Podcasts about colorado cancer center

Dr. Shannon Westin and her guest, Dr. Breelyn Wilky, discuss the JCO article, "“Botensilimab (Fc-enhanced anti-cytotoxic lymphocyte-association protein-4 antibody) Plus Balstilimab (anti-PD-1 antibody) in Patients With Relapsed/Refractory Metastatic Sarcomas." TRANSCRIPT  Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we get in depth on research that has been published in the Journal of Clinical Oncology. I am your host, Gynecologic Oncologist and Social Media Consultant Editor of the JCO, Shannon Westin. I serve here from the University of Texas MD Anderson Cancer Center. And I am so excited to welcome Dr. Breelyn Wilky. She's an Associate Professor and the Director of Sarcoma Medical Oncology in the Department of Medicine Division of Medical Oncology, and the Cheryl Bennett & McNeilly family endowed chair in Sarcoma Research, the Deputy Associate Director of Clinical research at the University of Colorado Cancer Center. Welcome. Dr. Breelyn Wilky: Thank you so much. I'm delighted to be here. Shannon Westin: And with all those titles, I'm super impressed that she was able to complete the manuscript that we're going to discuss today, which is “Botensilimab (Fc-enhanced anti-cytotoxic lymphocyte-association protein-4 antibody) Plus Balstilimab (anti-PD-1 antibody) in Patients With Relapsed/Refractory Metastatic Sarcomas.” And this was published in the JCO on January 27, 2025. And please note, our participants do not have any conflicts of interest. So this is exciting. Let's first level set. Can you review with us just the current state of sarcoma incidents, survival outcomes, that kind of thing so we all know where we're starting? Dr. Breelyn Wilky: Yes. So, you know, sarcomas are really, I like to call them the black box cancer type. And the big thing is that there's really more than a hundred different kinds of sarcomas, which collectively altogether make up only 1% of adult cancers. And so we talk about these as being bone and soft tissue tumors, but really, the heterogeneity is just incredible. You're talking maybe 10,000 to 12,000 new cases of soft tissue sarcoma per year, which is pretty rare in the grand scheme of things. And the trouble with these is that while you can cure sarcomas if you find them early and they're localized, when they metastasize and spread and are not resectable, we're looking at median overall survivals of really only 12 to 18 months, even, you know, with our best therapies that we have. So, really there's just a dire need for new treatments for this really tough group of diseases. Shannon Westin: Yeah, I agree. I'm a gynecologic oncologist, and we have our little subset of sarcomas that I know there's a little bit out of every one. So I'm really excited to pull this manuscript as one of our podcasts offerings because I think we're all seeing these patients in the clinic and certainly our listeners that have sarcoma or have family members with sarcoma, this is so good to have a real focus on a rare group of tumors that have been a little bit lumped together. Now, with that being said, I know this is such a heterogeneous population, but can you briefly overview a little bit around the standard of care for treatment of recurrent sarcomas? Dr. Breelyn Wilky: We have actually been using the same drugs really since about the 1970s, and up until very recently, nothing had really challenged doxorubicin, the old ‘red devil', like we used to call it. And this has been the mainstay of treatment for metastatic sarcomas and really used across the board. In the GYN literature, for uterine leiomyosarcoma, we did see some promising activity with the combination of doxorubicin and trabectedin coming out of the French group. But, except for that study, no combination therapy or new drug has been proven better in terms of overall survival compared to doxorubicin monotherapy, really over 40, 50 years. So it's definitely a tough situation. Now, we do have other drugs that we use, so most patients will wind up getting doxorubicin-based therapy. There's a couple of other regimens that we'll reach to, like gemcitabine docetaxel. And once you get into the specific subtypes, we have some approvals in liposarcomas and leiomyosarcomas for some other drugs. But really the median progression for survival for most of these regimens is somewhere four to six months. And response rates typically are somewhere like 10%, 15% for most of these. So it's really just a very tough field and a tough group of patients to try to make an impact for. Shannon Westin: So let's talk a little bit more kind of getting focused on what you've studied here. What's been the role of immunotherapy thus far in the treatment of sarcomas maybe prior to this particular study? Dr. Breelyn Wilky: Clearly, we all know that immune therapy has just changed cancer care forever over the last few years for so many different types of cancers and diseases like melanoma and renal cell and lung cancer have just been transformed by checkpoint inhibitors specifically directed against PD-1 or CTLA-4 or both. And so, of course, you know, sarcoma docs we're super excited to try to see if these might potentially have activity in our tumors as well. I never had seen myself in my career getting into immunotherapy until I was able to run an investigator-initiated study during my role in Miami, where we combined pembrolizumab, so PD-1 inhibitor, with axitinib which was a pan-VEGF inhibitor. And lo and behold, like I had patients that I was seeing responses when other treatments, all those chemotherapies I was just talking about had failed. And one of my first patients I treated was about a 60-year-old lady with something called cutaneous angiosarcoma. So this is a blood vessel sarcoma all over her face. And we had treated her with 10 different therapies, all the chemotherapy regimens, targeted therapies, clinical trials, and nothing was working. But I put her on a phase 1 trial with a baby dose of CTLA-4 and this woman had a complete response. And so for me, once I saw it work in even just those couple of patients, like that was nothing that we'd ever seen with our chemotherapy regimens. And so that sort of shifted my career towards really focusing on this, and this is about the time where some of the studies started to come out for sarcomas. And the take home with sarcoma is about 20% of sarcomas have this sort of immune hot physiology. So what that basically means is if you look at gene expression of immune related gene signatures, or you look for infiltrating T-cells, sort of the SWAT team of our immune system, like you can find those in the tumors. And it's sort of evidence that the immune system had some clue for that 20% of patients that this was a foreign tumor and that it should be attacking it and maybe just needed a little help. But globally, about 80% of sarcomas are these immune cold tumors, which means the immune system has no clue that these things are even a threat. And there's almost no immune activation, very, very few antigens. In other cancer types, high neoantigens or tumor antigens help the immune system work better. And so that basically goes with what we've seen with trials of PD-1 or CTLA-4 blockade. About 20% of sarcomas, with some exceptions, can respond. But really 80% across the board, you're stuck, you just can't get them to be recognized. And so that's where I think this data is so interesting is there's some signals of activity in these immune cold tumors which, at least historically with the trials we've done so far, we really haven't seen that with sort of the traditional checkpoints. Shannon Westin: So I think now this is a great time to maybe talk about the study design in general, the eligibility and just give us kind of a run through of that. Dr. Breelyn Wilky: So this trial was a phase 1 trial of a drug called botensilimab, which is a next generation CTLA-4 directed immune modulator. So what makes botensilimab different is that the CTLA-4 end is very similar to other CTLA-4 inhibitors that are out there, but it's been engineered on the back end of the molecule that binds to Fc gamma receptors to basically bind tighter with higher affinity. And what this translates to in laboratory models and increasingly now in patients is it does a better job of priming, of educating our T cells, our, again, these highly intelligent antigen specific cells, but also natural killer cells. It does a better job of sort of educating those. It helps to activate macrophages and other supporting actors in the immune response. And so the idea here is that there's evidence that botensilimab may do a better job at creating new responses in immune cold tumors. The study combined either botensilimab as monotherapy or in combination with a PD-1 inhibitor called balstilimab. And this was all comers, really a variety of tumor types. And to date I think we're close to about 500 patients with a variety of solid tumors that have been accrued to this study, this C-800-01 phase 1 trial. This paper reports on the sarcoma patients that were enrolled as part of this study. And so, again, given what I've told you about sarcomas being really immune cold, we were just so excited to have the opportunity to enroll on a next generation immune therapy for these tumors that really we were running into roadblocks trying to use immunotherapy previously. Shannon Westin: It's a very compelling idea and I'm so excited for you to tell people what you found. I think first things first, it was an early phase trial. So why don't we talk a little bit about the safety of the regimen. Was there anything that you didn't expect? Dr. Breelyn Wilky: Right. So similar to other checkpoint inhibitors, you know, the idea is that these drugs can cause immune mediated toxicities, right? So essentially you're revving up the immune system and it can sometimes get a bit confused and start attacking our normal cells, our normal organs, leading to essentially any number of toxicities of basically head to toe, something can get inflamed and you can develop a toxicity from that. So the key take homes with this particular drug with, botensilimab with balstilimab, we saw colitis was sort of the primary immune mediated toxicity and it was about a third of patients, give or take. It happens and it can be aggressive and needs to be managed aggressively. And you know, one of the things that we learned very quickly taking part in this study is how important it is that as soon as patients start to get diarrhea, immunosuppression gets on board. So steroids, early use of TNF alpha blockade, so infliximab for example, if we jumped on it quickly and we recognized it and we got the patients treated, it would resolve fairly quickly and even some patients could remain on treatment. So I think that was sort of the first take home is “Okay if you get colitis, you treat it fast, you treat it early and you can still have patients not only recover, which essentially everybody recovered from this colitis and then being able to continue on treatment and still have their anti-tumor responses.” So that's the first point. The second thing that was really interesting is part of the engineering of botensilimab on the back end of the molecule, it's been designed to decrease complement binding and it's thought that that triggers some of these other toxicities that we've seen with prior CTLA-4 inhibitors like pneumonitis or hypophysitis. We actually don't see that with botensilimab. So there's sort of this selective toxicity that may reflect the design of the molecule. But overall the treatment was, we didn't see any new safety signals that were outside of what we would expect in class. And colitis was sort of the dominant thing that we had to be ready for and ready to manage. Shannon Westin: We've been doing it for a while now, so we kind of know what to do and we can act quickly and really try to mitigate and avoid some of the major toxicities. So that's great that that was what was reflected in what you found. And then of course I think: What about the efficacy?” Right. This is what we care about as practitioners, as patients. Does it work and are there any subtypes that seem to benefit the most from this combination? Dr. Breelyn Wilky: Right. So for the sarcoma patients, we treated 64 patients and 52 of those patients were evaluable for efficacy. So a decent size group of patients in sarcomas, where, you know, typically our trials are pretty small, they're very rare, but we had 52 evaluable with at least one post baseline scan. So that was our criteria. And basically we saw across all of the patients, and keep in mind, these are heavily pre-treated patients, as you mentioned, so a median of 3 prior lines of therapy, so most of these patients had had chemotherapies and then about 20% had also had prior immunotherapy as well. So PD-1 treatments or so on. The overall response rate by RECIST was 19.2% for all of the evaluable patients. And then with iRECIST, which is sort of that immune adapted response criteria that allows for early pseudo progression, we actually had another patient who did have that. And so that response rate was 21.2%. Overall, we were really excited to see this in a heavily pre-treated group of patients. But what was really exciting to me was when we looked at the subset of patients that had angiosarcoma, that blood vessel tumor I was talking about earlier with my other patient. So angios come in two flavors. One is this sort of cutaneous type, or meaning involving the skin that has a UV signature, a UV damage signature, very similar to melanoma. So these tumors tend to have a high mutation burden. And oftentimes there is a track record that we've seen responses with immunotherapy in cutaneous angiosarcomas. But the other group that we deal with is called visceral angiosarcomas. And so these are totally different biologically. These are often driven by mutations in MYC or KDR amplification, and they arise in organs, so primary breast angiosarcoma, not associated with radiation, or they can arise in the liver or the spleen or an extremity. So these are very, very different tumors, and the visceral ones almost never historically have responded to checkpoint inhibitors. So we had 18 patients with angio split - 9 with cutaneous, 9 with visceral. And we were just blown away because the response rate for that group was 27.8%. And if you looked at the responses between the hot ones and the cold ones, it was almost equal and a little bit better in the visceral. So we had a 33% response rate in visceral angiosarcoma, which is crazy, historically speaking, and about 20% again in the cutaneous angios. So for a disease where visceral angio gets treated with chemotherapy, might respond initially, but then rapidly progresses - like these people go through multiple lines of therapy - to have a third of patients responding, and then some of those responses were durable. Our median duration of response for the study was 21.7 months, which is just nuts for sarcomas where we just don't see those sorts of long term benefits with the drugs that we have. So I think those are kind of the two main things. There were other subtypes that had clinical benefit and responses as well in d-diff liposarcoma, soft tissue leiomyosarcoma, which are again thought to be fairly cold immune subtypes. So just really exciting to kind of see responses we hadn't expected in a very challenging group of tumors. Shannon Westin: We see all these patients and we have patients that respond so well to immunotherapy with other histotypes. And so it's so exciting to see an option for these really hard to treat tumors that our patients struggle with. So this is so, so very exciting. I wanted to make mention, you know, I was really impressed with the amount of translational work you were able to do in this early phase study. So do you want to review just maybe a few of the key findings that you guys discovered? Dr. Breelyn Wilky: It's always great. I'm a translational researcher at heart and we do a lot of immune correlative work. And I think the reason I got so excited about this field to begin with was trying to learn why it works for some patients and why it doesn't work for other patients. So I'm a huge believer in learning from every patient that we can. So it's such a testament to the company, Agenus, who sponsored this trial to invest their time and resources into correlative studies at this phase. It's huge. So we learned a couple of things. IL-6 or interleukin 6 is a cytokine that basically has, in other tumor types, been associated with worse outcomes. And what we were interested in this group is we saw the same thing. And again, sarcomas have very, very little correlative biology that's done. We're really in infancy and understanding the microenvironment and how that milieu balances out in our tumors. So we were really excited to see again that lower peripheral interleukin 6 associated with improved overall survival. So again, kind of sorting out a group of patients that might be immunologically favorable when it comes to this type of therapy. The other thing that's important to know about sarcoma is so the other tumor types are lucky and have PD-L1 expression and the tumor is a biomarker, but we never have PD-L1 expression. We can find it in sarcomas and it can be loosely correlated with a chance of benefit with immunotherapy. But I've had patients respond that were PD-L1 negative, and I've had patients that were loaded with PD-L1 that didn't seem to make a difference. And that's not just in this study. So we saw in this trial a trend towards improved overall survival with PD-L1 expression that wasn't significant, but there was like this trend. And it's really interesting because, again, this is largely a CTLA-4 directed therapy. And so what we wondered is if PD-L1 expression is an index of sort of this underlying potential immunogenicity. And actually PD-1 works very late in the whole immune process. That's really at the very end where you've got the T cell that's facing the tumor cell and it's just activating that T cell that's already grown up and already educated and ready to go. Whereas CTLA-4 is really educating in early immune responses and expanding the T cells that have potential to kill. So I'm interested to look into this in more depth in the future to see if this is actually the biomarker for CTLA-4 directed therapy that we've been looking for, because we really don't have a great sense about that. And then the last piece just to note is that in this trial, like most others, very, very few sarcomas had high mutational burden. Everybody was very low, which reflects the population. And it's just really more encouragement than an immune cold tumor with very crappy neoantigens can still respond to immunotherapy if we get them the right agents. Shannon Westin: Yeah, I mean, I'm taking notes because we have such a struggle with this across the gynecologic tumors. I'm like, “Okay, maybe this is finally it.” So hopefully your work will go on to really inspire us across a number of solid tumors that have been traditionally cold. So, so very exciting. And I would just say for my last question, obviously, congratulations on this successful study. What do you think are the next steps for this combination in sarcomas? Dr. Breelyn Wilky: So, again, just to your point, this trial enrolled a bunch of different subtypes, and sarcomas are not the only immune cold tumor that this combo has looked really promising for, microsatellite stable colorectal cancer, ovarian cancer that was platinum refractory, non-small cell lungs. So I think the future is really bright for immune cold tumors kind of across the board. So, yes, lots of hope for not just sarcomas but in terms of our patients, I just have to be so grateful to Agenus for their interest in a rare disease. Sometimes it's hard to get that interest for a very challenging group of patients that are all heterogeneous, they are not all the same and our big clinical trials are a few hundred patients. It's just a very different environment. But they have been so supportive and involved in making sure that sarcomas are represented in their priorities. So there are ongoing discussions about what the optimal way to explore this further in sarcomas is going to be and I cannot wait to have the official plans in place. But my hope is this will not be the last that we see of these drugs for our patients. Shannon Westin: Well, I support that and my vote is on your side. So, thank you so much again, Dr. Wilky. This time just flew by. This was such a great discussion and I mean, I think it's, again, a testament to your exciting data. And thank you to all of our listeners. This has been JCO After Hours' discussion of “Botensilimab (Fc-enhanced anti-cytotoxic lymphocyte-association protein-4 antibody) Plus Balstilimab (anti-PD-1 antibody) in Patients With Relapsed/Refractory Metastatic Sarcomas,” published in the JCO on January 27, 2025. So be sure to check out the full manuscript. And we hope that you enjoyed this podcast. And if you want to hear more about research published in the JCO, check this out on our ASCO JCO website or wherever you get your podcasts. Have an awesome day.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Dr. Wilky Disclosures  Consulting or Advisory Role: SpringWorks Therapeutics, Deciphera, Epizyme, Adcendo, Polaris, Boehringer Ingelheim, AADi, InhibRx Research Funding: Exelixis Travel, Accommodations, Expenses: Agenus    

