Thursday, December 22, 2011

Rethink Breast Cancer presents: Your Man Reminder


Wednesday, December 21, 2011

Breast cancer gene mutations may have link to heart problems | CTV News

Breast cancer gene mutations may have link to heart problems CTV News

The Canadian Press
Date: Tuesday Dec. 20, 2011 11:35 AM ET

TORONTO — "Two new studies suggest women with gene mutations known to raise the risk of breast and ovarian cancer may also have a greater chance of developing heart disease.

And one of the studies suggests a chemotherapy drug commonly used to treat breast cancer may aggravate the problem in some of these women.

The studies are by researchers at Toronto's St. Michael's Hospital, and are published in the journals Nature Communications and the Journal of Biological Chemistry.

Lead researcher Dr. Subodh Verma says the proteins made by the genes BRCA1 and BRCA2 are critical for repairing damage to cellular DNA.

Women with mutations on the genes don't have enough of the protein, and that may be why they develop breast and ovarian cancer.

Verma's team says their work in mice and in tissue from human hearts suggests the proteins are also crucial for repairing damage to the heart, and women with the mutated genes may be at increased risk of heart disease as a result."

Read more:


Monday, November 28, 2011

The mystery of pain as a disease: Elliot Krane on


Tuesday, November 8, 2011

Cancer was leading cause of death in 2008: StatsCan - CTV News

Cancer was leading cause of death in 2008: StatsCan - CTV News Staff
Date: Tuesday Nov. 1, 2011 9:09 PM ET

"Statistics Canada says 2008 was the first year on record that cancer was
the leading cause of death in every Canadian province and territory.

The statistics agency said Tuesday that cancer caused 30 per cent of
all deaths in Canada that year, followed by heart disease (21 per cent) and
strokes (6 per cent)."

Read more:


Thursday, October 27, 2011

One Man at a Time — Resolving the PSA Controversy — NEJM

One Man at a Time — Resolving the PSA Controversy — NEJM

Excerpt (follow link above for article):

"Our perspective is that this evidence of a possible small but finite benefit from the largest trial would best support a grade C recommendation for men 55 to 69 years of age. With a grade C recommendation, the task force would be recommending “against routinely providing the service” while indicating that “there may be considerations that support providing the service in an individual patient” and stipulating that “there would need to be at least moderate certainty that the net benefit is small.” The task force's suggestions for practice in the case of a grade C recommendation include the suggestion that they “offer/provide this service only if other considerations support offering or providing the service in an individual patient.”

A grade C recommendation would allow the patient to be involved in the decision to skip or choose a PSA screening test, after a discussion with a primary care provider about the magnitude of the known harms and the potential for some benefit. The patient could then provide his perspective on how he views the trade-off. Weighing the pros and cons to make a decision about PSA screening is an individual process, and different well-informed men will make different decisions."


Single Nucleotide Polymorphism Associations With Response and Toxic Effects in Patients With Advanced Renal-Cell Carcinoma Treated With First-Line Sunitinib: A Multicentre, Observational, Prospective Study - OncologySTAT

Single Nucleotide Polymorphism Associations With Response and Toxic Effects in Patients With Advanced Renal-Cell Carcinoma Treated With First-Line Sunitinib: A Multicentre, Observational, Prospective Study - OncologySTAT

Excerpt: (for full story follow above link; may require login/registration which is free)


Background: Sunitinib is a tyrosine kinase inhibitor with proven efficacy in renal-cell carcinoma, but some patients do not respond or need dose reductions due to toxicity. Because there are no validated molecular predictors of response or toxicity to sunitinib, we aimed to identify genetic markers predictive of outcome and toxic effects.

Findings: We enrolled 101 patients between Oct 10, 2007, and Dec 13, 2010. 95 of these patients were included in toxicity analyses and 89 in the efficacy analyses. Two VEGFR3 missense polymorphisms were associated with reduced PFS with sunitinib on multivariable analysis: rs307826 (hazard ratio [HR] per allele 3·57, 1·75—7·30; p unadjusted=0·00049, p adjusted=0·0079) and rs307821 (3·31, 1·64—6·68; p unadjusted=0·00085, p adjusted=0·014). The CYP3A5*1 (rs776746) high metabolising allele was associated in a multivariable analysis with an increased risk of dose reductions due to toxicity (HR per allele 3·75, 1·67—8·41; p unadjusted=0·0014, p adjusted=0·022). No other SNPs were associated with sunitinib response or toxicity.

Interpretation: Polymorphisms in VEGFR3 and CYP3A5*1 might be able to define a subset of patients with renal-cell carcinoma with decreased sunitinib response and tolerability. If confirmed, these results should promote interventional studies testing alternative therapeutic approaches for patients with such variants.


Saturday, October 22, 2011

Study Finds No Cell Phone-Brain Cancer Link - in Oncology/Hematology, Brain Cancer from MedPage Today

Medical News: Study Finds No Cell Phone-Brain Cancer Link - in Oncology/Hematology, Brain Cancer from MedPage Today: "Action Points:

*Explain that an updated Danish study found that there was no association between central nervous system tumors and subscription to a mobile phone service.

*Point out that there also were no associations between central nervous system tumors and mobile phone use when assessed by length of subscription or tumor type."


Medical News: ECTRIMS: Cancer Drug Wins in Early MS Trial - in Meeting Coverage, ECTRIMS from MedPage Today

Medical News: ECTRIMS: Cancer Drug Wins in Early MS Trial - in Meeting Coverage, ECTRIMS from MedPage Today:

"Action Points:

*Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

*Explain that a low-dose regimen of the leukemia drug alemtuzumab (Lemtrada) decreased annualized relapse rates in patients with newly diagnosed multiple sclerosis compared with interferon-beta-1a (Rebif).

