33rd Annual San Antonio Breast Cancer Symposium kicks off

BY SUSAN MCCLURE | DECEMBER 8, 2010

What if I told you that losing your hair during chemotherapy may not be inevitable or that sometimes making irrational decisions can be beneficial? Or how about this...did you know that even cancer cells get stressed? Would I have your attention? These fascinating topics will be explored over the next few days at the 33rd annual San Antonio Breast Cancer Symposium, along with presentations on the latest research and treatment in breast cancer.

What began in 1978, when a group of 141 physicians and surgeons from a five-state area got together to discuss ways to reduce the death rate caused by breast cancer in San Antonio and surrounding counties, has turned into an international conference attended by physicians, researchers and advocates from over 90 countries. The overall objective of SABCS, however, remains the same. Its mission is to produce a unique and comprehensive scientific meeting that encompasses the full spectrum of breast cancer research, facilitating the rapid translation of new knowledge into better care for breast cancer patients.

For the next few days, the CURE team will be bringing you updates from this very important gathering of international thought leaders. Not only will we deliver the latest and greatest scientific news surrounding breast cancer, but will also be talking to survivors and advocates about their passionate causes. We'll be blogging, tweeting, writing and filming daily so be sure to follow us!

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• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting
• The big news from the American Society of Hematology

Patient Protection & Affordable Care Act (PPACA) shouldn't limit its focus to insurance carriers

BY SUSAN MCCLURE | OCTOBER 5, 2010

Yesterday I was opening a stack of mail that had accumulated in my inbox when I came across a hefty-sized letter from a CURE reader. We get heart-wrenching letters from readers on occasion so I cleared my desk, pulled the tissues close to me and opened it.

To my surprise, it wasn't a letter at all. A single page from our Summer 2010 issue was included with a highlighted sentence regarding upcoming legislative changes intended to give cancer patients improved access to affordable care. The reader highlighted a sentence that said, "The Patient Protection and Affordable Care Act will limit the ability of insurance companies to charge higher premiums based on health status." The article went on to say that eventually it will be illegal for insurance companies to charge higher premiums based on a person's medical history. The envelope also contained stacks of claim detail statements indicating that the reader was responsible for thousands of dollars worth of medical bills because the hospital and the insurance carrier disagreed on the value of the services rendered.

A letter from her employer was also enclosed. It stated that the hospital system where she was receiving care was no longer going to be covered by her insurance carrier because "it was charging up to three times the market price compared to other area hospitals." At the top of that page the reader scribbled, "I have metastasized cancer."

At that point, I realized that the tissues I had pulled close were unnecessary. I wasn't sad--I was mad as hell. How incredibly frustrating! So, this poor patient with metastatic cancer is going to have to find a new healthcare team at an entirely different facility because it was determined, well into her treatment I might add, that the cost of care was too high. Was this a case of price gauging by the hospital or a way for the insurance company to control costs? Who knows? All I know is that this poor reader is stuck in the middle of what is all too common a bureaucratic mess.

• More trail mix
• When the cancer comes back
• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting
• The big news from the American Society of Hematology

Triple negative breast cancer drug one step closer to approval

BY SUSAN MCCLURE | DECEMBER 13, 2009

On Friday, sanofi-aventis announced that the FDA has granted fast track approval to their investigational PARP1 inhibitor, BSI-201, and that accruals for their phase 3 clinical trial is on schedule and meeting expectations on patient accrual and trial site coverage in the United States. Investigators have enrolled 214 of their target number of 420 patients.

The "fast rack" process is designed to expedite the review of drugs being developed for serious diseases with the potential to address an unmet medical need.

BSI-201 entered a phase 3 clinical trial in the United States in July 2009 and is being evaluated in combination with chemotherapy in patients with metastatice triple-negative breast cancer (mTNBC), a condition defined by tumors lacking expression of estrogen, progesterone receptors and without overexpression of HER2. BSI-201 is a novel investigational targeted therapy that inhibits poly (ADP-ribose) polymerase (PARP1), an enzyme involved in DNA damage repair.

