A Close Look at Lymphoma and Recent Treatment Advances


Cancer Connect
Lymphoma is a curable cancer and this continues to improve with newer precision medicines and immuntherapy

Lymphoma is a cancer of the cells of the lymphatic system, which is composed of tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. The lymphatic system contains lymphoid tissue, which is made up of lymph cells, called lymphocytes. The two main types of lymphocytes are B-cells and T-cells. There are B-cell lymphomas (about 85 percent) and T-cell lymphomas (about 15 percent). The most frequent locations for lymphoma development—the lymph nodes, liver, spleen, and bone marrow—all contain large amounts of lymphoid tissue.

Lymphoma comprises more than 67 subtypes of two closely related cancers: non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma,1 named for Thomas Hodgkin, an English physician who described the disease in 1832.

More than 600,000 Americans have lymphoma.2 An estimated 75,000 people in the United States are diagnosed annually with lymphoma (65,540 cases of NHL and 8,490 cases of Hodgkin’s lymphoma), and 22,000 are expected to die of lymphoma (20,210 from NHL and 1,320 from Hodgkin’s lymphoma).1 Since 1997 death rates for NHL have decreased by 3 percent annually in men and by 3.7 percent annually in women.3

The seventh most common form of cancer, NHL ranges from indolent (slow growing) to highly aggressive (fast growing). Risk increases with age. “While indolent NHL is not curable (unless it is localized to one or two lymph node regions), some patients live for many years,” says Daniel Lebovic, MD, a clinical lecturer in the Division of Hematology-Oncology at the University of Michigan.

Hodgkin’s lymphoma represents about 11 percent of lymphomas and presents mostly during adolescence and early adulthood. It often develops in one lymph node region and spreads to neighboring nodes. It is very curable, even in its advanced stages.

Risk Factors and Symptoms

“Little is known about the causes of lymphoma,” says Anas Younes, MD, a professor at the University of Texas MD Anderson Cancer Center’s Department of Lymphoma/Myeloma. Almost all types contain mutations within DNA, and risk factors include older age, exposure to certain chemicals, immune deficiency (due to immunosuppressive drugs, HIV/AIDS, or congenital immune deficiency), certain infections (H. pylori of the stomach and human T-lymphotropic virus), radiation exposure, and possibly some viruses such as Epstein-Barr virus and hepatitis C virus.

Common signs and symptoms of lymphoma are enlarged lymph nodes, low energy, fevers, night sweats, poor appetite, weight loss, pain, profound fatigue, itching, and abnormal routine blood tests.

Making a Diagnosis

“Certain observations may raise the suspicion of lymphoma,” Dr. Lebovic says. A physician may feel enlarged lymph nodes during a routine physical exam, or a computed tomography (CT) or positron emission tomography (PET) scan may show an enlarged liver, spleen, or nodes.

“The most accurate diagnosis is made by biopsying an enlarged node,” says Bruce D. Cheson, MD, FACP, head of hematology and deputy chief of the Division of Hematology-Oncology at Georgetown University Hospital, Lombardi Comprehensive Cancer Center. A biopsy involves surgically removing a small tissue sample. By looking under a microscope, a pathologist can confirm lymphoma as well as the type.

Lymphoma can also present in bone marrow, and in some instances diagnosis is made by bone marrow biopsy.

Treatment Options

There are three broad categories of lymphoma treatment: systemic therapy, radiation therapy, and bone marrow (or stem cell) transplant. Treatments are often combined. A watch and wait approach may be recommended in some cases when a patient has a very slow growing form of lymphoma. “Some indolent lymphomas may not need treatment for months to years,” Dr. Cheson says. “Therefore you watch and wait.”

Systemic Therapy

Systemic therapy includes chemotherapy, immunotherapy, and radioimmunotherapy. These modalities are the mainstay of treatment for almost all lymphomas.