*Note that alemtuzumab was no better than interferon in the other primary outcome measure, the proportion of patients showing sustained six-month accumulation of disability."

'via Blog this'


Wednesday, October 19, 2011

Cochrane Review: Hormonal therapy in advanced or recurrent endometrial cancer

Wiley Online Library: Book Abstract

Cochrane Review: (December 2010)
{Follow link above for full review}

Author's Conclusion:

"We found insufficient evidence that hormonal treatment in any form, dose or as part of combination therapy improves the survival of patients with advanced or recurrent endometrial cancer. However, a large number of patients would be needed to demonstrate an effect on survival and none of the included RCTs had a sufficient number of patients to demonstrate a significant difference. In the absence of a proven survival advantage and the heterogeneity of patient populations, the decision to use any type of hormonal therapy should be individualised and with the intent to palliate the disease. It is debatable whether outcomes such as quality of life, treatment response or palliative measures such as relieving symptoms should take preference over overall and PFS as the major objectives of future trials."


Saturday, October 15, 2011

Vitamin Studies Spell Confusion for Patients - in Primary Care, Diet & Nutrition from MedPage Today

Medical News: Vitamin Studies Spell Confusion for Patients - in Primary Care, Diet & Nutrition from MedPage Today: "If it's Monday, it must be bad news about multivitamin day -- or was that Wednesday? No, Wednesday was good news about vitamin D, not so good news about vitamin E -- if you're confused, join the club.

The alphabet soup of vitamin studies making headlines in the last few weeks has left more than one head spinning, and most clinicians scrambling for answers.

As the dust begins to settle, physicians interviewed by MedPage Today and ABC News agreed on a bit of simple wisdom -- a healthy diet is more important than a fistful of supplements."

'via Blog this'


Friday, October 7, 2011

Angiogenesis: A prognostic determinant in pancreatic cancer?

Angiogenesis: A prognostic determinant in pancreatic cancer?


Thursday, September 29, 2011

Sunitinib-induced hyperparathyroidism - Baldazzi - 2011 - Cancer - Wiley Online Library

Sunitinib-induced hyperparathyroidism - Baldazzi - 2011 - Cancer - Wiley Online Library


ASCO Updates Guidelines on Antiemetics in Oncology - OncologySTAT

ASCO Updates Guidelines on Antiemetics in Oncology - OncologySTAT

"A common chemotherapy regimen gets reclassified as high risk for emesis; a new approach is recommended to tackle treatments with high emetic potential; and a particular antiemetic drug is now preferred for patients at moderate risk - these are among the changes to clinical practice guidelines from the American Society of Clinical Oncology.The guidelines also include new recommendations for preventing nausea and vomiting associated with radiation treatment."


Monday, September 26, 2011

ECCO-ESMO: Synchronous Chemoradiation Cuts Breast Cancer Relapse - in Meeting Coverage, ECCO-ESMO from MedPage Today

Medical News: ECCO-ESMO: Synchronous Chemoradiation Cuts Breast Cancer Relapse - in Meeting Coverage, ECCO-ESMO from MedPage Today: "STOCKHOLM -- Local recurrence in early breast cancer occurred 35% less often in women who received synchronous chemoradiation rather than sequential therapy, long-term follow-up data from a large clinical trial showed.

The five-year incidence of local recurrence was 2.8% with synchronous therapy, with radiation during or between cycles of chemotherapy, and 5.1% among women who received adjuvant chemotherapy followed by radiotherapy. Synchronous therapy also shortened the overall duration of treatment.

The findings were reported here at the European Multidisciplinary Cancer Congress, formerly known as the joint Congress of the European Cancer Organization and the European Society for Medical Oncology (ECCO-ESMO)."

'via Blog this'


Thursday, September 22, 2011

Medical News: Brain Steroids Found Lacking in MS - in Clinical Context, Multiple Sclerosis from MedPage Today

Medical News: Brain Steroids Found Lacking in MS - in Clinical Context, Multiple Sclerosis from MedPage Today


"Individuals with multiple sclerosis (MS) may have impaired production of important neurosteroid molecules in their brains, so replacement therapy could be helpful, researchers said.

Autopsy findings from 16 MS patients showed high expression of micro-RNA molecules in white matter that suppress enzymes responsible for neurosteroid synthesis, particularly allopregnanolone, according to Christopher Power, MD, of the University of Alberta in Edmonton, and colleagues.
The researchers also confirmed that levels of allopregnanolone and other steroids were depressed in the MS patients' white matter, they reported online inBrain.
Similar findings emerged from analyses of mice with experimental autoimmune encephalitis (EAE), a standard model of MS.
Most strikingly, treating the animals with allopregnanolone partly normalized their behavioral deficits and reduced levels of neuroinflammation and injury to nerve fibers, Power and colleagues indicated.
"These studies are the first report of perturbed neurosteroidogenesis in multiple sclerosis and the related model, EAE, which also showed improved outcomes in terms of neurobehavioural deficits, neuropathology and neuromolecular changes with neurosteroid (allopregnanolone) replacement," they wrote.
"The neurosteroid allopregnanolone, or perhaps closely related compounds, might represent unique therapeutic options for people with multiple sclerosis."


Monday, September 12, 2011

Switching from oxycodone to methadone in advanced cancer patients

Pain Management - Oncology Article Methadone

Switching from oxycodone to methadone in advanced cancer patients Supportive Care in Cancer, 09/12/2011 Clinical Article
Mercadante S et al.

– Switching from oxycodone to methadone is a reliable method to improve the opioid response in advanced cancer patients. A ratio of 3.3 appears to be reliable, even at high doses.

