Remission in Every Patient

Remission in Every Patient

Promising clinical response for rectal cancer patients

This weekend, Green Bay Oncology providers attended ASCO in Chicago where the results of a phase II trial was discussed involving patients with mismatch repair deficient locally advanced rectal cancer. These patients received treatment with PD-1 blockade, dostarlimab, and had a complete clinical response. This is exciting news for this subgroup of cancer patients.

Typically, locally advanced rectal cancer is treated with combination chemotherapy and radiation therapy followed by surgical resection. The standard approach does demonstrate a reasonable overall positive response but can have permanent effects of fertility, sexual health and bowel and bladder function. The implications of this study are quite profound and may lead to a remarkable change in our treatment approach.

The results are preliminary, and the long-term follow-up has not been completed to define if the responses are durable. However, with all these caveats, it is still quite impressive.

It encourages us to be relentless in research. Patients willing to participate in clinical trials are the hope for improving long-term survival and overall quality of life.

Dr. Tony Jaslowski

NY Times Article
New England Journal of Medicine Study

Oral Chemotherapy Bill

Oral Chemotherapy Bill

Presently, the state Senate is considering passing the bill on oral chemotherapy. The state Assembly last week passed the bill which would cap the amount of co-payment at $100 per month for the cost of oral chemotherapy. Currently, there is a very large disparity in the coverage for intravenous versus oral chemotherapy. The payments for some patients may exceed $3,000 per month for all oral chemotherapy as opposed to only $150 for intravenous chemotherapy.

There are a variety of newer oral chemotherapy agents available in the last ten years which are very active and are the preferred agents for the treatment of certain malignancies. An example is in the treatment for chronic myelogenous leukemia or CML – one of the cancers of the blood. The disease can usually is diagnosed in people in their 50s and 60s but occasionally can be discovered as young as the early 20s. It is characterized as elevated blood counts. It was uniformly fatal with life expectancies of only 3-4 years once diagnosed. The initial effective treatment was a bone marrow transplant which required a donor. A bone marrow transplant can be complicated and is a very difficult procedure for some patients due to their other medical problems and age. Through intensive research, a unique chromosome translocation called the Philadelphia chromosome was discovered and found to be the cause of CML.

Medications have been developed which can block the abnormal protein which the Philadelphia chromosome produces and can halt the growth of the abnormal cells. The first of these medications developed is called imatinib. This drug, when used in CML, can completely halt the growth of the CML cells and prolong a patient’s life. Unfortunately, it appears that imatinib will need to be continued for the rest of the patient’s life. Taking the pill form can be a more convenient process for patients vs having traditional infusion chemotherapy. When patients are taking imatinib, their lives can return to normal with limited side-effects and their life-expectancy can return to normal versus only 3-4 years without imatinib. The cost for oral imatinib is approximately $9,000 per month or $108,000 per year.  By passing the proposed bill, patients would be subject to markedly less costs subject to deductible, out-of-pocket maximums and a $100 per month copayment only.

As the above illustrates, it is imperative that the state legislature and our governor work diligently on passing legislation that will help bring the cost of these medications down for people of Wisconsin.

FDA Approves Ibrutinib

FDA Approves Ibrutinib

The US Food and Drug Administration (FDA) approved ibrutininb in November 2013 for the treatment of relapsed mantle cell lymphoma. Ibrutinib is a new drug which was developed to specifically block a particular enzyme called the Bruton’s tyrosine kinase which goes by the acronym, BTK. This enzyme, BTK, is over-active in many types of malignancies to include mantle cell lymphoma and chronic lymphocytic leukemia, CLL. Recent research has demonstrated remarkable response rates in patients with mantle cell lymphoma and CLL.

The exciting part of ibrutinib is that it is an oral medication with moderate side-effects. The clinical trial which lead to the approval was a multi-center, international study with 111 patients that had relapsed mantle cell lymphoma. The study demonstrated that the overall response rate was 66% with the average duration of response of 17.5 months. The most common toxicities were low blood counts, increased bruising, diarrhea, fatigue, muscle pain and rash. Only 9% of patients encountered a side-effect that lead to discontinuation of ibrutinib.

