Podcasts about taxol

    When Jessica Whorton discovered lumps on her left breast in 2011, she sought medical attention.  The doctors she spoke with said breast cancer was not indicated.  She walked around with the lumps for another nine months before seeking a second opinion.  Tests revealed she had Stage 3A invasive ductal carcinoma.  Doctors urged that she get a double mastectomy even though her right breast was still healthy.  After chemotherapy and radiation, Jessica achieved survivorship in 2013.   Jessica thought there was something wrong when she detected three lumps on her left breast in 2011.  She had them looked at, but doctors said they didn't feel anything that seemed cancerous.  Jessica did nothing for the next nine months, but then decided she needed to be seen by a different care team, led by a plastic surgeon.  After tests and a biopsy, he said while her right breast was healthy, there was cancer in her left breast.   As if that diagnosis weren't enough, her care team urged Jessica to undergo a double mastectomy to minimize the chance of a recurrence in the right breast.  The following week she underwent the procedure, and it was successful.   Jessica was told her post-surgery regimen would have to start with what is known as the ‘red devil,' a highly-potent chemotherapy cocktail.  She suffered the usual side effects, including extreme fatigue and hair loss.  After the red devil, Jessica was supposed to go on Taxol, but she had an allergic reaction to it and the Taxol was discontinued after two dosages.   Next up was super radiation, requiring 30 visits administered five days a week.  Jessica said the Taxol experience made the radiation even tougher, and just when she started feeling better after her weekly two days off, she would have to go in for more radiation.   However, things changed for the better and in 2013, Jessica Wharton was told she had gone into remission.  The day she got the news was, she said, “Like winning the lottery.”  She has been in remission ever since.   Jessica says to this day she still feels the effects of PTSD and is not able to return to the workforce on a full-time basis, but she is grateful that cancer is in her past.          

A print and runway model, Christine Handy withstood a lumpectomy, two mastectomies and a MRSA infection, plus a chemotherapy regimen featuring Herceptin and taxol to survive HER2+ breast cancer.  That inspired her to write a book, “Walk Beside Me,” and to produce a film, “Hello, Beautiful.”

In 2018, Beth Brubaker was clobbered by a double whammy.  First, she was diagnosed with breast cancer, then four days later, she learned she was pregnant.  Her initial diagnosis was Stage Zero Ductal Carcinoma In Situ; however, after a lumpectomy, further tests revealed Beth had HER2+ Invasive Ductal Carcinoma, presenting as Paget's Disease.  This required an immediate mastectomy to get rid of the cancer in her left breast, following by an aggressive chemotherapy regimen.  While she was carrying a child and dealing with chemotherapy, Beth continued working as a schoolteacher.  Through all this, she achieved survivorship, and had the blissfully uneventful birth of a daughter, Harper.  

Bonjour à tous, et bienvenue sur États Dames. Le podcast dédié à la santé des femmes, ou comme vous le savez chaque femme est unique mais certains parcours de santé s'entremêlent.  Aujourd'hui, j'ai le plaisir de vous partager le témoignage de Mélanie , diagnostiquée d'un cancer du sein à l'âge de 27 ans et oui vous avez bien entendu 27 ans ! Selon l'institut national du cancer,  Le risque d'avoir un cancer du sein augmente avec l'âge même s'il peut atteindre des femmes à des âges très différents. Le risque de cancer du sein chez les jeunes femmes est peu élevé. Environ 10% des cas de cancer du sein se manifestent chez les femmes âgées de moins de 35 ans et près de 20% avant 50 ans. Je vous laisse découvrir l'histoire de Mélanie, excellente écoute ! CONTACT  Instagram 

Ep. 30 Problems with Chemo. Part 2 of the cancer series with my wife Amy, as we follow her progress during chemotherapy. This week we see how her body reacted to a new replacement drug Abraxane and if the steroids were the cause of her extreme panic attacks after the first treatment. We also take some time to go over some of the very nice messages and a handful of questions from the comment sections. Part 1 on Episode 29, we discovered she had a severe reaction during her first chemo treatment to the drug Taxol and then things got worse later in the week as her body then had an issue with all of the steroids used during that treatment. Follow the Tossing Salad Podcast on all major podcast platforms as well as on Youtube, Tiktok, Instagram and Threads. --- Send in a voice message: https://podcasters.spotify.com/pod/show/tossingsaladpodcast/message Support this podcast: https://podcasters.spotify.com/pod/show/tossingsaladpodcast/support

Microbial consortia are groups of diverse microorganisms that have the ability to act together in a community. Such consortia are common in nature and are known to play important roles in many ecosystems but are not always well understood. Soil management and nutrient mobilization are one area where complex communities of microbes are known to be important, whether it be a naturally occurring consortium, or a man-made consortium.  In this episode of Absolute Gene-ius Jordan and Cassie talk with Dr. Ray Ketchum form Agrinos about the microbial consortia he and his team cultivate and produce to improve plan health and increase crop yields. We learn about the challenges of fermenting mixtures of more than 20 diverse microorganisms to reproducibly make products that improve plant health and mobilize nutrients in a completely organic way. As you might expect, digital PCR plays in important role in Ray's R&D and quality control process.  Here, they use dPCR to titer each of the species within their consortia for quality and regulatory purposes, a task that cannot be done by cell culture methods given the range of bacteria involved. Cassie's career corner gets Ray sharing his full career development story from undergraduate, through grad school and postdoc positions, and into his professional career. Ray is generous in sharing his early misconceptions about miscalculations while providing advice to help other avoid similar missteps.  Visit the Absolute Gene-ius page to learn more about the guest, the hosts, and the Applied Biosystems QuantStudio Absolute Q Digital PCR System.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.07.527540v1?rss=1 Authors: Chew, Y. M., Cross, R. A. Abstract: Taxol is a critically important cancer drug that stabilises microtubules. We report that taxol acts differently on different metazoan tubulin isotypes. 50 nM taxol blocks catastrophe of human or zebrafish 1{beta}4 but has no effect on human 1{beta}3 microtubules. 500 nM taxol blocks catastrophe in both 1{beta}3 and 1{beta}4 microtubules but introduces kinks only into 1{beta}4 microtubules. Taxol washout relaxes the kinks, suggesting taxol expands 1{beta}4 but not 1{beta}3 lattices. Kinesin-driven microtubule gliding detects this conformational shift - 1{beta}4 microtubules glide at ~450 nm/sec in 400 nM taxol, but at ~750 nm/sec in 10 M taxol, whereas 1{beta}3 microtubules glide at ~450 nm/sec, even in 10 M taxol. Thus, taxol readily stabilises 1{beta}4 GDP-tubulin lattices and shifts them to a fast-gliding conformation, but stabilises 1{beta}3 lattices much less readily and without shifting their conformation. These isotype-specific actions of taxol may drive the switch to {beta}3 tubulin commonly seen in taxol-resistant tumours. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Medicine's made from plants have been used throughout human history. Today, over 100 pharmaceutical drugs and medicines trace their "roots" to chemical compounds found in plants.  For example the medication Taxol which is a powerful chemotherapeutic medication to treat breast cancer is extracted from the Pacif Yew plant and the medication Digoxin used for irregular heart beats is extracted from the Foxglove plant. Listen to this episode of The Medical Truth Podcast as host James Egidio interviews medicinal herbalist and aromatherapist  Dr. Amber Robinson. For current and previous podcast episodes and show transcripts go to www.MedicalTruthPodcast.comFor Current and Previous Podcast Episodes, Show Notes, and Videos go to www.MedicalTruthPodcast.comYou can also find the Medical Truth Podcast on Facebook, Twitter, YouTube, Rumble, and Substack, as well as all the major podcast platforms such as Apple Podcast, Spotify, Google Podcast, Amazon Music, iHeart, and Podchaser

Dans cet épisode, je vous parle des effets secondaires de mes chimios de Taxol : l'hypersensibilité au soleil, les neuropathies des extrémités, la modification du goût, les bouffées de chaleur, etc. Tous ces désagréments ont commencé faiblement au début et se sont intensifiés au fur et à mesure que les cures de chimios s'accumulaient. Certains effets ont perduré des mois après ma dernière perfusion. Il faut beaucoup de force pour aller au bout de ce cycle de 12 chimios hebdomadaires, mais un jour arrive, et c'est enfin la dernière chimio !  Bon courage à tous ceux qui sont actuellement en cours de traitement, accrochez-vous ! ----------------------------------- Un épisode par saison est consacré à répondre à vos questions. N'hésitez pas à aller dès à présent les poser sur la page Instagram ou sur le formulaire de contact. Pour des posts inédits tout au long de la semaine rejoignez-nous sur la page Instagram MonCancerMaFilleEtMoi.  Ce podcast ne constitue en rien un avis médical. N'hésitez pas à consulter les professionnels compétents pour toutes questions médicales. Music by ComaStudio from Pixabay. Bonne écoute et au plaisir d'échanger !

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. 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. Guests' statements on this 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. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. At the 2022 ASCO Annual Meeting, registered nurse, breast cancer survivor, and patient advocate Stephanie Walker presented the results of the BECOME Research Project, which looked at Black patient participation in metastatic breast cancer clinical trials. In this podcast, Ms. Walker shares her story with Dr. Manali Patel, a medical oncologist and Assistant Professor of Medicine at Stanford University, as well as the Cancer.Net Associate Editor for Health Equity. They discuss Ms. Walker's experience with metastatic breast cancer, how she became involved with patient advocacy and research, and the work being done within the oncology community to make cancer clinical trials more equitable and inclusive. View disclosures for Ms. Walker and Dr. Patel at Cancer.Net. Dr. Manali Patel: Hello, I'm Manali Patel. I'm a thoracic lung cancer doctor at Stanford University and the VA in Palo Alto. And I'm a researcher that's focused on trying to improve and overcome health disparities and really trying to achieve health equity. I'm also the Cancer.Net Associate Editor for Health Equity. And today it's my great pleasure to talk with Ms. Stephanie Walker. Stephanie is a registered nurse, a survivor of metastatic breast cancer, and a leading patient advocate. She's the lead author of the BECOME Research Project on increasing Black patient participation in metastatic breast cancer clinical trials, which she presented beautifully at the 2022 ASCO Annual Meeting. Stephanie, we can't thank you enough for talking with us today. I'm going to first start off by saying that I am from North Carolina. And Stephanie, I read so much about you over the past few years and noticed that you are living in Tarboro, North Carolina. Is that correct? Stephanie Walker: That is correct. I currently live there. We moved here originally in 2012, but this is my, I think, third or even fourth time living in North Carolina, moving back and forth between Thomasville and Durham and now permanently in Tarboro. Dr. Manali Patel: Well, I love that we share our Tar Heel roots. I am a Tar Heel born, Tar Heel bred. When I die, I'm a Tar Heel dead. So I can't thank you enough for sharing those roots and then also for sharing your story with us today. You were first diagnosed with metastatic breast cancer in 2015. Can you tell us a little bit about your experience with that diagnosis and what it was like to be diagnosed? Stephanie Walker: Well, actually the diagnosis in 2015 was my first diagnosis. I was not an early stager that had a recurrence, so I guess I could say breast cancer was never on my radar regarding family history. I thought maybe kidney disease or hypertension or those kind of things, but never breast cancer. So to say my life derailed at that time, it had. And I don't know if I ever grieved when I was told that I had metastatic breast cancer, I took it and just ran with it. I did not really fall off until many years later when I had to stop working. At the time I was diagnosed, I was working as an on-call nurse for a hospice company. So I was working 7 days on, 7 days off. So on my 7 days on is when I received a call and during my nap time. But yeah, it was very hard. But like I said, I didn't think bad of it. When I did finally look it up and see that the life expectancy was like 36 months, that kind of kicks your butt into gear to do things. But I didn't do anything. I just continued to work. [laughter] I didn't stop working. So yeah, it went through the basic standard of care treatment of Adriamycin, Cytoxan, and Taxol. But I didn't get through my whole series of Taxol due to neuropathy and increased falls. So I stopped at 9 out of 12. Dr. Manali Patel: Still 9 out of 12, it's difficult. And that's a difficult therapy and difficult regimen. You talked about how it derailed your life. And I know I've had the pleasure of reading your story online. I think what's also really interesting is that you had a role as a hospice nurse and over 40 years as a hospice nurse. Stephanie Walker: No, most of my years of nursing was critical care. The last 14 years were hospice care, palliative life care. But, yeah, I just rolled with that. Even taking care of patients that had the same diagnosis kind of brought-- seeing death and dying every day. But then to see somebody with metastatic breast cancer dying was really hard. Dr. Manali Patel: Yeah. And I'm sure that your experience at nursing on the other side and the flip side, and then when you became a patient, is quite different and maybe challenging in and of its own. Stephanie Walker: A lot of people expected or said that. I think I got left out of a lot of things that could have helped my journey in the beginning, like a patient navigation and that kind of thing was kind of not given to me. And I guess it was because being a nurse. But I had no experience other than pediatric oncology. I knew what those children went through. And actually, it actually did help going through my treatment because I would remember this one little girl that was going through chemo, and she got up one morning and her pigtails started falling out, and then she wanted to get on the IV pole and go to the playroom. And I'm thinking to myself, if she can do it-- and I called her by name, if she can do it, what the hell am I complaining about? So it's like, just get up and go to the playroom. [laughter] So I kept going back to that, you know what I mean? These kids that are innocent and have not even started to live their life going through this, and they never complained. So being an old lady at 56, being diagnosed, hell, who was I to complain about it? So just pick your hair up and keep going. [laughter] Dr. Manali Patel: That's right. Get your IV pole and go to the playroom. Stephanie Walker: That's right. Dr. Manali Patel: It's interesting that you mentioned that being from the nursing field and from the medical field kind of excluded you from a lot of what we hope other people receive, which is good education about their diagnosis. And like you mentioned, a patient navigator. Do you think that being a Black woman in any way, shape, or form shaped your experience with cancer, and if so, how? Stephanie Walker: It didn't in the beginning. Like I said, from 2015 up until 2018 when I found myself suddenly without a job or insurance, I had no idea. I didn't know anybody else with metastatic breast cancer. I didn't know what was out there. I guess I didn't have a need that was not met. I had insurance that was paying the bills. I had a husband that helped care for me, 2 adult children that looked in on me, a job that I didn't consider a job, it was a calling, and I had no needs at that time that weren't met. So I didn't have the desire or the need to look outside my little tiny world, I guess, until I found myself in 2018. In 2017, we moved late in the year back to North Carolina from Louisiana and started a new job as a hospice nurse, same kind of a schedule and was out shopping with my husband one day, and I kept saying, "I'm really short of breath." And I said, "All this weight I've gained since treatment, it's horrible. I'm just fat and can't breathe." And he just kind of laughed at me and said, “No, you're fine, you're fine." Well, then I started experiencing chest pain and I said, "I think I need to go to the ER." And for me to say I need to go to the ER, then my husband kicked it into gear and thinking, "Oh gosh, maybe so." Went to the ER, thought I was having an MI [myocardial infarction, a heart attack], ruled that out, and sat back in the lobby for a couple of hours and then they came and got me again and, in a hurry, said that they'd seen that I had a blood clot in my left lung. So it's like, great, here I am now with the PE [pumonary embolism] and having to be on blood thinners. And then I had a TIA [transient ischemic attack, sometimes called a ministroke] on an oral blood thinner. So obviously that failed me. So that's when I had to stop work. And then that's when I went into a deep depression. And people say it's like just because you have to stop work, you get depressed and it's like, yeah, I mean, I had always told myself in the very beginning of my diagnosis, I'm going to work up until the very end. And then not to have that-- and I felt like if I don't do anything, I'm going to die quicker. So I did not know what I didn't know until I found myself trying to figure out how I was going to live, pay bills, eat, pay for treatment. You know, when you don't have that comfort, then I started looking for ways to help provide until I could figure out a plan. And that's when I found the world of metastatic breast cancer and advocacy that I went to my first metastatic breast cancer conference: Living Beyond Breast Cancer, actually in April of 2018. And I don't remember the weekend because I was just in awe that all these women around me had metastatic breast cancer and were thriving. And more than that is I've seen a whole lot of Black people that were like me. So I wanted to know more, learn more, do more. So that's when my whole-- I tell people that was my coming out party of metastatic breast cancer. So I did research trying to find funding and I spent 8 hours a day, 5 days a week looking for that since I didn't have a job, I didn't know what else to do. And luckily, I found enough resources to stop the bridge until I got my first disability check. Nobody told me there was a 5-month waiting period, right? And I found the insurance, thank you to my cancer center, provided ways for me to continue treatment because I made an appointment to tell them I'm going to stop treatment. I can't afford to pay you. But they came through, and I'm thankful for that. So that's when the world of advocacy opened up. It was in 2018, about 3 years after my diagnosis. Dr. Manali Patel: I love that you think and were part of the calling and your identity of being a nurse, and then of course as a hospice nurse, especially, but losing that identity, but then channeling and refocusing and helping other people and really advocating has given me a lot of inspiration as a daughter of a mother that also faced similar challenges. Stephanie Walker: I'm so sorry. Dr. Manali Patel: I really want to thank you for all that you've done on behalf of all women with breast cancer, and especially for Black and Brown community members who have breast cancer. We've read your story and know about you and so are really just thankful for you and the research that you've been doing, especially the research that you presented this past summer at our ASCO Annual Meeting 2022, where you presented the results of the BECOME Research Project. I was hoping that you could give us some background on the study and why you wanted to do research in this particular area? Stephanie Walker: First and foremost, I'm not a researcher. I don't like research, [laughter] and I didn't plan on doing research. So with that being out of the way, I am a nurse. I am a critical care nurse. I am a hospice nurse. I am an advocate. Researcher, not. So actually, it was done because there was another metastatic breast cancer huge advocate, Marina Kaplan, who is no longer with us. I met her at the San Antonio Breast Cancer Symposium in 2019, and she had done a poster presentation regarding patient-centered outcomes as well. And she noticed that the Black respondents to her survey was less than optimal. She only had like 8% return. And she said, "Stephanie, I don't understand, why so low?" And it was like, "Marina, I don't know. I did your survey, so I can't tell you." So she said, "There's got to be a reason." And she said, "Let's delve into trying to find out why." And she said, "How about this? You do the survey. You gear it to the Black population, men and women with metastatic breast cancer, and I'll help you." And I said, "You're definitely going to have to help me. I'm not a researcher. I don't do statistics either. I found that I didn't need that when calculating medication doses." Anyway, so with that being said, she said, "I'll do it. I'll do that part for you." And I thought, me being simplistic, how hard can it be to do a survey, right? You have questions, you put them on a piece of paper, you print them off, you make 100 million copies, and you send them out to people or you ask people in one of your Facebook groups or something, and you just write down the answers. That is not how it's done in the research world. So, unfortunately, before we could get it off the ground, she passed away. And actually, she was very sick at the conference. So she passed away actually the following January-- February. So I kind of put it on the shelf in the back of my mind because I just assumed that was just between me and her. Nobody else knew. She had told somebody else, and they came back to me. It was actually someone at Living Beyond Breast Cancer, Janine. She came back to me. She said, "Hey, do you remember when Marina talked to you about X, Y, Z?" And it's like, "Here it comes." And I said, "Yeah, sure." And I told her I would get it done. I told her I would do it. I told her I would do it. And people said, "She's gone. You don't have to do it." And it's like, "My word is my word." So she introduced me to a group at the Metastatic Breast Cancer Alliance, the information task force, and they looked at it and thought it was a great idea and picked it up as one of their projects. And there I was starting my research problem with being the project lead of people that I didn't know, with an idea that I didn't know how it was going to be done. So I am thankful for a bunch of people, man, I am telling you. So it got done. It was partnered with a marketing and strategic group, CB White, and they actually got it off the ground to which way it needed to go. I didn't realize it cost a lot of money either. [laughter] It started off, we did literature search. We found some ASCO literature that would support our survey. Then we did interviews with the patients, the clinicians, researchers, payers, and they asked the questions -- we formulated questions because we had a subcommittee and someone else did the interviews. And after those were all done, that's how the survey was formed. And the survey went out-- it basically went out via social media. And the subcommittee, it was a bunch of patients and industry people and from the Alliance that pushed us out and was supportive of it and really believed in it. And my goal was to get 500 respondents. I wanted 250 Black and 250 of everybody else. I didn't care who, but I say I didn't reach my mark, and it was a little disappointing. I only had like 420-some people that responded. But everybody said that was really good because I didn't offer them anything. I didn't offer you money. I didn't offer you a gift card. I didn't offer you a cup of coffee. But it was done, and I'm proud of the responses. It was all done -- this whole project was done during the pandemic. And you have to realize that a lot of people in the subcommittee that I had that actually worked really hard, I had never met. So this is a group of people that you only know a face like on Zoom or something. So the results were some of them were -- I kind of expected that. But the biggest shocker for me was -- the number one thing that we're focusing on is a general ask, right? No one asked us, as Black men and women with metastatic breast cancer, talked to us about clinical trials. Dr. Manali Patel: I think that that finding, can you briefly tell us the numbers for the readers? I've read through and also saw the presentation kind of what you found in terms of that being the biggest and then some of the other outcomes that you looked at. Stephanie Walker: Well, some of the other outcomes were like, other than the 4 that we're focusing on, is to better inform, you know what I mean? We need Black patients to know about and to get the information to make informed decisions about clinical trials. That's first. Then the second one was to inspire trust. We all know about all the stuff in the past and the distrust of the Black community with health care providers. So we need to build that, and it has to start in a community in which the person lives. And we also found that more Black than non-Black, when questioned, would try a clinical trial only if they were asked to, but they weren't. So to ensure access -- there were barriers, obviously, to people wanting to participate in a clinical trial. And some of those were the travel time, the difficulty in finding the trials, worrying about the financial burden. And a lot were like, if I go to another facility, is my insurance going to cover it? So that's a big thing. And the final was to address the concerns, legitimate concerns. We need the health care provider to communicate in a clear language that we understand, and also understand the reasons that motivate us to participate in a clinical trial. So with those 4 things, we came up with some actions to do. But those were the 4 big ones that I found out that needed to be addressed. Because when doing this, I didn't do it just to be doing it. I wanted to do it to find out what the barriers were and then to come up with actionable steps. And as a physician or anybody, there's all those surveys people want you to do, and then they stop there. They don't go on. And I'm one of these people, like, don't waste my time. Let's do something that's actionable that we can act upon or help other people to act upon. Dr. Manali Patel: I think those of us in the health equity space, right, are not surprised that a lot of what you found does really play in terms of what the health care provider and what the health system can do. The health system can do things to engender trust rather than putting the blame on the patient, saying that patients don't enroll in clinical trials. Well, maybe we aren't asking patients equitably if they're enrolling. And we need to take a hard look at our own selves and our own practices and think about what we can do similar to a checklist, right? When a patient comes in, how can we make this part of standard of care to make sure that everybody gets asked, and we've got all these fancy decision support tools and our electronic health record that turn up poppers of, "Did you ask the patient about this?" But making this part of the rubric of what we do, I think was really nicely highlighted in your study and your findings. Stephanie Walker: Yeah. And I truly agree. Rubric metric, however you want to say it, people are like, "Well, how are you going to get them to change it?" Like, first of all, with education, and second of all, man, if I could figure out a way to attach a dollar sign to that rubric or that metric, it would be great.  Dr. Manali Patel: I think for our readers, you and I know and really want to get the messaging out for equitable and accessible clinical trials. Can you explain from your perspective why it's so important to be inclusive and to have clinical trials that are accessible and equitable for all patients with cancer? Stephanie Walker: Well, the statistics speak for themselves. Only like 6% of participants in a clinical trial for a metastatic breast cancer are, like 6%. But it's important that the clinical trials are inclusive for everybody, all people, because you want the medications to work for quote-unquote "all people.” And we find that, speaking from just my experience and what I know and have heard, that there are treatments out there that don't actually work on Black people. And one of the big general ones is one of the blood pressure meds we have found recently that does not work or do not work very well with people of color. So we have to include everybody in these clinical trials to be able to have effective treatments to work for everybody, no matter where they are, where they live, who their doctor is, what hospital they go to. All people need to be included. And we find that 80% of the patients are treated in community cancer centers, and those are the patients that are usually left out just due to the fact they're not associated with a teaching medical institution/NCI facility. Dr. Manali Patel: I think this is so important and really appreciate you highlighting that important fact is that making sure that our treatments are effective and feasibly can be provided to all patients in our quest for achieving health equity. What work is currently being done to make clinical trials more inclusive? Stephanie Walker: Everybody is working on that. Even Stephanie is working on that. With a new subcommittee, a little branch out from BECOME, we found that -- we had just spoken of education. And so we came up with an idea of an actionable step. How do we do that, and how do we educate the health care providers regarding all of these facts that we found? And we are going to have a symposium. We came up with a symposium, a 1-day event. And we are going to attach it to the San Antonio Breast Cancer Symposium. We're actually going to have it the day before the symposium starts and hopefully, that will attract health care providers who we're targeting this to come and just listen to see what the patient has to say. We have it broken into 3 sections. The first section is about the health care provider, how to communicate with your patients. What does it look like on the other side? And then the other is broken down into the pharmacy or pharma industry section. What are they doing to help include all people in clinical trials? And a lot of them have jumped on that bandwagon to be inclusive. But really, what are you working on? I want to know. So that's the second session. And the third session is about the patient and the caregiver. From the patient's point of view, how they did with clinical trials, and also a clinical navigator, what their role is to help patients find out about the trials and be that support person and as well the caregiver. A lot of people forget the caregiver goes through this as well. And to get the view of what the caregiver had, what they had, what they needed, what they didn't receive, to find out that so we can provide those things for them, hopefully. But yeah, that's what we're doing now. We're still in the planning phase. Dr. Manali Patel: That's amazing. I love the action-orientedness of really moving to the next step, taking the findings that you found, moving towards really action, and bringing all of the partners together. I know that all the industry partners and really holding people accountable for what they are planning on doing. I love that. What actually are you doing and coming up with a plan for moving forward? Stephanie Walker: Yeah, you have to start holding people accountable, get rid of the biases. And I've been blessed that I had not experienced any kind of biases in my care until the pandemic. And that was when I wanted to get my cancer treatment at a community center closer to home because it was a simple treatment of fulvestrant injection, and I wanted to get it closer to home. And we all agreed. We found a physician that would accept me closer to home. And it was going great until I started having complications, and he totally blew me off, actually. He told me that I needed psychiatric help, but he didn't know I was already getting it. But anyway, after contacting several patients that see this physician, they experienced the same thing. So that's the first time I had experienced anything based on my race and who I am. And that happens when a physician walks into a patient's room, sometimes that's what they see. They don't see Stephanie, they see a Black woman, and they start thinking in their head ticking off things like, "Oh, she's Black. She doesn't understand. She doesn't even know what a clinical trial is. She's going to be non-compliant. She's going to quit. And then she's going to become this angry Black woman that I'm going to have to deal with." So all of that before it is, "Hi, my name is." So, yeah. That experience made me want to do a little bit more to try to get rid of the biases that patients experience. Dr. Manali Patel: Yeah, I think what you're doing to advocating, not only us clinicians, I'm so sorry that you have to experience that. Unfortunately, we've heard and know that it's sometimes the norm of what people experience or the systemic biases that then play into the role with implicit biases and then, unfortunately, lead to delays in care and also mistreatment or even lack of evidence-based treatment for people just based off of their skin color or from what community they may be from, or even how much income they may have or education level. I think what you said about what the work that you're doing and educating us clinicians, number one, first and foremost, what we can do with the health care system and looking at our own practices and our own policies and trying to reduce and remove some of the biases that are baked into the system. But then also what you're doing on the ground with other patients and advocating for patients. I want to close with 1 last question, and you've highlighted some of it, but if you were to give advice to people with cancer who are faced with needing to advocate for themselves, be it for care like you described, or for clinical trials, what advice would you give them? Stephanie Walker: It's almost like having to put burden on the patient to learn. But you do. You have to become Ph.D.-certified with your own illness. You got to go out there and know what you got and know what you need, what the standard of care is, and that is the truth. When you get that diagnosis, I believe you should, first of all, take somebody with you with a notepad to be able to write down things. When you hear the word “cancer,” you don't hear nothing after that. And you're only going to probably absorb a fourth of what you're told at the office. So have somebody to write down what the doctor says, suggestions, and research your plan of care. Find out what the standard of care is. I tell people, don't go to Dr. Google, but you're going to have to Google some things. But try to find vetted sites, reputable sites to do that. And there's lots of organizations out there that you can get the information from. And I don't want to say use Facebook, but believe it or not, there are great groups on Facebook that offer support, information, suggestions, "Hey, I'm getting ready to start this treatment. What happened to you? Or what do you think?" So always arm yourself with questions when you go in. Ask the questions. Don't be afraid to ask. If that doesn't work, of course, with the pandemic, I would have people that want to go with me, and I couldn't go, but I could sit out in the lobby on my cell phone and listen in and encourage them to ask this question or ask the doctor a question. Of course, that has to be given with permission from the physician as well. But arm yourself with as much information as you can. And if you are finding that you're not getting that feeling of, “This doctor has my best interest,” seek a second opinion, third opinion, a fourth opinion. Don't let a doctor railroad you into doing something that you don't understand. If you don't understand, speak up. I tell people all the time, they may know about cancer, but you know about yourself, so hold firm to that. I've told several doctors. I've fired several. So, I mean, they're out there. And I tell people all the time, don't be scared. Be comfortable and always know there's somebody out there. You're not alone to talk to. And being depressed or down sometimes, it's normal. You go there, but don't live there. If you find yourself living there, reach out for help. Because I'm one that thought that nurses don't reach out for help, but I finally did. So don't be afraid to ask for help and know that there's somebody out there with you. Call me. I'm available. Dr. Manali Patel: Ms. Walker, I can't thank you enough for sharing your story with us and telling us more about your experiences and the work that you've been doing-- the important work you've been doing in this area. It was really wonderful to have you, and I hope that we get to meet in person at some point. Stephanie Walker: I really thank you for the opportunity to share and hopefully the information that we both have provided, people will get it and understand it, and it will help somebody, because the work you done while you were at ASCO was amazing, too. So read that. [laughter] So I really do, and I really appreciate the opportunity. Dr. Manali Patel: We are very grateful. And thank you for Cancer.Net, for hopefully being that source of trust and source of information for all of our patients. ASCO: Thank you, Ms. Walker and Dr. Patel. You can find more stories from people with cancer at the Cancer.Net Blog, at www.cancer.net/blog. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

