Forty percent of advanced estrogen-receptor-positive (ER+) breast cancer patients have mutations that result in uncontrolled activation of the PI3K pathway. This pathway is involved in resistance to endocrine therapies and can promote the growth of ER+ breast cancer cells. SOLAR-1 is a phase III clinical trial of 572 patients with advanced ER+, HER2-negative breast cancer. The trial investigated whether there is a benefit to adding alpelisib, a drug that blocks the PI3K pathway, to treatment with fulvestrant (Faslodex), an anti-estrogen receptor drug. The addition of alpelisib resulted in a clinically meaningful extension of median progression free survival from 5.7 months to 11 months in both endocrine therapy sensitive and endocrine therapy resistant patients. Overall survival data will be reported in the future. The main side effect due to inhibition of PI3K was hyperglycemia (elevated blood glucose levels), which was easily detected and managed with oral medication. (Abstract GS3-08) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org.
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Did You Know? A cup of oatmeal provides tryptophan - amino acid that converts to serotonin - the feel good brain hormone that in turn converts to melatonin – the sleep promoting hormone. The carbs in the oats promote the production of insulin which helps tryptophan get into the brain. And oats are high in Vitamin B6-that helps tryptophan convert to serotonin and melatonin. Besides helping with mood and sleep, oats are high in fiber that promotes digestive health, cholesterol management and breast cancer prevention. Oats have special anti-oxidants, called avenantramides that help reduce the risk of cardiovascular disease. Oats, like other whole grains, are super rich in calming magnesium – an important cofactor for over 300 enzyme reactions in the body, including how the body uses glucose and insulin and how the body makes calming brain hormones. (The World’s Healthiest foods, whfoods.org) Steel Cut vs Rolled vs Quick vs Instant? Both steel cut (Irish) and rolled contain whole grain oats. But they are processed differently. Steel cut oats are oat kernels (groats) that have been chopped into thick pieces. Rolled oats are steamed, rolled, steamed again and toasted, ending up as thin flakes. Quick oats are steamed more-making them partially cooked and Instant oats are steamed even longer-more precooked and are often sold in packets with sweeteners and artificial mystery ingredients. According to Dr Andrew Weil, steel cuts are better since they digest more slowly than rolled or quick or instant oats. Steel cut oats rank lower on the glycemic index. “I recommend choosing steel cut (Irish) oats over rolled oats because they digest more slowly than rolled ones. Like all other grains in whole or cracked form, steel cut oats rank lower on the glycemic index than rolled oats. The reason is that it takes longer for digestive enzymes to reach the starch inside the thicker pieces, slowing down its conversion to sugar. As you probably know, the glycemic index is the measure of how quickly carbohydrate foods affect blood sugar. The higher on the glycemic index a food ranks, the more likely it is to cause spikes in blood sugar that over time can cause genetically susceptible people (many of us) to develop insulin resistance and metabolic syndrome. Insulin resistance is associated with obesity, high blood pressure, elevated blood fats, and an increased risk of type 2 diabetes. You can be pretty sure you're eating a whole grain with a low GI ranking if you have to chew it or can see the grains or pieces of grains in food products. The more your jaw has to work, the better. But when grains are processed, their surface area expands, allowing digestive enzymes easy access to their starch content.“ (Andrew Weil, MD) Want to hear more from Andrew Weil? Join us at our Spring Breakfast, May 15, where he will speak on nutrition for a healthier life. Get your tickets! Recipe Ingredients 1 cup, steel cut oats 3 cups, water 1 cup milk-dairy or another favorite “milk,” nut milk (almond, cashew, other), oat milk. ½+ tsp sea salt 1+ tsp. butter, organic, from grass fed animals, or ghee (clarified butter) 1+ tsp. cinnamon Add Ins/Toppings Apple, pear, or other sliced fruit Walnuts, almonds or other nuts Ground flax or chia Berries Dark maple syrup or jam Instructions 1. In a strainer, rinse 1 cup of steel cut oats. Drain. 2. In a pan, add 3 cups water and the 1 cup rinsed oats. Soak during the day or for at least 2 hours. (soaking the oats makes them more digestible and nutrients more absorbable) 3. In a strainer, strain the oats, rinse well, let drain. 4. In a pan, add strained oats, 3 cups water, ½ tsp sea salt. Mix. 5. Bring to a rolling boil. 6. Turn off the heat. Add butter or ghee, add cinnamon. Stir. 7. Let cool for about 20 min. 8. Refrigerate overnight. 9. Add a portion (about 1 cup) of oatmeal to a saucepan. 10. Add about 1/2 cup almond or other milk. Add more salt, cinnamon, butter or ghee, as desired. 11. Optional: add 1 chopped apple or pear, 2 Tbsp. chopped walnuts or other nuts. 12. Simmer until heated and the milk is absorbed. Add more milk, if needed. 13. Serve. Optional: Add 1 Tbsp. ground flax seed. Add nuts, berries, other toppings as desired. 14. Sweeten with dark maple syrup or jam, if desired. About the Author: Nancy Birang, BS, NC - Integrative Nutrition Consultant - 408-832-6178
