Monthly Archives: June 2008

Prostate Cancer Surgery: Is The Robot Better?

There is a revolution going on in prostate cancer surgery over the past several years since the introduction of robot assisted surgery in 2000. But the question that has not been answered to date in a meaningful way is whether or not all the hype about the robot is in fact born out by the evidence.


 


A recent article in the Journal of Clinical Oncology (JCO), along with an accompanying editorial, suggests that the advantages of the robot may be real in some respects, but may not be so great when it comes to the most important outcome, which is whether or not a man’s prostate cancer is effectively treated.


 


Where to get prostate cancer surgery is one of the more common questions I am asked by people who ask my advice. 


 


I find it interesting that men (usually with enough money to make the trip) will travel across the country to get robotic surgery by an “expert,” when a very competent and highly regarded prostate cancer surgeon is available in their home town.  The problem, these men tell me, is that Dr. So and So doesn’t use the robot, and they want the … Continue reading →

Ron Davis MD: The Circle Of Life

Imagine…


 


You are a physician in your 50’s.  You have devoted your professional life to public health, and are a recognized international expert on tobacco control.  You have been active in medical affairs from the beginning of your professional career, and you rise in stature in several leading local, state and medical organization.  You are highly regarded by your colleagues and your friends (many of whom fit both categories).  You lead a “good” life, doing everything right.  You have a wonderful family, devoted with love to each other.  You are reflective and admired for your accomplishments and your insights.  You have unusual level of humility for one who has achieved so much.


 


In June, 2007 you are inaugurated as the President of the American Medical Association and become the primary representative of the voice of medicine not only in the United States but in the world as well.


 


In March, 2008—while actively serving in your capacity as a leader of medicine, travelling the country, speaking in Washington, meeting with physicians and opinion leaders at the highest levels—you become ill.  You are diagnosed with Stage IV pancreatic cancer, and you … Continue reading →

When Disaster Strikes…

Having cancer is difficult enough.  Getting treatment is even more stressful.  But imagine having cancer, being in the midst of treatment, and having a natural disaster to deal with at the same time.


 


That’s the situation cancer patients and their families are now facing in many parts of the Midwest as heavy rains result in flooding in small and large communities to a degree not seen for many years.


 


I suspect that many of you have your own ideas about who the American Cancer Society is, and what we do.  But what you don’t see is the incredible staff spread throughout this great nation, many of whom work in large and small communities alike, including those now finding themselves struggling as a result of this natural disaster.


 


One of the things that makes me proud to be part of this organization every day is the incredible commitment of my colleagues at all levels to helping patients with cancer. 


 


That spirit of concern and commitment was evident in an emergency call convened this morning by our Midwest division staff to get updates on the current status of the communities and states that have … Continue reading →

Off-label Drugs And The Little Rooms

There is a recurring question I simply cannot get out of my mind as I am flying back from ASCO’s annual meeting in Chicago: “What the heck goes on in ‘the little room?’”


 


The little rooms, my friends, are the sound-proofed spaces that are an intrinsic part of many of the drug companies’ booths on the ASCO convention floor. 


 


From what I can tell, they must be part of another sovereign country. 


 


As a physician licensed in the United States, I am forbidden from going into the little room.  And I do mean forbidden. Very pleasant young women and men will forcibly prevent me from entering if I don’t have a convention badge that designates me as a physician from a country other than the United States.


 


What goes on in these little rooms? 


 


That’s where the pharmaceutical companies can have discussions about off-label and new uses of drugs for the treatment of cancer. 


 


Bottom line, my international physician colleagues can hear about these new drugs for cancer treatment, but I cannot.  I am forbidden to have access to that information.


 


This might … Continue reading →

Chemotherapy: The Right Drugs At The Right Dose

Did you ever wonder how your oncologist knows which drugs to give you at what doses if you are receiving chemotherapy?  Or how they stay up with the latest chemotherapy recommendations for the treatment of your cancer?


