Living with cancer blog

Mayo Clinic offers gene panel testing to target cancer treatment

By Sheryl M. Ness, R.N. May 22, 2014

In April, Mayo Clinic announced the launch of a cancer gene panel performed by next generation sequencing.

This cancer tumor gene panel is a test that can be used for patients who have solid tumors such as lung, colon, breast, kidney and liver cancers.

The gene panel looks at the patient's tumor cells and tests for 50 genes that can affect tumor growth and could identify specific treatment options directed against the genetic mutation.

For years, researchers and oncologists have been making discoveries about genetic mutations that drive the growth of certain cancers. Much work has been done to discover and create drugs that can target specific genetic mutations and shut down their ability to keep the tumor alive and growing.

It's this collection of know cancer genes (oncogenes) and targeted agents that are the background for the creation of the gene panel test.

This type of testing is a great example of how Mayo Clinic provides individualized cancer care.

Each person's cancer tumor makeup is different and should be treated using the most effective drugs or combination of drugs that are known to work against the tumor characteristics. The ultimate goal of the gene panel test is to help oncologists find the right drug the first time.

The test is now available to Mayo Clinic patients and to oncologists worldwide through Mayo Medical Laboratories.

For more information, see http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-launches-50-gene-cancer-panel-test.

Patients can be evaluated through The Mayo Clinic Center for Individualized Medicine, which is home to the Individualized Medicine Clinic, the world's first integrated multidisciplinary genomics clinic, serving patients with advanced cancer and complex diagnoses.

The center discovers and integrates the latest in genomic, molecular and clinical sciences into personalized care for each Mayo Clinic patient. For more, visit: http://mayoresearch.mayo.edu/center-for-individualized-medicine.

I'd love to hear from anyone who has experienced gene testing for their cancer. What was your experience?

With

Sheryl M. Ness, R.N.

Follow on Twitter: @SherylNess1

http://www.mayoclinic.org/diseases-conditions/breast-cancer/expert-blog/cancer-gene-panel-testing/bgp-20094536/?utm_source=newsletter&utm_medium=email&utm_campaign=living-with-cancer

Where You Live May Increase Your Odds of Certain Cancers

By Elise Solé, Shine Staff | Healthy Living – Wed, May 28, 2014 10:33 AM EDT

Your chances of developing certain types of cancer may depend on how affluent your neighborhood is, according to a new study published Tuesday in the journal Cancer. Scientists found that specific cancers are more prevalent among the poor and others among the wealthy.

Researchers used U.S. census information to analyze the poverty rate of each neighborhood (defined as a living space containing 4,000 people) in 16 states and Los Angeles County, which collectively accounted for 42 percent of the U.S. population. Income status was based on the percentage of households in each area that lived below the poverty level.

In wealthy areas of the country, more common cancers include testicular, thyroid, melanoma, breast, and cervical. In poorer areas, cancers stemming from certain risky behaviors are more prevalent. Those include cancers of the penis and cervix, which are linked to sexually transmitted diseases; cancer of the larynx, which can be caused by smoking, drinking, or HPV; liver cancer, often linked to drinking and hepatitis (which can be contracted by needle sharing); and Kaposi's sarcoma, a skin cancer that often occurs in people with AIDS.

Interestingly, the frequency of cancer is lower in poorer areas, but deaths from these cancers are higher. “One possible reason is that wealthier people have more access to health insurance and cancer screening technology such as mammograms and pap smears, so they’re likelier to detect the disease before it spreads,” lead study author Francis P. Boscoe, PhD, a research scientist at theNew York State Department of Health, tells Yahoo Shine. The results also explain why poor people are often diagnosed when their cancer is in advanced stages.

There are also certain risk factors associated with socioeconomic status, adds Boscoe. For example, wealthy, educated people tend to have fewer children or bear them later in life. And women who give birth after the age of 30 are more likely to develop breast cancer due to hormonal changes that occur with age. Wealthier people are also less likely to engage in risky behavior such as smoking thanks to access to better healthcare education.

Of course, no matter where you live, taking precautions to stave off cancer is crucial. This includes exercising daily (According to the Centers for Disease Control and Prevention, adults should get 150 minutes of moderate aerobic activity each week), maintaining a well-balanced diet (a variety of antioxidant-rich produce, lean proteins, and whole grain carbohydrates), and avoiding smoking and excessive drinking. 

https://shine.yahoo.com/healthy-living/cancer-income-wealth-poor-neighborhoods-rutgers-study-143339409.html

Know:BRCA

Know:BRCA tool for women • Know:BRCA tool for clinicians

Most breast cancers are found in women who are 50 years old or older, but about 9,000 women who are younger than 40 years old are diagnosed with breast cancer each year in the United States. In this younger group, breast cancer is generally more aggressive, found at a later stage, and has lower survival rates.

