Last Month in Oncology with Dr. Bishal Gyawali
By BISHAL GYAWALI MD
Long list of news in lung cancer
September was an important month in oncology—especially for lung cancer. The World Conference in Lung Cancer (WCLC) 2018 gave us some important practice-changing results, also leading to four NEJM publications. The trial with most public health impact is unfortunately not published yet. It’s the NELSON trial that randomised more than 15000 asymptomatic people at high risk of lung cancer to either CT-based screening for lung cancer or to no screening and found a significant reduction in lung cancer mortality rates among the screened cohort compared with the contr...
Source: The Health Care Blog - January 4, 2019 Category: Consumer Health News Authors: matthew holt Tags: Research Bishal Gyawali Breast cancer Cancer drugs Clinical Trials health spending immunotherapy Lung cancer Oncology pembrolizumab Source Type: blogs
AI Doesn ’ t Ask Why — But Physicians And Drug Developers Want To Know
We describe phenomena using science, which gives us a sense of understanding and structure – yet we often lack actual understanding about what we’re observing, or why our treatments work. We have scientific explanations that may appear solid at first glance, but are flimsy upon closer inspection. More commonly, I imagine, we rely on scientific explanations as heuristics to enable us to get through our days, as a scaffold upon which to organize our information.
I suspect AI is viscerally uncomfortable, and challenging to apply to clinical care or drug discovery (see part 2), because of the psychological importance and c...
Source: The Health Care Blog - November 16, 2018 Category: Consumer Health News Authors: matthew holt Tags: Artificial Intelligence Pharmaceuticals Physicians AI David Shaywitz Health Tech Source Type: blogs
Last Month in Oncology with Dr. Bishal Gyawali
By BISHAL GYAWALI MD
Me-too deja vu
I read the report of a phase 3 RCT of a “new” breast cancer drug but I had the feeling that I had already read this before. Later I realized that this was indeed a new trial of a new drug, but that I had read a very similar report of a very similar drug with very similar results and conclusions. This new drug is a PARP inhibitor called talazoparib and the deja vu was related to another PARP inhibitor drug called olaparib tested in the same patient population of advanced breast cancer patients with a BRCA mutation. The control arms were the same: physician choice of drug, except t...
Source: The Health Care Blog - November 8, 2018 Category: Consumer Health News Authors: matthew holt Tags: Drug Discovery Pharmaceuticals Bishal Gyawali Cancer immunotherapy Oncology Source Type: blogs
Nanoparticles Encapsulating Chemotherapy Drugs to Kill Triple Negative Breast Cancer
The cells of triple negative breast cancer tumors don’t have receptors for estrogen, progesterone, and HER2, the main targets used to attack breast cancers. This is why they’re so difficult to treat, but researchers at George Washington University have shown that a technique of delivering a chemotherapy agent within specially designed nanoparticles can be very powerful against these triple negative breast cancers.
The team, after much trial and error, concocted a formulation of the nanoparticles so as to have the greatest effects on the human cancer lines they worked with. Turns out the smallest nanoparticles ...
Source: Medgadget - October 3, 2018 Category: Medical Devices Authors: Editors Tags: Nanomedicine Oncology Source Type: blogs
Risk factors for trastuzumab cardiotoxicity
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Trastuzumab is a monoclonal antibody targeting the HER2 (human epidermal growth factor receptor 2) used in the treatment of HER2 positive breast cancer. The drug when used in the treatment of early stage breast cancer, reduces recurrences by half and mortality by one third. But trastuzumab trials have shown severe heart failure or cardiac event rate up to 3.9%.
Important risk factors for cardiotoxicity with trastuzumab treatment are:
Age above 50 years
Underlying heart disease or hypertension
Baseline left ventricular ejection fraction 50-55% or lower
Previous anthracycline therapy
Reference
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Source: Cardiophile MD - February 26, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs
The Skeptical Oncologist
By BISHAL GYAWALI, MD
Why conduct post approval studies at all?
Atezolizumab previously received accelerated approval in second-line metastatic or advanced urothelial cancer based on response rates from a single arm trial. The results of post approval confirmatory phase 3 are now published and demonstrate that atezolizumab did not improve survival versus chemotherapy (11.1 v 10.6 months, HR 0.87, p = 0.41). The concept of accelerated approval is to grant early and conditional approval and access to drugs in diseases of unmet need, and that the decision to fully approve or revoke be made based on results of confirmato...
Source: The Health Care Blog - February 7, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
I Am Very Confused
I realize this must be part of the vast conspiracy to keep breast cancer patients confused. Nancy, over atNancy ' s Point, blogged about theAJCC ’s Updates to the Breast Cancer Staging System, asking if we are confused about it. Well, since I didn ' t know about the updates (or even who the AJCC is) I was and still am very confused.Let ' s start with theAJCC or the American Joint Committee on Cancer. Apparently they are the people who set up cancer staging criteria. They set the original TNM staging system in 1959. TNM means Tumor size, Nodes positive, and Metastases. " The panel recognized the need to incorporate b...
Source: Caroline's Breast Cancer Blog - January 18, 2018 Category: Cancer & Oncology Tags: breast cancer breast cancer treatment confusion staging Source Type: blogs
Waiting for Cancer Research
After 12 years (how the heck did that happen?) of breast cancer coping, I have actually seen some cancer research go from new or in clinical trials to become standard of care. This includes length of hormonal treatment for breast cancer patients. But it does not include many, many others.Some cancer ' breakthroughs ' are still in trials, or have vanished because they didn ' t work. They provide us cancer people with instant elation at the possibilities it hints at, followed by deflation as we realize it is years or decades in the future.An example of this is this news that at UVA they are working to find a wayto stop tripl...
