Could cholesterol-lowering drugs work against colorectal cancer?


Elizabeth Whittington blog image

A recent study published in the Journal of Clinical Oncology found that statins, drugs used to lower cholesterol levels by blocking a key enzyme, improved survival in patients with non-metastatic colorectal cancer. The class of drugs is one of the most widely used in the country, with nearly half of Americans aged 65 and older taking them. The medications have a pretty good safety profile and are relatively inexpensive, but doctors aren't yet ready to begin prescribing the drug to patients with colorectal cancer.

The study looked at a group of more than 7,500 participants based in England with newly diagnosed stage 1-3 colorectal cancer. Researchers found that statin use, when taken for at least a year after the initial cancer diagnosis, was associated with longer rates of survival.

Earlier studies may explain why statins have an effect on colorectal cancer, including the drug's effect on cell apoptosis ("cell suicide"), inhibiting cell growth and angiogenesis (the process of supplying blood and nutrients to a tumor) and enhancing the immune response--processes that would impact cancer cells. The same cellular process by which statins block cholesterol production also may impact certain processes used in producing cancer cells and their growth. It could be that statins interfere with the cancer's ability to metastasize or possibly enhance the effect of chemotherapy.

Of course, more follow-up and randomized studies will need to happen before statin's effect on cancer can be confirmed and it makes its way into clinical practice. As with any treatment, risks and benefits will need to be weighed for each individual patient before prescribing, but it does look promising.

Thomas Cartwright, a colorectal cancer specialist with Florida Cancer Affiliates and a member of CURE's advisory board, says that while these latest study results are interesting, he doesn't think any physician would prescribe statins to a patient with colon cancer patient based on this single study.

"There are many potential confounding factors and limitations in a study like this," he says. "Statins can have side effects, as well, and a similar study showed statins may increase the risk of diabetes."


When the patient becomes a caregiver


suzanne lindley blog image

I'm typing this blog from the hospital bed next to Ronnie's in the wee hours of the morning. This time, I'm not the patient.

There are no IVs, oxygen or tubes hooked to me. Instead, they are connected to the person who has been my anchor through good and bad. The room is dark with the exception of a line of light peeking through the door. I capitalize on this and watch the steady drip of antibiotics fall through the tubing and slowly into his arm. Just as I have prayed so many times that chemo will shrink my tumors, I am now lifting similar prayers that this powerful drug will cure his infection. I find comfort in the cadence of his breath and occasional snore, then hear a train whistle in the distance, and think of the journey we have taken to get to this spot.

Two short weeks ago, we were in the middle of a fantabulous break from chemo and for the first part of summer break enjoyed a relaxed pace. These school-free months for Chloe have also been like "cancer-free" months for me. We have grabbed every second and have celebrated the gift of NOW with as much memorable fun as we could feasibly pack into a day.

There have been trips to the water park, fishing at the lake, bike rides, SuperRide drill competition, a Wade Hayes performance, a few Clay Thrash concerts, the zoo, Six Flags and even The Grand Ole Opry. There have been art classes, crafts and bedtime stories; hopscotch and chocolate chip cookies. Walks to the lake let us feed the ducks and watch the sun set, and I find myself believing that this is what normal feels like. We've had a couple of birthdays, another wedding anniversary, time with Katie and Karlie despite their busy adult lives, and are soon going to be walking Chloe into first grade. Life flies by sometimes simply; slowly and deliberately, and at other times with much more velocity and speed.

The last few weeks have made up for the easy glide into the beginning of summer with a tidal wave of Murphy's Law.

Ronnie punctured his finger. Though it seemed straightforward in the beginning, not all is what it seems. My mom had cataract surgery resulting in high pressures that took time to resolve. Then my dad had a stroke, and my mom had a second cataract surgery.

The pace quickened.

Then Ronnie's simple puncture didn't respond to the first round of antibiotics. Steroids didn't touch it and a second round of newer, stronger antibiotics didn't work either. Faster we go. Orthopedic surgeon visit. MRI. Surgery is scheduled and fast is now joined by furious as the infection outsmarts the bones in his finger. The infection becomes sneaky. And like waiting for the slow rumble of the train as it passes by the hospital window, we must patiently wait for the antibiotics to work and the infection to leave his body.

