Such a practice is relatively common among many illnesses, but it especially prevalent among breast cancer patients. Known as off-label drug use, doctors often prescribe drugs that are FDA-approved for the treatment of other conditions, but not breast cancer. The term “off-label” refers to the drug label report that is approved by the FDA. Such a report dictates approved doses and for which medical conditions the drug is considered a safe and effective treatment.

In terms of breast cancer, M.D. Anderson researchers found that 35 percent of women were treated with off-label chemotherapy drugs between the years of 1991 and 2002. This percentage was calculated by using the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. This database is considered the most extensive cancer registry in the United States, and represents 26 percent of the entire U.S. population.

All women in the study were aged 65 years or older. Researchers note that oncologists tend to treat older patients more conservatively. As such, the actual percentage of breast cancer patients using off-label medications may be higher than 35 percent.

The most prevalent off-label drug used to treat breast cancer was Navelbine® (used by 16 percent of all off-label breast cancer patients). Navelbine is a drug approved for the treatment of lung cancer. Gemzar® – a pancreatic cancer drug – was also a commonly prescribed off-label treatment.

Both chemo drugs have been shown to be effective in the treatment of breast cancer. However, clinical trials explicitly testing the safety and effectiveness of such drugs for use in breast cancer treatment have not been completed. Drugs that have been proven effective, but as of yet properly passed clinical trials, make up the majority of off-label drug cases.

However, some off-label drug use is considered hazardous or shows no signs of medical benefit. In fact, researchers found that seven percent of off-label breast cancer treatments were considered medically inappropriate.

Such off-label use raises controversy around the unrestricted use of FDA-approved drugs. Additionally, off-label use of chemo drugs is typically not approved by Medicare, Medicaid and insurance.

Resources: http://www.mdanderson.org/newsroom/cance…
 http://www.cancer.org/docroot/ETO/conten…

The benefits of HDAC inhibitors are linked to their ability to augment tumor growth. Specifically, these inhibitors interfere with angiogenesis (growth of new blood vessels needed to feed tumors) and cell cycling. They also spur programmed cell death.

HDAC inhibitors are further heralded for their ability to boost the effectiveness of current cancer treatments.

Histone acetylases are enzymes associate with RNA synthesis. A number of HDAC inhibitors have been found to exhibit beneficial control of cancer cell transcription. Different HDAC inhibitors alter cellular functions in a variety of ways, from cell differentiation and apoptosis to cytoskeletal modifications. These multiple pathways for treatment serve to provide researchers with a vast number of research possibilities.

A small number of HDAC inhibitors have already entered experimental trials. For example, FK228 (depsipeptide) has been found to be an effective treatment for prostate cancer among mice. The general consensus is that such treatments are relatively safe, with primary symptoms that include reduced white blood cell production (neutropenia) and reduced presence of platelets (thrombocytopenia).

HDAC inhibitors have also shown treatment potential outside of the realm of cancer. Most notably, brain disorders such as Huntington’s disease, multiple sclerosis and Rett syndrome have emerged as disorders that may benefit from HDAC inhibition.

Resources:
 https://www.leaddiscovery.co.uk/reports/…
 http://www.ncbi.nlm.nih.gov/pubmed/11914…
 http://www.nature.com/nrd/journal/v7/n10…
 http://cat.inist.fr/?aModele=afficheN&am…

The monoclonal antibodies, dubbed anti-41BB and anti-CD40, “super-charged” the immune systems to spur the eradication of cancerous neuroblastoma tumors in 40 to 60 percent of all laboratory tests.

When one of the antibodies was combined with a unique peptide (protein fragment), the results were similarly promising for more aggressive tumors.

The two antibodies are designed to bind with molecules in the immune system. Once attached, the antibody stimulates the production processes, causing the immune system to spring into action.

The study, while promising, is still in the very early stages of research. As Juliet Gray, leader of the Southampton study, states: “Although this work is still at a pre-clinical stage, we hope it has enabled us to identify a way that we can provide effective immunotherapy treatment against neuroblastoma.”

