Saturday, July 30, 2016

What Is Immunotherapy? The Basics on These Cancer Treatments

By DENISE GRADY and ANDREW POLLACKJULY 30, 2016

A nurse prepared an immunotherapy drug at the University of Texas M.D. Anderson Cancer Center in Houston. CreditIlana Panich-Linsman for The New York Times

Some of the most promising advances in cancer research in recent years involve treatments known as immunotherapy. These advances are spurring billions of dollars in investment by drug companies, and are leading to hundreds of clinical trials. Here are answers to some basic questions about this complex and rapidly evolving field.

What is immunotherapy?

Immunotherapy refers to any treatment that uses the immune system to fight diseases, including cancer. Unlike chemotherapy, which kills cancer cells, immunotherapy acts on the cells of the immune system, to help them attack the cancer.

What are the types of immunotherapy?

Drugs called checkpoint inhibitors are the most widely used form of immunotherapy for cancer. They block a mechanism that cancer cells use to shut down the immune system. This frees killer T-cells — a critically important part of the immune system — to attack the tumor. Four checkpoint inhibitors have been approved by the Food and Drug Administration and are on the market. They are given intravenously.

Another form of immunotherapy, called cell therapy, involves removing immune cells from the patient, altering them genetically to help them fight cancer, then multiplying them in the laboratory and dripping them, like a transfusion, back into the patient. This type of treatment is manufactured individually for each patient, and is still experimental.

Bispecific antibodies are an alternative to cell therapy, one that does not require individualizing treatment for each patient. These antibodies are proteins that can attach to both a cancer cell and a T-cell, that way bringing them close together so the T-cell can attack the cancer. One such drug, called Blincyto, has been approved to treat a rare type of leukemia.

Cell Wars

Articles in this series are exploring the novel uses of immunotherapy to combat cancer.

Vaccines, another form of immunotherapy, have had considerably less success than the others. Unlike childhood vaccines, which are aimed at preventing diseases like measles andmumps, cancer vaccines are aimed at treating the disease once the person has it. The idea is to prompt the immune system to attack the cancer by presenting it with some piece of the cancer.

The only vaccine approved specifically to treat cancer in the United States is Provenge, for prostate cancer. Another vaccine, BCG, which was developed to prevent tuberculosis, has long been used to treat bladder cancer. As a weakened TB bacterium, BCG appears to provoke a general immune system reaction that then works against the cancer. Researchers hope that other vaccines may yet be made to work by combining them with checkpoint inhibitors.

Which types of cancer are treated with immunotherapy?

Checkpoint inhibitors have been approved to treat advanced melanoma, Hodgkin’s lymphoma and cancers of the lung, kidney and bladder. The drugs are being tested in many other types of cancer.

So far, cell therapy has been used mostly for blood cancers like leukemia and lymphoma.

Which cancer drugs are checkpoint inhibitors?

The four on the market are: Yervoy (ipilimumab) and Opdivo (nivolumab), made by Bristol-Myers Squibb; Keytruda (pembrolizumab), by Merck; and Tecentriq (atezolizumab), by Genentech.

How well does immunotherapy work?

Though immunotherapy has been stunningly successful in some cases, it still works in only a minority of patients. Generally, 20 percent to 40 percent of patients are helped by checkpoint inhibitors — although the rate can be higher among those with melanoma. Some patients with advanced disease have had remissions that have lasted for years. In some cases, combining two checkpoint inhibitors increases the effectiveness. But for some people the drugs do not work at all, or they help just temporarily.

Cell therapy can produce complete remissions in 25 percent to 90 percent of patients with lymphoma or leukemia, depending on the type of cancer. In some cases the remissions can last for years, but in others relapses occur within a year.

What are the side effects?

Checkpoint inhibitors can cause severe problems that are, essentially, autoimmune illnesses, in which the immune system attacks healthy tissue as well as cancer. One result is inflammation. In the lungs it can cause breathing trouble; in the intestine it can cause diarrhea. Joint and muscle pain, and rheumatoid arthritis can also occur, and the immune system can also attack vital glands like the thyroid and pituitary. These reactions are dangerous, but can often be controlled with steroid medicines like prednisone.

Cell therapy can also lead to severe and potentially fatal reactions resulting from the overstimulation of the immune system. The reactions can usually be controlled, but patients may need to be treated in an intensive care unit.

