Stuart Scott's acceptance of Jimmy V award shows courage, vulnerability


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I'm sure by now you have probably seen or at least heard of Stuart Scott's acceptance speech for the 2014 Jimmy V ESPY Award for Perseverance. Stuart's experience with appendiceal cancer, including qualifying for a clinical trial, was chronicled in a short video that aired before the award presentation.

The video is filled wisdom, humor and inspiration.

"My first thought was 'I'm going to die.' Then about probably 5 seconds later, "I'm going to die and leave Taelor and Sydni. I don't want them to be without a dad. Cancer kills you. People die from cancer."

That was seven years ago. He continued to work at ESPN, travel, exercise, be there for his family... he lived his life. He looked into clinical trials. He underwent treatment. He shared his experience with cancer to the public. He "fought" and promised to "never give up."

Watching it with my family, I noticed some things my family probably may not have: The warrior analogies that many patients and survivors have issues with, the "never giving up," which is from the speech that Jimmy Valvano, who died of cancer in 1993, is so well-known for. Is dying from cancer "giving up" or not fighting hard enough?

Not only was the video moving, but his speech afterward laid those concerns to rest. He was quick to amend what he said in the video.

"Don't give up. Don't ever give up," he quoted Jimmy V's speech again. "I said 'I'm not losing. I'm fighting. I'm not losing.' I have to amend that. When you die that does not mean you lose to cancer. You beat cancer by how you live, why you live and the manner in which you live."

He said he couldn't do the "don't give up" by himself. He mentioned his family, his coworkers and bosses, his medical team, strangers that lift him up, especially when he was too sick to "fight" by himself, which apparently was as recent as last week.

Kudos to Stuart Scott to not only give an inspiring speech about living with cancer, but also showing his vulnerability. Living with cancer is not all about fighting, never giving up, being strong, and hopeful all the time. Scott shared his moments of weakness and doubt, which may have been just as inspiring as him promising to never give up.

You can view the video here.


Lung cancer studies demonstrate incremental progress


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While non-small cell lung cancer (NSCLC) has a reputation as a hard-to-treat cancer, several studies presented at ASCO may help researchers decide on the best treatment for individual patients, as well as uncovering possible new treatments for a type of NSCLC that hasn't benefited from the recent targeted therapy frontier.

On the heels of its Food and Drug Administration approval for gastric cancer, ramucirumab also has promise in NSCLC, as shown by the recently announced results of the REVEL study.

Researchers enrolled 1200 patients with NSCLC that had progressed on platinum-based chemotherapy. Typical second-line therapy for NSCLC includes docetaxel, Alimta (pemetrexed) and the targeted agent, Tarceva (erlotinib), which is reserved for patients with EGFR-mutated lung cancer. Unfortunately, these second-line treatments have limited use and median survival with them is around seven to months months.

In the study, patients who received ramucirumab with standard docetaxel lived a median of 10.5 months compared with patients receiving docetaxel alone (9.1 months). Study researchers noted that while the survival is incremental, this is the first trial that has shown a survival advantage in second-line therapy for NSCLC.

No surprising toxicities arose, but severe cases of neutropenia, fatigue, pneumonia and hypertension were reported during the study. Ramucirumab is an angiogenesis inhibitor, much like Avastin (bevacizumab), which is also approved for lung cancer, but as a first-line therapy. This class of drugs, which target VEGF (vascular endothelial growth factor), blocks blood vessel growth to the tumor and can carry a risk of bleeding issues.

Jyoti Patel, a lung cancer specialist at the Robert H. Lurie Comprehensive Cancer Center in Chicago, says that while the median survival was only a month and a half, patient response to the treatment was over a wide range. "There are certainly patients that benefit more when you look at the wide bell-shape curve."

Unfortunately, strategies to identify patients that would respond to VEGFR-targeted agents, such as ramucirumab have been unsuccessful. "We don't have a biomarker. It's been looked at for bevacizumab, and there are certainly efforts underway to find biomarkers, but it's not a single aberration."

In one of the largest study ever conducted in squamous cell lung cancer, necitumumab, an investigational agent that targets the EGFR mutation in certain lung cancers, did improve survival, albeit modestly.

The drug was tested in 1,092 patients with stage 4 squamous cell NSCLC. Patients who received necitumumab with standard chemotherapy had longer median survival (11.5 months compared with 9.9 months with standard chemotherapy). Progression-free survival was also slightly better with the agent. Because there are few options for this type of NSCLC, the company is expected to file necitumumab for approval by the end of the year.