Two genes influence risk for breast cancer: BRCA1 and BRCA2. All men and women have these genes. Normally, they help protect you from getting cancer. But when one or both of them have amutation (change), they increase your breast and ovarian cancer risk. Without treatment, women with a BRCA gene mutation are seven times more likely to get breast cancer and 30 times more likely to get ovarian cancer before age 70 than other women.

How do I know if I have a higher risk for a BRCA gene mutation?

Learn your family history of cancer. Talk to your doctor if you have—

• Multiple relatives with breast cancer.
• Any relatives with ovarian cancer.
• Relatives who were diagnosed with breast or ovarian cancer before age 50.

The Know:BRCA tool can help you learn about BRCA genes and assess your risk of having a BRCA mutation. Learning your risk can help you and your doctor make important decisions about your health. There is also a Know:BRCA tool for clinicians.

 

What should I do if I am at increased risk?

The only way to know for sure if you have a BRCA1 or BRCA2 gene mutation is to get a genetic test. You should meet with a genetic counselor before getting a genetic test. Your doctor can refer you to one. Most people do not need genetic counseling and testing. A genetic test helps only the small number of people with a higher risk for having a mutation.

If you learn that you have a BRCA gene mutation, you can take important steps to reduce your cancer risk.

What should I do if I am NOT at increased risk?

Most women who get breast and ovarian cancer do not have a BRCA gene mutation. If you do not have a family history of breast or ovarian cancer, follow recommended breast cancer screening guidelines.

How can I help others?

Help us promote awareness about hereditary breast and ovarian cancer by sharing this page and the infographics below.

Everyone Has BRCA Genes

Know:Your Risk

Know:BRCA

Know:BRCA Education Initiative

The Know:BRCA education initiative aims to build awareness about how BRCA gene mutations affect risk for breast and ovarian cancer. It was authorized by the Education and Awareness Requires Learning Young (EARLY) Act, section 10413 of the Patient Protection and Affordable Care Act (Public Law 111-148). The EARLY Act authorizes CDC to develop initiatives to increase knowledge of breast health and breast cancer among women, particularly among those under age 40 and those at higher risk for developing the disease.

http://www.cdc.gov/cancer/breast/young_women/knowbrca.htm

Cancer Side Effects Helper Mobile App

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Cancer side effects are round-the-clock realities that can impact quality of life during an already challenging time. That's why we created the Cancer Side Effects Helper. This free mobile app offers trusted nutrition guidance and practical tips to help survivors feel better, maintain strength, and speed recovery from common cancer side effects including:

     ▪ Change in Taste and Smell                   ▪ Gas and Bloating
     ▪ Constipation                                          ▪ Lactose Intolerance
     ▪ Diarrhea                                                ▪ Loss of Appetite
     ▪ Difficulty Swallowing                               ▪ Nausea
     ▪ Dry Mouth                                              ▪ Sore Mouth, Throat, and Tongue
     ▪ Fatigue                                                  ▪ Weight Gain
     ▪ Feeling Full Quickly                               ▪ Weight Loss

Select applicable side effects and view quick and easy suggestions from PearlPoint’s oncology registered dietitians. The app also includes access to My PearlPoint for more extensive cancer support including educational articles and videos, clinical trial information, nutrition guidelines, and resources for practical, financial, and emotional questions. 

The app is free! Download it today at iTunes or at the Google Play store.

https://pearlpoint.org/cancer-side-effects-helper-mobile-app

Rate of breast reconstruction increased after women’s health law enacted

• O&P Business News, June 2013

More breast cancer patients underwent reconstructive surgery after a mastectomy following enactment of the Women's Health and Cancer Rights Act in January 1999, according to a study published in the journal Cancer.

See Also

• Women's health care trade show announces annual meeting ...
• Mortality risk increased in women with breast cancer, diabetes ...
• Heavier tissue flaps increase risk of fat necrosis after breast ...

Researchers from the University of Pennsylvania looked at how the legislation, which requires that health insurance plans that cover the cost of a mastectomy also cover the cost of reconstructive surgery, affected a patient’s decision to undergo breast reconstruction. They identified 168,236 patients from the Nationwide Inpatient Sample database who underwent a mastectomy for cancer between 2000 and 2009 and classified them by their immediate breast reconstruction status (IBR).

They found that the rate of IBR for women with Medicaid increased from 5% in 2000 to 20% in 2009. Additionally, the rate of IBR increased from 4.3% in 2000 to 12.3% in 2009 for women with Medicare and from 22.1% to 57.1% for women with private insurance. The researchers also found that women with private insurance were more likely to undergo reconstructive surgery than women without it.

“After the enactment of policy designed to improve access to IBR, Medicaid and Medicare patients experienced the greatest relative increase in rates of IBR,” the authors wrote in the study abstract. “Although policy changes had the most impact on traditionally underserved populations, disparities still exist. Future studies should endeavor to understand why such disparities have persisted.”

