chemotherapy

RECENT POSTS

Cancer Haves And Have-Nots: Care And Treatment In 2 Different Worlds

By Michael J. Misialek, M.D.
Guest Contributor

Imagine feeling a lump on your body, visiting a doctor, and then waiting seven months (if you’re lucky) to find out whether it is cancer.

This has been the reality for the vast majority of patients in two of the world’s most impoverished nations, Rwanda and Haiti — both emerging from different but unthinkably grim histories of structural violence.

But since 2012, more patients are getting the care that everyone deserves, no matter what country they live in. A medical partnership between several Boston-based hospitals has radically reduced turnaround time for cancer diagnosis, and shrunk the number of people who fall through the cracks.

It is difficult to quantify the exact numbers here, since record keeping in the past has been poor. One data point: In Rwanda, where these interventions are in place, far fewer patients are lost to follow-up after they’ve been treated compared to patients in other poor countries, according to Dr. Larry Shulman, senior vice president for medical affairs at Dana-Farber Cancer Institute, and leader of the medical partnership.

As a pathologist at of one of these partner institutions — Newton-Wellesley Hospital — I can’t help but think about the patient behind the slides under the microscope. Here’s one: Tushime, an 11-year-old Rwandan girl, who had a large tumor protruding from her jaw.

The tissue sample from Tushime’s tumor arrived in Boston in a suitcase carried by an employee of Partners in Health, the global nonprofit. Like all other specimens, hers was processed into a slide by the pathology department of Brigham and Women’s Hospital and read by Harvard faculty.

Tushime’s tumor turned out to be a rhabdomyosarcoma, a common childhood sarcoma. After 48 weeks of chemotherapy and surgery in Rwanda, she is now healthy and free of disease. Doctors there used standard chemotherapy for a cost of about $300 (which was covered by Partners in Health, Dana Farber and the Rwandan government). They relied on age-old, tried and true chemotherapy drugs; in comparison, the newer chemotherapy agents in the U.S. often cost several thousands of dollars.

Even though access to care has improved dramatically in the developing world there is so much work to be done. There are patients who still present with tumors at an advanced stage, many being neglected for months or even years because of barriers to care. There’s often a lack of access to facilities for both diagnosis and treatment, and funding for cancer care is limited. As a result, ordinary diagnoses become extraordinary.

This is an image of a less aggressive (low grade) breast cancer, something that is fairly common among patients in the U.S. You can see the well formed tubules and glands of cancer, but fewer tumor cells growing in a more organized fashion -- only about 30 percent of the image is tumor. (Courtesy of Michael J. Misialek)

This is an image of a less aggressive (low grade) breast cancer, something that is fairly common among patients in the U.S. You can see the well formed tubules and glands of cancer, but fewer tumor cells growing in a more organized fashion — only about 30 percent of the image is tumor. (Courtesy of Michael J. Misialek)

This is an image of an aggressive (high grade) breast cancer not uncommonly diagnosed among patients in countries where access to medical care is limited, such as Haiti. You can see a solid mass of cancer -- the photo is 100 percent tumor. (Courtesy of Michael J. Misialek)

This is an image of an aggressive (high grade) breast cancer not uncommonly diagnosed among patients in countries where access to medical care is limited, such as Haiti. You can see a solid mass of cancer — the photo is 100 percent tumor. (Courtesy of Michael J. Misialek)

Under my microscope, I’ve seen some of the most aggressive appearing tumors from patients in these countries. What are typically rare cancers here in the U.S., such as sarcomas or unusual variants of breast cancers, are all too common in developing nations. Continue reading

Personalized Cancer Test Pinpoints Best Drug For Patients

By Alison Bruzek

Cancer, whether in the pancreas, the ovaries or the liver, can take on different characteristics and spread in different ways. That’s why, unfortunately, there’s no one-size-fits-all drug to help patients fight back.

But a new, quick test can personalize treatment and help oncologists choose which chemotherapy route to take.

The test, called Dynamic BH3 Profiling, quickly predicts whether or not a drug will work for a patient by first trying that drug on a tumor sample in the lab. A paper describing the method, which researchers say could become more widespread within a couple of years, was published in the journal Cell this week.

The idea echoes how we choose the most effective antibiotics, says study author Dr. Anthony Letai, a cancer researcher with the Dana-Farber Cancer Institute.

A new tool for predicting relapse in acute myelogenous leukemia (AML) was developed by Dr. Anthony Letai (Courtesy of Dana-Farber Cancer Institute)

A new tool for predicting relapse in acute myelogenous leukemia (AML) was developed by Dr. Anthony Letai (Courtesy of Dana-Farber Cancer Institute)

“When we’re trying to choose antibiotics for people … we simply isolate the bacteria that’s causing the problem and expose it to all the drugs that are available,” he says. Then researchers choose the drugs that best put a lid on the multiplying bacteria.