Traveling from patient to caregiver, I suddenly understand the many challenges, angst, frustrations and fears - as well as the total commitment and love - of those who have cheered and cared for me throughout this 15-year journey. My hand finds Ronnie's. His eyes open slightly and I hug him with all my might. Life is fiercely fragile.

Hug often....hug tight!

Suzanne Lindley has been living with metastatic colorectal cancer since 1998. She is the founder of YES! Beat Liver Tumors, an organization for individuals living with metastatic liver tumors, and an advocate for Fight Colorectal Cancer.


Targeted treatment approved for advanced cervical cancer


Elizabeth Whittington blog image

The gynecological cancer community is celebrating another milestone in the treatment of cervical cancer. Ahead of schedule, the Food and Drug Administration approved Avastin (bevacizumab) for women with recurrent, persistent or metastatic cervical cancer (read more).

Avastin is the first biological drug to be approved for advanced cervical cancer, a mere four months after it was accepted in the FDA's priority review program. Drugs that show the potential to improve efficacy or safety over currently available treatments can be accepted into the priority review program, which expedites the agency's review from nine months to six months. (You can read more on priority review in "A Primer on How Faster Approval Works.")

This latest approval was based on a study of 452 participants who were randomized to receive two different chemotherapy regimens with or without Avastin. The addition of Avastin improved overall survival from 12.9 months to 16.8 months, regardless of chemotherapy regimen. The full results were published in a recent issue of the New England Journal of Medicine, which you can access here.

Researchers noted in their study results that patients with advanced cervical cancer usually do not have sustained responses to chemotherapy, the standard of care for this disease. Given the aggressive nature of advanced cervical cancer, an improvement of nearly four months is considered meaningful. Some trial participants treated with Avastin, which works by disrupting the blood supply to tumors, experienced hypertension, fatigue and decreased appetite. Rare but severe occurrences of gastrointestinal perforations and fistulas were reported with the treatment.


Sorting out the low-risk cancers


Debu Tripathy blog image

There is so much attention on the aggressiveness and dangers of cancer – and rightly so, as it is a major cause of death in our society. However, there is a flip side to this story – a diverse group of low-risk cancers, or "precancers" that could in some cases even be better left undiagnosed, as the treatment may actually cause more harm than good. These types of malignancies include diagnoses like "in situ" or "non-invasive" cancers that are commonly seen in the breast, prostate and cervix, or "borderline ovarian tumors."

In many cases, they do not have the potential to invade other tissue or to spread, so they don't carry the same risks of illness and death. Some have even advocated that we rename these diseases without using the words "carcinoma" or "cancer," which bring out fear and anxiety and also motivate patients, as well as clinicians, to carry out more aggressive treatments.

However, these low-risk cancers can sometimes co-exist with more dangerous invasive (or infiltrating) cancers, and as they are typically treated with surgical removal, there can still be recurrences over the course of time, which can be either in situ or invasive. They rarely can result in death. However, these bad outcomes are unusual enough that when one looks at large population statistics for many of the in situ types of cancer, survival rates are indistinguishable from the normal population.

So, what are medical experts and even some patient advocates now saying?

The messages are mixed as there is controversy that balances the small risks of these cancers against side effects of diagnosis and treatment. For one, there are calls for modifying our cancer screening procedures – this is particularly true for breast and prostate cancer, where "overtreatment" of harmless cancers carry significant short- and long-term side effects. We also need to develop better imaging and tissue-based tests to identify the rare aggressive cancer hiding among a sea of low-risk cases. Finally, we need to make sure that physicians and the public are up to date on the latest recommendations and developments in this area, as it will continue to evolve.


Older is better


Jennifer Nassar

When Andrew Tomasello, of Little Silver, N.J. was chosen as an audience member to step on stage with Jimmy Fallon on "Late Night with Jimmy Fallon" in 2010, it was "one of the best days" of his life. Key word: 'was.'

"I can't say that anymore because I beat cancer," he tells me.