  • Chemotherapy a drug or combination of drugs administered intravenously, kills cancer cells and remains an integral component of treatment. “The more aggressive the lymphoma, the more intense the chemotherapy drugs will be. Chemotherapy is used to treat all Hodgkin’s lymphomas, all aggressive NHLs, and advanced-stage indolent NHLs.
  • Precision Cancer Medicine The purpose of precision cancer medicine is to define the genomic alterations in a lymphoma’s DNA that is driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify lymphoma-driving abnormalities in the cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other related change in the DNA programming of the lymphoma cells. Precision cancer medicine uses targeted drugs and immunotherapy engineered to directly attack lymphoma cells with specific abnormalities, leaving normal cells largely unharmed.
  • Immunotherapy is used to fight B-cell NHL by either stimulating a patient’s immune system to work harder or by giving patients man made versions of immune system components.(4)

Radiation Therapy

Radiation therapy is occasionally used as an adjunct to chemotherapy, as it destroys localized lymphoma cells that may have survived chemotherapy by damaging their DNA. Radiation is also an alternative for patients who cannot tolerate chemotherapy, and it can be used to manage pain or swelling.

Bone Marrow (or Stem Cell) Transplant

High-dose chemotherapy and a blood stem cell, or bone marrow, transplant is the best treatment available for certain lymphomas. Higher doses of chemotherapy (known as dose-intensive or high-dose therapy) kill more cancer cells than do lower doses in certain types of cancer. These higher doses also damage normal cells, however, particularly the blood-producing stem cells in the bone marrow.

To help bone marrow make healthy new blood cells, some stem cells (early, blood-forming cells that grow and mature in the bone marrow but can circulate in the blood) may be extracted before chemotherapy is given. These cells are then transplanted back into the body, where they restore bone marrow so that it can build healthy new blood cells.5

Stem cell transplants are classified based on which individual donates the stem cells and the source from which they are collected (bone marrow, peripheral blood, or umbilical cord). Each of these variables presents important advantages and disadvantages.

When the stem cells come from the patient, the transplant is referred to as an autologous transplant. This type is recommended for patients with aggressive lymphoma who initially responded to chemotherapy but relapsed after their first-line regimen. Because a transplant is most successful when it’s performed with as little active lymphoma as possible, patients receive two or three additional chemotherapy cycles prior to transplant. Autologous transplants are generally performed only in patients in relatively good health (aside from their lymphoma) who are under 70 years of age.

In an allogeneic transplant, the patient receives bone marrow cells from a bone marrow donor (someone with certain immune system similarities), often a sibling. Ideally, the donor bone marrow cells view the cancer as “foreign” and attack it. In some cases, however, the donor bone marrow cells view some of the patient’s normal tissue as foreign and attack them, a response called graft versus host disease. Allogeneic transplants contain far greater risks and are generally reserved for patients younger than 65.

An allogeneic transplant can benefit patients who relapse after an autologous transplant or who cannot receive an autologous transplant because their disease is not sensitive to chemotherapy.

Radioimmunotherapy (RIT)

RIT delivers radiation therapy directly to tumor sites. Radioimmunotherapy agents are therapies like Rituxan, which have a radioisotope attached to them. These “guided missiles” are able to destroy cancer cells because they attach to the lymphoma and deliver small doses of medicine to the cells.5 A treatment for advanced-stage indolent B-cell NHL, radioimmunotherapy is used as a single agent and requires only one treatment.

Recent Advances in Lymphoma Treatment

Rapid therapeutic advances in lymphoma continue at a gratifying pace, leading to important new treatment options for many patients. “Among these are new applications of existing medications, including very durable disease control for indolent NHL with maintenance therapy using the monoclonal antibody Rituxan® and the high response rates and lower toxicity of the chemotherapy agent Treanda® [bendamustine] for newly diagnosed and relapsed lymphoma,” says Michael E. Williams, MD, Byrd S. Leavell professor of medicine and the chief of the Hematologic Malignancies Section, Hematology/Oncology Division of the University of Virginia Health System.

