ASTRO: Brain Metastases Common in Ovarian Cancer

JoAnnDK said:

MedPage Today
Greg, MedPageToday should be ashamed of itself for this headline:

ASTRO: Brain Metastases Common in Ovarian Cancer

.....when this is not true at all and was extrapolated from ONE abstract of an article that has not yet even been peer-reviewed OR published in a medical journal.

This was one study of 78 women ---- conducted over 27 years. How many cases of ovarian cancer were seen at Sloan Kettering in those 27 years? I would bet it was thousands, yet this so-called study focused on 78.

So the headline should rightly say "Brain Metastases Common in 78 Ovarian Cancer Patients in 27 years". But this would not have garnered nearly as much attention, would it?

I have long noticed this tendency of MedPage to sensationalize in its headlines. Shame on them.

Here is a similar study done by/at MD Anderson which is NOT misleading because it states the number of patients there over the years who had ovarian cancer (8,225) versus the number studied (72).

http://www.ncbi.nlm.nih.gov/pubmed/15015663

This is even more accurate: http://theoncologist.alphamedpress.org/content/11/3/252.full

Background. Brain metastases from epithelial ovarian cancer (EOC) are rare. This report is based on a review of the literature.

california_artist said:

Mary Ann
Lung cancer as a primary, is one of the more likely causes of brain mets. I don't know if other cancers have to metastasize to the lungs and then onto the brain. But as a primary source, lung and colon primaries are more likely to produce brain mets. Ovarian and uterine rarely do, but they can.

Thanks for the thoughts of a wonderful day. The birds are chirping here, so it looks favorable for enjoying the day. You too, and to all of us.

california_artist said:

Jazzy doo,
I think when I posted that I tried to stress, that it isn't none, it's just a preponderance of veggies with a lesser amount of beans, grains, etc. Oats are the best at stopping cancer. In regards to bone strength, meat is a real bone depleter.

Even sugar, though a friend to cancer, can come in conjunction with some powerful cancer fighters. Organic concord grapes first things after a night's sleep can lure cancer into greedily taking them in and the ellegic sp? knocks the bejessis out of the cancer. A similar approach to coaxing cancer cells to take up the radioactive ladden sugar of a PET scan, except with a powerful punch.

So, sounds to me like you are doing a bang up job of it all. I hope I didn't give the impression of no beans and such. I'll have to reread see if it needs a tweeking.

What advice or things are you doing that you might feel are helpful, that you would like to share? Would appreciate your input.

I have read that the recommendation after a disease diagnosis, is a balance of 80% alkaline to 20% acidic, thus allowing for things one enjoys in moderation. Don't think I'd put artificial sweeteners there anywhere, but within reason. Were I stage four anything, I would most likely, a. cry, and b.go closer to 90-95% alkaline for a short time. You know, b. would most likely also be cry for a while longer, get it all out and then the old b. would become the new c..

california_artist said:

Jazzy doo,
About radiation. I posted in the mushroom wars thread an article about mushrooms with dark pigment changing radiation into an innocuous form in the body to lessen it's damage. You might want to look at that thread, it was started by Rosey.

About the photo, which one of the two ladies is you?

Love ya,

Claudia

gdpawel said:

Alternatives
Daisy

In regards to Taxol and what alternatives there are, if you visit the National Cancer Institute website, you'll see that for virtually all cancers, there is no single "best" regimen listed. Instead, you'll find that, for each cancer type, many drugs and drug combinations have been proven in clinical trails to produce about the same result among large groups of unselected patients.

However, looking at the individual patients within a clinical trial, all of whom have the same type and stage of cancer, some patients do not respond at all to a specific treatment while others respond very well and, even in some of the very difficult cancer types, some patients achieve long-term remissions and even cures.

What this suggests is, considering that there are many drug regimens which are equally-accepted by the NCI and by oncologists, these drugs regimens should not be administered blindly but rather each patient's cancer cells should be tested to determine which of the otherwise equally-acceptable drug regimen has the very best chance of benefiting that particular patient.

Greg

gdpawel said:

Accuracy not Efficacy with diagnostic tests
Soromer

Very good points and I thank you for bringing them up.

On the first issue, at comprehensive cancer centers/academic cancer institutions that are soulfully involved in clinical trials feel a subtle pull towards getting patients involved in those trials. Some researchers discourage patient empowerment so they can call the shots through these trials. They've even broaden their appeal by encompassing community hospital oncology practices. These researchers seem to have a readiness to believe that the clinical trial is more reasonable for the patient and other options do not offer an advantage.

Their (somewhat) head guidence society (ASCO) has been saying that chemotherapy sensitivity and resistance assays (CSRAs) should not be used outside the confines of a clinical trial setting. The same people who maintain that assay-directed therapy should not be used until proven in prospective randomized clinical trials, are the same people whose entire careers are utterly dependent upon mega-trials 100% funded by pharmaceutical companies (that, plus fees from speeches they give for these companies), are the same people who control the clinical trials system, the grant review study sections, and the journal editorial boards.