"Squamous cell lung cancer, although it accounts for less than half of patients with NSCLC, we have not made significant inroads," Patel says. "Every time we see a patient with this type of lung cancer, they are so hungry for options." And while the survival advantage was not what she had hoped, she says it's something. "There are gains, but they are small."

In early-stage lung cancer, a study examined Tarceva (erlotinib) in patients with non-metastatic NSCLC after surgery. While the treatment is approved for metastatic disease, experts wondered if the drug would help prolong disease-free survival and stave off recurrence. While results show that the use of Tarceva in this setting did not extend disease-free survival, further studies in EGFR mutation-positive patients are ongoing, which may reveal benefit in this group of individuals. Another study also examined the combination of Avastin and Tarceva in metastatic NSCLC. While this study had positive results, experts questioned if the Japanese-based trial would translate into the same benefit to Western patients.


ASCO: Huge survival gains when upfront chemotherapy is used in metastatic prostate cancer


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One of the largest jumps in overall survival in advanced prostate cancer was described at this year's annual meeting of the American Society of Clinical Oncology.

Hormone therapy is a standard treatment for men with advanced prostate cancer, but eventually resistance develops and the cancer progresses. Chemotherapy is a common second-line therapy. The question was posed that if chemotherapy was given earlier, during hormone therapy, would it improve survival.

Researchers found that adding docetaxel to hormone therapy improves survival by 10 months in patients with newly diagnosed, hormone-sensitive metastatic prostate cancer. (You can see the full abstract results here.) The trial studied 790 men, with about two-thirds having extensive metastases. Overall survival improved from 44 months to 57.6 months; men with extensive metastases saw an improvement from 32.2 months to 49.2 months--a 17-month improvement. Other than disease extent, the benefit was seen across many subgroups, including race, age and prior therapy for early-stage disease.

Michael Morris, of Memorial Sloan Kettering Cancer Center, provided commentary after the presentation and noted that no other large study in recent times in this patient group has seen such a large jump in survival, even with the new agents recently approved for prostate cancer. "If you look at every other drug trial that prolongs survival none even come close in terms of survival prolongation to 17 months. Our best therapies in castration-resistant disease are less than a third of that for the high-volume patients in ECOG3805 (study)," he said, adding that the combination uses a generic, older chemotherapy at a fraction of the cost of newer therapies.

Overall survival in men with less extensive metastases is not yet known, but researchers are continuing to follow the group to determine if there is a benefit of the combination.

Morris also commented that there should be a better definition of "extensive disease," to help guide the medical community on who would benefit from this regimen. Currently, extensive disease is defined as four or more distant lesions. However, men with small lesions who are asymptomatic may not do as well on the combination as a man who has three large distant lesions.

The addition of chemotherapy resulted in one treatment-related death out of 397 patients, in addition to reports of allergic reaction, low white blood cell counts and fever, which could result in increased infection risk, and neuropathy.

"The benefit in patients with a high volume of metastases is clear and justifies the treatment burden," said lead author and Dana Farber Cancer Institute oncologist, Christopher Sweeney, at the conclusion of the results presentation. "Longer follow up is required for patients with low volume metastatic disease."


National Patient Advocate Foundation creates movement to push cancer innovation


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This morning, the National Patient Advocate Foundation formally released its plan to increase cancer innovation in a goal to get cancer breakthrough therapies to patients sooner.

NPAF, a national non-profit that helps patients receive access to quality cancer care, created the Project Innovation movement to enhance access to clinical trials, policy changes, research collaborations, data sharing and funding options.

Nancy Davenport-Ennis, a two-time breast cancer survivor and founder of the NPAF, said they are working with researchers, advocates, doctors and legislators to find solutions to overcome the obstacles slowing down cancer innovation, including a drop in federally funded research and private investment in biotechnology and inefficiencies researchers and companies encounter when pushing treatment breakthroughs to the clinic. The group released its paper "Securing the Future of Innovation in Cancer Treatment" outlining how it will work to overcome these obstacles and more.

Launched at the 50th anniversary of the annual meeting of the American Society of Clinical Oncology, the program coincides with ASCO's theme this year of "Science and Society." In addition to improving scientific funding and research, scientists and activists are appealing to the public at large to get behind better cancer care--research, treatment, screening, access to healthcare, survivorship and overall quality of life.