Send us a textDr. Alessandra Maleddu, MD ( https://www.uchealth.org/provider/alessandra-maleddu-md/ ) is a Medical Oncologist specializing in the care of patients with soft tissue and bone sarcomas at the University of Colorado Cancer Center.Dr. Maleddu treats patients with soft tissue and bone sarcomas, and she has a special interest in desmoid tumors (aka desmoid fibromatosis), as well as leiomyosarcoma and treatment delivery in the elderly population.Dr. Maleddu completed her training in Italy and the UK. She did her Sarcoma Fellowship at the University College London Hospital in 2020, her general oncology training at the University of Bologna and her MD from the University of Cagliari in Italy.Important Episode Link - https://www.desmoidtumors.com/#AlessandraMaleddu #MedicalOncologist #UniversityOfColorado #Sarcoma #DesmoidTumors #Oncology #Cancer #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #Podcasting #ViralPodcast #STEM #Innovation #Science #Technology #ResearchSupport the show

Prof Martin Hutchings from Copenhagen University Hospital in Denmark, Dr Manali Kamdar from the University of Colorado Cancer Center, Dr Matthew Lunning from the University of Nebraska Medical Center and Prof Gilles Salles from Memorial Sloan Kettering Cancer Center in New York summarize currently available data guiding treatment decision-making for patients with relapsed/refractory diffuse large B-cell lymphoma and present cases from their practices.CME information and select publications here.

Prof Martin Hutchings from Copenhagen University Hospital in Denmark, Dr Manali Kamdar from the University of Colorado Cancer Center, Dr Matthew Lunning from the University of Nebraska Medical Center and Prof Gilles Salles from Memorial Sloan Kettering Cancer Center in New York summarize currently available data guiding treatment decision-making for patients with relapsed/refractory diffuse large B-cell lymphoma and present cases from their practices.CME information and select publications here.

In this episode, Dr Camidge sits down with Douglas Ney, MD, a professor of neurology and neurosurgery, program director of the Neurology Residency Program, and vice-chair of Education in the Department of Neurology at the University of Colorado Cancer Center in Aurora.  Drs Camidge and Ney discuss Dr Ney's journey to becoming a neurologic oncologist, how the management of primary brain tumors differs from that of brain metastases in his practice, and his experience as a physician with Tourette syndrome.

Dr. Christopher Lieu, Associate Director of Clinical Research at the University of Colorado Cancer Center and Vice Chair of the National Comprehensive Cancer Network (NCCN), is currently serving as chair of i3 Health's online activity, live webinar, and meeting series, Hitting the Target in HER2-Positive Metastatic Colorectal Cancer. With numerous research advances occurring in this field during the past year, Dr. Lieu sat down with us again to share updates in targeted therapies for HER2-positive metastatic colorectal cancer and the evolving landscape of biomarkers under investigation for this disease. Click the links below for Hitting the Target in HER2-Positive Metastatic Colorectal Cancer, an accredited CME/NCPD activity provided by i3 Health! Online Accredited CME/NCPD Activity: https://www.i3health.com/course-information/hitting-the-target-in-her2-positive-metastatic-colorectal-cancer Live Webinar Registration: https://www.i3health.com/course-information/Colorectal-Cancer-Webinar Live or Virtual Meeting Series: https://www.i3health.com/live/hitting-the-target-in-her2-positive-metastatic-colorectal-cancer-1

Guest: Dr. Jamie Studts, University of Colorado Cancer Center, American Cancer Society Representative and Kelly Moran, American Cancer Society, Senior Executive Director, Colorado & Utah The American Cancer Society has updated its lung cancer screening guideline, if you are over the age of 50, have a 20-year or greater pack-year history, currently smoke or used to smoke, you are eligible for lung cancer screening.  Regardless of if you have quit smoking, you would still benefit from lung cancer screening.  Your lungs do heal after quitting but they do not fully heal.  Not having a smoking history does not mean you will not get lung cancer, 10%-20% of people diagnosed with lung cancer do not have a smoking history.  November is lung cancer awareness month.  Lung cancer is the second most common diagnosed cancer for both men and women and is the leading cause of cancer death across the US.  The great American smoke out is coming up on 11/16, the American Cancer Society is encouraging people in Colorado who smoke to make a plan and commit to a smoke-free future. https://www.cancer.org/

Doctors increasingly see people contracting colon cancer before the recommended screening age of 45. We meet a wife and husband who were both diagnosed with it, Kacie Peters and Erik Stanley, of Denver. They juggle chemo, hospitalizations, and parenting. We also hear from oncologist Dr. Christopher Lieu, of the University of Colorado Cancer Center. March is Colorectal Cancer Awareness Month.

Doctors increasingly see people contracting colon cancer before the recommended screening age of 45. We meet a wife and husband who were both diagnosed with it, Kacie Peters and Erik Stanley, of Denver. They juggle chemo, hospitalizations, and parenting. We also hear from oncologist Dr. Christopher Lieu, of the University of Colorado Cancer Center. March is Colorectal Cancer Awareness Month.