The decision to commence with the phase 3 study in July was based on the encouraging phase 2 study results presented at ASCO on May 31, 2009. In the phase 2 clinical trial, women with mTNBC were randomly assigned to receive gemcitabine and carboplatin (GC) in combination with the investigational agent BSI-201 or GC alone. Updated phase 2 data including overall survival were presented on Friday at a poster session during the San Antonio Breast Cancer Symposium.

The addition of BSI-201 to GC improved median overall survival from 7.7 months to 12.2 months. BSI-201 did not add to the frequency or severity of adverse events associated with chemotherapy. This is not a final analysis of the phase 2 data, but an updated analysis of overall survival. Median survival hasn't yet been reached in the BSI-201 arm, therefore the data cut-off period for the phase 2 trial was from September to November.

"The updated analysis from the phase 2 program, including data on overall survival, are consistent with the positive results presented earlier this year at ASCO," declared Marc Cluzel, executive vice president, R&D, sanofi-aventis. "We are very encouraged by the fast recruitment of patients in phase 3 trial. We hope the findings will lead to emerging strategy that may help women with metastatic triple negative breast cancer."

• More trail mix
• When the cancer comes back
• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting
• The big news from the American Society of Hematology

New mammography guidelines continue to spark debate

BY SUSAN MCCLURE | DECEMBER 12, 2009

You'll recall the public outcry that occurred in October when the U.S. Preventive Services Task Force issued a report that recommended significant changes to existing mammography guidelines. The debate continues among physicians, scientists, and advocates here in San Antonio.

Back in October, the 16-member committee recommended that most women in their 40s should not routinely get mammograms. Additionally, women 50 to 74 should get mammograms every other year until they turn 75, after which the risks and benefits are unknown. Women 75 and older should not get regular screening. The committee is also against teaching women to do regular self exams because "the value of breast exams by doctors is unknown and breast self exams are of no value."

The American Association for Cancer Research (AACR) released a response to the new guidelines which stated that they recognize that these are complex issues that encompass a broad range of areas - medical, scientific, public health, economic and sociological - and that the interpretation of these data can result in legitimate disagreement among respected leaders in their fields. Decisions on the delivery of screening methods and treatment of cancer should be evidence based and that the "state of the art" in the field is evolving and will continue to change as our understanding of the biology and genetics of cancer is better understood. They also recognized that mortality rates from breast cancer have been falling since the mid-1990, and they believe that this is attributable at least in part to the more widespread utilization of mammography screening and other factors. Their statement concluded by saying that the issues are simply too complex to make a clear statement at this time supporting either the existing guidelines or those proposed by the USPTF.

To me, that response equates to issuing a "no comment."

The Breast Cancer Network of Strength took a much more definitive stance. Margaret Kirk, the foundation's President and CEO said, "We know that earlier diagnosis and treatment of breast cancer leads to better outcomes. As an organization that hears from tens of thousands of women through our 24/7 YourShoes support center, we would be disappointed if this new recommendation became yet another barrier that women will have to overcome to get the care they need."

Over 7,000 people have sounded off about the new mammogram guidelines by signing Breast Cancer Network of Strength's petition. You can too by clicking here.

I was 35 when I found my lump and had it confirmed via mammography and biopsy. It's important to note that my mammogram was considered diagnostic and would still be covered under the new recommendations. However, had I done the mammogram two months earlier, when my doctor recommended it at my annual check up, it wouldn't have been because the tumor hadn't been detected then. At 35, and with no family history, I felt invinsible. I procrastinated.

I salute Margaret Kirk and the Breast Cancer Network of Strength for keeping the public's voice at the forefront of this issue.

• For the Cure to a broken heart
• Two new drugs approved, one pulled from the pipeline
• Drug approved specifically for treating myelofibrosis
• Erbitux Approved for Metastatic Head and Neck Cancers
• Perfume me

Endocrine therapy passion gives three researchers rock star status

BY SUSAN MCCLURE | DECEMBER 10, 2009

This afternoon I attended a general session at SABCS where Susan G. Komen for the Cure awarded the Brinker Awards for Scientific Distinction to three researchers for their work in endocrine therapy. Huh? Ok, first, let me give you a definition of what endocrine therapy is. According the the National Cancer Institute, endocrine therapy is:

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body's natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called hormonal therapy, hormone therapy, and hormone treatment.

