C. noyvi-NT Shrinks Tumors When Injected into Rats, Dogs and Humans

Editor’s note: This interesting article describes new research in which a type of bacteria called C. novyi was modified by researchers and injected into a soft tissue cancer patient to shrink a metastatic tumor in her arm. Ongoing research aims to determine which other kinds of cancer patients might benefit from the new treatment.

“A modified version of the Clostridium novyi (C. noyvi-NT) bacterium can produce a strong and precisely targeted anti-tumor response in rats, dogs and now humans, according to a new report from Johns Hopkins Kimmel Cancer Center researchers.

“In its natural form, C. novyi is found in the soil and, in certain cases, can cause tissue-damaging infection in cattle, sheep and humans. The microbe thrives only in oxygen-poor environments, which makes it a targeted means of destroying oxygen-starved cells in tumors that are difficult to treat with chemotherapy and radiation. The Johns Hopkins team removed one of the bacteria’s toxin-producing genes to make it safer for therapeutic use.

“For the study, the researchers tested direct-tumor injection of the C. noyvi-NT spores in 16 pet dogs that were being treated for naturally occurring tumors. Six of the dogs had an anti-tumor response 21 days after their first treatment. Three of the six showed complete eradication of their tumors, and the length of the longest diameter of the tumor shrunk by at least 30 percent in the three other dogs.”

Early Palliative Care Referrals Better for Cancer Patients

“Involving palliative care teams early in the disease process in the outpatient setting can significantly improve end-of-life care for cancer patients, a recent study found.

“In a secondary analysis of palliative care patterns at the University of Texas MD Anderson Cancer Center in Houston, researchers found that outpatient referrals to palliative care 3 to 6 months before death were associated with fewer emergency room visits, hospital admissions, and hospital deaths compared with inpatient or late referrals. The findings are published in Cancer.

“ ‘Bottom line, this study highlights that patients will benefit if referred early and often to palliative care services,’ said David Hui, MD, MSc, assistant professor in the department of palliative care at MD Anderson and the study’s lead author, in a commentary in the July/August issue of Cancer.”

Successful Vemurafenib Treatment of Progressive BRAF V600E–Mutated Anaplastic Pleomorphic Xanthoastrocytoma

Editor’s note: Oncologists sometimes suggest a treatment based on specific mutations found in a patient’s tumor. People with metastatic melanoma whose tumors have mutations in the BRAF gene are often treated with the targeted drug vemurafenib (brand name Zelboraf). But BRAF mutations can also be found in other types of cancer. This story tells how a patient with a brain tumor that had a BRAF mutation was successfully treated with vemurafenib.

“The BRAF inhibitor vemurafenib (Zelboraf) is approved for treatment of BRAF-mutated metastatic melanoma. There are reports indicating that vemurafenib may be active in the treatment of intracranial neoplasms with BRAF mutations. As reported in the Journal of Clinical Oncology, Lee et al from Brigham and Women’s Cancer Center successfully treated a BRAF V600E–mutated glioma with vemurafenib monotherapy.

“The patient was a 41-year-old man with WHO grade 2 anaplastic pleomorphic xanthoastrocytoma with a BRAF V600E mutation who developed radiographic progression despite surgery, radiation, and treatment with temozolomide. The patient was initially observed with serial imaging for approximately 2 years until magnetic resonance imaging (MRI) showed increased surrounding enhancement. Treatment with temozolomide was followed by radiographic progression after two cycles.”

Cancer: Unpronounceable Drugs, Incomprehensible Prices

“Cancer drug prices keep rising.  The industry says this reflects the rising costs of drug development and the business risks they must take when testing new drugs.  I think they charge what they think they can get away with, which goes up every year.

“Let’s consider the two arguments, and how the latest new drug for lung cancer supports each.

“The drug is Zykadia, Novartis ’ pill for a sub-type of lung cancer caused by a defect in the Alk gene, approved by the FDA in April of this year.  The company charges $13,200 per month for it.  Its competitor is the older drug Xalkori, Pfizer ’s pill that has the same mechanism of action and targets the same type of lung cancer.  Approved in 2011, it costs $11,500 per month.   In other words, Zykadia costs almost $2000 more per month.

“The industry talks about the risk that a drug they develop may not work.  True, there are large risks, as clinical research often fails to pan out.  Novartis took that risk with Zykadia. But Zykadia is a me-too drug.  Xalkori, the drug it imitates, was the first of its kind.  So whatever Novartis’ risk, Pfizer’s was greater.    Yet Zykadia costs more.”

Editor’s note: This is an interesting opinion piece on the rising costs of cancer drugs.

Confronting the Most Aggressive, Evasive, and Cunning of All Brain Tumors

“Cody Mahan and his family didn’t think they would have to deal with cancer again so soon.”After graduating college, Mahan, 23, had earned a prestigious Department of Defense SMART scholarship and had just started working at Warner Robins Air Force Base. He was looking forward to a promising engineering career.

“In December, he started to experience headaches and then pain in his neck. His family took him to a hospital close to where they lived in Tennessee, suspecting meningitis. Doctors discovered a tumor on the right side of his brain. ‘It was quite a shock,’ says Cody’s mother, Lisa. ‘It was the furthest thing from our minds when we went to the ER.’

“They had thought cancer was behind them. As a teenager, Mahan had ALL () and had received full cranial radiation as part of his treatment. At the time, this was a standard prophylactic for patients with ALL. The radiation, his family suspects, may have led to the development of the brain tumor. In fact, is one of the only known risk factors for developing a brain tumor.”