The enzyme, BTK, is a recently identified protein that was discovered in a variety of malignant cells that are derived from the B-cells. B-cells are a specific type of blood cell which normally produces antibodies to help the body fight infections. The B-cells can develop into cancer through a variety of mutations which cause the cells to grow more rapidly and survive longer than normally. The malignancies which may have a B-cell derivation include CLL, Non-Hodgkin lymphoma and Waldenstrom macroglobulinemia.

Bruton’s tyrosine kinase was first discovered in 1993 and is named after Ogden Bruton who first described a disordered called Bruton’s agammaglobulinemia. When the enzyme is not presnt the B-cells are not able to produce the antibodies needed to help the body fight off infections. If the B-cells become malignant, then by blocking or inhibiting this enzyme, BTK, the growth of the malignant cells can be halted.

There are many clinical studies which are ongoing that will define the role ibrutinib will have in early stages of CLL, Non-Hodgkin lymphoma and mantle cell lymphoma. It is hoped that by adding ibrutinib to current treatments available for these malignancies that improved responses and prolongation of survival of patients will be seen. This is a very promising drug and we at Green Bay Oncology are very excited to bring this news to you. Please feel free to give us a call for further information.

Stand Up For Your Health

Stand Up For Your Health

This is not just a “catchy” slogan but is actually a fact. There is a growing body of evidence that has shown that sitting for long periods of time can be extremely bad for your health, almost as much as smoking. Periods of prolonged sitting is being studied by researchers to be linked to multiple health problems such as diabetes, high blood pressure, heart disease and cancer. Prolonged sitting increases inflammation, insulin resistance, and obesity.

How can this happen? Not only is sitting lousy at burning calories but it has been shown to suppress the production of an enzyme called lipoprotein lipase which is essential for turning bad cholesterol into good. Sitting has also been linked to insulin resistance and, therefore, trouble metabolizing sugar.

Unfortunately, our work environment has significantly contributed to the time most people spend sitting each day. Most jobs have removed physical activity in our lives and most of us spend our time at work sitting at desks with very little movement throughout the day. Watching television at home and computers only add to the number of hours spent sitting.

One study of men in the Netherlands reported that occupational sitting for 6-8 hours per day increased the risk for colon cancer. Other studies found that women who sat for long periods were also at a higher risk for developing endometrial cancer than were those who did not, regardless of whether the women participated in moderate to vigorous physical activity. A U.S. study found that women who sat for 6 hours or more per day had a 28% higher risk for Non-Hodgkin lymphoma than did women who sat for less than 3 hours per day.

In fact, exercise alone does not overcome the increased risks of prolonged sitting. The American Cancer Society published a study in 2010 in which mortality rates during the 14 year follow-up period were lower for participants who exercised regularly than for those who did not. However, study participants who sat for 8 hours or more per day had higher mortality rates than those who sat for less than 3 hours per day. In other words, physical exercise seems to reduce but not eliminate the negative effects of sitting.

How can we change our habit of prolonged sitting? Very easily! We need to get in the habit of learning to stand at work and at home more and spend less time on our bottoms. We need to take breaks, even 1 to 2 minute breaks every hour can lead to improved health. Some people have carried this to extreme measures such as putting a treadmill at their desks and spend time walking instead of sitting. Learning to take the stairs and getting up to talk to co-workers instead of calling or e-mailing will get us moving more in the workplace. Try pacing when on the phone or schedule walking meetings are other suggestions.

Remember to be creative; get up and just don’t sit there. Stand up for your health.

Care of the Cancer Caregiver

Care of the Cancer Caregiver

Being diagnosed with cancer is a life-altering event. To survive through the process, one usually relies upon others for help. This article is written for those individuals who are the “helpers” or the caregivers. The people who help can be a spouse, sibling, parent, child, neighbor or friend; a person who will be there for the cancer patient to lean on. It is very important not to overdo it when you are the caregiver as it can lead to burnout.

What are the common signs of burnout?

  1. Changes in emotion – feeling angry or upset, feeling overwhelmed, crying easily. Although all these emotions may be appropriate at certain times, having extreme amounts of these feelings which are interfering with the ability to make decisions or to help may be a sign of burnout.
  2. Changes in sleep pattern – sleeping too often, too little or experiencing interrupted sleep can often be a signal of developing burnout.
  3. Changes in appetite – eating too much or too little, eating lots of “junk” food. Eating poorly can lead to changes in weight and poor energy.
  4. Withdrawing from friends, family and social events – caregivers experiencing burnout may withdraw from others because they feel tired, guilty, or anxious about not being available all the time.
  5. Exhaustion – feeling extreme fatigue, inability to accomplish the basic activities of daily living; washing, bathing, dressing, brushing your teeth; is a danger signal of an approaching burnout crisis.