- 19 out of 542 patients admitted to the unit in 1 year underwent a switching from oxycodone to methadone. Almost all substitutions were successful
- Prevalent indication for opioid switching uncontrolled pain and adverse effects (12 patients)
- No significant changes between the initial conversion ratio and final conversion ratio between the 2 opioids were found


The cancer that plagues Steve Jobs | Health & Fitness | Life | Toronto Sun

The cancer that plagues Steve Jobs | Health & Fitness | Life | Toronto Sun:

"...estimated 12,000 to 15,000 Canadians who are affected by carcinoid neuroendocrine tumours (CNETs), or alternatively called neuroendocrine tumors (NETs) - the same cancer that has struck Jobs. But because the condition is underdiagnosed and misdiagnosed 90% of the time, there may be other Canadians who also have it.

Indeed, stories that circulated just after Jobs' resignation claimed that Jobs had pancreatic cancer, which he does not. The fact that CNETs are lumped in with other cancers is one reason why there needs to be more awareness of the condition, says Dr. Walter Kocha, a medical oncologist at the London Health Science Centre, in London, Ontario.

"This is a malignancy of a unique system of the body in that it doesn't comprise one of the major organ systems," Dr. Kocha explains. "It is comprised of single or groups of cells that have the unique ability to be used as a signalling system for the body for all sorts of functions such as the secretion of stomach acids, the movement of the bowels, and a whole number of other functions."

'via Blog this'


Thursday, September 8, 2011

Projects In Knowledge: Practice-Based Strategies: Triple Negative Breast Cancer Case

Link: Projects In Knowledge

Practice-Based Strategies: Triple Negative Breast Cancer Case (Tues., Sept. 13 - 8:00pm ET)

Join us for a mentor workshop by phone on strategies to manage metastatic
breast cancer in your patients with HER2-positive or triple-negative disease.
These case-based audio presentations, led by expert faculty, will be followed by
live Q & A. From the comfort of your home or office, you will have the
opportunity to interact with the faculty presenter and to learn from questions
posed by your colleagues nationwide. These 30-minute phone workshops are a
sequel to the data-driven webcast, "Targeting
the Treatment of Metastatic Breast Cancer."


Saturday, August 27, 2011

Non-Small Cell Lung Cancer Drug Gets FDA Nod - in Oncology/Hematology, Lung Cancer from MedPage Today

Medical News: Non-Small Cell Lung Cancer Drug Gets FDA Nod - in Oncology/Hematology, Lung Cancer from MedPage Today

"WASHINGTON -- The FDA has approved crizotinib (Xalkori), a novel targeted therapy for late-stage non-small cell lung cancer.

The Pfizer drug, an inhibitor of anaplastic lymphoma kinase, is a twice-daily pill intended for a select group of patients who express the abnormal anaplastic lymphoma kinase (ALK) gene, which causes cancer development and growth.
The FDA also approved a companion diagnostic called the Vysis ALK Break Apart FISH Probe Kid, made by Abbott Molecular, to help determine if a patient has the abnormal ALK gene.
"The approval of Xalkori with a specific test allows the selection of patients who are more likely to respond to the drug," Richard Pazdur, MD, director of the Office of Oncology Drug Products in the FDA's Center for Drug Evaluation and Research said in a press release. "Targeted therapies such as Xalkori are important options for treating patients with this disease and may ultimately result in fewer side effects."
Crizotinib's safety and effectiveness were established in two single-arm studies enrolling a total of 255 patients with late-stage ALK-positive non-small cell lung cancer. One of those studies, published in the New England Journal of Medicine last year, found that crizotinib shrank or eliminated 57% of ALK-positive non-small cell lung tumors.
The most common side effects reported in patients receiving crizotinib included vision disorders, nausea, diarrhea, vomiting, edema, and constipation."


Extended-Release Opioid Gets FDA OK - in Neurology, Pain Management from MedPage Today

Medical News: Extended-Release Opioid Gets FDA OK - in Neurology, Pain Management from MedPage Today

"Tapentadol was also well-tolerated, the company said. Opioids can cause a number of side effects, including constipation, that may cause patients to discontinue their use.

A 2010 phase III study comparing the drug to oxycodone in patients with painful knee osteoarthritis found that tapentadol provided effective pain relief with fewer of the gastrointestinal side effects seen with oxycodone"


Tuesday, August 23, 2011

Northwestern researchers report breakthrough in ALS research - Chicago Sun-Times

Northwestern researchers report breakthrough in ALS research - Chicago Sun-Times

"The apparent discovery of a common cause of all forms of amyotrophic lateral sclerosis — the fatal disease also known as Lou Gehrig’s disease — could give a boost to efforts to find a treatment for the fatal neurodegenerative disease, a new study by Northwestern University researchers contends.

Scientists have long struggled to identify the underlying disease process of ALS and weren’t even sure that a common disease process was associated with all forms of ALS.

In this new study, Northwestern researchers said they found that the basis of ALS is a malfunctioning protein recycling system in the neurons of the brain and spinal cord."


Wednesday, August 17, 2011

Vemurafenib approved for the treatment of patients with unresectable or metastatic melanoma

From FDA:

On August 17, 2011, the U. S. Food and Drug Administration approved vemurafenib tablets (ZELBORAF, Hoffmann-La Roche Inc.) for the treatment of patients with unresectable or metastatic melanoma with the BRAFV600E mutation as detected by an FDA-approved test.

The approval was based primarily on an international, randomized, open-label trial in patients with previously untreated metastatic or unresectable melanoma with the BRAFV600E mutation as detected by the cobas 4800 BRAF V600 Mutation Test (Roche Molecular Systems, Inc.). This companion diagnostic test was approved by the FDA concurrently with vemurafenib’s approval.