On the eve of her first chemotherapy infusion, Natasha hauls a pile of new prescriptions home and questions why so much harm must be done to be “healthy” again. After meeting her oncologist Dr. Chen, a specialist in HER-2 positive breast cancer, the clinical trial that originally sounded promising turned out not to be a good fit, leading to a much less invasive chemo recipe consisting of Taxotere, Carboplatin, Herceptin, and Perjeta spaced three weeks apart, but thankfully no need for Taxol. To save her hair from falling out, Natasha's dad graciously volunteers to cover the cost of cold caps (thanks Neil!) but the tradeoff is additional logistics, longer appointments on the chemo days, and no guarantee that it will work. Links Support the Breast Cancer Stories podcast https://www.breastcancerstoriespodcast.com/donate Subscribe to our newsletter here: http://eepurl.com/hX12YD Other Links Support the Breast Cancer Stories podcast https://www.breastcancerstoriespodcast.com/donate Subscribe to our newsletter here: http://eepurl.com/hX12YD About Breast Cancer Stories Breast Cancer Stories follows Natasha Curry, a palliative care nurse practitioner at San Francisco General Hospital, through her experience of going from being a nurse to a patient after being diagnosed with breast cancer. Natasha was in Malawi on a Doctors Without Borders mission in 2021 when her husband of 25 years announced in a text message that he was leaving. She returned home, fell into bed for a few weeks, and eventually pulled herself together and went back to work. A few months later when she discovered an almond-sized lump in her armpit, she did everything she tells her patients not to do and dismissed it, or wrote it off as a “fat lump." Months went by before Natasha finally got a mammogram, but radiology saw nothing in either breast. It was the armpit lump that caught their attention. Next step was an ultrasound, where the lump was clearly visible. One painful biopsy later, Natasha found out she had cancer; in one life-changing moment, the nurse became the patient. This podcast is about what happens when you have breast cancer, told in real time. Host and Executive Producer: Eva Sheie Co-Host: Kristen Vengler Editor and Audio Engineer: Daniel Croeser Theme Music: Them Highs and Lows, Bird of Figment (https://music.apple.com/us/artist/bird-of-figment/1434663902) Production Assistant: Mary Ellen Clarkson Cover Art Designer: Shawn Hiatt Breast Cancer Stories is a production of The Axis. (http://www.theaxis.io/) PROUDLY MADE IN AUSTIN, TEXAS

Nerve damage from chemotherapy can lead to lingering effects after treatment. There are several natural agents that can help. But, some can actually make it worse too! Listen in while Tina & Leah discuss how to prevent chemotherapy-induced peripheral neuropathy (CIPN) and what to (safely) do if you already have it.Chemotherapy drugs are designed to be toxic to cancer cells but sometimes they are also toxic to your nervous system. This can have long-term consequences. Take heart, there are ways to lessen the risk during treatment. There are also ways to improve peripheral neuropathy symptoms after treatment. Did you know that there is clinical trial data that shows this? (We may be creative, but not when it comes to recommending treatments.)Links we mention in this episode and other cool stuff:What drugs are most likely to cause chemotherapy-induced peripheral neuropathy American Cancer SocietyHigh-dose L-glutamine for taxane-induced peripheral neuropathy. Clinical Cancer ResearchOmega-3 fatty acids and taxane-induced peripheral neuropathy BMC CancerHigh dose L-glutamine in oxaliplatin-induced peripheral neuropathy The OncologistReview of natural agents & chemotherapy-induced peripheral neuropathy (CIPN) Nutrients (2022)Review of vitamin E studies - it only works for cis/carboplatin-induced CIPN (Frontiers in Cryotherapy)The ASCO guidelines for CIPN (We don't agree with doing nothing.) ASCOFrozen gloves (cryotherapy) for prevention of CIPN Annals of OncologyScrambler therapy for pain management Support Care CancerCytokines as targets in CIPN CytokineAlpha-lipoic acid alongside a taxane drug and doxorubicin Support Care Cancer (2022)Exercise counteracts CIPN symptoms Support Cancer CareReview of data on exercise and CIPN Cancer NursingWorse CIPN with the concurrent use of Acetyl-L-Carnitine J National Cancer InstituteSupport the show

Allison Hancock survived breast cancer, then decided to take action to help others with their cancer journeys.  She became a volunteer the Oregon-based Breast Friends Cancer Support Network before ascending to the position of Executive Director.  This is her story.

In the second of this two-part conversation Drs. Patrick Loehrer and David Johnson sit down with Dr. Deborah Schrag, the current Chair of the Department of Medicine at Memorial Sloan Kettering Cancer Center to continue the discussion of her roles as a leader, researcher, oncologist, public health expert, and more. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org.     TRANSCRIPT Dr. Dave Johnson: Hi everyone, welcome back to Oncology, Etc. an ASCO educational podcast. My name is Dave Johnson. I'm at UT Southwestern Medical Center in Dallas. And I'm here with my good friend Dr. Pat Loehrer who serves as a director of Global Oncology and Health Equities at Indiana University. In the second half of our conversation with Dr. Deborah Schrag, the current chair of Medicine at Memorial Sloan Kettering Cancer Center in New York. In part one, we heard about Dr. Schrag's early life and background, as well as the importance of affordable cancer care and much more. Let's jump back into the conversation and hear about her current goals and initiatives at Memorial Sloan Kettering. I have a question for you. Jumping ahead a little bit. But I mean, you're such a role model for all of us. But you're now in a very powerful position as head of medicine at the preeminent cancer center in the world. So, I'd be interested in knowing what are your top initiatives? What did you come to this role wanting to do short-term and long-term? I'd be curious to hear from you about that. Dr. Deborah Schrag: Yeah. So, I have lots of specific initiatives, all the things that are probably very similar across medical cancer centers. We have to figure out the role of immuno-oncology. We have to figure out the role of CAR T-cell Therapy. There are lots of specific things, but let me tell you about three sort of overarching principles and things that I think we need to think about. So, one of the reasons why I decided to leave my job where I really focused on training researchers and building a research program to lead a department of medicine that has a mix of clinicians, educators, and investigators is that there's really a profound sense of exhaustion and disconnection. I'll use the word even burnout or people get the sense of losing the joy in the practice of medicine. And as corny as it sounds, and I know I'm going a little corny here, Dave. But I really want to help bring back and connect people to the joy in the practice of medicine. It's the joy that we experience when we crack a tough case, when we help a patient, when our patients make us laugh, when our patients and their families make us cry, when they drive us bananas, when they cook us food that is inedible, just reconnecting us to the joy, to the stories. I really wanted to try to be a different kind of leader because I felt that I could make a contribution to the field of academic medicine in general and oncology in particular, by working with faculty to set them up to tap into that joy, because I know they all started with it. I know they all went into medicine because they care about those human stories, because they do want to make a difference. This past week, a fellow intern of mine who you may know, passed away. His name was Paul Farmer. He was the head of Partners in Health and he was an infectious disease physician. There's a book about him by Tracy Kidder that's really moving. There's also a documentary about him called, Bending the Arc, which I would highly recommend. Paul was an incredible inspiration, just incredible, but he brought so much joy to the practice of medicine. I remember when Paul was going to some of the poorest places on the planet, specifically Cange, Haiti. He got an idea that he needed to bring chemotherapy because there were large cancers that were untreated. And he wanted to get leftover chemotherapy from the Dana-Farber. So, in the 1990s, when I was a fellow, he would ask me whether I could get him any leftover Taxol. I was like, ‘Paul, I can't do that. It's not safe. You can't take leftover Taxol to Cange'. And he said, ‘Deb, just wait, the drugs will be oral soon, and then I'll get it'. But guess what? Paul came back to me in 1999, and capecitabine had been approved. The oral equivalent of 5-FU. He held my feet to the fire. He said, ‘Every time you have a dead patient, if there's any leftover capecitabine, I want you to get it for me'. Inspirational leadership, connecting people to the joy in the practice of medicine. I would say that's number one. There's no one simple formula or way to do that. It's hard work. It requires a team I think a lot more teamwork into the practice of medicine. I think we're coming out of a hard two years where we've been confined to Zoom boxes. But it's a lot easier when we can sit together in a room and have a pizza and a beer on a Friday afternoon. But we have to figure this out, and we will, step by step. The other big thematic area, I think, has to do with the patient experience. Dave, I mean, when I started out as a fellow, patients with advanced lung cancer were living for 10 months, 10-12 months, that was a pretty good run with advanced metastatic non-small cell lung cancer. Well, these days, it's 2-3 years, and there's even quite a tale of patients who were living 4-5 years. And that is a long journey. It's no longer the 800-meter sprint, it's a half marathon, turning into a marathon and even an ultra-marathon. So, the way we deliver care needs to change. So, we're really rethinking here, how we deliver care. So, as an example of some, if you go back to the 80s and 90s, cancer chemotherapy was something that happened in the hospital. And in the last quarter century, we've transitioned that to an outpatient practice. I think in the next quarter century, we won't transition all of it, but we will transition a lot of it to home. As an example, I'm struck by when patients undergo IVF, they get handed some Lupron and are taught how to self-administer Lupron every day, so they can undergo a fertility cycle. But when those same women get breast cancer, they have to come into the clinic and sit and wait and take half a day off of work to get the same Lupron. The same is true for men with prostate cancer. Why is that? It's because of policies, and it's not safety, it's not patient-centered. So, I think we have an opportunity to change the patient experience. I think we'll be able to give immunotherapy at home, and HER-2 agents at home. We have to do the trials and make sure that it's safe, but we have to make cancer care more patient-centric and improve the experience. And that's just essential when it's a marathon that we're asking our patients to run, not these 12-month sprints. Families need this also. So, those are a few of the challenges that I want to take on. Joy in medicine, patient experience, and of course, the physician-scientist pathway needs to be strengthened. Dr. Pat Loehrer: I love it. You can imagine between Dave and me, I think that resonates so much about having joy in medicine. I've not heard other people talk about that, but I really think that's an important vocation. But I'm going to ask you something else too because, in the efforts of being joyful and being a role model for that, there's the other side of it, where you can't actually let your hair down, and really be depressed, if you will, or down because you can't let the other side see that. And so, who do you lean on if you will, your confessor that you can talk to when you're feeling down when you're trying to fight the anti-joy part of your job? Dr. Deborah Schrag: I have lots of friends outside of medicine. And I've always found that that's really helpful to make time for friends outside of medicine. They help connect me to humor and other things. I'm coming up on a big high school reunion. My high school classmates and I still meet for picnics in Central Park. And there are about 120 in our graduating class. And I think we'll have about 110 of us getting together. We still have picnics with 40-50 people attending. So, there's nothing like old friends from childhood who now do all kinds of different things. So, that's really helpful. But I've also found that my mentors and colleagues who trained me and who know me really well, are a great source of advice. So, leaders in academic medicine, and I've always found that I've been able to get advice from people who were senior and leaders, people such as Dr. Mayer, Dr. Benz, Dr. Jim Griffin, and also junior colleagues. I now increasingly as I get old, I rely more and more on my trainees and my mentees. So, some of the folks I know best are people who I trained. So, I'll just give you one example. Many of you may know Ethan Basch. We worked together when we were both just coming up. I was an assistant professor. He was a couple of years behind me. I mentored him. Well, he's now chief of the Division of Oncology at UNC. He and I have written lots of grants together. We're really partners now. But it's been a lifelong professional friendship. Sometimes when I just need to let my hair down, I get on the phone with Ethan, and yeah, there's a little bit of commiserating. But I'll give you an example that runs through Dave. Some really valuable experiences had to do with being asked to serve on committees. I think it's great. I just want to give a shout-out to ASCO. Some of my earliest professional relationships were with superstars that I met through ASCO. So, people like Joe Simone, reading his Simone's Maxims everyone needs to read Simone's Maxims if you haven't. There was a guy by the name of Christopher Desh, who sadly passed on. But he was an ASCO member who practiced at the Virginia Commonwealth University back in the late 1990s. Boy, did that guy understand the joy in medicine, some of the early folks who started QOPI. Being introduced to those individuals who practiced in different parts of the country and who had different kinds of challenges - having that sort of rich network has been incredible. At some point, I think through such a connection, maybe it was through Dr. Mayer, I was referred to Dr. Johnson, who was then running the American Board of Internal Medicine committee that wrote the oncology exam. I participated in that for a few years that was led by Dr. Johnson. And I met incredible people on that committee, including Dr. Johnson, just Dr. Johnson's stories could inspire anyone and get them back on track just in terms of the humor and the joy and the love, and really the pride in the profession. But I met Jamie Von Roenn that way, who's now leading educational efforts at ASCO, she was on that committee. Lynn Schuchter became a good friend of mine as a result of that. So, I would just say, sometimes you need to get out of your own space. And sometimes I need to get out of Dodge, as they say, I need to get out of New York, get out of Boston, and being connected to colleagues across the country has been so rewarding. I have a network of friends at other institutions who I rely on. Serving on external advisory boards is a great place to meet people. Study section, if anyone has the opportunity to be on study section. That's a fabulous opportunity. So, I think participating in peer review, showing up at meetings, serving on ASCO committees, or ASH or AACR. These are really important experiences. And I will say in my leadership role, I'm really trying to make it clear to faculty that I encourage them to take time to participate in these activities and attend these events and even travel because the traveling is important, too. I could not have gotten the same dose of Dave Johnson, if I had not actually gone to the meeting, spent all day writing board review questions, and then having a nice meal afterward. That was part of the experience. I don't know what you would say, Dave, but that was my view. Dr. Dave Johnson: So, one of the things that Osler talked about was the fellowship of the profession, and how important it is to have those relationships. Even if one can't physically be with that individual, developing that spiritual relationship is really critically important. I'm so glad you brought this up and expanded on it in the way you did because I think it's absolutely critical to retain the joy of medicine. It's our colleagues, as well as our patients that make it such a marvelous, majestic profession, in my view. Dr. Pat Loehrer: I was going to just add something if I could. So, Deb, replace me on the ABIM, just to let you know, because we had certain slots on there. One of the not sure if it was the rules or guidelines that were mandated is that everyone needed to take the oncology boards, even though we wrote the questions, we had to take the test. And you knew that and you had such unbridled enthusiasm for this. I still remember this deeply, and that not only did you recertify for the oncology board, but you also studied to take the medicine boards too. Your love of medicine is so contagious. And I'm sure everyone at Memorial benefits from this. Dr. Deborah Schrag: Thank you. That's very nice to say. I do, I love the stories. I've been rounding with the house staff on the inpatient service. I think both of you know, inpatient oncology, as we're able to do more and more in the outpatient setting, our inpatients are very, very sick. And we often get a front-row seat to what I would call the social determinants of health challenges. In other words, if you've got relatives and resources, you may be able to be at home. But if you have severe pain or symptoms, and you lack the relatives, or you live on a fifth floor, walk-up, or just don't have the resources to get the home care that you need, you're more likely to be in our hospital. But as I round with the house staff, I find myself asking them to tell me more about the patient stories. Because when I round and they tell me that it's a 74-year-old with peritoneal carcinomatosis, jaundice, and abdominal pain. I'm so old that I've seen so many hundreds of those patients and the management hasn't changed very much. But what's really the privilege is to understand the journeys that got people where they are, and to learn a little bit about who these people are. I try to do that when I round with house staff and I find that it makes the experience better for them. I have to say that I do worry about how we train young physicians in oncology because what they see on the inpatient side is really the hardest of the hard, that's obviously less true in a leukemia service, where they're delivering lots of curative therapy or a stem cell transplant service. But in solid tumor oncology, it's really hard. I think it's something we have to have to tackle. We have to rethink education and medical oncology. I'm hoping that we're going to do that. That's also on the bucket list, by the way. I think we have to do that as a profession. And I know both of you are passionate champions and advocates for education, as is ASCO. But I think it's really imperative that we do that if we are to keep attracting talent. And then I just want to make one more point, which is that New York City is one of the most diverse places in the United States. I don't know about the planet, because I don't know the whole planet. But in the United States, we are incredibly diverse. But the oncology workforce does not yet look like that. So, we have a lot of work to do to train a much more diverse workforce. We're doing well with respect to gender, very well. We're literally about 50/50, we may even have a little bit higher proportion of women on the faculty here at MSK. And I think that's true nationally as well. But with respect to Blacks and Hispanics, and other underrepresented communities, Native Americans, we've got a long way to go. And we have a pipeline problem. And that's going to be hard. But it's hard work that we have to do, and I know you guys are working on that in your own centers as well. Dr. Dave Johnson: Let me follow up on that. What attributes are you looking for in trainees and newly hired faculty? Whether they be junior or senior faculty? What are the characteristics or attributes you seek that you think predict, or certainly you want your individuals to possess? Dr. Deborah Schrag: We all want people who have everything, but I would say creativity, the willingness to take risks, and the ability to ask a question. I say this to the trainees, frankly, I say it to my own children as well. ‘It's okay, take a harder course. Yes, you may get a B minus by trying something new and different, that doesn't play to your strengths. But try something new. Take risks. Yes, the trial may fail. Yes, you may not get that grant.' But I think a willingness to take risks, a willingness to put yourself out there, a willingness to stretch. I'm also looking for people who can work in teams because there is no aspect of medical care that happens in MSK, I suspect that it's also true that maybe medicine in Antarctica, but even medicine in Antarctica is probably a team sport. Medicine has become a very complicated team sport. It's a very complicated dance with pharmacists, nurses, and APPs. It takes a village to give a course of immunotherapy. It is very complicated. And so, when people like to control things and like to do everything themselves, they're going to have a hard time. And that's true I find for teaching, laboratory investigation, wet lab, dry lab, most good, impactful, important science in oncology these days, clinical trials, wet, dry, all of it gets done in teams. Teams that have people with different levels of training, different skill sets, early stage, late stage, people who are quantitative, people who can write, people who can program, people who can do lab experiments, and people who know what an organoid is. People who know how to program an in R. All different kinds of skill sets but they have to be able to work in teams. People who can't do that are going to struggle to achieve maximum impact. I'm not saying that there isn't room at the end for the occasional genius person who likes to work solo. But that's not really what we need to move the needle. So, I need team players. I think there is a big emphasis on collegiality. Of course, we want smart and we want brilliance. But sometimes a drop less brilliance and a drop more collegiality and being able to work together in a team, it goes a long way and it's the difference between doing something impactful and not. That's what I look for. I also think that it takes all different kinds of people. And no one has to excel at everything, but it's great for people to be able to excel at something. So, passion, drive, and ability to ask questions, and not being afraid to occasionally fail and having some tolerance for that and trying to make sure that leaders are able to tolerate that, too. We have to be able to. Dr. Dave Johnson: Yeah, I think those are great suggestions. We're getting near the end of our time today, and we have a lot more questions to ask. But what's your biggest fear, as the head of the Department of Medicine, looking to the future, what causes you to lose sleep at night? Dr. Deborah Schrag: I think the business of medicine. If medicine turns into something that feels just like [inaudible] work, and losing physicians, if we don't respect physicians' need to take care of themselves, to take care of their families, and yeah, to find that joy, then we will not attract the top talents. I think we need great minds and great hearts and people from all walks of life to enter the profession, because that's the talent that we need, to quote my friend, Paul Farmer, ‘Bend the arc'. And you know, we need to bend Kaplan-Meier curves in the right direction. And we need the talent to come into the profession, and if they see that we are not happy and not thriving, the next generation is going to go elsewhere. I don't want to begrudge my wonderful endocrinology colleagues. We need people to tackle diabetes, and we need great surgeons and great anesthesiologists, too. So, it's not just oncology. In medicine, I'm responsible for all kinds of discipline. And boy, we need a lot of cardio-oncologists because we've created all kinds of new challenges. So, it's all of the sub-disciplines of medicine, but I think physician well-being and attracting talent to the field is really essential and making sure that the business side of medicine doesn't take over and destroy the core promise and premise of academic medicine. It is a spectacular profession and calling, and it has led to so many advances that have really changed the world. And we have to, I think, preserve the good in that. My fear is that that gets further eroded. Dr. Pat Loehrer: Just one last question from me. Thank you for all your wonderful comments. But I think I have to ask this because it's such an unusual thing as they brought up at the beginning that you're the first female Head of Medicine at Memorial and Lisa DeAngelis is the first Physician in Chief. And so, although there is gender equity in medicine, there is not gender equity and leadership around the academic world. And this is a very unique situation there. Can you reflect a little bit about the significance of this and perhaps, lessons learned, particularly if you're speaking to a younger version of yourself or a young woman who's thinking about a career? What are the lessons between you and Dr. DeAngelis mean? Dr. Deborah Schrag: I'm not sure I've been at it long enough to have lessons. I'm just so grateful. So, I'm not in the generation that was a trailblazer. I'm a beneficiary. So, I've had the privilege of being trained by Dr. Jane Weeks, by Dr. Judy Garber. I, myself, had so many great mentors who were women. I would say to women, that you can have it all. You just may not be able to have it all at once. Women and men have to make choices. Can you have a lab and be a laboratory investigator? Yes. Can you do that and have a family? Yes. I think running a high-power lab and having a gigantic clinical practice and running clinical trials, I think the three-legged stool and the so-called triple threat is really, really hard. But I think it's hard for women and men. What I would also say to women is you don't have to be the boys - be yourself. I think the best advice I can give to leaders is to be authentic. Because everyone, men, women, people smell a phony and no one likes to phony. So, I think if you know how to partner, you understand that it's a team sport. I think women do that really well. So, I think being authentic, and I think women need to hear that, you don't have to emulate male role models. You have to be yourself. I would love to emulate the two of you. I have to thank both of you because the Indiana Miracle and Dave from his Vanderbilt days, Vandy, as Dave likes to call it, from his Vanderbilt days to his Texas days, like, the two of you are such incredible thought leaders and inspirational leaders in oncology, but I can't be you. The best we can be is sort of the best version of ourselves but we can be inspired by the great qualities that we see in other leaders and carry a little bit of that with us. So, I think that goes for women and for men. Dr. Pat Loehrer: Thank you! Well said, and I appreciate the thoughts. We've kind of gone through this and we're going to have to wrap it up. One of the questions that we often times ask our visitors is if there's a book that they're reading, a documentary that they're watching, a movie they're seeing, or anything you'd recommend? Dr. Deborah Schrag: That's a good question. So, yes, actually. One of the ways that I learn about leadership that I find, actually a fun way that's both relaxing and educational, is to read a biography. I love reading biographies. I'm going to name two. And these are popular books - for scholars these may not be. First really fun book is ‘The Splendid and the Vile', by Erik Larson. It's a book about Winston Churchill in 1940, and how he has to try to persuade the United States to enter World War Two, but it's really about a particular year in history and Winston Churchill. Dr. Dave Johnson: It's a great book. Dr. Deborah Schrag: It's called, The Splendid and the Vile. I just learned so much about leadership from that book and the decisions that Winston Churchill makes in his bathtub. So, just read that book and think about what Winston Churchill does in his bathtub. I can't lead from my bathtub, I live in a New York City apartment, but that's one. Then more recently, I guess there's a little German theme happening here, is, The Chancellor. It's about the life of Angela Merkel. It's long, I haven't finished it yet. But it's incredible. What a story, East Germany, her leadership style, how she studies chemistry, how she rises. It's a fantastic book. It's called, The Chancellor. So, I will recommend that one. Then the last one, my beloved nephew who's like a son to me. He's about 36 years old, and he has ALS. And he's completely paralyzed. He is on a vent and he has two little kids. But he released a documentary that actually won at the Tribeca Film Festival called, Not Going Quietly, which is about a cross-country trip that he made. He's a pretty inspirational character, despite the fact that my nephew was completely locked in, he communicates only with his eyes. He is living a remarkable life. I think that documentay, I know this is a shameless plug for my nephew, but he's a pretty inspirational character. I don't necessarily agree with 100% of his policy prescriptions and recommendations. But there are lots of ways to make meaning in the world. So, that's another documentary. Dr. Pat Loehrer: That's incredible. Thank you so much for sharing that. I'm going to look it up. People think cancer is the worst thing you can get but there are worse diseases to have. Dr. Deborah Schrag: Yeah, I think this one might change your idea. And then I would also say Paul Farmer's Bending the Arc. I think for young physicians who haven't seen that movie, I would recommend Bending the Arc. Dr. Pat Loehrer: Thank you. Dr. Deborah Schrag: Thank you! It's been great to chat with you. Dr. Pat Loehrer: It's great. So, that's all the time we have for today. And I really want to thank you, Deb, for joining us and for all your insight. It's been wonderful. I also want to thank all our listeners for tuning in to Oncology, Etc. This is an ASCO Education podcast where we'll talk about just about anything and everything, if you've heard. If you have an idea for a topic or guest you'd like to see on the show or a host that you would like not to see on the show, just email us at education@asco.org. Thanks again. And Dave, I just have a riddle for you here. How do you make an octopus laugh? Dr. Dave Johnson: Show him your picture. Dr. Pat Loehrer: Ten-tickles. That's all we have for today. You guys have a good evening. Take care.   Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.   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.