Neuroblastoma is a type of cancer that attacks the nervous system. Though rare, it is the most common type of cancer diagnosed in infants. Present chemotherapy treatment methods return a 60 percent success rate among patients diagnosed with the illness. It is hope that these new immunotherapy solutions may one day become a viable new treatment option.

Immunotherapy – the process bolstering the body’s immune system to better fight illness – has already proven successful in the treatment of adult cancers. Similar monoclonal antibodies are presently FDA-approved for medical treatment. Some of these include rituximab (Rituxan or MabThera) and alemtuzumab (Campath).

Next for the Southampton team is to research the safety and effectiveness of monoclonal antibodies in children. Studies will also be conducted to determine of immunotherapy can be used in conjunction with chemotherapy treatments.

Resources:
 http://www.reuters.com/article/latestCri…
 http://www.pharmacyeurope.net/default.as…

A handful of cancers have already been linked to viruses. For example, hepatitis B can cause liver cancer and the human papilloma virus can cause cervical cancer. However, Ewald believes that by the year 2050, we will have identified infections that cause as many as 95 percent of all cancers.

To verify this claim, Ewald points out that cancer requires “a few specific genes to be mutated, within a limited number of cell divisions, to cause the cells to divide uncontrollably.” A mutation of any of the other 30,000 genes results, not in cancer, but in cell death or similar crippling results. It has already been proven that both hepatitis B and human papilloma have evolved to specifically spur gene mutations associated with cancer.

Given the fact that random gene mutations are highly unlikely to target the correct genes, Ewald hypothesizes that unidentified infections are behind the majority of cancers. However, this does not mean that genetic defects or mutations do not contribute to cancer. Ewald states that “viruses push cells to the brink; additional mutations from genetic defects or the environment are needed for full-blown cancer.”

Sexually transmitted diseases and kissing diseases have the most potential to cause cancer, according to Ewald. This is due to the long-term low profile of these infections, which allows them to be passed on to multiple partners over the course of several years. Currently, almost all identified cancer-causing viruses fit into these categories.

Ewald believes that by targeting the evolution of viruses and other pathogens, healthcare costs could be cut by 80 percent in the future. This dramatic drop would largely be due to infection prevention measures that would ultimately halt the formation of cancer before it can manifest. Additionally, steps could be taken to ensure that, if you are infected with an identified virus, the probability of cancer can be minimized. Vaccines used to prevent cervical cancer and blood test screening for hepatitis B are current examples that such tactics work.

Resource:
 http://discovermagazine.com/2009/new-sci…

The findings serve as promising evidence that the improved sensitivity and effectiveness of DNA sequencing technology is providing more pertinent and rapid results in relation to cancer gene profiling. Successful identification of over-expressed genes, for both mesothelioma and other types of cancer, can help dictate the best course of cancer treatment.

As lead author of the BWH study, David Sugarbaker, explains: “after spending a year and a half to develop the methodology and software for the pipeline, new tumors can be analyzed over the course of about a month. Knowing which genes are mutated opens the door to better understanding and the discovery of more targeted and effective patient-specific treatments in real time.”

In the initial mesothelioma analysis, tissue samples were taken from four patients with malignant pleural mesothelioma, one patient with lung cancer and one with normal lung tissue. All expressed genes from each sample were sequenced (numbered in the billions). With no preconceived notions of which genes may be indicators of mesothelioma, 15 new mutations were identified in the four mesothelioma tumor samples.

Moreover, it was found that each tumor had unique genetic mutations not shared by any other tumor sampled. This suggests that mesothelioma tumors are singularly unique, much like our fingerprints.

Ultimately, this study exhibits the promise of advancements in DNA sequencing technology. One day such technologies may be a standard procedure for all cancers used for the purpose of identifying tumor mutations and dictating treatment. As Fleisher envisions it: “every patient’s tumor will be directly sequenced to determine its mutations and optimal treatment just as we now identify the cause of an infection before selecting the best antibiotic to treat it.”

