Interesting news on cancer research can come from all sorts of unexpected sources (and I don't mean the daily press or the BBC...). One recent example comes from 'Forever Surrey', the magazine for alumni and supporters of Surrey University (where I did my PhD in computer science). The latest issue carries a few interesting snippets on cancer research at the university.
First up is news of a new urine test for prostate cancer. Current testing for the test is geared around Prostate-Specific Antigen (PSA), which is produced by all prostate cancer cells, not just cancerous ones. This means a high PSA value may not necessarily be connected to cancer but be caused by other conditions. It's better than no test at all, but it's not ideal. It also makes it hard to distinguish between slow-growing prostate cancers that can be safely let alone or monitored over time, and those that are fast-growing, aggressive and have to be treated immediately. Professor Hardev Pandha, a professor at the university and a consultant oncologist at the Royal Surrey County Hospital, and his team have come up with a new test that is much more cancer-specific.
Targeting a protein called Engrailed-2 (EN2), which is produced by prostate cancer cells and present in urine, they have developed a test that is much more specific, faster and easier to use. For starters this is a urine test rather than a blood test (which is what the PSA test is), and the researchers are working on a version of the test that can be done using a dipstick (like a pregnancy testing kit). A more faster and more accurate test that can really pin-point cancer rather than just generic prostate problems would be a great step forward.
But it's not just a new and improved biomarker test that's being developed at Surrey. The same research team are also working on a new treatment for prostate cancer. Dr Richard Morgan, one of Professor Pandha's team, has been working on a drug that targets a protein called HXR9 which is only active in cancer cells. By being able to switch off this protein with a new drug it can safely treat prostate cancer - without the damaging side-effects of existing treatments.
Interestingly, the same drug seems to have activity in a range of other cancers, including ovarian, breast and melanoma. This is definitely one to keep an eye on in the future...
Commentary on cancer research, information on supplements and treatments, relevant book reviews, links to useful sites and other information that cancer sufferers, their families and friends may find useful.
Tuesday, 11 June 2013
Wednesday, 24 April 2013
George - Second Anniversary
One of the many doctors who treated George described him as a miracle child. And it was true. He had survived a rhabdomyosarcoma diagnosed at two and which was aggressively treated for about a year, followed by a few months in remission. When the disease recurred it was treated hard again but the last scan showed there was still evidence of disease. With no options left on the table we were sent home to prepare for the worst. George was just four years old. We refused to accept the news, and he was just a kid who wanted to play. And play he did, for the next eleven years. He really was a miracle child. But when he was fifteen he was diagnosed first with a basal cell carcinoma and then, a little later, with osteosarcoma. For us the miracle ended two years ago, when the osteosarcoma finally defeated our wonderful, lovely child, after the hard years of battle.
On this second anniversary it’s time to take stock of where we are with the Trust formed in his name. One of the things we wanted to focus when we started was on encouraging more research in Li Fraumeni Syndrome. We never imagined that we would be responsible for some of that research, but that is precisely what has happened. Over the last year I have developed a new theory about cancer initiation in LFS, one that is subtly different from the mainstream view. The first test of a new theory is to see if it can stand the peer review process and be published in a reputable peer-reviewed scientific journal. I am happy to report that the paper ‘Li Fraumeni Syndrome, cancer and senescence: a new hypothesis’ has been published in the journal ‘Cancer Cell International’. There will be more to say in the coming weeks and months about this paper, but for now it’s available for download at the journal’s website.
On this second anniversary it’s time to take stock of where we are with the Trust formed in his name. One of the things we wanted to focus when we started was on encouraging more research in Li Fraumeni Syndrome. We never imagined that we would be responsible for some of that research, but that is precisely what has happened. Over the last year I have developed a new theory about cancer initiation in LFS, one that is subtly different from the mainstream view. The first test of a new theory is to see if it can stand the peer review process and be published in a reputable peer-reviewed scientific journal. I am happy to report that the paper ‘Li Fraumeni Syndrome, cancer and senescence: a new hypothesis’ has been published in the journal ‘Cancer Cell International’. There will be more to say in the coming weeks and months about this paper, but for now it’s available for download at the journal’s website.
