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Melinda Liggett Irwin, discusses The Women's Activity and Lifestyle Study in Connecticut (WALC) study, a randomized trial of exercise on quality of life and fatigue in women diagnosed with ovarian cancer.

Melinda Liggett Irwin on Exercise and Fatigue in Women Diagnosed With Ovarian Cancer

Melinda Liggett Irwin, discusses physical activity, fitness and quality of life in cancer survivors. Specifically, she discusses the LIVESTRONG at the YMCA Program.

Melinda Liggett Irwin Discusses Fitness After a Cancer Diagnosis

Not all chemotherapy is by infusion. There are also oral chemotherapies.

That is what my oncologist is having me do for the next two weeks.

We stopped the intravenous infusions, which gave me a break from that experience. There is an expression we commonly use in our casual conversations that goes something like “Take the bitter and the sweet,” or “That was a bitter pill to swallow.”

Well, I am here to tell you that I am taking a bitter chemotherapy pill! As soon as it touches my tongue, my face begins to cringe. There is also a misguiding assumption that we can taste certain things better in different places on our tongue, but that is untrue. We can taste everything on all parts of our tongue. There are five types of taste buds (bitter, sweet, sour, salty and savory) and mine are working just fine. However, that is not true for my spouse. He has metastatic prostate cancer and went through target-specific radiation and his taste buds have not recovered yet. I have learned that everyone reacts differently to changes in the taste buds with radiation therapy.

For some people, they can recover as quickly as two months but for others, it can take up to two years or more. Unfortunately, my spouse is one of the latter. He went to the local farmer’s market and purchased some fresh raspberry and peach homemade jam. When he got home, he realized he could not taste it. When I put some of the jam on my toast with butter the flavor was subtle but good. I could clearly taste the peach and raspberry flavor. He has been noticing this side effectmore and more as we eat fresh fruits and vegetables. It is frustrating when you like something and can’t taste it. So I try to empathize with him.

The bitter pill that I take has to be taken with food. There is no wonder about that issue. Normally I take this pill first thing in the morning.

So, I have been making my breakfast with cereal and fresh fruit. I am rotating each day with fresh strawberries, peaches and blueberries. Now, I fill my stomach with cereal and fruit and then take the bitter pill with a slice of peach or a strawberry. That makes it tolerable. But there are a few occasions when it slips on my tongue, and I can immediately taste the bitterness blasting through my mouth! I am learning to take the bitter and the sweet in my mouth and in my life! It is the only way that we can get through our trials and tribulations. We have to accept the good and the bad. We have to embrace the positive and the negative.

We have to accept the happy times and the sad times. The bottom line is we must embrace the life we have been given. All we can do is try to find the balance in our life and be as resilient as possible. We have to strive for a positive outcome in our treatment and put up with the bitter pill!

For more news on cancer updates, research and education, don’t forget to 

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Oral chemotherapy offers an alternative to intravenous infusions, but it can present its own challenges, such as unpleasant taste. Taste alterations are common side effects of cancer treatments, with recovery times varying significantly among individuals. The narrative highlights the importance of resilience and finding balance amidst the challenges of cancer treatment. It emphasizes the need to accept both positive and negative experiences, striving for a positive outcome despite the difficulties. The story underscores the shared journey of patients and their loved ones in navigating cancer's complexities.

I’ve recently started on chemotherapy pills instead of infusions and the bitterness reminds me to accept not only the bitterness of the pill, but in life too.  

Tumor

 My Bitter Chemotherapy Pills for Chronic Lymphocytic Leukemia 

When a man receives a diagnosis of prostate cancer, Dr. Charles Ryan has two immediate questions: Has it spread outside of the prostate and, if so, is it resistant to the hormonal therapy typically used to treat the disease?

“When we talk about a patient with a life-threatening form of prostate cancer, those
are typically patients who have both of those phenomena,” said Ryan, director of the Division of Hematology, Oncology and Transplantation at the Masonic Cancer Center of the University of Minnesota in Minneapolis. “The cancer spreads to the bone, and standard hormonal therapy stops being effective, so the cancer begins to grow despite the lowering of testosterone.”

While those cancers, known as castration-resistant or hormone-resistant, represent the most advanced stage of the disease, the good news is that there are numerous ways to treat such cases, Ryan told 

. “In fact,” he said, “the number of treatments for prostate cancer has really exploded in the last four or five years, and it’s actually going to get even bigger in the next few.”

CURE®: What kinds of therapies are available to treat prostate cancer that has spread?