The trial enrolled 675 patients; 337 patients were assigned to vemurafenib, 960 mg orally twice daily, and 338 were assigned to dacarbazine, 1000 mg/m2 intravenously, every three weeks. Treatment continued until disease progression, unacceptable toxicity, and/or consent withdrawal. All patients had an ECOG performance status of 0 or 1, and 95% of patients had metastatic disease. The major efficacy outcome measures of the trial were overall survival (OS) and investigator-assessed progression-free survival (PFS). Other outcome measures included confirmed investigator-assessed best overall response rate.

The median follow-up at the time of the overall survival analysis was 6.2 and 4.5 months for the vemurafenib and dacarbazine arms, respectively. Overall survival was significantly improved in patients receiving vemurafenib compared to those receiving dacarbazine (HR=0.44; 95% CI: 0.33, 0.59; p< 0.0001, log-rank test). The median survival of patients receiving vemurafenib had not been reached (95% CI: 9.6 months, not reached) and was 7.9 months (95% CI: 7.3, 9.6) for those receiving dacarbazine.

Progression-free survival (PFS) was also significantly improved in patients receiving vemurafenib (HR=0.26; 95% CI: 0.20, 0.33; p<0.0001, log-rank test). The median PFS was 5.3 (95% CI: 4.9, 6.6) and 1.6 months (95% CI: 1.6, 1.7) in the vemurafenib and dacarbazine arms, respectively. Overall response rate (complete plus partial response rates) was 48.4% (95% CI: 41.6%, 55.2%) and 5.5% (95% CI: 2.8%, 9.3%) in the vemurafenib and dacarbazine arms, respectively.

Vemurafenib was also evaluated in a single-arm, multicenter trial that enrolled 132 patients with BRAFV600E mutation-positive metastatic melanoma who had received at least one prior systemic therapy. An independent review of treatment responses demonstrated a confirmed best overall response rate of 52% (95% CI: 43%, 61%), with a median response duration of 6.5 months (95% CI: 5.6, not reached).

The most common adverse reactions (≥30%) in patients treated with vemurafenib were arthralgia, rash, alopecia, fatigue, photosensitivity reaction, and nausea. Cutaneous squamous cell carcinomas (cuSCC), including squamous cell carcinomas of the skin and keratoacanthomas, were detected in approximately 24% of patients treated with vemurafenib. CuSCCs were managed with excision in clinical trials, and patients were able to continue treatment without dose adjustment. Other adverse reactions, sometimes severe, reported in vemurafenib-treated patients included hypersensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis, uveitis, QT prolongation, and liver enzyme laboratory abnormalities.

The recommended dose of vemurafenib is 960 mg, orally twice daily administered approximately 12 hours apart, with or without a meal.

Confirmation of BRAFV600E mutation-positive melanoma using an FDA-approved test is required before treatment with vemurafenib. Vemurafenib is not recommended for use in patients with wild-type BRAF melanoma. The approval also contains a Medication Guide to inform health care professionals and patients of vemurafenib’s potential risks.

Full prescribing information, including clinical trial information, safety, dosing, drug-drug interactions and contraindications is available at:


From Medscape:


This study is "practice changing," said Lynn Schuchter, MD, from the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, who moderated the press conference.

Responses with the new oral therapy can be dramatic — patients can have improvement within 72 hours of treatment, she said.

With 2 agents — vemurafenib and ipilimumab (which is approved by the US Food and Drug Administration) — emerging as effective treatments for metastatic melanoma in the past year, it is a "time for celebration for our patients," said Dr. Schuchter — "a time for hope."

"The results of the BRIM-3 study represent a major shift in the way we think about and treat melanoma," writes Marc Ernstoff, MD, in an editorial that accompanies the published study. He is from the Dartmouth Medical School and Norris Cotton Cancer Center in Lebanon, New Hampshire.

Melanoma is a collection of heterogeneous tumors that are differentiated by means of molecular markers, says Dr. Ernstoff, and "each molecularly defined subgroup will probably have a different treatment algorithm."

For patients with metastatic melanoma and the BRAF V600E mutation, "the availability of vemurafenib is a major defining moment that will have an important effect on survival and quality of life," he summarizes.

"These are definitely absolutely remarkable results," said Petra Rietschel, MD, PhD, from the Montefiore Einstein Center for Cancer Care in the Bronx, New York. "As soon as it is on the market, I will most certainly be using it in my clinic for patients with V600E BRAF mutations," she told Medscape Medical News.


Via Wikipedia:

Two mechanisms of resistance to vemurafenib (covering 40% of cases) have been discovered:

  • The cancer cells begin to overexpress a cell surface protein PDGFRB creating an alternate survival pathway.
  • A second oncogene called NRAS mutates, reactivating the normal BRAF survival pathway.[6]


Thursday, July 14, 2011

The V Foundation For Cancer Care: Jimmy V's 1993 ESPY Speech

On March 4, 1993, Jim Valvano was awarded the inaugural Arthur Ashe Courage and Humanitarian Award at the first annual ESPY Awards. The preceding wass his acceptance speech.

Full transcript at The V Foundation's website:

About The V Foundation:

"Since 1993, The V Foundation has raised more than $100 million and awarded cancer research grants in 38 states and the District of Columbia. Researchers have developed their laboratories and taken their science from the labs to the clinics with the help of funds raised by The V Foundation.

The V Foundation started with the dream of Jim Valvano, the passionate and committed former NC State basketball coach and award-winning broadcaster, as he battled cancer. Wanting to see the battle through to victory, Valvano recruited friends and family to lead The V Foundation in his quest to eradicate the disease that ultimately claimed his life. With a dire need for early developmental, critical-stage grant support, the Foundation was formed to assist the brilliant young researchers that will eventually find cures for cancer.