Resources: http://www.brighamandwomens.org/PressRel…

One of the newest technologies currently in development is a class of products known as microfluidics microchips. Such computer chips allow scientists to capture rare types of tumor cells and isolate minute gene expressions that could potentially help dictate viable treatment options.

Presently, such microchips are in clinical trials as a treatment aid for prostate cancer. The study, being conducted at the Genitourinary Oncology Service at Memorial Sloan-Kettering Cancer Center, will consist of prostate cancer patients that have responded poorly to other forms of treatment.

Through microchip analysis, a comprehensive genetic profile will be provided for each participant. As Martin Fleisher, chairman of Department of Clinical Studies at Sloan-Kettering, suggests: the goal of this gene analysis is to determine which “genes are over-expressed and whether or not [the participants] would be candidates for certain types of targeted therapies that would beat down their cancer.”

Gene profiling is currently used to dictate treatment regiments for several cancers. For example, Herceptin is typically only used on breast cancer patients that have a specific protein present in their tumors.

However, prior to microfluidics, doctors were required to obtain a biopsy to obtain a proper gene profile. Such a luxury is not always available. As a workaround, scientists have longed for a reliable way to identify and isolate the low concentrations of tumor cells present in the bloodstream. Sloan-Kettering’s microchip seems to be the solution.

The microfluid chip Sloan-Kettering is employing for the study is manufactured by Fluidigm. The technology is remarkably advanced, with the ability to filter DNA from each cell into one of 96 microscopic channels. Reagents entering from the opposite side combine with the cells to create 9,000 simultaneous reactions. These reactions indicate differences in gene expression, and serve to effectively profile cancer cells.

For the prostate cancer study, researchers will analyze approximately 30 key genes in each patient. Expression of these genes, many related to testosterone production and cell signaling, have previously responded well to dasatinib in animal models. Dasatinib is a chemotherapy drug that is currently used to treat chronic myelogenous leukemia.

Once the most promising candidates for the drug have been identified through microfluidics, clinical trials will be initiated to test the predictive effectiveness of this burgeoning technology.

Resource: http://www.technologyreview.com/biomedic…

The findings serve as promising evidence that the improved sensitivity and effectiveness of DNA sequencing technology is providing more pertinent and rapid results in relation to cancer gene profiling. Successful identification of over-expressed genes, for both mesothelioma and other types of cancer, can help dictate the best course of cancer treatment.

As lead author of the BWH study, David Sugarbaker, explains: “after spending a year and a half to develop the methodology and software for the pipeline, new tumors can be analyzed over the course of about a month. Knowing which genes are mutated opens the door to better understanding and the discovery of more targeted and effective patient-specific treatments in real time.”

In the initial mesothelioma analysis, tissue samples were taken from four patients with malignant pleural mesothelioma, one patient with lung cancer and one with normal lung tissue. All expressed genes from each sample were sequenced (numbered in the billions). With no preconceived notions of which genes may be indicators of mesothelioma, 15 new mutations were identified in the four mesothelioma tumor samples.

Moreover, it was found that each tumor had unique genetic mutations not shared by any other tumor sampled. This suggests that mesothelioma tumors are singularly unique, much like our fingerprints.

Ultimately, this study exhibits the promise of advancements in DNA sequencing technology. One day such technologies may be a standard procedure for all cancers used for the purpose of identifying tumor mutations and dictating treatment. As Fleisher envisions it: “every patient’s tumor will be directly sequenced to determine its mutations and optimal treatment just as we now identify the cause of an infection before selecting the best antibiotic to treat it.”

Resources: http://www.brighamandwomens.org/PressRel…

The funds will be provided via Obama’s $787 billion economic stimulus plan, and will largely be used to aid research into cancer, heart disease and autism.

The president made the announcement while visiting the National institutes for Health on September 30. As he puts it, the goal of this stimulus package is “to unlock treatments to diseases that have long plagued humanity, to save and enrich the lives of people all over the world.” Obama also noted that this is the “single largest boost to biomedical research in history.”