What does immunotherapy cost? Does insurance cover it?

Checkpoint inhibitors can cost $150,000 a year. Many insurers will pay if the drug has been approved for the type of cancer the patient has. But sometimes there are high co-payments. Patients in clinical trials may get the drugs free.

Manufacturers have not said yet how much they will charge for cell therapies, assuming they win approval and reach the market. But experts expect the price to be as high as a few hundred thousand dollars.

Where can I get immunotherapy?

Any oncologist can prescribe the checkpoint inhibitors that are on the market. Patients with cancers for which the drugs have not been approved may find insurers reluctant to pay, but may be able to get the drugs for free by volunteering for clinical trials.

Cell therapies are available only through clinical trials now. Most of the study sites are major medical centers.

How can I find out about clinical trials in immunotherapy?

Information is available on the Cancer Research Institute website, or by calling 1-855-216-0127 (Monday through Friday, 8:30 a.m. to 6 p.m. E.T.). Another source is C linicalT rials.gov.

http://www.nytimes.com/2016/07/31/health/what-is-immunotherapy-cancer-treatment.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=3&pgtype=sectionfront&_r=0

Sharon Jones, a Burst of Light, Even in Dark Times

By JIM FARBERJULY 29, 2016

The soul singer Sharon Jones, here with her band the Dap-Kings, is the subject of Barbara Kopple’s new documentary, “Miss Sharon Jones!” CreditJacob Blickenstaff/Starz Digital

On her emphatic new single, “I’m Still Here,” the soul singer Sharon Jones presents her life as a series of high hurdles she has cleared with grit and grace. The lyrics detail her birth in the Jim Crow South, her childhood in “the Bronx Is Burning” New York, the years she spent rejected by record companies for being “too short, too fat, too black and too old,” and, most recently, her well-publicized battles with cancer. “I didn’t know if I’d live to see another day,” the 60-year-old singer declares in the final verse. “But I’m still here!”

In fact, she is more present than ever. In the last nine months, Ms. Jones and her well-regarded band, the Dap-Kings, have recorded two albums, opened two national tours for Hall & Oates, and been featured, along with Matthew McConaughey, in a TV car commercial for Lincoln, performing the Allman Brothers’ “Midnight Rider.” For a capper, a documentary about her life, “Miss Sharon Jones!,” opened on Friday, after making the festival circuit.

Directed by Barbara Kopple, the film chronicles aspects of the singer’s career, including her extremely rare breakthrough to stardom in her late 40s, which made her an underdog hero. With her high-power vocals growling over the Dap-Kings’ caffeinated soul, Ms. Jones channels the power of James Brown in his prime. Mainly, though, the film traces her life from a terrifying diagnosis of Stage 2 pancreatic cancer in 2013 through her triumphant return to the stage in 2015.

The celebratory tone we hear from Ms. Jones at the end of the movie contrasts with the more muted one she sometimes strikes today. Though she was energized during a face-to-face interview, a phone conversation last week found her more enervated, reflecting a hard new turn in her story.

Ms. Jones in “Miss Sharon Jones!,” which chronicles the singer’s career and health struggles.CreditJacob Blickenstaff/Starz Digital

While on tour in May, doctors found cancer cells in her stomach, lymph nodes and lungs, necessitating a fresh round of chemotherapy. On Monday in New York, Ms. Jones endured more, but in a new calibration she had requested. “One of the chemo (drugs) that they’re giving me makes the neuropathy in my feet move up my legs,” Ms. Jones said several hours after her session. “I can’t take that anymore. I need to dance onstage. I don’t want something that makes me bedridden. I want to live my life to the fullest.”

Her determination gives the documentary its lift. “I don’t think this is a maudlin film,” Ms. Kopple said. “Sharon is always up. Even when she’s in the room where people are getting chemo, she’s the sunshine.”

Originally, the documentary wasn’t going to concentrate on Ms. Jones’s illness, according to her manager, Alex Kadvan, who initiated the film. “I wanted to tell her whole musical story,” he said. “But other things happened.”

The first day of shooting, on Labor Day weekend 2013, caught a rough moment: Ms. Jones was holding her shorn braids in her hands after having her head shaved. “I’ve seen the film three times, and every time I see that scene I cry,” she said.