Dr. Shannon Westin discusses ways to ensure continued employment for cancer patients with her guests, Dr. Cathy Bradley, Dr. Tina Shih, and Dr. Robin Yabroff. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast for the Journal of Clinical Oncology where we get in-depth on manuscripts that have been recently published in the journal. Today, we're going to be talking about a Comments and Controversies article titled “Ensuring Employment After Cancer Diagnosis: Are Workable Solutions Obvious?” This was published online November 3, 2020. And I'm thrilled that we're accompanied by all three of the fantastic authors of this manuscript, including Dr. Cathy Bradley, who is professor and Associate Dean for Research at the Colorado School of Public Health and Deputy Director of the University of Colorado Cancer Center. Welcome, Dr. Bradley.   Dr. Cathy Bradley: Thank you.   Dr. Shannon Westin: We're also joined by Dr. Tina Shih, who's professor chief of the Section of Cancer Economics and Policy in the Department of Health Services Research, the Division of Cancer Prevention and Population Sciences, at the University of Texas MD Anderson Cancer Center in Houston. Welcome. And then finally, we have Dr. Robin Yabroff, who's Scientific Vice President of Health Services Research at the American Cancer Society.   Dr. Robin Yabroff: Welcome. Thank you.   Dr. Shannon Westin: We're so excited to have the three of you, and I know this is going to be a lively discussion and such a timely and important topic that I really just don't think enough has been done in this area. So you guys are to be congratulated.   So let's start by level setting. How many survivors are of working age and may consider work continuation during treatment?   Dr. Cathy Bradley: Yeah, we don't have a perfect estimate of that. We know there are just over 18 million survivors, and half, maybe even 60%, are working age and possibly employed during their survivorship time.   Dr. Robin Yabroff: And I'll add to that and say that there are also a lot of informal caregivers who were taking care of patients receiving cancer treatment who are of working age. And so that includes spouses, children, and parents. Dr. Cathy Bradley: Excellent point.   Dr. Shannon Westin: It does bring up a good point because I think sometimes with this type of research, we're so focused on the survivor themselves. But when we really look at the definition of survivorship, it includes the caregivers and the people that are participating in the care of the actual patient.   Well, why don't you guys talk a little bit about some of the benefits of work continuation to cancer survivors? Like, why should we be even thinking about this?   Dr. Cathy Bradley: Yeah, I think there are a number of reasons. I mean, the two obvious, of course, are income and insurance. Income, in order to continue their daily lives, but also health insurance to continue their treatment and surveillance. And that health insurance is not just for them, but it's also for their dependents and for their entire families and sometimes for their caregivers and others as well. So there's being able to preserve income, and insurance is critical to cancer survivors, as it is to all of us.   And then there are all the other benefits of work, of continued career growth, to continue quality of life, that interaction, social interaction with others, and a sense of self-worth and identity that many of us have wrapped up in our jobs.   Dr. Tina Shih: Yeah, and I think the other issue to think about is income also tied to your retirement savings. So you don't want to stop your earning ability, so that makes continuing working also important. And then also to have a sense of achieving something so that you wouldn't be continuously thinking about only cancer treatment, but there's other aspects of life.   Dr. Shannon Westin: Yeah, I think what I've seen in my practice is that another benefit of continuing to work is they're not just focused on themselves as the patient. And I think you got at that a little bit with that idea of self-worth, but it's also a distraction, right? Like, not sitting at home thinking about what's going on with my cancer, what's the next step in my treatment. It's kind of just keeping your mind busy with other things. I also wonder if when we talk about chemotherapy brain, if continuing to work and stimulate your mind and things like that could potentially be helpful in that setting as well. Like, we tell patients to do puzzles and things like that, but staying busy at your job and pushing the envelope there sometimes could seem to be beneficial as well.   So I guess I want to back up a little bit and just see what kind of led you all to be interested in this area. What were the kind of inciting experiences that led you to start to explore this work?   Dr. Cathy Bradley: For me, it was just an observation over time and growing up and seeing people around me who had to make incredibly stark choices, whether or not to continue, to be diagnosed with a serious illness but not be able to get care without that health insurance. So it's a very stark choice that they have between being able to continue to work or take time off to care for their illness during this very acute phase. And that just struck me as such an important thing that we needed to shine a light on, that as we make advancements and treatment and early detection—and the thing with early detection is that you're going to pick up more people who are working age with cancer, and their source of insurance is their jobs. So looking at this stark choice, it just seemed critical to start to study these questions systematically and, as I said, shine a light on this issue.   Dr. Robin Yabroff: For me, I had the experience of my mother being diagnosed with cancer when I was in graduate school, and I was fortunate that I was working and I had a supportive employer. But everyone in my family, including my father and my sisters, were able to take leaves of absence with paid sick leave that allowed us to step up and care for my mother. But I realized that we were coming from such a place of privilege in having paid sick leave. As Cathy said, for many people who don't have the opportunity to continue working, it's a really stark decision. And then I'll also be a little bit of a fangirl; I saw Cathy give a talk a while ago, and I was so fascinated with her research related to this topic, so I approached her afterwards and asked if we could work together.   Dr. Cathy Bradley: You are too kind.   Dr. Robin Yabroff: I won't say how long ago it was, but it was a long time ago.   Dr. Tina Shih: I think, for me, I was trained as a labor economist in my Ph.D. program, and after that, I keep on wanting to connect cancer studies with labor market studies, but there's really not good data on that. So I'm also an admirer of Cathy's work, like she's able to build that connection. And, of course, it's been a lot of fun working with these two really accomplished researchers.   Dr. Cathy Bradley: It's been the best collaboration for the three of us to work together.   Dr. Robin Yabroff: Absolutely.   Dr. Shannon Westin: I love these cross-institution collaborations, and not even just institution, obviously, the ACS—well, I guess it's big enough to be an institution. But it really is inspiring to me because I think a lot of times we tend to collaborate within our own institution or within our own group even. So you all really have created a model of success here.   So, getting back to work continuation, what are some of the gaps of knowledge that we have in this area, and why do they exist?   Dr. Cathy Bradley: I think Tina said it best. There's just no good data sources out there. We're not like Scandinavian countries that can link our health system with our employment data and link it all up and understand what's going on, that this area, generally—I mean, from my studies—require primary data collection. And other studies. There are some surveys that are out there. Robin's done a great job publishing in this area using secondary data. We just don't have a single data source that ties it all together. So that is the biggest challenge in studying this area and leading to our gaps. We don't know which treatments lead to fewer or more side-effects. Work effects are not studied in clinical trials; they're not recorded in medical records. There's so much that we just don't know, that we can't say, and that providers can't have a conversation with their patients about how a particular treatment course will affect their ability to work.   Dr. Tina Shih: I think, to add to that, like for people who also are in the working age population, there's no equivalent data to see in Medicare. So a lot of time, you have to kind of guess what's happening with the cancer stage. A lot of time, you can only know what cancer patients have, but that kind of limits your ability to dig deeper into: Are they getting the right chemotherapy, or are they getting the right treatments? Because you don't really know at this stage.   Dr. Robin Yabroff: I'll just reiterate what both Cathy and Tina already stated, which is really the lack of comprehensive data, not only about cancer and the clinical details of treatment and diagnosis but also about the type of jobs that people have. So, many times, we know whether or not they had a job, but not how long they‘ve had it, how many hours they work a week. And so a lot of our data from national surveys are really pretty limited for exploring any of the longitudinal effects of the cancer diagnosis on work, which we think are really important, not only for patients but also for their informal caregivers and family members.   Dr. Shannon Westin: So I think I might know the answer to this based on what you all are saying, but how do we overcome these gaps to be able to increase research in this area?   Dr. Cathy Bradley: I think creating that data infrastructure and collecting the information is what's critical. And we know that providers and patients don't—not all of them have discussions about employment when they go in to make treatment decisions, that that's often not part of that shared decision-making about going forward, the employment component, and the patient is kind of left trying to figure it out. And I just think there are more opportunities to create that data infrastructure to stimulate that discussion and to have follow-up.   Dr. Tina Shih: And I want to add to that to say that a lot of time, the information we want to collect about employment, patients, they have the information. I think they would be willing to provide that information. I think the information is not as sensitive as, “Hey, what is your income level?” or things like that. I think we should be able to collect that information with really high-quality data just by asking patients.   Dr. Robin Yabroff: And I want to reiterate the importance of having longitudinal information about employment over time. Some people may take a brief or extended leave of absence from work while receiving cancer treatment, but what happens when they return? And what does that mean for career development and mobility and how they return to a fulfilling work life for both the patients and the family members? So, as Cathy said, many providers don't discuss employment and job tasks and things like that with patients.   And I think another advantage—and I don't remember if we mentioned this, but another advantage of these discussions is tailoring treatment so that patients will be most likely to complete the recommended treatment. Because you can imagine a situation where someone who is being treated for cancer cannot get time away from work and doesn't complete their treatment, or they can't get time from work because they don't have paid sick leave and they need the income and they can't complete their treatment.   Dr. Tina Shih: I want to add to that point being one of the studies we look at young women. We looked at the age of kids, and then we noticed that among those with lumpectomy, about 1 in 5, 20% of women, actually did not have radiation therapy follow-up after lumpectomy, so that's a big problem. And so that also reflects—you need to tailor your treatment based on your patient's needs.   Dr. Robin Yabroff: Yeah, I remember that study, Tina. I thought it was really clever, where you were looking at newly diagnosed patients with breast cancer who received breast-conserving surgery but did not complete the radiation treatment. And so thinking about childcare is really important too.   Dr. Cathy Bradley: Transportation, all of those things that play into treatment completion, especially for people who are employed and trying to balance their jobs with their treatment. And I think the scenario Robin laid out of someone taking leave and then coming back, but you also have the other scenario where people just try to gut it out and do everything at once and then later become the same. So this longitudinal data and understanding what's going on and the impact of whether or not they complete, as Tina has shown earlier and women in my studies have reported, they will miss treatment before they miss work if it jeopardizes their health insurance, especially if they have children. Going back to Tina's point, if they have kids and those kids are dependent on them, they are not going to risk health insurance and their family's wellbeing.   Dr. Shannon Westin: We see this quite a bit with patients with cervical cancer. Obviously, it's a problem across all cancer types, but there especially seems to be quite a bit of burden amongst survivors of cervical cancer. And they're required to have daily treatment for six weeks. And we know best outcomes occur when that timeline is kept very tight. And when we have multiple missed radiation treatments and the timeline extends out, say, past ten weeks, then you see worse outcomes. And so we definitely are living this every day in the clinic.   How can workplaces support survivors? Because I feel like a lot of what we're talking about is that fear of losing their job, that need to keep insurance. So what are some strategies or some suggestions, I guess, we should make to workplaces to help support their survivors?   Dr. Cathy Bradley: Of course, having benefits like paid sick leave and those things are critical. And being flexible, offering accommodations, flexible work schedules of when they come in and when they leave or if they're able to do their work in off hours or remotely, those things are all helpful. We've moved into more of a remote environment since COVID; those things can be very beneficial. But for somebody who does a job where that's not an option, I think there are other kinds of accommodations that employers can make. And being respectful and understanding of a patient who is going through this and valuing them as an employee, maybe not necessarily as a survivor, but as an employee who's dealing with something, that's pretty critical. And I'll let Robin speak for the caregiver component.   Dr. Robin Yabroff: As usual, you read my mind. That's exactly what I was going to say. The importance of offering paid sick leave and health insurance coverage for the patient and also for the informal caregivers and also those accommodations, because frequently informal caregivers are responsible for getting patients to and from treatment, which, when you think about daily radiation, for example, making sure that that caregiver has time away from work is also important.   Dr. Tina Shih: And I think the other issue is to be emotionally supportive for your workers so that they know they don't have to be afraid of losing their job after completing cancer treatments. Or if they have to take more sick leave than they have, they might be able to borrow some sick leave. Having cancer patients in small businesses is stressful for business owners. But I think that's just something that they need to think carefully about, not make cancer patients feel like you are increasing my company's premiums because you have cancer.   Dr. Cathy Bradley: Building off of what Tina just said, taking the long view. It's not a short-term thing, where let's take the long view. This is a valued employee who is going to continue to contribute to the company, to our organization, long term. Take the long view here, not make it so hard on them in the short term.   Dr. Shannon Westin: I love real strategies, and I think certainly those are things that people can do on the local level. We certainly need to discuss policy as well. It's hugely lacking.   What are the next steps, do you think, we could do from a policy standpoint to improve the lives of our survivors?   Dr. Cathy Bradley: I think there are a number of things that we can do: I mean, having health insurance outside of the employer-based mechanism as an alternative, having paid sick leave for someone who is ill as well as those who care for them, having a policy of accommodation. Currently, the ADA, or Americans with Disabilities Act, while it covers cancer survivors, it does not cover their caregivers. So there are things that we can do to extend. And then there are policies that are in place that are just cumbersome. You see this, I'm sure, in your own practice. For a person to qualify for disability benefits, it takes a year. Being able to do that quicker, expedite it. That's a huge deal. That's a protection we have in place that is just extremely cumbersome to use, such that by the time a year goes away, the patient could have passed away but yet still need those benefits for the family and income prior to that happening.   Dr. Robin Yabroff: I'll also add that we talked about occupational health and rehabilitation in our Comments and Controversies piece and the importance of making sure that health insurance coverage extends to occupational health and rehabilitation to ensure that patients can successfully return to work.   Dr. Tina Shih: I think, on the provider side, there might be things that providers can do to kind of somehow accommodate working population's schedule. I know this kind of adds to providers' burden; they might have to open evening clinic or weekends. But I think, for working population, they really cannot afford to be not at the office for the type of job. I think this kind of arrangement would be very helpful.   Dr. Robin Yabroff: Yeah. And I think for providers to be asking patients about their employment. Like, what type of job do you have? What types of job tasks do you need to do on a daily basis. Do you have health insurance coverage through your work, or is it through someone else in your family, or do you not have health insurance coverage at all? And then, importantly, do you have paid sick leave, and what types of accommodations will your employer offer you? And I know Cathy's done some really interesting work thinking about how patients can talk with their employers about work and what their options are.   Dr. Cathy Bradley: Yeah. Opening the discussion would be a huge step forward to figure out what kind of referrals they need, what kind of letters need to be written for employers. How can they expedite the process to get patients what they need rather than have it be an afterthought?   Dr. Tina Shih: And I think if this is too much for providers to take on, then I think mitigators can also share some of the workload or research nurse. I think those are information you can collect on patient intake.   Dr. Shannon Westin: Great. So I guess the final question I have for you is what are your next steps? Where does this go next?   Dr. Cathy Bradley: I think we have a number of things that are ongoing. I'm involved in a study now with the team here at the University of Colorado, the Total Worker Health Team, and they're looking at the impact of interventions with providers, the oncology care team, for things that they can do to be more supportive of the patient who is undergoing treatment. So it's a really unique perspective of how they apply Total Worker Health concepts to the oncology care team. And that study is just getting underway and hopefully will provide guidance for the oncology care team of how to interact with the patient in order to provide the support they need. I think it's somewhat of a black box, everyone being well-intentioned but not having the data to support them.   So that's one study that I'm involved in currently, and then the three of us are always looking at policies and implications and what's the downstream effect. Tina did some great work on looking at the impact on the financial hardships and long-term impact on people who are diagnosed with cancer, how it extends well into retirement. And I think understanding those impacts and being able to communicate it is an important role that we play as a team.   Dr. Robin Yabroff: I'll also add that we have other things underway, sort of thinking about the impact of disruptions in employment for any period of time or for any reason and what that means in terms of development of financial hardship. And thinking about outside of the cancer diagnosis, how the cancer diagnosis affects employment and then affects development of financial hardship later. I think it's a really important area, especially as there is more attention to medical financial hardship broadly. Many researchers I know are actively interested in the topic.   And then I'll also add, so we're talking about research, but I'm increasingly interested, and hopefully can work with Tina and Kathy on this, in benefits managers and how those decisions are made for employers. Many employers take up a set package of benefits to offer for their employees without carefully considering what it means for patients with cancer and their caregivers—so thinking a little bit more about the decision-making process that employers have and thinking about the benefits they offer their workers.   Dr. Tina Shih: So as a data geek, I think I'm still trying to figure out a way to collect the claims data with short-term disability and then to see can I figure out who took short-term disability and came back and what happened to those people? And it's been a difficult task because not many data collect those information. That goes back to the data infrastructure issues, that we really need to have better data to understand working-age cancer patients.   Dr. Shannon Westin: Well, thank you all so much. This has been incredibly fascinating. I learned so much. I just want to thank all three of you, Dr. Bradley, Dr. Yabroff, and Dr. Shih, for your exciting work, and I hope that we can continue to make strides in this area.   And just thank you to all of our listeners. Again, this has been a JCO After Hours on “Ensuring Employment After Cancer Diagnosis: Are Workable Solutions Obvious?” published online November 3, 2022. Please do check out our other podcast offerings on the JCO website, and we will see you next time. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Dr. Narjust Florez discusses the POSEIDON trial with guest Dr. Tejas Patil, assistant professor at Thoracic Oncology Research Initiative, University of Colorado Cancer Center. This Phase III study led to the recent FDA approval of Tremelimumab in combination with Durvalumab and chemotherapy as first line treatment in patients with metastatic non small-cell lung cancer (NSCLC).

Tejas Patil, MD, assistant professor of medical oncology at the University of Colorado Cancer Center, talks with Robert A. Figlin, MD, about new targeted therapies for non-small cell lung cancer (NSCLC), particularly tepotinib (Tepmetko) for MET exon 14 and sotorasib (Lumakras) for KRAS G12C. The MET exon 14 skip mutation has attracted renewed attention because tepotinib and capmatinib (Tabrecta), which both target this mutation, recently received FDA approvals. But MET can be disrupted in other ways, as well. Listen as Dr. Patil discusses the different types of MET alterations, how to identify MET activation in patients, and best practices for using tepotinib to treat MET activation that arises as a resistance mechanism to the EGFR inhibitor osimertinib (Tagrisso).

Dr. Nicole Ehrhart, VMD, MS (http://www.cvmbs.colostate.edu/DirectorySearch/Search/MemberProfile/cvmbs/1013/Ehrhart/Nicole) is the director of the Columbine Health Systems Center for Healthy Aging at Colorado State University (https://www.research.colostate.edu/healthyagingcenter/about/), where she leads an interdisciplinary research effort to identify basic and translational mechanisms that promote healthy aging. Dr. Ehrhart holds the Ross M. Wilkins M.D. Limb Preservation Foundation University Chair in Musculoskeletal Oncology and Biology. She is a board-certified veterinary surgeon (Diplomate ACVS; ACVS Founding Fellow in Surgical Oncology), a professor of surgical oncology in the Dept. of Clinical Sciences in the College of Veterinary Medicine and Biomedical Sciences, and a research faculty member at CSU's Flint Animal Cancer Center. In Dr. Ehrhart's research lab, the Laboratory of Comparative Musculoskeletal Oncology and Traumatology, she conducts translational aging, limb preservation, tissue engineering, and sarcoma research, as well as bone and muscle regenerative medicine, to benefit both human and canine patients. Dr. Ehrhart holds joint faculty positions in the School of Biomedical Engineering, the Cell and Molecular Biology program, the Gates Regenerative Medicine Center at the University of Colorado, and The University of Colorado Cancer Center. In addition to her research, Dr. Ehrhart has held several leadership positions in national and international organizations, such as the American College of Veterinary Surgeons, Veterinary Society for Surgical Oncology (President), Veterinary Orthopedic Society (President) and Chair of the 2014 World Veterinary Orthopaedic Congress Committee. 

