Category: Myeloma Treatment

Myeloma Treatment

Cancer survival rates impact type of Web communities used by patients

By Corrie Feldkamp
UMHS Public Relations

Online support communities for high survival rate cancers contain a greater amount of emotional support content than online support communities for cancers with low survival rates, according to a new study from the U-M Health System (UMHS) and the VA Ann Arbor Healthcare System.

The researchers also found that support communities for low survival rate cancers contain a greater amount of informational support content than online support communities for high survival rate cancers.

“Online communities have become an important resource for individuals seeking emotional and informational social support related to cancer,” says senior author Dr. Caroline Richardson, assistant professor in the Department of Family Medicine at UMHS.

The study — led by Lorraine Buis, a postdoctoral research fellow at the VA Ann Arbor Healthcare System — assessed differences in emotional and informational social support content in online communities for cancers with high and low survival rates.

The researchers also found that, overall, emotional support was more prevalent than informational support across all communities and all types of cancers.

Both emotional and informational support widely is available within online communities for cancer, but not all of these sites are created equally, Buis says.

“When primary care providers refer individuals to online communities for support, they should be aware that there might be differing amounts of support based on the survival rare of a particular cancer,” she says. Buis also explains that not only are such online communities for patients, “but they help family and friends cope with the struggles that cancer presents.”

Until Richardson’s and Buis’s most recent study, there had been no previous research on the influence of patients’ cancer survival rates on social support content within online support communities for cancer.

Participants in this study all were reviewed under the same time period, were online community members who participated in online support communities for four different types of cancer — lung cancer, pancreatic cancer, thyroid cancer and melanoma — and participated in eight different online communities in the investigation.

The study was presented last week at the annual meeting of the North American Primary Care Research Group. In addition to Buis and Richardson, Pamela Whitten of Michigan State University also was an author of the study.

http://www.ur.umich.edu/0809/Nov24_08/25.php?print

Predicting Early or Late Mortality in Multiple Myeloma?

Would you want to know if your myeloma was likely to result in early vs late mortality?  I would like to know. What’s your feeling about this?

Multiple myeloma flame shaped plasma cell
Multiple myeloma flame shaped plasma cell (UVA photo)

Gene Variants Can Predict Early or Late Mortality in Multiple Myeloma
Elsevier Global Medical News. 2008 Nov 11, MG Sullivan

Genetic variants in the DNA of patients with multiple myeloma appear to strongly influence survival, a groundbreaking new genomic study has concluded.

In this first pass at identifying genetic markers for survival, treatment response, and complications in the disease, a group of 3,400 variants predicted early or late mortality 76% of the time, Dr. Brian Van Ness said in an interview about the initial report (BMC Medicine 2008 Sept. 8 [doi: 10.1186/1741-7015-6-26]).

“Clearly, inherited genetics influenced survival,” said Dr. Van Ness
of the University of Minnesota, Minneapolis. “What we have not yet done is identify which specific variants are responsible for these differences. Our hypothesis is that it won’t be a single variant driving response or survival, but a complex interaction of many.”

After narrowing down the initial 3,404 candidate single nucleotide polymorphisms (SNPs), Dr. Van Ness and his colleagues are now focusing on 1,000 SNPs found to be most strongly associated with the outcome
measures. More studies are on the way using this genetic panel, he said.

Indeed, just 2 weeks after the first study appeared, a coinvestigator, Dr. Gareth Morgan of London’s Royal Marsden Hospital, published findings on the association between certain SNPs and the incidence of
treatment-associated venous thromboembolism (VTE). The analysis showed that some of the variants associated with thalidomide-related VTE occurred in pathways important in drug transport and metabolism.

“The effects of the SNPs associated with thalidomide-related VTE may be functional at the level of the tumor cell, the tumor-related microenvironment, and the endothelium,” Dr. Morgan and his colleagues wrote (Blood 2008 Sept. 19 [Epub ahead of print]).