A relatively young organization, The V Foundation has a strong presence in the scientific community that belies its youth."


Friday, July 8, 2011

Pain & Opiates 3D Animation


The Mechanisms of Musculoskeletal Pain


Pain Perception and the Human Brain


Central Nervous System Mechanisms of Pain Modulation


Phases of Nociceptive Pain


Thursday, July 7, 2011

FDA Okays Fentanyl Nasal Spray for Ca Pain - in Public Health & Policy, FDA General from MedPage Today

Medical News: FDA Okays Nasal Spray for Ca Pain - in Public Health & Policy, FDA General from MedPage Today

By Cole Petrochko, Associate Staff Writer, MedPage TodayPublished:

July 02, 2011 WASHINGTO -- The FDA has approved a nasal spray formulation of the drug fentanyl (Lazanda) to manage breakthrough pain in cancer patients ages 18 and older who are already using opioid therapy. The drug comes in 100 mcg- and 400 mcg-spray doses.

Drug efficacy was established in a double-blind study that found fentanyl nasal spray outperformed placebo at the primary endpoint of sum of pain intensity difference at 30 minutes.

The nasal spray formulation is not equivalent to other fentanyl products for breakthrough pain on a microgram-per-microgram basis. Healthcare professionals prescribing Lazanda should not convert from other fentanyl products. A dosage conversion guide is not available at this time.


Everolimus Trial Stopped for Benefit in Breast Cancer - in Oncology/Hematology, Breast Cancer from MedPage Today

Medical News: Everolimus Trial Stopped for Benefit in Breast Cancer - in Oncology/Hematology, Breast Cancer from MedPage Today


"A phase III trial of everolimus (Afinitor) in locally advanced or metastatic breast cancer has been halted after an interim analysis indicated that the study's primary endpoint -- a significant difference in progression-free survival relative to a control therapy after six weeks -- was met, the drug's manufacturer said.

According to Novartis, the combination of everolimus and exemestane (Aromasin) was more effective than the latter drug and placebo in preventing tumor growth in women with estrogen receptor-positive, HER2-negative breast cancer that did not respond to other aromatase inhibitors.

The international trial, BOLERO-2, was testing everolimus at 10 mg/day orally plus 25 mg/day of oral exemestane. It included more than 700 patients randomized 2:1 to the combination versus the control regimen.

Novartis did not indicate the degree of improvement in progression-free survival with the combination. It promised that full results would be presented at "an upcoming medical conference" and that it would file marketing applications worldwide by the end of this year."


Thursday, June 16, 2011

Medical News: FDA Warns of MI, PAD Risk With Varenicline - in Primary Care, Smoking & Tobacco from MedPage Today

Medical News: FDA Warns of MI, PAD Risk With Chantix - in Primary Care, Smoking & Tobacco from MedPage Today

WASHINGTON -- The FDA warned today that smokers with a history of heart attack or stroke who use the smoking cessation drug varenicline (Chantix; Champix in Canada) may increase their risk of a second heart attack or new onset peripheral vascular disease.

The agency said an additional warning will be added to the drug's label and prescribing information describing a small, but measurable increase in the risk of cardiovascular events including nonfatal myocardial infarction, angina, and need for coronary revascularization.

Additionally, the label will warn that use of varenicline may increase the risk for a "new diagnosis of peripheral vascular disease or admission for a procedure for the treatment of peripheral vascular disease" among persons with a history of cardiovascular disease.

In its announcement, the FDA noted that smoking significantly increases the risk of cardiovascular events, so it advised physicians and patients to weigh the known benefits of varenicline treatment "against its potential risks when deciding to use the drug in smokers with cardiovascular disease."


Vandetanib Has Risk of Causing Torsades de Pointes

Update from ArizonaCERT QT Drug Lists by Risk Groups:

"...on June 6, 2011, we added Vandetanib to the list of Drugs with a Risk of Causing Torsades de Pointes. Keep in mind that whenever a drug is added to any of our lists, it is also automatically included on our list of Drugs to be Avoided by CLQTS (congenital Long QT Syndrome) Patients.

Vandetanib, which will be marketed under the brand name Zactima®, is an anti-cancer drug of the tyrosine kinase inhibitor class. It was approved in April 2011 for use in adults with medullary thyroid cancer for whom surgery is not an option."

Ref:  1. “FDA approves new treatment for rare form of thyroid cancer” Retrieved 6/14/2011


Friday, June 10, 2011

Medical News: Cancer Risk Forces Actos Off French, German Markets - in Endocrinology, Diabetes from MedPage Today

Medical News: Cancer Risk Forces Actos Off French, German Markets - in Endocrinology, Diabetes from MedPage Today


Drug regulators in Germany and France have ordered doctors to stop prescribing the type 2 diabetes drug pioglitazone (Actos) following a French study suggesting a heightened risk of bladder cancer.

But the European Medicines Agency (EMA), the FDA, and their Japanese counterpart have withheld action pending additional review of the data.

The French study, conducted by the nation's health insurance agency, examined cancer rates in some 155,000 people taking pioglitazone in France from 2006 to 2009 and 1.3 million other diabetics who were not receiving the agent.

The researchers found an adjusted hazard ratio of 1.22 (95% CI 1.05 to 1.43) for bladder cancer among those on pioglitazone.

There also appeared to be a dose effect, with a higher risk (HR 1.75, 95% CI 1.22 to 2.50) among patients receiving a cumulative dosage of 28,000 mg or more during the study period.

The study was completed on Tuesday. France's regulatory agency officially suspended sales of pioglitazone on Thursday, and Germany followed suit early Friday.

