Learning to Silence Incurable Brain Cancer Genes

MRI glioblastoma GBM

What You Need to Know: A team from Northwestern University (USA) is the first to demonstrate delivery of a drug that turns off a critical gene in the complex cancer known as glioblastoma multiforme (GBM). While not ready for routine human use, the drug appears to significantly increase survival rates among animals with the deadly disease.

Background: Glioblastoma multiforme (GBM) is an aggressive and incurable brain cancer. You may recall that it took the life of US Senator Edward Kennedy, and will strike about 13,000 Americans each year.

Why I Am Excited: Investigators delivered a non-toxic drug through an intravenous injection, increasing survival by nearly 20 percent, with tumors reduced by a factor of three to four. Using highly adaptable spherical nucleic acids, the researchers specifically targeted a gene associated with GBM and turned it off in a live animal. Mirkin and colleagues designed a nucleic acid sequence to match the target gene, one that is related to GBM’s resistance to conventional therapies. The investigators thus provide proof-of-concept for an innovative technique that someday may be aimed at brain, lung, colon, breast, and other tumors. I’m Dr. Michael Hunter, and that’s the breakthrough cancer treatment of the day.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: SA Jensen, et al. Spherical Nucleic Acid Nanoparticle Conjugates as an RNAi-Based Therapy for Glioblastoma. Science Translational Medicine, 2013l 5(209).

Aromatase Inhibitors & Joint Stiffness: Walking Program Shows Promise

woman holding wrist arthritis joint stiffness

Summary: A self-directed walking program shows promise in easing joint stiffness among older women who experience these symptoms while taking the “anti-estrogen” drugs known as aromatase inhibitors. This is the conclusion of research present this week at the America College of Rheumatology Annual Meeting in San Diego (USA).

Background: Postmenopausal women with breast cancer whose treatment often includes an aromatase inhibitor (AI) often experience joint pain or stiffness as a side effect. Some studies have suggested that up to 20-32% will stop taking the drug because of this side effect. But the incorporation of these drugs into the breast cancer management program has led to impressive reductions in breast cancer recurrence and death.

Researchers at the University of North Carolina at Chapel Hill (USA) conducted a pilot study to see whether physical activity could improve joint pain or stiffness. Women in the program followed the walking program for six weeks. Twenty patients participated, all of whom were 65 or older, had Stage I-III disease, and reported joint pain or stiffness associated with an aromatase inhibitor.

Results: At the end of the study, 100% of the study participants said that they would recommend the program to other breast cancer survivors experiencing joint pain or stiffness. The average joint pain scoopers among the participants decreased by 10 percent, fatigue decreased by 19 percent, and joint stiffness dropped by 32 percent.

My Take: For selected postmenopausal patients with breast cancers driven by estrogen, aromatase inhibitors can provide improvements in survival and relapse chances. But these women are much more likely to experience side effects such as hot flashes, night sweat, cold swears, joint pain and stiffness, as well as other problems. Simply walking may help with the common side effect of joint pain and stiffness. I typically suggest a minimum of 30 minutes of the equivalent of a brisk walk, 5 to 6 times per week.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: American College of Rheumatology Annual Meeting (San Diego, 2013).

Does Obesity Increase the Risk of Prostate Intraepithelial Neoplasia (PIN)?

English: Male Abdominal obesity.
Male obesity. (Photo credit: Wikipedia)

PIN: Prostatic intraepithelial neoplasia (PIN) means that some of the prostate cells look abnormal under the microscope. Epithelial cells line the tiny sacs in the prostate and ducts that carry fluid in the prostate. Sometimes, the PIN changes are mild, not other times they start to look like they have cell changes characteristic of cancer cells. Whether PIN will progress to cancer (and what we should do if we find PIN, especially high-grade PIN) is unclear.

The study: Researchers from the Columbia University School of Public Health in New York City found that patients who had benign biopsies of the prostate and were obese were more likely to be found with prostatic intraepithelial neoplasia (PIN). Adjusting for family history, PSA levels, and digital rectal exam findings led to the finding (1.57x increased risk).

My take: This study shows that obesity is associated with a higher risk of precancerous abnormalities. This type of research is not very helpful from a practical standpoint. Questions remain: What is it about obesity that makes some types of prostate cancer more common? Is it the obesity itself, or something associated with it? Inactivity? Diet? Let’s move on to better studies, including a weight loss intervention (or dietary intervention) and then assess prostate cancer risk. While this is an interesting study, I’d like to know if obesity is a true causal agent for some prostate cancers. I’m Dr. Michael Hunter.

Reference: Rundle A. Cancer Epidemiol Biomarkers Prev 2013;doi:10:1158/

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Venous Thromboembolism (Blood Clots) in Patients with Cancer: Risk

B0002113 Electron micrograph of blood clot
Electron micrograph of blood clot (Photo credit: wellcome images)

The close association between cancer and thrombosis (blood clots) has been recognized for over 150 years. Today, I present a risk score for patients with cancer, based on several factors:

Very high risk: Stomach or pancreas cancer: 2

High risk (lung, lymphoma, gynecologic, bladder, testicular): 1

Pre-chemotherapy platelet count at least 350,000: 1

Hemoglobin level less than 10 or use of red blood cell growth factors: 1

Pre-chemotherapy leukocyte count over 11,000: 1

Body Mass Index 35 or higher: 1

High risk score: 3 or higher; intermediate risk = 1-2; low-risk = 0

When this risk model was retrospectively evaluated in large randomized trials, the risk of venous clots among high-risk patients was significantly reduced in those randomized to blood thinning drugs (thromboprophylaxis).