"I thought what a wonderful instance of serendipity," she says. "All stake holders will come together with issues that ASCO is talking about, and those same stakeholders know the importance of innovation. Without innovation, we don't find cancer cures."

The NPAF is partnering on the program with legislators, researchers, other non-profits and oncology organizations, including The Oncology Nursing Society, The Association of Community Cancer Centers, The Colon Cancer Alliance, Cancer Support Community and Friends of Cancer Research. The group is also calling on patients, survivors, advocates and caregivers to share their own personal stories of how cancer innovation has impacted their lives.

"We are on a cusp of major transition," she says. "We feel that Project Innovation can energize the American people ... With the launch of the program, it's an open invitation for anyone in America to join us."


50 Years of progress in cancer ... and more to come at ASCO's annual meeting


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Starting today, more than 30,000 professionals in the oncology field are gathering in Chicago for the largest cancer research meeting in the world. Organizers predict it to be a record attendance this year, which also mark the organization's 50th anniversary of the annual meeting.

With five days of abstracts, presentations and meetings, it can be a little overwhelming.

Clifford Hudis, ASCO president and chief of the breast cancer medicine service at Memorial Sloan Kettering Cancer Center, led off the opening press conference today by mentioning the progress we've made in the past 50 years – that 2 out of 3 people now live at least five years after receiving a cancer diagnosis, the death rate has dropped, and people have a much better quality of life during and after cancer. It's real progress, he says, but there are many more challenges left to overcome.

I'm always amazed at how much information is disseminated in only five days, in the forms of poster abstracts, presentations, press conferences, exhibits and off-site meetings. This is also a chance for oncologists and researchers to collaborate and talk amongst themselves about clinical trials they're working on, what they are doing to help individual patients and treatment strategies. Meetings can start as early as 6:30 in the morning or end in the late hours of the day.

We at CURE will do our best over the next several days to bring you highlights and commentary from the meeting, as well as interviews with experts and a look into what cancer research has on the horizon for patients, survivors, caregivers and advocates.

While the meeting officially begins Friday afternoon, the Plenary Session on Sunday will reveal results of the top abstracts chosen by the ASCO committee. Those studies, which highlight research in breast, colorectal and prostate cancer, will hopefully hold good news and be helpful in patients who are currently being treated for those types of cancer.

Based on the released abstract titles, the studies may answer the following questions: Does a common aromatase inhibitor work better than tamoxifen in young women with hormone-positive, early-stage breast cancer?

In newly metastatic, hormone-sensitive prostate cancer, does adding chemotherapy to hormone therapy improve overall survival for patients?

Does adding either Avastin (bevacizumab), a targeted therapy that blocks blood vessel growth to tumors, or Xeloda (cetuximab) to standard chemotherapy improve survival in patients with newly diagnosed metastatic colorectal cancer?

In patients with HER-positive breast cancer, which treatment regimen works best: Tykerb (lapatinib) alone, Herceptin (trastuzumab) alone, Herceptin followed by Tykerb or a combination of the two? Because they both target HER2, but in different ways, many have wondered if using both will improve outcome. This will be the first results from the phase 3 trial, which is why there is so much interest in the outcome.

Results of these studies will be available Sunday morning through the abstract links listed above.

In addition to these studies, we will also keep an eye out for advances in other cancers, survivorship and quality of life issues, as well as other aspects of cancer care. We will be blogging from ASCO, and CURE will include coverage in our upcoming Summer issue in mid-June and in CURExtra, our online newsletter (sign up here).

You can also follow along on Twitter using the hashtag #ASCO14.


Lung Cancer Action Summit accepting applications


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The Lung Cancer Action Summit: Tools for Change is currently accepting applications for its annual advocacy meeting, which will take place in mid-September in Pittsburgh. The deadline for applications is July 1. Travel grants are available.

In its seventh year, the Summit offers participants information on educating their community about lung cancer, fundraising, creating a local awareness and advocacy campaign and more. The Summit will also include a guided tour of the University of Pittsburgh Medical Center's lung cancer research labs. The program is limited to 75 participants to keep it interactive and personal.

Geared toward patients, survivors and advocates, registrants do not need experience in advocacy, just a desire to bring lung cancer awareness and action to their local communities.

You can view the 2014 agenda here.