"Yasmin Hussain was diagnosed with Stage 3 Breast Cancer in October 2020. She had six months of chemotherapy, 12 weeks of Taxol, followed by two and half months of aggressive chemotherapy, and a double mastectomy after that. Yasmin got her lymph nodes removed. After a small break, she had five weeks of radiation every day. She never gave in and managed her emotional well being with a very positive mindset. Her oncologists and friends were her most extensive support system. She always believed this one thing ""That I had cancer, but cancer never had me."" ""I beat it with positivity."" Zenonco.io - Making quality integrative oncology cancer care accessible to all. Visit our website: https://zenonco.io/ If you or your loved one has been diagnosed with cancer recently, and need guidance on treatment or have any doubts or queries, please call ZenOnco.io on +91 99 30 70 90 00.

Kristen adjusts to Taxol, the drug used in the second phase of chemotherapy, which brings bizarre side effects requiring special booties and mittens to prevent permanent nerve damage in her hands and feet. Her beachfront living arrangement is upended, and while moving is stressful, her home is replaced with an even better beachfront home through the generosity of a friend. Being single, having cancer, and wondering if you're going to die alone is scary. As the days go by, it becomes clear who's really in her corner for the long haul. Links Support the Breast Cancer Stories podcast https://www.paypal.com/paypalme/breastcancerstories Read about Taxol (https://chemocare.com/chemotherapy/drug-info/taxol.aspx) Chemo mittens and booties shopping list: Best chemo cooler/backpack (https://amzn.to/3nXD4lT) Ice mittens (https://amzn.to/2ZQA7eu) Ice booties (https://amzn.to/3CLAOof) Ice booties refill (https://amzn.to/3H00SP5) Meet Kristen's doctors: surgical oncologist Dr. Louis Rivera (https://www.scripps.org/physicians/31924-louis-rivera?tab=overview), hematologist and oncologist Dr. Sonia Ali (https://www.scripps.org/physicians/8669-dr-sonia-ali?tab=overview), plastic surgeon Dr. Salvatore Pacella (https://www.drpacella.com/), and radiation oncologists Dr. Anuradha Koka (https://www.scripps.org/physicians/4516-anuradha-koka-md?tab=overview) and Dr. Kenneth T. Shimizu. (https://www.scripps.org/physicians/5313-kenneth-shimizu) About Breast Cancer Stories Breast Cancer Stories follows Kristen Vengler, a 56 year old single empty nester in San Diego, from her diagnosis of hormone positive breast cancer through chemotherapy, mastectomy & breast reconstruction, radiation, and whatever happens after that. In 2020, Kristen moved from Austin to San Diego to be near family and start her life over after a life-shattering workplace trauma. A few months later she had that terrifying moment in the shower we all hope we never have. From her breast cancer diagnosis, through chemotherapy, breast reconstruction, and radiation, we experience each new milestone as it happens. This podcast is about what happens when you have breast cancer, told in real time. Support the show by sharing online, writing a review, or donating at https://www.breastcancerstoriespodcast.com/donate Host and Executive Producer: Eva Sheie Co-Host: Kristen Vengler Editor and Audio Engineer: Daniel Croeser Theme Music: Them Highs and Lows, Bird of Figment (https://music.apple.com/us/artist/bird-of-figment/1434663902) Production Assistant: Mary Ellen Clarkson Cover Art Designer: Shawn Hiatt Breast Cancer Stories is a production of The Axis. (http://www.theaxis.io/) PROUDLY MADE IN AUSTIN, TEXAS

Track 1: Introductions to: The show Rus Willis overview Chelsea Buckner Deeper story of Rus & how he got involved with YewTips. Information on Taxol (1 of the elements in Taxanes) Start Track 2: 20:57 Track 2: Story of Mildred Nelson and Rus How the tea changed from the bark to the tips Call about bark harvest vs. sustainable harvest Nann Vance: was publishing Yew Research Realized that there were only water-soluble components of the tea Development into capsules and tinctures Call about Stomach Cancer and if Rus has cancer or why he is taking the Yew products himself Yew Products and Anti-inflammatory properties and immunostimulant properties to the cold and flu   Start Track 3: 41:30 Track 3: Questions about stomach cancer 9 mL (3x3mL in mouth + swallow) Tea has tannins in it - bitter component Taxanes: also anti scarring properties Taxol used on stints to prevent scar tissue from forming and causing further surgery Use salve on wounds, cuts, & abrasions to help with healing time & scarring when you heal as well. Continuous anecdotal stories Rus story about dog “white out” getting stuck in blizzard while mountain lion hunting Rushed to the vet after finding him 3 days later… 1 degree from not surviving - loaded him up with heated intervenes liquid to raise his body temperature Frostbitten paws - TWICE their normal size and near needing to be amputatedNo pharmaceutical antidote for frostbite in vet world…. Used the Yew Salve out of desperation to see if it could do anything… ALL THE SWELLING WENT DOWN OVERNIGHT! Did take a few months until he was able to go back to normal functionality again but still HUGE ability to use the salve   Start Track 4: 59:52 Track 4: Minor technical difficulties but we made due!Rus continues his story about frostbitten hands and using Yew Salve from Track 3 Chelsea's Family and their use of YewTip Salve and YewTip Oil YewTip Salve for BABIES & any kind of rash! Text about specific taxanes Text about breathing problems Anti inflammatory and HELPS with breathing Text about specific Lung cancer Non small-cell lung cancer respond well 9 capsules/day 3 with each meal WITH FOOD Nebulizers with YewTea Text about shelf life of powder 3 years (industry standard) Horse story about laminates - hoof disease   Start Track 5: 1:17:17 Track 5: Call about small-cell lung cancer Taxol is mixed with cream for (synthetic castor oil)- causes hair loss Friend took 9 capsules/day - while doing chemo (didn't tell the doctor about the capsules) & started gaining weight What if Diarrhea Stop for 1 week Restart 1 capsule/day - 3 days then move to 2 capsules/day for  3 day Call about Colorectal Cancer Text about cost of products www.bighornbotanicals.com/shop   Start Track 6: 1:33:51 Track 6: Call about arthritis & gut health Chelsea talks about difference between Salve and Lotion Text about how to use the salve Text about boosting immune system with asthma for kiddos Text about prostate enlargement Rus plays the Yew-Tar Rus explains benefits of taxanes on immune system Suggested dosage of YewTip for animals: Horses 800-1200 lbs for inflammation or cancer 1 ounce YewTip tincture mixed with 1 cup applesauce and then added to grain ration 1x/day EXTERNAL tumors: use YewTip Salve 2x/day Cat's/Dogs Cancer and Inflammation 1 mL YewTip oil for every 10 lbs of body weight mixed with soft food/day (1/2 for morning and night feedings)

