As we all know, there is much more to mounting an offense against cancer or any other serious or chronic illness than just pharmacotherapy or radiation or surgery. An integrated approach that combines traditional medical interventions with lifestyle changes such as exercise, diet, yoga and meditation practice can play a vital role in strengthening our mind, body and spirit.
The attached document is a compilation of many online resources (graciously shared by Kevin Berrill, LCSW, at Ann’s Place in Danbury, CT) that offer mostly free access to computer and smartphone apps offering help with the practice of Mindfulness and Mindful Meditation. It includes resources for all levels of practice, some guided, some with music, some with both.
One of my favorites is called Insight Timer (https://insighttimer.com/) that has hundreds of free recordings to help you practice meditating, relaxing, gratitude, and sleep, to name a few. They can be anywhere from a few minutes long to over an hour, depending on the time you have available.
When patients with advanced prostate cancer become metastatic, castrate resistant (mCRPC), their cancer cells sometimes morph from the typical “adenocarcinoma” to the far more aggressive and difficult to treat “high grade neuroendocrine” subtype. Historically, the prognosis for such patients has been poor. But this appears to be changing. A recent Phase II “basket trial” revealed far superior results for such patients who were treated with dual immunotherapy consisting of ipilimumab (Yervoy) and nivolumab (Opdivo), two immunotherapy drugs already FDA-approved for use in other cancers. A basket trial is one which includes patients with different tumor types (prostate, lung, liver, etc.) that have a common characteristic, such as a gene mutation or, in this case, a neuroendocrine cell morphology.
The clinical benefit rate (response or stable disease for more than 6 months) was 42% in patients with high-grade tumors. The 6-month progression-free survival rate was 31%, and the median overall survival was more than 11 months.
“These outcomes compare favorably with historical patients, where the clinical benefit rate at 6 months is about 20% for patients with refractory tumors, the 6-month progression-free survival is around 10%, and the median overall survival is around 3 months,” said Dr. Sandip Patel (UCSD).
The combination regimen was well tolerated. The most common overall toxicities were fatigue (30%) and nausea (27%). The most frequent immune-related toxicities of any grade were hypothyroidism (31.3%) and aspartate transaminase elevation (25%). The most common grade 3 and immune-related toxicities were liver function abnormalities (9%) and colitis (6%).
With heavy heart, I write this sad post to report my dear friend, Professor Bill Burhans, AnCan’s trusted Board and Advisory Board Member, and mentor and confidant to several readers, passed last Wednesday, Oct 9 after bravely managing his prostate cancer for six (6) years. He was 67 years old.
Bill was a remarkable man with a heart of gold who could not do enough to help others. Much of his life philosophy was developed through the loss of his mother to cancer in Bill’s teens, no doubt BRCA-induced; it left him and a younger sister raising the three youngest siblings. Bill’s caregiving for his mother significantly influenced how he responded to his own disease where it was of utmost importance to him that he did not create a burden for his immediate family.
Bill had a significant amount of cancer in his own family; that may have influenced his decision to become a cancer researcher although he once told me that was not his first choice of career; I seem to recall that may have had more to do with his love of nature and the outdoors. While he lived in Buffalo, teaching and researching at Roswell Park Cancer Institute since 1992, Bill’s heart lay in Vermont where he was raised and studied at the University of Vermont, both as an undergraduate and for his Ph.D. In later years, his favorite location for hiking, back-packing, X-country skiing, snow shoeing and stacking wood was in the Northeast Kingdom at his brother, Buzz’s house on The Hill although his siblings lived in the southern part of the state.
It was there that I first hung out with Professor Bill on a trip filled with synchronicity. One of my own rowing coaches, with the same nickname as Bill’s lifelong best buddy and brother, Buzz, was to be found teaching on a lake no more than 5 minutes from The Hill. Then it turned out that the future in-laws of another close friend and metastatic prostate cancer veteran from Marin, Ca. were also good friends of Buzz and his wife, Chris, and ran a maple syrup farm close by.