Videos: 1. Agenda 2030 and the World Economic Forum Plan to Remake the World: Alex Newman (26:00) 2. Pfizer Docs Reveal 800 People Never Finished Trial Due To Death Or Injury (4:39) 3. Vaccines, what are they good for? – Dr Sam Bailey (19:00)  4. Bodily Autonomy is Only Supported When Coupled With The Abortion Agenda (1:00)  5. New Rule: The Misinformation Age | Real Time with Bill Maher (HBO) 6. George Carlin – It's A BIG Club & You Ain't In It!    Active Component of Grape Seed Extract Effective Against Cancer Cells University of Colorado Cancer Center, June 13 2022  A University of Colorado Cancer Center study published online ahead of print in the journal Nutrition and Cancer describes the laboratory synthesis of the most active component of grape seed extract, B2G2, and shows this synthesized compound induces the cell death known as apoptosis in prostate cancer cells while leaving healthy cells unharmed. “We've shown similar anti-cancer activity in the past with grape seed extract (GSE), but now we know B2G2 is its most biologically active ingredient which can be synthesized in quantities that will allow us to study the detailed death mechanism in cancer cells,” says Alpna Tyagi, PhD, of the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. The group pinpointed B2G2 as the most active compound, but, “it's expensive and it takes a long time to isolate B2G2 from grape seed extract,” Tyagi says. This expense related to the isolation of B2G2 has limited the group's further exploration. So instead of purifying B2G2 from GSE, the group decided to synthesize it in the lab. The current study reports the success of this effort, including the ability to synthesize gram-quantity of B2G2 reasonably quickly and inexpensively. In the paper's second half, the group shows anti-cancer activity of synthesized B2G2 similar in mechanism and degree to overall GSE effectiveness. Improving Memory Naturally: Sage Contains Similar Compounds as Modern Alzheimer's Drugs Newcastle and Northumbria Universities, June 14 2022 Sage was named “Herb of the Year” in 2001 by the International Herb Association.  Some of the latest research shows how sage can boost memory and cognitive health. The leaves and stems of sage contain these antioxidant enzymes that protect against free radical oxidative cell damage as well as provide inflammatory relief from ailments such as arthritis and asthma. The Medicinal Plant Research Centre (MPRC) of England conducted studies at Newcastle and Northumbria Universities with sage oil herb pills against placebo pills. Those who took the sage performed much better with a word recall test than those who took the placebo.  In the long run, home-made tinctures are the most economical way to have and use highly effective tinctures for a long time.  Trade the chair for fresh air: Study explores link between sitting time and cardio health Simon Fraser University (Canada), June 15 2022 New research is adding further weight to the argument that prolonged sitting may be hazardous to your health. An international study surveying more than 100,000 individuals in 21 countries found that people who sat for six to eight hours a day had a 12–13 percent increased risk for early death and heart disease, while those who sat for more than eight hours daily increased that to a sobering 20 percent. Their research followed individuals over an average of 11 years and determined that high amounts of sitting time were associated with increased risk of early death and cardiovascular disease.  Not surprising, those who sat the most and were the least active had the highest risk—up to 50 percent—while those who sat the most but were also the most active had a substantially lower risk of about 17 percent. “For those sitting more than four hours a day, replacing a half hour of sitting with exercise reduced the risk by two percent,” Lear notes. “With only one in four Canadians meeting the activity guidelines there's a real opportunity here for people to increase their activity and reduce their chances of early death and heart disease.” Acupuncture Can Treat Alzheimer's Disease Hubei University of Chinese Medicine (China), June 5, 2022  An increasing number of clinical and animal studies have confirmed that acupuncture is effective for the treatment of Alzheimer's disease. Moxibustion is reported to be more effective than electro-acupuncture for improving space-recognizing memory ability in aged mice, suggesting that moxibustion is another alternative or complementary therapy used to treat Alzheimer's disease. Dr. Yanjun Du and team from Hubei University of Chinese Medicine, China only used suspended moxibustion (also named warming moxibustion, scarring moxibustion, or herb-partition moxibustion) on Baihui and Shenshu  acupoints to observe the action of pre-moxibustion on preventing apoptosis in a rat model of Alzheimer's disease. The pre-moxibustion group was treated with moxibustion for eight courses (each course lasting for 6 days) prior to the exposure and 14 days after Aβ1–42 exposure.  Moxibustion prior to Aβ1–42 exposure was more effective than moxibustion after Aβ1–42 exposure in protecting the neuronal structure and lowering the apoptosis rate. Their findings indicate that a combination of preventive and therapeutic moxibustion has a beneficial effect for the prevention of Alzheimer's disease development. Men and women with brain condition could be helped by vitamin E Cangzhou Central Hospital (China), June 15 2022.  Leukoaraiosis is an abnormality in the brain's white matter that appears on magnetic resonance imaging (MRI) as white matter hyperintensities. In an article published in the International Journal of Neuroscience, researchers at Cangzhou Central Hospital in Hebei, China reported improvements in factors related to leukoaraiosis among adults given supplements containing vitamin E. “Leukoaraiosis (LA) is a disease manifested by demyelination and gliosis in white matter, mainly caused by cerebrovascular diseases,” Yan Wang and colleagues wrote.  “Leukoaraiosis is closely related to the expression level of inflammatory factors, oxidative stress, and vascular endothelial dysfunction in patients. Vitamin E may play antioxidant and anti-inflammatory roles in various diseases.” Participants received 200 IU, 400 IU or 600 international units (IU) vitamin E or a placebo daily for 12 weeks. At the end of the treatment period, blood samples were evaluated for the inflammatory factors C-reactive protein, complement C3 and C4, and matrix metalloproteins 2 and 9, as well as for markers of oxidative stress and endothelial function (function of the lining of the arteries, which is impaired in cerebrovascular and cardiovascular disease). Inflammation, oxidative stress and endothelial function improved in all groups that received vitamin E in comparison with the placebo. Cognitive function scores also significantly improved in the vitamin E-treated groups. Improvement in all measured factors was correlated with higher doses of vitamin E. Chlorogenic acid plus chromium improves insulin resistance and lowers obesity in mice University of Toledo, June 10 2022 In an article published in Nutrition & Metabolism, University of Toledo researchers report that a combination of chromium and chlorogenic acid (CGA), a polyphenol occurring in coffee, reversed the development of obesity and insulin resistance in mice caused by the intake of a high-fat diet. Sonia M. Najjar and her associates fed male BL6 mice a standard diet or a high-fat diet for seven weeks. During the last three weeks of the diet, the high-fat group received a daily oral supplement containing water, chlorogenic acid, or a combination of chlorogenic acid and chromium in a base that contained caffeine. Body weight was measured weekly, insulin tolerance was assessed at four and seven weeks, and glucose and glucose tolerance were assessed at the end of the treatment period. At four weeks, animals supplemented with chlorogenic acid and the combination of chlorogenic acid and chromium experienced weight loss within two weeks, and attained weights comparable to those of animals that received a standard diet. While insulin resistance after four weeks was greater among high-fat diet-fed mice compared to those fed a standard diet, supplementation with chlorogenic acid plus chromium reduced this effect, and restored it to a level comparable to that of standard-diet-fed mice. Glucose tolerance and glucose levels were similarly restored in animals that received the supplement combination. 

This episode is sponsored by BTG Speciality Pharmaceuticals. BTG provides rescue medicines typically used in emergency rooms and intensive care units to treat patients for whom there are limited treatment options. They are dedicated to delivering quality medicines that make a real difference to patients and their families through the development, manufacture, and commercialization of pharmaceutical products. Their current portfolio of antidotes counteracts certain snake venoms and the toxicity associated with some heart and cancer medications. Their drug, Voraxaze, is for high-dose methotrexate toxicity. Dr. Breelyn A. Wilky, MD is a sarcoma medical oncologist and clinical trialist with research interests in immunotherapy, targeted therapy and precision medicine, and early phase drug development. She is Associate Professor and Director of the Sarcoma Program at the University of Colorado School of Medicine, and is a member of the Phase One and Experimental Molecular Therapeutics (POEMS) research program. As the Deputy Associate Director of Clinical Research for the University of Colorado Cancer Center, she leads the investigator-initiated clinical trials committee to help advance novel research to the clinic. Her laboratory studies the tumor and immune microenvironment of sarcomas, to identify new drugs that boost the immune system for future clinical trials in sarcoma. What We Do at MIB Agents: PROGRAMS: ✨ End-of-Life MISSIONS ✨ Gamer Agents ✨ Agent Writers ✨ Prayer Agents ✨ Healing Hearts - Bereaved Parent Support ✨ Ambassador Agents - Peer Support ✨ Warrior Mail ✨ Young Adult Survivorship Support Group ✨ EDUCATION for physicians, researchers and families: ✨ OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma ✨ MIB Book: Osteosarcoma: From our Families to Yours ✨ RESEARCH: Annual MIB FACTOR Research Conference ✨ Funding $100,000 annually for OS research ✨ MIB Testing & Research Directory ✨ The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter.

In this episode, Marsha Clements, RN, MSN/Ed, PhD, OCN, executive director of an oncology service line in New Hampshire, and Andrea (Andi) Dwyer, director of the Colorado Cancer Screening Program (CCSP) at University of Colorado Cancer Center, share insights on developing sustainable oncology navigation programs that provide values to healthcare administrators, patients, and providers.

Mushrooms boost immunity, suggests research   University of Florida Institute of Food and Agricultural Sciences, April 16, 2022   A new University of Florida study shows increased immunity in people who ate a cooked shiitake mushroom every day for four weeks. In a study led by UF Food Science and Human Nutrition , 52 healthy adults, age 21 to 41, came to the Gainesville campus, where researchers gave them a four-week supply of dry shiitake mushrooms. Participants took the mushrooms home, cleaned and cooked them. Then they ate one, 4-ounce serving of mushrooms each day during the experiment. Through blood tests before and after the experiment, researchers saw better-functioning gamma delta T-cells and reductions in inflammatory proteins. If you eat a shiitake mushroom every day, you could see changes in their immune system that are beneficial. "We're enhancing the immune system, but we're also reducing the inflammation that the immune system produces."   (NEXT)   Oral milk thistle extract stops colorectal cancer stem cells from growing tumors   University of Colorado, April 22, 2022   In results presented at the American Association for Cancer Research, a University of Colorado Cancer Center study shows that orally administering the chemical silibinin, purified from milk thistle, slows the ability of colorectal cancer stem cells to grow the disease. When stem cells from tumors grown in silibinin-fed conditions were re-injected into new models, the cells failed to develop equally aggressive tumors even in the absence of silibinin. "It's very simple: tumors from mice that were initially fed silibinin had fewer cancer stem cells, were smaller, had lower metabolisms and showed decreased growth of new blood vessels. Importantly, when these cancer stem cells from tumors in mice fed silibinin were re-injected into new mice, we found these stem cells had lost their potential to repopulate even in the absence of silibinin exposure. Silibinin is a non-toxic, potentially chemopreventive agent derived from milk thistle seeds.   (NEXT)   Chilli peppers hold promise of preventing liver damage and progression   European Association for the Study of the Liver (Austria), 23 April 2015    Results revealed  that the daily consumption of capsaicin, the active compound of chilli peppers, was found to have beneficial effects on liver damage. In the study, capsaicin was found to reduce the activation of hepatic stellate cells (HSCs) in mice models. HSCs are the major cell type involved in liver fibrosis, which is the formation of scar tissue in response to liver damage. The study demonstrates that capsaicin partially improved liver damage in the BDL mice and inhibited further progression of the injury. In the second group of CCl4-treated mice, capsaicin prevented livers from injury development but did not reduce the fibrosis when it was already established.   (NEXT)   Compassion meditation reduces 'mind-wandering,' research shows    Stanford University, April 23, 2022    The practice of compassion meditation may be a powerful antidote to a drifting mind, new Stanford research shows.   Compassion meditation focuses on benevolent thoughts toward oneself and others, as the researchers noted. It is different in this aspect than most forms of meditation in the sense that participants are "guided" toward compassionate thoughts. This is the first report that demonstrates that formal compassion training decreases the tendency for the mind to wander, while increasing caring behavior not only towards others but towards oneself. "Mind-wandering" is the experience of having your thoughts not remain on a single topic for long. Prior research suggests that people spend as much as 50 percent of their waking hours in mind-wandering, often without realizing it. Doty said that mindfulness is extremely useful in today's world with its myriad of distractions, as humans are often overwhelmed and can find it difficult to attend to necessary tasks. "By closing one's eyes and engaging in attention training through a mindfulness practice, not only does it diminish the negative physiologic effects of distraction, which can result in anxiety and fear, but it can increase one's ability to attend to important tasks and not have an emotional response to the often negative dialogue which is frequent in many individuals," he said. As the researchers noted, compassion is defined by an awareness of suffering, sympathetic concern and a wish to see the relief of that suffering, and a responsiveness or readiness to help relieve that suffering. The study examined 51 adults during a compassion meditation program, measuring their various states of mind-wandering (neutral, pleasant, and unpleasant topics) and caring behaviors for themselves and others.  They were encouraged to meditate at least 15 minutes daily and, if possible, 30 minutes. The results indicated that compassion meditation decreased mind-wandering to neutral topics and increased caring behaviors toward oneself.   Videos: Tucker: You are seeing a full-scale attack on free speech How is everything getting coordinated globally on the scale that it is. “Ministry of Truth.”

Dr Christopher Lieu from the University of Colorado Cancer Center in Aurora, Colorado, discusses recent therapeutic advances in the management of colorectal cancers. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayCRCANAL21/Issue2).

HEALTH NEWS   Adding herbs and spices to meals may help lower blood pressure Texas Tech University, November 8, 2021 In a controlled-feeding study, the researchers found that seasoning foods with 6.5 grams, or about 1.3 teaspoons, of herbs and spices a day was linked with lower blood pressure after four weeks. The findings offer people a simple way to help improve their heart health. For the study, the researchers recruited 71 people with risk factors for heart disease. Every participant consumed every spice diet—one low, one moderate, and one high in herbs and spices—in a random order for four weeks each, with a two-week break between each diet period. Blood samples were drawn from each participant at the beginning of the study as well as after each diet period. The doses included a blend of 24 different herbs and spices, ranging from basil and thyme to cinnamon and turmeric, designed to simulate the way people use different herbs and spices throughout the day while cooking. The researchers found that after consuming the diet including a high dose of herbs and spices, participants had lower systolic blood pressure than after the diet with the medium dose. Participants also had lower diastolic blood pressure after the diet with a high dose of herbs and spices than after the diet with a low dose.   Bitter melon can lower blood sugar levels and even prevent cancer University of Colorado Cancer Center, November 11, 2021 Bitter melon (Momordica charantia), also known as bitter gourd and balsam pear in other parts of the world, is one of those foods that meet more than your senses of sight and taste.  A study conducted by researchers from the University of Colorado Cancer Center demonstrated the vegetable's ability to fight pancreatic cancer, one of the hardest cancers to treat. It found that treating pancreatic cancer tumors in mice with 5 milligrams of freeze-dried bitter melon juice every day reduces the tumors' size and makes them 64 percent smaller than those in untreated mice. What more, bitter melon proved more effective than a common chemotherapy drug used in a similar study, which reduced the tumor size by only 52 percent. The researchers noted that the dosage used in the study caused no adverse effects on the mice and may be adapted for human consumption. In another study, bitter melon caused apoptosis – cellular death – in four pancreatic cancer cell lines, reducing the viability of two lines by 90 percent and the other two by an impressive 98 percent. It also halted the metastasis and re-growth of the cancer cells. Further research has shown the vegetable's activity against other types of cancer as well, including blood, colon, liver, stomach, and breast cancers. If you really don't think you can take the vegetable's flavor, you can take it in capsule form. Do note that some studies showing its benefits for blood sugar control used dosages as high as 2,000 mg a day. To ensure that bitter melon supplements are the best for your condition, it would be best to consult with your healthcare provider before taking them.   Flame retardants linked to autistic-like behavior University of California at Riverside, November 7, 2021 Polybrominated diphenyl ethers, or PBDEs, are a class of fire-retardant chemicals that are ubiquitous. They are found on upholstery, carpets, curtains, electronics, and even infant products. Flame retardants migrate out of products into dust that humans contact and can ingest.  Considered to be global environmental pollutants, they have been detected in water, soil, air, food products, animals, and human tissues. They are found, too, in breast milk of women all over the world. A research team has found that when female mice exposed to PBDEs pass on these neuroendocrine-disrupting chemicals to their developing offspring, the female offspring show traits relevant to autism spectrum disorders, or ASD. Their short-term social-recognition ability and long-term social memory is reduced significantly and the offspring show exaggerated “marble burying” behavior — repetitive behavior reminiscent of human compulsive behavior, a core symptom of ASD.  “Humans mostly rely on faces to recognize people and most autistics show deficits in face-identity processing,” Curras-Collazo explained. “Mice, on the other hand, rely on smell for social recognition. The female offspring of mother mice exposed to PBDEs showed olfactory deficits that dampened their ability to recognize other mice. In effect, these offspring do not distinguish new mice from familiar ones. Humans with ASD also show abnormal olfactory ability.”  To the authors' knowledge, their study is the first to show autistic-relevant behavior and brain changes in female offspring from maternal transfer of environmental pollutants. The behaviors were also tested in exposed mothers, but they were largely unaffected. ype and social neuropeptide alterations in female mice offspring induced by maternal transfer of PBDE congeners in the commercial mixture DE‑71.”   Two omega-3s in fish oil may boost brain function in people with heart disease   Harvard Medical School , November 8, 2021 Two omega-3 fatty acids found in fish oil may help improve brain function in older adults who have a type of heart disease known to put people at risk for cognitive decline. A new study found that DHA and EPA, given in a combined supplement at prescription levels, improved cognitive function in older adults with coronary artery disease, or CAD. It is a common type of heart disease that occurs when plaque builds up in the arteries and hinders proper blood flow. Studies have shown people with CAD have a 45% increased risk for cognitive decline. The largest improvements in brain function were seen when higher levels of both types of omega-3 fatty acids were present in the bloodstream. When analyzed individually, DHA levels were a better predictor for cognitive improvement than EPA, suggesting the presence of one type of omega-3 fatty acid was more important than the other, the authors concluded. "The study showed EPA adds additional benefit when DHA levels are already high," said study researcher Dr. Francine Welty, an associate professor of medicine at Harvard Medical School in Boston. "But EPA levels alone had no predictive ability for cognitive improvement."   Despite understanding the concept of mindfulness, people are applying it incorrectly, research finds University of Waterloo (Canada), November 8, 2021 Mindful awareness is about both accepting and engaging with life's challenges, and that's what popularized concepts of mindfulness tend to miss, new research has found. Studying popular concepts of mindfulness, the researchers found most laypeople are confusing the practice with passive acceptance of problem—a misconception scientists say ignores the important work of engaging with them. Originating in Buddhist religious practice, much of the mindfulness movement's popularity grew from clinical research affirming its potential for reducing stress and related health disorders.  It is, in fact, the engagement with stressors that ultimately results in stress relief. More specifically, mindfulness includes two main dimensions: awareness and acceptance. "While we found that people seem to conceptually understand that mindfulness involves engagement, the general public is not walking the talk. Our results suggest that laypeople may understand what awareness is, but the next step of acceptance may not be well understood—limiting potential for engaging with problems," said Ellen Choi, lead author on the paper.   Bacterial pneumonia far more dangerous to the heart than viral pneumonia, study finds   Intermountain Medical Center (Utah), November 11, 2021   Heart complications in patients diagnosed with bacterial pneumonia are more serious than in patients diagnosed with viral pneumonia, according to new research. In the study of nearly 5,000 patients, researchers found that patients diagnosed with bacterial pneumonia had a 60 percent greater risk of a heart attack, stroke, or death than patients who had been diagnosed with viral pneumonia. "We've always known pneumonia was a risk factor for a major adverse cardiac event, like a heart attack, within the first 90 days of being diagnosed," said J. Brent Muhlestein, MD, a cardiovascular researcher with the Intermountain Heart Institute at Intermountain Medical Center. "What we didn't know was which type of pneumonia was more dangerous. The results of this study provided a clear answer, which will allow physicians to better monitor patients and focus on reducing their risk of a major adverse cardiac event." Nearly 80 percent of the patients were diagnosed with bacterial pneumonia, and 34 percent (1,270 patients) of them had a major cardiovascular event within 90 days. At the same time, 21 percent of the patients were diagnosed with viral pneumonia, and 26 percent (258 patients) had a major adverse event within the 90-day window. "The likely underlying cause is that bacterial pneumonia causes greater inflammation of the arteries compared to viral pneumonia," said Dr. Muhlestein.   Researchers find exposure to microplastics may alter cellular function Florida State University, November 11, 2021 Pollution from miniscule pieces of plastic, or microplastics, have been a growing concern for scientists, public health advocates and environmentalists as these nondegradable items have increasingly made their way into waterways and even the air we breathe.  Now, a team researchers found that exposure to microplastics for only a few days caused human lung cells to slow down their metabolism and growth, change shapes, and decluster so that gaps exist in what is typically a solid sheet of cells. The findings raise questions about the long-term effects of microplastics on human health, particularly for those who already have respiratory conditions.   The team exposed lung cells in a petri dish to small amounts of polystyrene at levels that are commonly found in the environment and found that though the plastic didn't cause cell death, it caused some interesting changes. After only a few days, they found that the cell's metabolic processes had slowed down, cell proliferation was inhibited, the shape of the cell morphed and the delustering had occurred. Additionally, the team found that the microplastic particles were uptaken by the cells and had formed a ring around the nucleus in the cell.  