The precision cancer medicine Adcertris (brentuximab vedotin) has shown dramatic response in patients with otherwise treatment-resistant Hodgkin’s lymphomas as well as certain NHLs,” Dr. Williams continues. “Additional novel monoclonal antibodies and targeted therapeutics are in the advanced stages of clinical testing, and there is every expectation that these dramatic improvements in outcomes, survival, and cure will continue.”

Here are just some of the therapies that exemplify the advances being made:

  • Calquence (acalabrutinib) is a kinase inhibitor that works by blocking an enzyme needed by the cancer to multiply and spread. Calquence has been approved for the treatment of Mantle Cell Lymphoma based on a reported overall response rate of 81 percent.
  • Venclexta (ventoclax) The BCL-2 protein is a type of protein that contributes to a cancer cell’s survival. Over expression of the BCL-2 protein in lymphoma cells is associated with increased survival time of the cancer cells as well as resistance to standard chemotherapy. Venclexta is an agent that binds to the BCL-2 protein, thereby disabling its ability to keep cancer cells alive.
  • Gazyva (obinutuzumab) Gazyva is an engineered monoclonal antibody designed to attach to CD20, a protein found on certain types of B-cells. It is thought to work by attacking targeted cells both directly and together with the body’s immune system. The FDA approved Gazyva based on a clinical trial comparing chemotherapy with Rituxan or Gazyva. The progression-free survival was significantly improved with Gazyva compared to Rituxan.
  • About Aliqopa (copanlisib) Aliqopa is a precision cancer medicine that inhibits several key cell-signaling pathways in lymphoma cell lines resulting in cancer cell death by apoptosis and inhibition of the growth of primary malignant B cell lymphoma cell lines.
  • Keytruda® (pembrolizumab) belongs to a new class of medicines called PD-1 inhibitors that help the immune system recognize and attack cancer. PD-1 is a protein that inhibits certain types of immune responses. Drugs that block PD-1 may enhance the ability of the immune system to fight cancer. Keytruda® works by blocking PD-1.
  • Adcetris (brentuximab Vedotin) This antibody-drug conjugate is targeted to CD30, a defining marker of Hodgkin’s lymphoma, and is also a target expressed on various T-cell cancers and other hematologic malignancies.1 Adcetris is a type of immunotherapy/chemotherapy, administered intravenously, and FDA approved for the treatment of several types of Hodgkin and non Hodgkin lymphomas.
  • Imbruvica (ibrutinib) Imbruvica is a targeted agent that works by inhibiting the enzyme needed by the cancer to multiply and spread. The drug’s approval was based on the results of a study that included 111 patients with MCL who were given Imbruvica daily until their disease progressed or side effects became intolerable. Results of the study indicated that nearly 66 percent of patients experienced an objective response—meaning their cancer shrank or disappeared after treatment.
  • Revlimid® (lenalidomide) This oral immunomodulatory therapy is being evaluated as a single agent for patients with mantle cell lymphoma and T-cell lymphoma, as well as in combination with Rituxan in patients with follicular NHL and following Rituxan plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment in patients with diffuse large B-cell lymphoma.2
  • Rituxan® (rituximab) Studies show that in patients with advanced indolent NHL, maintenance Rituxan (a type of immunotherapy administered intravenously) after chemotherapy significantly prolongs progression-free survival to a far greater extent than has been achieved by any previous strategy and with minimum toxicity.3
  • Treanda® (bendamustine) The simpler two-drug regimen of Treanda plus Rituxan could become the new standard first-line therapy for indolent NHL, in place of the current standard regimen of R-CHOP. A study showed that this chemotherapy regimen improved progression-free survival and complete remission rates while showing a better tolerability.4

Chimeric Antigen Receptor (CAR) T-cell Therapy

CAR-T is a new type of treatment that utilizes a patient’s own T-cells (a type of immune cell) to fight certain types of blood cancers. The T-cells are removed from the patient and engineered to recognize specific proteins found on the surface of cancer cells. The T-cells are then infused back into the patient to fight the cancer in their body.