 


This is actually a very important question, and one that has intrigued me for many years.


 


After all, our knowledge about cancer treatment is constantly increasing.  There is no way the typical physician can stay abreast of all there is to know about chemotherapy recommendations for all the different types of cancers.


 


That’s why I find the recent release of “chemotherapy order templates” by the National Comprehensive Cancer Network (NCCN) so interesting. 


 


Determining the right regimen and the right doses of chemotherapy drugs is not a new problem.  When I started practice in 1977, it became evident to me and others that staying up-to-date with the latest chemotherapy treatment options was difficult.  And that was at a time when we had nowhere the number of drugs and regimens that we have today.


 


But the problem was more than just one of knowing the drugs and the doses.  Research at the time showed … Continue reading →

Cetuximab In Lung Cancer: A Small Step Forward

A study being presented this afternoon at the plenary session of the American Society of Clinical Oncology (ASCO) annual meeting reports on the success of cetuximab (Erbitux) on improving survival for patients treated for advanced non-small cell lung cancer.


 


Cetuximab is a drug which was found several years ago to improve the response to treatment for patients with advanced colorectal cancer, and more recently in advanced head and neck cancer.


 


Today’s report suggests that by using cetuximab in addition to chemotherapy, the outlook for lung cancer patients may be a small bit brighter.  The improvement in survival may be limited, but it is a step in the right direction.


 


Cetuximab targets a receptor on cancer cells called epidermal growth factor receptor, or EGFR.  We can actually study tumor samples and determine whether or not EGFR is present.


 


In colon cancer, when the drug was first approved, it was recommended that only patients who had EGFR found in their cancer should receive this drug.  Subsequently, researchers determined that the presence or absence of this marker didn’t make much difference whether or not cetuximab improved the outlook of these patients.


 


Today’s report looked … Continue reading →

Finding New Treatments Where You Don’t Expect Them

It is always fascinating to learn about a new cancer treatment that essentially comes out of nowhere and ends up helping to improve the lives of patients with cancer.


 


Such is the story of zolendronic acid, commonly known by the trade name Zometa.  This drug—which was originally developed and used to prevent the destruction of bone in cancers that can spread to the bone and more recently has been approved to treat osteoporosis—has apparent direct anticancer treatment benefits in breast cancer.  The study is being reported this afternoon at the annual meeting of the American Society of Clinical Oncology.


 


Working with Zometa, researchers recognized that the drug had other actions beyond its impact on the bone to prevent destruction from cancer cells. 


 


They found in the laboratory that Zometa reduced the ability of cancer cells to travel through the body, improved immune responsiveness, prevented the growth of new blood vessels in cancer tumors (anti-angiogenesis), increased the effectiveness of other anti-cancer drugs and led to cancer cell death.


 


The next step was to take these discoveries in the lab and apply them to the treatment of cancer patients. 


 


So, the researchers … Continue reading →

Vitamin D And Breast Cancer Redux: Caution Ahead

A couple of weeks ago, I wrote a blog about vitamin D deficiency and its impact on breast cancer recurrence.  The information was based on an abstract that had been released in advance of the American Society of Clinical Oncology’s annual meeting, currently underway in Chicago.


 


In that blog, I reported on the conclusions of the researchers from the University of Toronto, Canada, that outcomes for women with breast cancer were worse if they were vitamin D deficient at the time of diagnosis, compared to women who had sufficient amounts of vitamin D in their blood.


 


Yesterday, the researchers presented their paper at the ASCO meeting.  And that presentation emphasized the fact that what appears in an abstract is not always the whole story.


 


The basic results reported at the meeting were essentially the same as those in the abstract.  Adequate levels of vitamin D in the blood of newly diagnosed breast cancer patients were associated with a less aggressive cancer and a better prognosis.


 


But there were two important points that were made that were in fact different from what was in the abstract or weren’t in the abstract at … Continue reading →