Both agencies recommended that patients currently taking the drug continue to do so until they talk to their doctors about alternative medications.


Monday, June 6, 2011

Radiology Tutorials Website

Radiology Masterclass is a growing resource in medical imaging education.

Interpreting x-rays takes time to learn. Many medical students (and other healthcare professionals may find beneficial) find they don't get enough formal teaching in radiology, and feel under-prepared when it comes to being a junior doctor. These tutorials will help you develop a structured approach, to avoid the many pitfalls.


Saturday, May 21, 2011

Lymphedema: Basics, Management and New Research


Wednesday, May 18, 2011

Gabapentin: Withdrawal Symptoms After Abrupt Discontinuation

The anticonvulsant gabapentin, which was discovered over 40 years ago by the Japanese who were initially searching for an antispasmodic or muscle relaxant,  is commonly used to treat neuropathic pain, possibly helping relieve symptoms of burning pain, shooting pain, hyperesthesia, and allodynia.

As per Medscape (June, 2010):

Patients who have abruptly discontinued gabapentin have reported symptoms of anxiety, diaphoresis, irritability, agitation, confusion, tachycardia, catatonia, and status epilepticus.[16–22] The symptoms that have been associated with gabapentin withdrawal tend to mimic some of the same withdrawal symptoms associated with ethanol and benzodiazepine withdrawal, possibly because gabapentin augments GABA levels, as does ethanol and benzodiazepines.
In the setting of treating neuropathic pain, gabapentin can be tapering fairly quickly, but cautiously, monitoring for the above symptoms. I have seen it tapered and discontinued a number of ways with success:
  • 50% of the total daily dose for 1 week, then stop.
  • Decreasing by 25% weekly (or even every 3 to 4 days) would be a more cautious approach.
What experiences can share from your practice?


On another note with respect to gabapentin, is that is becoming more widely know as a medication with a potential for abuse.

From BC Poison Control Centre:
It is becoming increasingly evident that gabapentin may be subject to abuse in particular  populations.  Case reports describe gabapentin misuse in patients with prior histories of substance abuse and dependency; either to deal with cravings or abstinence symptoms, or as a  substitute for substances such as cocaine.  Drug users seeking pleasurable effects (e.g., euphoria) abuse gabapentin at various doses, and are willing to share their experiences.  Pharmacists should  be alert to the potential abuse or misuse of prescription drugs, and may be surprised (and somewhat disconcerted) at the information readily available through sites such as Erowid.


Sunday, April 17, 2011

Susan Lim: Transplant cells, not organs | Video on

Susan Lim: Transplant cells, not organs | Video on


MD Anderson Proton Therapy Center


Thursday, April 14, 2011

Cancer: ppar gamma implication in cancer


Cancer: Sorafenib (Nexavar) English


Cancer: Fulvestrant (Faslodex ) Mechanism of


Cancer Growth Animation


3D Medical Animation - What is Cancer?


Cancer: Cisplatin


Cancer: Antibody-Drug Conjugates (Anticorps conjugués à un médicament) T...


Thursday, February 24, 2011

Danny Hillis: Understanding cancer through proteomics | Video on

Danny Hillis: Understanding cancer through proteomics | Video on


Tuesday, February 1, 2011

A pilot phase II trial of magnesium supplements to reduce menopausal hot flashes in breast cancer patients

Via Supportive Care in Cancer:



We tested if magnesium would diminish bothersome hot flashes in breast cancer patients.


Breast cancer patients with at least 14 hot flashes a week received magnesium oxide 400 mg for 4 weeks, escalating to 800 mg if needed. Hot flash score (frequency × severity) at baseline was compared to the end of treatment.


Of 29 who enrolled, 25 women completed treatment. The average age was 53.5 years; six African American, the rest Caucasian; eight were on tamoxifen, nine were on aromatase inhibitors, and 14 were on anti-depressants. Seventeen patients escalated the magnesium dose. Hot flash frequency/week was reduced from 52.2 (standard error (SE), 13.7) to 27.7 (SE, 5.7), a 41.4% reduction, p = 0.02, two-sided paired t test. Hot flash score was reduced from 109.8 (SE, 40.9) to 47.8 (SE, 13.8), a 50.4% reduction, p = 0.04. Of 25 patients, 14 (56%) had a >50% reduction in hot flash score, and 19 (76%) had a >25% reduction. Fatigue, sweating, and distress were all significantly reduced. Side effects were minor: two women stopped the drug including one each with headache and nausea, and two women had grade 1 diarrhea. Compliance was excellent, and many patients continued treatment after the trial.


Oral magnesium appears to have helped more than half of the patients and was well tolerated. Side effects and cost ($0.02/tablet) were minimal. A randomized placebo-controlled trial is planned.

Magnesium, a mineral found in tofu, grains, nuts, potatoes, leafy green vegetables, chocolate and cocoa powder, has been found to decrease during menopause, according to the University of Maryland Medical Center. cites a study in which patients who increased their magnesium experienced decreased symptoms and eventual elimination of hot flashes, so supplementing magnesium levels may decrease the severity and frequency of your hot flashes.
From (accessed Feb 1st/2011):

Brief Safety Summary:

Likely safe: When used orally, intravenously, or intramuscularly in people with normal renal function. Oral magnesium has been given in doses of 600-1,200mg daily for months without major adverse effects.
"Hormonal effects: Oral magnesium has been reported to benefit mood changes associated with premenstrual syndrome (PMS) (6). Facchinetti et al. theorized that this effect may be due to raising intracellular magnesium levels."

