Sunday, 1 July 2018

Personalized Medicine for Cancer

f you or someone you know has cancer, you’ve probably been scouring anything you can get your hands on to find the best way to beat the disease. It’s likely you’ve seen terms like “personalized medicine,” “precision medicine,” or “targeted drugs.”
What are these things? More importantly, can they help you?
Personalized medicine -- also called precision medicine or pharmacogenetics -- is a new way to fight cancer. It uses information about you and your tumor to figure out what’s driving the disease and create a plan just for you.

Genetics as a Teacher

For years, cancer treatment was a cookie-cutter process. You’d have surgery to remove a tumor, then chemotherapy or radiation to kill cancer cells. But blasting cancers with chemotherapy or radiation kills healthy cells as well, which can lead to a host of nasty side effects.
Now, researchers can examine your cancer cells and learn the order of the genes in their DNA. While most cells in your body have identical genes, the ones in cancer cells have mutations, or changes. This is what allows them to grow into tumors.
 
What’s more, your cancer may have different genetic changes than someone else’s. Scientists also now know that genetically, one person’s breast cancer may be more similar to another person’s stomach tumor than to other breast cancers. This makes the need for personalized medicine even greater.

Matching Patients With Drugs

The FDA has approved more than a dozen drugs that target one of these mutations. They include imatinib (Gleevec), a drug used on chronic myelogenous leukemia, and the breast cancer drug trastuzumab (Herceptin).
Tumor genetics can also tell doctors which drugs won’t work. For example, if your colon cancer has a genetic mutation called KRAS, doctors won’t give you two common colon cancer drugs because they know they won’t work.
Many clinical centers do something called tumor profiling. Your doctor takes a look at your tumor’s genes. If he thinks your cancer may have specific mutations, he might start you on a specific drug that’s approved for your type of cancer.
For instance, if you have breast cancer, a genetic test would tell him if Herceptin might work for you.
Profiling can also help if other treatment options, like chemotherapy, haven’t worked for you. A genetic mutation might point your medical team toward an unexpected drug, like one originally designed for another type of cancer.

Not a Magic Bullet

The personalized approach works better to shrink tumors -- and save lives -- than traditional treatment. But it isn’t always a cure.
Tumors can contain cells with different gene mutations, so a targeted therapy designed to pick off cells with one mutation may work on only part of a tumor. The cells that remain may keep growing.
Talk to your doctor to find out if this approach could work for you.

A New Kind of Clinical Trial

Standard trials to test cancer treatments use people whose tumors are similar in size or location. They might choose only people with stage IV lung cancer, for instance. But now that there's personalized medicine, researchers need new ways to study how targeted treatments work on a variety of cancers.
Basket trials combine folks with many different cancer types into a single “basket” and use a precision medicine approach to find treatments that work. So a single trial could include people on many different drugs.
The creation of new treatments requires a constant back-and-forth between doctors and scientists. New drugs are made to combat new gene changes. Then, they’re tested in the clinic. As tumors change in new ways, more new drugs will become available.

CAR T-Cell Therapy for Multiple Myeloma

Researchers are finding new ways to fight multiple myeloma, including a new treatment called CAR T-cell therapy. It's still experimental, but you may get a chance to join a clinical trial if your other treatments aren't working.CAR T-cell therapy works differently from other cancer treatments. It trains your immune system to find and kill cancer. And it's tailor-made for you.

What Happens in CAR T-Cell Therapy?

First, doctors collect immune cells called T cells from your blood. These cells are genetically engineered to make a chimeric antigen receptor (CAR). CARs seek proteins on the surface of cancer cells and attach to them.
Technicians multiply these engineered immune cells in a lab until there are millions of them. Your doctor puts them back into your body through an IV, where they seek out and kill cancer cells. CAR T cells can stay alive in your body and keep attacking cancer cells for many years.
CAR T-cell treatments for multiple myeloma target a protein called B-cell maturation antigen (BCMA). BCMA is on the surface of myeloma cells but not healthy cells.

How Well Does It Work?

