Monthly Archives: April 2010

The FDA verdict: Provenge Works In Prostate Cancer

Today’s announcement by the Food and Drug Administration (FDA) that they approved Provenge® for the treatment of advanced, hormone resistant prostate cancer is significant for several reasons, not the least of which that it offers new hope to men with advanced prostate cancer where progress in treatment has been very slow in coming.

Equally important, it closes the door on decades of unfulfilled hopes that tumor vaccines and immunotherapy would eventually play a significant role in cancer treatment.  We now have a demonstrated success, which is especially important given the many near-misses that have occurred over the years.  This reinforces for many the dream that one day we would be able turn on the body’s own defense mechanisms as one more approach to treat (or one day—perhaps—prevent) certain cancers.

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As exciting as this announcement is, and with all of that hope it brings to patients, their families and the physicians who treat them, it is important that we keep this development in perspective for what it is: one small step in an otherwise complex and still difficult situation.  It is not a miracle cure, especially for men with very advanced, symptomatic disease.

Provenge® is a brand … Continue reading →

Crux Of The Dilemma:Whose Cancer Is Overdiagnosed?

An article and editorial in today’s issue of the Journal of the National Cancer Institute speaks once again to what is becoming a recurring and repetitive theme, namely the overdiagnosis of cancer, its implications, and what to do about it.


 


My overriding concern is how an academic discussion is going to be interpreted and responded to by a profession and a public that is not particularly familiar with all of the nuances of that discussion and whether in fact we may end up drawing premature or incompletely informed conclusions about a very important topic.


 


What I find interesting about the entire concept of overdiagnosis is the thought that this is something new or something we haven’t thought about in the past.  That’s simply not the case.


 


A bit of history:


 


When I was a freshman medical student lo those many years ago (in the late 1960’s), one of the first things we learned was that there were cancers found in the bodies of people who were autopsied that were never discovered during life and would likely not have been a problem during life.  We aren’t talking about large tumors that were simply not found because … Continue reading →

CT Screening For Lung Cancer: Caution Ahead

The findings reported yesterday in the Annals of Internal Medicine that lung CT scans used to screen moderate to heavy smokers for early lung cancer resulted in up to 33% of the studies incorrectly suggesting that the participants may have had lung cancer is no surprise to me, and probably shouldn’t be a surprise to you.


 


After all, as I have written about previously in this blog, even reasonably healthy non-smokers like me have had to cope and contend with a false positive scan result from a chest CT scan.  And, as the use of CT scans becomes even more widespread, we are going to find ourselves as doctors and patients dealing more often with the question of what to do when something unexpected and unanticipated shows up on one of these tests.


 


Let’s briefly review how this study was done.


 


Currently, there is a nationwide study underway to find out whether or not lung CT scans in otherwise asymptomatic long term smokers can find lung cancer early and reduce deaths from that disease.  Given the fact that lung cancer is the leading cause of cancer deaths in this country for both men and women, … Continue reading →

Reducing The Risk Of Breast Cancer: The STAR Trial

A paper presented today at the annual meeting of the American Association for Cancer Research (AACR) in Washington DC (and being published simultaneously in the journal Cancer Prevention Research) highlights an issue that has been “out there” for quite some time, namely the use of medications to prevent breast cancer and why more women and their doctors don’t take advantage of what we know works.


 


Although we have known for several years that we can reduce the risk of breast cancer by lifestyle changes (think overweight and obesity in postmenopausal women as well as decreasing alcohol intake) as well as the use of preventive medicines for women at higher than average risk of the disease, there has been little “uptake” of this approach by patients and their health professionals.  The net result is that most women still don’t know their own risk of breast cancer, and even fewer seem to be doing much about it.


 


The current study, which is a longer term follow-up of a study reported in 2006, confirms that two medicines—tamoxifen and raloxifene—are both effective in preventing breast cancer, although one may be somewhat more effective than the other.  And while both have … Continue reading →