why I was told the word would get around and they could lose potential patients. Isn't that horrible!!!
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jessie123: that is sad. IMO, the state of care for our elders does not reflect well on us as a society. It is troubling that neglect is not reported.... but some seniors undoubtedly fear the alternative more than the neglect. I have personally observed some terrible states of care... but with no longer term care coverage, we pretty much 'hang our seniors out to dry.' The wave of elders that is coming may change things but not without a great deal of pain on the parts of many, I fear.
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Why Elephants Rarely Get Cancer
They have multiple copies of a gene that causes mutated cells to commit suicide.
"I've always been so enamored with elephants -- one of the things that's just amazing to me is that elephants have such an incredibly low rate of cancer. And it doesn't make any sense that elephants have a low rate of cancer, because they're so big and their cells are dividing so fast,"
"Their cells are dividing so quickly that just by chance alone they should just have really high rates of mutation and cancer. But they have a gene -- they have many copies of this gene, as a matter of fact -- that causes their cells to commit suicide if they mutate. It could not have evolved to be that large if it did not also evolve to have that gene,"
Researchers at the University of Utah are now working with human cells to see whether the elephant's cancer-fighting technique could lead to new medical treatments.
https://www.insidescience.org/video/why-elephants-rarely-get-cancer
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If I was a collector, I would have wall shelves with nothing but elephant sculptures.
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More Attention Needed on Misdiagnosis, Experts Say
Study finds many cases fall into three disease categories
More money should be spent on researching ways to reduce misdiagnosis and to get patients diagnosed more quickly, several experts said here. "For too long, the problem of inaccurate and delayed diagnosis was not given the attention it deserved," Paul Epner, MEd, CEO and co-founder of the Society to Improve Diagnosis in Medicine (SIDM)... {A} study, published in Diagnosis, looked at nearly 12,000 diagnostic error malpractice cases and found that the "Big Three" disease categories -- vascular events, infections, and cancers -- accounted for 74.1% of high-severity cases, with the top five diseases in each category accounting for 47.1%. Roughly half of the cases involved primary care clinicians; the rest were divided between medical specialties like cardiology, gastroenterology, and neurology (16.3%), surgical specialties (15.4%), and diagnostic services like radiology and pathology (14.8%). Having physicians learn from their mistakes is important to improving diagnoses, Burstin said. "All of us can immediately think of a patient they saw where there is clearly an issue ... Some of it is that we don't know what the ultimate diagnosis was," she said. "Feeding that information back to clinicians is such a powerful learning tool ... Those opportunities [are needed] for better systems, better understanding, and outcome tracking." Several of the panelists told their own misdiagnosis stories. {Some are recounted in the article.} "Looking back, I just wish someone had listened to me..."
https://www.degruyter.com/view/j/dx.ahead-of-print/dx-2019-0019/dx-2019-0019.xml
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Lumpie, that link about the Elephants having genes that cause cells with mutation errors to commit suicide is so very interesting! Coming from a humorous standpoint, it makes me wonder if fossils of dinosaurs might have dna with similar genetic code. I mean what's bigger than Elephants? Oh maybe a Brachiosaurus???! LOL. But this really is so exciting to learn. IMO there is SO much we can and should be learning from Elephants. I've always been enamoured by them. Thankfully I was able to go to AFrica as a part of my college studies back in the 90s and see herds of them that stretched for as far as the eye could see. Just amazing creatures.
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And whales! "Scientists know that age and weight are risk factors in the development of cancer. That should mean that whales, which include some of the largest and longest-lived animals on Earth, have an outsized risk of developing cancer.
But they don't. Instead, they are less likely to develop or die of this enigmatic disease. The same is true of elephants and dinosaurs' living relatives, birds." (sorry can't post links yet)
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Pairing targeted drugs for breast and lung cancer could overcome treatment resistance
Targeted drugs for breast and lung cancer could be used together to overcome resistance to treatment in several different tumour types, a new study shows. Scientists discovered that when the breast cancer drug palbociclib was combined with the lung cancer drug crizotinib, the two-drug combination was significantly more effective against cancer cells in the laboratory than either drug used on its own...
Based on this discovery, the researchers found that pairing CDK4/6 inhibitors such as palbociclib together with crizotinib -- which blocks MET activity -- created a combination treatment that was much more effective than either drug on its own against cancer cells grown in the lab or human tumours growing in mice.
https://www.sciencedaily.com/releases/2019/07/190711200609.htm
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How cell-free DNA (cfDNA) can be targeted to prevent spread of tumors
"After infection or injury, a group of specialized immune cells called neutrophils release small sticky fibers of chromatin, which is undegraded dead-cell DNA. These fibers are called neutrophil extracellular traps (NETs). Although NETs can stop harmful bacteria from spreading in the bloodstream, NET release can sometimes become uncontrolled; this could cause clotting or embolism (lodging of the clot inside a blood vessel), a potentially fatal condition. Prof Mizuta states that DNase1L3 can degrade NETs into cfDNA and thus be used to treat thrombosis caused by NETs.
NETs are also known to be the "seeding soil" for tumors. Tumor cells released in blood might latch onto NETs and grow on them and spread to other organs. For this, Prof Mizuta says, "Because DNase1L3 degrades NETs and generates cfDNA, we speculate that DNase1L3 treatment may also be useful to prevent tumor metastasis. We are now conducting experiments to test this speculation."
That said, can more research on cell-free DNA make human life cancer-free? Only time will tell..."
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Imprinted Spheres Fight Breast Cancer: Inhibition of HER2 on tumor cells by molecularly imprinted nanoparticles
A particularly aggressive, metastasizing form of cancer, HER2-positive breast cancer, may be treated with nanoscopic particles "imprinted" with specific binding sites for the receptor molecule HER2. As reported by Chinese researchers in the journal Angewandte Chemie, the selective binding of the nanoparticles to HER2 significantly inhibits multiplication of the tumor cells.
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