Category Archives: Medical Research

KEYTRUDA USES IMMUNE SYSTEM TO FIGHT LUNG CANCER

keytruda“It is a new day for lung cancer…  For the first time, we will be offering immunotherapy to our lung patients,” commented Dr. Stephan Zimmerman of University Hospital in Switzerland.  Dr. Zimmerman was stunned by the breakthrough trial showing that the immunotherapy drug Keytruda or pembrolizumab outperformed standard chemotherapy in a very specific group of patients with non-small cell lung cancer. Keytruda is a new cancer drug called an immune checkpoint inhibitor.  Keytruda helps your own immune system to be released to fight your lung cancer.  It’s just one of many drugs in the “personalized medicine” revolution.

KEYNOTE-024 STUDY SHOWS EXTENDED LIFE EXCPENTANCY

The breakthrough results come from the KEYNOTE-024 study published in the October 9, 2016 issue of the prestigious New England Journal of Medicine.  In this landmark study of 305 patients with advanced non-small cell lung cancer, survival (without lung cancer progression) was extended from 6 months to 10 months.  To look at the KEYNOTE-024 study another way, 70% of immunotherapy patients were alive at 1 year compared to adjust 54% of chemotherapy patients.

Although this breakthrough study is exciting, Dr. Jean Charles Soria from the Gustave Roussy Institute in France commented to Medscape, “… so the patients who are in this trial probably represent only 10% of the patients seen in clinical practice.”  But if you happen to be one of these patients, Keytruda may just be the answer for you.

WHO CAN BENEFIT FROM KEYTRUDA

Non-small cell lung cancer patients now eligible for the immunotherapy drug called Keytruda include those patients whose lung cancer biopsy showed no EGFR or ALK mutations but high levels of a cancer cell protein called PD-L1.  So it is crucial that your cancer specialists order those tests on your biopsy.

If you have any questions about your lung cancer diagnosis or treatment options, please call me, Dr. Edward Hughes, at 855-Dayton 1.

 

Breast Cancer Genetics Equals 50% Less Chemo

Genetics testing shows that 50% of breast cancer patients do not need chemotherapy.

Genetics testing shows that 50% of breast cancer patients do not need chemotherapy.

Wouldn’t it be great if you knew whether or not your breast cancer will come back? If a crystal ball could help you decide what type of treatment to have now. Chemotherapy and/or Radiation Therapy? Double Mastectomy vs. Lumpectomy? Will I develop distant metastasis – cancer spread to other organs like bone, brain, liver or lung?

Genetics Testing Can Now Answer Some of These Questions

The landmark breast cancer study called MINDACT showed that breast cancer patients deemed clinically high risk by their doctors but low risk by a genetic study (called MammaPrint) had identical survival whether or not the women had chemotherapy or not.  The 5 year rate of surviving without distant metastasis was 95.1% in those women with clinical high risk features but low genetic risk for their breast cancers. The MammaPrint test is a genetic study on your actual breast cancer itself, not on your normal tissues. It is not like testing for BRCA1/2.

50% Less Need Chemo!

Dr. Martine Piccart, chair of the MINDACT study that enrolled 6,693 women in 9 countries, told Onc.Live, “The important message here is, among the clinically high risk patients, the clinical use of MammaPrint is associated with almost a halving of the use of chemotherapy.”  That is a big number.  What the MINDACT study showed is that half of those women whose doctors thought they had high risk breast cancer did not need chemotherapy at all.

The MammaPrint genetic study was able to sort out those women who really need chemotherapy and those who did not.  And that is because many of those high risk breast cancer women really had a low genetic risk for a recurrence.  So it’s genetics, not size that matters in breast cancer treatment.

From my point of view as a breast cancer specialist, the MINDACT study is huge, providing  level I evidence – the best scientific evidence – that MammaPrint can spare many women the side effects and cost of chemotherapy.

If you have any questions about your breast cancer treatment, please feel free to call me, Dr. Ed Hughes, at 855-Dayton1.

3 New Studies On Prostate Cancer You Need to Know About

1.  Stop PSA Screening  –   Not so Fast!

In 2012, the US Preventative Services Task Force (USPSTF) came out against routine PSA screening  for prostate cancer in men, regardless of age.  But the major study used for this recommendation was likely flawed.

