Monday, May 25, 2009

Memorial Day Call To Arms

Memorial Day is not just the start of summer. It is a day set aside to honor those who have fought valiant battles and gave the ultimate sacrifice, their lives. Everyone has someone in their family who is a veteran, some even have lost them in wars over the years. Some have family serving right now in the armed forces.

At this time, we honor all who have served. And we will always remember those who have been lost.

On another front line, there is a tender army fighting every day for their lives. They fight while they keep their jobs, take care of their kids, keep the family together and try to live the best they can. They have wounds from the battle, not from bullets, but from surgeons and chemicals. They keep going, they look forward and try not to look back.

Some, however, are challenged with new attacks from a returning enemy. They are suddenly classified as being at the end of their fight when, in fact, they have only just started it. No one can imagine what it is like to fight every day and live from scan to scan. But they do so, bravely and valiantly.

There have been casualties in this war. In fact, we lose over 40,000 a year. An entire generation of beautiful, vital, living, breathing, moms, daughters, sisters, lovers and friends are gone. This Memorial Day, we honor those lost on the front lines of breast cancer. May someone, someday, see the figure of 40,000 deaths a year, and make a sea change in the funding for research in the cure for this disease.

There are other, horrible diseases. They need funding too. But there is an inequity and it must be addressed. AIDS in America, gets four times the funding that breast cancer does, and the annual death toll is under 11,000 a year for the patients who are afflicted with that disease. We are not suggesting giving less to HIV/AIDS in America, but level the playing field so women with breast cancer can also have the types of drug combinations that keep AIDS patients alive and thriving for 25 plus years.

When 40,000 women are taken from America every year, we ask how vital it is to spend $500,000,000 just for the take off of the Space Shuttle that serves as a giant service station in space. Is it possible to reduce the number of flights to change the spark plugs on the International Space Station and take that money and give it to an NIH lab currently working on better detection, more effective treatments, and gene identification for targeted eradication of this disease?

There are many ways money can be redirected. We don’t have the answer. But we have just one request: We ask that next Memorial Day, may this list be shorter.

Our Warrior Angels from 2008-May 2009
Kari Lynn

This list compiled from the In Memoriam List from No Surrender Breast Cancer Foundation and the Angel List from breastcancer. org.

Saturday, May 23, 2009

2009 ASCO conference-Triple Negative News

The ASCO conference is in Orlando this year and will begin on May 31.
They have released some of the Abstracts that will be discussed.
One in particular caught my eye.
It is about the effectiveness of anthracycline therapy on basal, triple negative breast cancer vs CMF.
It appears that CMF is superior to Adriamycin and Epirubicin in this particular trial.
However, these same drugs are superior to CMF in NON-basal, Her2+ breast cancers.

I was diagnosed in 2001 with Triple Negative Breast Cancer. I received CMF. The triple negative cancer has not returned. Yet, I did get a new primary which was estrogen and progesterone positive for which I received Adriamycin.

The following is a copy from the ASCO site

Anthracyclines in basal breast cancer: The NCIC-CTG trial MA5 comparing adjuvant CMF to CEF.

Sub-category: Adjuvant Therapy

Category: Breast Cancer--Local-Regional and Adjuvant Therapy

Meeting: 2009 ASCO Annual Meeting

Citation: J Clin Oncol 27:15s, 2009 (suppl; abstr 519)

Abstract No: 519

Author(s): M. Cheang, S. K. Chia, D. Tu, S. Jiang, L. E. Shepherd, K. I. Pritchard, T. O. Nielsen; University of British Columbia, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; University of Toronto, Toronto, ON, Canada