Subscribe to our Benzinga Crypto Youtube Channel Register for our FREE Healthcare Small-Cap Conference and have a chance to win 1 year of Benzinga Pro! Register for FREE hereEpisode Summary:Bitcoin Holding the Line Chainlink + Boost Mobile + CardanoBull Market UpdateCrypto TaxationMoon or Bust - To Play Moon or Bust go to https://www.benzinga.com/markets/cryptocurrencyTokens talked about on the show:Bitcoin, Sushi, ADA,COTI, Chiliz,ZilliqaGuests:Ricky Lavina CEO of Taxfyle https://www.taxfyle.com/Resources:IS ETHEREUM A GOOD INVESTMENT?Check Out Other Benzinga Podcasts Here:Check Out All Benzinga Crypto News HereGet Moon or Bust Crypto Merch Here Join the Telegram: https://t.me/moonorbustBZ for 25% of Moon or Bust Podcast swag.Claim 1000 ZING airdrop: https://www.benzinga.com/zing Meet The Hosts:Brian MoirSolidity and React Developer | Blockchain Enthusiast | Decentralized Internet Advocate | Crypto investor since 2012https://twitter.com/moirbrian Logan RossBlockchain Analyst @ Benzinga | President @ Wolverine Blockchain | Crypto investor and educator since 2016https://twitter.com/logannrossRyan McNamaraBought sub $90 ETH during the bear market | Liquidated on ByBit | Was into DeFi before it was cool | Ran ASIC mining operation in 2016 (sorry planet Earth) | $UNI Bag Holderhttps://twitter.com/ryan15mcnamaraDisclaimer: All of the information, material, and/or content contained in this program is for informational purposes only. Investing in stocks, options, and futures is risky and not suitable for all investors. Please consult your own independent financial adviser before making any investment decisions.Unedited TranscriptHello, zinger nation. Welcome back to flight 50, aboard the moon or bust rocket. Ship your home for all things, all coins and defy. My name is Logan Ross, and I am piloting today's mission along with defy developer, Brian Moore and Ryan mutant, ape McNamara. How y'all doing. Doing good. Happy mute in Monday.Uh huh. Are you just coming up with this now? Or is this a fake? No, it's a real thing. Oh yeah. What do you do on said mute and what do you do on set Newton Monday and some you and Monday you'd understand if you had them urinate, but if I wasn't a poor, I would get myself a mutant today's episode is brought to you by the numbers.Uh, also before we can get started, I need to, to talk about some safety procedures, uh, on this rocket ship. So I need all who are willing and able seated in any of the rows to please activate their light button into the, on position to let other, uh, space travelers metaverse travelers know that moon or bust is where.At, uh, also got to point out the Benzinga crypto YouTube channel in the description below. If you are here for the crypto content, then you should be there as well. We are going to start streaming exclusively from that channel as soon as it hits 1000 subscriber Rooney's so, uh, go over there and get in early, we'll be doing a giveaway to one of our.1000 subs. When we hit that, mark, I'm thinking an ENS domain would be pretty cool as a giveaway, but I'm open to hear what you guys think, what you guys want as well. What's good. STBC nice to see you again. Uh, okay. So we also have a telegram channel and we got some sick moon or bust merge. See this, this dope eith hat right here.Uh, if you join the telegram, we'll toss you a. 5% off discount code. Can't get that alpha anywhere else on the. All right with that out of the way, make sure to connect with us on Twitter as always come say what's up, our DMS are open. Uh, and also I want to remind you guys that we are going to try to start bringing on some of our best guests, our best viewers.Uh, if you are here often in the comments, then hit us up. If you want to come on and we will make it happen. So let's get into the news for today. So I want to start with the chain link Cardinal. Partnership. This is huge for the blockchain space in general. I think mostly for chain link. We'll see a lot of that value from ADA, uh, flow into chain link and it will connect it to Yves, polka dot all these other dope ecosystems.So it's good to see that Cardona is integrating, uh, with chain link. Uh, I, you know, I have positions in both of these. I think it's good news. For both assets, Ryan, what do you think about this integration? Yeah, it's definitely interesting. I like your point, Logan. I think it is more bullish for chain-link than it is for ADA, because chain-link is going to be multi chain now to a degree, you know, it's, it's diversifying the risk for chain link.Now, if a theory ends up failing in some hypothetical scenario, then chain link can still survive. Unlike most tokens on Ethereum's network. If a theorem were to fail, then mostly these tokens that are on Ethereum. We'll fail with it. But now that chain link is integrating with Kurt donno. It has another avenue to kind of diversify risks.So I agree with you, Logan. This is very bullish for link. I think it's also very bullish for Cartano. It's very important to have an Oracle on a network and there's no one better than chain links. I think this is bullish for, for both ADA and for chain-link dope. Brian, do you have any additional thoughts on this partnership?No, I think it's going to work really, really well for them. I mean, chain-link is integrated into a whole. Uh, set of projects that you wouldn't even under, wouldn't even realize they are. And the amount of like technology and data you can get back from channeling is astounding. So I think it's really exciting.So does this mean that that chain link will be on Kardos network as a Cardinal token? Uh, I guess that would make sense. Yeah. I mean, I would assume they would eventually have that, but really, I think they're just running a node, which they can integrate it into Cardona so you can get data from. Yeah. I mean, I don't think they'll mint, new tokens that are like eight, a formatted.They might move over a bunch of them. And they also might try to switch link over to like a chain link based token or asset, which, uh, would be pretty cool as well. Uh, what's up, Zolty see you out there in the chat doing what. I hope you're doing well. Also, you see, STBC, uh, is down to come on, talk some NFTs with us.Uh, that would be pretty cool. Uh, so let's set that up, brother. Uh, okay. So next up, Ryan, I think you have this piece of news. Yeah, man, you got to pull up open. See you gotta see this diamond hands NFT investor who made $2.8 million on a single NFT in a matter of months now he didn't even have thousands of dollars.He had $100 and he, he made that into $2.8 million on a single Cromey squiggle and Ft. Talking about money. It's about 20,000 times return on his investment. Not person. It's about 2000000% return on his investment. Okay. So I have Z pulled up here. How should I go about finding this? Should I just go to our blocks and look forward in the squiggles?I would, I would go to the squiggles look under recent sales and scroll down until you see a 945 E trade. Then 945 ether equates to about $2.8 million. Just over that off of a $100 investment. That's ridiculous. So this is the second crummy squiggle we've seen sell for over $2 million this week, which I think is incredibly bullish for chromium squiggles.We've seen the floor go from about eight or nine Eve. Now it's up to about 13 and a half Eve. So over 50% alpha on Ethereum alone. I'm excited to see where this project goes. I've been watching it for a while and I think it's only going to be going up right now with these super high sales for these rare chromium.Very cool. Okay. So I have my screen share now live on this screen and this is sorted by recently sold. So, uh, uh, if you could just point out key rainbow boy, that's his name? He's chunky and very rainbow. That was chunky.Uh, recently sword. Hey, the floor price is only what, 1.45 is that what it said? Yeah, but that's for all of our blacks, right? So our blacks has a ton of different collections. You have to filter it by a certain collection to sketch here. She is the chunker herself.So Ryan, can you tell us a little bit about art blocks and about Cromey squiggles? Why this one is so valuable compared to the other ones? Yeah. So crummy, squiggles, I'm pretty sure it was actually the first collection of NFTs on art blocks and art boxes, almost like an art house for NFTs. They curate collections and they have a few different segments.So art blocks curated is kind of like the most coveted NFTs in the art Black's collection. They also have a few other things. Art blacks Playhouse for some experimental art and a few other different things. But chromium squiggles, you see them all over crypto Twitter, lots of high-end NFT investors are getting into these and they're algorithmically generated pieces of art.They're pretty cool. And I mean, some of them will sell for 10 to 15 Eve, but then you go up to these rare different types of traits with these crummy squiggles, and you can get into the millions of dollars now, as we've seen. That's crazy and look at it. It moves. I know. Tell the masses crummy squiggles move.So this guy's zonked here. He, uh, was clearly very early in art blocks. Let's see what else he's got in his collection.Minted that crummy squiggle. And like I said, it was about a hundred dollars on it nine months ago. Wow, man. Why didn't you tell me about that? I thought I did, man. Put any Cromey squiggles that man don't let me down again. Okay. Okay.Interesting. Not really, honestly so far. Not really. Well, I guess he doesn't really have to care about really much for quite a while. He's getting, he does other art, blacks too. I mean, that's what you see. A lot of these blue-chip NFT collectors are collecting art blocks, Ponce and board apes. And we should also talk about cool cats.Uh, well, we're talking NFTs. This became the third project. Hit a ten eighth floor just yesterday. The hype surrounding them is pretty crazy right now.Yeah. I wanted to get one a while ago, but I never pulled the trigger. I saw the potential, but at the same time, it sounds corny. I didn't really like the art, right. I didn't buy it. I didn't like the art. And as with a lot of those early NFTs, we see them increase in value. I think that a pudgy penguins could be next.I think they're sitting around three to 4, 8, 4. I haven't checked lately, but we saw those gains some hype early on, same with cool cats. And now we see them appreciating even more. Now I'm thinking the, the whales is secret society of Wales. That's, that's my, I do own a few of the, a few of those, and I'm hoping that those will be the next ones, a hype.And there've only been three NFT projects to hit the 10 eith for first it was crypto punks, then it was board apes, and now it is cool cat. So it'll be interesting to see what the fourth project to hit that 10 eith four will be. Cause there's more it in it's going to be inevitable that these blue-chip NFT projects will get more and more.So speaking of big money spent on the Ethereum blockchain, uh, this morning, uh, Bitfinex, the exchange made a little oopsie, uh, and while transferring a hundred thousand dollars of tether, they spent, uh, let's see. $23.7 million on gas. So you guys thought you were paying a lot of gas fees? Uh, not, not quite as much as Bitfinex.Not really sure what went wrong here. They must have not set a limit, uh, and some sort of loop, maybe in a smart contract caused it to just burn and burn and burn. So they spent $23 million in fees to make a single hundred thousand dollar, uh, transfer of USD T. Oops, woopsy they probably half of that got burned, at least.So, you know, maybe that affected the theory. I'm just a little bit, it was like a, it was really sad compared to the right. I know my inner mate with a lot of money, then let's say a minor does some sort of rig got paid handsomely. Oh, man. I hope it was mine. I see you have here on the, uh, on the dock, a hundred thousand dollars in tethered, $23 million.It's this the future. Sure France. I, I hope not. Uh, okay. So we have a lot of stuff going on in the fungible token market, a lot of movement. Uh, we saw a weekly close yesterday. The one that we have been talking about for months, uh, but we will get to all of. After the interview. So today we have the CEO of tax file on, uh, with us today to talk about crypto taxes, uh, and how, um, tax file, you know, places itself in the industry.So I'd like to welcome to stream Ricky. Levina. Thank you so much for joining us today. Hey guys, what's up? Not too much. Uh, so before we really dive into it, could you tell us a little bit about your background, uh, how you started tax filing? Sure. So I'm a, I'm a CPA. Uh, before I started Taxol, I worked for PricewaterhouseCoopers.Um, and then some, some, some regional firms, but I'm a, I'm a CPA, I'm an accountant. And about, I'm sorry for the voice, uh, about six years ago started Taxol and my two co-founders, um, basically trying to democratize, uh, the supplies. Uh, things, uh, in the accounting industry, meaning I got a license, my CPA, or you could be an IRS enrolled agents.Uh, but basically you have your, your county license and, uh, in the olden days you just had to go to a, to an accounting firm and the pay via W2. Right. Um, but I felt that our licenses were worth something, you know, uh, out in the market and, um, You know what thought it'd be really cool if we create a platform that will route jobs, uh, to them.So, you know, Taxol is a, an app where you guys y'all could download it on, on, on iOS and get your taxes done, uh, directly through it, uh, via a CPA like myself, I'm not on the app, I'm saying I'm a CPA, but, uh, but we also, uh, route work from like institutionals. So if someone's outsourcing their accounting department or a CPA firm is.Tight, uh, with, with, uh, with staff, which is a big trend over the past 12 months. And we think it's only gonna get worse now. Uh, they put all this work on, on the platform. And so, uh, our algorithm prices out all that work on an individual basis, uh, kind of works like match.com, um, based off, you know, there's different types of CPAs, right?So if you specialize, let's say crypto taxes or something like. Uh, you'll get, you'll get matched up with these jobs. You'll see exactly how much you'll make on it. And, and by when you gotta do it by. So, um, that's a little bit about tax volume. Hmm. Awesome. Ricky. So I understand you're interested in crypto as well.Yourself. Could you tell us why our audience of mostly crypto investors might be interested in using tax file? Uh, especially with the latest things going on in DC. No, it seems like crypto they're really hell bent on at least in the federal level to treat crypto as a security. Right. And, um, not all platforms, especially, you know, for, for your type of audience are, are, you know, using Coinbase and, uh, and their wallet, uh, you know, we're, we're using, you know, you know, Swiss products or, you know, uh, uh, Singaporean products and, and, and that could really fall through the loopholes.Right. Uh, cause when you deal with. How crypto is trying to be treated in terms of, uh, from a tax position. Uh, you know, once you exit a position, right? Let's say you're moving from BTC to, to ease that now becomes a realizable event. And we don't really think about it, especially, you know, as, as you guys know, uh, let's say we're, um, you know, we're, we're, um, define, right.And, uh, we're, we're collecting an interest and then. We decided to add some LP. Right? Uh, so, so we, we opened up a pool or we're in a pool or steaks and now, and now we want to, to get some action. You're getting interested in, in another one of the products on the website. Um, you know, you have, you have to track all these things and not all those entities are going to give you a tiny and I like Coinbase, right?So it's not just when you move into. You know, and the government's pretty, at least they're saying they're going to be pretty serious about this. So it really helps to, uh, there's a lot of great apps out there, but it really helps to consult someone. Um, because given that. These platforms are in different countries and different transactions.You mean different things. Are you moving, like you said, into a stable coin or are you, are you moving to something that's more volatile, right? Uh, you really have to be organized in terms of nutting out your gains and losses, and there's a ton of advantages there. So obviously Metta mask doesn't provide those tax documents like Coinbase does, as you said.So what has been kind of the past method for reporting taxes, with defined Mehta mask events, uh, and what do you see as the better alternative that. Well remember, I just, I just supplied the people. So, uh, when you get linked up to one of our crypto pros, uh, they'll have their own software. Right. So similar to like Uber doesn't own the cars for the drivers.Right. But depending on your complexity, our algorithm detects all. Yeah. This is a high-frequency trader or whoever. Right. As opposed to someone who just had one, you know, uh, one position in, on ether or BTC or light coin or something on their app. Right. Um, So, you know, that that's for Taxol could really help out from there.It's, it's really consultative. Right. So, um, you know, you'll get matched up with your pro and you work through, uh, their software. They'll see, first of all, what you got, I think it starts really, um, you know, at home and being proactive on this stuff. So if you're looking to, you know, tax seasons, Not right around the corner.Right. But we're getting closer to the end of the year. Or you may want to start getting organized, you know, ROC might be faced with a crap ton of work, uh, come January and you might have to extend and, and, and then you realize, oh wait, even though I had all these gains and if I'm extension, it's not an extension for payment, the IRS still.Their money by April 15th. Right? So, um, we, we see that snowball for, for individuals, right? And, and the best thing they could do is, is, is work with someone. If you need help in advance to get organized or start getting organized yourself, because no one knows your, your, your crypto position like you. And, um, you know, and, and, and not, not, not even the best CPAs could look into, obviously w where, where you had realized.So tell me about this algorithm you mentioned, is this a proprietary algorithm? Can it look through your meta mask transactions? How does it determine, uh, like the best fit CPA for you? So, um, I'll say it's, it's basically an intake form on our platform platform. It's called work layer that we use to power tax file.And, uh, whether, like I said, it's, it's a crypto account or a 401k.Question by question and start drilling into. Okay, well that didn't have a million transactions or, or was there one and in what, uh, in what platforms? Right? So on our end, it's, it's basically our job to find someone with that level of statistics. Right. And it's not want to say it's and it's the platform is doing and not, we don't have like an individual looking for coming through our 4,000 CPAs.Um, you know, it's, it's someone, uh, that, that has has, you know, Some, some, I'm not going to prop up any tax, uh, crypto tax software, but they leveraged something in their, from that that really helps them out in terms of getting your schedule D uh, which is a schedule on 10 40 that you report, um, you know, all these transactions on and they could really help you, let's say net out your gains and losses.Um, so that you're an optimal position. Okay. That makes sense. So what are some of the strategies you can use to lower your tax liability within crypto Korea? Or are there any, yeah, there definitely is. Uh, but, but it's all proactive, right? So if you have. Whatever happens in 2021. Right. And then you're trying to file your taxes.Um, you're kind of limited, right? Because it is what it is. Uh, and, and, um, I would say that the, most of the best planning that we see cause cause there is no. Okay. So for you guys, uh, I don't know. You're familiar with. Okay. But before used to be like, oh, I'm training a light kind asset for another like-and asset.And because I'm just rolling it forward from asset to asset the IRS, there used to be this gray area where you can say, okay, well that's not really a taxable event because I didn't get any cash from it. I didn't realize it. How am I going to pay taxes on something that I haven't gotten to cash from?Right. Like, you're I have this basis of, you know, on paper to $12 million or whatever it is, but you know, my checking account only got 5,000. So how the hell am I gonna. You know, uh, a huge tax bill on that. Now with this new regulation. Um, it doesn't really matter. They're there, they're going to tax you for, for, for moving from asset class, asset class.So that's why getting practice with this stuff is really important. You know, it may affect when you exit a position, right. Or when you switch from one point to another, if you need to go to. Um, USD, excuse me, or U S era tether or something like that, a stable coin, um, you know, and then eventually converted to, uh, to Fiat, you know, it's a pay your bill, but that's part of the planning, right?So making sure that, you know, if you're going to attend any nine, this is going to be recorded as, as a game. Okay. Uh, I'm going to have this liability. Uh, the other part is. I know, I know everyone gets wrecked every now and then, uh, you know, I, I certainly have, uh, and we've been doing it for quite a while here at Taxol.We've been trading, you know, for, for a few years, but, um, it's important to track all that because those losses offset your gains. Right. So, you know, don't, don't just think out of sight, out of mind, you know, onto the next one, you know, this is just a bad break record it, uh, because that would definitely offset, you know, Tax liability.And are you able to write off gas fees as a transaction expense? That's a good point. Um, it depends on how you set it up. Um, so the IRS distinguish really between hobby and, and, and, uh, work, right? So let's say you have enough justification and it's kind of complex on, on determining this. It's more like I'm a lawyer.Uh, you know, th that's making your case, uh, that you're a, you know, that you're doing this as an avid, this is your full-time job, right. As an avid worker, as opposed to just an enthusiast. Right. Um, this isn't something I just do in passing. Right. So, um, what that would trigger on your 10 40? Let's say, if you are active trader is.Uh, which, which essentially means that on your 10 40, you have a schedule C or better yet, if you're incorporated now pros and cons are incorporated, you know, you want to track everything and, you know, and make sure that you're really on top of it all, because now you're incorporated and you're telling it to the world that you're trading crypto under this entity.But the benefit are, yes, gas could be deducted, right? As, as, as cost of doing business, that's on your PNL. That's an expense, right? Obviously your, your. Your revenue on that business is your realized gains. Right. And on your balance sheet, right. Is, is the unrealized portion, right? So my long hole long-term holdings on a, on a position like ether or whatever.Right. Um, so I would say if you qualify, you know, to do this as a legit business and, and the best way to do that. So as a Porter with the IRS, some corporate, even if it's just, you set up. Yeah, right. You know, uh, you know, coined Inc something and, um, I'm sure that's taken, I'm just giving you an example. And through that entity, you know, you, you log all your transactions and, um, if you do enough of it, you, you know, it may pass, uh, the test and want to talk about NFTs just shortly.So our NFTs tax is the same way as other cryptocurrencies. So right now they're not. Um, but it seems like they're gonna move the way of being treated as any other security, you know? So, um, there's a ton of ambiguity. Uh, I think the, the funniest thing is that the people creating these slides, like before you get to NFTs, they, they, I mean, they don't even understand the blockchain, you know, proof of stake.Like you talked to them about purpose. They can have no idea. So it's like, um, they're not even there. Uh, there's, there's a lot of gray area. I think it's, it's where we were in terms of general crypto tax laws, like four years ago. Like, how are you, how do we treat Bitcoin? Uh, so, uh, To be honest, there's just, you have to just take it situation by situation.Right? How big of a profile is this in terms of, uh, you as an individual, uh, maybe working with a CPA, if you have a big, uh, profile here and a lot of the, you know, In my experience, not just in crypto, but just, you know, uh, consulting for clients and, uh, what I've seen, you know, through the tens of thousands of users that we have here, you know, attacks all, um, and maybe even hundreds of thousands of returns at the end schedules that we do every year.Um, Is is, is taking a rational approach to it, right? Like, am I just blowing off millions and millions of dollars? I'm not going to, you know, be reporting here or really, you know, obviously that's illegal. Right. But it's like, okay, well, how big am I into NFTs? And how open, how, you know, you have an opportunity to get up front of it just because it's not tax season.Doesn't mean you can make an essay, made a pain in our two, which, you know, ahead of time, which really. Um, to be in the good gracious of the IRS, right? Because let's say down the road, they make a mistake or you have to open up a case with them or something that happens to everyone, you know, mistakes happen and it happens pretty frequently.Um, and. It probably happened to anyone, you know, by the time, you know, we're dead in the ground here, uh, you know, over the next 30, 50, hopefully 60 years. But, um, when that does happen, you want to make sure you have a clean record. Right. And that all that stuff that you're open and you're upfront with stuff, and you worked well with them and you got ahead of the payments.So my follow-up question to that was can you claim losses for an NFT, say by selling it before the end of the year, if it loses value and then buying it back, I think you kind of already answered it. It's just not regulated enough, but, uh, do you have an answer for. I honestly, I don't, I don't. And, and, and here's the thing, they're not going to see it as an NFT.They're going to see it as some type of acid, right. Whether it's security or another type of asset. Right. So that's why I said it depends case by case, you know, uh, your 10 40 is your, year's like a storybook. It's a, it's a chapter in your book, right. For the IRS, um, for that year. And, uh, depending on how all the narratives kind of string together depends on whether you're in a stronger weaker.Interesting. So, um, you said that they're trying to classify NFTs as securities also. Um, what would be their motivation behind this? Maybe just collect more tax money, like I'm guessing fine art isn't, isn't considered a security and it's taxed differently, right? Uh, so why wouldn't they apply the same rules there?Like I said, I just don't think, I just think that people that, that are, have running these laws and in, in this infrastructure infrastructure, bill just weren't focused on NFTs, like, or an expertise, right. They got, you know, their, their lobbyists from whatever institution, you know, it's definitely not from Coinbase or from someone that knows what's kind of what's going on.Although they're having more presence, you know, in the industry, uh, whether it's a good thing or a bad thing. Uh, but. Um, it's probably someone from B of a right. Protecting their own interests. So, um, yeah, it's not really called on the new bill. Um, they want to classify th they throw this all blockchain stuff as they want to treat all blockchain.Okay. As a security it's wild. I know. And I know that it could be true, you know, depending on what we're doing on blockchain.You know, comparing apples to oranges, like, like in this case, in this example of NFTs. Right? So, um, that's, that's, that's where we're at right now. Uh, yeah, I think that, that if there would be a Silicon valley of cryptocurrency, the us is doing everything they can to push it outside of its borders. Uh, I think this is probably going to be detrimental.For the, for innovation and crypto innovation, blockchain innovation inside the U S would you agree with that? Ricky? It's weird. I didn't try out for the 20th time band. Right. So I have no idea what's going on. Um, I really don't. It's tough. It's it's like, okay, well, are they just. You know, some people are saying they're trying to sink it so that they could buy low legal again, and then it farms, and then it's illegal for the 20, you know, for the 21st time.Um, you know, so. I don't even think it's like 40 trusting it, to be honest with you guys. I don't think, um, like in terms of, I mean, this bill is in the trillions of dollars, right? Like just the bill itself. Okay. there, there's so much things pushed through this thing that it's not like it's a crypto bill, right?It's it's it, it had his own little card out, you know, with its own, you know, group of lobbyists, uh, on it that had their opinion. They're obviously gonna. And try to get this, uh, uh, this, uh, the section on the bill in their favor. Right. Who, who knows what that is in terms of position, but, um, in terms of the U S trying to push crypto off shore, you know, I don't, I don't think they really care about that, you know, because they just saw China, you know, make it illegal.So then, then when, I mean, Know Chinese, the most populated country. We'll try to do some self a crypto here. Right. You know, they, you, you, you guys all seen it on Twitter. Although the mining equipment being steamrolled by bulldozer and the CCP putting that out there. Right. So. I have no idea. I definitely know that, you know, decentralized decentralization and blockchain, you know, gives, gives power to the people and, and that's, um, that's why it's, it's a really hot topic, you know, and it empowers individuals like us and it's really, but also makes it really exciting.Belly. So back to another question on taxation, are there any types of transactions in crypto that are not taxable events? Say maybe if I put my money into a smart contract, you brought up the example of maybe a liquidity pool earlier. If my money is in a liquidity pool and it's transferring between say Ethan Bitcoin is each one of those traction, a transactions, a taxable event, or is that considered something else?Now? All those high-frequency stuff. Okay. Yeah. Yeah. So it sucks. I know. Um, yeah, it definitely sucks. So right now, the way that the realized gain is being realized, even though you're not moving to Fiat. Okay. At all, like. You know, it's, it's not like you're getting out your block five card and you're paying for something.Right. Um, it doesn't matter. They're, they're treating that as the exchange of one asset to another, that ties back into my previous point about how they got away from like on exchanges. Right? In the past you could say that's a light kind of change an asset for an asset, but now no, they've been pretty explicit on that.That's, that's a realized transaction. And depending on whether you're taking a loss on those micro transactions or game, all, getting that out at the end, That's interesting, especially for a program like Unisoft because they meant me. I provide liquidity on UNICEF and they made me an NFT. So really I'm holding the non fungible token, which has underlying assets in it.And at any given time it could be chain-link or Ethereum, depending on the ratio between those two. It's constantly trading. So, I mean, to me, it just doesn't seem realistic for the government to ask for me to be like, realize all of these gains when I'm not really even realizing them. I just am holding a non fungible token that represents any given ratio at any time of these two assets.Yeah. Um, I was, it was a Coinbase. I don't know who it was. Um, uh, but a few weeks ago on Twitter, they, you know, they were really going into, uh, the reporting requirement. That the brokers, because they're getting treated like brokers. Right? So, um, so this high frequency, uh, high frequency, but this liquidity pool, who is the third unit swap unit swap, are they based here in the U S uh, Unisoft labs is.Yeah. All right. So they will be responsible for, uh, 10 89. That's going to be a disaster for them. That's why it's almost impossible for them really. And the overhead, the expense to just track all that and to sort that out and send it out in the liability that's associated with it. I think the liability is a real reason why Coinbase was being so vocal about this.Um, because it's, it's nuts. It's crazy. So it's really on them. But the alternate responsibilities on you. So they have their own requirement, you know, that's why they were looped into this latest bill, right. The brokerage requirement and really anything over $10,000 has to, has to be tracked. So it's basically everything in a second.Yeah, exactly. So anything over $10,000, they got. All right. Um, the government's trying to put this, uh, responsibility on them because they think that'll add pressure to you guys, right. Or to us. Right. So then report, because if we know it's being tracked that Coinbase or something, right. Um, what happens is on there on a 10 99, they give you a copy, but.Uh, you know, side of it goes to the IRS, right? So, uh, once that's done, then you're like, oh, well I gotta report this now. Right. So, so that's the whole spirit behind the law. Um, obviously without diving into the practicality of interesting. So the units will have protocol is decentralized with the unit swap labs team operates outside of the U S if I was in their position, I would just like go to The Bahamas or go somewhere outside of the U S boundaries.And then their problem is solved. Uh, well, you know, the IRS are going to say no because technically, yeah, technically they, they need to report this. Right. Cause, uh, um, the certain, uh, knowing your investor, you know, we know this, you know, you know, anytime there was an initial coin offering ICO or whatever, right.You know, you can't accept someone from the U S and you know, some of crazy rules right on, on the brokerage, you know, knowing your investor, uh, type stuff. Um, technically they still have the responsible. Hmm. What about say you're running a trading bot and, um, you know, you're trading almost, you know, just as quickly as a liquidity pool, but you're, you're using a third party software.And then on something that allows it like Coinbase pro or all that stuff. So you're pretty much saying that every single transaction, no matter what you use or how you do it, that's tax just like how a stock is. That's doesn't matter, which it doesn't matter which program now it's, it's, it's all treated like the security and, uh, you, once you exit a position, that's it, that's, that's what the training is a taxable event.It doesn't mean when you come back from, you know, the realm of, of, of crypto into Fiat, it doesn't matter anymore whenever, any exit of any position. And then if let's say you're just doing defy, right? So let's say. I don't know I'm DePaul. I got it. All right. So, uh, probably cat or Becca or something like that.Let's say, let's say, you know, you just staking there and you're earning interest. Right. But that's your only position, right? You came in with Fiat, right. With USD in my case, right. That went to tether and then tether. I used to swap on Q coin for. Yeah, or something like that or for Kai and then kind of tobacco.Okay. Forget about all those micro-transactions leading up, which technically will be taxable events, but there's not really a holding period gain or loss there. Cause I'm just swapping one for one. Uh, once I move into backline and I start earning interest on it, that's, that's essentially taxable interests.Right. So my base is. Right. My basis isn't and the, and let's say, you know, usually obviously with defy, you know, the, the value of the coin actually goes down, but let's pretend that the value goes up. Right. And you want to exit that position, right? Well, unless you exit that, that, that Beko coin to something else, like higher or something like that.You're not going to get taxed on, on it's. Cause it's unrealized. Right. But the, but the interest is, so your earnings is cause that's paying now, right? So you have two. Technically report that obviously, you know, I don't know what that goes out of, but I don't think it's the U S um, and they're not gonna issue a Tahlia nine.So, I mean, kind of go look with that or reconciling all that. Yeah. I think a lot of people, a lot of trainers myself and. Pretty much anyone we've talked to you're talking about are going to have kind of a really big eye-opener when it comes to next year's taxes. I mean, last year I did my taxes for crypto and everything, but you're kind of, a lot of people were confused and there wasn't as many rules, but now people are gonna flip, you know, it's just going to be kind of a little overwhelming.So we have people, you know, hire professional to actually look at it and say, That's why we have tax file. That's right. Yeah. It's like, it's, it's a process. You guys, you and your listeners should have, try to get out of, to be honest with you, um, you know, start planning and think about what happened this past year in terms of just start with what projects were you in, right.And how. That could be perceived by these guys. All right. By the IRS, you know, so it wasn't earning interest. Was I, you know, what was I doing? What was it? Was it just simply trading, you know, on Q coin or something. Right. Um, and then think about all the transactions you made. That's why you hold there. Um, think about all the transactions you made and then, um, Yeah, don't take your gains and losses and then start working with someone, um, to see, okay, well, we should really should start paying on this, right?Because even if you have an exit, a position, but you're earning interest on something, you still have to make probably quarterly payments on it. Right. Like I said, just when you, cause you extend your tax, your tax form, your filing deadline, right. The IRS is always going to want their money. Right. So, so when you, oh, All right.Uh, they want you to start paying and at the end of the year, right, the fiscal year is over for them. Right. You're going to have a balance due, right. So you have to start planning as to how you're going to pay that. Obviously, then they're not going to take crypto Fiat, but take USD. Right? So you have to probably think about what you want to exit to be liquid enough to don't have to pay that bill, if you're lucky enough to do.You know, obviously on the, on the right side of that, on that ledger, you could obviously have a loss and then that's great. That'll go against your regular earnings. Your, if you have another job or something never been wanting a loss more than right now. Uh, so Ricky, I'm sure we'll be in touch. Uh, I'm sure you have, you have experts.I'm assuming for all these defy NFT crypto tax. Yeah. Yeah, we definitely do. So if you just go to tax law.com sign up. All right. Cool. Thank you. Um, and, and you'll get connected. You just answer some simple questions and then you can start consulting with a CPA and they can help be your therapist to the whole process, right?For no extra charge. All right, guys. Uh, this was Ricky. Levina the CEO and co-founder of tax file. If you guys are deep into. Maybe a little bit too deep, like I'm realizing I am right now. Uh, make sure to check out tax file link in the description below. They can get you hooked up with an expert so you can get on top of your taxes this year.Ricky, thank you for joining us. Exactly. All righty. Hope you guys enjoyed that interview. If you're just tuning in. Now we did a little bit of news earlier and we are about to do our market update and moon or bust at the same time. So, uh, we're gonna start off with a couple of cryptos that we picked out, uh, and then we will pass it to you, drop your coins and your NFT projects that you're looking at in the chat.Uh, and we'll pull them up, do a little market update for you. Uh, let's get it started with some BTC and some, a theory on the classics. Give me a second to pull up trading view. Ryan, is there anything else you've been looking at this week that you might want to take a peak into? Um, I wouldn't mind looking at sushi swap since I have been buying some of that up over the past week, but definitely Bitcoin, since everything follows Bitcoin and Ethereum would be good too.And we also saw a unit swap plus 25% yesterday. Uh, so we'll have to check that one out as well. Please work, Mr. Trading view.Okay. So here we have Bitcoin USD pair, uh, through the BitMEX exchange. Uh, and what we saw, uh, is a weekly close right around this bull market support ban that we've been talking about for months now. So. Watching last week, uh, we said the most bullish scenario would be to, uh, close the weekly candle right around this line.And. Sunday, as we went into the close, we saw a huge rally right to the line we've been talking about. So a little bit, uh, called it there. Uh, and we see this second, this new weekly candle forming, uh, it had a wick up, but now it is a little bit in the red, slight pullback this afternoon. Um, but I don't think we are in dangerous territory yet by any means.I think this is still very, very, very bullish and I am prepared. For takeoff. Brian, what do you think? Yeah, I think that we pretty much called it and it kind of followed the exact supporting technicals. We laid out because you know, Bitcoin's not going anywhere. It's here to stay and people realize that, and I don't think it fell below 40,000.Yeah, there's a wig just barely, but just a little bit below the bulls are definitely winning right now. At least it's seems we've tried to go down and break that $40,000 mark. And it seems like we are holding the line. Like Logan said, these next couple of weeks are definitely going to be definitive though for Bitcoin and its price going through the rest of quarter four in this year, I'm starting to get FOMO already.Seeing us holding the slide now four weeks in a row. I think that's pretty strong support. And I mean, I'm scared that I'm going to be stuck in some Fiat currency and I'll have to be buying during the pump. But I mean, we have a couple more weeks. I think we'll see where it goes and I'll, I'll certainly be dollar cost averaging my position specifically into sushi for the upcoming week or a couple of weeks.Maybe you should save some of that for your taxes, Ryan? No, I don't have any profits. Don't worry about it. Yeah. I've lost enough. You hear that? STC or IRS? Uh, okay, so let's pull up sushi since you've been talking about it so much, uh, I believe your thesis is show you, is that correct? Show you is definitely a big part of it specifically because they are paying very large dividends to sushi holders with show you NFT.It's going to be 2.5% of the transaction feeds on the platform. Right now they pay dividends. They pay 0.05% of the transactions fees on the decentralized exchange. But I just, I really like my thesis is basically, I really like how they're adding value to the sushi token. They're finding different ways to diversify it, to pay dividends out to the sushi token holders.And I also like how it's being actively developed and they're making new programs that really don't have anything to do with the decentralized exchange or making NFT marketplace. They have a token launch pad and they have a lot of other features. I think that'll do them very well over the one. Nice. So do you have a target price for sushi in the next couple weeks?Not in the next couple of weeks, I've been trying to buy, whenever it dips down to around nine to $10, I'm trying to get an under that $10 is my average cost, because I think this could be a 10 X over the market cycle right now. There's about a $1.2 billion valuation. So 10 X would bring you up to 12 billion, which, yeah, that's a lot of money, but a lot of other crypto projects already have that.I think fast probably. More than $12 billion in market cap. And I could see sushi overtaking eventually, uh, which isn't good for my bags, but it hopefully will be eventually once I, once I stack up the sushi. So you say, you think you can, uh, see sushi taking over a unit swap. Uh, it's hard. It's really hard to say.I think there is potential for it because of all these different avenues that are being developed to earn dividends for sushi is tokens as well as all the different programs being built on sushi. But it's hard to say because I mean, you know, swap was out first and at the end of the day, sushi swapped did fork from union swap.So. Some stigma there. Uh, and you know, the swap will definitely be going up with the markets. And if sushi, 10 X is then, I mean, you know, the swaps probably going to be going up quite a bit to probably not 10 X in, just because there's so much more capital that would have to be involved for, you know, swap to 10 X, then it would be for sushi because, you know, swap has such a higher market capitalization.We might have one inch and offshoots like that kind of happened to yep. I have some one inch and I'm expecting that to do pretty well with the general markets. It's a Dex aggregator. So, I mean, it works alongside a lot of these other programs. Yeah. So yesterday we saw a uni rip from 17 books at the bottom to about $25 at the top.I'm sure a lot of traders had a good day and just as many had an equally bad day. Uh, it's pulled back a little bit since then. Um, but it still looks like a breakout, in my opinion. I mean, you can kind of see this line here. Maybe not a breakout may be more of a fake-out, but we'll have to see the next two days next, next couple of days, uh, will be very telling, as Ryan said.Uh, so Brian, you have anything you want me to pull up or should we go to this plethora of coins we have in the chat? Yeah, just pull up ADA for a second. Alrighty. So ADA also announced during their, um, Their car Dano summit 2021 summit that they are not only integrating with chain link, but also being the strategic partner for dish network who owned also has a subsidiary boost mobile.So they are going during in talks where, um, I H okay. Uh, media, which is the company that brought us Cartano is I'm going to be helping them build things such as. The proof of coverage for cell phones or dish network, um, having your identity on the blockchain and having, um, uh, referral programs through Cardona.So there's a lot of stuff going on there. I mean that overnight we'll bring, once that's implemented, we'll bring over nine to 10 million views. Over to the condo, blockchain over just like that. So there's a lot of, there's a lot of bullish movements here, even though they've been slow to run things out.There's a lot of people that trust them. And, you know, we think that Charles Hoskins cause hearts, you know, should I say it kind of doubles it hot, hard skin sins is going to, um, actually make things happen. I mean, I I'm very, it makes me even way more bullish. ADA and Cardona in general than I have ever been.And I've always liked it. So I'm pretty pumped about it too. This is smart contracts yet kind of, kind of. So what's a smart contract. You who needs them, apparently you don't apparently. Uh, okay. So speaking of Cardinal partnerships also chain link. We talked about this a little bit earlier. They are integrating with the car Dano network for Oracles into the real world.Uh, this is going to be very bullish, uh, for chain link. And Cartano both. We see, uh, we saw some, some crazy price action. I think this might have. I actually know it was just released recently. So these are the weekly candles. It could not have been that one. Um, but yeah, I guess we're still looking for that breakout on this.Uh, trading pay right here. There's gonna be a lot of stuff. That's going to integrate chain link into their technology and a lot of stuff that isn't even blockchain related to do. So, I mean, the weather service, the company that backed us, the weather channel weather, you know, they've integrated. So, I mean, there's a man there's only good news for a lot of these things to move in the future.All right. What's up Jim Cruz. Uh, we got Coty here for you. Uh, this is a smart contract blockchain. I think it's an Ethereum competitor. Uh, and you can program smart contracts in any language, uh, on this chain. I think that's its selling feature. It's been a while since I really dove into this project, but we see it here in full on price discovery mode.It has broken through, uh, that the. Actually, it looks like March was there all time high. Uh, and so we're going to look for this continued movement. I'm assuming, what do you guys think about this chart? I don't know much about it. Is it like a car TZ car Tessie, C R T S I, where you can write smart contracts in any language as well.Maybe that's what I was thinking of. Yeah. Maybe I think Cody is a different project. Maybe we can pull it up on coin market cap really quickly just to do a quick fundamental on the platform. Yeah. I just brought it up. We should definitely go into it because I, yeah, you're thinking of car Tessy but this is a little bit different.I personally. Yeah. Currency of the internet. That sounds right. Cody. I personally never buy into all time highs when I see this, which I mean, that's just my personal trading preference. I feel like there's a little bit too much risk to get in once we're breaking new, all time highs. But that being said, once you're in price, discovery, sentiment changes really fast and you could see huge gains still.We saw that with Solano and we saw that with a lot of other cryptocurrencies, even just Bitcoin. You see that when we go up to new all-time high. You never see it just go up another 5% from the all time high that's when the mania starts and that's when you can really make big gains. But personally, I try to enter positions when there's fear in the market and not when there's FOMO, I find that works better and it's generally less than.No, this is actually a pretty cool project. If you scroll down and see where they said, uh, what makes it unique is it allows you to, uh, create your own coins that are stable in price and take control of your finances and your data. And so you can pretty much turn this into really, however you would like it.If you need a stable coin, if you want to make sure that you're creating something that gives you the best, you know, just control of everything that you do. That's pretty neat. I don't know what the new regulations for everything is going to happen with it or what, how that affected. But I haven't seen something like this.Very cool. Uh, if you're just tuning in this is moon or bust your home for all things, all coins and defy right now, we're going over your token picks in the chat. So drop them down there. Uh, and well, your down there, make sure to drop us a like, if you are enjoying the content. Uh, okay. So next up we got chilled.Uh, Jim Cruz again with another nice recommendation for us. So Chili's is like a sports, uh, integration network. So they have partnerships with a bunch of the huge soccer clubs over, across the pond. And now they are expanding into the U S they could see a boom in activity and price, and these, uh, you know, brand name recognition, uh, with all these U S partnerships.This could be very bullish. Uh, zoom out a little bit. They are still a ways down from their all time high. Uh, so this might be a good one to get into. If you're not already, it looks like they had a little bit of a attempted breakout and shot back down on that China food. Uh, but do you guys know anything about this coin?You want to add anything? I know it's a platform and teams can make their own fan tokens, which is an interesting concept. We don't really see it implemented in blockchain too much. I think chili is really has the market for this right now. And they have the biggest partnerships. So, I mean, in that sense with the fundamentals, I think it's a good investment.I think the technicals look good too right now. Uh, it's down, I mean, 60% or so from all time highs. And if the market continues to go. Through quarter four, I could see chilies, uh, outperforming a lot of these larger market cap coins. No, they're also big with the, uh, soccer. Teams and fans. So it was more of an international thing than for us and a us thing, but it's pretty big in those areas.So that's, that's a huge, um, influx of users that want, you know, those NFTs or have a token player. I mean, a players token or all that kind of stuff. So I think there's a lot of room to go with this one. we got crypto maniac in the chat, shout out, Matthew Stafford. He also wants to know about so far. Is this similar or no?So, uh, no, so far as a centralized lending platform where you can give them your coins and other people will borrow them from sofa and you can earn some interest on them through, uh, their, uh, what's it called? Custody wallet, custody program, unless there's a sofa cryptocurrency that we're missing out on.Oh boy. Is there, you never know, by the way, guys, if you're curious to learn more about sofa, uh, check out Benzinga is so Phi review that Ryan and I worked on, uh, you heard of rule number 35. No, I haven't. What's that? It's a, if it exists, there's a cryptocurrency of it.That was a good one. Uh, there is social finance, but this is definitely not 6,000. Yeah. With the real. So Phi, so C, Z Quilla. I can't say some of these Soliqua maybe. Well, I'd had, I don't know. I was trying to guess. Yeah, this is a old school one, but not well, quote unquote old school, but it's, um, super decentralized, um, anonymous and a lot like a Murano mundane.Minero Minero they're all over the place. Yo producer, go on. Can we get a super cut of that? Yeah. And then I say it wrong, then I get embarrassed. And then I just say it wrong again, and just, it's like a snowball effect. Good content right there. Uh, can you need to do some vocal compilation episode? Yeah, that's what I'm saying.Tik TOK. Super cut of all the, the goofs. Uh, okay, so let's see. What is the use of this like Monero? You. Old coin. I mean, we can go into it. It's says a de-centralized blockchain by the token and they, they kind of a rebel in the anonymous transactions. I gotcha. Um, okay. It is three o'clock. Unfortunately guys, we are out of time.Uh, but thank you guys all so much for tuning in today. If you're new to Benzinga or new to moon are bust, make sure you subscribe to the channel and drop a like on the video. So YouTube will show it to more people. We can grow our community. Also, if you're here for crypto, do not forget to subscribe to the Benzinga crypto separate YouTube channel.It's the first link in the description below. We are going to move over to that channel and really push growth on that. Once we hit a thousand subs. Uh, so make sure you're early. If you want to be entered. That giveaway. Um, but yeah. Thank you guys all so much for tuning in. As I already said, I'm going to take this off.Uh, and you guys have any closing thoughts for us, Ryan or Brian? Follow me on Twitter for mute and Monday. Yeah. I'm going to work on my vocal lesson. I don't know. I'm not a professional shout out to all the apes out there in the chat. It is up on Twitter, connect with us. We'd love to talk to you. Uh, but until then, uh, we will see you on Wednesday.Right now. We have pre-market prep at the close coming up. Uh, so if you want that stunk alpha, make sure to stick around. All right. Peace guys.Why the heck did we have 10 people watching when we started? Yeah, there was no redirect. Uh, it was a coal, you can blame. It's all equals fault.Support this podcast at — https://redcircle.com/moon-or-bust/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Track 1: Introduction to Rus and our topic on the YewTip What is the Yew How big of an area Northern California up to the coast into Canada January 1991 when he started the business Outfitter Asked about Yew Tree in MT - originally used to make archery equipment “Taxol” cancer drug National Cancer Institute in Washington, DC Who is involved? —> Bristol Meyer Squibb 1991 + 1992 + 1993 until February 1994 13,000 lbs, 90,000 lbs, 200,000 lbs. BMS: rights to Yew on all Federal Land in 1992: Rus heard stories about people making Yew-Tea 7 types of Yew Trees in Northern Hemisphere Pacific Yews are NOT poisonous European and Asian Yews are VERY poisonous - Taxane causes your heart to stop - most trees you buy in nursery are European and Asian Yews or a mix of the two… When then drink yew tea their cancer went down. Start of prostate story - continued in Track 2. Start Track 2: 21:12 Track 2: Story about friend with stage 4 prostate cancer spreading to the bones and liver. Started 4-6 cups daily 6 months later cancer FREE Story about Vietnam vet tumor at base of spine —> healed February 1994 BMS Stopped the operation Was directed Mildred Melson Clinical Nurse in Biomedical Clinic in Tijuana After using the tea she came to MT to see the trees She suggested to test the tips (10-12 inches) more effective than the bark Went completely Yew Tip in 1995 Call about bladder cancer being healed Tax species —> containing taxanes 100's of them - they peaked at the height of summer What Taxanes do: Most important part is using Anti Cancer Diet: No sugar Call about where to find more information: bighornbotanicals.com online or in our store here in Bozeman, MT Discussion on recommending dosage   Start Track 3: 45:20 Track 3: Quick Recap of show so far Registered with FDA 41 page compliance regulations Different products most popular: capsules tincture = alcohol extract mixed with juice oil = nonalcoholic liquid internal or external usage options Equal parts of yew tip extract w/ equal parts organic olive oil made in crockpot on low 1/8 tsp pwd 1 mL of tincture/oil = 1 300mg capsule For dogs and cats: use Yew 1 mL/ 1 dropper per 10th of weight mix with food cut the dosage in half for inflammation How long does it take for Yew Trees to grow back? Sustainability Start   Start Track 4: 1:03:01 Track 4: Sustainability continued Nan Vance, PhD (Oregon) Rus explains how fast + how Yew trees regrow Give them at least 4 years Rus goes back every 5th year Rus keeps track of every patch How does he work with the Forest Service? internal products: capsules powered tea tincer oil External products: salve lotion soap lip balm Not all taxanes are in the tree Oil is tasting good What expiration dates on products? You need stability study Call about kidneys   Start Track 5: 1:26:20 Track 5: Recap of the show Harvesting is seasoned End of June - End of August Different Types Taxans Caratenoids Flavonoids Lignans Phytosterols All types are antiviral, anti-fungal & antibacterial Testimonials: How the Salve became to be because of Mildred Nelson, RN Rus broke his hip From friend with Henry (w/Melanoma) Salve is used for anything external Repeat how Taxanes affect spindle fibers in cancer cells   Start Track 6: 1:44:26 Track 6: All different compounds in Yew, coming from soil Visits from FDA What happens Big Horn Botanicals First + Only One