Magnesium is the second most abundant intracellular cation (positive ion) in the human body and is involved in more than 300 enzymatic reactions, including glucose use, the synthesis of fat, protein, and nucleic acids, the metabolism of adenosine triphosphate, muscle contraction, and some membrane transport systems (154). Magnesium is known to be essential for all ATPase activity, including its capability to facilitate movement of calcium across and within the cell membrane of cardiac and vascular tissues (155).

Absorption: Based on clinical review, 35-40% of ingested magnesium has been shown to be absorbed in the gastrointestinal tract (156). It has been found to reach steady-state after 2-3 hours and maximum concentrations at 4 hours (156). Magnesium is primarily absorbed in the small intestine (156).

Distribution: Normal serum magnesium levels are generally considered to be between 0.70 and 0.94mM/L; the average 70kg adult body contains approximately 24g of magnesium (60% is in the bone; 35% is in the muscles, particularly the heart and skeletal muscles; 1% is found in the extracellular fluid compartment). Approximately 35% of the body's magnesium is bound to albumin, with the rest primarily in ionized form (157).

Metabolism: Based on secondary sources, magnesium is not metabolized.

Excretion: Magnesium excretion is primarily via the kidneys and averages only 3-5% of the filtered load; excretion ranges from 10-5,000mg over a 24-hour period (156). Urinary magnesium and pH are known to modulate urinary calcium excretion; however, the underlying mechanism is unknown (158).

Read more:


Dog Sniffing Out Cancer May Lead to Early Detection Test

Via Medscape:

January 31, 2011 — The latest study demonstrating that dogs can sniff out cancer has confirmed the notion that a specific cancer smell does exist, and has added fuel to the idea of developing a test based on odor.

Previous studies have reported on dogs that can detect lung and breast cancer from breath samples, and there has been anecdotal evidence suggesting that dogs can detect melanoma, bladder, and ovarian cancers.

In this latest study, published online January 31 in Gut, a Labrador retriever was trained over several months to sniff out colorectal cancer in breath and watery stool samples.

The dog correctly identified cancer in 33 of 36 breath tests and in 37 of 38 stool tests. This equates to 95% accuracy overall for the breath test and 98% accuracy overall for the stool test, the researchers report.

The highest detection rates were among samples taken from patients with early-stage cancer, they add. Samples taken from smokers and from people with other gastrointestinal diseases, which might be expected to mask or interfere with cancer odors, did not appear to confuse the dog.

"This study shows that a specific cancer scent does indeed exist," the researchers conclude.

They are not suggesting using dogs in clinical practice, however. They point out that training the dog was expensive and time-consuming, and that ability and concentration vary between individual dogs and even the same dog on different days. The dog's concentration tends to decrease during the hot summer season; hence, they conducted their test between November and early June.

What they do propose is that this research could be used to develop cancer detection tests based on "odor materials."
This would involve identifying the cancer-specific volatile organic compounds (VOC) that are being detected by dogs using chemical analysis, and then developing an early cancer detection sensor that would substitute for the dog, they explain.


Timing of Commencing HRT Influences Breast Cancer Risk

Via Medscape:

January 31, 2011 — Breast cancer risk associated with combination hormone replacement therapy (HRT) is greater if the therapy is started soon after menopause, according to the results of the observational Million Women Study conducted in the United Kingdom...

...Among current users of estrogen–progestin formulations, the relative risks for breast cancer were greater if use began less than 5 years after menopause (relative risk [RR], 2.04; 95% confidence interval [CI], 1.95 to 2.14) than if it began 5 years or more after menopause (RR, 1.53; 95% CI, 1.38 to 1.70)...

...Overall, for women who used combination HRT, compared with control subjects, there was a 39% increase in the relative risk of developing breast cancer in the Million Women Study and a 26% increase in the WHI trial, which the editorialists call "consistent" findings...

"The question of the effect of estrogen-only formulation use on breast cancer risk in postmenopausal women, even with longer-term hormone use, still stands unanswered," write the editorialists.

J Natl Cancer Inst. Published online January 28, 2011. Full text, Editorial
The other question that remains unanswered is what are the impact of other formulations of estrogen and progesteron supplementation for HRT.

For instance:
- Estrace & Prometrium
- "bioidentical" hormones (compounded)

Interestingly, here is an article that was published Feb '10 (epublished about 6 months ago) in the Gynecological Endocrinology Journal. This article looks at women who were administered natural estrogen plus progesterone with or without DHEA or testosterone. It is obviously not a long-term study looking at breast cancer incidence outcomes, but leaves one thinking "what if" and what would be the outcome should this be readily explored. Ethics may come into the equation, however, given the other mainstream evidence that has been published.


"Mental symptoms experienced upon presentation improved in 90% of the patients. Sixty percent of the patients, who had gained weight during menopause, lost an average of 14.8 lbs [SD 11.98 lbs]. Complications described with traditional HRT did not develop in this group of patients."


Thursday, January 27, 2011

Eric Mead: The magic of the placebo | Video on

Eric Mead: The magic of the placebo | Video on


Wednesday, January 26, 2011

San Antonio Breast Cancer Update 2010 - Video Highlights

From (requires registration - Free)

4 Parts:

Part 1 - Hormone Receptor Positive
Part 2 - Adjuvant Bisphosphonates
Part 3 - Adjuvant Chemotherapy
Part 4 - Targeted Therapy
(Dr. Sunil Verma)


Tuesday, January 25, 2011

Thomas Goetz: It's time to redesign medical data | Video on

Thomas Goetz: It's time to redesign medical data | Video on


Thursday, January 20, 2011

Anders Ynnerman: Visualizing the medical data explosion | Video on

Anders Ynnerman: Visualizing the medical data explosion | Video on

(TED = Ideas worth sharing)


Rank Ligand - Key mediator in bone destruction

Rank Ligand
This link has been set up by Amgen Canada. It highlights Rank Ligand and its role as a key mediator in the vicious cycle of bone destruction.