"The purpose of a [clinician] or any human in general should not be to simply delay the death of a patient, but to increase the person's quality of life.” - Patch Adams, MD If you distilled the sweetest goodness of medicine, you’d get the Bay Area Cancer Connections. Twenty-five years ago, a patient and a surgeon dreamt up a community center for breast cancer patients, survivors, and families. It has now expanded to include those affected by ovarian cancer as well. The newly diagnosed embarking on treatment are given comfort totes: bags filled with lavender sachets, tea, a hand-knit hat, handwritten notes of strengthen and encouragement. There are walks along the water just for caregivers to restore themselves with one another. There are support groups for metastatic patients; there are zumba, yoga, and healing touch classes. When zumba’s in session upstairs, you can hear a happy parade through the ceiling. There are Death Cafes where people can speak frankly about dying over cups of coffee. There is a pro-bono medical information specialist to help explain pathology reports. There is a library of every cancer book you can think of that you can borrow from, as well as wall-to-wall binders of the newest journal articles and pamphlets. There’s a boutique of fashionable prosthetics: wigs, camisoles, scarves, and boobs of all sorts. There are lectures from clinical experts, community events, and conferences. Think of Harry Potter’s Room of Requirement, but for breast and ovarian cancer. It is a place wherein someone can enter, and give the details about themselves and their diagnosis (if they have children, if they are taking Tamoxifen, if they had or are having surgery…) and then, if they wish, be paired with a matching buddy to walk the walk with them. To discuss what having a bilateral mastectomy was actually like, or what you need and don’t need to tell your boss about your medical leave, or what it was like to tell their kids. The things clinicians don’t usually have answers to. Community and friendship. Personally, I’m a boutique kind of gal. Maybe it’s silly, but I bet it’s what a good church feels like for believers. It’s a special feeling when you meet a woman overcome with grief over losing her hair, and she goes for the awesome raspberry beret. Then there’s a fashion show set to Prince, and you see a little confidence in her eyes when she waves goodbye wearing it. The kind you find in a secondhand store! What’s sweeter than that? It’s the most beautiful place in the world, and this is your invite. They are always looking for volunteers. You’re welcome. About the Author: Iva Petrovchich
Iva Petrovchich is a second year nurse practitioner student, and completed the MEPN program. She hopes to work in oncology after graduating in June 2019. Find her original article here. The standard of care after lumpectomy for early-stage breast cancer typically includes whole breast radiation (WBI) to reduce the risk of local recurrence. WBI is usually delivered daily for 3–6 weeks. Several recent studies have investigated the effectiveness of accelerated partial breast irradiation (APBI), which restricts the radiation to the area of the original tumor. Partial breast radiation may be a more palatable option for patients and oncologists, as a smaller area of the breast is irradiated in a shorter time period compared to WBI. Vicini et al. reported the results of the NSABP B-39 trial involving three different types of partial breast radiation (balloon catheter, multi-catheter, and 3D-CRT) delivered twice a day for five days, compared to WBI delivered daily for 25 days. This study of 4,216 patients with early-stage breast cancer found that APBI was statistically not equivalent to WBI at preventing a recurrence in the breast, but the absolute difference between the two techniques was very small, less than 1%. Side effects were low but more common in patients treated with APBI. The authors concluded that APBI may be an acceptable option for some patients. (Abstract GS4-04) The RAPID