Monthly Archives: May 2015

Breast Cancer- Are Women Getting the Best Treatment?

Build the best team to beat your cancer. A surgeon, a chemotherapist and a radiation oncologist should all be consulted.

Build the best team to beat your cancer. A surgeon, a chemotherapist and a radiation oncologist should all be consulted.

Many Women Need Radiation Even After a Mastectomy

Every week I see breast cancer patients decide on whether or not to have mastectomy, or whether to have lumpectomy and radiation. Many women tell me “I just want to have surgery and get it over with.”  But for women whose breast cancer has spread to 4 or more lymph nodes in their axilla (armpit), a course of radiation treatment may be life-saving.  Radiation treatments after mastectomy can reduce breast cancer recurrence by as much as 25%.  And national guidelines explicitly recommend radiation for breast cancer patients with 4 or more positive axillary lymph nodes. There are a great many studies that suggest radiation after mastectomy may be indicated in women whose breast cancer spread to only one lymph node.

So How Many Women Get the Full Treatment That They Need?

The answer is that 1 in 3 breast cancer patients do not receive radiation recommended after mastectomy.  And that’s really a big number in the United States. Dr. Quyen Chu, a professor of surgery at Louisiana State University Health Services Center, led a study of 56,990 women diagnosed with breast cancer in the National Cancer Database.  Those women with breast cancer that spread to 4 or  more lymph nodes were studied between 1998 and 2011.  According to Dr. Chu’s study, only 65% woman underwent radiation therapy that was recommended.  In a press release, Dr. Chu said “we could not tease out whether patients refuse treatment or there is a lack of awareness among women and physicians about the need for radiation therapy after mastectomy for locally advanced breast cancer.”

So Why Didn’t These Women Have Radiation?

I can only conclude it is because their surgeon did not schedule a consultation with a radiation oncologist before or after surgery. Upon more detailed analysis, 2 interesting facts emerged from this study.  Firstly, those women who had chemotherapy or were re-admitted to the hospital within 30 days after surgery were more likely to undergo the recommended radiation.  Secondly, whether or not women underwent radiation did NOT depend on insurance, education, race, ethnicity, income, education status, rural versus city locale, or size of the hospital.

To say these findings on nearly 57,000 breast cancer patients is disappointing is a real understatement.  What was not reported in the study is whether or not women even saw a radiation specialist as part of their decision making process.

In this day and age, I believe that each and every breast cancer patient, whether or not they undergo lumpectomy or mastectomy, young or old, early-stage or advanced stage, needs to have a radiation oncologist as part of the “breast cancer conversation.”

Watch my interview on this subject to learn more. Living Dayton Interview on Breast Cancer

 

 

 

 

Why is Cyber Knife Revolutionizing Cancer Treatment? It’s More Than Just 5 Versus 40 Visits.

Simply put, Cyber Knife Stereotactic Ablative Body Radiotherapy, or SABR for short, controls cancers even better than predicted.  For example, the results for patients with early stage lung cancer have been particularly striking. Studies have shown 85-90% cancer control rates with a 3-5 Cyber Knife treatments versus only 30% with 30-40 ordinary radiation treatments.  This means that  85-90% of lung cancer patient treated with the Cyber Knife got rid of their cancer. That is a huge increase in successful cancer treatment. More people are beating their disease with the Cyber Knife than with ordinary radiation therapy.

Because of this success, a lot of research is being done to find out why it is working so well. And to learn how else SABR can be used to treat cancers and other diseases. Here are some cutting-edge facts:

Cyber Knife Damages Cancer’s Blood Supply  

    1. In a recent editorial, oncologist Dr. Paul Sperduto and colleagues stated “the literature supporting this phenomenon (high-dose radiation results in indirect tumor cell death) is not fragmentary, but actually quite robust….  However, we have consistently underestimated the role of indirect cell death by devascularization and its possible role in radiation-induced immune enhancement.”  (Int. J Radiation Oncol Biol Phys. 91, No.1,pp121-13, 2015)
    2. When you cut off the blood supply to the cancer cells, they die. Decades of research shows that a few high doses of radiation will damage the blood vessels supplying the tumor. There is now active research combining Avastin, a drug that blocks blood vessel formation and SABR. Using Avastin and the Cyber Knife may double the efforts to cut off the tumor’s blood supply.