One billion dollars of the package will be set aside for cancer research geared towards understanding genetic causes associated with cancer and improving personalized treatment mechanisms. To facilitate this goal, $175 million has already been set aside for grants devoted to the Cancer Genome Atlas.

The Cancer Genome Atlas is an initiative currently underway to extensively map the unique genetic changes that affect cancer. Specifically, the money will be used to collect tens of thousands of cancerous tissue samples and subsequently sequence the entire DNA strands of over 20 forms of cancer.

President Obama stresses that the more than 12,000 grant awards will largely take place at not-for-profit institutions such as the National Institutes for Health. By eliminating profit incentives, the president hopes to spur unbiased research.

Beyond touting the potential for significant advancements in the study of cancer and other medical ailments, Mr. Obama noted that the $5 billion package will serve to “create new jobs, tens of thousands of jobs” for medical workers, researchers, educators and medical equipment manufacturers.

Along with discussing the stimulus package, Obama highlighted the importance of his health care reform package. As he puts it, all the medical advancements achieved through the package “make no difference to the family that is dropped from an insurance policy when a child gets sick.”

Since 1995, the National Institute for Occupational Safety and Health (NIOSH) has recommended that coal mine dust exposure be limited to a concentration of 1.0 mg/m3 TWA for up to 10 hours a day over a 40-hour work week. Well over a decade after this recommendation was first made, the Mine Safety and Health Administration (MSHA) continues to mandate a concentration of 2.0 mg/m3.

It is estimated that even at the 1.0mg/m3 level, dozens of mine workers will continue to be diagnosed with black lung and related diseases each year. At the present heightened level, even more hard-working miners are being needlessly exposed to high levels of hazardous coal dust.

In an effort to urge the MSHA to lower acceptable coal dust levels, the Appalachian Citizens’ Law Center (ACLC) recently submitted a petition calling for improved miner safety. In support of the petition, numerous health professionals sent a letter to the MSHA. A key point of the letter states that:

“According to a 2008 report by NIOSH, the prevalence of CWP has more than doubled since 1995 among coal miners with more than 20 years of exposure. NIOSH has also identified advanced cases of respiratory disease in working U.S. miners as young as 39 years of age.”

The ACLC petition is just the most recent attempt to sway MSHA to reduce miner exposure to coal dust. Other petitions and lawsuits have been filed in the past. Despite these efforts, the MSHA does not plan to propose new rules on airborne coal dust and silica until April of 2011.

Resources:
 http://thepumphandle.wordpress.com/2009/…

According to UK researchers at the Institute of Cancer Research (ICR), the drug may find a new use as a tailored treatment for bowel cancer patients who have a specific genetic fault. In studies, it was shown that methotrexate effectively killed cells that carried the faulty gene, dubbed MSH2.

The MSH2 gene has been linked to a genetic condition known as HNPCC. For men who carry this gene, 90 percent will be diagnosed with bowel cancer by the time they are 70. For women, the probability is 70 percent.

In total, the gene is linked to approximately 5 percent of all cases of bowel cancer. 40 percent of all patients with HNPCC have a faulty MSH2 gene.

Though use of methotrexate has dropped significantly since the 1940s (newer chemo drugs are typically preferred), the drug is still frequently used as a leukemia treatment. Now, researchers are hopeful that it can also be used as a tailored treatment for bowel cancer.

As Dr. Alan Ashworth, leader of the ICR study, explains: “What’s exciting about methotrexate is that it selectively destroys the cells lacking the MSH2 function. This indicates that it may make an excellent treatment for patients with the genetic alteration.”

Clinical trials to confirm the safety and effectiveness of methotrexate as a treatment for bowel cancer have already begun. While the potential for the customized drug will only affect a small proportion of bowel cancer patients, the new findings are promising indeed. Methrotrexate is one of the antifolate class of chemotherapy agents.

Customized cancer treatment based on specific genetic mutations or cancer subtypes continues to be a promising field. Methotrexate is just one of many drugs currently being investigated for the use as a tailored cancer medication.

Resources:
 http://news.bbc.co.uk/2/hi/health/822344…
 http://www.hc2d.co.uk/content.php?conten…