Natalie is a wellness and lifestyle coach, mom of 3 beautiful children, a public speaker and a faith filled servant.  After hearing on multiple occasions not to use a loofah for washing, Natalie noticed a lump while washing with her hands.  Natalie was diagnosed with Stage 3 Invasive Ductal Carcinoma at the age of 38.  Natalie describes complications with Taxol, despite being a fit and active person with expectations she would rock her chemo.  Natalie describes the season after her treatments, anger, sadness, loss, hope, joy, anxiety and guilt.  Natalie started Tuman Breast Cancer Foundation in order to help other women through their journey.   Natalie is a podcast host of LifeWork, please check it out!   Natalie describes her relationship of mental health and the impact that Desire Taylor made on her life (link below), a therapist that specializes in cancer journeys. https://tumanbreastcancer.business.site/https://podcasts.apple.com/us/podcast/lifework-the-podcast/id1501964748https://doctor.webmd.com/doctor/desiree-taylor-890be5d9-e7a6-47a6-a802-c74f98e91eef-overviewIG @mythinkfit

Après les EC, place au Taxol, la chimio qui finit d’achever la perte d’identité, mais qui est plus facile à supporter... Pour me suivre : Triple Négatif : instagram.com/triplenegatif/ Emilie Daudin : instagram.com/emiliebrunette Logo par Salty Studio : www.saltystudiofrance.com/

Could one of the most important anti-cancer compounds really have come from the bark of infamously poisonous yew trees? And as these yews were already threatened, how did we harvest enough bark to produce the drugs we needed without killing them all off? In this second Plants as Our Medicines episode, we dive into the recent history of yews and Taxol, the anti-cancer drug they provide. We're joined by Dr Ramchandra Poudel, Senior Scientist at Nepal Academy of Science and Technology, who has a background in community-based conservation of medicinal plants. Ram discloses how yews have long had a variety of uses in Nepal, far predating the scientific discovery of Taxol. Even now, Himalayan yews remain at the centre of economic conflict in Nepal, as farmers who have waited years for their slow-growing yews to mature now find stiff competition from competitors producing Taxol in much faster ways. ‘Plants & Our Health' is a 10-part miniseries made in collaboration with the Royal Botanic Garden Edinburgh, and kindly supported with funding from the British Ecological Society. Not Another Science Podcast is co-created by Helena Cornu and Tom Edwick, brought to you by Edinburgh University Science Magazine (EUSci). Our podcast manager is Alix Bailie. The logo was designed by Apple Chew, and the cover art was designed by Heather Jones. You can visit our website at www.eusci.org.uk to check out the latest issue of the magazine, a ton of other cool science content by our student journalists, and to see how to get involved. You can also follow EUSci on Facebook, Instagram, LinkedIn, and Twitter. All podcast episodes and transcripts can be found at www.eusci.org.uk/podcasts/. Music is Wallpaper by Kevin MacLeod (Link: https://incompetech.filmmusic.io/song/4604-wallpaper; License: https://filmmusic.io/standard-license)

Rod was diagnosed with Stage IIIB IBC and treated with FEC x 3, Taxol x 3, a mastectomy and axillary clearance, with 2/23 nodes positive, and had 33 doses of radiation. He has been on tamoxifen for six years. Rod soon realised that he needed to get up to speed on treatments to ensure that the was receiving best-practice protocols. Two years later, he was diagnosed with prostate cancer and had a prostatectomy. Currently he's NED for both cancers. Rod tries to engage effectively on social media He is a regular poster on Twitter @malefitness and contributes to various closed breast and prostate cancer Facebook pages. He also writes articles and creates videos. The articles can be found HERE and on the Media page of his website, MaleBC.org, which includes links to the latest research, and to a Manifesto which is aimed at securing some basic equivalence for men diagnosed with and treated for this disease. He's also the survivor story editor for the Male Breast Cancer Coalition. As well as speaking about male breast cancer at local functions, he volunteers as a telephone counsellor. Rod regularly appears in a variety of media, educating and informing the public about breast cancer as a genderless disease.

In this episode, Tina tells an edge-of-your-seat story about a “bad reaction” to a particular drug and what to look out for when taking a medicine known as Taxol.