Bill and I first met through the UsTOO Prostate Cancer Forum on Inspire where Bill’s inimitable handle was @buffalowill ! His initial radiation treatment left Bill with significant damage to his urinary tract for the balance of his life, plaguing him with frequent serious UTI’s that often led to hospitalization. Bill hypothesized that his BRCA2 mutated genes made him way more susceptible to radiation damage than the normal patient; for his last 3 years or more, Bill had an intrathecal pain pump installed. Soon after diagnosis, Bill opted to germline test for inherited mutations based on his family history and was found positive for BRCA2 that tragically he has passed on. For several years Bill had been collaborating on the development of PARP-Inhibitors with other renown medical researchers like Dr. Johan de Bono at the Royal Marsden in the UK. Knowing the effectiveness of this drug category for BRCA driven disease, Bill argued to his own Roswell Park tumor board that they should prescribe olaparib off-label which they did. Bill got 2-3 years from suggesting this strategy.
Later on, when Bill switched his quarterback to Dr. Atish Choudhury at Dana Farber Cancer Institute in Boston, he participated in a clinical trial for an ATM inhibitor with a Parp-I (olaparib again). This time it was Dr. B’s own lab at Roswell Park that had discovered the key pathway through which the ATM inhibitor operated. Bill rapidly became a major celebrity on his visits to Dana-Farber.
Amongst Professor Bill’s other principle research interests were yeasts – in fact Bill characterized himself as a yeast geneticist. In this area,Bill spent a lot of time experimenting with sugar/glucose and its impact on cancer. He was one of the first scientists along with Valter Lungo to postulate the importance of fasting and the keto diet for cancer management. Unlike Lungo, Bill was not a self-promoter .. and for that we loved him.
It saddens us greatly that the published obituary fails to mention one word about prostate cancer. Awareness and teaching were amongst Bill’s highest priorities; in fact Bill delighted in telling his AnCan Advanced PCa Virtual Group about his hospice experience this past August and planned to repeat the presentation to a live audience at Roswell Park before becoming too sick.
Should you wish to make a donation in Professor Bill Burhan’s memory, you can do so here. A memorial service and mass will be held in Buffalo on Nov 16, 2019 – for further information, please e-mail me at info@ancan.org.
PSA level to scan on recurrence – Axumin v PSMA; generic abiraterone; Yonsa; 50 yr old Dx with lymph node Mx; gall bladder issues; progression after carboplatin + etoposide; progression on Xtandi
AnCan’s good buddy and Advanced Prostate Cancer Virtual Group participant, Jerry Deans – who also happens to be Vice Chair of our partner UsTOO’s Board – has been using a wonderful service, Mercy Medical Angels for some time. He recently wrote to us:
I want people to know about a service that is being offered to those who qualify financially or are veterans. It’s called Mercy Medical Angels https://mercymedical.org/
They have transported me free of charge from Richmond, Virginia to NYC on two occasions.
One trip was for a clinical trial at NY Presbyterian for a Progenics 18F]DCFPyL PSMA PET scan and the second trip was to meet with Dr Charles Drake for discussion of next steps in my treatment. One of the pilots Royce Repka recorded this video.
Jerry recently published a book on his and his wife, Patsi’s struggle with disease and much more. The book is titled Lost But Not Forgotten – read the Customer Reviews and you’ll find this tome is full of hope!
Some of you may already know that AnCan is privileged to partner with the Male Breast Cancer Coalition to offer a men’s virtual breast cancer support group. While the incidence is much lower in men, all too often we forget that breast cancer hits men as well as women. If you heard our presentation on immuno-oncology this past week, you would have heard me remind our illustrious presenter that too!
My radar is now tuned to male breast cancer, so it is not too surprising I caught a report on Cancer Network today reporting a study that reveals that when compared to women men have significantly worse overall survival from breast cancer. And this is still true when disease demographics are matched up. Read the Cancer Network report here that links to the original study.
Buried in all of this is what I suspect to be the reason men fare worse than women ….. they are diagnosed later at a more advanced stage. That is through no fault of MBCC who strives to make us all aware of male breast cancer!