The early part of the film casts back to Ms. Jones’s childhood, which was rife with racial indignities. During her birth in Augusta, Ga., her mother needed a cesarean operation, but since the hospital didn’t allow African-Americans in their main units, the procedure took place in an unsanitary storage room. In the film, Ms. Jones returns to a local store she patronized as a child, where she said the owner had trained his parrot to recite a racial epithet whenever a black person entered. “It had a lot of effect on us as children,” Ms. Jones said. “You’d be afraid when you saw white people.”

After her parents divorced in the mid-60s, “I came to New York and got sassy,” Ms. Jones said with a laugh. Over the years, she sang in church and in wedding bands, while holding day jobs as a prison guard at Rikers Island and in security for Wells Fargo. “She’s got a tough attitude,” Ms. Kopple said. “I think she drew on that later.”

While major labels repeatedly shunned the singer as over the hill and “too dark,” she finally found a perfect partner, and a breakthrough, via the fledgling indie Daptone Records, which specializes in reanimating the vintage sounds of soul, funk and Latin music. In the aughts, she helped to construct the label’s studio in Bushwick. The prolific Dap-Kings have put out seven albums with Ms. Jones and backed Amy Winehouse on her album “Back to Black,” while Ms. Jones herself has been a popular choice for cameos on recordings and live shows for artists like Michael Bublé, Rufus Wainwright, David Byrne and Phish.

Central parts of the film show the financial hardships both Ms. Jones and her band underwent when they weren’t able to work during her illness. The film balances that with scenes of the star being nursed back to health in upstate New York by an acquaintance, Megan Holken, whom Ms. Jones had only connected with a few times over the years. Ms. Jones’s fiancé and Ms. Holken were friends when the women first met. “She didn’t like the way he ended it with me,” Ms. Jones said. “I must have made a real impression on her back then. She would cook and spend the whole day with me, and never did she complain.”

One of the most uplifting scenes finds Ms. Jones going to church to sing for the first time after enduring months of chemotherapy. Walking up the stairs, she’s exhausted. But the minute she starts singing “His Eye Is on the Sparrow,” she taps a herculean strength. “The spirit came over me,” Ms. Jones said. “That was amazing.”

At a news conference for the film’s first showing at the Toronto Film Festival last September, Ms. Jones dampened things by announcing news of her cancer’s initial return. At that time, doctors found a spot on her liver (later treated with radiation). “I didn’t want people to come up and congratulate me on beating cancer when it’s back,” she said.

Similarly, the singer lets her audience at shows this year know some of what she’s going through with the cancer’s latest re-emergence. “There’s pain in my hips, and my legs feel like tons,” she said. “Getting out on that stage, that’s my therapy. You have to look at life the way it is. No one knows how long I have. But I have the strength now and I want to continue.”

http://www.nytimes.com/2016/07/30/arts/music/sharon-jones-documentary-interview.html?emc=edit_tnt_20160730&nlid=52389906&tntemail0=y

Wednesday, July 27, 2016

Must-Know Facts About Melanoma

By Ingrid Strauch
Reviewed by Kalyan Banda, MD

Melanoma is a type of skin cancer that doesn’t discriminate, but it does tend to favor those who spend time in the sun. Learn how to protect yourself from this deadly disease.

Alamy

Anyone with an increased risk of melanoma should have their skin checked regularly by a dermatologist.

Like all cancers, melanoma develops when DNA damage in a cell triggers genetic mutations that cause the cell to multiply rapidly and to form new, abnormal cells.

In melanoma, the damage occurs in a type of skin cell called a melanocyte. Melanocytes make a brown pigment called melanin that protects the deeper layers of the skin from some of the harmful effects of the sun.

Melanomas can form anywhere on the skin, and they can also form in the eyes, mouth, and genital and anal areas.

Nearly 74,000 Americans were expected to be diagnosed with melanoma in 2015, and nearly 10,000 were expected to die from it, according to the National Cancer Institute. Close to one million people were living with melanoma in 2012, the last year for which statistics are available.

The rate of new cases of melanoma has been on the rise for the past 40 years, even among children. Here’s what you need to know about this deadly form of cancer.

What Are the Risk Factors?

