Showing posts with label metastatic cancer. Show all posts
Showing posts with label metastatic cancer. Show all posts
The Little B****rds

The Little B****rds

I'm sorry I just don't have a better word for cancer cells which spread.We'll just call them the little B's. Anyway, some new research has been done on metastatic cancer cells. The goal is to find them and snuff them out, obviously.

Dr Rauscher of the Wistar Institute's cancer center recently discussed some new information discovered about breast cancer metastatic cells:

"Solid tumors such as breast cancers grow their own blood supply, a process called angiogenesis. It's clear that breast tumors shed malignant cells into the bloodstream. And it's clear that most of these cells get killed by the stress of shearing off from the primary tumor, or by the immune system. But in some patients, a tiny subset of sloughed-off cells develop the colossal powers that are required to become metastatic. At what point does that happen? "That's one of the questions we still have to answer," Rauscher said.

Recently, the ability to rapidly sequence whole genomes (the entire genetic code of a cell) has enabled scientists to analyze differences between primary tumor cells and metastatic cells. Surprisingly, Rauscher said, "there is not much genetic difference."

That finding has big implications. First, metastatic cells may not have a distinctive mutation that can be used as a neat molecular target for new drugs. Second, the important difference between primary tumor cells and metastatic cells may involve which genes are turned on and off by biochemical processes. These outside-the-gene activation processes are called "epigenetic."

Depending on the organ the metastatic cells travel to, varying genes may be activated because each organ has a different "microenvironment," controlled by distinctive cellular signals. That brings up another question: Why do certain types of metastatic cells gravitate to certain organs? Metastatic breast cells, for example, often colonize the bones first, then other vital organs. So far, Rauscher said, the explanations are unclear.

When these incredibly versatile marauders arrive at a new organ, they have the characteristics of all-powerful stem cells. That means they can go dormant for long periods, then suddenly start multiplying uncontrollably. While dormant, metastatic cells are basically invisible to the immune system, as well as impervious to chemotherapy, which works by disrupting the DNA of fast-multiplying cells.

A significant recent discovery is that metastatic cells don't travel and resettle individually. Rather, they detach from a tumor and move in clusters, the better to invade and take over a new microenvironment. It's sort of like moving a whole house, rather than just the furniture, Rauscher said.

While metastatic cells may not have a neat genetic Achilles' heel, researchers areuncovering vulnerabilities. "One therapeutic approach is to find the signals that turn dormant cells on, then block those signals," Rauscher said. "In mice, we've done this.""

So there is work in progress. If its up to the mouse stage, it is progress. But it still has a long way to go. Unfortunately.
More from ASCO - Metastatic Breast Cancer Database

More from ASCO - Metastatic Breast Cancer Database

Metastatic breast cancer is the kind that kills people. Little research seems to be going on for these patients (both men and women). This is a huge frustration for the metastatic breast cancer (MBC) community. However it seems that is about to change.

A poster session at ASCO last week discussed a new MBC program - a database being collected of those with MBC to help learn more about them and find new treatment strategies.

"“Our goal is to understand the biology of metastatic breast cancer and find new treatment strategies,” Nikhil Wagle, MD, of the Dana-Farber Cancer Institute told the ASCO Daily News during the “Cancer Prevention, Genetics, and Epidemiology” Poster Discussion Session on June 6. “One of the ways we can do this is by creating a database of clinical information that is linked to genomic information for patients with metastatic breast cancer and share that with the world so that lots of researchers can use it to make discoveries.”

To increase the volume of tumor samples from women with this disease, the Metastatic Breast Cancer Project was designed to capture information from the vast majority of metastatic breast cancer tumors that are not available for research, largely because most patients are cared for in community settings where genomics studies are not conducted."

I think this is a great idea. Those who wish to participate are sent a saliva collection kit so they can provide a DNA sample and then they release their medical records and tumor information. They study then looks at outliers - those who best responded to certain treatments. But I am sure there is much more. I did find a link to the project's website.

I am elated to learn of this. The metastatic community has almost been ignored in most research. And this is a great step in the right direction.
She Left Us A Great Legacy

She Left Us A Great Legacy

Last week, Jody Schroger, passed away from metastatic breast cancer - that's the kind that kills people. Jody was legendary in the breast cancer world. Why? Because she did so much. She helped build the metastatic breast cancer community, on Twitter and elsewhere.

Jody was the kind of person we should all be. Very low key but very strong in her actions. If you google her, you will be surprised on how many places she turns up. That's because she helped found Breast Cancer Social Media.

"The Breast Cancer Social Media (BCSM) community began with a simple question – could the power of social media be utilized to unite, educate, and empower those affected by breast cancer?" 

Two breast cancer patients, one of them Jody, and one doctor set out to answer that question. They have a huge impact on the breast cancer community through their Twitter chats. I am not a Twitter chatterer but I did read through some of them and was impressed with them. (If you search #BCSM on Twitter you will see what I mean.)
I actually met Jody, really met in person, at some event we were both at. Was it a DOD CMRP or a pharma industry meeting? I can't remember. But after the meeting we both ended up in the same terminal at the airport and hung out for a while as we waited for our flights.

It wasn't a significant conversation. We talked about a few issues, chit chatted about being stuck in an airport, as well as coping with cancer and the importance of being active. Then we parted and headed for our respective gates. I had a weird feeling that I would probably never see her again. She left us a great legacy.

Metastatic Breast Cancer Treatment Protocol

Metastatic Breast Cancer Treatment Protocol

While I do not have metastatic breast cancer, I have friends who are stage IV and follow their treatment issues. One thing I have wondered what the standard treatment protocol is for MBC as I have often heard complaints about treatment options for them. Finally, I found an article covering the options, the full text of it can be found here.

First of all, I want to say I am a little appalled by this statistic:

"Depending on prognostic factors, in the worst scenario, up to 30% of node-negative and up to 70% of node-positive breast cancers will relapse. The prevalence of metastatic disease is high because many women live with the disease for several years."

I had no idea the numbers were that high. I had one tiny little node that was positive at my diagnosis so that puts me in the second group, I think. But 70%? I do have to keep in mind that the words "up to" and ignore the "70". But yowza!

Other words that are intimidating are:
  • Isolated local–regional recurrence should be treated like a new primary with a curative intent including ‘secondary’ adjuvant treatment modalities as appropriate
Okay, that's pretty good if isolated recurrences can be treated with a curative intent. Its nice to know you can have a recurrence which is not considered terminal.
  • "The management of metastatic breast cancer (MBC) should involve all appropriate specialities in a multi/interdisciplinary team (medical, radiation, surgical and imaging oncologists, palliative care specialist, psychosocial support), and patients should be offered personalized appropriate psychosocial, supportive and symptom-related interventions as a routine part of their care.
Well that's nice to know they want all sorts of help to support the patients and they include the emotional side as well as the medical side. Often I think doctors don't think outside their medical realm. And a team discussion on treatment protocol is better than a single person's decision.
  • There are few proven standards of care in MBC management, therefore well-designed, independent, prospective randomized trials are a priority.
Yes few standards. Clinical trials are key.
  • The vast majority of MBC is incurable and hence the main treatment goal is palliation, with the aim of maintaining/improving quality of life, and possibly improving survival."
Thanks for putting this out there. Incurable is not a nice word. But I think its important that it is stated. Too many have misguided thoughts that 'oh, we can just fix this'. Please do not let the patients have any delusions about their prognosis. It would not be fair.

I strongly suggest people read this article to better understand the options available and what should be expected for a treatment protocol. Often patients are not fairly treated especially if they do not know what they should expect. I hope this gets expanded in the future.