Dr. Hayes interviews Dr. Bruce Chabner on his experience with cancer drug discovery and development, phase I trials and pharmacology.   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 JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO podcast network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.ASCO.org. Today my guest on this podcast is Dr. Bruce Chabner. Dr. Chabner's is widely considered one, or frankly if not the father, of our understanding of the pharmacology principles of anti-neoplastic drugs.   And probably more importantly, the translation of these principles to the intelligent application of the agents we use in clinic every day. Among the many accomplishments that Dr. Chabner has had working with his mentor, Dr. Joseph Bertino at Yale, who developed the concept of high dose methotrexate leucovorin rescue, that was completely based on their preclinical understandings of the mechanism of action, and more importantly, resistance to this agent. Dr. Chabner was also instrumental in the development of paclitaxel when he was at the National Cancer Institute, and he was intimately involved in many of the early studies that led to better understanding of AIDS and the ways to treat it.   Dr. Chabner was raised in Shelbyville, Illinois, and I'm going to digress for a moment, because I've always had a very special soft spot in my own heart for Bruce Chabner. A, because of his science, but more importantly, because I was raised in Shelbyville, Indiana. Both of these towns were named after Colonel Isaac Shelby, who was a hero in both the Revolutionary War and the War of 1812. By the way, Dr. Chabner, I know you were a big student of history when you were in college, so I thought you'd like this.   Dr. Shelby became the first and then the fifth governor of Kentucky, and as a citizen he was a land surveyor. There were actually nine counties and 11 cities and towns spread around the Eastern and Midwest regions that are named after Colonel Shelby. And I don't know about you, Bruce, but I had this drilled into my brain in eighth grade history class. I had to learn all about Colonel Shelby.   Anyway, so he and I are brothers in Shelbyville. Dr. Chabner received his undergraduate degree of Yale, where again, he spent a lot of his time in the history department but also in the biology department. And then he got his medical degree at Harvard, where he stayed to complete his residency in internal medicine at the Peter Bent Brigham Hospital before it became the Brigham Women's Hospital.   In 1967, Dr. Chabner became a clinical associate in medical oncology at the National Cancer Institute, where he was, in succession, a senior investigator in the laboratory of clinical pharmacology, chief of the clinical branch of the clinical oncology program, associate director of the clinical oncology program, and then he succeeded Dr. Ben [? Stabida, ?] someone I have previously interviewed for this series, as director of the division of cancer therapy.   In 1995, after 25 years at the NCI, he moved to Boston as the chief of the division of hematology oncology and the clinical director of the Massachusetts General Hospital Center, where he is now the clinical director emeritus. Dr. Chabner has authored, I counted, over 500 peer reviewed papers. I think even more than that. By the way, his first was in 1969, a case report of shaking chills related to occult lymphoma, authored with Drs. DeVita and the [INAUDIBLE] of the [INAUDIBLE] syndrome. Bruce, that really shows how old you are.   He's been the editor of all five editions of the Principles and Practice of Cancer Chemotherapy and Biologic Response Modifiers, which I consider the bible of cancer pharmacology. And I'm looking at my fifth edition on my bookshelf right now. He's trained too many Fellows for me to name, but numerous of them have gone on to be cancer center directors, chiefs of division, department chairs, and other leaders of oncology in the world. He's won way too many awards me to go through, but he received a Karnofsky award from ASCO, and he served on the ASCO board of directors.   Dr. Chabner, welcome to our program.   Nice, that's a lot of history. It speaks to my name.   Well, that's the problem of interviewing all of you folks. It takes a long time to get through all the things you've done. It's a good problem to have, though. First, I want to start out, I understand you carry the flag rank of rear admiral. And I want to know, have you ever even been on a ship? And more importantly, did you and Dr. Shelby actually serve together in the Revolutionary War? I couldn't figure that out.   You know, I never bumped into him when I was on the battleship Shelbyville, but who knows. He seemed to be what I call a name dropper. He left his name on so many different things, and I think there's a Shelby County, Tennessee, which is Memphis. Plus I think the smallest thing that he ever created was Shelbyville, Illinois, which was even smaller than your hometown.   Yep, that's true. All right, that's the last joke I'm going to tell in this interview, but I like that connection. Anyway, so how did a guy from Shelbyville, Illinois get to Yale and then Harvard and NCI? And more importantly, what made you decide to be an oncologist? I know your father was a general practitioner, but at that time the field barely existed. What was your motivation?   Well, OK, I'll tell you a bit of a story. My mother came from Chicago and she had a brother who was pretty smart. And he went to Harvard. And he used to come down to Shelbyville because he liked the pies that she made. And we were 200 miles south, so it was a trip for a pie, but anyway we used to play chess together. And when he was a college student and I was like in fourth grade, I beat him in chess and he said, Jesus, you ought to go to an Ivy League school. So that put the idea in my mind.   And then my parents were not really happy with that. They wanted me to go to Washington University or University of Illinois, but I wanted to get away from home. It was a little bit confining to be around my parents for the rest of my life. So I applied to Yale, Harvard, and Princeton, and the deal was I could go to school if I got a scholarship. So I got a scholarship to Yale, so I went there. I was happy with that choice. I really-- it was sort of, you know, life changing, actually. Stayed on the east coast.   But I still have many good friends from my Shelbyville days. We all get together once a year to play golf and poker and tell life stories.   So I have to interject. My father told me I could go to any college in the United States as long as the tuition was the same as in-state tuition of Indiana University, which at the time was $400 a year. So I ended up going to Indiana University. So how did you--   That was such a great deal. Yeah, that was my--   How did you get into oncology?   Well, when I was at the Brigham, I got interested in cancer. There was not much going on there, but one of my residents was a guy named Jack [? Moxley, ?] who had been a part of the initial study with DeVita and others, George [? Kinellas, ?] of the mop treatment for Hodgkin's disease. And I got really interested in that. And actually during my internship my sister got an immediate stromal tumor during her pregnancy, and it turned out to be a thymoma. But cancer really intrigued me at that point.   And we all had to apply for positions at NIH as a way to get out of the draft, and I wanted to do research, so that really appealed to me. And I actually applied for cardiology and cancer, and I was interviewed by Gene Brown for cardiology, and he didn't seem very impressed. But the cancer people did like me, particularly George and Vince, who had come back there. And they were young and energetic and they had interesting ideas about combination therapy, so I ended up in oncology.   Yeah, I talked with some of the other people I've interviewed about the so-called era of the yellow berets and how that really transformed medicine, in my opinion. Because so many smart people went to the NIH to stay out of Vietnam. It's probably the only good thing that came out the Vietnamese war, as far as I can see, and especially the NCI. So when you went to the NCI, [? Harlan ?] and Frye and [? Freirach, ?] I believe, were gone. So you've already started to say, it sounds like Dr. DeVita and Dr. [? Kinellas ?] were the movers and shakers at the time. Is that fair, or?   Yeah, well they were really young. I mean, it was like working for, you know, contemporaries. There were no old people there. And Frye and [? Freirach ?] weren't that old at that time. They were in their 40s with Vince and George, who were in their mid 30s. And I was 28 years old, I guess, when I went down there. I loved it. We had laboratory opportunities, we had patients, we had people that believed that they could change the way cancer was treated. George and Vince, particularly Vince, were so energetic and so committed to the idea of changing therapy, and particularly combination therapy.   And then the other thing that made it such a great experience were the colleagues that I had in my first group of clinical Fellows. Bob Young was part of it, and I became very close friends with Bob Young. And in the same group, David Livingston was my next door neighbor, and we had interned together and been arrested together. So we had just constant stimulation from a lot of different people, all of them energetic and interested in research.   Who else was in your class besides Dr. Livingston and Young, then?   Phil Shine, who made a name for himself in toxicology and then in industry. And let's see--   He was director at the cancer center at Georgetown for a while.   Georgetown, right. Subsequently, there was just a long list of wonderful Fellows. When I came back, I actually spent two years at Yale between my NCI time and then coming back to NCI. And I had a wonderful time with Joe Bertino. He was, I think, very important to me, because he was really a great scientist. And I learned a lot about biochemistry enzyme purification and working in the lab.   And so when I came back to NCI I had sort of converted to being an anti-folate person from being interested in alkylating agents. And so I was always interested, I guess, in anti-metabolites. But that was a great anti-folate experience with Joe, high dose methotrexate. It was really his idea, not mine. But the thing I worked on was the clinical pharmacology and trying to figure out why it was so toxic to kidneys. So we actually did some really interesting experiments.   We gave high dose methotrexate to monkeys, and then when they died, we took the kidneys out and looked at them. And we were doing it because we thought we would see interesting pathology. What we saw were a bunch of yellow gravel in their tubules. And it turned out it was methotrexate, and it became obvious what was happening. The drug was precipitating in the acid urine environment. But that was sort of the beginning of the methotrexate studies.   And personally, I don't think we teach pharmacology very well anymore. What made you want to go to high dose methotrexate?   Well, interestingly, I was particularly interested in-- Joe was trying head and neck cancer. There was almost simultaneously an article from Frye and Isaac [? Jurassi ?] about adjuvant therapy of osteogenic sarcoma. And there were several interesting things about that. One is that it turned out that 12 patients weren't all patients with osteogenic sarcoma. But prognosis of those patients wasn't apparently obvious.   But there seemed to be some success with it, and there was a lot of toxicity that they didn't really know how to deal with. And so I started doing pharmacokinetic monitoring in patients that we had that were on the treatment. And then when they went into renal failure, they just didn't clear the drug. The drug was hanging around for many days and they were getting this horrible toxicity. So we got into this business of why the renal toxicity and the need for hydration and alkylization, particularly.   And so first of all, I have to tell you I blamed you for much of my first year as a Fellow, because we had to draw the blood. So there were no study coordinators. Dr. Frye would just run around at all times of day and night drawing blood on patients for getting high dose methotrexate. And I still mumble under my breath when I hear your name.   Well, you don't have to do all of that now, but you know, in those days we were trying to get a more complete profile, so we did. There was a woman there at the Farber that was doing similar work. I can't remember her name.   Sue Pittman I think, right?   Yeah, Sue Pittman. That's right, that's right, that's right. But that was certainly the introduction to the anti-folate. And then I got into a very interesting area of polyglutamation and how it changed the potency of the drug and led to retention, and it was an important determinant of response. That was quite an interesting area of research.   Were you the first to report amplification of DHFR? No, that happened in 1978. I was working on MTX at the time and we had noticed that you could select highly resistant cells in culture. But then we were interested in knowing why, and Joe and Joe Bertino had described the fact that increased dihydrofolate reductase activity was found in this circumstance. But the actual demonstration of amplification in mammalian cells was done by Bob [? Shimke ?] when Joe was on a sabbatical with him.   And they had a medical student working in the lab on that on that paper, and that was Dan [? Haber ?] actually. Who came back to--   Who is now the cancer center director [INAUDIBLE], right?   Yeah, he wrote a key paper. So we had, at the time when that came out, we got interested in that. And we stuck radiolabeled methotrexate in the culture with some tumor cells and found these odd migrating entities that turned out to be polyglutamate. So that led to the whole issue of what were polyglutamates and how did they change the biochemistry? And that was quite interesting, and then actually at the same time we saw a patient.   It was a young man who came to NIH with non-Hodgkin's lymphoma and was treated with high dose methotrexate. I can't remember. I think he had CNS involvement or something like this. We found evidence of gene amplification in this patient. So it was actually the first demonstration that gene amplification occurs in people on the drug. There are a lot of interesting things that were happening at that time.   How was translational medicine before it was called translational medicine?   That was the nice part of NIH, you know? The emphasis was on the labs working with the clinics, and particularly with physician scientists. So, you know, we were one of the few places where our Fellows were expected to work in labs in their second and third years, and they did, and we had a wonderful group of Fellows that came through. The first guy that worked on polyglutamation of MTX was Rich [? Shilske. ?]   Who is now the chief medical officer of ASCO, and many, many other accomplishments after that.   Right. But many--   Actually, I'd like to change gears for a minute, because I know you had a lot to do with the development of paclitaxel. And I always found that story interesting that, you know, it was in the bark of the Japanese yew tree, which had to do with ultimate supplies. But also the first phase one trials, which some of that was done at the Dana Farber when I was there. Can you just walk through the history of paclitaxel? I think our listeners would love to hear this.   Well, it was an accident of history. Believe me. The thing started in 1964, when a group at the research triangle, a chemist, isolated this compound from the yew tree. And they didn't actually know what it was, but it was cytotoxic. And it was an anti-mitotic, and it took him seven years to figure out the structure. So finally in 1971 a guy named Ronnie from that group published the structure. It was a ridiculously complicated structure, And nobody could synthesize it, at least at that point.   It hung around in the lab and nobody was interested in developing it, because it was such an odd molecule. It was insoluble. Nobody can put it in solution. So it really wasn't an attractive pharmaceutical. And the thing that happened was, in 1978 or 1979, we had a very hot drug that was called maitansine. And we were very eager to put this into the clinic. And it was an anti-mitotic also, and very, very potent drug.   And so Dr. DeVita asked me to personally shepherd this thing and he told me that he didn't want it to fail. And so I put it into patients and it was terrible. And I kept telling him, this is not going to work. He said, it's got to work. He was pretty persistent. Well, it didn't, and he was very disappointed. So was I. And the fact is, we had nothing else to put in the clinic at that time except for paclitaxel. So we said, oh, well, we'll try it.   And we put it in a lipid emulsion. It was like putting it in engine oil or something, but it went into the clinic in several places. Peter [? Wernick ?] did it. Einstein. I guess you guys did it at the Farber. And it was causing all sorts of hypersensitivity responses. It looked impossible. And it took about, I don't know, four or five years to get it into a regimen that was tolerable. And there had been responses. The first response was in melanoma, so we were all excited about that.   That was the usual circumstance in those days that, when you took a drug into the clinic, melanoma would be the first response. And no one else from melanoma. Everywhere was-- and so but then Peter began noticing responses in ovarian cancer. And a regimen was worked out with antihistamines so it was reasonably tolerable. And finally in 1991, which was eight years after it went into the clinic, we finally decided, well, it was time to license it to industry. There was no patent, but we did it under a co-operative research and development agreement.   And the only company that was interested in the US was Bristol-Myers. Everybody else said, this is ridiculous. Nobody wants this drug. And it was too hard to make it. You had to make it from the bark of plants and it was insoluble and it caused hypersensitivity. So they took it. And about a month afterward there was a report from M.D. Anderson saying that it was active in breast cancer. And at that point it just took off like a rocket. And, you know, tried in all sorts of different diseases. Was active in lung and bladder and-- I can't remember all the other things. Head and neck.   Anyway, it became the first billion dollar drug in the cancer drug industry. And I think, you know, there are two things that really set off industry to be interested in cancer. One was that, the fact that you could actually make money on it. And the second was the notion of targeted therapies, which was growing at that time.   So to my knowledge, this is the only time somebody at the NCI had to work with the US Forest Service and the Bureau of Land Management regarding a new drug. Can you tell that story?   Well, yes. The only place where you get the raw material for the drug was from the US Forest Service. And so Texas plants were being sort of cut and burned because they were considered scrub and not worth anything as lumber. So they were cooperating. And finally when we licensed it, Senator Ron Wyden, who's still in the Senate from Oregon, got interested in this whole thing. He said, why isn't the government making money on this license? Why did you license it to Bristol-Myers and you didn't you didn't ask for anything back?   And we said, well, you know, that's not the function of NIH. We didn't have a patent. I guess we could have asked for a slice of the pie, but we didn't because no one else wanted it. We really were trying to give it away. And he was giving us a really hard time at this hearing. And then the key thing that happened was a woman who was a forest ranger with ovarian cancer, we found this woman, and she testified to how much good it did for her. And that sort of stopped all the fuss about the license.   And we actually, it was the first drug where as part of the licensing agreement we had the chance to fix the price or agree to the price that Bristol-Myers fixed. And the government never has done that since that time. Of course, this was a circumstance where we sort of owned the information, so they had to listen to it. But they set the price at $2,000 a course. And we consider that pretty high, but it was sort of equivalent to what other drugs were costing at the time, so we let that go by. But ever since then, the price of drugs has just escalated remarkably.   I hope there are some young people listening, because this story, in my opinion, the story of trastuzumab again, I think people think that these things just happen because the system makes them. And my experience is they happen because the drug or the treatment gets a hero, gets a champion. Ultimately the science has to prove it works, but I'm sure lots of people wanted to walk from Taxol.   You know, everybody thought it was a dog. Because it was, you know, caused hypersensitivity, it wasn't all that active in the initial testing, and it was really hard to make the stuff.   Well, the same thing is true with platinum I did my residency at UT Southwestern with Donald Sullivan, who's the chair of medicine. He was a renal guy, and a patient with metastatic-- and I had gone to Indiana. So Dr. [? Einhardt ?] taught me how to give it. So I had a patient come in with widespread testicular cancer, I wanted to give him cisplatin, and Dr. Sullivan wouldn't let me do it because it would hurt his kidneys. I said, Dr. Sullivan, he's going to die if we don't do this. And he said, he'll die anyway.   And so I did it behind Dr. Sullivan's back and I got a complete response. Fortunately in those days the residents didn't have a lot of oversight so I could do what I wanted to do. There were a lot of people that thought these drugs should be shut down, and it took the courage that you guys had back at the NCI and other places to push them out.   Don Sullivan was very anti cancer chemotherapy for the rest of his life. And it was odd for me, because I actually had a relative who was on his faculty and I went down there a couple times to talk. And I always felt very uncomfortable telling him that we were accomplishing something. Because his concept of success in science was getting an RO1 in your lab.   Yeah. He finally came to terms because [? Shelfke, ?] myself, Fred [? Lemaitre, ?] and a number of us went into oncology and had been reasonably successful. And I think he decided that it was worthwhile after all. But it wasn't easy for him. We lost him a year ago. I still miss him.   Yeah, he was an amazing guy, but he really did have a hard time believing in cancer.   So the other question, I wanted to change gears a little bit, because I know just about the time you became the director of the DCT was when the AIDS epidemic was exploding in the early 1980s. That must have been a very confusing situation about who should be in charge of this at the NIH, which institute, and how you approach it. Can you give us some background on that?   Again, it was really a crazy time. Because I remember one of the first patients that was identified as having AIDS was a person admitted to the immunology branch at the NCI. Not the medicine branch or the clinical branches. It was a patient who had disseminated tuberculosis and it had no CD4 cells. And, you know, everybody said, oh my god, what is this? This is really a weird, weird circumstance. And then other people began reporting this from San Francisco and New York.   So we actually, DCT, the reason we got involved was because of Bob Gallo. Bob Gallo had discovered the HTLV1 virus, which was causing this lymphoma in T cells. And we suspected that this might be a syndrome caused by a T cell virus. So in 1981, really quite early, we convened I think the first meeting about the biology of what was called HTLV2, I think, at the time, or three. I can't remember which one it was. But at any rate, there were a cadre of people at NIH that felt that it was caused by inhaling gases or, I don't know, their various weird theories about it.   But this theory that made sense to us was that it was caused by a virus. So Sam [? Brodeur ?] was collecting samples from patients and brought them over to Gallo's lab. And of course Gallo mixed those samples with the French sample and found virus and then made a test kit for the virus, which was really a key event in beginning to control the epidemic. And because of all that work going on at NCI at the time, we were asked-- we had the only drug development system at NIH.   We were asked to, well, look, can you set up a drug development system for this? And Sam [? Brodeur ?] set up assays in infected T cells and showed that certain nucleocyte analogs could stop the virus from replicating. The first one was ADT. And his first study was, I think, was 16 patients with AIDS in which he showed that the T cell counts recovered and people didn't die. And from that point on, we were getting significant funding for doing research on treatment development. And it was it was done in conjunction with NIAID and Tony Fauci.   What Tony did is he delegated a fellow to work with us and sort of be the liaison. And the first fellow that did that was Margaret Hamburger, who became [INAUDIBLE] FDA subsequently. And, you know, subsequently, four other people from our division-- well, actually one from NGH, became directors of FDA. Ned Sharpless most recently, and then Steve Hahn, who was a Fellow in the medical oncology group at NCI.   Yeah, he's just been named.   It was, you know, an unusual breeding ground for people interested in therapeutics.   That's interesting. You know, I was a third year resident at UT Southwestern. I was at the VA in March and a young man was admitted to our service. He had been a Vietnam veteran and he had red splotches all over him, so I called a dermatologist who biopsied it. And I got a page from the pathologist and I called him back and he said, you have mislabeled the samples. And I said, what do you mean? He said, well, this says it's a 37-year-old man. This is something I've never seen before, but I looked it up and it's called Kaposi sarcoma, and that only happens in old men or people from Africa.   And I said, I don't think we mislabeled things. And I think he was probably the first man in Dallas to be diagnosed with this. Because just as the MWR and the new journal paper came out a few months after that. So again, for the young folks listening to this, and we've already hit this a couple of times, it's one or two patients that pique your interest that often change the world in terms of, gee, I wonder why that happened.   Yeah, absolutely. I mean, you know, a lot of this is an outcome of the fact that you have research people as physicians who are working with patients, and then they ask questions.   Yeah. One of the things I've carried forward, Dr. Frye used to always say, think like a scientist. Think like a doctor. And ask yourself, so what? And I know you do that, because again, you've already told us today and I've seen you do that in other places. You know, so what? Why did this happen to this patient?   Why did that happen, yeah.   What in my lab actually will change that? And you guys did that in spades, I think, 40, 50 years ago. It's pretty amazing.   Yeah. Well, I [INAUDIBLE].   [INAUDIBLE]. Go ahead. Go ahead.   No, it's really happening a lot now, you know, in terms of recognizing subsets of diseases. We used to think that non-small cell lung cancer was just one disease. Now it's 20 diseases. It's amazing, you know? It's amazing, you know, as science progresses, you begin to understand the complexity of cancer. And then therapies become meaningful.   Yes, I agree.   It's so nice. And so I wish, you know, we were curing people. But we are making a difference, and least we're understanding it a little.   I agree. Anyone who has not heard or read Bruce Johnston's ASCO presidential address should do so. Because he did point out exactly what you just said. He had a pie chart, and 10 years ago the entire pie chart was chemotherapy for metastatic non-small cell lung cancer with little or no success. And now the pie chart is well over half the patients getting some kind of targeted or immunotherapy. Yeah, it's pretty amazing.   It is quite [INAUDIBLE] for young people that are listening to this, is that there are enormous opportunities for doing even better than we did. So we just made a start in this whole thing.   OK. With that inspiring message, which I'm glad you said it, we've run out of time. Actually we come at the end of our time. But Dr. Chabner, I want to thank you on behalf of all of us who trained after you, who've learned so much from what you've done, and more importantly, the patients who have benefited from the stuff that you've contributed to the field. It's pretty remarkable and inspiring. I don't use that word too often, but it is. So thank you, and thank you for taking time today. I hope folks listen to this and say, I'm going to go back and make a difference here.   Thank you, Dan. I have enjoyed it. It's been a wonderful time in this career.   Yeah. Well, my pleasure. Until next time, thank you for listening to this JCO's Cancer Story, the Art of Oncology Podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.ASCO.org.