Friday, 12 April 2013
Ablation of bone tumours
For patients with advanced cancer bone tumours, (whether
from primary bone cancers like osteosarcoma or metastases from other types of
cancer, such as breast or prostate), can be a cause of persistent and hard to
treat pain. A standard treatment in many such situations is radiotherapy, which
can have unpleasant side-effects, and, in the case of Li Fraumeni Syndrome patients,
might also have long-term implications regarding further cancers. Additionally,
treating cancer pain with opiate-based pain-killers, such as morphine, can also
be problematic given the evidence that opioids can cause further cancer
progression (though this can be reversed with the use of naltrexone).
In which case there’s some encouraging news being reported at the 29th Annual Meeting of the American Academy of Pain Medicine. A group of French clinicians have reported on treating patients with tumour pain, including bone tumours, with micro-wave ablation (MWA).
One of the doctors, Adrian Kastler of the Centre Hospitalier Universitaire, in Besançon, France, is reported as saying:
In which case there’s some encouraging news being reported at the 29th Annual Meeting of the American Academy of Pain Medicine. A group of French clinicians have reported on treating patients with tumour pain, including bone tumours, with micro-wave ablation (MWA).
One of the doctors, Adrian Kastler of the Centre Hospitalier Universitaire, in Besançon, France, is reported as saying:
"This technique may be applied to any patient suffering from bone tumour pain, mainly in patients suffering from bone metastases, refractory to conventional therapies. The main advantage of ablation techniques is the fast pain relief obtained - immediately after the procedure - as opposed to delayed pain relief obtained with radiation therapy… Our research showed that the use of MWA in bone and soft-tissue tumours is feasible and effective concerning pain palliation. However, MWA needs to be studied in order to apply the same procedure in a curative intention."The last point is certainly one that needs urgent attention. Bone tumours are notoriously hard to treat, so any new treatment that shows signs of being effective needs to be researched as a matter of priority. And, given that primary bone cancers are often unresponsive to chemotherapy, any physical treatments that can be used alongside surgery are urgently needed.
Thursday, 21 March 2013
Milk, cancer and hype
The headlines were striking enough, for example the Daily Mail declared that 'Breast cancer patients who eat cheese, yogurts or ice cream could HALVE their chances of survival', while the Daily Mirror ran the headline 'High-fat dairy food increases risk of death in breast cancer patients'. The question is are these scary headlines warranted?
The source of the headlines is a study that looked at dairy intake in women after they had been diagnosed with early-stage invasive breast cancer between 1997 and 2000. These women were asked to fill in questionnaires about their diet, and these were followed up five or six years later. The researchers then looked at the associations with dairy intake and outcomes. The reported outcome was that intake of high-fat dairy was associated with a great risk of death, both from cancer and other causes.
The first thing to say is that this paper is not open access. It's published in the Journal of the National Cancer Institute (JNCI), which is a tax-payer funded body, and it's outrageous that scientific research like this is kept away from the public. When there's a story as potentially important as this then there's no excuse for keeping the data behind a pay-wall. US tax-payers should be demanding that the JNCI switch to open access publishing immediately.
That said, and without access to the full paper, there are some comments to make on what's reported in the abstract of the paper. Firstly this is a study that depends on questionnaires. This is one of the most unreliable sources of information on long term diet that there is. It depends on people being able to accurately remember what they eat and drink, and that they're not lying to themselves or trying to impress the people running the survey. In a long time frame, it also means the researchers have to make assumptions about the long periods between questionnaires. Remember, the researchers are trying to establish the cumulative intake of dairy.
The source of the headlines is a study that looked at dairy intake in women after they had been diagnosed with early-stage invasive breast cancer between 1997 and 2000. These women were asked to fill in questionnaires about their diet, and these were followed up five or six years later. The researchers then looked at the associations with dairy intake and outcomes. The reported outcome was that intake of high-fat dairy was associated with a great risk of death, both from cancer and other causes.
The first thing to say is that this paper is not open access. It's published in the Journal of the National Cancer Institute (JNCI), which is a tax-payer funded body, and it's outrageous that scientific research like this is kept away from the public. When there's a story as potentially important as this then there's no excuse for keeping the data behind a pay-wall. US tax-payers should be demanding that the JNCI switch to open access publishing immediately.
That said, and without access to the full paper, there are some comments to make on what's reported in the abstract of the paper. Firstly this is a study that depends on questionnaires. This is one of the most unreliable sources of information on long term diet that there is. It depends on people being able to accurately remember what they eat and drink, and that they're not lying to themselves or trying to impress the people running the survey. In a long time frame, it also means the researchers have to make assumptions about the long periods between questionnaires. Remember, the researchers are trying to establish the cumulative intake of dairy.