Two agents used in the engineering process of T-cells have already been approved by the United States Food and Drug Administration (FDA) for the treatment of specific types of leukemia and lymphoma.

One of the two CAR T cell therapies approved by the FDA, Kymria ™ (tisagenlecleucal), is being evaluated for treatment of DLBCL that has stopped responding to prior therapies. Kymria is an important component in engineering the T cells to recognize and bind to the CD-19 antigen, a protein that is found on B cells – which are the cancerous cells in DLBCL.

The JULIET trial demonstrated an overall anti-cancer response rate in 37%, and a complete disappearance of cancer (complete response) in 30% of patients with recurrent, refractory DLBCL.

The ZUMA-1 trial evaluated Yescart™ (axicabtagene ciloleucel) which is already approved for the treatment of DLBCL, and targets the CD-19 antigen.The trial included108 patients with fast-growing DLBCL, or other aggressive B-cell NHLs, that had stopped responding to prior therapies. Patients were treated with a single infusion of CAR T cell therapy. One year following CAR T cell therapy, 40% of patients have no evidence of cancer

A clinical trial directly CAR T cell therapy to the standard stem cell transplant among patients whose NHL has stopped responding to prior therapy will be initiated shortly to further clarify the role of CAR T cell therapy in this group of patients.

An Alternative Treatment Option: Clinical Trials

Clinical trials are research studies that are conducted to answer questions about a promising treatment or a new way of using an old treatment. Daniel Lebovic, MD, a clinical lecturer in the Division of Hematology-Oncology at the University of Michigan, recommends that patients volunteer for clinical trials if they have a lymphoma subtype that doesn’t have good treatment options or if they haven’t adequately responded to typical treatments.

Patients can learn about clinical trials through their treatment center or through the following organizations:

The Recovery Process

“Once lymphoma patients are in remission, they have laboratory testing and CT or PET scans every three to six months, followed by an oncologist visit,” says Dr. Cheson.

Generally, the more aggressive the lymphoma, the shorter the period between remission and relapse. For that reason, Dr. Lebovic says, “patients with aggressive lymphomas who achieve remission are followed closely for the first couple of years, but then the intensity of monitoring declines.” Patients with indolent lymphomas are followed less frequently, Dr. Lebovic says, though with similar intensity.

The five-year survival for Hodgkin’s lymphoma patients is approximately 85 percent, whereas the 10-year rate is 81 percent. The five-year survival for NHL patients is approximately 67 percent, and the 10-year rate is 56 percent.2

References

1.Jaffe ES, Harris NL, Stein H, Isaacson PG. Classification of lymphoid neoplasms: the microscope as a tool for disease discovery. Blood. 2008;112(12):4384-99.

2.Altekruse SF, Kosary CL, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2007. National Cancer Institute website. Available at: http://seer.cancer.gov/csr/1975_2007. Accessed April 7, 2011.

3.Cancer Facts & Figures 2010. American Cancer Society website. Available at: http://ww2.cancer.org/downloads/STT/Cancer_Facts_and_Figures_2010.pdf. Accessed April 7, 2011.

4.Immunotherapy. American Cancer Society website. Available at: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/Immunotherapy/immunotherapy-what-is-immunotherapy. Accessed April 7, 2011.

5.Lymphoma Treatments. Lymphoma Research Foundation website. Available at: http://www.lymphoma.org/site/apps/s/content.asp?c=bkLTKaOQLmK8E&b=6298135&ct=8806721. Accessed April 7, 2011

1.Brentuximab Vedotin (SGN-35). Seattle Genetics website. Available at: http://www.seagen.com/product_pipeline_sgn35.shtml. Accessed April 7, 2011.

2.Clinical Data from Two Phase II Studies Evaluating Revlimid Plus Rituximab in Indolent Non-Hodgkin’s Lymphomas Presented at ASH. Celgene website. Available at: http://ir.celgene.com/phoenix.zhtml?c=111960&p=irol-newsArticle_pf&ID=1505167. Accessed April 7, 2011.