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. 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. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. Greg Guthrie: Hi everyone, I'm Greg Guthrie, and I'm a member of the Cancer.Net content team. And I'll be your host for today's Cancer.Net podcast. As a reminder, Cancer.Net is the patient information website of ASCO, The American Society of Clinical Oncology. Today, we're going to be talking about some research highlights from the upcoming Supportive Care in Oncology Symposium. And my guests are Dr. William Dale and Dr. Joe Rotella. Dr. Dale is the Arthur M. Coppola Family Chair in Supportive Medicine at the City of Hope National Medical Center in Duarte, California. He is also the Cancer.Net Associate Editor for Geriatric Oncology. Thanks for joining us, William. Dr. William Dale: Thanks for having me. I'm happy to be here. Greg Guthrie: And Dr. Rotella is the Chief Medical Officer of the American Academy of Hospice and Palliative Medicine. Thank you for joining us as well, Joe. Dr. Joe Rotella: It's nice to be here with you today. Greg Guthrie: All right. Now, I also want to comment that William and Joe both served on the news planning team for this symposium, which means they helped select the studies that we'll be discussing on this podcast. So let's start off by discussing what is meant when we say “supportive care.”  William, what do you think when I say supportive care? Dr. William Dale: So supportive care medicine, and we have a Department of Supportive Care Medicine here at City of Hope, focuses on providing quality of life considerations for patients in a multidisciplinary way to emphasize functional status, to emphasize overall health for patients. Within supportive care, almost any part of the multidisciplinary team could be included outside of the cancer-directed therapy itself. As an example, palliative care exists as a division within our department of supportive care along with psychology, psychiatry, interventional pain, social work and some others. So when someone says supportive care, I think of everything outside of the cancer-directed therapy that we might do on a multidisciplinary team. Greg Guthrie: That's a great foundation to have before we jump into these studies. And the first one I'd like us to talk about is called “A pilot study of oncology massage to treat chemotherapy-induced peripheral neuropathy, also called CIPN.” So Joe, what is chemotherapy-induced peripheral neuropathy? Dr. Joe Rotella: Well, peripheral neuropathy is a nerve damage which is often associated with neuropathic pain which can be of 2 sorts: sort of a constant burning or a deep kind of pain, or it can be more of a sharp and shooting type of pain. But it's associated with the toxicity of some common chemotherapy drugs, particularly those related to platinum and the Taxol family of drugs. And so it's a pretty common side effect of pretty common chemotherapy that's given to people with advanced cancers and not an easy symptom to treat. The typical pain medications that we would use for any sort of pain, for example opioids, don't always work that well for neuropathic pain. And, of course, there are safety issues and other concerns around using opioids. The other medicines that are often used might fall in the class of the medicines like Gabapentin, or anticonvulsants. And they also can have quite a few side effects and are just not terribly effective. So this study looked at a nonpharmacological approach to managing the pain of chemotherapy-induced peripheral neuropathy. Very interesting, they looked at a standardized Swedish massage technique applied to the lower extremity, and then they had a number of other less intensive massage therapies that were used as a control. And they gave this 3 times a week over 6 weeks, and they were actually able to show a significant reduction in the symptoms related to the chemotherapy-induced peripheral neuropathy, and that it actually was sustained for up to 6 weeks after the massage treatment had been completed. So this was fascinating that we could apply what appears to be a low-risk treatment that seems to be free of significant side effects that falls in that category of complementary alternative medicine that is so appealing to patients, and that this actually showed results that lasted beyond the duration of the intervention. And the less intensive control interventions did not result in as much symptom improvement. So very interesting study. Greg Guthrie: Great. William, what do you think of this study? Dr. William Dale: You know, peripheral neuropathy is extremely difficult for patients to deal with in our treatments as Joe just pointed out, are kind of notoriously ineffective. It works for a few patients, but often it doesn't that well and the side effects are quite high. So looking for alternatives to medications is something that's on all of our lists. Too often patients, in some ways, either get medicines or they're left on their own devices. We don't really have good evidence base to tell them what to do. Even though this study is not huge, it was very well constructed. So we know what kind of massage was used, what kind of evidence we had, and that it had a longer-term effect. And I agree with Joe that it's really nice to have an alternative that we can say has evidence that we might let patients consider and that's outlined in a way that lets us say this was a causal relationship or at least seems to be that patients were put into these two groups and it really was the group that got this very specific Swedish massage that had these enduring effects. So it'd be great to see this in a larger group of patients and to know for sure if this will work from a wider group of patients, but as a starting point, to have an alternative to medications for such difficult-to-treat side effect with such quality of life implications is really exciting. The other thing I would mention and ask Joe about is they make the point that, these are licensed professionals. These were people who were expert at doing this kind of intervention. And patients sometimes ask, "Oh, can I get this?" And it would be nice to say just like any other intervention whether it was a medication intervention or a procedural intervention to say, "This is the way that this has to be done," and very specifically, what the outcome is expected. Too often we give vague information to people when it comes to so-called alternative therapies. But this was very specific to people trained to do this, presumably in patients who have cancer. Dr. Joe Rotella: Yes, I agree. It's actually important to have a sense of what the intervention is that is actually performing better, let's say, than control or better than placebo or better than no intervention. The more we can pin down exactly what works and what frequency, what intensity is needed to get the optimal results, the more we can treat this like we would a pharmacological therapy where we can say, "Here's precisely what I recommend for you. Here's the dose. Here's the frequency. This is where the evidence says you're likely to get the most benefit." And I think there are certain interventions in complementary alternative medicine where we're starting to get there, where we can actually say, "This technique works better than that technique." And I think that's when we can begin to bring it into the same sort of rigor that we do our pharmacological treatments. Greg Guthrie: Yeah, that's really great, just having an evidence-based approach to complementary therapies. So let's move on to our next study which is called “Anxiety, depression, pain, and social support in a large representative cancer population.” So what questions did this study set out to investigate? Dr. Joe Rotella: This study started with the recognition that pain is a very common symptom in patients with cancer and actually looked at what are some associations with pain? How does it relate to the presence of anxiety and depression? How does it relate to whether people have good social supports or not? Can we start to get a sense of how these things all interrelate to modulate the intensity and frequency of pain? And this study was interesting because it really looked at over 11,000 patients. And it was looking at patient-reported information. These were patients who were undergoing treatment for anywhere from stage I to IV cancer who were using a tablet to record their symptoms and information in a large academic center. And through this large database, a lot of analysis could be done to determine what were the key drivers of pain or modulators of pain. And what they found was a number of things were independently associated with the severity of pain in these cancer patients, included the site of the tumor. For example, head and neck cancer versus gastrointestinal cancer. The degree or severity of the disease, how advanced it was. Race and ethnicity was a predictor, lower income, all of these were independently associated with severe pain. But this study went a little further and looked at the effect of anxiety or depression and the level of reported social supports. And in all cases, if the patient reports high anxiety or high depression, it is associated with higher pain scores. But those could be further modulated by the degree of social support. So if a patient had low social support level as self reported, then the effect of the depression on pain was more. If they had anxiety and high levels of pain and the ones who had transportation issues, for example, tended to have even more pain. So with this really large database, we begin to get a sense of how these various factors interface. And it's not just a tumor type, it's not just a stage of the tumor, it's not just things like race, ethnicity, socio-economic status, but it's also the degree to which anxiety and depression are present and the degree to which there are social supports that can actually play a role in the level of pain that patients report. All of this would support this multidisciplinary holistic approach that we take in supportive care programs or when we're providing palliative care through a team. This really supports that concept that pain is not an island unto itself. The whole rest of the patients’ experience has a big impact on how they experience pain. Greg Guthrie: William, what are some patient takeaways from this study? Dr. William Dale: Yeah, to pick up on Joe's great summary of this, so overall, sometimes we have big studies but we don't have a reason for those studies to be big other than we happen to have a lot of data. What was nice in this study was they used the fact of a large dataset to show how the various variables interacted with each other. So in many cases, you can say well, if someone has a lower income or comes from a certain part of the world, whether a city or in an urban area versus a more rural area, they have worse outcomes. But, of course, those are very non-modifiable things. And it's perfectly fine to say it, but then what do we do about it? What made me feel good about this study was they said, "Well, if you have anxiety and depression, you can approach the problem this way. You can start to take care of those modifiable issues and that will help you with pain." Or if they live in a remote location, you could identify transportation. If you noted that they were living alone, for example, and they needed more help in the home, you could get that support. We all sort of feel that in our field, intuitively, that those things matter and are important. But this really started to connect the dots between pain and these other factors and how we might start to both take care of patients better, but to also start learning and putting the causal picture together about how this works. And to your question about patient outcomes, so the idea of patient-reported outcomes has become more common and I think for good reason to actually ask the patient, “What's going on? What's their experience? How are they feeling?” And this was nice because it put an emphasis on that. And in many cases as they reported—this was on tablet computers—patients and respondents to surveys will be more honest when they're talking to a computer than they were to people, especially if it's their oncologist. We know that they will often become nervous, that if they could tell the oncologist, "Oh, I'm having these other problems," that someone might stop their therapy. And so they don't want that to happen when they really need those outcomes so they can identify what's needed. So screening people for these problems, which we advocate for, this just emphasizes how important they are even for something as basic as pain management. And 1 other thing I wanted to mention, and Joe may want to weigh in on this as well, was this may help explain why we've had this so-called opioid crisis. And I don't want to overemphasize it, but if every time someone reports pain, our first instinct is to give them a medicine, especially an opioid medicine, and just increase the dose. Without identifying all these other factors, it's just an “If I have a hammer,” kind of solution to a problem, when really the multidisciplinary approach that palliative care and supportive care have always emphasized would do better even for something like the overuse of opioid medications. Dr. Joe Rotella: William, I really agree with you on that. Actually, the founder of the modern hospice movement who really started the whole palliative care movement as well, Cicely Saunders, had a concept she called “total pain.” And what it meant was that you may experience pain physically, but it is an experience that involves your physical being, your mental being, your social relationships, your spiritual concerns, that the whole person plays a role in how you experience pain. And whether we're prescribing an opioid or massage or a ride to the chemotherapy center, whatever else we're doing, that multidisciplinary approach that looks at all the experience of the patient, not just their physical experience, but what's happening not just in their body, but in their mind, in their heart, in their spirit. That's really the key to giving people the very best quality of life. And those interventions that are less physically oriented tend to be lower risk, they're tolerated well. It's just a question of getting that team engaged and providing that more holistic approach. Greg Guthrie: That's really great insight into this study. So let's switch to our third and last highlighted study for this symposium which is called “Racial/ethnic disparities in hospice utilization among Medicare beneficiaries dying from pancreatic cancer.” Before we delve deeper into the study, I think it's important if we define what hospice care is and what we may mean when we say disparities. So Joe, how would you describe these terms? Dr. Joe Rotella: Sure. Hospice care is a particular form of comprehensive palliative care that's provided to people near the end of life. Palliative care, supportive care is appropriate at any stage of illness when patients may experience stress or symptoms. But hospice care is designed for those patients that are near the end of life. And in our country, we have a Medicare hospice benefit which is in myriad insurance benefits, which means that it's generally a care that is accessible to almost everyone who is designated as most likely to be near the end of life. The Medicare benefit actually requires a physician to predict that it's probably the last 6 months or so. And it's a very comprehensive form of palliative care. It's really the gold standard of care for people who are nearing the end of life. And so what's interesting about hospice care though is even though it's comprehensive palliative and supportive care with a team right where you live in your home, wherever you call home, a lot of people don't access it at all or they don't access it until very late. Nationally, the trends are that about half the patients with Medicare who die actually get any hospice care before they die. And of those who do get hospice care, half of them get it for less than 3 weeks. And so it's really not fully utilized. And we could do a whole separate podcast on why people don't fully use it. But it's interesting then if it's sort of an underutilized service to try to determine either what drives that. And among other things, one way to try to understand it is to look at whether there are disparities. And by disparities, we mean, does 1 population seem to be treated or seem to be having outcomes that are different from another population who only differ, let's say, in race or ethnicity or gender? And so this study is trying to look at is there a difference in hospice utilization among Medicare beneficiaries who have a very specific condition? They're dying from pancreatic cancer. And again, large database looked at thousands of patients, and really, they were trying to see if there was an association between race or ethnic minority and the utilization of hospice before dying. Pancreatic cancer is a high mortality illness, and in fact, in this study, something like 64% of the patients did die during the course of the study. And there was a difference. Those from ethnic and racial minorities were less likely to initiate hospice care before they died. What's also interesting though is that disappeared if you looked at the very short hospice stay. If you looked at the patients who only got hospice for 1 or 2 or 3 days before they died. In that case, you don't see a racial disparity. But for that earlier hospice care, you do. This study can't explain why, but it really raises questions around why. Is it about how we present the option? Is it because there are different preferences for treatment near the end of life? Is it socioeconomic factors? Don't know from this, but what we can show here is just like with so many other parts of healthcare, there are in fact important disparities here that we should try to understand. Greg Guthrie: William, what are your thoughts on this study? Dr. William Dale: It's such a complicated story of why there are differences between groups. And this study has a great job of showing that we see these differences. I will reflect on my own personal experience of being in 2 different places with 2 different populations. First in Chicago where we had a mix of largely African-American patients and white patients, and now in Southern California where we have a group that's roughly one-third white, one-third Hispanic and one-third Asian. And just to take a simple thing like that, we all noticed differences in the communities with acceptance of the terms of hospice and end of life care. And I think we've all wondered gosh, it does seem like certain groups get it more often than others for a variety of reasons. And to have some data and a large dataset to show, that's really a good thing for us, so that we can advance to the next step of what are the reasons for that or as Joe just said, why is that? I note in the general population, about two-thirds of people when you ask them at the end of your life, what is your preferred location for dying? And two-thirds will say at home. And then when you look at the actual likelihood of where people die, it's about one-third that dies at home and about two-thirds that are in the hospital. Dr. Joe Rotella: Just to add a little bit more, there was something interesting kind of a side observation, and that is that in this particular study, although there was that disparity, overall, 74% of the patients actually did receive hospice care before dying. And so that's actually much better than that 50% or so that you see across the board for all people with all serious illnesses. And another set of disparities we might want to look at sometime besides race and ethnicity would be disease-specific disparities. Why do cancer patients have a higher rate of hospice utilization than patients with end-stage kidney disease, for example? Dr. William Dale: Yeah, that's a great point, Joe. And it makes me think of our ultimate goal when we talk about people having certain goals for their care including their end of life goals. And we use the term “goal-concordant care” so that people pass away where they want to. But boy, that is a moving target sometimes. And so it's helpful to just see well, where do we usually end up in terms of goal-concordant care. And cancer patients, I don't know what you think Joe, do tend to end up in hospice more often, but I still think the length of stay are pretty short even in the cancer population. Dr. Joe Rotella: I think that's true. And a lot of times, I think it may have to do with when the patient stops taking chemotherapy or some other direct cancer treatment. And in many cases, that's close to the end of life, and so then the stay is short. Dr. William Dale: Yeah, I think that's right. I do point out I'm at a cancer center. Our name is City of Hope. And so patients come here with that sense of their coming with hope for something. Usually some form of a new treatment or almost a miracle treatment that will rescue them. And we in the field are often trying to make sure patients understand hope for, can be hope for lots of different things. My old mentor, Bob Arnold, used to say hope for higher quality of life. Hope for meaningfulness. Hope for comfort. All should be part of the conversation. So broadening, again, beyond just the hyper focus on what can we do about this disease to a broader set of questions is probably the next thing we need to understand. Dr. Joe Rotella: Yeah, that'd be a great podcast [laughter]. Greg Guthrie: Well, I wanted to say I've heard the terms quality of life, multidisciplinary, and overall health a lot in our discussion today. And I think that that really just underwrites the role that supportive care plays in cancer treatments. And I think that that's just a great way to summarize the really interesting research that's coming out of this year's Supportive Care in Oncology symposium. So William, Joe, thank you for coming onto this podcast to talk about these studies and to show how they can help start to make improvements in patients’ lives. I really appreciate you taking the time to join us. Dr. William Dale: Well, thank you, Greg. We're looking forward to seeing these studies discussed at the conference. Dr. Joe Rotella: It was a pleasure. Thanks so much. Greg Guthrie: Thank you. ASCO: Find more research from recent scientific meetings at www.cancer.net.  And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network, a collection of 9 programs covering a range of educational and scientific content offering insight into the world of cancer care. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

Plants are stationary soldiers. Rooted to one spot, they are not able to chase nutrients or flee from herbivores and pathogens. So in addition to the basic metabolites they synthesise for their survival, they produce a diverse array of organic compounds through specialised biochemical pathways to counterattack threats. Some of these compounds have been found to combat human threats as well, and herbalists have been scouring these palettes of secondary metabolites for their health-promoting properties for centuries. Modern medicine also incorporates plant compounds. Around 80% of the world’s population already relies on ethnobotanical remedies and plant drugs, such as the antineoplastic Taxol, the antimalarial artemisinin, the analgesic codeine, the antidiabetic allicin, and the cardiac depressant quinidine. The high cost of new drugs, unpalatable side-effects and microbial resistance are driving a constant and renewed public interest on alternative and complementary medicine. Yet only a small fraction of the vast diversity of plant metabolism has been explored. Original article by Michelle Vierra, Strategic Marketing Manager at Pacific Biosciences If you'd like to view the original article then follow the link below: https://www.ddw-online.com/drug-discovery/p322923-mining-plant-genomes-a-modern-approach-to-herbal-healing.html You can also download the original article pdf here: https://www.ddw-online.com/media/32/136067/(7)-a-modern-approach.pdf For more information on Drug Discovery World, head to: https://www.ddw-online.com

Can life change with a single letter in the mail? For my guest today, it did, and subsequently, so did the lives of millions of people with various forms of cancer, including breast cancer.The letter in question came from the National Cancer Institute in 1977. The recipient was Dr. Susan Horwitz. The result: The creation of one of the most important cancer drugs that come from a natural product: Taxol, which is isolated from the yew plant. Today it is given to over a million patients.As you’ll hear, Dr. Horwitz work – indeed, her incredible curiosity – didn’t end there. She has continued to investigate new cancer treatments that leverage natural products. Why?Take triple negative breast cancer. By definition, it’s among the most challenging cancers to treat, comprising some 15-20 percent of all breast cancers. These aggressive tumors are treated with a cocktail of chemotherapy drugs. And although many patients have excellent survival following treatment, some patients with specific types of triple negative breast cancer have an incomplete response or even a relapse after a period of remission.Making them even more difficult: Triple negative breast cancer tumors are frequently resistant – or become resistant – to a variety of drugs, increasing their potential to spread to other tissues – a process called metastasis.To address these challenges, some scientists have screened novel chemotherapy drugs against triple negative cells to identify those with superior activity and less toxicity than conventional therapy. The goal: Find new therapeutic options -- new drug candidates – that they hope may lead to targeted therapies and new combination approaches to counter drug resistance and improve outcomes for patients with aggressive breast cancer.How does this process work? What progress has been made? How hopeful do the outcomes seem?Dr. Horwitz is the one to ask.Dr. Horwitz is a Distinguished University Professor and the Rose C. Falkenstein Chair in Cancer Research at the Albert Einstein College of Medicine in New York. Among her many honors: The Warren Alpert Foundation Prize from Harvard Medical School; American Cancer Society's Medal of Honor; the American Association for Cancer Research Award for Lifetime Achievement in Cancer Research. Most recently, Dr. Horwitz earned the 2019 Canada Gairdner Award, the country’s highest scientific prize. She has served as president of the American Association of Cancer Research, and has been a member of The National Academy of Sciences, the Institute of Medicine of the National Academies, [the American Academy of Arts and Sciences, and the American Philosophical Society,] and others. She also has been a BCRF Investigator since 2007.This was a remarkable conversation, not only for the science discussed, but also the role Dr. Horwitz has played in its history.

Paclitaxel is used to fight cancer by disrupting mitosis.

(Bonus: I bleeped any curse words so you can share this episode with your kids and your grandma.) Yes, October is Breast Cancer Awareness month but Dr. Donna-Marie Manasseh spends 12 months a year as a tumor hunter, saving lives. She is brilliant, uplifting, hilarious and a hero, quite honestly. She sat down in her Brooklyn office to talk about prevention, diagnosis, prognosis, when to get screened, what to do if you feel something weird, how to look forward to mammograms, how men can help family members stay informed, self-care and how she unwinds. Also: getting help with boob honkery, and rubbing rocks on your pits. This episode might be required listening for literally ... everyone. All the people. Dr. Donna-Marie Manasseh is the Chief of Breast Surgery at Maimonides Medical Center A few Breast Cancer Awareness resources: cancer.org, breastcancer.org, komen.org Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes! Follow @Ologies on Twitter or Instagram Follow @AlieWard on Twitter or Instagram More links at www.alieward.com Sound editing by Steven Ray Morris Theme song by Nick Thorburn A portion of Patreon donations this month will be donated to breast cancer research. Support the show.

Dr. Jack West, Swedish Cancer Institute, raises the question of whether to use immune checkpoint inhibitors as first-line treatment of lung cancer, alone or in combination with chemotherapy.

Dr. Jack West, Swedish Cancer Institute, raises the question of whether to use immune checkpoint inhibitors as first-line treatment of lung cancer, alone or in combination with chemotherapy.

Dr. Jack West, Swedish Cancer Institute, raises the question of whether to use immune checkpoint inhibitors as first-line treatment of lung cancer, alone or in combination with chemotherapy.

Dr. Jack West, Swedish Cancer Institute, defines maintenance therapy in advanced NSCLC and discusses maintenance treatment strategies.

Dr. Jack West, Swedish Cancer Institute, defines maintenance therapy in advanced NSCLC and discusses maintenance treatment strategies.

Dr. Jack West, Swedish Cancer Institute, defines maintenance therapy in advanced NSCLC and discusses maintenance treatment strategies.

Dr. Jack West, Swedish Cancer Institute, reviews the choices for a first-line chemotherapy regimen based on a squamous histology.

Dr. Jack West, Swedish Cancer Institute, reviews the choices for a first-line chemotherapy regimen based on a squamous histology.

Dr. Jack West, Swedish Cancer Institute, reviews the choices for a first-line chemotherapy regimen based on a squamous histology.

Dr. Jack West, Swedish Cancer Institute, addresses the issue of choosing a first-line chemotherapy regimen based on an adenocarcinoma histology.

Dr. Jack West, Swedish Cancer Institute, addresses the issue of choosing a first-line chemotherapy regimen based on an adenocarcinoma histology.

Dr. Jack West, Swedish Cancer Institute, addresses the issue of choosing a first-line chemotherapy regimen based on an adenocarcinoma histology.

Dr. Jack West, Swedish Cancer Institute, discusses the anti-angiogenic agent bevacizumab (Avastin) and the trial evidence of its efficacy for non-squamous NSCLC.

Dr. Jack West, Swedish Cancer Institute, discusses the anti-angiogenic agent bevacizumab (Avastin) and the trial evidence of its efficacy for non-squamous NSCLC.

Dr. Jack West, Swedish Cancer Institute, discusses the anti-angiogenic agent bevacizumab (Avastin) and the trial evidence of its efficacy for non-squamous NSCLC.

Dr. Jack West, Swedish Cancer Institute, identifies the platinum-based chemotherapy doublet as the backbone of first-line treatment for the majority of NSCLC patients.

Dr. Jack West, Swedish Cancer Institute, identifies the platinum-based chemotherapy doublet as the backbone of first-line treatment for the majority of NSCLC patients.

Dr. Jack West, Swedish Cancer Institute, identifies the platinum-based chemotherapy doublet as the backbone of first-line treatment for the majority of NSCLC patients.

For this episode, I was fortunate enough to speak with one of the real powerhouses of North Carolina, Bob Geolas. Bob is a North Carolina native who has reaped the benefits of the region’s growth over the past 50 years, and has made it his life’s work to give back first and foremost to the people and the future of this fine state. Bob’s career has taken him from politics to technology to his current job, which can only be described as building the cities of the future. As humble as he is, Bob knows the kind of individual and the sort of culture it takes to develop Research Triangle Park, one of the world’s best examples of brilliance in workplace engineering and culture building. RTP is an office park that houses some of the world’s greatest companies in technology and life sciences. The big ones, like IBM, Glaxo-Smith-Klein, and Cisco all have some of their largest and most forward thinking employee pools in RTP, each with over 5000 employees. They are housed next door to tiny startups, as almost 50% of RTP companies have fewer than 10 employees. Over time, companies housed in this 7000 acre park- a combination of trees, lakes, hiking trails, and massive buildings- can be credited with prolific inventions like Control-Alt-Delete, the scannable barcode, 3d Ultrasound technology, and Astroturf (that athletic turf we’ve all scraped our knees on during high school gym football.) Among the most significant of RTP accomplishments was the discovery of Taxol, hailed by the National Cancer Institute as the most important new anti-cancer drug of the past 15 years, and AZT, a drug used to fight HIV-AIDS. So ya, they do good work. Bob Geolas is the man charged with creating an environment for continued success in RTP. We talk about his time as an artist, his life as a non-technical leader in a technical world, his awesome snow day policy, Michillen restaurant guides, and much more. As Bob tells it, Walt Disney is a huge inspiration for him, so I’ll launch our conversation with a quote from the famed imagineer. “No city of today will be a guide for the city of tomorrow.”