: We can divide them into three or four categories. With hormonal therapy, the standard of care would be some form of ablation of the level of testosterone in the body (because testosterone fuels the cancer). We typically do this with injections that lower the level of testosterone by about 90%. The most commonly used drugs would be leuprolide (Lupron Depot), degarelix (Firmagon) and goserelin (Zoladex). 

On top of that, we have targeted hormonal therapies that block the effect of testosterone even when the first line of therapies has failed. And that’s where we have drugs like enzalutamide (Xtandi), abiraterone (Zytiga), apalutamide (Erleada) and darolutamide (Nubeqa).

Compared with some other cancers, we use relatively little chemotherapy, but we do have some very effective chemotherapies. Docetaxel can be used in advanced hormone-resistant disease or as an initial therapy for metastatic disease. And we have a drug called cabazitaxel, which is similar.

The new class of drugs that we’re using now is the PARP (poly-ADP ribose polymerase) inhibitors, which target the mechanism of DNA repair (making it harder for cancer cells to repair themselves when damaged; these are used in patients whose cancers are already deficient in this ability due to gene mutations). In addition, we have a cellular therapy called sipuleucel-T, which is used in castration-resistant, metastatic disease. Finally, we have a radioisotope called radium-223, which is used in disease that has spread to the bone, causing bone pain.

Do patients have trouble sticking with any Q of these regimens, and, if so, what kinds of problems can that cause?

Treatment adherence has to do with whether the prescribed medication actually gets into the patient. Adherence for injected drugs is, of course, high; if a patient shows up and has the drug injected, adherence is almost 100%. But with oral drugs, we can lose adherence for a number of reasons. One is that a patient could take a bottle of pills home, put it in his medicine cabinet and never take it. Or, it could be that a patient starts to take a medication and because he doesn’t feel so good, he stops taking it. We would want to hear about that, why he doesn’t feel well and whether we could reduce the dose or give him a treatment break. As oncologists, that’s our job.

But the reality is that all the research in the world that leads to the development of a new therapy isn’t effective if we don’t get it into the patient. So, it’s sort of a dialogue between the doctor and the patient about what can or cannot be administered and why. It may not be just one factor. 

Unfortunately, a problem in this country is that patients sometimes bear a lot of the cost of their medication, so not being able to pay would be one (reason) for a patient not adhering to the treatment regimen. And that is something that I, as a doctor, would want to hear about, because we can think about patient assistance programs if they exist in your area, or we can think about ways we can reduce the dose to allow us to effectively deliver the drug, but perhaps on a slightly more cost-effective schedule.

How do treatment side effects impact the quality of life for patients?

The major driver of quality of life in advanced prostate cancer is the efficacy of the therapy, and this has been shown, for example, with chemotherapy. Many men might think, “Well, chemotherapy is going to be associated with a very poor quality of life.” But that didn’t bear out in a study that was done many years ago, in which patients (newly diagnosed) with metastatic disease were treated with standard hormonal therapy with or without chemotherapy. 

The patients who were on the chemotherapy had a slightly lower quality of life after about three months of treatment, but after 12 months of starting treatment, the patients who had received the chemotherapy had a better quality of life. And that was because 12 months after starting the treatment, the patients had already been done with the treatment for six months. They were less likely to have their cancer worsening, and better cancer control leads to better quality of life.

What treatments are being tested in clinical trials that might eventually become options for men with advanced prostate cancer?

I would put clinical trials into one of two categories. The first would be optimization studies using therapies that exist, but maybe we’re testing them in an earlier disease population, or looking for a better outcome by giving it to a patient with a lower volume of disease.

For example, there are studies of enzalutamide and abiraterone, commonly used drugs that, when first approved, were given to patients who had received all (available) prior therapies and chemotherapy. But then we showed that we could give them to patients with castration-resistant prostate cancer who did not have chemotherapy, and then to patients (who were) newly diagnosed, and the outcomes were better than giving standard hormonal therapy alone. 

Now, studies are looking at patients who do not have metastatic disease. This is where we’re going with prostate cancer therapies: Optimizing their use, moving them earlier in the disease spectrum and maybe changing doses.

The next type of clinical trial would be (one that uses) new therapies and new approaches. One would be the PARP inhibitors, which are relatively new. The two that are approved currently are called Lynparza (olaparib) and Rubraca (rucaparib).

The second category that’s really exciting is PSMA (prostate-specific membrane antigen) targeted therapies, and we have one that’s looking really interesting. It’s a molecule that targets PSMA (a protein in prostate cancer cells that fuels the disease), which arises from a very common mutation of a gene called PTEN. On one end, the treatment binds the PSMA, and on the other end, it has a sort of molecular basket. 