Bottom line: Dr. Maha Hussain states that olaparib (Lynparza) for patients with selected DNA damage repair gene alterations (BRCA1/2, ATM) should represent a new standard of care for mCRPC patients who have progressed on abiraterone or enzalutamide, regardless of prior treatment with taxane chemotherapy. This bodes well for eventual FDA approval of olaparib for metastatic, castrate-resistant prostate cancer patients who harbor DNA Damage Repair (DDR) mutations.
Details:
The PROfound study is a Phase III, randomized, multicenter trial evaluating the efficacy and safety of the PARP inhibitor olaparib versus physician’s choice of enzalutamide or abiraterone acetate in pre-treated metastatic castration-resistant prostate cancer (mCRPC) patients with a qualifying homologous recombination repair (HRR) gene mutation.
In order to be included in the study, patients had to have mCRPC, have had disease progression on either enzalutamide or abiraterone, and have alterations in one more pre-selected DNA damage repair genes as assayed by the customized FoundationOne® sequencing test (https://www.foundationmedicine.com/ ). Patients with a DNA damage repair (DDR) alteration were stratified into 2 cohorts: (1) Cohort A with BRCA1, BRCA2 or ATM alterations, as these have the strongest preclinical and prior trial support data, and (2) Cohort B with 12 other DDR alterations. Both cohorts proved superior to treatment with enzalutamide or abiraterone + prednisone, but Cohort A (BRCA1/2, ATM) demonstrated the best response.
Treatment in these cohorts were reasonably well tolerated in this group of patients, though more adverse events were reported in the olaparib arm than in the Abi/Enza arm. Anemia, nausea, fatigue, asthenia and decreased appetite were the most common adverse effects, with anemia seen in 21% of patients.
For the full summary of the trial presented at ESMO 2019 Conference, click here: http://tiny.cc/Olaparib
Multiple myeloma is a heterogenous plasma cell disorder that contains a small fraction of clonogenic stem cells, just like many other cancers. Although the exact nature and biological properties of these cells remain elusive, multiple myeloma stem cells (MMSCs) have pronounced drug resistance and are believed to be the root cause of failure of many myeloma management therapies. We are talking to Dr William Matsui of LIVESTRONG Cancer Institutes to learn about the latest research on multiple myeloma stem cells and their role in novel drug development to treat multiple myeloma.
To replay the webinar presentation, please click here. We recommend you download the Presentation Slide Deck to follow along – FongAnCan9-2019 .
AnCan is excited to host one of the World’s leading cancer immunologists, Professor Dr. LarryFong. Not just a leading researcher in the field of immuno-oncology, AnCan’s good friend Larry is a highly compassionate genitourinary clinician who has treated several of our participants over many years. We are honored to have Larry as an Advisory Board Member,
As you see above, Larry loves to smile – what a gift in the field of oncology! Not only does he smile often – he also has a great sense of humor. There’s a wonderful story behind this heart-warming pix with our dear, departed buddy, Jerry Carniglia – listen in to hear it! Amongst Jerry’s many talents, he was a collectible fine artist; this video, shown at a posthumous show at the Townsend Gallery on UC Berkeley campus, will make you smile and cry! Jerry’s Trust has donated some 18 enormous canvasses for display on rotation in the brand new Bakar Precision Medicine Building.
Dr. Fong will first explain the principles behind immuno-oncology in understandable terms with a pan cancer focus. He will then take questions on specific disease – BUT PLEASE keep your questions general rather than case specific.
With heavy heart, I write this sad post to report my dear friend, Professor Bill Burhans, 
Some of you may already know that AnCan is privileged to partner with the 
Dr. William Matsui
Gary Petersen
Cynthia Chmielewski
Jack Aiello
Shweta Mishra
As you see above, Larry loves to smile – what a gift in the field of oncology! Not only does he smile often – he also has a great sense of humor. There’s a wonderful story behind this heart-warming pix with our dear, departed buddy, Jerry Carniglia – listen in to hear it! Amongst Jerry’s many talents, he was a collectible fine artist; this