In 2012, Andrew, then 20, was living the life of an aspiring politician and broadcast journalist in Washington, D.C. He was elected chairman of the College Republicans at The Catholic University of America, interned at N.J. Gov. Chris Christie's office and had a job lined up at a TV station. Everything was going great until a tumor was diagnosed on his pelvis. It was deemed non-malignant, so he had non-surgical treatment to remove the tumor, and went on with his life.

When the tumor reccurred a year later, it was malignant; and Andrew received a diagnosis of osteosarcoma. That May, Andrew underwent a 10-hour surgery in which two-thirds of his pelvis was removed. "A significant part of the surgery was spent separating the tumor from his nerves so that his leg would not be paralyzed and would function, as well as his bladder and bowel," says Andrew's Orthopedic Surgical Oncologist James Wittig, chief of Orthopedic Oncology at John Theurer Cancer Center in Hackensack, N.J.

Thankfully, Andrew didn't have to undergo amputation. "In Andrew's situation, I was able to save the important nerves, blood vessels and muscles necessary for saving the leg," Wittig says. Andrew had to start treatment almost immediately following the surgery. On July 1, 2013, he had the first of his 19 rounds of chemo. His treatment also included 35 rounds of radiation. He spent the "Big 21" in the hospital due to complications from treatment. "It's ironic because I always knew I would spend my 21st birthday in the hospital sick, but I never thought it would be for chemo," he says.

Andrew spent a couple nights in the hospital for each chemotherapy treatment. During that time, he developed close friendships with his healthcare team, especially his nurses. He often posted photos on his Facebook and Instagram account of times with them.

Andrew Tomasello

Andrew Tomasello

While Andrew maintained a very optimistic spirit, he had his down times; especially in the beginning. "Yeah, I had cancer, it sucked," he says. He was saddened by having to put his life on hold; his job, school and independence--a common issue young adults with cancer face during treatment. However, the feeling was short lived. "It is hard to see anybody diagnosed with a cancer, let alone such a young man just starting college and getting his life underway," Wittig says. "He approached the entire situation very bravely."

Andrew was officially deemed in remission on April 17. "I'm 100 percent cancer–free, and it's all because of Dr. Wittig," he says. "He's the greatest man on the face of the earth."

It was just as beneficial for Wittig. "Personally, I gain such an incredible amount of fulfillment from taking care of such a brave young person and being presented with one of the largest most challenging limb-sparing surgeries and having a perfect outcome in an immensely positive and grateful patient. I will have the delight to watch Andrew finish college, lead a productive life and grow old with a great quality of life," he says.

Dr. Wittig and Andrew Tomasello

On July 29, Andrew was able to have a "cancer-free" birthday. He was thrilled not to just make up for his 21st, but to be able to celebrate more birthdays. He was set to make "22 the new 21" with his hashtag #Andrews22. He admits that he, at first, was in denial about getting older, but now he embraces it.

Can cancer be glamorized?

When Andrew and I discussed the movie "The Fault in Our Stars" (TFIOS) and he says that while it wasn't the perfect portrayal of cancer, it's very eye-opening.

He says the problem with cancer portrayal in today's storytelling is "throwing cancer into the story just for the sake of having cancer," especially with love stories. That can be misleading, he says. TFIOS "wasn't a love story that someone threw in cancer." It's a cancer story from the beginning.

Wittig says that cancer in storytelling gives young patients "courage and positivity." He says it "brings a public awareness about sarcomas and childhood cancers. It shows young adults that they can lead a normal productive life despite being stricken by such a difficult disease and that this can be overcome just like any other obstacle."

TFIOS best relates to Andrew's story and the person he is. He jokingly tells people that he's just like Augustus Waters. They both had the same cancer and prospective. "The only difference is I lived and didn't lose a leg," he says. He also makes subtle jokes, like Waters. Watch this video and see for yourself.

Wittig says one important thing young adult cancer patients can learn from Andrew is "how to make the best of a tough situation."

"There were many times when Andrew was in the hospital receiving chemotherapy and posting Facebook updates with smiling and laughing photos with his nurses," he says.

Andrew offers three bits of advice for young adults battling cancer.

1) It gets better. Just take it one day at a time.
2) You won't see it now, but you'll be a better person in the end.
3) Watch plenty of Netflix.