Other risk factors include infection, as well as lung or kidney disease.

The American Society of Clinical Oncology (ASCO) updated guidelines recommend that patients with cancer be educated about the symptoms and signs of blood clots, and that risk be assessed at the time of chemotherapy initiation and periodically thereafter. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: The ASCO Post (volume 4, issue 11; 10 July 2013).

Aspirin: Does It Lower Risk for Subtypes of Colon Cancer?

aspirinBackground: Aspirin and related drugs are known to reduce polyp formation for those with familial adenomatous polyposis (FAP), can lower the risk of colorectal cancer among those with Lynch syndrome, and may reduce the risk of colorectal cancer for the general population, too. For those with colorectal cancer, aspirin (and similar drugs)  may improve survival, too. But does everyone with colorectal cancer benefit, or is it just those whose tumors express cyclooxgenase-2 (a target for aspirin therapy)? Recent data indicate this beneficial effect is limited to those with PIK3CA-mutant cancers.

This Study: Researchers in the current study set out to determine the predictive value of PIK3CA mutations for benefit from both cyclooxygenase-2 inhibition and aspirin in 896 patients enrolled in the Vioxx in Colorectal Cancer Therapy: Definition of Optimal Regime (VICTOR) trial. The large, randomized trial compared the effects of rofecoxib (Vioxx, Merck) with placebo after primary colorectal cancer surgery (resection). Researchers compared RFS and OS between rofecoxib therapy and placebo, as well as between the use and nonuse of low-dose aspirin. The investigators evaluated results based on tumor PIK3CA mutation status.

Results: Regular aspirin use post-diagnosis was associated with a decreased rate of colorectal cancer recurrence in those with PIK3CA-mutant cancers (HR=0.11; 95% CI, 0.001-0.832). Researchers did not observe the benefit in patients without PIK3CA mutations (HR=0.92; 95% CI, 0.60-1.42; P=.71). Researchers observed no evidence of greater benefit with rofecoxib therapy in patients with PIK3CA mutations (multivariate adjusted HR=1.2; 95% CI, 0.53-2.72) compared with those with PIK3CA wild-type cancers (HR=0.87; 95% CI, 0.64-1.16).

My Take: First, I would note that the researchers are consultants for the drug company, Bayer. Still, these findings are concordant with recent data and support the prospective investigation of adjuvant aspirin in PIK3CA-mutant colorectal cancer. If confirmed, we might someday routinely recommend the use of aspirin for selected patients with colon cancer. For now, ask your healthcare provider if aspirin is appropriate (or not) for you.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Domingo E. J Clin Oncol. 2013;doi:10.1200/JCO.2013.50.0322.

Does Cooking Vegetables Destroy Vitamins? It Depends…

raw food vegetable fruit on forks

We know that the way you cook your fruits and vegetables can change its nutritional contents. Cooking can break down some valuable nutrients, but in other cases can enhance the availability of others. So, raw vegetables of not always pack in more nutrition than their cooked counterparts. So what should you do? Today’s New York Times provides a nice reminder of the effects of cooking.

A study of 200 Germans who ate a raw food diet showed that they had higher levels of beta carotene, but below average levels of lycopenes. As you may know, lycopenes are in tomatoes (and watermelon),and cooking breaks down the thick cell walls of the plant, allowing the nutrient to come out. Water-soluble nutrients (think vitamins B and C, as well as polyphenolics) appear to be the most vulnerable to processing and cooking.

Canned peas and carrots lose 85-95% of their natural vitamin C. After 6 months, frozen cherries may lose as much as half of anthocyanins, the nutrients found in the dark pigments of fruits and vegetables. Cooking removes about two-thirds of the vitamin C in fresh spinach. Depending on the cooking method, loss of vitamin C during home cooking can range from 15% to 55% (University of California, Davis research). But vitamin C levels are often higher in frozen produce compared with fresh produce. Vitamin C levels can drop during the transport and storage of produce.

What about fat-soluble compounds such as vitamins A, D, E, and K and the antioxidant carotenoids? Boiling is better for carrots, zucchini, and broccoli than steaming, frying, or serving them raw. Frying vegetables is the worst method for nutrient preservation. Of course, each cooking method has tradeoffs. For example, boiling carrots can significantly increase carotenoid levels (compared to raw carrots). But raw carrots have more polyphenols than do cooked ones.

And microwaving? Surprisingly, microwaving can increase the concentrations of certain vitamins. Steaming and boiling drop vitamin C levels of broccoli by 22% and 34%, respectively. Microwaving and pressure cooking foods retain 90% of their vitamin C.

In summary, there is no single cooking or preparation method that is optimal for vegetable nutrient preservation. As long as you eat your vegetables, you are on the right track to better living. Mix it up: Steam, boil, eat raw, bake, and grill. Eat a variety of fruits and vegetables on a regular basis, and worry less about the method of cooking. I’m Dr. Michael Hunter, and I love grapes and watermelon!

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: NY Times 25 October 2013