  1. Rituximab Maintenance Improves Progression-Free Survival in Indolent Lymphoma. Medscape Today website. Available at: http://www.medscape.com/viewarticle/589819. Accessed April 7, 2011.
  1. Bendamustine Plus Rituximab Could Replace R-CHOP in Indolent Lymphomas. Medscape Today website. Available at: http://www.medscape.com/viewarticle/713573. Accessed April 7, 2011.
  1. Schuster, Bishop, Tam, et al. Primary analysis of Juliet: A global, pivotal, phase 2 trial of CTL019 in adult patients with relapsed or refractory diffuse large B-cell lymphoma. Proceedings from the 59th annual meeting and exhibition of the American Society of Hematology; Atlanta, GA; December 9-12, 2017; Abstract #577. Retrieved from https://ash.confex.com/ash/2017/webprogram/Paper105399.html
  1. United States Food and Drug Administration. FDA News Release. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm495253.htm. Accessed April 13, 2016.
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Prophylactic cranial irradiation fails to improve overall survival in NSCLC


Dr Alex Sun.

An updated 10-year analysis of the RTOG 0214 trial showed that the use of prophylactic cranial irradiation (PCI) improved disease-free survival (DFS) and reduced brain metastases, but failed to improve overall survival (OS) in patients with locally advanced non-small-cell lung carcinoma (LA-NSCLC).

The results of the 10-year follow-up of this phase III study, done from September 2001 to August 2007 in 356 patients with stage III A/B LA-NSCLC (median age, 60), showed that PCI did not improve OS rate vs observation alone (17.6 percent vs 13.3 percent; hazard ratio [HR], 1.23; 95 percent confidence interval [CI], 0.95 to 1.59; p=0.124)  [Sun A, et al, WCLC 2018 abstract OA01.01]

Patients who underwent PCI, however, experienced better DFS (12.6 percent vs 7.5 percent; HR, 1.32; 95 percent CI, 1.03 to 1.69; p=0.0298) and less central nervous system (CNS) metastasis (16.7 percent vs 28.3 percent; HR, 2.33; 95 percent CI, 1.31 to 4.15; p=0.0298) vs those who were just observed.

“There was only 45 percent power to detect the hypothesized difference [HR=1.25], and if we were able to accrue the targeted number, there may have been a benefit in OS,” said study investigator Dr Alex Sun from the University of Toronto, Toronto, Ontario, Canada.

“As compared with previous trials, PCI employing delivery of 30 Gy in 15 fractions as used in the RTOG 0214 study might also be too low a dose to exert its desirable effects,” commented discussant Dr John Armstrong of St Luke’s Radiation Oncology Network, Dublin, Ireland. [Radiat Oncol 2016;11:67]

“However, a subgroup analysis among 225 patients who did not have surgery as primary treatment showed that patients who underwent PCI had better OS [p=0.026] and DFS [p=0.014] and a lower incidence of brain metastases [p=0.003],” said Sun.

Most patients in the study experienced grade 1 (14.6 percent) or grade 2 (35 percent) acute toxicities or grade 1 (12.7 percent) or grade 2 (8.7 percent) late toxicities, with neurocognitive-associated toxicities being the most commonly reported.

“The most probable reason why we do not do much PCI is due to concerns about its reported toxicities such as somnolence, cognitive disturbances, neuropathy, memory impairment and dizziness. It is difficult to convince patients to undergo a procedure which will unlikely alter their survival,” said Armstrong. [J Clin Oncol 2018;36:2366-2377]

A previous study in 113 cancer patients with brain metastases showed that hippocampus-sparing intensity-modulated radiation therapy (IMRT) is associated with a significantly lower decline in Hopkins Verbal Learning Test-Revised Delayed Recall scores vs historical controls (p<0.001). [J Clin Oncol 2014;32:3810-3816]

In the future, PCI in NSCLC is foreseen to involve identification of ultra-high-risk individuals and performance of research which can be used for profiling patients who will experience brain metastases. For these patients, aggressive surveillance with volumetric MRI and early intervention with stereotactic surgery should be performed.