You can learn more about the summit and register at


Angelina's genes


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When a Vanity Fair writer congratulated Angelina Jolie on her fortunate lottery when it comes to genetics, it rubbed a few people the wrong way. I admit I was taken aback when I first read:

What to get the mother who truly does have everything in the genetic, romantic, professional, and philanthropic departments?

Part of me feels we're splitting hairs, that the writer only meant to point out the fact that Jolie is tall, attractive, athletic and has a beautiful family. But how can you dismiss the fact that the woman has lost her mother to genetics? Or that she gave up organs to avoid the consequences of those genetics? Or that she will certainly worry about passing on those genetics to her children.

One of the first few comments on the Facebook feed pointed it perfectly:

I deeply question your observation that she has 'everything' including 'genetics' when those same genes predispose her to fatal cancers.

Angelina Jolie

Are we being too sensitive or is this yet another point that shows awareness for BRCA-related and other hereditary cancers is still needed?


When it comes to brain cancer, does awareness matter?


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Our community's Relay For Life event was this past weekend. That's where I met a special caregiver and her family. She explained that her husband, who was diagnosed with brain cancer a few years ago, was now in hospice. She rarely leaves his side.

The night of Relay was one of the few outings she allowed herself. She had on her button. She was wearing her t-shirt. I had the feeling that she wears them both frequently.

Brain Cancer Awareness Month

After talking with her, I made the connection that it was May ... Brain Cancer Awareness Month. I was acutely aware of brain cancer and the devastation it can have on a family after our conversation. Maybe awareness is not just a t-shirt, a button, a color. It's a face and a name. And maybe that's more important than the symbols we assign each type of cancer.

When Liz Salmi touched on the topic of brain cancer awareness in her blog, "Zero shades of gray: Who's to blame for lack of brain cancer awareness," it questioned the impact a gray ribbon could have on brain cancer. I have to agree that reading her story made more of an impact on me.


Overcoming unique challenges faced by young adults with cancer


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A Q&A with Karen Fasciano, clinical psychologist at the Dana-Farber Cancer Institute, highlights the challenges and progress in treating the non-medical issues young adults with cancer face during and after treatment.

"Young adults have unique needs when coping with cancer," says Karen Fasciano, clinical psychologist and director of the Dana-Farber Cancer Institute's Young Adult Program in Boston. Her training and experience working in both the pediatric and young adult cancer settings bring a dual perspective to her work. "I can bring my clinical skills to each encounter but also the wisdom I have gained from each young person who has honestly shared their cancer journey."

CURE asked Fasciano a few questions about her work with young adults, a group defined as those diagnosed with cancer between the ages of 18 and 39; however, the program evaluates anyone who identifies themselves as a "young adult" to see if it is a right fit for them.

CURE: What are some of the emotional and psychological issues you see in young adults diagnosed with cancer?

Fasciano: Young adults (YAs) often experience disruptions in many areas including: identity, self image, role in family and career and education. Young adulthood is a time when many YAs are exploring both independence and intimacy at the same time as they are trying to assert control over their future goals. Illness can expose young adults coping with cancer to a need for dependence on others, a sense of their own vulnerability, and a struggle with managing the many uncertainties that come along with treatment. YAs also face, many for the first time, the existential distress that comes with a life-threatening illness. Peers may not be struggling with the same issues, so YAs may feel isolated in the processing and sorting out of these complex issues. Life disruptions, for any of us, require recalibration which often comes with emotional distress: anxiety, grief over what has changed and fear.

CURE: Are there common issues that young adults with cancer face that they may not be expecting?

Fasciano: When diagnosed, most young adults assume that they will want to celebrate at the end of treatment. They don't often expect that they will feel increased distress after cancer treatment is over. While this can be a difficult time for all cancer patients, young adults have some unique challenges. Transitions and changes during the young adult years are many and parts of the YA's environment may have changed by the time treatment concludes (friends have graduated from college while they are returning to finish degrees; entry-level jobs that they were on leave from may not look the same a year or two later).

In addition, the life structure and goals the YA had before treatment may not be feasible or desired at the conclusion of treatment. Getting back into a structure and routine and re-evaluating and sometime re-establishing life goals can take longer than the YA expected. Many YAs find that the end of treatment is a time when they process the impact of the cancer and the emotional reaction to the treatment in a different way. Although it is not fully understood why emotions can be so high at this time, my speculation is that without the physical demands of the daily routines of treatment, the YA has more energy to put into their emotional reactions.