Dr. Susan Band Horwitz, professor and cochair of the Department of Molecular Pharmacology at the Albert Einstein College of Medicine and associate director of the Albert Einstein Cancer Center, in conversation with her colleague Dr. David Goldman, professor of medicine and molecular pharmacology at the Albert Einstein College of Medicine and director of the Albert Einstein Cancer Center.   Dr. Horwitz reflects on her career, including how she developed an interest in cancer therapeutics, and her involvement in the development of Taxol.

GRACE, cancerGRACE, GRACEcast, Jared Weiss, Unveristy of North Carolina-Chapel Hill, UNC-Chapel Hill, induction therapy, neoadjuvant therapy, head and neck cancer, HNSCC, carbplatin, paclitaxel, cetuximab, Taxol, Erbitux, weekly

GRACE, cancerGRACE, GRACEcast, Jared Weiss, Unveristy of North Carolina-Chapel Hill, UNC-Chapel Hill, induction therapy, neoadjuvant therapy, head and neck cancer, HNSCC, carbplatin, paclitaxel, cetuximab, Taxol, Erbitux, weekly

GRACE, cancerGRACE, GRACEcast, Jared Weiss, Unveristy of North Carolina-Chapel Hill, UNC-Chapel Hill, induction therapy, neoadjuvant therapy, head and neck cancer, HNSCC, carbplatin, paclitaxel, cetuximab, Taxol, Erbitux, weekly

Dr. Jared Weiss from the University of North Carolina, reviews several options as induction therapy for head and neck cancer and focuses on the potential appeal and tolerability of the combination of weekly carboplatin and paclitaxel with cetuximab.

Dr. Jared Weiss from the University of North Carolina, reviews several options as induction therapy for head and neck cancer and focuses on the potential appeal and tolerability of the combination of weekly carboplatin and paclitaxel with cetuximab.

Dr. Jared Weiss from the University of North Carolina, reviews several options as induction therapy for head and neck cancer and focuses on the potential appeal and tolerability of the combination of weekly carboplatin and paclitaxel with cetuximab.

Dr. Jared Weiss from the University of North Carolina, reviews several options as induction therapy for head and neck cancer and focuses on the potential appeal and tolerability of the combination of weekly carboplatin and paclitaxel with cetuximab.

Dr. Jared Weiss from the University of North Carolina, reviews several options as induction therapy for head and neck cancer and focuses on the potential appeal and tolerability of the combination of weekly carboplatin and paclitaxel with cetuximab.

Dr. Jared Weiss from the University of North Carolina, reviews several options as induction therapy for head and neck cancer and focuses on the potential appeal and tolerability of the combination of weekly carboplatin and paclitaxel with cetuximab.

Drs. Nate Pennell, Mary Pinder, and Jack West review the results presented at ASCO 2013 from the PARAMOUNT trial of maintenance therapy with the ECOG 4599 regimen vs. carboplatin/Alimta (pemetrexed)/Avastin (bevacizumab) followed by Alimta/Avastin maint.

Drs. Nate Pennell, Mary Pinder, and Jack West review the results presented at ASCO 2013 from the PARAMOUNT trial of maintenance therapy with the ECOG 4599 regimen vs. carboplatin/Alimta (pemetrexed)/Avastin (bevacizumab) followed by Alimta/Avastin maint.

Drs. Nate Pennell, Mary Pinder, and Jack West review the results presented at ASCO 2013 from the PARAMOUNT trial of maintenance therapy with the ECOG 4599 regimen vs. carboplatin/Alimta (pemetrexed)/Avastin (bevacizumab) followed by Alimta/Avastin maint.

Drs. Nate Pennell, Mary Pinder, and Jack West review the results presented at ASCO 2013 from the PRONOUNCE trial of the ECOG 4599 trial regimen compared with carboplatin/Alimta (pemetrexed) followed by maintenance Alimta. 

Drs. Nate Pennell, Mary Pinder, and Jack West review the results presented at ASCO 2013 from the PRONOUNCE trial of the ECOG 4599 trial regimen compared with carboplatin/Alimta (pemetrexed) followed by maintenance Alimta. 

Drs. Nate Pennell, Mary Pinder, and Jack West review the results presented at ASCO 2013 from the PRONOUNCE trial of the ECOG 4599 trial regimen compared with carboplatin/Alimta (pemetrexed) followed by maintenance Alimta. 

Ovarian cancer expert William P. McGuire III Medical Director of Inova  Health’s Gynecological Cancer Outreach Program discusses his experience treating ovarian cancer over the past 4 decades.  Topics discussed include: How Dr. McGuire helped discover the role for Taxol in the treatment of ovarian cancer. New developments in the management of ovarian cancer Our understanding of the causes of ovarian cancer What’s on the horizon The role of nutrition in treating ovarian cancer You can reach Dr. McGuire  to schedule a consultation or second opinion  at 703-970-6545 and ask for Rubi 3289 Woodburn Road Suite 320 Annandale, VA 22003   Like What You Are Seeing (and Hearing) Please Share This Post With Your Friends By Clicking On the Links Below Not Already Receiving Weekly E-mail summaries of Dr T”s Health Blog?  Click Here To Register    …

Runtime 44:00 Memorial Sloan Kettering experts describe peripheral neuropathy caused by chemotherapy and offer tips for managing symptoms.

Dr. Gerard Silvestri, pulmonologist from Medical University of South Carolina (MUSC) in Charleston, reviews the subject of pneumonitis (inflamation of the lung tissue) induced by chemotherapy commonly used for treating lung cancer.

Dr. Gerard Silvestri, pulmonologist from Medical University of South Carolina (MUSC) in Charleston, reviews the subject of pneumonitis (inflamation of the lung tissue) induced by chemotherapy commonly used for treating lung cancer.

A cell-based, high-throughput screen identifies activators and inhibitors of invadopodia formation.

Taxol podcast from Chemistry World - the magazine of the Royal Society of Chemistry

The transcription factor HIF-1α is essential for a cell's response to low oxygen conditions. Carbonaro et al. demonstrate that production of HIF-1α protein is regulated by dynamic microtubules and that microtubule-targeting drugs shift HIF-1α mRNA into cytoplasmic P-bodies, where its translation is repressed by miRNAs. This biosights episode presents the paper by Carbonaro et al. from the January 10, 2011, issue of  the Journal of Cell Biology, and includes an interview with authors Marisa Carbonaro and Paraskevi Giannakakou (Weill Cornell Medical College, New York, NY). Produced by Caitlin Sedwick and Ben Short.   Subscribe to biosights via iTunes or RSS View biosights archive The Rockefeller University Press biosights@rockefeller.edu

Guest: William Burke, MD Host: Mark Nolan Hill, MD Scientists at many institutions are researching to find neuroprotective agents for ALS. While today's guests research focuses on other neurological diseases, he recently wrote a commentary to a published neurology article about ALS research suggesting that the properties of a drug, Taxol should also be considered in animal models researching ALS. In this segment, Dr. Mark Nolan Hill talks with Dr. William Burke about ALS and why Taxol may be a worthwhile drug to examine in animal models as a neuoroprotective agent for ALS.

Vererbung und intrazelluläre Positionierung von Mitochondrien werden in eukaryotischen Zellen durch verschiedenartige Zytoskelett-abhängige molekulare Maschinerien vermittelt. Dabei spielen insbesondere Mikrotubuli eine herausragende Rolle in Säugetierzellen und in einigen Pilzen. Außer einzelnen Motorproteinen, welche an der Interaktion von Mitochondrien mit Mikrotubuli in Säugerzellen beteiligt sind, sind keine weiteren die Interaktion vermittelnden Komponenten bekannt. Ziel der Arbeit war, in dem filamentösen Pilz Neurospora crassa als Modellorganismus Proteine zu identifizieren, die an der Interaktion von Mitochondrien mit Mikrotubuli beteiligt sind und diese zu charakterisieren. Zuerst sollte die biochemische Grundlage der Wechselwirkung zwischen Mitochondrien und Mikrotubuli durch Entwicklung und Einsatz von in vitro-Testsystemen aufgeklärt werden. Hierfür wurde ein biochemisches Testsystem entwickelt, in dem isolierte Mitochondrien mit Taxol-stabilisierten Mikrotubuli unter verschiedenen Bedingungen inkubiert werden, um nach Saccharosegradienten-Zentrifugation die Assoziation zwischen Mitochondrien und Mikrotubuli zu analysieren. Zusätzlich sollten die Ergebnisse dieser Versuche in einem fluoreszenzmikroskopischen Testsystem verifiziert werden. Dafür wurde die Expression von mitochondrial zielgesteuertem GFP in N. crassa etabliert. Auf diese Weise konnte nicht nur das Verhalten und die Morphologie von Mitochondrien in verschiedenen Stadien des Lebenszyklusses in vivo beobachtet werden, sondern isolierte GFP-gefärbte Mitochondrien konnten zudem für eine mikroskopische Interaktionsanalyse mit Rhodamin-gefärbten Mikrotubuli verwendet werden. Unter Einsatz der beiden Testsysteme wurde eine spezifische ATP-abhängige Interaktion zwischen Mitochondrien und Mikrotubuli nachgewiesen, die durch peripher mit der mitochondrialen Außenmembran assoziierte Proteine vermittelt wird. Diese Ergebnisse deuteten auf eine Beteiligung von Motorproteinen an der Assoziation von Mitochondrien mit Mikrotubuli hin. Deshalb wurde im Genom von N. crassa gezielt nach Sequenzen gesucht, die Kinesine kodieren, die diese Rolle übernehmen könnten. Es wurden zwei neue Mitglieder der Unc104-Kinesinfamilie identifiziert und im Rahmen dieser Arbeit charakterisiert. Eines dieser Kinesine, Nkin2, ist peripher mit der Außenmembran von Mitochondrien assoziiert. Unter Verwendung der in vitro-Testsysteme wurde die Beteiligung von Nkin2 am Transport von Mitochondrien im Wildtyp belegt. Die Interaktion der Mitochondrien mit Mikrotubuli in vitro kann durch eine Präinkubation von Zusammenfassung Mitochondrien mit Antikörpern gegen Nkin2 geblockt werden. Um die Funktion von Nkin2 im Mitochondrientransport in vivo zu untersuchen, wurden nkin2-Deletionsmutanten erstellt und funktionell charakterisiert.Die Deletion von Nkin2 führt in vivo zu einem eingeschränkten Mitochondrientransport in auswachsenden Hyphen. Dieser Phänotyp wird durch Überexpression des zweiten neu identifizierten Mitglieds der Unc104-Familie, Nkin3, komplementiert. Zwar ist Nkin3 im Wildtypstamm nicht auf Mitochondrien lokalisiert, es wird aber bei Abwesenheit von Nkin2 hochreguliert und spezifisch an die Mitochondrien rekrutiert.In Abwesenheit von Nkin2 ist Nkin3 essenziell für die Interaktion in vitro von Mitochondrien mit Mikrotubuli. Diese Ergebnisse deuten auf eine funktionelle Redundanz von verschiedenen Motorproteinen im Mitochondrientransport in N. crassa hin, die in ähnlicher Weise auch in Säugerzellen vorliegen könnte. Da Transport und Vererbung von Mitochondrien nicht nur von dem beteiligten Motorprotein abhängen, sondern auch mit Fusions- und Teilungsvorgängen der mitochondrialen Membranen verknüpft sind, wurde eine Stammsammlung von Deletionsmutanten nichtessenzieller Gene in der Hefe Saccharomyces cerevisiae nach Komponenten mit einer Funktion in der Morphogenese von Mitochondrien durchmustert. Im Rahmen dieser Arbeit wurden drei neue Gene identifiziert. Die aus der Deletion dieser Gene resultierenden Phänotypen werden beschrieben.

Zusammenfassung: Unter den Tumoren des weiblichen Genitales hat das Ovarialkarzinom die schlechteste Prognose. Die Möglichkeiten der Früherkennung und apparativen Diagnostik sind sehr eingeschränkt so dass 75 % der Erkrankungen erst in den fortgeschrittenen FIGO-Stadien II, III und IV diagnostiziert werden. Es ist daher wichtig dass diese Frauen in spezialisierten Zentren durch onkologisch erfahrenen Gynäkologen behandelt werden. In unserer Klinik wurden in einem 5-Jahreszeitraum 118 Patientinnen zum Teil mehrmals sowohl operativ als auch chemotherapeutisch behandelt. Die Anzahl der Patientinnen die einheitlich behandelt wurde ist somit ausreichend groß um Aussagen über das operative und chemotherapeutische Vor-gehen treffen zu können. Die Ergebnisse zeigen das trotz ständiger Suche nach neuen Prognosefaktoren die bekannten Faktoren wie das Grading und der belassenen Tumorrest für das Überleben entscheidend sind. Der Tumormarker CA 125 liefert in dem Fall wenn er von den Tumorzellen expremiert wird ein gutes diagnostisches Instrument um das Ergebnis der Therapie und den Verlauf der Erkrankung zu kontrollieren. Die präoperative Diagnostik zeigte dass insbesondere über die sichere Dignität und das Ausmaß des Tumorbefalls keine sicheren Aussagen getroffen werden kann und eine optimale Vorbereitung der Patientinnen in jedem Ver-dachtsfall unerlässlich ist. In dieser Arbeit wurde ein Patientengut untersucht die in der First-Line The-rapie eine platinhaltige Chemotherapie und in der Second-Line Therapie eine Taxol Therapie nach einer möglichst maximalen tumorreduktiven Chirurgie erhielten. Die operativen Ergebnisse zeigen dass auch in fortgeschrittenen Tumorstadien bei vielen Patientinnen eine nahezu vollständige Tumorreduktion unter vertretbarer Morbidität möglich ist. Es ist uns unter Einsatz des CUSA-Gerätes gelungen eine geringe Quote an Darmresektionen zu erreichen so dass die notwendige Chemotherapie bei geringen postoperativen Komplikationen baldmöglichst begonnen werden konnte. Auch bei Frauen mit einem Rezidivtumor war durch die erneuten Operationen bei ca. der Hälfte der Pati-entinnen eine neuerliche Tumorfreiheit zu erzielen. Auch wenn diese Patientinnen in der Regel jünger und waren und eine bessere Prognose hatten zeigen unsere guten Überlebensraten nach 1. Interventionslaparotomie zwei weitere Ergebnisse. Erstens ist auch beim Rezidiv die maximal reduktive Tumorchirurgie möglich und sinnvoll und das Chemotherapeutikum Taxol hatte auch in der Second - Line Therapie gute Ansprechraten. Vergleicht man unsere Ergebnisse jedoch mit den neueren Daten seit Mitte der neunziger Jahre in dem Taxol und Carboplatin in der First-Line Therapie eingesetzt wurden können wir die verbesserten Überlebensraten nicht erreichen und haben aufgrund der vorliegenden Daten unser chemotherapeutisches Vorgehen seit 1994 umgestellt. Es scheint aufgrund dieser Daten eine erneute Diskussion um eine alleinige platinhaltige First-Line Therapie nicht sinnvoll. Wir denken das aufgrund unserer Ergebnisse bei der großen Anzahl der Patientinnen die unter gleichen Voraussetzungen behandelt wurden und der damit verbundenen Erfahrung es wichtig ist einen Vergleich zu unseren Patientinnen die nach Einführung des Taxol in die First-Line Therapie zu haben. Wir haben daher eine weitere Arbeit über einen gleichen Zeitraum mit Patientinnen unserer Klinik geplant und können dann sicher noch exaktere Aussagen über die Wertigkeit des operativen Vorgehens und der First-Line Chemotherapie treffen. Trotz des Wechsels des chemotherapeutischen Vorgehens sind die Überlebensraten dieser Erkrankung weiterhin ernüchternd und es muss weiterhin an einer verbesserten Früherkennung gearbeitet werden. Das unterschiedliche biologische Verhalten der heterogenen Gruppe der Ovarialtumore muss besser verstanden werden um eine optimale Chemotherapie im entsprechenden Stadium durchführen zu können. Die Möglichkeiten einer suffizienten Rezidivtherapie nach Einführung des Taxol und Carboplatin in die Primärtherapie müsste eindeutiger geklärt werden. Vielleicht können uns in Zukunft neue Ansätze im Bereich der molekularen Ebene innovative Diagnostiken und Therapien bringen und den Wunsch erfüllen das Ovarialkarzinom heilbar zu machen.

Der programmierte Zelltod (Apoptose), ist ein evolutiv konserviertes Selbstmordprogramm der Zelle, um auf äußere oder endogene Signale zu reagieren. Es dient dazu, überflüssige und/oder geschädigte Zellen zu entfernen. Dieser Prozess ist bei Krankheiten wie z.B. Krebs teilweise außer Kraft gesetzt, und bei Parkinson- oder Alzheimer-Erkrankung zu stark ausgeprägt. Im Rahmen dieser Arbeit wurden zwei Gene biochemisch und molekularbiologisch näher charakterisiert. Bei diesen zwei Genen, die mit Hilfe eines speziell zur Identifikation dominanter, Apoptose–induzierender Gene entwickelten Screnningsverfahrens identifiziert wurden, handelt es sich um CybL, eine Komponente von Komplex II der Atmungskette, und um Saip (Small apoptosis inducing protein) einem Protein, das am endoplasmatischen Retikulum (ER) lokalisiert ist. Bisher war bekannt, daß die Atmungskettenkomplexe I und III bei der Fas-Ligand und der Ceramid-vermittelten Apoptose beteiligt sind. Über einen Zusammenhang von Komplex II und Apoptose-Induktion war zu Beginn dieser Arbeit nichts beschrieben. Im Rahmen dieser Arbeit wurde entdeckt, daß neben CybL kann auch noch die kleine Untereinheit von Komplex II (CybS) Apoptose auslösen kann, wohingegen die übrigen Komponenten von Komplex II, das Flavinprotein (FAD) und das Eisen–Schwefelprotein (FeS), nicht in der Lage sind, Apoptose zu induzieren. Die laut Datenbank vorhergesagten vier Transmembrandomänen von CybL sind für die apoptoseinduzierende Eigenschaft notwendig. Darüber hinaus führt nur eine 3,8–fache Induktion von CybL über dem endogenen CybL zu Apoptose in Säugetierzellen. In der vorliegenden Arbeit konnte auch gezeigt werden, daß CybL einerseits bei Überexpression Apoptose induzieren kann, und andererseits Apoptose durch seine Inaktivierung reduziert wird. Daß CybL damit ein spezifischer Sensor für Apoptose ist, konnte dadurch ermittelt werden, daß eine Reihe verschiedener Apoptosestimuli (Doxorubicin, Etoposid, Menadion, Cisplatin, Taxol) und der Fas-Rezeptor einen intakten Komplex II zur Signalvermittlung benötigen. Dazu wurde mit sogenannten B9/B30 Zellen gearbeitet. B9/B30-Zellen sind Lungenfibroblasten aus Hamsterzellen, in denen CybL inaktiv ist (B9), wohingegen die B30-Zellen ein Fusionsprotein zwischen CybL und GFP enthalten, welches die physiologische Aktivität von Komplex II wiederherstellt. In den B9-Zellen ist die Apoptoseinduktion durch Cytostatika (Ausnahme Arsentrioxid) bzw. durch den Fas-Rezeptor reduziert, verglichen mit den B30-Zellen. Auch Untersuchungen an HeLa WT- bzw. HeLa 0-Zellen (die keine intakte Atmungskette besitzen) zeigten, daß für die Apoptoseinduktion mit den oben genannten Reagenzien eine intakte Atmungskette benötigt wird. Im Jahre 2000 wurde CybL als Tumosupressor beschrieben. Es ist daher zu vermuten, daß die Tumorsuppressor-Eigenschaften von CybL auf der Fähigkeit von Komplex II beruhen, proapoptotische Signale aufzunehmen und weiterleiten zu können. Bisher war bekannt, daß eine transiente Inhibition einiger Atmungskettenkomplexe (Komplex I, II, III) zur Bildung von reaktiven Sauerstoffintermediaten (ROI) führt. Es konnte gezeigt werden, daß auch CybL bei Überexpression reaktive Sauerstoffintermediate produziert, und daß viele proapoptotische Signale zur spezifischen Inhibition von Komplex II führt. Da bereits eine geringe Expression von CybL ausreichend ist, um Komplex II zu inhibieren, und dadurch Apoptose ausgelöst wird, kann Komplex II als spezifischer Sensor für Apoptose angesehen werden. Das bisher unbekannte Gen mit dem Namen Saip löst dominant Apoptose in Säugetierzellen aus. Die proapoptotische Eigenschaft von Saip ist vermutlich auf einen evolutiv konservierten Mechanismus zurückzuführen, da auch ein Homolog aus C.elegans nach transienter Transfektion in Säugerzellen Apoptose auslöst. Dabei induziert Saip Caspase-abhängige Apoptosewege, die zur Apoptose-typischen DNA–Fragmentierung und Bildung von apoptotischen Körperchen (Membran blebbing) führt. Es konnte auch eine physikalische Protein-Proteininteraktion (mittels Co-Immunpräzipitation) mit Bap31 gefunden werden. Dieses Protein ist ebenfalls am ER lokalisiert und Bestandteil eines lokalen Apoptose-Sensors, der einen Proteinkomplex mit Procaspase-8L sowie antiapoptotischen Mitgliedern der Bcl-2-Familie (Bcl-2 bzw. Bcl-XL) bildet. Des weiteren interagiert Saip auch mit einer Deletionsmutante von Spike (Small protein with inherent killing effect-SpikeN19), einem neuen proapoptotischen BH3-only Protein, das ebenfalls am ER lokalisiert ist, und an Bap31 bindet. Saip ist ein ubiquitäres Protein und wird in sehr vielen der getesteten Gewebe und Zelltypen exprimiert. Im Northern-Blot-Verfahren konnte vergleichsweise eine hohe Expression an humaner Saip-mRNA in Niere, Placenta, Herz, Leber, Dünndarm und Skelettmuskulatur detektiert werden. Mit Hilfe von weiteren Northern-Blots wurde herausgefunden, daß Saip durch diverse Reagenzien, die bekanntermaßen Apoptose induzieren können, transkriptionell hochreguliert wird. So ist zum Beispiel das Signal von Saip nach 5-Fluorouracil-Behandlung (5FU), um das 80-fache gegenüber der Kontrolle erhöht. 5FU ist ein sehr effektives und bekanntes Zytostatikum, das in der Klinik zur Behandlung von Colon- und Mammakarzinomen erfolgreich eingesetzt wird. Wird Saip mittels der RNAi–Methode deaktiviert, wird die 5FU-induzierte Apoptose um 1/3 reduziert. Saip könnte somit eine wichtige Rolle in der Behandlung von Tumoren spielen, die mit 5FU therapiert werden.