[Mark11]

NYT Op-Ed article, "Trying To Fool Cancer"

by Mark11 on Sun Mar 29, 2015 9:35 am

I wasn't sure where the best place to put this op-ed piece. I thought it was a realistic contrast to the HBO Vice piece, so it could have gone after the recent posting about it. It could also go in the thread about the upcoming Ken Burns documentary as well.

The article is written by an oncologist and director of the leukemia program at the Cleveland Clinic.

When it airs on Monday, the Ken Burns-produced documentary “Cancer: The Emperor of All Maladies” will emphasize how much more we now know about the genetic basis for cancer. This year, according to President Obama, cancer research and funding will focus on so-called precision, personalized or targeted medicine – using cancer’s molecular underpinnings to develop drugs that attack the genes or gene products that make up cancer’s factory while sparing normal cells. What a beautiful concept.

The problem is, cancer is rarely that simple, or that easily fooled ...

Without doubt, therapies that target genetic abnormalities have made huge inroads in the survival of cancer patients, most notably in some chronic leukemias, melanomas and lung and breast cancers.

But they haven’t been curative. And we shouldn’t delude ourselves, or our patients, in thinking that standard chemotherapy is a thing of the past. Or that a few more months of life, which is what many targeted drugs have been able to deliver on average, is a panacea in cancer care."

From: Mikkael A. Sekeres, "Trying to Fool Cancer," The New York Times, March 28, 2015 (link to article)

[Boris Simkovich]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by Boris Simkovich on Sun Mar 29, 2015 8:12 pm

Thanks for the posting, Mark.

It's worth mentioning that Dr. Sekeres, the author of the op-ed article, is a very well respected hematologist / oncologist. His area of focus is myelodysplastic syndromes (MDS), which many here will recognize as a disease that can occur as a secondary cancer in myeloma patients. It's probably fair to say that Dr. Sekeres ranks among the very top MDS specialists worldwide.

Dr. Sekeres also was a member in the past of the FDA's Oncologic Drugs Advisory Committee (ODAC). He was an ODAC member, in fact, when it reviewed Kyprolis prior to its approval by the FDA almost three years ago.

[mikeb]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by mikeb on Mon Mar 30, 2015 2:09 pm

Hi Mark,

You beat me - I was going to post a link to Dr. Sekeres's op-ed piece too.

I found this piece to be a very sobering article. I've had a lot of hope for the combination of gene expression profiling and data analytics to lead to breakthroughs for us. The experiments described in the article take that basic approach but show that things are way more compli­cated and complex than I had ever imagined. There's still a long way to go ...

And following up on Boris's comment about Dr. Sekeres - Dr. Sekeres writes a blog for the NY Times. I highly recommend his articles; they give insight into the "human" side of medicine, if that makes sense. Here is a link to some of his pieces.

Mike

[Boris Simkovich]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by Boris Simkovich on Mon Mar 30, 2015 2:31 pm

Thanks for that follow-up, Mike.

I don't know if Dr. Sekeres mentions this article in his blog for the Times, so I thought I would ref­erence it here just to give a sense of the range of his writings:

M Sekeres, "What My Patients Taught Me About Love," Journal Of Clinical Oncology, Oct 2009 (link to full text of article).

[mikeb]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by mikeb on Mon Mar 30, 2015 5:16 pm

Hi Boris,

I haven't seen that article mentioned in any of his blog writings, but I happened upon it about 6 months ago. It is now my favorite article I have ever read in a scientific journal.

Thanks for pointing it out here!

Mike

[Mark11]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by Mark11 on Tue Mar 31, 2015 8:28 am

Hi MikeB,

I hope you are doing great today.

It was an ex­cel­lent article. The only thing I would have liked in that last paragraph was for Dr. Sekeres to state that "non-targeted" therapies do cure some cancer patients. I have never quite understood this fascination with "targeted therapies" since there is no evidence that they are cur­ative by themselves.

I think the experience with non-Hodgkin's lymphoma with respect to how a targeted therapy can be helpful is what we will see moving forward. The common upfront therapy is R-CHOP. R is ritux­i­mab (Rituxan), which is a targeted antibody and the most recent addition to the cocktail. CHOP is a cocktail of older chemotherapy. For example the C is for Cytoxan (cyclo­phos­pha­mide), an alkylator. CHOP was curative for roughly 50% of the patients. Adding the rituximab raises the cure rate to 70% or so, but by itself rituximab is not curative.

