I have seen a few different things in the news and in support groups about cancer research recently. There were 3 particular studies that have stood out for me. Right now I can only remember 2 of them but hopefully before I finish this post I will remember what the third one was about.
The big thing in cancer research in Canada in the past week was the show on CBC called Cracking Cancer (sorry, the only link I could find does not allow the show to be viewed outside of Canada). It was hosted by David Suzuki and it followed several patients that were involved in the Personalized Onco-Genomic study out the of the Vancouver Center of the BC Cancer Agency.
The study has been running for about 6 years so far with some very optimistic results. The study involves comparing a patient’s regular DNA to their tumour’s DNA to find the specific mutations in the tumour that drive it to grow. Then literature is searched to find any drug that is known to act against the mutation. In some cases there is no currently available drug for a specific mutation, but that doesn’t mean a drug won’t be found in the future.
A little under 5% of participants were classified as “super-responders”. I take this to mean that the patient ended up with either extreme decrease in tumour or load or they reached the state of no evidence of disease (NED). About 40% of patients had at least a year with a decent quality of life. That doesn’t necessarily seem like much but when you are living a life where things can be great but you can still be dead in 3 months, an extra year feels like a lifetime. Especially if side effects are minimal and quality of life is good.
I really appreciated how the lead researcher talked about metastatic cancer in general. She was very clear about how complex cancer is and how very individual it can be. People may be diagnosed with the same type of cancer such as breast cancer but the only similarity may be the location of the primary tumour. The mutations can be different even if the sub-type, ie. ER-, Her2+, is the same. The goal of the researcher is to make cancer a chronic disease where the treatment is tolerated well so that quality of life remains high. That is a much more realistic goal than the idea of a “cure”.
At the end of the show they specifically mentioned the Ride to Conquer Cancer as a major source of funding for the study. Sooo…..one more shout out to Grace and all the other participants and everyone who has donated money to the cause. This has been money well spent and is has been improving life for many patients and giving a sense of hope to the large community of metastatic cancer patients.
The second item I saw was an article in the Globe and Mail about a report in a recent Canadian Medical Association Journal looking at how lifestyle changes may help prevent cancer recurrence in early stage patients.
It was very interesting as the 2 biggest things to prevent recurrence appear to be activity level and not gaining more than 10% of your pre-diagnosis weight regardless of what your BMI was. A high percentage of patients deal with fatigue which puts a real damper on activity level so recommendation 1 is not fabulous. For recommendation 2, many patients go on steroid treatment to deal with side effects which for many patients results in about a 20 pound weight gain during treatment. If weight really has a significant effect on potential recurrence then a different method of dealing with side effects is needed.
For activity level, I’m really not sure how to improve fatigue. Some treatments likely cause less fatigue but it seems almost unavoidable. Exercise is supposed to help with fatigue but I often find that exercise just leaves me more tired the next day. I try to push through but after a few days I hit burn out and I need at least a day on the couch to recover, often I am lucky if it is only a day I need. My fatigue was better back in the good old days when I was just on Herceptin and there was pretty much no sign of cancer but I still definitely had days of extreme fatigue.
Aside from activity and weight there was a mention of high doses of vitamin C. That is trickier for patients on treatment as there is a general consensus that high dose vitamin C can interfere with chemo. I don’t know if there is actually any truth to that claim as I have no interest in doing IV vitamin C so I have never looked into it. I know of several patients that have been specifically told by their oncologists to not use vitamin C this way and a few oncs are VERY against it.
The report also said that there was no clinical indication that significant dietary changes such as spending hours a day juicing, switching to vegetarian diets, or avoiding soy had any affect. That is reassuring for me as I figure I don’t know how long I’ve got so I’m eating whatever I want, in moderation of course, whenever I want……unless it causes mouth sores, heartburn, diarrhea, or any other general unpleasantness I would prefer to avoid. Depending on dietary habits pre-diagnosis some patients may find that some dietary changes may help them feel better, but I didn’t eat much processed food, Ian or I cooked most meals, and we ate a relatively well balanced diet so I didn’t think I needed any changes. If I want chocolate cake I’m eating chocolate cake……or cinnamon bread…….
Made it on Monday while it was snowing and I didn’t feel like leaving the house.
Jasper enjoyed going out in the snow, but I got tired of having to towel him off constantly. I think he started getting annoyed when I stopped giving him treats for standing still.
Okay, back to cancer research stuff, I did remember the 3rd item. It was in regards to the genetic testing patients can pay for to determine what treatments would be most useful for them. There are a couple of different companies based in the U.S. that offer the testing. One costs least $5000 USD and I wouldn’t be surprised if the other was similar. The tests are a little different as one test uses actual tumour samples to do the testing while the other test uses cell-free circulating DNA from blood.
The researchers looked at test results from 9 patients that had samples tested by both companies. Now, 9 samples is not very many I know and a larger sample size would definitely be better, but the discrepancies were so great between the two sets of results that even at that small a sample size the results were significant.
The initial results of the study were reported in a letter to the Journal of the American Medical Association Oncology in December 2016. One patient in the group had no genetic alterations recognized by either test. Of the remaining 8 patients, a total of 45 genetic alterations were recognized. Ten of those 45 were found by both tests. That is 22%. For 2 patients the recognized alterations were completely different between the 2 tests.
As an aside the test that uses actual tumour samples looks at 315 potentially cancer related genes while the other test, using blood, only looks at 70 genes. Initially, the researchers looked at the total number of alterations found for each patient. Then they looked at how many of the alterations could only be found using the test with the 315 gene methodology. Sixty-five alterations were specific to this methodology and they were excluded from the compared data so the discrepancies between the tests are not artificially inflated.
What makes the study more interesting to me is that each test, based on the genetic results, then goes on to recommend which drugs would be the most successful for treatment. Among the 8 patients that had recognized genetic alterations, 36 drugs were recommended as possible treatments. Nine of the 36 were recommended for the same patients by both methods of testing. Five patients had no drugs recommended by both tests. For the 3 patients that did have drugs that matched, 2 of them were breast cancer patients (5 breast cancer patients were in the study) and they both had 4/7 drugs match. When the altered genes are the same from both tests 8 of the 13 recommended drugs matched.
This tells me that more work needs to be done before I would consider throwing that much cash at something that looks a bit like a crap shoot. Also, the way tumours can change suggests that re-testing may be required as treatment fails as it would not be known how the tumour became resistant to treatment. It is possible the tumour has become resistant to more than just that one drug. I’m sure most people would prefer to assume the new resistance is to the single drug but I’ve been around the cancer world long enough that pretty much anything is possible.
Overall, the idea of these tests are similar in idea to the POG study at the Cancer Agency where genetic information is being used to select treatment, but the drugs recommended are currently limited to standard treatments unlike the POG study that looks at all available drugs. Hopefully the companies that offer these tests are continually doing research to improve their drug selection and possibly even expand the number of mutations they look for.
So that is my roundup of some cancer research I have heard about recently. One last thing that I don’t know anything about is a drug in the pipeline that may be useful for Her2+ patients that have become resistant to targeted therapies. At this point I have seen limited research done on Her2+ patients as the studies seem to be focussing on hormone receptor positive patients. I will keep my eye out for more information in that area as the study is thought to be ending soon so results should start coming out by summer.
That’s all for now. My next post will be about my latest experience at the Pain & Symptom Clinic.