More importantly, since 2012, the number of men diagnosed with advanced stage prostate cancer is increasing (Cancer Epidemiology Biomarkers Prev.  2016; 25:259-263).

Dr. Richard Hoffman, an expert in shared decision-making about prostate screening, told Medscape Medical News that “abandoning PSA screening is proving harmful.”

 From my own vantage point in our clinic, PSA testing for men ages 55-70 makes a lot of sense.  Urologists and radiation oncologists are now well aware of overtreatment of patients with early-stage prostate cancer.  Active surveillance can be offered for a number of our patients.  But missing advanced stage prostate cancer or aggressive prostate cancers can be deadly.  Most of the patients that I see in my clinic are not aware of the fact the prostate cancer is the second biggest killer of men in the US, second only to lung cancer.

2.  Artery-Sparing Radiation May Help with Erectile Dysfunction 

Dr. Patrick McLaughlin of the University of Michigan Medical School reported on the benefits of using MRIs in radiation planning for patients with early stage prostate cancer.  His study was published recently in the British journal, Lancet Oncology.  While sparing the critical arteries and nerves going into the prostate gland, Dr. McLaughlin and colleagues reported that 92% of men were still able to be sexually active even 5 years after radiation. 

In my opinion, Cyber Knife offers the best sparing of the arteries and nerves leading into the prostate of any of the radiation technologies.  And at First Dayton Cancer Care, our patients have the choice of Cyber Knife or IMRT or IMRT combined with temporary, robotic seed implants.

3.  Atkins Diet Can Help Some Side Effects of Hormonal Therapy for Prostate Cancer 

Dr. Stephen Freedland of Cedars-Sinai Medical Center in Los Angeles reported on the low carbohydrate diet and hormonal therapy at the recent American Urologic Association (AUA) annual meeting.

While on hormonal therapy for prostate cancer, the Atkins diet or low carbohydrate diet resulted in better blood sugar control and weight loss than in those men who ate a regular diet.

So there is some hope in managing the side effects of hormonal therapy or androgen deprivation therapy (ADT) for patients with prostate cancer.  Unfortunately, there was no difference in PSA levels. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

Targeted Therapy Improves Radiosurgery for Patients with Metastatic Melanoma To the Brain

Radiosurgery, like that delivered by Cyber Knife, plays a big role for patients with metastatic melanoma with spread to the brain.  It’s an all too common situation-as many as 25-50% of melanoma patients develop brain metastasis during the course of their disease.  And 20-50% of all deaths among melanoma patients are linked to spread to the brain. 

But there is now good news, especially for metastatic melanoma patients whose tumors carry that BRAF V600 E mutation – about 50% of all patients with melanoma.

Physician researchers from NYU’s Langone Medical Center in NYC showed that treating metastatic melanoma patients with drugs that inhibit the BRAF mutation after radiosurgery did better than those patients on BRAF inhibitors before radiosurgery for their brain metastasis. 

And the survival results were significant with 41% of metastatic melanoma patients surviving at 12 months after radiosurgery and treatment with the BRAF inhibitor drugs compared to 19% for those patients who did not have the mutation.  The inhibitor drugs included dabrafenib, vemurafenib, or the dabrafenib/trametinib combination. 

Dr. Amparo Wolf, the senior author of this study, told Medscape Medical News, “What we have shown is for the first time median survival of melanoma has passed 1 year.”  The paper was published in the May 2016 issue of the Journal of Neuro Oncology and presented at the recent meeting of the American Association of Neurological Surgeons. 

From my point of view, the implications of the study are huge.  Firstly, it’s great news for metastatic melanoma patients whose cancer has spread to the brain.  Secondly, using targeted therapies, like the BRAF inhibitor drugs, opens up the possibility of using other targeted therapies against many other cancers, like lung, breast, prostate, kidney, and colon cancer.  Finally, I believe that the use of targeted therapies, identified by genetically mapping an individual patient’s cancer, and combining a precision drug with radiosurgery is the wave of the future. 

If you have any questions about your brain tumor or brain metastasis, please feel free to call me, Dr. Edward Hughes, at 855-Dayton1

Is Late Night Snacking Putting You at Risk for Breast Cancer Recurrence?

kitchenclosedFasting for 13 or more hours at night, including sleep, just may help reduce the risk of breast cancer recurrence.  And the effects were huge – a 36% higher risk for breast cancer recurrence for women who did not fast. This study of 2,413   non-diabetic women with early-stage breast cancer was published in the March 31, 2016 issue of JAMA Oncology.