Tuesday, 12 March 2013
Itraconazole - Anti-fungal and anti-cancer
One of the common themes of this site is the use of existing drugs as anti-cancer agents. Given the many years and millions of dollars it takes to get new drugs from the lab and into early phase human trials, it makes a lot of sense to re-look at existing, approved drugs to see if they can be re-purposed as anti-cancer therapies. Prominent examples of such drugs include metformin (used in diabetes), aspirin (pain killer), beta blockers (used for treating hypertension) and mebendazole (used as an anti-parasitic agent).
The latest example is the anti-fungal drug Itraconazole. A Phase II trial has just been reported in a paper in the Oncologist - freely accessible to all here: http://theoncologist.alphamedpress.org/content/18/2/163.full. The drug was used to treat advanced prostate cancer (metastatic castration-resistant prostate cancer to be exact). Two dosing schedules were used, low-dose (200 mg/day) or high-dose (600 mg/day), and the men were treated for 24 weeks and then assessed for a reduction in PSA and, more importantly, for progression free survival.
The low dose arm of the trial was abandoned early because of the low levels of response, however the higher dose arm continued to completion. The results were fairly impressive. The primary end-point of the study was stopping the increase in PSA levels, and this was acheived in 48% of men on the high dose (12 of 25 men). The main secondary end point was freedom from disease progression (which is the more important measure overall), and here the result was that 24-week PFS rate was estimated to be 61.6%.
The latest example is the anti-fungal drug Itraconazole. A Phase II trial has just been reported in a paper in the Oncologist - freely accessible to all here: http://theoncologist.alphamedpress.org/content/18/2/163.full. The drug was used to treat advanced prostate cancer (metastatic castration-resistant prostate cancer to be exact). Two dosing schedules were used, low-dose (200 mg/day) or high-dose (600 mg/day), and the men were treated for 24 weeks and then assessed for a reduction in PSA and, more importantly, for progression free survival.
The low dose arm of the trial was abandoned early because of the low levels of response, however the higher dose arm continued to completion. The results were fairly impressive. The primary end-point of the study was stopping the increase in PSA levels, and this was acheived in 48% of men on the high dose (12 of 25 men). The main secondary end point was freedom from disease progression (which is the more important measure overall), and here the result was that 24-week PFS rate was estimated to be 61.6%.
Wednesday, 6 March 2013
The 2-Day Diet
It may seem odd to find a review of a diet book on a web site devoted to cancer, but there are good reasons for looking at this book. Firstly, it's an accepted fact that there is a strong link between obesity, metabolism and cancer. Secondly, there is an increasing view among some researchers that cancer is a metabolic syndrome, and that cancers are associated with a whole set of metabolic changes, both in the tumour and the surrounding tissues. Cancer and metabolism, and therefore diet, are inextricably linked. And, as discussed on this site in the past, there is evidence that altering diet can impact cancer treatments as in the work that looked at chemo response and fasting. There is another reason for looking at this book - the authors (Professor Tony Howell and Dr Michelle Harvie) are both working in breast cancer research, and are involved specifically in helping patients reduce their chances of getting the disease or reducing the risk of recurrence. One of the authors, Tony Howell, is well known to regular readers of this site for his work on the reverse Warburg effect and his association with Michael Lisanti and the development of new theories that link cancer with metabolism.
That said, this is primarily a book about diets and losing weight rather than a book specifically about cancer. Although the links to cancer are there in the text, and many of the patient stories include mention of cancer, the main aim is to help readers lose weight and keep it off. And, in doing so, to reap the overall health benefits across the board.
So, what is the 2-day Diet, and how does it differ from the thousands of other diet books on the market? A key point to make up front is that this is a diet that's been backed up by clinical data. There are no celebrity endorsements, no one selling expensive supplements or foods, no hand waving or bold claims unsupported by evidence. This is a diet that has been shown to work, it's that simple. Simple too is the basic idea behind the diet - it's simpler to stick to a strict diet for two days per week than it is for seven. And, importantly, the changes induced by a strict two day a week diet are significant enough to cause changes in body weight, glucose tolerance, mood and so on.