In this basket, you can put a molecule: In this case, it’s the radioisotope lutetium-177. The targeted treatment sort of hand delivers the radiation therapy to the prostate cancer cell. And that looks really interesting and could get FDA (Food and Drug Administration) approval in the next few months or year.

There’s another less-known, genetic-based therapy being studied, a drug that targets a molecule called AKT (generated by a fairly uncommon) mutation. If that mutation is there, then this AKT is activated and stimulating the cancer, and the drug blocks it. We might hear data on that in the coming year, and it could become available, most likely, in the advanced castration-resistant metastatic setting.

What will all this progress mean to patients? 

We started maybe 20 years ago thinking about this idea of personalized medicine and targeted therapies, and we’re kind of there. We’re not quite there totally, because we’re not at the point where every patient has some unique profile that leads to a special cocktail of treatment. I think that’s still a little bit far off, but we are seeing the beginning of this process.

If patients want more information or support, where can they turn?

I would first recommend that patients go to the website of 

ZERO is not only an informative website, it’s also an advocacy organization. ZERO also has an annual meeting that patients can attend. I’ve spoken at it the last couple of years, and I have a number of colleagues who have, and there’s a lot of information there. 

I would also recommend looking at the National Cancer Institute’s 

. They have a thing called PDQ, patient data query, which is a very dry presentation of patient outcome data but can be helpful for making decisions. 

, which is a group that I’ve worked with. They have patient materials that one can order, such as a cookbook for patients with prostate cancer and other things that can help them address lifestyle issues in a way that might be helpful for their long-term health.

Prostate cancer management involves assessing metastasis and resistance to hormonal therapy. Advanced cases, often hormone-resistant, have seen a surge in treatment options, including hormonal therapies, chemotherapies, PARP inhibitors, and radioisotopes. Treatment adherence is crucial, with challenges arising from oral medication compliance and financial burdens. Side effects impact quality of life, but effective cancer control can improve it. Clinical trials focus on optimizing existing therapies and exploring new ones like PSMA-targeted treatments. Progress in personalized medicine is ongoing, with resources available for patient support and information.

A growing number of treatments are available to men whose prostate cancer has spread and become resistant to hormonal therapy.

Treatments for Men Whose Prostate Cancer Has Spread and Become Resistant to Hormonal Therapy are Growing

There were several updates in the field of skin cancer in 2020. Here, 

® looks back at some of the most-read news and updates in the field of skin cancer that patients may have missed.

Patients with stage 3 melanoma who had one or more circulating tumor cells were found to relapse sooner, providing physicians with an important biomarker to treat the likelihood of relapse. 

Adjuvant Tafinlar (dabrafenib) and Mekinist (trametinib) elicited a greater than 50% relapse-free survival (RFS) rate in patients with resected, stage 3 BRAF V600E/K-mutant melanoma, according to findings from a five-year analysis of the phase 3 COMBI-AD trial. 

A personalized vaccine has demonstrated long-term disease-free and overall survival benefits in patients with stage 3 or stage 4 melanoma at a high risk of recurrence following complete surgical resection, according to the vaccine’s manufacturer, Elios Therapeutics. 

Patients appear open to the idea of using artificial intelligence (AI) to help in screening for skin cancer, however many patients stress the need to preserve the patient-physician relationship if implemented, according to study results published in 

Following a median follow-up of three years, the use of immunotherapy agent Keytruda (pembrolizumab) for the adjuvant treatment of patients with resected, high-risk, stage 3 melanoma demonstrated a sustained and clinical meaningful improvement in recurrence-free survival (RFS), compared with placebo. 

In 2020, significant advancements were made in skin cancer treatment and research. Circulating tumor cells in stage 3 melanoma patients were identified as a biomarker for relapse. Adjuvant therapies like Tafinlar and Mekinist showed promising relapse-free survival rates in BRAF-mutant melanoma. A personalized vaccine offered long-term survival benefits for high-risk melanoma patients. Patients expressed openness to AI in skin cancer screening, emphasizing the importance of maintaining the patient-physician relationship. Keytruda demonstrated improved recurrence-free survival in high-risk stage 3 melanoma patients.

A roundup of some skin cancer news and updates that occurred in 2020 that patients may have missed.

The Top 5 Skin Cancer News and Updates That Patients May Have Missed in 2020

Although patients with metastatic breast cancer benefit from many factors including a multidisciplinary approach to care and thorough education to make treatment decisions, one of the most critical tools throughout this entire process is communication between patients and their care teams, an expert said.

 in Metastatic Breast Cancer, a panel of experts from Miami Cancer Institute in Florida discussed the space including information on initial and subsequent treatments, biomarkers and other areas that may be helpful for patients with the disease.