Dr. Ruth Patterson, the senior author of the study, told Medscape Medical News “To our knowledge, this is the first paper examining nightly fasting and breast cancer progression.”  Dr. Patterson went on to say, however, that “the data are not mature enough to make clinical or public health recommendations.”

 As always, the study raised more questions that it answered.  And is likely to take a decade of research to confirm these results.  But I believe the current results are simple and yet profound.  So do what your grandmother always told you, “The kitchen is closed after dinner.”  This simple recommendation of not eating after dinner results in a huge decrease in the chances for breast cancer cure after treatment.

If you have any questions about your breast cancer, please feel free to write or call me, Dr. Edward Hughes, at 855-Dayton1.

 

Is American Medicine Rigged? The Truth about Lung Cancer

Are American patients being told all of their options?

Are American patients being told all of their options?

The Presidential primary election season has been eye-opening, with outcries by candidates from both parties of a “rigged system”. The “establishment” has recoiled from such talk. But shining the light on “the accepted way” of doing things has made all Americans more aware of the pitfalls of the system.  And asking probing questions is never bad.

It’s taken two lung cancer specialists from “Down Under” at the MacCallum Cancer Center in Australia to shine the light on the lung cancer surgery establishment in America.  In a thoughtful review of the existing studies of stereotactic ablative body radiation therapy (SABR) versus lung surgery, Dr. Siva and Dr. Ball make a compelling case for the use of SABR to treat early stage non-small cell lung cancer patients.  Dr. Siva and Dr. Ball conclude “SABR and surgery had similar estimated overall and disease-free survival.”  Their study was recently published in the prestigious  journal,  The Oncologist 2016; 21:1-6.

The situation is exactly the same as 30 years ago when I started training in radiation oncology at Harvard.  The raging controversy at that time was lumpectomy and radiation therapy versus mastectomy.  Despite study after study showing that lumpectomy and radiation was exactly the same as mastectomy, the vast majority of early stage breast cancer patients still underwent mastectomy.  But it’s always been hard to get surgeons to tell patients about surgical alternatives for early stage cancers, whether it’s breast cancer or lung cancer.

Did you know that only 14 of 50 states in America require that physicians inform early stage breast cancer patients of lumpectomy and radiation as an alternative to mastectomy?  Any wonder that those same states have more women undergoing radiation and lumpectomy than surgery?

Do you know how many states require that doctors tell early stage non-small cell lung cancer patients of using stereotactic ablative body radiation, or SABR for short, to cure early stage lung cancer versus surgery?  Exactly 0! Any wonder that many early stage lung cancer patients have never even heard of stereotactic ablative body radiation (SABR), like that delivered by Cyber Knife?  Or that the information given to them was inaccurate or incomplete?

Dr. Michael Steinberg and colleagues from UCLA looked at 102 early stage non-small cell lung cancer patients treated with stereotactic radiation (SABR)-56% had no prior knowledge of SABR before meeting a radiation oncologist.  Among those 102 patients, 39 patients had prior lung surgery for a previous lung cancer.  And 90% of those patients would rather have had stereotactic ablative body radiation, like that delivered by Cyber Knife, than another lung surgery (Lung Cancer 2015; 90:230-233).

So what’s an early stage lung cancer patient to do?  I have a modest proposal.  Early stage lung cancer patients need to be “difficult patients.” All of us doctors know the type – asking a lot of questions, having many family members present, and coming armed with a lot of facts found on the Internet. Challenging your physician can sometimes be a good thing.

So if you have any questions on your early stage non-small cell lung cancer, please feel free to call me, Dr. Edward Hughes at 855-DAYTON1

 

Lightning Can Strike Twice: Why Follow-up Visits Are Important

A new study of over 32,000 patients showed that survivors of certain cancers, namely head and Cancer-Screeningneck cancer, bladder cancer, and lung cancer are at an increased risk of another, yet different cancer.  And the second cancer can be lethal – and it’s called non-small cell lung cancer.

Dr. Geena Wu presented her research from the City of Hope National Medical Center at the recent 2016 annual meeting of the Society of Thoracic Surgeons Dr. Wu and colleagues looked at the SEER national database of 32,058 patients with a prior cancer who then went on to be diagnosed with a lung cancer 6 months or later following completion of their initial treatment.