How do diagnostic tests affect your lung cancer treatment plan. Dr. Tejas Patil discusses appropriate testing for lung cancer, latest targeted therapies and how emerging research is affecting patient outcomes.About the Guest: Dr. Tejas Patil is an academic thoracic oncologist at the University of Colorado Cancer Center focused on targeted therapies and novel biomarkers in lung cancer. Learn more about Dr. Patil, here. 

There are 2 different options when it comes to cord blood, collect or discard.  If you choose to collect cord blood then there is another decision, do you donate to a public bank or keep it for your family through a private banking agency. Couple of things to watch out for when you think about cord blood banking.  There can be false claims as to what stems cells and cord blood are currently capable of treating. Misleading patients to bank cord blood for future use of treatment that is either being researched or hypothecated is wrong and illegal.  A recent study done at the University of Colorado Cancer Center is showing some pretty good response when it comes to cancer patients needing bone marrow transplants.  To get more information about cord blood donation or banking, it's important that you speak with your OB/GYN. Visit our website www.thenursingpostpodcast.com for show notes and references for this episode. 

Guest: Scott Pearson Chairman Golfers Against Cancer started in 1997 in Houston and the Denver chapters started in 2009.  They are 100% volunteer based and all the money stays here in Colorado and goes towards cancer research.  The money raised in Denver goes to the Colorado Cancer Center.  This year they have a few big events happening to help raise money.  They first event is a Hitmaker Music Event on June 3rd and the other is a golf tournament on July 26th.            http://www.denvergolfersagainstcancer.org/ See omnystudio.com/listener for privacy information.