“Another study, currently submitted, has identified an association between some of the variants and the development of severe myeloma bone disease,” Dr. Van Ness said.

The initial investigation used a genetic screen developed from two DNA data sets: cells from the Coriell Institute for Medical Research, and samples obtained from multiple myeloma patients enrolled in two
randomized drug trials, as well as some unaffected spouses. The samples came from white, black, Hispanic, and Asian patients from North America and Europe. The candidate SNPs, occurring on 983 genes, were chosen based on the most recent genetic research and included on a myeloma-specific gene-testing chip.

The investigators chose extremes of survival as the first test of the panel, because this comparison was most likely to show the effects of any genetic variant. “We took the worst outcomes – people who died in
the first year of their disease – and the best outcomes – those who survived at least 3 years without progression,” Dr. Van Ness said. After repeatedly running the screen on both data sets, the team concluded that, as a whole, it discriminated the survival groups correctly 76% of the time.

Further drilling down identified several SNPs of particular interest, including some associated with drug metabolism, transport, and export; a variant that induces myeloma apoptosis; one associated with cellular
migration and angiogenesis; and several linked to proliferative responses.

Although not designed to detect racial differences, the initial screen did identify some interesting variations: 401 of the SNP variants occurred only in black patients. In whites, there was no difference in these SNPs between cases and controls.

“We know that African Americans have a two- to threefold increase in the incidence of myeloma, but we don’t yet know why,” Dr. Van Ness said. “We’ll be trying to identify those genetic variants that might uniquely increase the risk for one race to develop myeloma over another.”

Neither this initial analysis nor subsequent ones will examine the possible interplay of environment with genetics. But, Dr. Van Ness said, such studies may be forthcoming. The International Myeloma Foundation of North Hollywood, Calif., is conducting a patient survey to begin assessing what role – if any – environmental exposure plays in disease development. The 36-page survey asks patients to detail their environmental, dietary, and geographical exposures. The National Cancer Institute will collaborate with the group in evaluating the data.

The International Myeloma Foundation is also the curator of the DNA samples used in the analysis through its Bank on a Cure program. “Bank on a Cure was developed by an international group of physicians and scientists to deal with a disease that’s difficult to deal with,” Dr. Van Ness said. “It’s not a high-incidence cancer, so it’s not easy to research.”

The Bank on a Cure group developed cooperative agreements with national and international clinical trial groups, and the studies were funded by the International Myeloma Foundation. While exploration of genetic variants relevant to multiple myeloma is in its infancy, Dr. Van Ness predicted the effect could be profound.

“It’s already fairly well established that the genetics of the tumor cells themselves impact response and survival,” he said. “But beyond this is the impact of every individual patient’s genetics – how they absorb, distribute, metabolize, and export drugs, even what race they are. If we understand why someone doesn’t respond to a drug, we could better target their therapy. If we could predict which patient might develop a life-threatening blood clot during treatment, we could take steps to prevent it.”
Copyright © 2008 International Medical News Group

Source: http://www.oncologystat.com/news-and-viewpoints/news/Gene_Variants_Can_Predict_Early_or_Late_Mortality_in_Multiple_Myeloma_US.html

Fred Baron dies soon after receiving approval to use Tysabri

Dallas attorney, Fred Baron, lost his battle with multiple myeloma on Thursday. He was 61 years old. Mr. Baron made the news when he tried to get the Biogen drug Tsyabri to treat the myeloma that was taking his life. There aren’t any reports about whether or not Mr. Baron actually was treated with the drug.

I had never heard of Mr. Baron before a few weeks ago even though he was a supporter of and fundraiser for John Edwards. Edwards was a democratic candidate for president this year and vice president in 2004. He was a North Carolina senator whose affair with a woman who produced videos for his campaign probably ruined his future in politics. According to the Dallas News, Mr. Baron was the friend who got Mr. Edwards’s mistress out of Dodge when it was feared knowledge of the affair would go public.

Elizabeth Edwards, wife of John Edwards, has breast cancer with bone metastasis. It was discovered during his presidential campaign after she fractured a rib while moving some furniture, according to the News and Observer.