Dr. Wu found that patients with a history of certain, specific cancers had higher rates than expected of getting non-small cell lung cancer years after their first cancer was cured.  Survivors of head and neck cancer, lung cancer, and bladder cancer were especially at risk.  Even survivors of lung cancer were at risk for coming down with a completely different second, unrelated lung cancer.  And it follows that smoking is not only the likely culprit of not only the first cancer, but the second one as well. Smoking can cause multiple cancers.

As a cancer specialist, I see patients for follow-up visits each and every day.  I hear the same story.  “I’m finally done with surgery.  I’ve been through months of chemotherapy and weeks of radiation.  And now I have to come for follow-up visits, not just for months but for years? So why won’t you specialists just give me a break?”  The answer, without question is that follow-up visits are important. You need to continue to be screened for other cancers.

Unfortunately there is no limit on the number of cancers a person can get. Especially when you are talking about cancers that can be driven by lifestyle choses such as tobacco use. Cancer screenings like mammograms, colonoscopies, skin checks, and low dose lung cancer CT scans all still need to be performed on a regular basis for cancer survivors. These routine follow ups are more important for survivors than for those who have never had cancer.

I hear our survivors tell me on a day-to-day basis, “But can’t my family doctor just do the follow-up visits?”  I think that follow-up visits by primary care physicians are ideal, but a recent poll of primary care physicians showed the two thirds preferred follow-up visits for cancer be done by cancer specialists, not the family doctor.  I think that primary care physicians are already put upon to look after your general health in a 15 minute visit.  I think the cancer specialists are uniquely trained to spot early signs of recurrent cancer as well as spotting the symptoms of a new, unrelated cancer.  Once again, early detection is key to survival.  Follow-up visits with your cancer specialist is time well spent.

If you have any questions, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

SOMETIMES WEIGHT LOSS CAN BE A BAD THING

Weight loss is not always a good thing when you are a cancer patient.

Weight loss is not always a good thing when you are a cancer patient.

Often times people experience sudden weight loss that sends them to see a doctor. All too often this is the symptom that leads to a cancer diagnosis. Cachexia-the loss of muscle mass associated with cancer-is a fancy word for an all too common symptom of newly diagnosed patients with advanced lung cancer.  Every doctor knows cachexia when they see it, especially in patients with locally advanced lung cancer. Patients experience loss of muscle instead of fat because muscle is easier for the body to metabolize into the much needed calories. Cancer itself can also cause a dramatic inflammatory response which adds to this loss regardless of how many calories are eaten.

The overall weight loss and loss of muscle mass in cancer patients can be profound. Cachexia affects 50-80% of cancer patients. And the results of cachexia can lead to a continuing decline in overall health and continued impairment of immune function. Remarkably, cachexia is the direct cause of death in 20% of cancer patients. So patients with locally advanced lung cancer are already behind the 8 ball even before starting treatment, treatments that may include chemotherapy and radiation therapy. A vicious cycle starts that can lead to further loss of appetite and fatigue, compounding the cachexia.

But a recent study published in the journal Lancet Oncology shows that help is on the way for locally advanced lung cancer patients who suffer from cachexia (Lancet Oncology February 19, 2016) Dr. Jennifer Temel, a cancer specialist at Harvard’s Dana-Farber Cancer Institute, looked at 2 different phase 3 studies-the gold standard of clinical studies-of 979 patients with advanced cancer.  653 of these 997 patients were treated with the new drug Anamorelin and 326 were treated with a placebo-a pill with no active ingredients.

After only 12 weeks, those patients who took the drug Anamorelin gained weight compared with patients who took only the placebo.  Of course, there were side effects-the main one was elevated blood sugar.

From my point of view as a cancer specialist, the studies with Anamorelin are a good start. Our advanced lung cancer patients need all the help that they can muster to help combat the side effects of chemotherapy and radiation therapy.  More research will be needed to refine the role of Anamorelin to treat cancer related weight loss and muscle loss. But I’m glad that help is on the way.

If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1

Extending Survival with Radiation after Prostate Cancer Surgery

The surprising fact to most men who undergo surgery for prostate cancer is that about 25% need radiation even after surgery.  But who should undergo radiation?  And when?