 Perspectives on the Pandemic | "The Illusion of Evidence Based Medicine"  Leemon McHenry 10 mins   Leemon McHenry is Emeritus Professor in the Department of Philosophy , California State University, Northridge. Leemon does research in Philosophy of Science, Metaphysics and Bioethics. His current project is 'Evidence Based Medicine'.   Vitamin A for nerve cells University Medical Center Freiburg (Germany), April 1, 2021 Neuroscientists agree that a person's brain is constantly changing, rewiring itself and adapting to environmental stimuli. This is how humans learn new things and create memories. This adaptability and malleability is called plasticity. "Physicians have long suspected that remodeling processes also take place in humans at the contact points between nerve cells, i.e. directly at the synapses. Until now, however, such a coordinated adaptation of structure and function could only be demonstrated in animal experiments," says Prof. Dr. Andreas Vlachos from the Institute of Anatomy and Cell Biology at the University of Freiburg. But now Vlachos, together with Prof. Dr. Jürgen Beck, head of the Department of Neurosurgery at the University Medical Center Freiburg, has provided experimental evidence for synaptic plasticity in humans. In addition to Vlachos and Beck, the research team consists of Dr. Maximilian Lenz, Pia Kruse and Amelie Eichler from the University of Freiburg, Dr. Jakob Strähle from the University Medical Center Freiburg and colleagues from Goethe University Frankfurt. The results were presented in the scientific journal eLife. In the experiments, the team investigated whether so-called dendritic spines change when exposed to a vitamin A derivative called retionic acid. Dendritic spines are the parts of the synapse that receive, process and transmit signals during communication between neurons. As such, they play a crucial role in brain plasticity and are constantly adapting to everyday experience. For example, learning can change the number and shape of dendritic spines. However, a transformation in the number or shape of the spines is also found in diseases such as depression or dementia. The research shows that retinoic acid not only increases the size of dendritic spines, but also strengthens their ability to transmit signals between neurons. "We have concluded from our results that retinoic acids are important messengers for synaptic plasticity in the human brain. Thus, this finding contributes to the identification of key mechanisms of synaptic plasticity in the human brain and could support the development of new therapeutic strategies for brain diseases, such as depression," says Vlachos. To experimentally demonstrate that synaptic plasticity also exists in humans, the researchers use tiny samples of human cerebral cortex, which must be compulsorily removed during neurosurgical procedures for therapeutic reasons. The removed brain tissue was then treated with retinoic acid before functional and structural properties of neurons were analyzed using electrophysiological and microscopic techniques.       Study: Chemical compound in certain essential oils promotes wound healing Indiana University, April, 2021 A study from Indiana University revealed that a chemical compound in essential oils may enhance wound healing, especially when applied topically. According to co-author Sachiko Koyama, essential oils – like those from lavender, rosemary, ylang-ylang and black pepper – contain a chemical compoundcalled beta-caryophyllene. This contributes to improved wound healing, based on a murine model. “This is the first finding at the chemical-compound level showing improved wound healing in addition to changes in gene expression in the skin,” said Koyama. Beta-caryophyllene may decrease inflammation and accelerate re-epithelialization. The latter refers to the restoration of structure and function of injured tissues. During this process, epithelial cells at the wound start to migrate and cover the injured area. The researchers added that beta-caryophyllene may prevent cell death, allowing cells to survive and proliferate. “I thought maybe wound healing would be accelerated if inflammation was suppressed, stimulating an earlier switch from the inflammatory stage to the next stage,” she added. The team also noted increased gene expression of hair follicle stem cells in the treated tissue. This potentially indicate that there’s more to wound-healing activity of beta-caryophyllene than just activating genes. “It’s possibly more complicated,” she added. “Our findings suggest the involvements of some other routes in addition to CB2. I hope to clarify the mechanisms of action in the near future.” Koyama, a social neuroscientist at Indiana University, said that she wasn’t interested in studying essential oils at first, as her field of expertise was in pheromone and social status. However, her interest was sparked when she saw students working on the wound healing process in mice. She knew from experience that beta-caryophyllene can also activate cannabinoid receptor 2 (CB2), which has anti-inflammatory and analgesic properties. Healing beyond smell Most people know essential oils by way of aromatherapy. These are often used with diffusers, aromatic spritzers, inhalers, facial steamers and clay masks to bring out the aroma coming from the oil. Essential oils, in particular, may help with asthma, insomnia, fatigue and depression, among others. In the study, the researchers did not find any relationship between the sense of smell and the healing properties of beta-caryophyllene. (Related: Curcumin found to aid in the healing of skin wounds.) Koyama also offered a caveat for those looking to use essential oils for treatment, in particular, warning against the use of any essential oils. In the study, the researchers used essential oils that underwent purification processes to achieve that result. “It’s not very precise to use the essential oils themselves because there are differences,” she added. “Even if you say you used lavender, when the lavender was harvested, where it was harvested, how it was stored—all of this makes a difference in the chemical composition.” The team is also hopeful that their results will warrant further studies to determine an exact chemical composition for beta-caryophyllene that can be used to treat skin wounds. “There are many things to test before we can start using it clinically, but our results are very promising and exciting; someday in the near future, we may be able to develop a drug and drug delivery methods using the chemical compounds found in essential oils,” she added.     Exercise may help slow cognitive decline in some people with Parkinson's disease Hallym University (South Korea), April 1, 2021 For people with Parkinson's disease, problems with thinking and memory skills are among the most common nonmotor symptoms of the disease. A new study shows that exercise may help slow cognitive decline for some people with the disease. The study is published in the March 31, 2021, online issue of Neurology. Research has suggested that people with Parkinson's who have the gene variant apolipoprotein E e4, or APOE e4, may experience faster cognitive decline and earlier in the disease than people without the variant. APOE e4 is known as a genetic risk factor for Alzheimer's disease. The study looked at whether exercise could play a role in slowing cognitive decline for people with APOE e4. "Problems with thinking skills and memory can have a negative impact on people's quality of life and ability to function, so it's exciting that increasing physical activitycould have the potential to delay or prevent cognitive decline," said study author Jin-Sun Jun, M.D., of Hallym University in Seoul, Korea. The study involved 173 people with early Parkinson's disease who were on average 63 years old at the time and 59 years old when they developed the disease. A total of 27% had the APOE e4 gene variant. People reported their physical activity with a questionnaire on how much activity they had in the previous week through leisure activities such as walking or biking, household activities such as dusting or yard work and work activities for pay or as a volunteer. People took a test of their thinking skills at the beginning of the study and then one and two years later. Overall, scores at the beginning of the study averaged 26 points. For people with the APOE e4 gene variant, test scores declined by an average of 1.33 points by the end of the study compared to those without the variant. But researchers also found that greater physical activity at the start of the study lessened APOE e4-related cognitive decline two years later by an average of 0.007 points. "Additional research is needed to confirm our findings, but these results would support the use of interventions that target physical activity as a way to delay cognitive decline in people with early Parkinson's who have the APOE e4 gene variant," Jun said. A limitation of the study was that participants reported their own levels of physical activity, so there is the possibility that they would not remember their levels exactly.   Time to shift from 'food security' to 'nutrition security' to increase health and well-being Tufts and Georgetown Universities, April 1, 2021   In the 1960s, a national focus on hunger was essential to address major problems of undernutrition after World War II. In the 1990s, the nation shifted away from hunger toward "food insecurity" to better capture and address the challenges of food access and affordability. Now, a new Viewpoint article argues that today's health and equity challenges call for the U.S. to shift from "food insecurity" to "nutrition insecurity" in order to catalyze appropriate focus and policies on access not just to food but to healthy, nourishing food. The Viewpoint, by Dariush Mozaffarian of the Friedman School of Nutrition Science & Policy at Tufts University, Sheila Fleischhacker of Georgetown Law School, and José Andrés of World Central Kitchen, was published online in JAMA this week. The concept of food security focuses on access to and affordability of food that is safe, nutritious, and consistent with personal preferences. In reality, however, the "nutritious" part often has been overlooked or lost in national policies and solutions, with resulting emphasis on quantity, rather than quality, of food, say the authors. "Food is essential both for life and human dignity. Every day, I see hunger, but the hunger I see is not only for calories but for nourishing meals. With a new focus on nutrition security, we embrace a solution that nourishes people, instead of filling them with food but leaving them hungry," said Chef José Andrés, founder of World Central Kitchen. The authors define nutrition security as having consistent access to and availability and affordability of foods and beverages that promote well-being, while preventing -- and, if needed, treating -- disease. Nutrition security provides a more inclusive view that recognizes that foods must nourish all people. "'Nutrition security' incorporates all the aims of food security but with additional emphasis on the need for wholesome, healthful foods and drinks for all. COVID-19 has made clear that Americans who are most likely to be hungry are also at highest risk of diet-related diseases including obesity, diabetes, heart disease, and many cancers - a harsh legacy of inequities and structural racism in our nation. A new focus on nutrition security for all Americans will help crystallize and catalyze real solutions that provide not only food but also well-being for everyone," said first author Dariush Mozaffarian, dean of the Friedman School of Nutrition Science & Policy at Tufts University. "It's the right time for this evolution," said Sheila Fleischhacker, adjunct professor at Georgetown Law School, who has drafted food, nutrition and health legislation and campaign positions at the local, state, tribal and federal levels. "By prioritizing nutrition security, we bring together historically siloed areas - hunger and nutrition - which must be tackled together to effectively address our modern challenges of diet-related diseases and disparities in clinical care, government food and food assistance policies, public health investments, and national research." "The current approach is not sufficient," the authors write, and "traditionally marginalized minority groups as well as people living in rural and lower-income counties are most likely to experience disparities in nutrition quality, food insecurity, and corresponding diet-related diseases."     Fasting acts as diet catalyst in those with metabolic syndrome Max Delbruck Center for Molecular Medicine (Germany), March 30, 2021 One in four Germans suffers from metabolic syndrome. Several of four diseases of affluence occur at the same time in this 'deadly quartet': obesity, high blood pressure, lipid metabolism disorder and diabetes mellitus. Each of these is a risk factor for severe cardiovascular conditions, such as heart attack and stroke. Treatment aims to help patients lose weight and normalise their lipid and carbohydrate metabolism and blood pressure. In addition to exercise, doctors prescribe a low-calorie and healthy diet. Medication is often also required. However, it is not fully clear what effects nutrition has on the microbiome, immune system and health.  A research group led by Dr Sofia Forslund and Professor Dominik N. Müller from the Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) and the Experimental and Clinical Research Center (ECRC) has now examined the effect a change of diet has on people with metabolic syndrome. The ECRC is jointly run by the MDC and Charité Universitätsmedizin Berlin. "Switching to a healthy diet has a positive effect on blood pressure," says Andras Maifeld, summarising the results. "If the diet is preceded by a fast, this effect is intensified." Maifeld is the first author of the paper, which was recently published in the journal "Nature Communications". Broccoli over roast beef Dr Andreas Michalsen, Senior Consultant of the Naturopathy Department at Immanuel Hospital Berlin and Endowed Chair of Clinical Naturopathy at the Institute for Social Medicine, Epidemiology and Health Economics at Charité - Universitätsmedizin Berlin, and Professor Gustav J. Dobos, Chair of Naturopathy and Integrative Medicine at the University of Duisburg-Essen, recruited 71 volunteers with metabolic syndrome and raised systolic blood pressure. The researchers divided them into two groups at random.  Both groups followed the DASH (Dietary Approach to Stop Hypertension) diet for three months, which is designed to combat high blood pressure. This Mediterranean-style diet includes lots of fruit and vegetables, wholemeal products, nuts and pulses, fish and lean white meat. One of the two groups did not consume any solid food at all for five days before starting the DASH diet. On the basis of immunophenotyping, the scientists observed how the immune cells of the volunteers changed when they altered their diet. "The innate immune system remains stable during the fast, whereas the adaptive immune system shuts down," explains Maifeld. During this process, the number of proinflammatory T cells drops, while regulatory T cells multiply.  A Mediterranean diet is good, but to also fast is better The researchers used stool samples to examine the effects of the fast on the gut microbiome. Gut bacteria work in close contact with the immune system. Some strains of bacteria metabolise dietary fibre into anti-inflammatory short-chain fatty acids that benefit the immune system. The composition of the gut bacteria ecosystem changes drastically during fasting. Health-promoting bacteria that help to reduce blood pressure multiply. Some of these changes remain even after resumption of food intake. The following is particularly noteworthy: "Body mass index, blood pressure and the need for antihypertensive medication remained lower in the long term among volunteers who started the healthy diet with a five-day fast," explains Dominik Müller. Blood pressure normally shoots back up again when even one antihypertensive tablet is forgotten.  Blood pressure remains lower in the long term - even three months after fasting Together with scientists from the Helmholtz Centre for Infection Research and McGill University, Montreal, Canada, Forslund's working group conducted a statistical evaluation of these results using artificial intelligence to ensure that this positive effect was actually attributable to the fast and not to the medication that the volunteers were taking. They used methods from a previous study in which they had examined the influence of antihypertensive medication on the microbiome. "We were able to isolate the influence of the medication and observe that whether someone responds well to a change of diet or not depends on the individual immune response and the gut microbiome," says Forslund.  If a high-fibre, low-fat diet fails to deliver results, it is possible that there are insufficient gut bacteria in the gut microbiome that metabolise fibre into protective fatty acids. "Those who have this problem often feel that it is not worth the effort and go back to their old habits," explains the scientist. It is therefore a good idea to combine a diet with a fast. "Fasting acts as a catalyst for protective microorganisms in the gut. Health clearly improves very quickly and patients can cut back on their medication or even often stop taking tablets altogether." This could motivate them to stick to a healthy lifestyle in the long term.   Rice bran adds microbiome diversity, slows growth of colon cancer cells University of Colorado, April 5, 2021    At the American Association for Cancer Research (AACR) Annual Meeting, University of Colorado Cancer Center researchers at Colorado State University present results of a phase II clinical trial of 29 people exploring the effects of adding rice bran or navy beans to the diets of colorectal cancer survivors. After the 4-week randomized-controlled trial during which people added rice bran, navy bean powder or neither, both the rice bran and navy bean groups showed increased dietary fiber, iron, zinc, thiamin, niacin, vitamin B6, folate, and alpha-tocopherol. The rice bran group also showed increased microbiome richness and diversity. When researchers treated colorectal cancer cells with stool extracts from these groups, they saw reduced cell growth from the groups that had increased rice bran and navy bean consumption.   Previous work shows the ability of these diets to decrease colorectal cancer risk in animal models. The current trial confirms that people can eat enough bean- and rice bran-enhanced foods to promote gut health at levels shown to prevent colorectal cancer in animals. Guidelines from the American Institute for Cancer Research recommend reducing the risk of cancer by eating more vegetables, fruits, whole grains and legumes, such as beans. Ryan has established from these studies that eating a half-cup of beans and 30 grams of rice bran per day is enough to see changes in small molecules that can confer protection against colorectal cancer.   "The simple message is, 'Food is medicine,' and we are looking at how to simplify that and make it apply to our everyday lives," says study co-author Regina Brown, MD, assistant professor at the CU School of Medicine and oncologist for CUHealth.   Brown is long-time collaborator of CU Cancer Center investigator and CSU assistant professor, Elizabeth Ryan, PhD. The Ryan Lab in the CSU College of Veterinary Medicine and Biomedical Sciences studies the potential power of navy beans and rice bran to promote digestive health and to prevent metabolic alterations in obesity, heart disease and certain cancers.   "The evidence is there in animals and we can now study this in people. The question is, what are we doing to achieve adequate levels of intake of these foods?" Ryan said. "It's not enough to say 'I eat them once in a while.' That's not going to work, particularly if you are at higher risk. You have to meet a dose, just like you need a dose of a certain drug, you need to reach intake levels and consume increased amounts of these foods, and that's where people, including me, are challenged. Not everyone wants to open up a can of beans and eat them every day."   The two met about 10 years ago, when Ryan was a researcher in CSU professor Henry Thompson's Cancer Prevention Lab, and Brown was practicing medicine in Fort Collins and caring for her mother, who had uterine cancer. "It was kind of a novel partnership and had we not dug in our heels it could have died, but I told Elizabeth, 'Your work is so interesting and so valuable. We have to take this translational research from the benchtop to the clinic.' I guarantee, nine out of 10 of my patients, the first thing they ask is about their diet," Brown said.   The study's lead author is Erica Borresen, Ryan's research associate and study coordinator, who worked with colorectal cancer survivors to make sure they ate their beans and rice bran provided in meals and snacks, and that they filled out their food logs and gastrointestinal health questionnaires. It was sometimes intimate and awkward, but so is getting a colonoscopy and being treated for colorectal cancer. "Our participants donated their time and effort, and I want to make sure they understand they are appreciated," said Borresen, who earned her Master of Public Health at the Colorado School of Public Health, and plans to become a physician's assistant. "I came to realize I love the patient interaction - that's one of my favorite parts about coordinating our studies."   The next phase of Ryan's research examines effects of the cooked navy bean powder and rice bran on the colon tissue of people who have already had colorectal cancer and are at high risk for recurrence. "I really feel that there's hope in this being a practical solution to improve gut health and specifically colorectal cancer prevention," says Ryan.       Research suggests L-tryptophan supplements might help prevent impulsivity associated with psychological disorders University of California Berkeley, April 2, 2021 According to news reporting originating from Berkeley, California, research stated, “Emotion-related impulsivity, defined as the tendency to say or do things that one later regret during periods of heightened emotion, has been tied to a broad range of psychopathologies. Previous work has suggested that emotion-related impulsivity is tied to an impaired function of the serotonergic system.” Our news editors obtained a quote from the research from the University of California Berkeley, “Central serotonin synthesis relies on the intake of the essential amino acid, tryptophan and its ability to pass through the blood brain barrier. The aim of this study was to determine the association between emotion-related impulsivity and tryptophan intake. Undergraduate participants (N = 25, 16 women, 9 men) completed a self-rated measure of impulsivity (Three Factor Impulsivity Index, TFI) and daily logs of their food intake and exercise. These data were coded using the software NutriNote to evaluate intakes of tryptophan, large neutral amino acids, vitamins B6/B12, and exercise. Correlational analyses indicated that higher tryptophan intake was associated with significantly lower scores on two out of three subscales of the TFI, Pervasive Influence of Feelings scores r = -.502, p< .010, and (lack-of) Follow-Through scores, r = -.407, p< .050. Findings provide further evidence that emotion-related impulsivity is correlated to serotonergic indices, even when considering only food habits.” According to the news editors, the research concluded: “It also suggests the need for more research on whether tryptophan supplements might be beneficial for impulsive persons suffering from a psychological disorder.” This research has been peer-reviewed.         Nutritional supplementation in preconception and pregnancy linked to reduced risk of preterm birth University of Southampton (UK), March 30, 2021 Increasing evidence suggests that a mother's nutritional status at the onset of pregnancy has an important influence on the growth and development of her baby, and that a good nutritional status during pregnancy may help reduce the risk of pregnancy complications. A specific blend of nutrients and probiotics was tested in an international multicentre double blind randomized controlled trial NiPPeR (Nutritional Intervention Preconception and during Pregnancy to maintain healthy glucosE levels and offspRing health). Researchers from the international EpiGen Global Research Consortium, an academic group of clinicians and scientists including from around the world, including the University of Southampton, specifically assessed the effects of a nutritional intervention, a combination of myo-inositol, probiotics and micronutrients, consumed both before and during pregnancy, on maintaining healthy blood sugar levels in pregnancy and sustaining a healthy pregnancy and delivery. As published in the journal Diabetes Care, (Myo-inositol, Probiotics and Micronutrient Supplementation from Preconception for Glycemia in Pregnancy: the NiPPeR study involved 1,729 women from the UK, New Zealand and Singapore who were planning pregnancy—one of the largest international preconception randomized controlled trials of its type. While the study found that the intervention did not influence the mother's blood sugar levels or birthweights of the 585 babies born, the nutritional supplement decreased the incidence of preterm birth, particularly the cases associated with preterm pre-labor rupture of membranes. "Preterm delivery is a serious, common and costly public health problem worldwide that continues to increase in incidence," said Professor Keith Godfrey from the MRC Lifecourse Epidemiology Unit at the University of Southampton. "Preterm pre-labor rupture of membranes is a major cause of preterm birth. Our study presents for the first time a clinical trial of a novel non-pharmacological approach that started preconception and extended throughout pregnancy, through the innovative use of a combination of nutritional ingredients. The study findings highlight the potential value of the mix of nutrients and probiotics in reducing the risk of preterm birth and supporting a timely delivery," Professor Godfrey continued.  Associate Professor Shiao-Yng Chan, a principal investigator on the study from the Yong Loo Lin School of Medicine, National University of Singapore, deputy executive director at the Singapore Institute for Clinical Sciences, A*STAR, and Senior Consultant, Department of Obstetrics & Gynaecology, National University Hospital, commented "One of the strengths of our study is the diversity of its participants as we have involved women of multiple ethnicities from the general population across three countries, which means that the outcomes have wide relevance to women planning for pregnancy. Additionally, the study included blinded intervention and control groups, so bias is minimized." Sharing his thoughts, Professor Wayne Cutfield, principal investigator on the study from the University of Auckland, New Zealand, said, "The importance of the preconception period on maternal and offspring health is being increasingly recognized, but there are very few randomized control trials seeking to optimize preconception nutrition." Dr. Isabelle Bureau-Franz, Head of Nestlé Research, who partnered with EpiGen for this academic-led trial, says, "We are focused on discovering science-based solutions for mothers and their infants during preconception, pregnancy and while breastfeeding. The NiPPeR study is a great example of how a public-private partnership can build scientific evidence on nutritional interventions in a largely understudied group."

Dr. Wilky  is the Director of Sarcoma Medical Oncology at the University of Colorado. She cares for patients over the age of 18 with every type of sarcoma and is an expert not only in traditional chemotherapy treatments for sarcomas, but also at using modern technology such as gene sequencing and molecular profiling to identify out-of-the-box treatments particularly in targeted therapy.  Dr. Wilky is also a translational researcher who conducts and designs clinical trials for sarcoma patients, with a focus on early immunotherapy protocols.  Her laboratory studies the interaction between sarcomas and the immune system. Additionally, Dr. Wilky leads the investigator-initiated clinical trials committee at the University of Colorado Cancer Center, helping other researchers bring laboratory science discoveries into human clinical trials You can get so much great information about sarcoma and treatments by following Dr. Wilky on social media on Twitter or on her blog In this episode we discuss: How are clinical trials used in medicine The hope of clinical trials Phase 1 clinical trials Phase 2 and 3 clinical trials  Learning from all patients enrolled on clinical trials Big data and sarcoma Immunotherapy and sarcoma Compassionate use and right to try What are the most important questions you should ask your doctor when considering a clinical trial  music: Rospigg photo credit: volodymyr-hrysh

This special episode of Lung Cancer Considered features a conversation between host Dr. Stephen Liu and co-host Paul Bunn. Dr. Liu and Dr. Bunn are joined by, Dr. Tal Zaks, the chief medical officer at Moderna, and Dr. Amy Moore, a trained virologist and cancer researcher. Dr. Bunn is the founding director of the University of Colorado Cancer Center, former president of IASLC and ASCO. Dr. Moore serves as the director of Science and Research for the GO2 Foundation for Lung Cancer. Together, they discuss the development of the Moderna COVID-19 vaccine what lung cancer patients, doctors and advocates should know.

In this podcast, lung cancer experts Dr. Erin Schenk and Dr. Tejas Patil discuss the role of genetic testing results in lung cancer care—including treatment decisions—and share important advice for self-advocacy.About the Guests:Dr. Tejas Patil is an academic thoracic oncologist at the University of Colorado Cancer Center focused on targeted therapies and novel biomarkers in lung cancer. Learn more about Dr. Patil, here:  https://www.cudoctors.com/Find_A_Doctor/Profile/24489.Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here: https://www.cudoctors.com/Find_A_Doctor/Profile/27915.

In this episode of ASTCT Talks, we sit down with Dr. Lia Gore, professor of pediatrics in hematology-oncology and bone marrow transplantation and co-director of the Developmental Therapeutics Program at the University of Colorado Cancer Center. Dr. Gore was the co-investigator on the AALL1331 trial and led the preceding open-label Phase 1–2 trial, AALL1121, which was the first to demonstrate the antileukemic activity of single-agent blinatumomab in children with relapsed or refractory B-ALL. We talk about her research and how the trial signals future research of bispecifics in pediatric care.