trial found that delivering APBI twice a day with an external beam (3D-CRT) is equivalent to standard WBI at reducing recurrence in the breast. Short-term side effects (radiation dermatitis and breast swelling) were less with APBI; however, over time APBI resulted in more toxicity to normal tissue (fibrosis, spider veins) and worse cosmetic outcomes when compared to WBI. As a result of these late side effects, the researchers remarked that they are unable to recommend the twice-a-day 3D-CRT APBI regimen for routine use. They are currently investigating the use of once-a-day 3D-CRT APBI. (Abstract GS4-03) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org. Triple-negative breast cancer is characterized by the lack of the estrogen receptor, progesterone receptor, and HER2 receptor. Chemotherapy is the mainstay of systemic treatment for this type of cancer. A study led by researchers in Peru found that the time to initiation of chemotherapy is important for women diagnosed with stage II-III triple-negative breast cancer. Women who started chemotherapy more than 30 days after surgery had a higher risk of recurrence and lower overall survival compared to women who started chemotherapy 30 days or less after surgery. The longer the delay in chemotherapy, the worse the outcomes. (Abstract GS2-05) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org. A 2017 Gallup poll indicated that 64% of Americans now support cannabis legalization, as many are turning to cannabis to safely and effectively treat symptoms related to neurological disorders, cancer, psychological disorders, gastrointestinal disease, infectious disease, and inflammatory disease. How can one plant help with so many conditions and have so few side effects? To understand the answer, you must understand the endocannabinoid system. All living organisms regulate their internal environment to maintain the relatively narrow range of conditions needed for proper cell function. For example, your body temperature needs to be kept relatively close to 98.6 degrees Fahrenheit. Your body’s pH must be kept within a very narrow range to survive and function. Your blood must approximate specific levels of systolic and diastolic pressures to remain healthy. This maintenance of a stable internal environment, even in the face of an ever-changing external environment, is called homeostasis. All mammals have a physiologic system, called the endocannabinoid system (or ECS), and its job is to maintain this cellular homeostasis. Since its discovery in 1992, we’ve learned that the ECS regulates mood, appetite, sleep, pain, and memory. For example, a stimulation of the ECS can reduce inflammation, relax muscles, lower blood pressure, dilate bronchial passages, and normalize over-stimulated nerves. Research suggests that many disease states arise from a deficiency in the ECS. This condition is called Clinical Endocannabinoid Deficiency (CED), and there is speculation that this deficiency may be the cause of fibromyalgia, migraines, irritable bowel syndrome, cancer, depression, anxiety, heart disease, stress, cystic fibrosis, phantom limb pain, post-traumatic stress disorder, and dysmenorrhea. Dr. Ethan Russo has suggested that all humans have a base level of endocannabinoids (neurotransmitters that our bodies naturally produce), and when this level is deficient, it manifests in diseases marked by chronic pain, dysfunctional immune systems, fatigue, and mood imbalances. If your ECS is failing to function at its optimal level, can you address this deficiency with cannabis? The research clearly demonstrates that, because plant-based cannabinoids mimic the effect of our endocannabinoids, the cannabinoids found in cannabis can be palliative, preventative, and curative. How can cannabis help you? Cannabis has demonstrated safety and efficacy when treating the following symptoms and conditions: + Insomnia and Sleep-Related Issues You can use cannabis to help treat insomnia and other sleep-related conditions. Cannabis can be more effective and safer than many pharmaceutical sleep aids, which can cause harmful side effects, especially in seniors. Diphenhydramine and Zolpidem, for example, are not recommended for patients over the age of 65. Small amounts of THC (average doses range from 2.5 mg to 10 mg) when smoked or vaporized can help you fall asleep. Myrcene, a compound commonly found in many cannabis strains, can also help you fall asleep. Edibles and tinctures are also good options for treating sleep issues. The effects of orally and sublingually ingested cannabis last longer than the effects of smoked cannabis, and many patients use edibles to help stay asleep through the night. However, dosing is critical: 2.5 mg to 5 mg is commonly