The awards went to Geoffrey L. Greene, PHD of the University of Chicago, Benita Katzenellenbogen, PHD, University of Illinois-Urbana Champaign, and Professor Ian Smith of the Royal Marsden Hospital of London. In a nutshell, their combined resarch revolves around understanding estrogen receptors and how we can provoke them respond to treatment.

I'm no scientist, and I promise to stick to "color commentary" from this point forward, but what I can tell you is these guys are heavy hitters. They have not only changed the way cancer is dianosed and treated, but also how outcomes can be predicted.

In a packed hall with hundreds of docs hanging on every word, each researcher told the audience about their work in endocrine therapy. Dr. Greene's research determined that receptors exist. Dr. Katzenellenbogen's reseach focused on how receptors respond to various hormones. Dr. Smith's research involved early clinical development of anti-cancer drugs based on this research.

One of the first questions doctors want to know when assessing treatment options for their patients is whether the tumor is ER positive or negative. The answer will determine which treatment pathway to follow. This reasearch will also help doctors determine which patients will (and won't) respond to chemotherapy. More on that tomorrow.

The cure to cancer is complicated, but tonight's award-winners have helped us better understand this deadly disease by finding ways to trick hormones into working with us instead of against us.

• More trail mix
• When the cancer comes back
• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting
• The big news from the American Society of Hematology

Federal task force says women need fewer mammograms. Sound reasoning or rationing?

BY SUSAN MCCLURE | NOVEMBER 17, 2009

Bewilderment. That's the only word I can use to describe how I felt upon reading an article in my daily newspaper this morning (Yes, I still read the daily paper). The story reported on an influential federal task force's recommendation that women have fewer mammograms. "We're not saying that women shouldn't get screened. Screening saves lives," said Diana Petitti, vice chairman of the U.S. Preventive Services Task Force. "But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully." The recommendations of this committee would set the standards for preventative health care services under health care reform and would be used to determine which tests would be covered by insurance plans. These guidelines are for the general population, not for those at high risk of breast cancer.

The 16-member committee recommended that most women in their 40s should not routinely get mammograms. Additionally, women 50 to 74 should get mammograms every other year until they turn 75, after which the risks and benefits are unknown. Women 75 and older should not get regular screening. The committee is also against teaching women to do regular self exams because "the value of breast exams by doctors is unknown and breast self exams are of no value."

Those who side with the task force's findings say that more testing, exams, and treatment are not always beneficial and may cause harm to patients. The article stated that in about 10 percent of cases, false positive results caused anxiety among patients and lead to unnecessary procedures such as disfiguring biopsies and in some cases, surgery, chemotherapy, and radiation.

Those on the opposing side said that this is a huge step in the wrong direction. Daniel Kopans, a radiology professor at Harvard Medical School said, "Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it." Dr. Phil Evans, director of the Center for Breast Care at UT Southwestern Medical Center in Dallas predicted that conducting fewer mammograms would be a mistake. "Mammography is not a perfect test, but it's still the best test for finding breast cancer early," argued Evans.

The most ominous quote in the article came from Dr. Michael Grant, my breast surgeon at Baylor University Medical Center at Dallas. He said that the timing of this made him suspicious. "Ultimately, this may be how we provide rationale for rationing. They're not saying it isn't worth it -- just that the number of lives it saves is not counter balanced by the cost and trouble of doing it," said Grant. Roughly 39 million women in the U.S. have mammograms each year, costing the healthcare system more than $5 billion annually.

I think I need to dust off my old copy of George Orwell's, Animal Farm. This arguement is sounding vaguely familiar. "All animals are equal-- just some are more equal than others."