Clinical trials for multiple myeloma so far have been small, but promising. One study of a CAR T-cell therapy included 21 people who had already tried an average of seven other treatments. Eighteen of them got a higher dose of the treatment. About 56% of those 18 people had complete remissions, meaning there was no longer any sign of their cancer.
Another study included 35 people with multiple myeloma. About 94% showed signs of remission after CAR T-cell therapy.
These two studies are the earliest types of clinical trials, called phase I, which are done to check the treatment's safety, not how well it works. More studies that are longer and have larger groups of people are needed to show this treatment works for multiple myeloma and how long people live who get it.

Side Effects and Risks

One of the most common side effects from CAR T-cell therapy is called cytokine release syndrome (CRS). It's an immune response that's triggered by a flood of immune system chemicals called cytokines into your body.
CAR T-cell therapy can also cause side effects like:
  • Shaking
  • Headaches
  • Confusion
  • Trouble speaking
  • Seizures
  • Balance problems
People who've been treated with CAR T-cell therapy for multiple myeloma have not had these side effects.
If you have CAR T-cell therapy, your doctor will monitor you for about 2 to 3 months afterward while you recover. You'll be checked often for side effects and to see if the treatment is helping. Source WebMD.com

How to Talk to Your Doctor About CAR T-Cell Therapy

Ask your doctor if you qualify for a CAR T-cell therapy trial. Usually you'll need to have tried several other multiple myeloma treatments first.
Before you join a clinical trial, ask the study doctor:
  • What is the purpose of this trial?
  • How might this treatment help me?
  • How long will the trial last?
  • What kinds of tests and treatments are involved?
  • What are the possible side effects?
  • How do the risks and benefits compare to other multiple myeloma treatments?
  • Will I have to pay any of the costs for tests, treatments, or for travel to the trial site?shutterstock197341133

Do liquid biopsies have potential to outperform tissue diagnostics?

 

Cancer diagnosis can often be an exhausting, extensive process with endless tests, scans, and screenings. We all know the importance of early detection and successful treatments to potentially save thousands of lives every year, so could liquid biopsies offer the lifeline we’ve been holding out for?
Liquid biopsies are an alternative to surgical methods which involve using a blood sample to detect circulating fragments of tumour DNA not associated with a cell, (ctDNA), in the patient’s blood serum or plasma. Conventionally, blood tests are used to detect abnormalities—either in blood cell counts, organ function, or protein and hormone levels. In cancer screening, the presence of certain proteins in the blood is used as an indicator for tumours, e.g. cancer antigen test for detecting ovarian cancer or prostate specific antigen for prostate cancer. These tests have a tendency to suggest many false positives, as a result of many of the indicating proteins being present in other conditions. However, advances in molecular profiling have led to the use of blood samples to study tumour genomics in a much more precise and less invasive way compared to standard methods.
Tissue biopsy, either by surgery or needle, has long remained the established method of tumour diagnosis, but liquid biopsies offer a range of advantages. Because some tumour sites can lie in hard to reach places, tissue biopsies can carry increased risk and difficulty to obtain. The use of liquid biopsies solves this issue, with blood samples being relatively quick and easy to obtain. Both between different tumours and within the same tumour, there is a degree of heterogeneity. For this reason, tissue biopsies may not always be representative of the entire tumour, whereas blood samples can give visibility of tumours as a whole.
Recently, researchers at the John Hopkins Kimmel Cancer Centre in Maryland, US made headlines with news of a single blood test capable of detecting eight different cancers ((ovarian, hepatic, lung, breast, stomach, and pancreatic) via mutated ctDNA and certain protein presence. Currently, five of these cancers have no screening available—however, sensitivity does vary depending on type. Breast cancer detection was approximately 30% effective, whereas hepatic and ovarian tumours exceeded a 95% detection rate.
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The world of medicine is continuously moving towards targeted treatments bespoke to individual genetic profiles and ultimately precision medicine is associated with better outcomes. Using liquid biopsies, the number of RAS mutations detected in metastatic colorectal patients was found to be higher in plasma specimens compared to tumour biopsies for progressing tumours. The ability to consistently obtain samples via liquid biopsy allows for monitoring of tumours and mutations, hence ctDNA has been shown to indicate optimum treatment options and also suggest likelihood of resistance. Similarly, a small study focused on breast cancers, reports the use of liquid biopsies to detect acquired resistance to treatment inhibiting certain proteins known as cyclin dependent kinases.
ctDNA presence in plasma was also used after surgery in melanoma patients to determine prognosis and predict probability of relapse. The majority of patients with detectable levels of ctDNA taken in samples 12 weeks after surgery deteriorated within a year, and so it was concluded that ctDNA may be indicative of relapse in Stage II/III melanoma, where radioactive imaging falls short.
In the last few years, growth of research into liquid biopsies and diagnostics has been exponential, however many studies have been centred around already formed tumours. Evaluation of liquid biopsies as a diagnostic tool is somewhat far away, as researchers have to give enough time for a tumour to develop before recording results. But in terms of tailoring and predicting the right treatment, ctDNA and liquid biopsies appear to offer a much greater insight than tissue biopsies credit Kiashini Sriharan