For more information:

Yang RL. Cancer. 2013. doi: 10.1002/cncr.28050.

http://www.healio.com/orthotics-prosthetics/post-mastectomy/news/print/o-and-p-business-news/%7Bf2690e0b-af31-4fd1-b196-d6bf3563a112%7D/rate-of-breast-reconstruction-increased-after-womens-health-law-enacted

Heavier tissue flaps increase risk of fat necrosis after breast reconstruction

• May 31, 2013

The weight of tissue flap used for women undergoing breast reconstruction after mastectomy affects the risk of fat necrosis, according to recent study results.

See Also

• Rate of breast reconstruction increased after women's health ...
• Mortality risk increased in women with breast cancer, diabetes ...
• A New Look at Breast Prostheses

Researchers analyzed risk factors for fat necrosis in 123 women undergoing breast reconstruction after mastectomy for breast cancer and evaluated surgical and patient-related factors affecting the risk of fat necrosis after reconstruction.

Of the 179 flaps analyzed, fat necrosis occurred in 7.5% of flaps. The risk was significantly higher for women with heavier tissue flaps. According to study results, for each 100-gram increase in flap weight the risk of fat necrosis increased by 50%. The risk of fat necrosis was also affected by the number of supplying blood vessels. Among all women, African American women had a risk of fat necrosis nearly 12 times higher than white women. However, risk was not significantly affected by patient age, body weight and various medical and surgical factors.

“Flaps with increasing weight have increased risk of fat necrosis,” the researchers concluded. “These data suggest that inclusion of more than one perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders and flap weight may optimize outcomes.”

For more information:

Mulvey C. Plastic and Reconstructive Surgery – Global Open. 2013doi: 10.1097/GOX.obo13e318294e41d.

Disclosure: The researchers have no relevant financial disclosures

http://www.healio.com/orthotics-prosthetics/post-mastectomy/news/online/%7B93ff5d77-3fda-404c-a7b1-9dfd57ff77db%7D/heavier-tissue-flaps-increase-risk-of-fat-necrosis-after-breast-reconstruction

FGFR Inhibitors of Interest in Bladder and Lung Cancer

By Alice Goodman
May 15, 2014, Volume 5, Issue 8

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Related Links:

Expert Point of View: Paul K. Paik, MD

Figures:

Rodrigo Dienstmann, MD

Lecia Sequist, MD

FGFR Inhibitors in Cancer Therapy

Fibroblast growth factor receptor (FGFR) inhibitors are an emerging area of interest in cancer therapeutics. Studies presented at the 2014 American Association for Cancer Research (AACR) Annual Meeting in San Diego provided early encouraging data for two investigational pan-FGFR inhibitors for the treatment of advanced solid tumors driven by FGFR alterations—notably, bladder and lung cancer. Both drugs are oral agents that inhibit FGFR1, FGFR2, FGFR3, and FGFR4, and both are moving into further development for several types of cancer.

JNJ-42756493

The first study showed that the FGFR inhibitor JNJ-42756493 had excellent activity in patients with advanced solid tumors. This phase I trial enrolled 41 patients with various tumor types that had progressed despite previous therapies.

All patients enrolled in the trial had normal phosphate levels at baseline. Increased phosphate levels are an on-target effect of FGFR inhibition. As expected, hyperphosphatemia was the most frequent adverse event, occurring in 58% of patients. Other commonly reported adverse events were asthenia (20%), fatigue (60%), and gastrointestinal effects (20%). No cardiotoxicity was observed in these patients.

The dose-finding phase of the trial identified 9 mg as the recommended dose for phase II trials. At the 9-mg dose level, 7 of 8 patients developed hyperphosphatemia, said lead author Rodrigo ­Dienstmann, MD, Vall d’Hebron Hospital, Barcelona, Spain. Dr. Dienstmann and colleagues instituted a detailed management approach for hyperphosphatemia that included dose reductions. This approach seemed to reduce the occurrence of hyperphosphatemia.

Maximal RECIST responses were seen in patients treated at 6 mg or higher. Responses were observed in patients with FGFR amplification and translocation.

Ongoing studies of JNJ-42756493 include efforts to optimize dose and schedule and to analyze biomarkers. Expansion cohorts are currently enrolling patients with FGFR-aberrant tumors, including lung and breast cancer.

BGJ398

The second study evaluated a pan-FGFR inhibitor called BGJ398 in patients with solid tumors that expressed FGFR abnormalities. Study results suggested that bladder cancer and lung cancer are particularly susceptible to FGFR inhibition.

“About 15% of bladder cancer patients have FGFR mutations, and an additional 6% have an FGFRtranslocation. About 21% of non–small cell lung cancer patients have FGFR abnormalities,” explained lead author Lecia Sequist, MD, of Massachusetts General Hospital Cancer Center, Boston.