CURE also spoke with Dr. Jane Emilie Mendez, chief of breast surgery at Miami Cancer Institute in Florida, who chaired the event, to learn more about how information like this can be beneficial for patient outcomes.

“[Cancer isn’t] one street,” Mendez said in an interview with CURE. “It’s not your doctor wants to do this and that's that, because we need to know that we're keeping a balance between our efforts to cure you — at least keep your metastatic disease at bay — and your quality of life. … Even [if] we're keeping the cancer at bay but you're miserable with the side effects, what have we gained? … Ultimately, it's all about quality [of life].

Mendez added that multidisciplinary care that is often applied to patients with metastatic breast cancer is not “one size fits all.”

“We need to tailor the therapy to the specific characteristics of the tumor,” she said. “We have now so many ways that we can do that, either with tissue biopsy or liquid biopsy (with blood), tissue sampling, and how far we’ve come in terms of trying to better define all the subtleties about the tumors.”

With the identification of biomarkers, cancer teams can steer the treatment of patients with metastatic breast cancer in a direct that may be more effective.

“What are the characteristics within the particular tumor that the patient has that will allow us this ability to look for other potential treatments once they failed the standard and the minimally invasive [option],” Mendez said in an interview.

Even though treatment often starts with hormone therapy, which is minimally invasive and is often tolerated the best before systemic treatments, Mendez said, tumors may mutate over time. Thus, tumors should be checked periodically for any changes in biomarkers.

“It’s really more important to check that the tumor hasn’t mutated,” Mendez said. “And that will open the ability for us to find other potential treatments for the patient. It’s an ever-evolving trajectory. We cannot assume, and each patient is unique as well as their cancer. So those continued biopsies, when indicated, we see progression, that's our avenue for what else can we use.”

Knowing all of this information while navigating the treatment landscape of metastatic breast cancer is help so that patients can advocate for themselves and feel empowered along the way.

“[Patients should] know, if they're at a place that they're not seeing this type of activity or this type of [treatment] flow, they can seek out other opportunities so that they can get what's best for them, given their circumstances,” Mendez said. “At least be aware, because knowledge is power.”

Even with education, there may be a risk of overwhelming patients with information, some of which may also be misinformation.

“If [patients are] tech savvy, they can go to the computer, but a lot of [the information] might not be applicable to them, but be misinformation,” Mendez said. “And how do you know, as a patient, to discern what's real and what's not? And how do we, as people who are in the business, control that? Dr. Google is very famous, so that's a big problem that we have.”

In addition to misinformation, the educational material patients read should also be tailored to their educational level.

“There’s a lot of people who don’t even understand the word ‘cancer,’” Mendez said. “So how do you simplify that information so that they get it, and they can feel even that they have power with what’s happening to their body. It’s really hard.” 

Building Confidence to Discuss Side Effects

Patients have many members on their care team including the oncologist, the advanced practice provider (like nurse practitioners), a nurse and patient navigators, in some instances. As long as patients voice any concerns — no matter how big or small they may seem — to someone on that team, it should be then discussed with the member of the team who makes treatment decisions. 

Mendez said that patients should feel comfortable to discuss their side effects, ask questions and communicate with their team, even though some patients may be like to discuss their concerns than others.

“Not all patients have the same needs,” she said. “Some patients are very, very self-sufficient, and they'll be very vocal. It's more about the patient who doesn't want to impose upon the doctor. They feel that they would be bothering the doctor by calling. But in reality, if we don't know, we cannot do anything about it.”

Once made aware of any concerns, care teams may be able to help address them either with pharmaceutical modalities or even adjusting doses of the cancer treatments.

“A lot of these side effects occur not when you're at the doctor's office; they occur when you're taking the medication at home,” Mendez said. “You might be having dehydration. You might have diarrhea. You might be having fatigue. You don't want to do anything. You might be depressed. Whatever the reason might be, if we don't know, how can we change that or adjust the treatment to make it more palatable for the patient?”

Effective communication between patients and care teams is crucial in managing metastatic breast cancer, alongside a multidisciplinary approach and patient education. Tailoring treatment based on tumor biomarkers is essential, as tumors can mutate over time, necessitating periodic reassessment. Patients should be empowered to advocate for themselves, but must navigate potential misinformation. It's vital for educational materials to match patients' comprehension levels. Patients should feel confident discussing side effects with their care team, as addressing these can improve treatment tolerability and quality of life.

Through communication and education, patients with metastatic breast cancer may be able to balance treatment with quality of life. 

Melinda Liggett Irwin

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