sufficient for an average quality of sleep. + Chronic Pain When used to treat chronic pain, cannabis is not toxic like opioids and other non-narcotic pain medications. Unlike opioids, cannabis does not cause constipation (though it can exacerbate it), does not cause any physical dependence, and has fewer side effects. Also, there is no lethal dose of cannabis. Cannabis works synergistically with opioids. Clinical studies have demonstrated that patients use fewer opioids when medicating with cannabis. The cannabis treatment recommended for chronic pain patients depends on the type of pain. An experienced healthcare professional can help you determine how best to use cannabis to treat pain. + Anxiety and Depression Anxiety and depression are often a result of other underlying issues: pain, insomnia, other health issues, fear of aging and dying, or the loss of a spouse. Many of the medications prescribed for anxiety and depression are associated with severe side effects. These medications can be addicting and nearly impossible to wean from completely. Benzodiazepines, for example, are extremely difficult to stop using. Cannabis has long been used to treat depression and anxiety—one of the first Western references was in 1621. Cannabis can help treat psychological disorders by enhancing mood, providing energy and focus, relieving anxiety, inducing hunger, and combating insomnia. Stress is one of the leading causes of depression, and moderate use of cannabis can alleviate stress and stabilize moods. A 2006 study demonstrated that both occasional and daily cannabis users have lower levels of depressive symptoms than non-users. Another study at McGill University in Montreal demonstrated that THC in low doses produces serotonin and can act as an antidepressant. + Appetite and Weight Loss Issues Appetite issues and weight loss are commonly a result of cancer, aging (because of changes to the taste buds), pain, or as a side effect of prescribed medications. Cannabis has demonstrated efficacy in increasing appetite when treating patients with HIV, cancer, or other diseases associated with muscle wasting (also known as cachexia). Cannabinoids can activate the CB1 receptor to affect appetite stimulation. This process may also be associated with the release of ghrelin (known as the “gut-brain hormone”), a peptide hormone that is secreted from the stomach and intestines to increase hunger. And, cannabis can be very effective for treating nausea and vomiting. Regardless of the symptom or side effect that you want to treat, you should work with an experienced and knowledgeable healthcare professional who can help you create an individualized treatment plan. Generally, you should start with a low dose, then slowly and iteratively increase the dose until you reach efficacy. Starting with a low dose minimizes unwanted side effects and reduces the chances of building a tolerance to the effectiveness of your dose. A treatment plan should always include how much of a medicine to take, how frequently to take it, how long to take a specified dose, when and under what circumstances you should increase your dose, as well as the predicted length of therapy. Also, a healthcare professional can help you determine which routes of administration might best affect your condition. For example, if you’re treating constant arthritic pain, you might need to apply a topical directly to the area, ingest cannabis to help treat the pain throughout the day, and inhale cannabis to treat breakthrough pain. Even with this guidance, some experimentation is often necessary. You might need to further individualize your treatment plan to fit your lifestyle by experimenting with different cannabinoids, dosages, and frequencies. And, of course (as with any therapeutic substance) cannabis can produce side-effects. Typically, adverse effects are dose-dependent and are much better tolerated than those associated with corresponding prescription medications. Despite these concerns, many patients find relief with cannabis—it can be a safe and effective choice for treating age-related and chronic illness, and for possibly reducing your intake of pharmaceuticals that have severe side effects. Patience and persistence often pay off. About the Author: Timothy Byars Timothy Byars, CEO, Radicle Health and Eloise Theisen, RN, MSN, AGPCNP-BC CVO, Radicle Health Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect those of Bay Area Cancer Connections. This article was selected for publication in response to requests from our clients, who have asked for information on cannabis. It is not considered comprehensive and is intended for informational purposes only. For additional information on cannabis, please explore the links listed below or contact our Medical Information Service. This information does not substitute for