Source: Caroline's Breast Cancer Blog - December 4, 2017 Category: Cancer & Oncology Tags: breast cancer treatment cancer research clinical trials waiting Source Type: blogs
Quantum Dots Attached to Antibodies Seek Out, Light Up Tumors in Bright Technicolor
Quantum dots are tiny nanoparticles made of semiconductors that have unusual optical properties. In medicine, they may be very useful because they emit light when stimulated by electricity or an external light source, making them easy to spot in diagnostic tests. They’re more than ten times brighter than fluorescent dyes commonly used today, potentially allowing their use to significantly improve many existing tests and systems that rely on fluorescence. A major challenge of putting quantum dots into clinical practice is how to attach them to antibodies that seek out diseases without ruining the functionality of neit...
Source: Medgadget - November 20, 2017 Category: Medical Devices Authors: Editors Tags: Diagnostics Medicine Nanomedicine Source Type: blogs
Tumor Size Doesn't Matter
This study shows that it ' s not only tumor size that is important for breast cancer patients but also tumor biology. All tumors in the study were small - less than 1 cm - and the lymph nodes were free of cancer (node negative), which in principle should be a signal of good prognosis. But nearly one in four patients - those identified as genomic high risk - derived benefit from chemotherapy. " "" " Small node negative tumors can be very aggressive, even if they are classified as clinical low risk, " said de Azambuja. " Tumor biology needs to be taken into account when deciding adjuvant treatments in this patient population...
Source: Caroline's Breast Cancer Blog - October 11, 2017 Category: Cancer & Oncology Tags: breast cancer treatment cancer research tumor Source Type: blogs
Why a case report being circulated by advocates doesn't show that the ketogenic diet combats cancer
In conclusion, this combined metabolic approach appears effective in treating advanced TNBC, given this patient’s complete response with a good quality of life.Now, there is one thing that is interesting here. The doses of chemotherapy used were considerably lower thanwhat is usually used, with doses decreased by at least half or more. Does this mean anything? Who knows? cPR rates for TNBC have been reported to range from 20-35%. It could mean the regimen made the chemotherapy more effective, or it could mean that this woman just happened to have a particularly chemosensitive tumor. Even if we take this case report at fa...
Source: Respectful Insolence - October 4, 2017 Category: Surgery Authors: oracknows Source Type: blogs
Why a case report being circulated by advocates doesn't show that the ketogenic diet combats cancer
In conclusion, this combined metabolic approach appears effective in treating advanced TNBC, given this patient’s complete response with a good quality of life.Now, there is one thing that is interesting here. The doses of chemotherapy used were considerably lower thanwhat is usually used, with doses decreased by at least half or more. Does this mean anything? Who knows? cPR rates for TNBC have been reported to range from 20-35%. It could mean the regimen made the chemotherapy more effective, or it could mean that this woman just happened to have a particularly chemosensitive tumor. Even if we take this case report at fa...
Source: Respectful Insolence - October 4, 2017 Category: Surgery Authors: oracknows Source Type: blogs
We Can Improve Care Management
As a physician and CIO, I ’m quick to spot inefficiencies in healthcare workflow. More importantly, as the care navigator for my family, I have extensive firsthand experience with patient facing processes.My wife ’s cancer treatment, my father’s end of life care, and my own recent primary hypertension diagnosis taught me how we can do better.Last week, when my wife received a rejection in coverage letter from Harvard Pilgrim/Caremark, it highlighted the imperative we have to improve care management workflow in the US.Since completing her estrogen positive, progesterone positive, HER2 negative breast cancer treat...
Source: Life as a Healthcare CIO - September 12, 2017 Category: Information Technology Source Type: blogs
What Netflix can teach us about treating cancer
Two years ago, former President Barack Obama announced the Precision Medicine initiative in his State of the Union Address. The initiative aspired to a “new era of medicine” where disease treatments could be specifically tailored to each patient’s genetic code.
This resonated soundly in cancer medicine. Patients can already manage their cancer with therapies that target the specific genes that are altered in their particular tumor. For example, women with a type of breast cancer caused by the amplification of gene HER2 are often treated with a therapeutic called herceptin. Because these targeted therapeutics are spe...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/elana-fertig" rel="tag" > Elana Fertig, PhD < /a > Tags: Conditions Cancer Source Type: blogs
Back to Breast Cancer Stuff
(So my plan is coming together and my life goes back to reflecting on breast cancer crap.)Earlier this week, the FDA approved a new medication to be used with Letrozole (Femara) or other aromatase inhibitors for hormone positive metastatic breast cancer patients. This medication (which I can ' t pronounce and just think of it as the ' kis... ' ) is calledKisqali (chemical name: ribociclib). It works similar to Ibrance... Not that that means much to me but as a reference.My real concern is the cost. Ibrance costs $9850/month for treatment. Not cheap. All new cancer treatments seem to cost so much. But I am pleased to l...
Source: Caroline's Breast Cancer Blog - March 18, 2017 Category: Cancer & Oncology Tags: breast cancer treatment cancer costs medication costs medications Source Type: blogs