Monday, 28 May 2018

Can Food Help Prevent Cancer?

Experts say eating healthy is an important way to protect yourself from cancer. When you put the right kinds of foods -- and the right portions -- into your body, you fuel your cells with the nutrients they need to stay healthy. You’ll also avoid unhealthy ingredients that could make you sick.

How Do Foods Fight Cancer?

People who eat more fruits and veggies tend to get less cancer. That may be because those foods are high in antioxidants -- chemicals that fight the cell damage that leads to cancer. 
You can find antioxidants in fruits, vegetables, tea, coffee, and other plant-based foods, as well as in supplements. But research suggests that getting them from food works better than getting them from pills. Some supplements may raise your risk of getting cancer.
Aim for at least 2 1/2 cups of fruits and vegetables every day, and try to eat a variety of types and colors.
Your produce doesn’t have to all come straight from the farmers market, either. Canned or frozen fruits and veggies have many of the same nutrients as fresh ones. You can also add garlic to your shopping list. This flavorful ingredient may protect against several types of cancer.

Basic Health Rules Apply

If you eat a lot of fat, sugar, and refined carbs (like white bread), you’re more likely to gain weight and become obese. It's even more likely if you don’t do enough to burn off the extra calories.
Obesity is linked to several types of cancer, so it’s smart to follow an eating plan that helps you keep your weight as low as you can without being underweight. Cancer experts say it’s key to avoid high-calorie processed foods and sugary beverages like soda, sweet tea, and juice-flavored drinks. They have lots of calories but won’t help you feel full.
Alcohol is also tied to several types of cancer. All types -- beer, wine, and spirits -- seem to raise your chances. Drink in moderate amounts. That means no more than one drink a day for women, and no more than two for men.

Eat This, Not That

Experts have figured out what foods are best to eat -- or skip -- for specific types of cancer. Here’s the list: 
Breast cancer: People who eat lots of veggies, fruit, poultry, fish, and low-fat dairy products have lower rates of this type of cancer.
There’s strong evidence that alcohol boosts your chances of getting it. Even a few drinks a week can make it more likely. If you’re worried, just say no. 
Colorectal cancer: If you have a spare tire, you’re more likely to get this cancer. Do you eat lots of red or processed meat? That can also play a role. So can chemicals called nitrates, which are often added to lunch meat, ham, hot dogs, and bacon.
You should also cut back on meats that are fried, broiled, or grilled over an open flame. When animal products cook at high temperatures, they form chemicals that cause cancer. Make sure any meat you eat doesn’t burn, and skip the blackened or charred parts.
To lower your risk, eat foods with fiber, especially whole grains. Calcium and vitamin D may also protect you. But be careful: Too much could raise your odds for getting other types of cancer. Stick to the recommended levels.
Uterine cancer: Extra belly fat can make you more likely to get this type. It could be that overweight women make more estrogen, which often fuels cancer growth. Stick to a diet and exercise plan that helps you lose extra belly fat and keep it away.
Lung cancer: Smoking is the biggest risk factor here. But many studies show that people who eat at least five servings of fruit and vegetables a day are less likely to get it than those who don’t.
Digestive cancers: Obesity often brings on acid reflux, which boosts your chances of cancer in the esophagus and stomach. A healthy weight can keep your risk low.
Avoid beverages and foods that are hot enough to burn you. They can damage cells in your mouth, throat, and esophagus and may raise your chances of getting one of these cancers.
Salty food has been linked to higher odds of stomach cancer. Processed meat could also make it more likely.
Ovarian cancer: Soybeans or foods made with soy (like tofu) could lower your odds of getting ovarian cancer. Tea, especially green tea, may also keep it at bay. But not all research supports these findings. The jury is still out on how much they help. 
Pancreatic cancer: Belly fat is linked to a higher risk of this type, especially for women. A diet high in red and processed meat could also play a role. Limit these foods, and slim down if you’re overweight.
Prostate cancer: If you’re a man, chowing down on tomatoes, soy, beans, and other legumes could lower your prostate cancer risk. Add cruciferous veggies -- broccoli, cauliflower, and cabbage -- to the mix, too.
Several studies have linked high levels of calcium, or large amounts of dairy foods, to higher odds of prostate cancer. Don’t take calcium unless your doctor recommends it.