CT screening cuts lung cancer mortality, greater benefit in women


Prof Harry de Koning.

Population-based lung cancer screening with multislice CT substantially reduces mortality from the disease among high-risk former and current smokers, with larger risk reductions in women vs men, the NELSON study has shown.

The results, presented at the International Association for the Study of Lung Cancer (IASLC) 19th World Conference on Lung Cancer (WCLC 2018), showed a 26 percent risk reduction in lung cancer mortality in men (95 percent confidence interval [CI], 0.60 to 0.91; p=0.003) and a 39 percent risk reduction in women (95 percent CI, 0.35 to 1.04; p=0.0543) who underwent screening compared with controls after 10 years of follow-up. [Koning H, et al, WCLC 2018, abstract PL02.05]

At 8-year and 9-year follow-up, men who underwent screening had a 25 percent (95 percent CI, 0.59 to 0.95; p=0.015) and 24 percent (95 percent CI, 0.60 to 0.95; p=0.012) reduction in risk of lung cancer mortality, respectively.

“Strikingly, women who underwent screening had a 61 percent [95 percent CI, 0.18 to 0.78; p=0.0037] reduction in risk of lung cancer mortality at 8 years, and a 53 percent [95 percent CI, 0.25 to 0.84; p=0.0069] risk reduction at 9 years,” reported principal investigator Professor Harry de Koning of the University Medical Center Rotterdam, the Netherlands.

The study included 15,792 individuals aged 50–74 years who were smokers (>10 cigarettes/day for >30 years or >15 cigarettes/day for >25 years) or who had quitted smoking in the last ≤10 years. Participants were recruited from population-based registries in Belgium and the Netherlands. Those randomized to receive lung cancer screening (n=7,900) underwent CT scans at year 1 (n=7,557; 95.6 percent), year 2 (n=7,295; 92.3 percent), year 4 (n=6,922; 87.6 percent) and year 6.5 (n=5,279; 66.8 percent), while those in the control arm (n=7,892) received no screening.

“More than 80 percent of participants in each arm were men. About 55 percent were current smokers, and the median tobacco exposure was almost 40 pack-years,” said de Koning.

The overall screening uptake rate was 85.6 percent. A positive result was reported in 2.2 percent of the participants, while 9.3 percent had an indeterminate result and underwent further CT scans 3–4 months after the initial scans.

“The lung cancer detection rate was 0.9 percent, with a positive predictive value for a positive test result of 41 percent,” said de Koning. “In the screening arm, lung cancer cases were mainly in stage I, with just over 10 percent of the cases being in stage IV. In contrast, about half of the cases in the control arm were in stage IV.”

“Among male participants, there were 214 lung cancer deaths in the control arm and 157 lung cancer deaths in the screening arm. A clear difference was observed as early as in years 2–3,” he noted.

“The NELSON trial showed larger risk reductions in lung cancer mortality than the earlier NLST trial [National Lung Screening Trial],” said discussant Professor John Field of the University of Liverpool, UK. [Cancer 2013;119:3976-3983] “Based on the results of these two large, randomized controlled trials, there is now conclusive evidence for implementation of lung cancer screening, at least in Europe.”

Are Certain Bacteria Associated With Development of Colorectal Cancer?


The gut microbiome may play an important role in the development of colorectal cancer, according to a study published in the Journal of Gastrointestinal Oncology. Study author Jessica D. Dahmus, MD, of the Thomas Jefferson University Hospital, and colleagues sought to analyze the potential carcinogenic associations of five strains of sulfidogenic bacteria based on prior published research.