 Cyber Knife Can Generate an Immune Response to Attack the Cancer

Cyber Knife may help unleash your body’s own immune system to fight your cancer. Recent studies suggest that SABR cause the body to release tumor-specific antigens. These antigens are unique molecules released after radiation destruction of cancer and can generate a cancer-specific immune response.  Once again, there is now active research combining SABR, like that delivered by Cyber Knife, with the recent FDA approved drugs called immune checkpoint inhibitors.

Cyber Knife Tracks Your Cancer As It Moves

Much like a jet-fighter pilot who always has a enemy target in its cross-hairs, Cyber Knife can track your lung cancer as it moves with each and every breath.  Cyber Knife’s pencil thin beams of radiation can destroy your tumor, while sparing surrounding normal tissues.  Because of this precision, Cyber Knife  uses hundreds of beams of radiation instead of 5 – 7 beams delivered with other radiation machines. With the Cyber Knife you do not have to hold your breath during treatment. You just lie still and the machine does all the work for you.

It is not just lung cancers that move.  Prostate cancer, liver cancer, pancreas cancer, and many other cancers move inside the body.  Cyber Knife is the only radiation device that directly watches your cancer as it moves, keeping collateral damage to a minimum.

If you or a loved one has cancer, learn all the options. Cyber Knife may be the answer to beating your cancer. Call me to discover how I may be able to help win your fight.

4 Key Things You Can Do When a Loved One Has Cancer

We celebrated Mother’s Day this past Sunday. I cherished the phone call that I made to wish my own mother a Happy Mother’s Day.  I enjoyed seeing my wife’s daughters and family wish her the same. Mothers are the ultimate caretakers. Everyone needs to be cared for at different stages in their life.

"One person caring about another represents life's greatest value."- Jim Rohn

“One person caring about another represents life’s greatest value.”- Jim Rohn

But it was a bittersweet holiday for me this year. My own mother will soon be 89 years old. I know that there will not be many more of those phone calls. And while it was great seeing my wife showered with love, I also know how difficult this day was for her. It was her first Mother’s Day without her own mother. She passed away from head and neck cancer last fall. My wife spent much of last year traveling to Florida to help take care of her. Many of us have experienced this role reversal. The child becomes the caretaker.

I see this in my profession time and time again. But anytime you experience it first hand, it teaches you many new lessons. One of the charitable organizations we support is “Stand Up to Cancer.” For Mother’s Day weekend that organization ran newspaper ads stressing the power of caregivers and how much they really can help cancer survivors. Here are some tips that they had for caregivers that hit home to my wife and me.

1) They talk, you listen.

It’s harder than you think  – just listening without judging and without problem solving. Cancer patients simply want compassionate understanding. You can help care for them, but you cannot fix them or truly know what they are going through. You can hold their hand and be silent as you listen. Remember that laying hands on someone may be the greatest gift you can give.

2) Don’t ask, just do.

Instead of waiting for the cancer survivor to ask for help, just jump in and do. Most of us are too proud to ask for help even though we desperately need it. It is the everyday tasks that can be overwhelming. Simple tasks like doing laundry, grocery shopping and cleaning house become giant hurdles when the person doesn’t have the energy or strength. You can offer specific tasks that you can do for them. Helping with these little things are a huge help to the cancer survivor.

3) Learn, so you can understand.

While you will never fully know what your loved one is experiencing, you can learn what needs to be done to help them through this battle. Unless you are specifically asked, you do not want to give your opinion on medical issues. However if you understand all that is involved in their medical care, you’ll be better able to understand the treatment process and the terms being used. This way you can help the patient understand what is happening when they have so much information coming at them. You can track questions, help with appointments and know how you can be most useful. It’s best to use good Internet sources. If you are involved in their doctors’ visits, ask their nurses what are the resources that they recommend. Stick with national organization web sites for starters.

4) Keep them connected, be the bridge.