Dr. S. Lindsay Davis, medical oncologist and assistant professor at the University of Colorado Cancer Center, highlights key abstracts on GI cancers that were featured at the #ASCO20 Virtual Scientific Program.   Transcript ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carol, a reporter for the ASCO Daily News. I'm delighted to welcome Dr. Lindsay Davis to the podcast today. She's a medical oncologist and assistant professor at the University of Colorado Cancer Center, where her clinical focus is gastrointestinal tract cancers.   She joins me today to discuss key abstracts in the GI field that were featured at the ASCO20 Virtual Scientific Program. Dr. Davis reports no financial conflicts of interest relating to the issues discussed in this podcast. Full disclosures relating to all daily news podcasts can be found on our episode pages. Dr. Davis, it's great to have you on the podcast today.   Dr. Lindsay Davis: Thank you, Geraldine. I am excited for the opportunity to discuss some of the key abstracts related to GI malignancies with you today. I must say the virtual scientific program was a bit of a different ASCO experience than we're accustomed to. However, the high quality of the data and presentations we expect at the annual ASCO meeting was really beautifully maintained in the virtual sessions.   ASCO Daily News: Well, what are the abstracts, Dr. Davis, that really caught your attention in the GI field this year?   Dr. Lindsay Davis: To me, the results from the KEYNOTE-177 study, abstract LBA4, which was presented at the plenary session, is really the standout in terms of GI malignancies from this ASCO meeting. KEYNOTE-177 is a randomized, open label, phase III study, comparing pembrolizumab to standard of care chemotherapy as first-line treatment for microsatellite instability-high and mismatch repair deficient metastatic colorectal cancer.   With a median follow-up of 32 months, the primary progression-free survival endpoint was met, with a median PFS in the pembrolizumab group of 16.5 months, as compared to 8.2 months in the chemotherapy group. So that's a doubling of PFS and a hazard ratio of 0.6.   In addition, and as expected, the toxicity rates were significantly lower in the pembrolizumab versus chemotherapy arms, with grade 3 or higher events occurring in only 22% of patients treated with pembrolizumab. And that's compared to 66% of patients treated with chemotherapy. This, of course, provides us the best case scenario of a treatment that is more effective, but also less toxic.   And though the MSI high population represents a relatively small proportion of our patients with metastatic colorectal cancer, this study is still clearly practice changing, making pembrolizumab the first-line treatment of choice for patients with metastatic MSI high disease.   In addition, I think this object is also important, as it provides further direction toward the biomarker-driven treatment of metastatic colorectal cancer. So I would encourage our listeners to look at abstract 4000, the DESTINY-CRC01 study.   There are a couple of additional biomarker-based trials in colorectal cancer that I wanted to touch on as well. The first is the PANDA study. This is abstract 4002. This is a randomized phase II trial, evaluating 185 patients aged 70 and above. The median age in this study was actually 77.   These patients had untreated RAS and BRAS wild-type metastatic colorectal cancer and were treated with FOLFOX plus the EGFR inhibitor panitumumab, or with 5-fluorouracil plus leucovorin and panitumumab for up to 12 cycles, followed by panitumumab maintenance. So really, the key difference between the arms here is that oxaliplatin was not included in the second arm.   Interestingly, approximately 20% of patients treated in each arm on the PANDA trial had right-sided primary tumors, which we now have data to suggest in a general population, not specific to age, would be less likely to benefit from EGFR inhibitor therapy in the first-line setting.   The primary endpoint for this study was progression-free survival in each arm, with no direct comparison made between the arms in this trial. The median PFS was 9.6 months in the FOLFOX panitumumab arm and very similar at 9.1 months in the 5-fluorouracil leucovorin panitumumab arm.   This was accompanied by a significant decrease in grade 3 and greater toxicity, including, of course, neurotoxicity-related to oxaliplatin as well as neutropenia and diarrhea. In general, these results are promising for our elderly patients with RAS and BRAF wild-type metastatic colorectal cancer and warrant further assessment in a phase III study for formal comparison of the arms.   And importantly, I'll say in clinical practice, we do encounter elderly patients who are not candidates for oxaliplatin or who are unlikely to tolerate intensive chemotherapy due to competing medical risks. So this data provides us some evidence for proceeding with 5FU and EGFR inhibitor therapy in this population.   That said, given the data regarding the decreased benefit of EGFR inhibitor therapy as part of first-line treatment for RAS wild-type right-sided colorectal cancer, I would limit the use of this strategy to elderly patients with left-sided tumors that are RAS and BRAF wild-type.   I would also like to just briefly mention a third biomarker-based abstract for metastatic colon cancer, abstract 4001, which detailed the updated survival results from the phase III BEACON CRC trial. And I wanted to mention this study because these results are the basis for the recent FDA approval of the encorafenib cetuximab doublet for the treatment of BRAF V600E mutant metastatic colorectal cancer beyond first-line.   This subset of metastatic colorectal cancer has historically been associated with a very poor prognosis with minimal response to cytotoxic chemotherapy. The BEACON CRC trial evaluated the doublet of encorafenib plus cetuximab, as well as a triplet of encorafenib plus cetuximab and MEK inhibitor binimetinib, as compared to standard chemotherapy for the treatment of BRAF V600E metastatic colorectal cancer. This was in the second or third-line setting.   The results presented at this ASCO are a post-hoc analysis of the previously published BEACON data, including an additional six months of follow-up. This data demonstrated a median overall survival of 9.3 months for both the encorafenib, cetuximab doublet, as well as the encorafenib, cetuximab, binimetinib triplet. And this was compared to only 5.9 months in the control arm with chemotherapy.   As expected, there was added toxicity in the triplet arm as compared to the doublet arm, consistent with the known toxicity of MEK inhibitor therapy. So as the FDA approval supports, this targeted regimen of encorafenib, cetuximab should be considered the standard of care for this population in the second-line setting and beyond, given improved survival outcomes as compared to standard chemotherapy and improved side effect profile as compared to the triplet combination.   ASCO Daily News:  Dr. Davis, are there any new agents that will potentially change standard of care moving forward?   Dr. Lindsay Davis: Some very promising data was presented on the compound trastuzumab deruxtecan, or T-DXd, an antibody drug conjugate composed of anti-HER2 antibody with a topoisomerase I inhibitor payload. Studies evaluating this compound were presented both for patients with HER2 expressing metastatic colorectal cancer, as well as HER2 expressing gastric cancer. We'll talk about each of these.   In the DESTINY-CRC01 study, T-DXd was evaluated in patients with HER2 expressing RAS wild-type metastatic colorectal cancer in the third line and beyond. 78 patients received T-DXd, of whom about 90% had left colon rectal cancer, which was heavily pre-treated with a median prior lines of therapy of 4, and it ranged from 2 to 11 prior lines.   The primary endpoint in this open label phase II study was objective response rate in patients with HER2 IHC 3+ or HER2 IHC 2+ with a positive ISH test. Confirmed overall response rate in this population was 45% with one complete response, which was quite impressive, given these patients are heavily pretreated with the median of four prior regiments.   Also of note is the overall response rate in patients with prior HER2 treatment, which actually represented 30% of the population. The overall response rate in this group was 44%. In terms of toxicity, grade 3 and greater treatment emergent adverse events were documented in 62% of patients, with the most common being cytopenias, neutropenia, and anemia mostly.   However, in addition, five patients developed interstitial lung disease related to treatment. This is a toxicity that has been seen in other trials of this compound. But in this study, it included two fatal grade 5 events of interstitial lung disease. So in terms of HER2 positive RAS wild-type metastatic colorectal cancer, I think T-DXd represents an encouraging option for treatment of this molecular subgroup, with notable effects in patients pretreated with HER2 targeted agents.   However, given the notable risk of treatment-related interstitial lung disease, this will need to be further vetted in a phase III trial. I think the study further highlights the importance of broad molecular testing in colorectal cancer, as though HER2 positivity is only identified in 2% to 3% of patients with this disease. Effective targets for this and other uncommon molecular alterations are being developed.   Similarly, promising results were presented in the DESTINY-Gastric01 study. This is abstract 4513, an open label, randomized, phase II trial evaluating T-DXd and HER2 expressing advanced gastric or GE junction adenocarcinoma. Patients had centrally confirmed HER2 positive disease, according to the same definition as the CRC01 study with progression on at least two prior lines of therapy.   Patients were randomized 2 to 1 to T-DXd or physician's choice of chemotherapy, which included irinotecan or paclitaxel. All patients in the trial had received prior HER2 therapy, of course, as this is standard of care for HER2 positive gastric and esophageal cancers. The primary endpoint on the study was overall response rate. And in the 187 patients treated, the overall response was 51% in patients treated with T-DXd, as compared to only 14% in those treated with chemotherapy.   With central confirmation of response, this overall response rate was a bit lower at 43% in the T-DXd arm, versus 13% in the control group. In addition, overall survival was prolonged in the T-DXd arm at 12.5 months versus 8.4 months in the chemotherapy group with a hazard ratio of 0.59.   Grade 3 and greater adverse events occurred in 86% of patients treated with T-DXd, as compared to 57% treated with standard chemotherapy, and were similar to those documented in the CRC01 study, including treatment-related interstitial lung disease documented in 12 patients.   Though there were no grade 5 events of ILD documented in this Gastric01 study, one grade 5 occurrence of pneumonia was noted in the treatment arm. These results are important, as they suggest a potential effect of a HER2 targeting therapy beyond trastuzumab, the only HER2 targeted therapy shown to be effective for the treatment of HER2-positive gastroesophageal cancers to date.   However, similar to the CRC01 study, the pulmonary toxicity documented in this trial remains a concern. We will look forward to a phase III study to further expand upon these findings.   ASCO Daily News: Are there any additional biomarker-focused studies of interest presented for GI malignancies outside of metastatic colon cancer?   Dr. Lindsay Davis: Yes, there are two additional studies focused on HER2-positive gastroesophageal cancers that were presented at this meeting. Here, they're evaluating the addition of HER2 targeted agents in the curative setting. The PETRARCA study, which is abstract 4502, evaluated perioperative FLOT, or FLOT with trastuzumab and pertuzumab, followed by nine cycles of trastuzumab plus pertuzumab in patients with resectable HER2-positive gastric or GE junction adenocarcinoma.   The primary endpoint for this study was pathologic complete response rate, which was significantly improved in the trastuzumab pertuzumab arm at 35% versus only 12% in the FLOT alone arm. There's also suggestion of benefit on PFS and OS in this study, though it was not powered for formal analysis.   Important to note is the added toxicity of trastuzumab pertuzumab to the FLOT regimen, which is already associated with a significant burden of adverse effects. Grade 3 or greater adverse events were documented in 85% of patients in the trastuzumab pertuzumab arm versus 75% of patients in the FLOT alone arm. And diarrhea and leukopenia were the most notable in the arm that added trastuzumab and pertuzumab therapy.   It should be noted that this trial was originally designed as a phase II/III study, but it was halted at phase II due to the emerging results from the JACOB trial. The JACOB trial was a phase III study which failed to meet its primary endpoint of improved overall survival for the addition of pertuzumab to trastuzumab and chemotherapy in the metastatic setting.   Despite this, I believe these phase II results from the PETRARCA study suggest there is rationale for proceeding with further assessment of this combination in the phase III setting. In contrast to these promising results for the addition of HER2 targeted therapy to standard chemotherapy and HER2-positive gastric and GE junction adenocarcinoma, the RTOG 1010 study, abstract 4500, did not meet its primary endpoint.   This study evaluated the addition of trastuzumab to tri-modality therapy with carboplatin, paclitaxel chemoradiation, followed by surgery in 571 patients with HER2 overexpressing esophageal or GE junction adenocarcinoma. Patients receiving carboplatin paclitaxel chemoradiation followed by surgery had a median disease free survival of 14.2 months as compared to 19.6 months in the trastuzumab arm.   However, this did not meet the prespecified primary endpoint of increasing disease free survival from 15 to 25 months. These results further confirm that defining the role of anti-HER2 therapies for the treatment of HER2-positive gastroesophageal cancers in the curative setting is complex, though deserving of continued attention and investigation.   ASCO Daily News: Dr. Davis, are there any updates on immuno-oncology therapies for the treatment of GI malignancies beyond colorectal cancer?   Dr. Lindsay Davis: Yes, updated results from the randomized phase III KEYNOTE-061 study were presented at this virtual meeting in abstract 4503. The KEYNOTE-061 study is a randomized phase III trial evaluating pembrolizumab versus paclitaxel as a second-line therapy for advanced gastric or GE junction adenocarcinoma in patients with PDL1 combined positive scores greater than or equal to 1.   In the previously presented primary analysis of this study, the primary overall survival endpoint was not met. However, duration of response was significantly longer at 18 months in the pembrolizumab arm versus 5 months in the paclitaxel arm. Presented in this abstract is data from an additional two years of follow-up, as well as further assessment according to additional combined positive scores of greater than or equal to 5 and greater than or equal to 10.   The survival benefit of pembrolizumab over paclitaxel seemed to increase with increasing combined positive score. In the general cohort of CPS greater than or equal to 1, patients treated with pembrolizumab had an overall survival of 9.1 months versus 8.3 months with paclitaxel. This is a hazard ratio of 0.81.   This is compared to an overall survival of 10.4 months with pembrolizumab versus 8.3 months with paclitaxel, a hazard ratio of 0.72 in the CPS 5 or greater population. And finally, in patients with CPS 10 or greater, the overall survival in the pembrolizumab versus paclitaxel arms was 10.4 versus 8.0 months, with the hazard ratio of 0.69.   In addition, the duration of response numerically increased with increasing CPS score, from 19 months in the CPS 1 group to 33 months in the CPS 5 group. And the duration of response has actually not been reached in the CPS 10 group.   I think the conclusion from these updated results is that a proportion of patients have long-term survival benefit from second-line pembrolizumab, which might be somewhat improved with higher CPS. This calls into question a need to adjust our selection criteria for pembrolizumab in patients with gastroesophageal cancers.   In summary, I think the underlying theme of this group of abstracts focused on GI malignancies is that we are continuing to move toward personalized cancer care for the treatment of gastrointestinal tract cancers. These studies also highlight the importance of broad molecular testing for GI cancers, as well as the importance of involvement of our patients with targetable alterations in clinical trials in order to help us continue to improve the individualized care we provide our patients.   ASCO Daily News: Well, thank you, Dr. Davis, for sharing your valuable insights with us today on these promising developments in the GI field.   Dr. Lindsay Davis: Thank you, Geraldine. It was my pleasure.   ASCO Daily News: And thank you to our listeners for joining us today. If you're enjoying the content on the podcast, please rate and review us on Apple Podcasts.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Guest: Amanda Dempsey, MD, PhD, MSPH, University of Colorado Cancer Center investigator, professor of pediatrics at the CU School of Medicine, and board member for the Colorado Children's Immunization Coalition and Lisa Bade, American Cancer Society communications director Discussed what is HPV and the fact that the vaccine protects against 9 different strains of the virus.  The vaccine can prevent certain types of cancers that are associated with HPV.  It's recommended for adolescents through the 20's, but can be given later in life with a doctor consultation.  The vaccine is recommend by the CDC as a main vaccine, so it is covered by most insurances.  The vaccine can be given after someone has been exposed to HPV because of the number of strains that it protects against.  HPV is a family of over 100 different viruses.  About 80 percent of all adults have been exposed to HPV infections.  14 million Americans are infected with HPV.  cancer.org See omnystudio.com/listener for privacy information.