Fred Baron, Myeloma and Tysabri

Have you read about the furor over Fred Baron’s quest to get Tysabri to attempt to treat his myeloma?

According to his son’s blog, they believe it could help prolong his life. Andrew Baron says that Biogen, the maker of Tysabri (a drug used to treat MS), will not allow him to have the drug.  It is, however, being tested on MM patients in a phase I trial.

I still have to do some reading on this drug. The side effects are potentially serious, but, when you have only weeks left to live, I don’t suppose that matters.

Andrew’s blog:  http://dembot.com/post/54498664/open-letter-to-james-c-mullen-ceo-of-biogen
http://www.pharmalot.com/2008/10/biogen-tysabri-a-dying-democratic-fundraiser/

Doxil side effects

skinproblem.jpgThis is what Doxil does to my hands. They recover some during my time off. Sometimes there’s bleeding, and it usually hurts (but just when I bend my fingers). Someone recommended that I try New Skin Liquid Bandage, which I have. I must say, it’s smelly! Plus, when I paint it on, it stings.

In addition to the HFS (hand-foot syndrome), I also have some stomatitis. It’s not too bad, and doesn’t last very long (4 days per cycle, maybe). However, a few days ago, my tongue was actually bleeding. On the worst days, I sort of want to just keep on eating ice cream at a steady rate. I tried toast for breakfast one day, and it felt like I was chewing on razor blades. That’s an exaggeration, yes.
Here’s a link to the Doxil site’s list of possible side effects for your reading enjoyment.

No matter what this stuff does to me, it’s still better than dex!

Velcade & Doxil Update

I’ve been on Velcade & Doxil since January now, so it’s time for another update. There have been a few cycles during which I missed a dose because of a rash, shingles and a trip to Mayo.

I’ve tolerated Velcade & Doxil quite well, with the exception of the skin problems. I also have a problem with the skin on my hands, which we think comes from the Doxil (HFS). Last Friday when I had treatment, I tried a suggestion from on of my doctors. During the infusion, I held an ice pack in each hand. They call this regional cooling, and more information can be found here:

http://doxil.com/optimize_treatment/managing_side_effect.jsp

What happens to me is that the skin on my hands splits open and the result is soreness and ever-present bandaids.

During my treatment, I receive some IV dex and benadryl to help lessen the hives (rash) that appeared after my second cycle. Since I started having the premeds, the hives have been practically non-existent.

I also have Anzemet, an anti-nausea drug. I’m not really sure that I need it, but I don’t want to find out. I think the Anzemet may be responsible for a headache I get the night of treatment. When there are so many things being pumped into your vein, there’s no way to be sure.

So far, the drug combo has worked for me. My IgA and m-spikes are still not in the normal range, but my bone marrow biopsy indicates that the % of plasma cells is down to 6.2%, and it was 30% last fall after Rev/dex (20% BEFORE Rev/dex).

I plan on staying with this regimen while I think about SCT and other things, and hope that it continues to work (even slowly) while I ponder.

Velcade and Doxil Side Effects

Here’s some advice I got about Velcade/Doxil from one of the researchers involved in early trials. I thought I’d pass it on.

Myeloma treatment with DoxilWith the Velcade and Doxil, have they started you on oral Vit B6? When we used to run the Phase I study of that combination, we have recommended pyridoxine (Vit B6) 200 mg by mouth daily. I think this is even over the counter but you can definitely let your local doctor be aware that you are taking this. This drug is to prevent the hand-foot syndrome which is a potential side-effect of the Doxil.

There is also the risk of neuropathy with Velcade. A patient once told me that the Velcade neuropathy (which is more of pain) is different than the Thalidomide/Revlimid neuropathy (which is more of the numbness and tingling sensation). As of this time, there is no approved treatment for neuropathy or formal studies comparing all the drugs that are being used to alleviate neuropathy. We have been using either Neurontin or Lidocaine patch.