New Ideas in Cancer Treatment

Immunotherapy

One thing that makes cancer tough to fight is that its cells can dodge your immune system. Your body either doesn’t see them as threats, or it simply can’t work hard enough to fight them.
But new immunotherapy drugs “mark” these cells so that they’re easier to find. These medicines can also make your body's defenses stronger so they can attack tumors.
This type of treatment is already fighting some forms of cancer. Many more drugs are in the works.
The FDA has approved a form of gene therapy called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and change them by adding new genes so they can better find and kill cancer cells

Personalized Medicine

It used to be that most people with a certain type and stage of cancer got the same treatment. Now, doctors know that a solution that helps one person may not work well for someone else.
Your genes can now give doctors a better idea which treatments will help you the most.
Some drugs are more targeted, too. Instead of wiping out all cells, even healthy ones, some can focus just on deadly cancer cells.
For instance, a drug being tested may be able to help people with stage IV pancreatic cancer. If their cancer cells have a high level of a sugar called hyaluronic acid, the drug, called PEGPH20, can break it down.
This would let immune cells and medicines get inside tumors and fight back.

High-Tech Breakthroughs

Advances in imaging are making it easier for doctors to learn about the cancer they’re up against.
Multiparametric-magnetic resonance imaging (mp-MRI), for instance, can uncover the jumble of blood vessels in a new prostate tumor. That close-up view can help doctors decide the best treatment.
Fluorescence lifetime imaging (FLI) is used to help women with breast cancer. A scan tells your doctor if you have proteins that are helping your cancer cells grow. If you do, he can prescribe treatment that blocks the growth.
Thanks to better imaging, other high-tech tools can kill tumors. For instance, doctors can use a technique called cryoablation (freezing) to treat them. This means they wouldn’t have to remove all or part of a lung.
In MRI-guided focal laser ablation, high heat from a laser targets cancer cells in your prostate. If doctors can see cancer in an imaging scan, they can get to it and destroy it.

Drug-Free Treatments

Drug-free therapies like yoga, massage, meditation, and hypnosis can help you live better during your cancer treatment. Some relieve stress and help your mood. Others make the side effects caused by chemotherapy or radiation a bit easier to take.
Acupuncture, an ancient Chinese practice that uses thin needles placed under your skin, can relieve symptoms like:
  • Night sweats
  • Nausea
  • Fatigue
  • Hot flashes
  • Depression
  • Pain

Lifestyle Changes

You know you should cut down on fatty foods, be more active, and limit the alcohol you drink. These everyday tips are also good ways you can stave off cancer.
Working out can drop your risk of 13 different cancers. You don’t need to run marathons to reap the benefits, either. Walking just 30 minutes each day during your lunch break will help.
In life, having options is good. The increasing number of options for people with cancer is great, and becoming greater.