medical care, and should not be used for the purposes of diagnosis or treatment. As each medical condition is unique, we strongly advise you to consult your physician with questions about your own situation, or about any of the information provided as it may relate to your specific case. If you are considering using cannabis, we encourage you to be informed and aware of the differences in state and federal laws regarding its use. HER2-positive early breast cancer patients who have cancer remaining in their breast or lymph nodes after neoadjuvant (before surgery) chemotherapy plus HER2-targeted therapy have a high risk of recurrence and death. KATHERINE is a phase III clinical trial that randomized node-positive patients of all stages who did not fully respond to chemotherapy before surgery to receive T-DM1 (Kadcyla) or trastuzumab (Herceptin) for 14 cycles after surgery. They sought to answer the question of whether substituting T-DM1 for trastuzumab would improve outcomes. T-DM1 is an antibody drug conjugate that consists of the HER2 antibody joined with the chemotherapy drug, maytansinoid DM1. When T-DM1 interacts with HER2 receptors on the surface of cancer cells, it gets taken up by the cells and the chemotherapy drug is released into the cell. Analysis of the KATHERINE trial data showed that giving T-DM1 after surgery instead of trastuzumab resulted in a clinically meaningful improvement in invasive disease-free survival (IDFS). Three-year IDFS improved from 77% to 88.3% with T-DM1. This benefit was seen regardless of hormone receptor (ER/PR) status and the extent of disease that remained after chemotherapy. More follow-up is pending to evaluate the effect of T-DM1 on overall survival; however, T-DM1 is likely an essential part of the new standard of care for this patient population. (Abstract GS1-10) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org. Five years of endocrine therapy with an aromatase inhibitor (AI) is highly effective in reducing the risk of recurrence of hormone-receptor-positive breast cancer; however, the risk continues beyond the five years of treatment. Researchers analyzed the combined results of 12 clinical trials involving 24,912 postmenopausal women with estrogen-receptor-positive disease to determine if there is a benefit to taking endocrine therapy for more than five years. All of the women in the trials had at least five years of endocrine therapy; with either tamoxifen alone, tamoxifen followed by AI, or AI alone. The study authors compared the outcomes of patients who received five additional years of AI to those who received no further therapy. Overall, they found extended therapy resulted in a quarter reduction in local recurrence (in the breast), a modest reduction in distant recurrence, and a very modest reduction in breast cancer mortality. The study authors noted that the follow-up period needs to be extended to truly evaluate the effect of extended AI therapy on breast cancer mortality. The beneficial effect of extended AI therapy differed by the type of prior endocrine therapy received, with a larger benefit for women who took five years of prior tamoxifen. Importantly, the benefit of extended therapy was greater for patients with positive lymph nodes. In women with four or more positive nodes, there was a 7.7% absolute risk reduction in local or distant recurrence. Patients with negative lymph nodes had a marginal benefit of 1.1% risk reduction. Risk of bone fracture increased by approximately 25% with prolonged AI therapy. The meta-analysis did not assess additional side effects and impact of AIs on quality of life. (Abstract GS3-03) Highlights from the 2018 San Antonio Breast Cancer Symposium
By Anh Diep, VMD, PhD Candidate, and Erika Bell, PhD, Manager of Medical Information, Bay Area Cancer Connections In early December 2018, thousands of researchers from across the world convened in San Antonio, Texas, for the 41st Annual San Antonio Breast Cancer Symposium. This five-day symposium brought together experts in basic, translational, and clinical research; clinicians; and patient advocates to present and discuss advances in breast cancer research and treatment. As progress in breast cancer continues, the challenges remain: to personalize treatment based on characteristics of the cancer, to minimize over- and under-treatment, and to maximize quality of life. This article highlights several of the talks from the 2018 symposium that are most likely to have a direct impact on the clinical care of breast cancer patients. For access to complete symposium resources, including abstracts, posters, and presentations, visit sabcs.org. |