 Key Takeaways from the 2019 Gastrointestinal Cancers Symposium with Dr. Stephen Leong   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Welcome to the ASCO Daily News podcast. I'm Lauren Davis, and joining me today is Dr. Stephen Long, associate editor of ASCO Daily News. Dr. Long is associate professor in the division of medical oncology and is a translational researcher in the GI and developmental therapeutics programs at the University of Colorado Cancer Center. Dr. Long, welcome to the podcast. Thanks for having me. It's a pleasure to be here. Dr. Long, you've just returned from the Gastrointestinal Cancers Symposium. How was this year's event compared with previous years? First of all, I love you GI ASCO. I always find it informative. And I love the format of the talks and presentation. This year there was no significant practice changing presentations like in years past. However, there were still some excellent presentations and talks. And what were some of the presentations that stood out to you? There were some reports of a couple of clinical trials that sort of intrigued me. One was KEYNOTE-181. This was a phase III study comparing pembrolizumab monotherapy versus standard chemotherapy in patients with local events and metastatic esophageal cancer in the second line setting. They reported a significant improvement in overall survival in patients with PD-L1 combined positive score of greater than 10. And these patients received 9.3 months overall survival compared to 6.7 months for those who received [INAUDIBLE] choice of chemotherapy, which then consists of paclitaxel, docetaxel, or irinotecan. In addition, pembrolizumab was better tolerated and had a better safety profile. What made it really intriguing was of the total 628 patients that were enrolled in the trial, 64% of them had squamous cell carcinoma of the esophagus, which is unusual, especially in a phase II setting. And even though the study had a statistic overall survival benefit, in the squamous cell carcinoma cohort, there was a non-statistical trend in overall survival of 8.2 months versus 7.1 respectively. Pembrolizumab did boost the objective response rate compared with chemotherapy in the PD-L1 CPS greater than 10 and a response rate of 21.5% versus 6.1%. And then squamous cell carcinoma, it was 16.7% versus 7.4%. That leads to a whole bunch of questions. One, should we improve our PD-L1 scoring by including a CPX score greater than 10 and making our predictions based off that? In addition, should pembrolizumab expand its indications to include squamous cell carcinoma, since presently in the United States, pembrolizumab is only approved for adenocarcinoma. Also, there were the reports of the phase II ROAR study, which was looking at biliary tract cancers with BRAF V600E activating mutations. And these patients received a combination of dabrafenib, a BRAF inhibitor, and trametinib, a MEK inhibitor. There were 33 patients. And they had an objective response rate of 42%. All of them with partial responses. And 7 of the 14 patients with responses had the responses lasting more than six months. And adding those with stable disease, they had reported a disease control rate of 88%. They looked at survival data. And the median progression free survival in this cohort was 9.2 months with an overall survival of 11.7 months. And to put this into context, usually second line biliary tract cancers we rarely ever see survival being more than five months. And these PFS and overall survival is very comparable to the first line setting for gemcitabine cisplatin, where the original study showed a PFS of eight months and overall survival of 11.7 months. So this potentially could be another treatment option for people with V600E biliary tract cancers. And then there were the preliminary results of a single phase II study at Memorial Sloan Kettering, which was evaluating pembrolizumab in conjunction with trastuzumab HER2 antibody with CAPOX and those with HER2 positive metastatic esophageal gastric adenocarcinoma. They had 32 patients with the overall response rate of 87%. They reported three CRs and 25 partial responses. And then when you factor in the stable disease, they had 100% disease control rate. And all the patients had some degree of tumor regression. The PFS were 11.4 months with an overall survival having not been met after six months. This is extremely exciting, and this has already led to the development of a global phase III study, which will be known as KEYNOTE-811. That's great. That sounds very promising. Were there any research presentations that you were interested in? Oh, yeah. There was a lot of great preclinical work. One of the most intriguing was in pancreatic cancer, where the Canadians did a study known as COMPASS, where they took advanced pancreatic ductal adenocarcinoma, and these patients underwent whole genome sequencing, as well as RNA sequencing of their tumors, prior to the initiation of first line chemotherapy with either modified FOLFIRINOX or gemcitabine and abraxane. Treatment outcomes were then compared to their molecular characteristics. The data suggests that chemotherapy differs depending on the transcription features of the tumor. So for example, the best survival data came out of those patients with the classical ductal adenocarcinoma subtype that were treated with FOLFIRINOX. And they had a median survival of 7.17 months. And when they were compared to the basal-like subtypes and were treated with FOLFIRINOX, they had a median progression free survival of 2.5 months. Now, patients with the basal-like subtype actually had a better response to gemcitabine and abraxane, which had a PFS of 5.65 months compared to the classical subtype, where they had median progression free survival of 4.93 months. So in summary, those with the basal-like subtype actually had a resistance for FOLFIRINOX. In addition, the researchers also mentioned that GATA6 RNA expression significantly correlates to the PDAC classic and basal-like molecular subtype. So it could actually be used as a marker in determining subtypes. And all this put together means that we could potentially identify patients who have a better chance of responding to FOLFIRINOX versus gem abraxane in the first line setting in pancreatic cancer. And obviously there needs to be more work to validate this, but this actually is quite intriguing. Also, there was data from the amino scoring testing, which was looking at its test in high risk stage 2 colorectal cancer patients. And for those who are not familiar, patients with stage colon cancer have a poor prognostic if they had a T4 disease, had fewer than 12 lymph nodes removed, had a point differentiation subtype, and also had evidence of vascular emboli, lymphovascular invasion, perineural invasion, or actually had a presentation of bowel obstruction or bowel perforation. And these patients are often offered adjuvant chemotherapy following curative resection due to their high risk of recurrence. The amino score test measures the density of CT3 positive T cells, as well as cytotoxic CDH cells within and surrounding the tumor to gauge the strength of the host immune response at a tumor site. So therefore a high amino score indicates a high anti-tumor immunity, which correlates with a low risk for disease recurrence. And these investigators looked at 1,130 patients with stage two colon cancers. And their conclusion for time to recurrence was those with high risk disease with high amino scoring compared to those with low risk disease had a very similar five-year survival of 87.4% versus 89.1% respectively. In contrast, if you have a high risk disease and a low amino scoring, your five-year time to recurrence was only 72.2% in the absence of adjuvant therapy. So this could potentially be used as a prognostic tool for those who are high risk stage two in the future. What about education sessions? Were there any that caught your attention? So my favorite was the neuroendocrine session. Neuroendocrine, as most people know, is a pretty rare disease population. However, there has been significant advances in the past few years with new drugs, new understanding of the biology, new diagnostic procedures, as well as testing. And it was a great panel of leading experts to help us navigate the new landscape of neuroendocrine and understanding how we should be approaching this. So that was my favorite session. Were there any other takeaways that were important during the symposium? There were a few other presentations I thought that were quite interesting. The Japanese presented their Prep-02 or JSAP-05 trial. And this was the first study to ever demonstrate the efficacy of neoadjuvant therapy in resectable pancreatic cancer. And their neoadjuvant chemotherapy regimen was a combination of gemcitabine with an oral drug S1. And they showed that it met its primary endpoint of overall survival of 36.72 months in those patients who received neoadjuvant therapy versus 26.65 months in those who went from upfront surgery. And for the Japanese, which tend to do upfront surgery followed by adjuvant chemotherapy in the past, I think this may be a shift in their paradigm, where this could be the new standard in Japan of using neoadjuvant therapy prior to surgery. Also, there was the oral drug trifluridine and tipiracil, which was studied in a phase III metastatic gastric and GE junction adenocarcinoma for those who have received two previous line of therapies. And they were randomized to the drug versus placebo. And it demonstrated a 2.1 survival benefit over placebo. And their main concern was a lot of these patients end up getting gastrectomies. But being an oral drug, could that affect its efficacy? And it seems like this benefit was also seen in those who had a gastrectomy versus those who didn't as well. So this potentially could be another option for those in the third line setting for gastric cancer. However, the big debate is even though it met its overall survival, is 2.1 months clinically significant? And I guess we'll have to have more data regarding safety and tolerability before we can make that decision. There is also the French GRECCAR-6 trial, which was evaluating the optimal time to surgery following chemoradiation for rectal cancer, where patients who underwent neoadjuvant chemoradiation were randomized to waiting 7 or 11 weeks prior to a mesoresection of the rectal cancer. They demonstrated that they had very similar path CR rates between the two. But more interesting, they found that if you had a good disease response to chemoradiation, there was no difference in disease free survival if you waited 7 weeks versus 11 weeks prior to surgery. However, if you were a bad disease responder, you had a poorer disease free survival if you waited more than seven weeks. However, this was not statistically significant. And then the authors concluded that we shouldn't be waiting more than seven weeks prior to surgery following neoadjuvant chemoradiation for rectal surgery. Thank you so much. Again, today my guest has been Dr. Stephen Long. Thank you for being on our podcast today. And to our listeners, thank you for tuning into the ASCO Daily News podcast. If you're enjoying the content, we encourage you to rate us and review us on Apple podcast.  

Today's show offers two feature interviews: New Theory of How Cancer Evolves Inside Us (start time: 0:58): It is commonly known that cancer afflicts old people more than youth. Conventional wisdom has held we get cancer with age largely because we accumulate lots of genetic mutations over many years, and it’s the mutations that cause cancer. Our guest, Dr. James DeGregori,  deputy director of the University of Colorado Cancer Center, discusses with host Susan Moran his new theory--one that challenges conventional wisdom--about why and how we get cancer. In his new book, called Adaptive Oncogenesis: A New Understanding of How Cancer Evolves Inside Us, DeGregori argues that cancer is as much a disease of evolution as it is of mutation. Mutated cells outcompete healthy ones in the ecosystem of the body’s tissues. Dr. DeGregori is a professor in the Department of Biochemistry and Molecular Genetics at the University of Colorado Anschutz Medical Campus. Studying Health Impacts of Oil&Gas Wells (start time: 12:54) Many people living all along the Front Range are familiar with the sights and smells of oil rigs operating in fields near their homes and schools.  State regulators argue  that this convergence of people and oil rigs is safe. But many nearby residents and scientists are concerned about the potential health impacts of these drilling operations so close to residential neighborhoods and schools. Our guest, Dr. Lisa McKenzie, is the lead author on a new study that adds some critical evidence to back concerns of residents. It found that for people living within 500 feet of a well, the risk of their getting cancer over the course of their lifetime is eight times higher than the upper acceptable levels established by the federal EPA. Dr. McKenzie is an assistant research professor at the Colorado School of Public Health at the University of Colorado Anshutz Campus. She discusses the study and its implications with hosts Daniel Glick and Susan Moran. (Here is our interview with Dr. McKenzie a year ago about a related study.) Hosts: Daniel Glick, Susan Moran Producer: Susan Moran Engineer: Maeve Conran Executive Producer: Joel Parker Listen to the show here:

Medical Marijuana is a topic of much debate and discussion. We catch up with Dr. Tim Byers about his views on the subject and ask those questions many patients are wanting to know. As more and more states are developing medical marijuana programs, patients and caregivers need to be informed about the potential risks and benefits. Dr. Byers is an Associate Dean at the Colorado School of Public Health and the Associate Director of the University of Colorado Cancer Center talks about medical marijuana. He is an expert leader in the cancer prevention research field. Medical Marijuana is not legal in all states - Fight Colorectal Cancer does not condone the use of marijuana where it is illegal. Please talk with your healthcare team about your treatment and use of all therapies. Colorectal cancer patients: let us guide you through. Download our free eBook for stage III & stage IV patients: http://fightcolorectalcancer.org/guideinthefight/

Acquired Resistance Forum Video #8: Dr. Robert Doebele of the University of Colorado Cancer Center spoke to ALK and ROS1 patients about how and why their cancers become resistant to treatment and what options are available.

Acquired Resistance Forum Video #8: Dr. Robert Doebele of the University of Colorado Cancer Center spoke to ALK and ROS1 patients about how and why their cancers become resistant to treatment and what options are available.

Acquired Resistance Forum Video #8: Dr. Robert Doebele of the University of Colorado Cancer Center spoke to ALK and ROS1 patients about how and why their cancers become resistant to treatment and what options are available.

Enjoy the two features we offer today, June 4: Feature #1 (start time 5:36):  Cancer drugs are much more targeted than they were many years ago.  But researchers are still trying to find a way to deliver drugs much more precisely to cancer cells, partly to avoid damaging, sometimes lethal, side effects. A huge obstacle has been getting nucleic acids to cross the membrane of cancer cells.  A new study has brought researchers closer to crossing this big hurdle.  Dr. Tom Anchordoquy, a lead author of the study, speaks with co-host Susan Moran about the study and what it means for cancer patients and researchers. Dr. Anchordoquy is an investigator at the University of Colorado Cancer Center in Denver and a professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences.   Feature #2 (start time 15:02): Being an astronaut is a risky job, but perhaps one of the less-known risks is the high levels of radiation beyond the relatively protective cocoon of Earth’s magnetic field.  This will be a particularly important problem to address for long-duration deep-space flight such as going to Mars.  Until recently there have not been a lot of measurements available of the interplanetary radiation field for the types of radiation that could affect humans.  But on the Curiosity rover of the Mars Science Laboratory, there is a radiation detector designed to make those important measurements. The instrument team recently published their initial results.  Dr. Don Hassler, Science Program Director at Southwest Research Institute’s Boulder office and the Principal Investigator for the Radiation Assessment Detector on the Mars Curiosity rover, talks with co-host Joel Parker about the results. Hosts: Susan Moran, Joel Parker Producer: Susan Moran Engineer: Joel Parker Executive Producer: Joel Parker Listen to the audio here:

Tripawds Podcast Episode #18: Tune in for an informative discussion with Dr. Barbara Biller, Veterinarian and Assistant Professor of Oncology at Colorado State University Animal Cancer Center The primary focus of Dr. Biller’s research is on the interactions between the anti-tumor immune response and metronomic chemotherapy. Recently she completed a study for Morris Animal Foundation (MAF) in which she evaluated metronomic chemotherapy treatment on dogs with soft-tissue sarcoma. During the study, it was Dr. Biller’s mission to learn more specifics on how to treat dogs using metronomics. She says: “Even though veterinarians have been using metronomic chemotherapy on patients, we have been guessing on important factors like what drugs we should use, what dose is needed and at what intervals we should treat the patient. We hope to determine some of those factors.” Dr. Biller is also involved in a number of collaborative studies with investigators at the University of Colorado Cancer Center and the Garden State Cancer Center evaluating immunotherapies in dogs with lymphoma and brain tumors. Join us in the Tripawds Live Chat during the show! DISCLAIMER: Information provided at Tripawd Talk Radio and Tripawds.com is not a substitute for medical care by a qualified veterinary professional. Always seek the advice of a licensed veterinarian prior to making any medical decisions about your dog’s health. Tripawds.com is not responsible or liable, for any damages resulting from the use (or misuse) of information contained in or implied herein. Support the show (https://tripawds.com/support)