Oranges aren’t enough

The interest in these studies seems to have partly come from the fact that vitamin C is considered ‘natural’ and found in lots of foods, from oranges to broccoli. It can also be consumed in high doses via supplements.
But a closer look at the research reveals that neither study used food or supplements as the source of vitamin C being tested to treat cancer. Instead, the researchers were injecting patients or mice with very high doses of vitamin C – much higher than you could get from food or supplements directly.
A mixed basket of results

In the most recent studies, results tentatively support the idea that high-dose vitamin C has potential as a cancer treatment.
The first study tested vitamin C as a treatment in mice with blood cancer, and found that injecting high doses of vitamin C slowed down the progression of the disease.
But as mice are very different to people, this has some way to go before we can say that vitamin C will help treat cancer patients.
The other study was testing the safety of high dose vitamin C injections in people with either non-small cell lung cancer or glioblastoma, an aggressive type of brain tumour, not if it’s an effective treatment. These tests would follow only if the injections are safe.
This early work showed that doctors could safely inject high doses of vitamin C into patients, but as they only tested it in a small number of people it’s hard to say if this would be the same for everyone.
This is far from the clear-cut answer some headlines would have you believe. Especially considering neither study looked at long term effects of a vitamin C jab in people, and to date there’s no evidence that vitamin C improves cancer survival.
Some studies have suggested that vitamin C may help alleviate some of the side effects of cancer treatment. But other clinical trials had to be stopped early due to severe side effects caused by vitamin C itself.
Some studies have even suggested vitamin C could interfere with some anti-cancer drugs, with one study showing it may even protect breast cancer cells from the drug tamoxifen.
Together, the research paints a confused picture, and perhaps it’s unsurprising that headlines around vitamin C can often be misleading. But as there’s no evidence a vitamin C jab cures cancer, and may even cause harm, this is unlikely to become a treatment any time soon.


High dose injections of vitamin C aren’t routinely available for cancer patients. And research testing these jabs is in its earliest stages. But when headlines draw connections between this research and what we eat, cancer patients may be left asking: ‘Is it worthwhile taking vitamin supplements?’ Martin Ledwick, Cancer Research UK’s head information nurse, says cancer patients shouldn’t take them without first talking to their doctor.
“The key thing is we just don’t know if it is safe to take them alongside conventional treatment that is known to work. It is possible that in some situations they may interfere with the way chemotherapy works, which might make treatment less effective.”
This doesn’t mean to say vitamin C won’t be of benefit to some patients one day. But there’s certainly no evidence yet from any clinical trial that vitamin C improves cancer survival.
Either way, given the mixed results so far, media reports around vitamin C could be doing more harm than good. And as for vitamin C as the next big wonder drug? The signs aren’t pointing that way just yet.

Friday, 27 April 2018

New 'Superblood' Treatment Targets Deadly Cancers

         

 Scientists are harnessing the untapped power of red blood cells to help fight deadly cancers and other diseases.

Nicknamed ''superblood,'' the treatment is under study by at least three companies following similar approaches. Researchers collect red blood cells from patients, modify them so anti-cancer or other medicines can be enclosed, then inject them back into patients. The goal is improve the medicines' effectiveness while reducing harmful side effects.

American Association for Cancer Research conference in April, researchers said that adding L-asparaginase, an enzyme that’s part of a multi-drug chemotherapy treatment, to red blood cells and injecting the cells into 13 patients with acute lymphoblastic leukemia (ALL), a blood cancer, appears safe.

"L-asparaginase is a very good treatment” for acute lymphoblastic leukemia," says Alison Walker, The less-toxic superblood approach also allows the drugs to target tumors more directly, experts say. The drugs also stay in the body longer, so superblood may be more effective in the long term. 

Experts say the new technology builds on another treatment advance known as CAR T-cell therapy. CAR T-cell therapy draws on the power of the body's T cells, known as the workhorses of the immune system, due to their ability to find and kill diseased cells.

In the CAR T process, blood is drawn from a patient, T cells are separated and genetically engineered to boost their tumor-fighting ability, then returned to the patient through an IV compared to CAR T, superblood has more advantages, experts say. The superblood treatment is easier to use, can be made more quickly, and is long lasting.