Jennifer Nassar is the senior editorial intern at CURE magazine. She is a second-year graduate student at the University of North Texas and a 2013 graduate of the University of Mississippi.


New screening test approved for colorectal cancer


Elizabeth Whittington blog image

This week, the Food and Drug Administration approved a new colorectal cancer screening test called Cologuard, a stool-based test. While there are other stool-based screening tests, Cologuard is the first to use a particular non-invasive method in detecting colorectal cancers and potentially cancerous polyps.

The study results, which led to the approval, were recently published in the New England Journal of Medicine. You can read the full article here.

The trial looked at more than 10,000 individuals who were at average risk of colorectal cancer and between the ages of 50 and 84 years old. The participants used either Cologuard or another type of stool test called a fecal immunochemical test. Cologuard detected 92 percent of colorectal cancers and 42 percent of advanced large polyps, compared with 74 percent and 24 percent, respectively. However, Cologuard did have a higher number of false positives, incorrectly identifying people who were negative for cancer or large polyps called adenomas (87 percent versus 95 percent).

An individual's physician would need to order the test, but the kit is mailed directly to the person's residence. The person collects the sample and mails the kit back to the company using a prepaid mailer. Results are sent to the physician, who then contacts the patient for follow-up.

The test looks for biomarkers in the stool sample that indicate the presence of cancerous cells and blood. As stool moves through the large intestine and rectum, it absorbs cells from large pre-cancerous polyps. By testing the stool using known biomarkers, Cologuard can detect blood cells and polyp cells that contain colorectal cancer-related mutations in its DNA. While the test accurately detects potential cancer, individuals who have a positive result would need to undergo a colonoscopy to confirm the polyp or cancerous mass.

Current guidelines for colorectal cancer, which include fecal occult blood tests, sigmoidoscopy, and colonoscopy, do not include the new screening test. However, that may soon change. The Centers for Medicare and Medicaid Services issued a proposed national coverage determination for the test and is expected to be issuing a coverage ruling before the end of the year. Updated guidelines may follow.

Unlike sigmoidoscopy and colonoscopy, the Cologuard test is not invasive and does not require the prep process that many people find uncomfortable. The new test may ultimately improve the rates of colon cancer screening and hence lower cancer incidence over time. The test's maker has set the price for the test at around $600.

Study authors mentioned in the NEJM article that offering a choice among tests may improve the uptake of screening. "A non-invasive test with a high single-application sensitivity for curable-stage cancer may provide an option for persons who prefer noninvasive testing."

Routine colorectal cancer screening is effective at lowering rates of colorectal cancer and death from the disease. Several groups, including the U.S. Preventive Services Task Force and the American Cancer Society, recommend people of average risk begin screening at age 50. Individuals with a family history of colorectal cancer or a medical history that increases the risk of colorectal cancer should start screening at an earlier age.

Updated 8/15/2014: One of our readers posed the question on when the test would become available. We reached out to the test's maker, Exact Sciences, and received this statement from CEO Kevin Conroy: "Exact Sciences is able to take orders for Cologuard today in the U.S. The company is completing the expected and appropriate packaging and logistical activities that are normal immediately following FDA approval. The company should be able to process orders in the very near future."


Shedding light on sun protection: Separating sunscreen facts from fiction


Shannon Trotter

August is Summer Sun Safety Month, an ideal time to think about the effectiveness of your sun protection habits. Protecting your body from the damaging rays of the sun has always been a serious health issue, but with SPF numbers ranging from two to 100 and new "sunscreen" pills hitting the market, it's surprisingly difficult to understand how much and what type of protection is best. It's important to know the facts so you don't get 'burned' by your sunscreen now and in the future.

For instance, when it comes to sunscreen, more is better. Many people don't slather on enough sunscreen to get the full protective coverage they need. Look for a product labeled "broad spectrum" with an SPF of 30 for the best protection against skin cancer. Apply sunscreen about 30 minutes before sun exposure and use about 1 oz. of sunscreen for the body, which is enough to fill a shot glass. Reapply that same amount every two hours. For a day at the beach or the pool, one person should use about half of an 8 oz. bottle.