Why else would they want this technology tested under the clinical trial setting?

No wonder ASCO dosen't recommend the use of CSRAs (no matter how good they are) to select chemotherapeutic agents for individual patients outside of the clinical trial setting. Besides the authors, in their "closed" tech assessments, trying to invent a brand new criterion for validating a laboratory test, they'd like to have these tests in clinical trials.

Tens of thousands of scientists pushing a goal of finding the tiniest improvements in treatment rather than genuine breakthroughs, that fosters redundant problems and rewards academic achievement and publication above all else.

Packing the (ASCO) panel with academicians whose entire careers are utterly dependent upon mega-trials funded 100% by big pharmaceutical companies further reinforces lack of confidence that the information conveyed will be balanced and fair. Until the controlled, randomized clinical trial approach has delivered curative results with a high success rate, the choice of physicians to intergrate promising insights and methods remains an essential component quality cancer care.

Chemosensitivity/Resistance Assay Part of NCCN Guidelines

http://cancerfocus.org/forum/showthread.php?t=3077

In regards to the second issue, the cell "block" technique is useful for special stains and immunohistochemistry (IHC) and can give morphological (structural) details by preserving (in paraffin wax) the architectural patterns.

However, when it comes to "drug selection," investigators can only measure those analytes (substance or chemical constituent) in paraffin wax that they know to measure. If you are not aware of and capable of measuring a biologically relevant event, you cannot seek to detect it.

The cell "block" technique (cell-lines) in paraffin-embedded tissue can change over time. These proliferating populations of cells are biologically distinct in their behavior from "fresh" live cells that comprise human tumors.

Tissue that is frozen, miniced, fixed, formalin-fixed or paraffin-embedded (cell-lines) have always played and continue to play an important role in drug screening and drug development. The problem is that cell-lines do not predict for disease or patient specific drug effects (drug selection).

If you can kill ovarian cancer cell-lines with a given drug, it doesn't tell you anything about how the drug will work in real-world, clinical ovarian cancer (real-world conditions). But they can learn certain things about general drug biology through the study of cell-lines.

As a general rule, studies from established cell-lines, tumor cells are cultured and manipilated so they continue to divide. But this is not reflective of the behavior of the fresh tumor samples (live samples derived from tumors) in primary culture, much less in the patient.

Cancer patients never undergo therapy without a tissue biopsy. It is virtually always possible to obtain tissue for study if a dedicated team of physicians makes the effort to get it processed and submitted to a functional profiling laboratory. The time and energy required to conduct an excisional biopsy pales in comparison to the time, energy and lost opportunities associated with months of ineffective, toxic therapy.

In regards to the third issue, I'm not here on the board to promote any particular laboratories. I advocate a technology which I firmly believe in because it works: cell function analysis. There are no perfect drugs, there are simply drugs that work for certain patients.

Patients would certainly have a better chance of success had their cancer been "chemo-sensitive" rather than "chemo-resistant," where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival.

The choice of a lab is not a geographical consideration, but a technical consideration. The labs vary considerably with regard to technologies, approach to testing, what they try to achieve with the testing, and cost. The best ones utilize "cell-death" assay technology. Some add 3D analysis to increase accuracy. And a few utilize functional profiling, because cancer dynamics are not linear. Cancer biology does not conform to the dictates of molecular biology. We are forced to confront the realization that "genotype does not equal phenotype."

For a very brief explanation of "genotype does not equal phenotype," the particular sequence of DNA that an organism possess (genotype) does not determine what bodily or behaviorial form (phenotype) the organism will finally display. Among other things, environmental influences can cause the suppression of some gene functions and the activation of others. Out knowledge of genomic complexity tells us that genes and parts of genes interact with other genes, as do their protein products, and the whole system is constantly being affected by internal and external environmental factors.

The gene may not be central to the phenotype at all, or at least it shares the spotlight with other influences. Environmental tissue and cytoplasmic factors clearly dominate the phenotypic expression processes, which may in turn, be affected by a variety of unpredictable protein-interaction events. This view is not shared by all molecular biologists, who disagree about the precise roles of genes and other factors, but it signals many scientists discomfort with a strictly deterministic view of the role of genes in an organism's functioning.

Until such time as cancer patients are selected for therapies predicated upon their own unique biology, we will confront one targeted drug after another. Our solution to this problem has been to investigate the targeting agents in each individual patient's tissue culture, alone and in combination with other drugs, to gauge the likelihood that the targeting will favorably influence each patient's outcome. Functional profiling results to date in patients with a multitude type of cancers suggest this to be a highly productive direction.