A recent report from the 2016 Genitourinary Cancer Symposium sheds some light on the issue.  Dr. Danielle Rodin and co-workers looked at the clinical records of 388 men at the Massachusetts General Hospital who underwent prostate cancer surgery followed by radiation because of a rising PSA level months to years after their surgery.  Of those 388 men who had salvage radiation, only 4 died from prostate cancer.  The Massachusetts General Hospital findings confirmed the risk factors for a rising PSA after surgery-a higher Gleason score, cancer

PSA needs to be followed after surgery.  Salvage radiation is often necessary.

PSA needs to be followed after surgery. Salvage radiation is often necessary.

invasion through the capsule, and invasion into the seminal vesicles found at time of surgery.

 But the new finding from Dr. Rodin’s study centers on the importance of PSA doubling time.  Dr. Rodin commented “We found that when the PSA level was less than 1 ng/ML, PSA doubling time was actually a more significant predictor of disease progression than the actual PSA level itself.”  

The absolute PSA level does not have to be very high before radiation is recommended by most prostate cancer specialists.  When the PSA has reached a threshold of only 0.3 ng/ML, each further increase of 0.1 ng/ML resulted in higher rates of prostate cancer progression.  Dr. Rodin went on to comment that “When you are looking at a patient and evaluating all the risk factors, if you see a rapid doubling time in a patient with a very low PSA, I think that would support starting salvage radiation therapy.” 

So What’s A Prostate Cancer Patient To Do? 

I strongly believe that prostate cancer patients who have surgery need to be proactive.  I think that they need to ask their urologist exactly what was found at surgery.  Was their cancer worse than what was thought prior to surgery?  Did the Gleason score go up as compared to the biopsy before surgery?  Did their prostate cancer go through the capsule or into the seminal vesicles?

And remember the importance of PSA doubling time-even a score of only 0.3 ng/ML that doubles to 0.6 ng/ML in less than 12 months is reason enough to start radiation therapy.  And do ask your urologist to actually calculate your own PSA doubling time.  Your health and quality of life may well depend upon it. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.  

 

Extending Survival with Radiation after Prostate Cancer Surgery

The surprising fact to most men who undergo surgery for prostate cancer is that about 25% need radiation even after surgery.  But who should undergo radiation?  And when?

A recent report from the 2016 Genitourinary Cancer Symposium sheds some light on the issue.  Dr. Danielle Rodin and co-workers looked at the clinical records of 388 men at the Massachusetts General Hospital who underwent prostate cancer surgery followed by radiation because of a rising PSA level months to years after their surgery.  Of those 388 men who had

PSA needs to be followed after surgery. Salvage radiation is often necessary.

PSA needs to be followed after surgery. Salvage radiation is often necessary.

salvage radiation, only 4 died from prostate cancer.  The Massachusetts General Hospital findings confirmed the risk factors for a rising PSA after surgery-a higher Gleason score, cancer invasion through the capsule, and invasion into the seminal vesicles found at time of surgery. 

But the new finding from Dr. Rodin’s study centers on the importance of PSA doubling time.  Dr. Rodin commented “We found that when the PSA level was less than 1 ng/ML, PSA doubling time was actually a more significant predictor of disease progression than the actual PSA level itself.”  

The absolute PSA level does not have to be very high before radiation is recommended by most prostate cancer specialists.  When the PSA has reached a threshold of only 0.3 ng/ML, each further increase of 0.1 ng/ML resulted in higher rates of prostate cancer progression.  Dr. Rodin went on to comment that “When you are looking at a patient and evaluating all the risk factors, if you see a rapid doubling time in a patient with a very low PSA, I think that would support starting salvage radiation therapy.” 

So What’s A Prostate Cancer Patient To Do? 

I strongly believe that prostate cancer patients who have surgery need to be proactive.  I think that they need to ask their urologist exactly what was found at surgery.  Was their cancer worse than what was thought prior to surgery?  Did the Gleason score go up as compared to the biopsy before surgery?  Did their prostate cancer go through the capsule or into the seminal vesicles?

And remember the importance of PSA doubling time-even a score of only 0.3 ng/ML that doubles to 0.6 ng/ML in less than 12 months is reason enough to start radiation therapy.  And do ask your urologist to actually calculate your own PSA doubling time.  Your health and quality of life may well depend upon it. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.