“That has operated for many, many decades,” Letai says, “so we thought, why not do that for cancer cells?”

Letai’s team isn’t the first to think of this strategy. “People have tried to do this kind of thing in years past but there have been a variety of advances in technology … that make it more feasible this time around,” says Levi Garraway, a cancer researcher at Dana-Farber who was not involved with the study.

What’s different about Letai’s work is its speed: It can quickly determine whether a drug, or combination of drugs, is working. The test looks not at when the tumor cells are dead, but rather when they’re beginning to die.

The ‘Death Switch’

The researchers found that there is a point of no return, a threshold of doom, when cells begin to die that is indicative of their actual death. The team looked at varying types of cancer cells (breast, lung, melanoma) and saw that there was essentially a death switch that when flipped on, ensured the cell’s destruction.

Examining if a cancer drug flipped this switch, instead of waiting to see if the cells would eventually die, allowed the researchers to know, in about 16 to 24 hours, which drugs were working. Continue reading

WaPo: Cancer Patients On Medicare Turned Away Due To Budget Cuts

Blaming the sequester budget cuts, clinics are turning away cancer patients on Medicare, The Washington Post reports, because their chemotherapy drugs are too pricey.

(TipsTimes/flickr)

(Tips Times/flickr)

The Post’s Sarah Kliff reports:

Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.

Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” Continue reading

BMS Recalls Units Of Chemotherapy Drug

(A-4 Nieuws.nl/flickr)

The New York Times reports that Bristol-Myers Squibb is recalling an injectable chemotherapy drug used to treat several types of cancer:

Bristol-Myers Squibb Co. is recalling more than 31,000 units of a chemotherapy drug after discovering one vial was overfilled, putting patients at risk of an overdose.

The company’s action affects 10 lots of BiCNU, an injection of the drug carmustine, used to treat brain tumors, multiple myeloma, Hodgkin’s disease and non-Hodgkin’s lymphoma.

Bristol-Myers said taking too much of the drug could result in lung or kidney toxicity, though no adverse events have been reported yet.

For more information, the AP report says to call this number: 1-888-896-4564.

Study In Mice: Fasting May Help Chemo Work

By Karen Weintraub
Guest Contributor

A study out today suggests that fasting for a few days at a time may help cancer patients better tolerate chemotherapy, and may even be an effective treatment.

Although the findings are still quite preliminary – the only solid research is in mice – cancer patient Marie Pechet says the study is provocative enough to spur a conversation with her doctor.

“I’d give it shot, I definitely would,” she said earlier today.

The scientist who led the research, Valter Longo, a professor of gerontology at the University of Southern California, advises patients to check with their doctor before attempting to fast. Going without food can be dangerous, particularly for people with diabetes, heart disease and other ailments, he warned.

But he’s bullish enough about the idea of fasting that he does it himself several days a month.

Today’s study, Longo’s second on the subject, looks at mice who were allowed no food or drink except water before and after getting chemotherapy.

Amazingly, up to 40 percent of the mice who fasted during treatment were actually cured of the cancer, as far as researchers could tell – compared to a zero cure rate for chemo alone.


Continue reading

Chemotherapy For Life: One Woman’s Story

Marie Pechet and her son, Aidan

Marie Pechet lives in Cambridge and has written about her cancer previously for CommonHealth. In this piece, part of our Listening To Patients series, she grapples with the reality of being on chemotherapy for the rest of her life.


At age 15, I was working as a cashier at our family’s small grocery store in a sketchy neighborhood.
Just before closing time one day, after I totaled a customer’s sale and the cash drawer sprung open, a gunman appeared. He aimed his gun at my stomach and grabbed frantically at the cash.

My initial reaction was to push the cash drawer closed; his reaction was to push the gun more firmly into my stomach.

In that moment I realized, “He has a gun. This is real. This is happening.”

Time slowed, and I took in the details of everything around me: The exact number of large bills he was grabbing, the faces of the customers, the sound of my father’s voice as he approached the robber with a butcher knife. And then, it was over.

I wasn’t scared, but I was shaken and oddly alive with adrenaline. I was held up, and I survived! It felt like an adventure.

Years later, I heard the words, “You have cancer.” More than one time. Each time, it felt like standing in front of a loaded gun. I initially felt like this can’t be real, then realized I had an underlying threat to my life. I wasn’t sure whether or when the bullet would fire, and I wasn’t sure what I could do about it. So, I tried to pay attention, do what I was told, and each time, survived. And each time, the survival was exhilarating and empowering in its own way.

Stage IV Colorectal Cancer

The most recent diagnosis came last January. Continue reading