Background: MA5 randomized premenopausal women with node-positive early breast cancers to cyclophosphamide- methotrexate-fluorouracil (CMF) or cyclophosphamide-epirubicin-fluorouracil (CEF) adjuvant chemotherapy. This and other trials have shown that adjuvant regimens containing anthracyclines confer significant survival benefit to breast cancer patients. Meta-analyses have revealed most benefit in women with HER2(+) or TOPO2 (+) tumors. Population-based data suggest that patients with a core basal phenotype (negative for hormone receptors and HER2, positive for CK5/6 or EGFR) conversely have worse survival on anthracycline containing vs. CMF regimens. Here we test the hypothesis specified a priori that for basal breast cancers anthracyclines may be inferior, using data from MA5. Methods: From 710 patients in MA5, blocks suitable for tissue microarray construction were recovered for 549. Immunohistochemistry for ER, PR, HER2, Ki67, CK5/6 and EGFR was obtained, allowing stratification of 511 cases into intrinsic biological subtypes by published methods (Cheang MC et al. Clin Cancer Res 2008;14:1368-76). Prespecified analyses were conducted independently by the NCIC- CTG statistical centre. Results: In the CEF arm, patients with core basal tumors had a hazard ratio of 1.8 (log rank p=0.02) for overall survival (OS) relative to the other biological subtypes. In the CMF arm, there was no significant difference (HR 0.9, p = 0.7). The interaction between core basal status and treatment was borderline significant (p=0.06). Relapse free survival differences did not reach significance. Conclusions: Data from this randomized trial supports the hypothesis that anthracycline containing adjuvant chemotherapy regimens are inferior to adjuvant CMF in women with basal breast cancer.

Tuesday, May 19, 2009

Yo, FDA, Hurry UP!

The new 410 implants look natural, don't ripple, and have better outcome.... you can get them in Canada and France but the FDA can't seem to decide on the label.

Meanwhile, women are waiting, stuck with old style implants that look like grapefruit halves hot glued to their chests....

Give us a break- if it was a drug for ED you can bet the FDA would have it available faster than a jackrabbit on his honeymoon.....

An exercise in clock watching - the fda's review of Allergan's 410 "gummy bear" breast implants
Posted Apr 26 09 10:11pm

As the plastic surgeons of the United States await approval of Allergan's style 410 breast implant (aka "the gummy bear" implant), I frequently get questions from patients about when this device will be approved.

The short answer is "I don't know!"

The approval of medical devices of all sorts has been heavily politicized. After a number of recent high profile issues with prescription drugs, cardiac pacemakers, and vascular stents (devices used to prop open clogged blood vessels or fix aneurysms), the FDA is under the microscope. Caught up in all this is the fate of the next generation of breast implant devices, for which the FDA has been sitting on the manufacturers approval applications for nearly 3 years.

For some context, "form stable" implants like Allergan's 410 have been used clinically around the world for over 15 years. In clinical trials (like this )they have an unparalleled safety record for this kind of medical device, and offer both superior durability and a reduction in every single kind of indexed complication (pain, capsular contracture, rippling, rupture, etc...) after cosmetic and reconstructive breast surgery that we observe and track.

The NY Times reported earlier in April ( here )on the ongoing reexamination of "legacy" devices that were exempted prior to the late 1970's from review as they were already being used. Silicone and saline breast implants actually already went through this review by the FDA in the early 1990's and eventually emerged with a clean bill of health. The only reason the newer implants have to go thru this process at all is the higher cohesiveness of the silicone polymer exceeds some artificial cut-off that would make them fall under the existing approval. This illogical rationale has cost tens of millions of dollars to companies and delayed patients access to improved devices.

As to the fate of the 410 implant, my understanding is that the FDA is satisfied with the safety and clinical efficacy of the implants and is negotiating on the final labeling to be included with the product. Apparently, surgeons will be required to attend an instructional course prior to being given access to the device (even someone like me who actually used these devices as a resident and fellow during clinical trials). We are hopeful that the ongoing activity signals approval is immanent this quarter!

Sunday, May 17, 2009

Learning to Let Go

Cancer has many downsides, and Lord knows we have examined them here. But a diagnosis and its ensuing horrors does help us put things into perspective. We also learn how to accept losses gracefully.

As a young woman who was diagnosed, I had to give up a lot. The biggest loss was having children. After that, the other losses don't seem so bad. Many of us have given up part of our bodies, been forced to give up our careers and find new ones. Some have even lost their spouses because they were not able to handle the new woman their wives had become.

We learn to let go and see the never ending possibilities before us.

Cancer has trained me well. It was a baptism by fire to be sure. But I like the new woman it made me. I am glad to be free.