A major risk factor for melanoma is exposure to ultraviolet (UV) rays. People who regularly expose themselves to direct sunlight, tanning beds, or sun lamps are at a higher risk for melanoma. Some of the other risk factors for melanoma include:

A family history of melanoma or of dysplastic nevus syndrome (also called familial atypical multiple mole melanoma syndrome)
A personal history of melanoma
Fair skin that burns and freckles easily
A personal history of blistering sunburns
A weakened immune system, either from a disease or medical treatment
Being a man over 45
Increased age (although melanoma is one of the most common cancers among people under 30)

Anyone with an increased risk of melanoma should have their skin checked regularly by a dermatologist and should additionally keep an eye on their own skin for signs of cancer.

What are the Signs of Melanoma?

The first sign of melanoma is often a new mole or changes in an existing mole.

The American Cancer Society recommends using the ABCDE rule for monitoring your skin and checking your moles. Those letters stand for:

A: asymmetrical shape

B: irregular borders

C: different colors within one mole

D: a diameter bigger than a pencil eraser

E: evolving shape, color, or size of a mole

A mole that itches, oozes, bleeds, or is ulcerated is also suspect and should be examined by a dermatologist.

Not all melanomas have a mole-like appearance, however. A type of melanoma called acral lentiginous melanoma usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is the most common among African-Americans and Asians, and the least common among Caucasians, according to the Skin Cancer Foundation.

What Are the Treatment Options?

Depending on how early the melanoma is caught, treatment can range from minimal surgery to remove the cancerous tissue to more extensive surgery, chemotherapy, radiation, immunotherapy, and targeted therapy.

The stage at which the melanoma is diagnosed largely determines the choice of treatment:

Stage 0: The cancer is located in the outer layer of the skin and can usually be treated with surgery to remove it, as well as a small amount of normal tissue.

Stage I and Stage II: The cancerous area is surgically removed, and a biopsy of the nearby lymph nodes may be recommended, since melanoma frequently spreads from the skin to the lymph nodes.

Stage III: In this stage, the cancer has spread to the lymph nodes. The cancerous skin is removed, as are the affected lymph nodes. Treatment for Stage III melanoma may also include radiation, chemotherapy, targeted therapy, and/or immunotherapy.

Stage IV: Cancer diagnosed at this stage is very hard to cure, as the disease has spread from the skin and lymph nodes to other parts of the body. Surgery, radiation, chemotherapy, targeted therapy, and immunotherapy may all be part of the treatment plan.

RELATED: Spotting the Signs of Skin Cancer

What’s the Survival Rate?

Survival rates are a standard way of estimating a person’s prognosis. The 5-year and 10-year survival rates indicate the percentage of people who have lived at least that long following a diagnosis with melanoma.

Stages 0 or I: If melanoma is found early, in stages 0 or I, the 5-year survival rate is as high as 97 percent, and the 10-year survival rate is as high as 95 percent, according to the American Cancer Society. That’s because cancers that only affect the skin are much less dangerous.

Stage II: The 5-year survival rate for stage II melanomas ranges from 53 to 81 percent, and the 10-year survival rate ranges from 40 to 67 percent.

Stage III: As the initial diagnosis stage becomes more severe, the survival rate declines. For Stage III cancers, the 5-year survival rate ranges from 40 to 78 percent, and the 10-year survival rate ranges from 24 to 68 percent.

Stage IV: When the cancer is found in Stage IV, the 5-year survival rate drops to 15 to 20 percent, and the 10-year rate to 10 to 15 percent.

This highlights the importance of both protecting your skin to avoid melanoma, and regularly checking skin for irregularities.

How Can I Prevent Melanoma?

Avoiding UV radiation is one of the best and easiest ways you can reduce your risk of melanoma. You can reduce your exposure by doing the following:

Limiting your exposure to the sun by:

Staying in the shade, especially at midday
Wearing clothing and hats that cover most of your skin and head
Wearing sunglasses to protect your eyes and the skin around them
Wearing sunscreen on skin that isn’t covered by clothing

Avoiding tanning beds and booths
Avoiding black-light lamps
Wearing protective clothing and UV shields if your job involves arc welding or using xenon or xenon-mercury arc lamps or plasma torches

Protect children from excessive sun exposure by having them wear clothes, hats, and sunscreen when spending time outdoors.

People with a family history of melanoma should ask their doctor about getting regular skin exams and learning to do self-exams.

http://www.everydayhealth.com/news/must-know-facts-melanoma/?xid=fb_s_072716_n_skincancer_

Saturday, July 30, 2016

What is immunotherapy?

What are the types of immunotherapy?

Cell Wars

Harnessing the Immune System to Fight Cancer