I see a lot of patients who think sunscreen with a higher SPF means they can apply less and stay out in the sun longer. That's not true, and SPF numbers can be deceiving. For example, SPF 15 blocks about 93 percent of harmful sun rays, and SPF 30 blocks about 97 percent. Thus, doubling the SPF doesn't necessarily provide that much more protection. I tell my patients that SPF 30 is usually sufficient for most people, and the focus should be on reapplication every two hours or sooner, if you're sweating a lot or in the water.

Keep in mind that no sunscreens are "waterproof." If a lotion is labeled, "water resistant," the FDA now requires manufacturers to designate how long the sunscreen is protective while swimming or sweating.

I also caution patients about using spray-on sunscreen. It's a great option, but it can be difficult to get an even application. Make sure you spray an even coat across your skin, holding the bottle about 4-5 inches from your body. Be careful not to inhale spray sunscreen. When applying it to the head or neck, spray it into your hands first and then rub it onto the face, neck or scalp.

Although researchers are trying to develop a true "sunburn pill," the ones available today are only supplements, not federally approved medications. While they may seem like a safe alternative to sunscreen, there's no real evidence that pills alone offer protection from the sun's rays. Antioxidants in some supplements have shown promise, but before taking them you should talk to your doctor, as they could interact with other medications.

In addition to sunscreen, I advise patients to use other methods to protect themselves from the sun, such as clothing that covers their arms and legs, wide-brimmed hats that protect the face, head and ears, and sunglasses that have 100 percent UV protection. You can also buy clothing that has sun protection in it, called UPF or ultraviolet protection factor. It's also a good idea to avoid midday sun, the time when the sun's rays are the strongest.

By taking action to avoid being burned by your sunscreen this month, you're taking action to protect yourself from skin cancer in the future. Simply knowing your number and the best ways to apply your lotion can reduce serious health risks. The next time you sit in the sun, remember to separate the facts from fiction.

Shannon C. Trotter is a dermatologist at The Ohio State University Comprehensive Cancer Center specializing in skin cancer.


Immunotherapy for the melanoma patient with an autoimmune disease


Katherine Lagomarsino blog image

In the past few years, advances in melanoma treatment have generated a flurry of activity, and much of that activity has focused on immunotherapy. From vaccines to checkpoint inhibitors to T-cell therapy, these strategies involve harnessing the body's immune system to kill cancer cells, and it has been used in a variety of other cancers, from lung to bladder to kidney cancer. But is immunotherapy appropriate for the patient with an autoimmune disease?

Recently, two melanoma researchers at MD Anderson Cancer Center in Houston addressed that point during an OMEDLive webinar hosted by the Albert Einstein College of Medicine at Yeshiva University in New York.

"We often have these kinds of patients that come in and have other diseases, such as autoimmune diseases, where the immune system is already attacking the body," said Patrick Hwu, chair and professor at MD Anderson's Department of Melanoma Medical Oncology, who co-hosted the webinar with Sapna Patel, an assistant professor. These diseases include, among others, psoriatic arthritis and ulcerative pancolitis, both of which might require medications that suppress the immune system. In some cases, either immunotherapy is ineffective because of the immune-suppressing drugs, or it can exacerbate a condition, like in the case of ulcerative pancolitis.

"The issue is whether you would withhold immunotherapy from somebody who has an essentially life-threatening melanoma simply because they have an underlying autoimmune disease," explained Patel. "However, it is also the idea that if you're stimulating the immune system, and someone is on therapy that may be blocking the immune system, how effective will that be, or are you setting them up for toxicity?" In addition, transplant patients on anti-rejection medication might not be good candidates for immunotherapy, as those therapies might enhance the possibility of organ rejection.

With this in mind, what are the options for melanoma patients who must take immune-suppressing drugs?

"You first go looking for actionable mutations in that patient," explained Patel. "Maybe there is a way to treat them outside of using immunotherapy." Some targeted therapies, such as BRAF inhibitors and MEK inhibitors, are showing promise in treating melanomas with certain mutations. She added that chemotherapy might still be an option as well.

"But also you have to have a really important discussion with the patient if they have a very aggressive melanoma that could be terminal if it's untreated and unchecked, and yet they have this underlying autoimmune disease," said Patel, regarding determining the risks and benefits of immunotherapy. "If your back is up against the wall, you may have to bite the bullet."