Functional Profiling with Cell Culture Assays

http://cancerfocus.org/forum/showthread.php?t=253

In regards to the fourth issue, so many on the cancer boards are chasing mets (metastasis) because of inappropriate and ineffective therapy. With information gain from assay analysis, physicians can quickly modify less effective therapy, thereby improving patient outcomes and reducing the cost of ineffective treatment.

Impact of a chemoresponse assay on treatment costs for recurrent ovarian cancer

http://cancerfocus.org/forum/showthread.php?t=3334

Best wishes!

Greg

gdpawel said:

Further clarifications
Claudia

The "surgical specimen" is the "personalized" part of personalized cancer medicine. Surgeons and pathologists are playing a more pivotal role in cancer medicine. Surgeons will continue to cure cancer with greater success rates through earlier detection and excision, but as custodians of the tissue will also be central to improving cancer management. The surgical cut or larger bore tru-cut biopsies take a sample of tissue with preservation of the histological architecture of the tissue cells. Anything less does not preserve the histological architecture of the tissue cells. Nothing really substitutes for the biologist's thorough examination of the features of a cancer cell.

Many pathologists have come to have a deep appreciation of the challenges of surgical oncology. Happily for patients, surgeons can cure cancer on a fairly regular basis by excising it with expert technique and detailed knowledge of human anatomy and tumor biology. The tissue resected by the surgeon and analyzed by the pathologist is the source of crucial information that, in turn, informs the decisions and actions of their medical oncology colleagues.

Soromer

Genomic "instability" is the hallmark of cancer. The mutagenic effects of "ineffective" chemotherapy on a genetically-unstable tumor can drive the tumor into a state of more aggressive behavior. You might kill off a whole lot of cancer, only to cause a mutation in the remaining cancer, such that the remaining cancer behaves in a more aggressive fashion.

I believe your statement, "there are too many conflicts of interests for most oncologists to be willing to participate in them," is astute enough to get the picture. A number of medical oncologists in private practice have told me (in so many words) that they have never heard ASCO had been knighted a regulatory agency.

ASCO guidelines are fine but many practices use other guidelines or develop evidence based treatment guidelines for their own individual practices or modify guidelines based on evidence which they use as their defined evidence based standards for their practices. The self-educated oncologist doesn't submit to the status-quo. They know how to think for themselves.

You'd be surprised, when it comes to physicians themselves getting cancer, how many look to the assays for themselves. One such physician comes to mind, because he posted his experience, back in 2003, on this very same CSN board. I believe if you look at the lung cancer board and search for Mark Fisher, I believe his posting is still there. He had a remarkable array of five novel drug combinations to put him into a remission. And he didn't need to have Gamma-Knife for his solitary brain met. "Effective" combination of therapy took care of that.

Greg

RoseyR said:

What ADDITIONAL questions should I ask my ONC next week?

Greg,

Diagnosed with stage IB uterine carcinosarcoma a year ago (a highly aggressive tumor), am due to see my onc next week for first three-month checkup.

Having finished six rounds of carbo/taxol and 25 pelvic radiation sessions, I plan to ask the following questions to decide whether I want to stay with her or move on to another oncologist. She is reputedly "the best in the city" but has been SO uncommunicative, polite and responsive, but she never elaborates on any issue. (Not once have I had a sit-down consult of half an hour or more. When I once asked what taxol/carbo would DO for me, her jaunty answer was "prevent it from coming back." Talk about an infantilizing response!) I later asked for review articles and received them, but wish I had an onc who would elaborate just a bit on any important issue.

Her willingness to answer the following questions next week may determine whether I stay with her. If there are a few OTHER questions I should ask, please let me know.

1) Is my tumor a hormonally sensitive one? (She's never commented on that.)

2) If I have a recurrence, I would like to have a tissue assay done before submitting to further chemotherapy; are you open to that procedure? Why or why not?

3) If I have a recurrence, I would also like to have fractionalized chemo (more frequent doses at lower intensities, which MD Anderson has found to be far more effective in using taxol/carbo to treat ovarian cancer); can this be provided?

4) After pelvic radiation, I was advised to use a dilator to ensure no shrinkage or contraction of vaginal tissue. But the vaginal lubricants your center recommends all contain harmful chemicals such as propylene and butylene glycol and methylparaben. If we are trying to PREVENT recurrence in the vaginal vault, does this make sense? Why not safer vaginal lubricants?

5) One of your residents recently told me that you have "a few patients" with my tumor who are doing "really well." I asked if that meant they were surviving at least six to seven years. He said "yes." Have you surveyed them to find out what they are eating or otherwise doing that might account for their success--and could the rest of us with this rare tumor communicate with them to find out what they are doing? (When I asked the resident this, he condescendingly smiled and said, "It has nothing to do with what they're eating.") I consider his response absolutely maddening and wonder if I should pose the same question it to my oncologist.

Although even these five questions are likely to provoke incredulous looks, are there others I should be asking, I wonder? (This is "one of the top ten treatment centers in America," by the way.)

Appreciatively,
Rosey R