How can you prevent burnout? There are several ways to avoid cancer caregiver burnout, allowing you to continue offering help and support to your loved one during their cancer journey:

  1. Take care of yourself – you cannot give of yourself unless you make sure that you have what you need to survive. You need to keep up with your daily activities; exercising, keeping up with your own doctor appointments.
  2. Take breaks – you will need time off, time to relax, time to rejuvenate. Regularly schedule trusted friends, family or home health aides to relieve you of caregiving duties for a period of time each day, when possible. Many caregivers feel guilty about leaving the bedside, but this is also good for the patient. Seeing a new face and knowing the primary caregiver is getting relief can uplift morale and the patient may feel like less of a burden if the caregiving is shared.
  3. Delegate tasks to family and friends – you will be surprised at how many family members and friends will pitch in if you ask. Things like cooking meals, running errands, and cleaning the house can be delegated to family and friends. Having others pitch in and lighten your load can help keep you balanced and give you more time and opportunity to provide care for your loved one.
  4. Educate yourself about the disease – the more you know, the better you’ll know what to expect and be able to be prepare for what the future offers. Ask the doctors and nurses about your loved one’s condition and what you as a caregiver need to know. There are many helpful websites such as the American Cancer Society site ( and our own website. There are no silly questions that you should be worried about asking. If you are unsure about anything, please ask.
  5. Get organized – many caregivers also are responsible for managing medical records, insurance claims, and finances, not to mention medication and eating schedules. The key to success here is organization. Keep medical records neat and accessible by storing them in a large file, organized by date. Medicine schedules can be created on a spreadsheet, and then printed out daily or weekly. As each dose is given, it can then be checked off. The same can be done with eating schedules. Ask your provider for other suggestions, if desired.

Being a caregiver can be very rewarding. By watching out for burnout, you can continue to provide the care and love needed throughout the cancer journey. If you do feel so burned out that you may harm yourself or another, call 911 or go to the closest emergency room. You can also call the Crisis Center at (920)436-8888. Please remember that life is a journey, not a destination. We are here to help you and your loved one through this life experience.



Obesity & Cancer

Obesity & Cancer

Obesity is an epidemic and a preventable illness. It is estimated that 1 in 3 adults and 1 in 5 children in the United States are obese. In a few years, obesity (NOT tobacco) will become the number one cause for many types of common cancers.

Obesity is defined as having too much body fat, as opposed to being overweight which refers to an excess of body weight. One way to determine obesity is to use the body mass index or BMI. To calculate the BMI:

Weight in pounds divided by (height in inches x height in inches) x 703

  • Ideal BMI = 18-25
  • Overweight = 25-30
  • Obese = 30-40
  • Morbidly obese = anything over 40.

Obesity is caused by taking in more calories than a body burns. The extra calories are then stored as fat. Contributing factors include taking in too many calories as well as not getting enough exercise each day.

Obesity results in a long-term energy imbalance that increases a person’s storage of fat and also circulating levels of fatty acids. These higher levels of fatty acids can cause resistance to insulin. Insulin is a hormone essential to regulating the body’s metabolism. Insulin resistance has been associated with the development of diabetes, heart disease, hypertension and certain cancers including breast, colon, prostate, kidney, liver and endometrial.

The association of obesity and cancer isn’t yet fully understood. So far, we know that:

-Fat tissue produces excess amounts of estrogen, high levels of which have been associated with an increased risk of breast and endometrial cancer.

-Elevated levels of insulin and insulin growth factor-1 in the blood of obese people causes increased cell division, which could eventually lead to cancer. Fat cells produce hormones called adipokines which stimulate cell growth. Also, the adipose tissue causes a state of chronic inflammation which lowers the body’s immune response and allows abnormal cells to grow and propagate.

Unfortunately, there is no one way to magically solve the obesity epidemic. Exercise and appropriate diet can slowly reverse the process. Hopefully, future research will give new insight why certain people are more prone to obesity and this will allow for development of new treatment options.  Until then, an ounce of prevention is definitely worth a pound of cure.

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.