The animations help explain in the link noted below.

Osteoblastic versus osteolytic bone metastases

Bone metastases are often characterized by their radiographic appearance as either osteolytic, osteoblastic, or mixed.

Most patients with breast cancer have predominantly mixed or osteolytic lesions. In contrast, patients with prostate cancer are often found to have predominantly osteoblastic lesions. However, regardless of appearance, there is significant osteolytic activity. In fact, osteolytic activity in these lesions often is comparable with, if not higher than, that typically seen in breast cancer and multiple myeloma. Such activity has been demonstrated by markedly elevated biochemical markers of bone resorption in the serum and urine of such patients. Only in multiple myeloma do purely lytic bone lesions develop.

Learn more at:


Tuesday, January 18, 2011

Bleomycin-Induced Flagellate Hyperpigmentation

The incidence may be as high as 20%.

Most tissues contain a cysteine proteinase capable of hydrolyzing and inactivating bleomycin.

The reduced concentration of bleomycin hydrolase in the skin and lung, as compared with other tissues, may explain the medication's adverse reaction profile.

The patient was counseled that the flagellate hyperpigmentation usually fades over a period of several months after the cessation of the medication.

During the past year, the hyperpigmentation in this patient has faded but not yet resolved.

(NEJM 363:e36December 9, 2010)


Nilotinib & QT Prolongation

QT interval prolongation may occur, which may in turn result in torsades de pointes, leading to syncope, seizure, and/or death. Sudden deaths have been reported (0.1-1%); ventricular repolarization abnormalities may have contributed.

Prolongation is concentration-dependent. Significant prolongation may occur if taken inappropriately with food, and/or strong CYP3A4 inhibitors, and/or medicines with a known potential to prolong QT interval. The presence of hypokalemia and hypomagnesemia may further enhance this effect.

Drugs that prolong QT interval should be avoided due to the risk of potentially fatal arrhythmias.


Pain from Vinorelbine Infusion

  • Pain in tumour-containing tissue (rare) as per BCCA.  
  • It has been hypothesized that it is caused by a ‘‘two-step’’ pathogenetic mechanism.
  • First, surgery, radiotherapy, or the tumor itself causes a neural lesion.
  • Vinorelbine administration then induces production of pain modulators at the site of the lesion.
  • It could be classified and treated as an incident pain.
  • Patients in treatment with opioids could receive one-sixth of the daily dose 15 minutes before vinorelbine administration.
  • Opioid-naïve patients could be treated with low doses of morphine. Ketorolac alone does not allow effective control of pain and we do not recommend it to treat, or to prevent, vinorelbine associated pain.
  • Finally, PO administration (?compounded) does not seem to induce vinorelbine-related pain and a switch from IV to PO vinorelbine could be proposed as a method for opioid-resistant patients.



Monday, January 17, 2011

Fulvestrant Dose Approved by US FDA

On September 10, 2010, the US Food and Drug Administration (FDA) approved the use of fulvestrant (Faslodex®, AstraZeneca) injection at a dose of 500 mg intramuscularly per month for hormone receptor–positive metastatic breast cancer in postmenopausal women with disease progression following anti-estrogen therapy. The previously approved dosing regimen was 250 mg monthly.

(J Clin Oncol. 2010;28(30):4594-4600).


Advancing the Art and Science of Prostate Cancer–Related Bone Disease Management (CME)


Eribulin (Halaven) approved by US FDA

Sea sponge - Halichondria okadai
- new treatment option for late-stage breast cancer

- Halaven is a synthetic form of a chemotherapeutically active compound derived from the sea sponge Halichondria okadai. This injectable therapy is a microtubule inhibitor, believed to work by inhibiting cancer cell growth. Before receiving Halaven, patients should have received prior anthracycline- and taxane-based chemotherapy for early or late-stage breast cancer.

US FDA News Release Nov. 15, 2010


Bevacizumab Status in Breast Cancer

FDA begins process to remove breast cancer indication from Avastin label Drug not shown to be safe and effective in breast cancer patients

the results of four clinical studies of Avastin in women with breast cancer and determining that the data indicate that the drug does not prolong overall survival in breast cancer patients or provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients. These risks include severe high blood pressure; bleeding and hemorrhage; the development of perforations (or “holes”) in the body, including in the nose, stomach, and intestines; and heart attack or heart failure.

FDA: Bevacizumab (marketed as Avastin) Information


Potential tamoxifen & methadone interaction

Drug Interactions
(as per Lexicomp Online accessed Jan 6/11)

Risk Rating D: Consider therapy modification

Summary: CYP2D6 Inhibitors (Moderate) may decrease the metabolism of Tamoxifen. Specifically, CYP2D6 inhibitors may decrease the formation of highly potent active metabolites.

Severity: Major
Reliability Rating: Fair

Patient Management Moderate CYP2D6 inhibitors may reduce the clinical effectiveness of tamoxifen; consider alternative therapy with less of an effect on CYP2D6 activity when possible.


Sunday, January 2, 2011

Cancer: HER3 pathway


VEGF and EGFR pathways in detail: Target for new therapies against cancer




Chemotherapy Part 1


Understanding Radiation Therapy - part 1


Nanotechnology for Targeted Cancer Therapy


An Overview of LDN - Dr Tom Gilhooly Part 1

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About Onco-PRN

Welcome and thanks for visiting Onco-P.R.N. - The oncology website with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer and palliative care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

*Note: This website is not affiliated with Alberta Health Services (AHS) or CAPhO and the opinions expressed herewithin are that of the author(s).

Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia:

Journal of Palliative Medicine - Table of Contents

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