Remember that the cancer patient still wants to be part of everyday life. After diagnosis friends and even family may drift away. As a caregiver you may be in the best position to keep family and friends informed. With the Internet it’s easier than you think. There are websites like Caring Bridge and Care Monster to help you communicate with family and friends in a private forum. This also keeps you from having to explain what is going on over and over again. They can also leave messages for the survivor to read when they feel up to it. This is a way to stay connected on the survivors own time. Encourage friends and family to keep the survivor involved in everyday happenings too. This helps them feel connected and hopeful. Sometimes a loving note or words of encouragement can mean the world to the survivor who is feeling all alone in this.

Being a caregiver can be as self-less and as exhausting as motherhood. Neither the caregiver nor the mother are often told thank you, but they are both essential to the happiness and well-being of those that are in their care. So as we honor our mothers this May, take the time to say ‘Thank You’ to all the caregivers in your life. If you are a caregiver, know that you matter.

 

3 Key Advances in the Immunotherapy of Cancer You Need to Know About

The hottest topic at April’s meeting of the American Association of Cancer Research was the immunotherapy of cancer. Over 18,000 cancer specialists at this meeting were excited at the thought of unleashing your body’s own immune response to combat cancer. At the same time, the results of two key studies were published in the prestigious New England Journal of Medicine, the April 19 2015 edition. These results support the latest advances in immunotherapy.

Immune Check Point Inhibitors Are Effective for Patients with Advanced Lung Cancer

Medicines that Ignite Your Own Immune System to Fight Cancer

Medicines that Ignite Your Own Immune System to Fight Cancer

1. Even when chemotherapy fails, immunotherapy of cancer with immune check point  inhibitors takes advantage of the fact that many cancers can evade the body’s own immune response from activated T-cells. These T-cells can kill cancer, but the newly approved drug, Ipilimumab, takes the natural brakes off the immune system. Unleashing it’s power.

Dr. Edward Garon and colleagues of the KeyNote-001 investigation group, studied 495 patients with advanced lung cancer, many of whom had prior treatment with chemotherapy. The exciting finding was that 18% of 394 previously treated patients and 24.8 % of 101 previously untreated patients, had a positive response to the newly approved immune checkpoint inhibitor drug. The drug, Ipilimumab, works by blocking the CTLA-4 molecule on activated T-cells. Of the advanced lung cancer patients who responded to the newly approved drug, 84% had no lung cancer progression.  Importantly, the median or average response lasted for over 12 months. Therefore, this new drug extending the life of these lung cancer patients without giving them more chemotherapy.

A Combination of 2 Different Immune Check Point Inhibitors Are More Effective Than One for Patients with Metastatic Melanoma

2. Dr. Caroline Robert and coworkers of the KeyNote-006 investigation group conducted a randomized, controlled phase 3 trial on 834 patients with advanced malignant melanoma. This type of clinical trial is the gold standard of clinical trials. The study showed conclusively that the immune check point inhibitors Pembrolizumab plus Ipilimumab were better than Ipilimumab alone. The relative risk of cancer progression or death was decreased by 42% with the combination regimen. And with a low risk of harmful side effects – less than 10% of patients.

Adding Stereotactic Body Radiotherapy May Be the Most Effective Treatment Combination

3. One reason that patients with metastatic melanoma may not respond to Ipilimumab is that their immune system has not been activated against their own cancer. Stereotactic body radiotherapy, like that delivered by CyberKnife, has been shown to release tumor antigens. Tumor antigens are the molecules on the surface of cancer cells that are recognized as foreign by the body’s immune system (just like a cold virus). These tumor antigens can stimulate the body’s own immune system to activate T cells- the immune cells that can kill cancer- creating, if you will, a “personalized cancer vaccine.” A multi-disciplinary team of cancer specialists at the University of Pennsylvania School of Medicine is currently conducting a trial that combines stereotactic body radiotherapy with Ipilimumab. And the preliminary results are very optimistic.

I believe that the new wave of the future for many cancers will be upfront CyberKnife treatment followed by immune check point inhibitors. Surgery and/or chemotherapy will follow, but only after the patient’s own immune system has been ignited.

Please feel free to contact me, Edward Hughes, M.D. PhD, at First Dayton CyberKnife                1-866-DAYTON1 if you have questions about immunotherapy and CyberKnife.