“We specifically enrolled only patients with FGFR genetic alterations in their tumors because we predicted that these patients would have the greatest chance of benefiting from the drug,” she said.

Dr. Sequist commented that the results in patients with bladder cancer were “exciting” because these patients have few treatment options.

The phase I study she reported included dose-escalation and dose-expansion phases. In the dose-escalation phase, patients were treated with oral BGJ398 once or twice a day in a 28-day cycle. The maximum tolerated dose was defined as 125 mg. Ongoing dose-expansion cohorts include squamous cell NSCLC and bladder cancer. Of 95 bladder cancer patients screened, 7 (7%) had an FGFR3mutation; of 147 lung cancer patients screened, 14 (9%) had FGFR1 amplification.

The results Dr. Sequist presented were based on 107 patients with a mean age of 59 years. Thirty-eight percent had breast cancer, 34% had lung cancer, and 9% had bladder cancer. Eight patients remain on treatment at the time of the AACR meeting. Most withdrawals were due to disease progression.

At the maximum tolerated dose, 87% of patients developed hyperphosphatemia, 43% had stomatitis, 34% had decreased appetite, 23% had fatigue, 30% had alopecia, and 15% had nausea. These adverse events were mainly mild to moderate.

“Hyperphosphatemia is an on-target expected effect that is manageable with dietary restriction, phosphate-lowering therapy, and dose interruptions. We found that an intermittent dosing schedule reduced hyperphosphatemia, so going forward, 3 weeks on and 1 week off will be our preferred dosing schema,” Dr. Sequist said.

A waterfall plot showed tumor shrinkage by RECIST criteria in patients treated at doses > 100 mg/d, with the most notable responses seen in bladder and lung cancer. In her presentation at AACR, Dr. Sequist focused on the bladder cancer patients. She said the lung cancer data will be presented at this year’s ASCO Annual Meeting.

Of six patients with bladder cancer, five with a driver mutation of FGFR3 did very well. Overall response rate was 40%, and disease control rate was 100% in these five patients. The sixth patient had FGFR1amplification and very aggressive disease.

“The key feature [of effective therapy] seems to be selection of patients based on FGFRabnormalities,” she said. ■

Disclosure: Drs. Sequist and Dienstmann reported no potential conflicts of interest.

References

1. Dienstmann R, Bahleda R, Adamo B, et al: First in human study of JNJ-42756493, a potent pan fibroblast growth factor receptor (FGFR) inhibitor in patients with advanced solid tumors. 2014 AACR Annual Meeting. Abstract CT325. Presented April 8, 2014.

2. Sequist LV, Cassier P, Varga A, et al: Phase I study of BGJ398, a selective pan-FGFR inhibitor in genetically preselected advanced solid tumors. 2014 AACR Annual Meeting. Abstract CT326. Presented April 8, 2014.

An earlier version of this article incorrectly identified Dr. Sequist's affiliation. This error has been corrected.

http://www.ascopost.com/issues/may-15,-2014/fgfr-inhibitors-of-interest-in-bladder-and-lung-cancer.aspx

Are Tanning Beds Safe?

 Dana-FarberMay 3, 2013Health and wellness

If you’re thinking about hitting the tanning beds to get started on your “base tan,” don’t. That’s the advice of Jennifer Y Lin, MD, of Dana-Farber’s Center for Melanoma Oncology.

Melanoma, the most deadly form of skin cancer, is on the rise, particularly in women aged 25-32. The frequency of tanning and age at which you start tanning both affect your risk of melanoma. Too much sun exposure of any kind can be harmful, but tanning booths are even worse. 75 percent of melanomas diagnosed between the ages of 18 to 29 years of age are associated with tanning bed use. Tanning beds emit three to six times the amount of radiation given off by the sun, meaning that using a bed or a booth for 20 minutes translates into one to three hours of lying out at the beach without any sun screen protection.

Perhaps that is why the Food and Drug Administration (FDA) has proposed putting warning labels on tanning beds.

Indoor tanning systems expose users to ultraviolet A (UVA) radiation, which deeply penetrates the surface of the skin, damages underlying cells, and prematurely ages skin. Contrary to common thought, tanning beds don’t provide users with any vitamin D, an essential part of health. (Most people only need five to ten minutes of sun exposure 2 to 3 times a week to help your skin make this crucial vitamin.)

To better your skin health, incorporate orange juice, milk, fish, and supplements into your diet as alternative sources of Vitamin D, avoid prolonged periods of time in the sun without sun screen protection, see your dermatologist yearly, and stay away from tanning beds.

In an earlier Insight blog post, Lin points out the myths about skin cancer. Her related video discusses how to prevent and identify melanoma.

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