Editor’s note: This well-written story describes a new approach to glioblastoma surgery.

OncoBriefs: Local Tx for mRCC, Cervical Ca Prevention (CME/CE)

Editor’s note: This article describes three separate new findings in cancer research. The first is relevant for people with metastatic renal cell carcinoma (mRCC). Researchers have found that image-guided local ablation of tumors still has an important treatment role, even though there have been recent improvements in mRCC drugs. The second finding concerns people with metastatic neuroendocrine tumors (NETS). A clinical trial with volunteer patients found promising results for patients treated with the new drug lanreotide (aka Somatuline). The third finding has to do with preventing cervical cancer in women at high risk for the disease. The women involved in the study had high-grade cervical intraepithelial neoplasia (CIN 2/3), and were treated with surgical removal of the squamocolumnar junction (SCJ). These women had only low-grade recurrences, suggesting that removing SCJ cells might help prevent cervical cancer.

“More than 80% of patients with metastatic renal cell carcinoma (mRCC) remained alive without disease progression 3 years after image-guided local ablation of tumors, a retrospective study showed.

“Six of 76 evaluable tumors recurred an average of 1.6 years from treatment. Local ablation represents a “relatively safe procedure with acceptable local control rates,” authors concluded in an article published in the August issue of the Journal of Urology. A summary of the article leads off this edition of OncoBriefs, which also examines a somatostatin derivative for neurendocrine tumors and a surgical approach to cervical cancer prevention.”

Race Affects Opioid Selection for Cancer Pain

“Racial disparities exist in the type of opioid prescribed for cancer pain, according to a study published online July 21 in the Journal of Clinical Oncology.

“Salimah H. Meghani, Ph.D., R.N., from the University of Pennsylvania in Philadelphia, and colleagues recruited 182 patients from clinics within a single health system. All participants reported the presence of cancer-related pain plus a prescription for morphine or oxycodone. The abbreviated Modification of Diet in Renal Disease formula was used to estimate kidney function.

“The researchers found that the severity of analgesic-related adverse effects was greater for patients with chronic kidney disease (CKD) who received morphine versus oxycodone (P = 0.010). Compared with white patients, African-American patients had 71 percent lower odds of receiving a prescription of oxycodone (P < 0.001), when controlling for health insurance type. The effect of private insurance was no longer significant on limiting the analysis to patients with CKD, but race remained a significant predictor of the prescribed opioid selection. In the presence of CKD, race was a strong predictor for adverse effect severity, and this association was partially mediated by the type of opioid selection.”

Drugs to Avoid in Patients on Tyrosine Kinase Inhibitors

Editor’s note: More and more people with cancer are being treated with drugs known as tyrosine kinase inhibitors (TKIs). As with any other drug, oncologists who prescribe TKIs must be aware of other drugs a patient is taking to ensure there will not be a dangerous drug-drug interaction. Researchers recently published a report outlining known and potential drug-drug interactions between TKIs and other drugs. Oncologists and patients may wish to take these into account when considering cancer treatment with TKIs.

“With the rapid and widespread uptake of tyrosine kinase inhibitors (TKIs) in oncology over the past several years, serious drug–drug interactions are an “increasing risk,” according a new report.

“To guarantee the safe use of TKIs, ‘a drugs review for each patient is needed,’ write Frank G.A. Jansman, PharmD, PhD, from Deventer Hospital in the Netherlands, and colleagues in a review published in the July issue of the Lancet Oncology.

“The review provides a comprehensive overview of known and suspected interactions between TKIs and conventional prescribed drugs, over-the-counter drugs, and herbal medicines.

“All 15 TKIs approved to date by the US Food and Drug Administration or the European Medicines Agency are evaluated.

“They are axitinib (Inlyta, Pfizer), crizotinib (Xalkori, Pfizer), dasatinib (Sprycel, Bristol-Myers Squibb and Otsuka America), erlotinib (Tarceva, Osi Pharmaceuticals), gefitinib (Iressa, AstraZeneca), imatinib (Gleevec, Novartis), lapatinib (Tykerb, GlaxoSmithKline), nilotinib (Tasigna, Novartis), pazopanib (Votrient, GlaxoSmithKline), regorafenib (Stivarga, Bayer), ruxolitinib (Jakafi, Incyte), sorafenib (Nexavar, Bayer), sunitinib (Sutent, Pfizer), vandetanib (Caprelsa, AstraZeneca), and vemurafenib (Zelboraf, Roche).”

Living With Cancer: A Tour of Hospice

“Before the visit, I had been split in two not by fear of death but by dread of dying — in anxiety, dementia, but mostly in pain from recurrent ovarian cancer.

“My mind was always running on two tracks. On one track, I attended to whatever actual event was occurring, be it an outing to the library or the making of a meal. The simultaneous second track was psychic or psychotic, depending on your point of view, but invariably chilling. It took me to scenes of the degeneration that would ensue after the targeted drug I am taking stopped working.

“So I welcomed the idea suggested by a member of my cancer support group: that we tour the new hospice facility where our friend Leslie had died. “Not a recruitment visit, just a field trip,” we joked as we decided to invite our partners to join us in meeting with the co-director of Hospice House, Dr. Robert Stone.

“On a fearfully cold day, we drove to a lodge on a wooded lot at the edge of our small town. By a blazing fireplace surrounded by comfortable chairs, about 10 of us amassed — six women dealing with gynecological cancer and some of our husbands. We were quiet because the family of a patient was using the adjacent kitchen.”

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