Sunday, October 3, 2010

I-Spy 2

No, this isn't another blog on lurking and lurkers but a project to potentially speed up breast cancer drug development based at UCSF. Traditionally new drugs are investigated as follows: the first clinical trial is conducted on Stage 4 patients. If a huge benefit is seen then the drug is added to conventional agents (the so-called standard of care drugs, we all know the ones) for early stage breast cancer patients. Since recurrences don't seem to happen until at least 5 years out (except for TNBC, recurrences come fast and furious), it takes at least that long to see if there is an improvement in survival over controls. An example would be Herceptin, which is good for the her2+ ladies. It had to be tried first with stage 4. It took about 10 years for it to be the standard of care for her2+ ladies who are stage 1 or 2. Meanwhile lots of ladies' lives could have been saved if they had access to that drug 10 years ago.

This program is making a few changes in the usual protocol. First it starts with advanced early stage patients (such as myself). Instead of slash then poison, it reverses the steps so the clinician can see right away if the tumor is responding to the new mix of drugs instead of waiting 5 years to see if there is a difference in survival.. Second, it recognizes that not all tumors have the same genetics so it screens each tumor for particular markers that might respond to a particular drug instead of treating all patients the same. It also tests multiple drugs at once.

The point of all this is to stop the spread of early stage breast cancer which causes 45,000 deaths in the US each year. One problem with this program is that it assumes mets have the same genetics as the mother tumor. A drug good for the primary tumors isn't necessarily the best for distal tumors.

I was not offered chemo first as it was thought that I had a small tumor. By the time they got around to removing it, it had doubled in size.

A question I have had for the treatment of estrogen positive ladies is if estrogen feeds there tumors, shouldn't they be measuring its levels to make sure enough anti-estrogen drugs are being taken? Even if the patient is believed to be compliant, strange stuff can happen such as the recent finding that certain antidepressants interfere with the metabolism of Tamoxifen  such that it then does nothing to lower the estrogen levels.

A windy, cool fall day here in Michigan.

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