For the full presentation, click here.


Growing old is empowering


suzanne lindley blog image

Get up. Get ready. Go.

Life moved in a routine that was fast and furious before cancer. Time never allowed for moments to really stand still, free and easy, just to enjoy. We were too busy planning for the rest of our lives when colon cancer, like a thief in the night, stole our perceived certainty of the future. At 31, we put our dreams on hold. We mourned the fact that I would die. We slowed our pace and began to savor each day.

During this decade and a half of dancing with cancer, I have experienced a future that I once thought had been snatched by colon cancer. Instead, I've gladly joined the ranks of a growing population of long-term advanced cancer survivors. With increased cancer research and the development of new therapies (now 10 available for colon cancer where once there was only one) and treatments (like Cyberknife, RFA, SIR-Spheres and the list goes on), we are creating our own survival statistics. It hasn't happened overnight, but instead with the slow and steady ticking of the clock that culminates in so many rich experiences. Life and death, grief and joy, sadness and happiness, trial and tribulation. It's hard to reminisce these past 15 birthdays with cancer and to fully absorb all that has happened in this time. I barely remember life without cancer but know that many of my most treasured memories have been held more tight and dear because of it.

The age of time seems to tell only the number of years I have lived but little about the milestones and memories made along the way. Age shares not the number of cherished memories: together times picking blackberries, walking in the morning dew, of the heavenly smell of honeysuckle or the crunch of autumn leaves beneath our feet. It doesn't embody the milestones hastened by cancer or the rush to slow down and simply grab the muchness of now.

Aging in spite of cancer does, however, provide the wisdom that borrowed time is indeed a splendid gift. The need to "get up, get ready, and go" has long been forgotten; consciously replaced with the power of "holding fast, hugging often, and hoping always." Here I am, celebrating 47 years of life and feeling that growing old - if you consider 47 old - is empowering.

Suzanne Lindley has been living with metastatic colorectal cancer since 1998. She is the founder of YES! Beat Liver Tumors, an organization for individuals living with metastatic liver tumors, and an advocate for Fight Colorectal Cancer.


Myeloproliferative neoplasm heroes honored


Kathy LaTour blog image

One of my favorite things about what we do at CURE is to honor those who help behind the scenes to support and educate patients and their families and friends. Every year we hold the Extraordinary Healer award to honor a nurse who goes above and beyond, and last year we added a new award event where we honor eight heroes who have served those with myeloproliferative neoplasms (MPNs).

While MPNs are not seen as cancer because they don't act like malignancies, MPN patients and those who have rare cancers share in many of the side effects of treatment and possible early mortality, as well as the lack of information and support for what they are experiencing.

Those suffering from this family of blood disorders not only have a complicated name to remember but also a complicated definition for one of eight types of neoplasms included in the MPN category. Within the eight, three of the neoplasms are related to a gene that produces a protein that impacts the growth of the conditions. Sometimes called the "classic" MPNs, these three are Polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF).

Those with PV have an excess of oxygen-carrying red blood cells, often accompanied by an elevated platelet count that could result in life threatening blood clots. ET is driven by an overproduction of platelets, which can slow the flow of blood and increase an individual's risk of clotting. PMF develops when the blood stem cells fail to mature properly, resulting in decreased levels of red blood cells, white blood cells and platelets. This eventually results in a scarring effect in the bone marrow impacting the marrows ability to form new cells.

Nearly 300,000 Americans live with one of these classic MPNs, and, because they are rare, those who can provide help and support to the newly diagnosed have become increasingly important.

Last year in conjunction with Incyte, CURE recognized eight MPN Heroes, patients and healthcare professionals who have committed to these diseases either personally or professionally. The MPN Heroes were recognized for either their individual commitment to patients by providing guidance, education or support above and beyond, or a broader commitment to the MPN community, meaning leadership in developing services and programs addressing the needs of MPN patients their families, friends, caregivers and medical professionals.

This year eight MPN Heroes will again be honored and CURE is collecting nominations now until September 12, 2014. So, if you know of someone who has made a difference in the lives of those with MPNs now is the time to nominate them as an MPN hero.


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