CURE: What advice would you give in dealing with the emotional and psychological issues newly diagnosed young adults may face during and after cancer? Be conscious of nurturing your personal identity outside of your illness. Your life goals may have been disrupted. Setting short-term goals or focusing on expressions of your values can help.

Fasciano: Understand that the emotional demands of cancer require attention. Nurture these needs in the same way you will your physical needs.

Think about how you have coped with difficult situations in the past, as this may help you to identify your personal strengths as you cope with this challenge. However, be open to and seek out new coping strategies as the demands of cancer may require a variety of strategies.

Challenge yourself to clearly ask for what you need or receive help from others to identify what you need. As supportive as family and friends can be, they need your input. You are your best advocate.

Consider peer support from other YAs who have coped with cancer as many find this helpful.

CURE: Is it important for young adults with cancer to connect with other young adults in similar situations?

Fasciano: Many YAs find peer connections helpful and find that connecting with even one YA who has coped with cancer can help them navigate the experience and feel less alone. Connections can be in person or via social networking. As helpful as these interactions can be, for some YAs, talking or messaging others who have had a different experience with cancer or are in a different place in their treatment process can promote anxiety. Understand that although YAs with cancer share a common experience, it might not the same experience as yours.

CURE: What are some of the future directions you see in treating young adults with cancer? What are some advances you predict we'll see in this field?

Fasciano: Our YA program is looking at innovative ways to deliver emotional care to the YA population. We are interested in understanding what kind of support is most helpful to YAs and in what effective ways that support can be delivered to this population. We are finding that using technology, social networking and peer support can be an important addition to structured counseling interventions. All YA deserve education and psychological support to address their distress but also to promote resilience and growth.


A Conversation about Cyramza with Dr. Charles Fuchs


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"Stomach cancer has not had sufficient attention in terms of drug development, efforts in finding new drugs or really in understanding the fundamental biology until recently," said Charles Fuchs, who leads Dana-Farber Cancer Institute's Gastrointestinal Cancer Center. "I've been pleased to see over the past several years that more attention has been paid to the disease."

That attention resulted in the Food and Drug Administration (FDA) approval of Cyramza (ramucirumab) on April 21 for patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma (read the FDA announcement). Historically, gastric cancer treatment has been limited to chemotherapies developed for other cancers, Fuchs says. "That may seem like a subtle point, but most of the drugs used in gastric cancer were actually developed for other cancers and subsequently tested and approved for stomach cancer."

Moreover, Cyramza is the first drug approved for patients whose gastric cancers have progressed on first-line treatment. While oncologists have been treating patients in the second-line treatment setting for years, until now, there has been no standard of care. That unmet need was a catalyst for the priority review the FDA granted last year to help speed along the potential approval (read more).

The approval was based on the phase 3 REGARD study, in which Fuchs was a lead investigator. The study found that patients who received Cyramza had a 1.4 month improvement in median overall survival over patients receiving best supportive care (5.2 months compared with 3.8 months), in addition to better progression-free survival. Side effects included high blood pressure and diarrhea, but overall, side effects were well managed and tolerable, he says.

Fuchs points out that the risk of certain side effects, such as fatigue and nausea, were actually lower in the Cyramza arm than in the placebo arm. "That may seem a bit odd, but patients with stomach cancer who have progressed on first-line therapy have symptoms from the disease," he says. "What's also interesting is that when you look at the results of the REGARD study, which I was involved in, and you compare those results to similarly designed studies where they compared second-line chemotherapy to placebo, the benefit is almost exactly the same (to Cyramza)."

He concludes that the benefit of Cyramza appears to be comparable to standard chemotherapy, but with a better side effect profile. The next step may be combining the drug with chemotherapy, which was the basis for the RAINBOW trial. This trial looked at the combination of Cyramza and paclitaxel. Results showed an even greater survival benefit not previously seen in second-line stomach cancer, Fuchs says.

"It wasn't part of the approval because that study is more recent, but I hope the FDA, upon reviewing that study, will amend the approval to include the use of the drug with paclitaxel," he says. "In my own practice, I anticipate it will be the principal way I use it to treat patients in that setting."

Cyramza is also being examined for other cancers, including non-small cell lung, liver and colorectal cancers. A Cyramza study looking at the drug in patients with breast cancer did not show progression-free survival benefit.

Read more about the approval in gastric and gastroesophageal junction cancers from CURE here.


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