That said, this is primarily a book about diets and losing weight rather than a book specifically about cancer. Although the links to cancer are there in the text, and many of the patient stories include mention of cancer, the main aim is to help readers lose weight and keep it off. And, in doing so, to reap the overall health benefits across the board.
So, what is the 2-day Diet, and how does it differ from the thousands of other diet books on the market? A key point to make up front is that this is a diet that's been backed up by clinical data. There are no celebrity endorsements, no one selling expensive supplements or foods, no hand waving or bold claims unsupported by evidence. This is a diet that has been shown to work, it's that simple. Simple too is the basic idea behind the diet - it's simpler to stick to a strict diet for two days per week than it is for seven. And, importantly, the changes induced by a strict two day a week diet are significant enough to cause changes in body weight, glucose tolerance, mood and so on.
Wednesday, 27 February 2013
PDT Norfolk
The mainstays of cancer treatment remain chemotherapy, surgery and radiotherapy. These are the big three treatment modalities and have, largely, remained in place as the core weapons in the arsenal of oncologists despite the advent of a number of newer treatments. However, there is a class of treatments called ablative therapies that really need to become the fourth big weapon in the anti-cancer arsenal. Ablative therapies include photodynamic therapy (PDT), cryoablation, radio-frequency or microwave ablation and the new kid on the block, irreversible electroporation (which I have previously written about here).
Of these treatments, which all take the approach of directly and physically attacking tumours rather indirectly using drugs or radiation, it is PDT which is the most mature and most widely used. PDT works by injecting a light sensitive drug (called a photosensitiser) into a patient and then letting the drug accumulate in tumour cells – normal cells do not take up the drug to the same extent. Once the drug has been absorbed by the tumour light is applied to it – usually by a surgeon operating to gain access to the tumour and then shining a laser or LED directly on to the tumour. The photosensitive drug in the tumour cells reacts to the light and in the process kills the cell. In this way PDT can be used to destroy solid tumours directly.
While PDT is the most mature of the ablative treatments, it’s still not used widely enough in the UK, and even many oncologists remain unaware that it is available and that it’s a viable treatment option for their patients. This is a treatment that works, can be used against a wide variety of tumour types and does not produce the long-term side-effects of radiotherapy or chemotherapy. If ever there was a treatment that needed to become more widely known and available to more patients it’s this one. And, luckily, there are people around who are actively campaigning to raise awareness of PDT amongst the medical profession, amongst patients and the general public.
One such group is PDT Norfolk (take a visit to their site here: http://www.pdtnorfolk.co.uk/). Recently I travelled up from London to meet with the team at PDT Norfolk to discuss some of the science, some strategy and ways that we could work together. It was a good meeting and I think some very positive ideas came out of it. I think this is a campaign that has the potential to advance research in PDT as well as to raise the profile of the treatment, provide resources for patients and help to bring this treatment to a wider range of patients.
Of these treatments, which all take the approach of directly and physically attacking tumours rather indirectly using drugs or radiation, it is PDT which is the most mature and most widely used. PDT works by injecting a light sensitive drug (called a photosensitiser) into a patient and then letting the drug accumulate in tumour cells – normal cells do not take up the drug to the same extent. Once the drug has been absorbed by the tumour light is applied to it – usually by a surgeon operating to gain access to the tumour and then shining a laser or LED directly on to the tumour. The photosensitive drug in the tumour cells reacts to the light and in the process kills the cell. In this way PDT can be used to destroy solid tumours directly.
While PDT is the most mature of the ablative treatments, it’s still not used widely enough in the UK, and even many oncologists remain unaware that it is available and that it’s a viable treatment option for their patients. This is a treatment that works, can be used against a wide variety of tumour types and does not produce the long-term side-effects of radiotherapy or chemotherapy. If ever there was a treatment that needed to become more widely known and available to more patients it’s this one. And, luckily, there are people around who are actively campaigning to raise awareness of PDT amongst the medical profession, amongst patients and the general public.
One such group is PDT Norfolk (take a visit to their site here: http://www.pdtnorfolk.co.uk/). Recently I travelled up from London to meet with the team at PDT Norfolk to discuss some of the science, some strategy and ways that we could work together. It was a good meeting and I think some very positive ideas came out of it. I think this is a campaign that has the potential to advance research in PDT as well as to raise the profile of the treatment, provide resources for patients and help to bring this treatment to a wider range of patients.
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