Called GenieCanHelp. (looks like a neat way to keep all your meds, appointments, contacts together. Many of my patients are older and not all are IT literate (I hope that offends no one). They are however often accompanied by caring family or friends, who may be happy to store such info on their smartphones.. just a thought.
Latest Blogs
SABCS 2017
sorry I haven’t posted for a while , New Years resolution-post more. I did tweet from SABCS if someone wants to follow my twitter feed at conferences. If I can see I have some interested followers it will motivate me to tweet more when I am away.
It was an interesting conference, and also was the first time it snowed in San Antonio for 28 years.
The medical highlights included more data supporting the use of CK4/6 inhibitors in advanced ER+ breast cancer, this time Monaleesa 7 (I was an investigator in this study) showing the benefit of ribociclib in premenopausal women with advanced breast cancer (ABC) , combined with goserelin and letrozole. This adds to a number of studies in post -menopausal women receiving any of the three inhibitors (ribociclib, abemaciclib and palbociclib). Ribociclib is now available for post-menopausal women with ABC through an access program. Pre-menopausal women would need a BSO (ovary removal) to gain access. There will be a study (PATINA) opening soon for patients with ER+ Her2+ ABC .
There was a meta-analysis (collected data from many studies) supporting the use of dose-dense chemotherapy as adjuvant therapy even in ER+ early breast cancer. previously such approaches at least in my practice were confined to triple negative early breast cancer.
There was some surprising randomised data supporting the use of acupuncture in the management of joint symptoms of patients receiving aromatase inhibitors (letrozole, anastrozole, exemestane).
There was lots of new science particularly focussing on immunotherapy(IO) in breast cancer. only a subgroup of patients seem to benefit from IOs and we need to understand who can benefit from single agent PD1 inhibitors (checkpoint inhibitors) and who might derive benefit from IO doublets or combinations with chemotherapy. My colleague Sherene Loi (Peter Mac) presented some interesting data on IO added to trastuzumab in patients with Her2+ve ABC previously treated with trastuzumab showing activity in a group of patients.
I am heading to the European meeting in March and may have more for you then.Cheers Shane
ENHANCE. a breast cancer rehab program
A patient of mine gave me the good oil on this; I am sure Epworth won’t mind if I promote this. It is covered under private insurance and is specific to breast cancer (sorry anyone else, breast paves the way for others to follow!). A physical and psychological assessment is performed and subsequently patients can participate in an exercise program and counselling if needed. It is a great way to follow up the challenges of early breast cancer treatment and hopefully will be a vanguard for other centres to follow. See ENHANCE
Meal Train
dear all
Meal Train..this looks a great new website that creates a meal roster for someone ill, that family and friends can contribute to.
Step 1
Identify a friend who could use a little support and enter their name, email address, and where to drop off meals.
Step 2
Enter the dates meals would be helpful.
Step 3
Enter your friend’s food likes, dislikes, allergies, and the best time to drop off a meal.
Invite Others
Invite friends, family, congregation members via email, facebook, twitter, newsletters, and more.
POEMS study
Hi all.
It has been a while since last comments. San Antonio was a bust with me recovering from flu. Anyway, one of the best recent study outcomes was the POEMS study (http://www.nejm.org/doi/full/10.1056/NEJMoa1413204). This randomised study demonstrated conclusively that the hormonal implant goserelin can protect the ovarian function and therefore fertility during chemotherapy. This has huge ramifications for women receiving chemotherapy who still want to bear children or those wanting to avoid an early menopause. It is not government funded and will cost about between 700-1800$ depending on the length of the chemotherapy course.
It generates a temporary menopause or hibernation of the ovaries if you prefer. Side effects may include hot flushes, mood disturbance and loss of libido.
Spring thought of the day ..apps
dear all, it occurred to me how useful the smartphone would be as a patient management tool. That statement may be a no-brainer but i think it is well known how under utilised our IT systems are. Having a quick trawl through the Apple App Store (I am sure there is an Android equivalent for pretty much well everything!), there are some free apps that can track medication lists/doses and provide reminders when scripts are due. Apps such as Evernote are great; recordings of consultations can be kept (I hate my voice on tape but never mind) and results can be photographed and stored. This apps can be connected to similar computer-based applications that are password protected.
Finally, the good old calendar with alarms can be used for appointments. I must say I love the Week Cal app as it nicely shows the whole week which the Apple Cal isn’t so brilliant at.
Over time , the various patient or consumer resources will become app friendly. I note with interest that there is a BreaCan Navigator app.
Happy Spring. Shane
new immunotherapy
The oncology world appears to be on the verge of revolution, not simply evolution. The notion of immunotherapy as a means of cancer therapy has been one of the oncological “holy grails” for years. Major developments have been seen in melanoma first with ipilimumab which targets CTLA-4 and augments the immune attack on cancer. The inhibitors against PD1 and PDl1 have a different mechanism blocking immune tolerance to cancer, or as I like to think of it, removing the cancer camouflage, exposing it to attack. The Austin and other institutions are now in the throes of Phase I-III studies testing these new agents. This was as a result of data such as http://www.nejm.org/doi/full/10.1056/NEJMoa1200690 where an efficacy signal was seen for the first time.
clinical trials
For those who are interested we have a whole host of studies in lung cancer at the Austin hospital testing agents targeting EGFR, ALK and PD1/PDL1. The breast cancer portfolio was a wee bit quiet for a year but this is expanding including studies in triple negative breast cancer. Phase I studies run by A/P Hui Gan include a novel PARP inhibitor (attractive in breast and ovarian cancer partic in the BRCA +ve patients).
We are very collaborative in Melbourne and I work closely with colleagues at Peter Mac , Royal Melbourne Hospital (only to name a few centres) to give patients the option to participate in studies that suit their particular circumstances better. This is often under the auspices of Cancer Trials Australia (see introduction). We strongly encourage patients to consider trials. Ultimately as their clinician, I want them to personally benefit from such participation. It is true that altruism is maybe an important part of developing new and better treatments and improved outcomes in cancer medicine, and in health in general. SW Aug 2014
SOFT/TEXT ASCO presentation/publication in NEJM
This was a combination of 2 trials (SOFT/TEXT) for a total of 4690 premenopausal pts with hormone drive early breast ca (ER+)
All were treated with ovarian suppression (injections or ovarian surgery /radiation) for 5 yrs and either tamoxifen or exemestane. Exemestane is an aromatase inhibitor (AI)(like anastrozole and letrozole) which is superior to tamoxifen in the ppost menopausal setting. Thus, the SOFT/TEXT study aimed to emulate these results in premenopausal patients.
Overall 5yr DFS (prim endpt) was 91.1% for exe vs 87.3% tam. So there was a 4% improvement in freedom from breast cancer recurrence (helping an extra 1/25 patients). Some criticisms or concerns would include the lack of long term followup and assessment of implications for bone thinning (osteoporosis) and cardiovascular disease. The AIs can be challenging with higher rates of joint aches, mood disturbance and libido issues.
My sense is that this may suit the right premenopausal patient with higher risk disease who wants to maximise theie therapeutic gain and has maybe through chemotherapy not found the hormonal disruption troubling in the leadup to this discussion and consideration. A quirk of the PBS is that exemestane can only be used after prior TAM for 2-3 years but I don’ t regard its action as having a therapeutic advantage over the other AIs which are PBS listed ‘up front’. http://www.nejm.org/doi/full/10.1056/NEJMoa1404037