• More trail mix
• When the cancer comes back
• Two new drugs approved, one pulled from the pipeline
• Emerging treatment option for myeloma presented at hematology meeting
• The big news from the American Society of Hematology

Certain anti-depressants taken with tamoxifen pose risk

BY SUSAN MCCLURE | SEPTEMBER 8, 2009

In CURE's upcoming Fall issue we write about the importance of talking with your doctor if you are taking tamoxifen along with an anti-depressant such as Prozac, Paxil, or Zoloft--three widely prescribed serotonin reuptake inhibitors (SSRIs for short). Many women are prescribed anti-depressants to combat hot flashes--a well documented side effect of tamoxifen. New studies indicate that certain SSRIs may in fact put women at a much higher risk for recurrent breast cancer. It appears that not all SSRIs are alike, and while some demonstrated cause for alarm, others didn't pose a problem at all. Before you flush your anti-depressants down the toilet, however, let me give you a warning... Don't discontinue taking any anti-depressant without first consulting your doctor.

I was talking with a close friend recently who began taking Lexapro a couple of years ago to combat hot flashes. She lives in Brazil now and has discovered that it's very difficult to get her prescriptions filled in South America. She was spending a few hundred dollars each month to refill her prescription and decided to stop taking the Lexapro rather than battle the bureaucracy. In her mind, the benefit didn't outweigh the cost.

Fast forward a couple of weeks... She began to feel like she was getting the flu. She was achy, having chills, was feverish, and disoriented. She was incredibly depressed too. She slept all day and told me that she didn't even have enough energy to go outside. As her mystery illness progressed, she and her husband became very concerned. After a bit of investigative work (and an overdue trip to the doctor), they realized that she was experiencing withdrawal symptoms from her abrupt discontinuation of Lexapro. She was put back on the medication and after a few days, she felt normal again. Her doctor informed her that she should never stop taking her Lexapro without talking to him first and that she needed to gradually wean herself from the drug in order to minimize the risk of withdrawal symptoms.

All drugs are given with specific product information. It's a good idea to keep the package insert for future reference–-since some people experience the infrequent side effects, which can be major. And always discuss stopping a medication with your doctor-- don't just do it.

• For the Cure to a broken heart
• Two new drugs approved, one pulled from the pipeline
• Drug approved specifically for treating myelofibrosis
• Erbitux Approved for Metastatic Head and Neck Cancers
• Perfume me

When ordinary people do extraordinary things

BY SUSAN MCCLURE | JULY 1, 2009

Currently, the world is abuzz with news of Michael Jackson's death. When a superstar like Jackson dies, it becomes difficult to find a news agency that isn't covering the story 24/7. We can't hide from it. Our voyeuristic fascination with the rich and famous sometimes makes us miss the more poignant, heartwarming, heroic tales of people like us--ordinary people who do extraordinary things.

Take the story of Dr. Jerri Nielson Fitzgerald. She's the doctor who discovered and treated her own breast cancer while stationed in Antarctica in 1999. Her base was closed for the winter when she detected a lump in her breast. There was no way for her to be airlifted to a hospital until the weather improved. When the lymph nodes under her arm began to swell she realized that if she didn't do something drastic she might not make it out alive.

With the help of a welder she performed a biopsy on herself in order to confirm that she did indeed have cancer. She said that she'd work on herself until she got tired, then he'd do it, then she'd do it, and so on. Once the cancer was confirmed, she had supplies airdropped by a US Air Force plane and taught the welder how to administer chemotherapy. Three months later when the weather improved, she was airlifted out.

Dr. Nielson Fitzgerald wrote a book about her harrowing journey called Ice Bound: A Doctor's Incredible Battle for Survival at the South Pole, and was in remission until 2005 when her cancer returned. She spent the final years of her life inspiring cancer patients worldwide, saying that her experience with the disease gave her life "colour and texture." She also said that she used to think adventures were a thing of the past and that no more were to be found. Her time at the South Pole taught her that adventures are all around us. "The adventure is now", she said.

Dr. Nielson Fitzgerald died on June 24th--one day before Michael Jackson.

• Two new drugs approved, one pulled from the pipeline
• Cancer screening rates low
• A call for more pancreatic cancer research
• An introduction to cancer: From a father and his daughter
• The cushion of silence