Combining older "non-targeted" therapies with newer therapies can produce very successful outcomes for blood cancer patients. In my opinion, that is the path we will see moving forward in myeloma if the doctors want to cure more myeloma patients

Mark

[Ron Harvot]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by Ron Harvot on Tue Mar 31, 2015 9:19 am

Mike and Mark,

Thanks for posting this about Dr. Sekeres. I will add this to my reading list.


Ron

[NStewart]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by NStewart on Tue Mar 31, 2015 12:16 pm

Last night's episode of "The Emperor of All Maladies" talked a lot about using multiple drugs to target cancer because each drug by itself approaches the cancer in a different way and may also have synergistic effects with one another.

The other issue that was addressed was the fact that often the treatment of one cancer leads to the development of a secondary cancer. This was presented through the case of the young boy who was treated for leukemia and then later developed MDS.

One of the things that I think that this documentary is pointing out very clearly is that there is still so much that is unknown about how each cancer type functions. But, I feel that it is giving hope that the treatments will be more effective as more is learned. Yes, there are people who are cured with the treatments that they receive, but there are also many who aren't. Does that mean that cancer treatment is a failure? I don't think so. I think that it means that we don't yet know enough, and maybe never will, to guarantee that the majority diagnosed with cancer will be cured.

Nancy in Phila

[Mark11]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by Mark11 on Tue Mar 31, 2015 1:12 pm

Hi Nancy S,

Thanks for the great post. I missed the documentary last night. I am going to try and check it out online today.

There was an Italian cancer study that estimated that roughly a quarter of Italian cancer pa­tients are cured.

The study showed a steady increase over time (nearly +3% per year) of prevalent cases in Italy. A quarter of Italian cancer patients alive in 2010 can be considered as already cured. The AIRTUM Report 2014 describes characteristics of cancer patients and former-patients for 50 cancer types or combinations by sex and age. This detailed information promotes the conduction of studies aimed at expanding the current knowledge on the quality of life of these patients during and after the active phase of treatments (prevalence according to health status), on the long-term effects of treatments (in particular for paediatric patients), on the cost profile of cancer patients, and on rare tumours. All these observations have a high potential impact on health planning, clinical practice, and, most of all, patients' perspective."

Reference: L Dal Maso et al, "Italian cancer figures, report 2014: Prevalence and cure of cancer in Italy," Epidemiologia & Prevenzione, Nov-Dec 2014 (abstract at PubMed)

[Mark11]

Re: NYT Op-Ed article, "Trying To Fool Cancer"

by Mark11 on Tue May 12, 2015 12:18 pm

Here is another excellent piece by Dr. Sekeres. Next year will be 5 years since my allo. Hopefully I will get the chance to have this type of discussion with my doctor next May. I hope we get to have it for my doctor's sake as well. It must be great for a doctor to see success in difficult to treat cases like mine.

In the past, with other patients who had achieved this five-year goal, I would come bounding into their exam rooms exclaiming, “We can say it now! We can use the C-word. You’re cured!” And we would all celebrate noisily. Oncologists, like baseball players, tend to be superstitious. Until this time point has been reached, we tend to avoid tempting the fates by using words like “cure,” preferring instead convoluted phrases like “long-term disease-free survival.” But after this five-year mark, I would tell my patients that, as much as I enjoyed their company, they no longer had to fight the traffic to see me anymore.

But then, a couple of these patients showed up on my clinic schedule again, eight or 10 months later, having gone to their primary care doctors complaining of fatigue, or of just not feeling “right.” Routine blood work again showed abnormalities, and they returned to my office, confused and devastated.

Sometimes I realized that we hadn’t really cured the leukemia so much as reset the clock to a time just before the leukemia diagnosis, when they had an underlying bone marrow disorder that turned into leukemia, and that this was responsible for the recurrent abnormal blood counts. Sometimes they really did have leukemia again, and I wondered if we had caused this second bout with the chemotherapy we had used to treat the original leukemia.

I would be equally devastated. As a result, I have become more reserved in the joy I used to have for my patients. Rather than rejoicing, I caution them that there is still a chance the leukemia may return. Is it fair of me, though, to continue to burden them with this threat of relapse, to hold the sword of Damocles over their heads, when we all know how special it is to reach this five-year mark?

From:

Mikkael A. Sekeres, "Cured From Cancer, Almost," The New York Times, May 11, 2015 (full text of article)