Archives for February 2013

New treatments for Chronic Myelogenous Leukemia (CML)

New treatments for Chronic Myelogenous Leukemia (CML)

In the United States, about 5500 patients per year will be diagnosed with CML; a chronic leukemia associated with high white blood cell counts and other blood count abnormalities; which in the past was only curable with a bone marrow transplant.  However for the last 12 years, treatment with an oral drug called imatinib (brand name Gleevec), which belongs to a class of drugs called tyrosine kinase inhibitors, has been a major breakthrough in that many patients who were started on Gleevec saw their chronic leukemia disappear. Patients do have to remain on the medication indefinitely, otherwise the chronic leukemia could come back.

Over the years, two other oral drugs (dasatinib and nilotinib) which are even more successful than imatinib have been approved for the treatment of CML. However, there are CML patients who do not see their chronic leukemia go away with Gleevec or even when treated with dasatinib or nilotinib.

For those patients, treatment with bosutinib may be an option. The drug was approved by the FDA in September 2012 for patients who did not benefit from treatment with imatinib,dasatinib or nilotinib. Patients who had been on imatinib, in particular, experienced significant improvement of their chronic leukemia when they took bosutinib.

When CML cells become resistant to standard treatment, it is usually through specific mutations of certain proteins within the cell. One particularly feared mutation is the T315I mutation which confers resistance to all oral anti-CML medications. There is a promising new drug called ponatinib which in one study resulted in complete normalization of blood counts of all patients who had the T315I mutation. I am happy to report that ponatinib received FDA approval on December 7, 2012 giving patients with standard-treatment-resistant CML a promising treatment option. The brand name of ponatinib is going to be Iclusig.

Lastly, the FDA recently approved another drug for the treatment of CML called omacetaxine (brand name Synribo) which has to be injected under the skin twice daily on certain days of the month. It may play a role in the treatment of patients who cannot tolerate any of the other FDA-approved anti-CML drugs or those who have not responded to them.

Cancer Myths

Cancer Myths

Webster’s Dictionary defines a myth as an unfounded or false notion. Information on cancer is available seemingly everywhere. Unfortunately, not all that is written is factual or proven in regards to cancer.  The following information sets a few of these myths straight.  

MYTH: The number of people diagnosed and dying from cancer is increasing.

FACT: According to multiple sources, including the National Cancer Institute the Centers for Disease Control and Prevention and the American Cancer Society, the number of new  cancer cases decreased steadily between 1999 and 2006. The number of deaths from cancer decreased steadily between 2001 and 2006. More people with cancer are now living longer lives with a better quality of life due to early diagnosis, lifestyle changes and improved treatment options.

MYTH: Cancer is a death sentence; it is always a terminal disease.

FACT: People diagnosed with cancer have a very good chance of surviving the cancer.  The long term survival for all cancers combined is estimated to be approximately 60 % at 5 years. This improvement has been achieved through years of research with earlier detection and better surgical, radiation and chemotherapy options.

MYTH:  Cancer is contagious.

FACT: No cancer can be spread by touching, holding, hugging or kissing a person with cancer. If this was true, there would be no oncologists left. There are a few cancers that can be caused by viruses. For example, if a person is exposed to and contracts hepatitis C, then he or she will be at a higher risk of developing liver cancer.

MYTH: If a parent has cancer, then his or her child will also develop cancer.

FACT:  All cancers are due to genetic changes, but not all genetic changes are a result of heredity. Only 5-10% of cancers are hereditary. Most cancers occur after a lifetime of accumulated mutations, especially after exposure to agents such as tobacco, excessive sunlight, radiation, obesity and other factors, some of which have not been identified yet.

MYTH: Many beliefs about treatment options.

FACT: If a supposed cancer treatment is supported only by testimonials or anecdotes of a few dozen people, there is a good chance that this is not a valid treatment option. Scientists and physicians never rely on testimonial evidence, rather, they determine if a treatment is effective by testing it in a clinical trial with many patients.  

Please talk with your treatment team regarding any information you are unsure about.

How Does Cancer Occur?

How Does Cancer Occur?

Understanding the advancements in cancer means having an understanding of how cancer starts and how it is treated.

Basically cancer is a broken cell. At one point the cancer cell was a normal cell, but somewhere along the way its internal mechanism became broken or abnormal.
We call that event a mutation. From that event on, the cell is never the same and doesn’t do its job right. It either grows too fast, multiplies too often, or spreads to a place it doesn’t belong. Fundamentally, it just doesn’t die. A cancer cell can arise from any cell: a breast cell, colon cell, prostate cell, or a blood cell. It multiplies and multiplies until instead of 2 abnormal cells you now have 2 billion abnormal cells in the form of a tumor or cancer.

Now I separate cancer into 2 broad categories: solid cancers and liquid cancers.

Solid tumors are easier to visualize. Say a breast cell or a colon cell mutates and begins to multiply. It eventually grows into the form of a solid mass or tumor.
Liquid tumors are pretty much the same. These are cancers like leukemia, lymphoma, multiple myeloma. These cancers start out as a liquid blood cell, immune cell or a protein that floats in our blood stream. These cells can mutate too and eventually multiply and spread throughout the bloodstream taking over organ function and stealing the resources that healthy cells need to survive.

The key to successful cancer treatment and cure is to identify these mutations, or triggering events that make these once healthy normal cells behave so badly, multiplying and surviving until they become a tumor or cancer.

In some unique cancers, it is as simple as identifying the one mutation and designing a drug that can turn off that event and stop the cancer cell from living, growing and spreading. Other cancers (most cancers) are much more complex, but the concept is still the same. We look for the triggering events or mutations that are present and try to turn them off through treatments that can either cure the cancer or prevent it from returning.