Sulfidogenic bacteria was focused on due to its production of hydrogen sulfide, which has been shown to cause DNA damage. This can result in genomic instability, notably found in more than 80% of sporadic colorectal cancers. The authors suggested that hydrogen sulfide affects mitochondrial function in intestinal epithelial cells, resulting in hyperproliferation in the Ras/MAPK pathway. Colorectal cancer is one of many malignancies for which this pathway is a known mechanism of carcinogenesis.

Researchers analyzed Streptococcus bovis, Fusobacterium nucleatum, Helicobacter pylori, Bacteroides fragilis, and Clostridium septicum. S. bovis seems to be associated with higher rates of both adenomas and carcinomas. Patients with colorectal cancer have been shown to have high concentrations of F. nucleatum and less microbial diversity than control groups. H. pylori infections appear to be associated with a 1.4-fold risk increase for colorectal cancer, although the authors mentioned that data may be controversial due to publication bias from the original research. The subtype Enterotoxigenic Bacteroides fragilis produces a toxin that has been shown to affect the development of colorectal cancer. Finally, C. septicum has not been associated with the initial appearance of colorectal cancer, but it does appear to have a mutually beneficial relationship with malignancies in progress.

“Future research may focus on whether the detection of certain bacterial concentrations within stool or biopsied polyps could serve as adjuncts to current screening modalities to help identify higher risk patients,” the authors concluded.

Novel Approach to Predicting Response to Immunotherapy in Melanoma


Researchers have created a gene-expression predictor that determines whether specific patients with melanoma are likely to respond to treatment with immune checkpoint inhibitors, based on a study conducted by Noam Auslander, MD, of the University of Maryland, and colleagues. Published in Nature Medicine, the study suggests that the new predictor, called IMPRES, appears to be accurate across many different melanoma patient data sets, unlike other existing predictors.

“There is a critical need to be able to predict how cancer patients will respond to this type of immunotherapy,” commented Eytan Ruppin, MD, PhD, of the National Cancer Institute’s (NCI) newly established Cancer Data Science Laboratory, who led the study, in a press release. “Being able to predict who is highly likely to respond and who isn’t will enable us to more accurately and precisely guide patients’ treatment.”

The researchers tested IMPRES (the immune-predictive score) on 297 samples from multiple studies. The higher the IMPRES score for a sample, the more likely it was to undergo spontaneous regression. They found that the predictor outperformed existing approaches, with an overall accuracy of AUC = 0.83. In addition, it seemed capable of diagnosing almost all patients who responded to the inhibitors and more than half of those who did not.

“We now know that immunotherapy works, but we do not understand well why a particular therapy will work for some patients but not others,” said Tom Misteli, PhD, Director of the Center for Cancer Research at NCI. “This study is a step forward in developing tools to address this challenge.”

Are Current Staging Systems for Cutaneous Squamous Cell Carcinoma Satisfactory?


According to the results of a nested case-control study, “four current staging systems distinguished poorly to moderately between [cutaneous squamous cell carcinoma] patients who developed metastasis and those who did not.” The worst-performing system was that of American Joint Committee on Cancer (AJCC), 7th edition, in its “ability to cluster patients with similar outcomes within the same staging category,” wrote the researchers in JAMA Dermatology.

Ingrid Roscher, MD, of Oslo University Hospital, and colleagues also evaluated systems used by Breuninger et al and Boston’s Brigham and Women’s Hospital (Brigham), as well as the AJCC, 8th edition. They identified all patients in Norway diagnosed with primary invasive cutaneous squamous cell carcinoma between 2000 and 2004 (n = 6,721) and then the 112 patients diagnosed with metastasis within 5 years. These patients were randomly paired with 112 controls, matched for sex and age, whose cutaneous squamous cell carcinoma had not metastasized. Expert histologic reexamination of the biopsies yielded 103 patients with metastasis and 81 without.

Results indicated that in the systems used by Breuninger et al and Brigham, high-risk categories for diameter and tumor thickness (Breuninger) and the T2b category (Brigham) collected relatively homogeneous groups. And in both those systems, “risk of metastasis was significantly elevated with increasing stage or risk category.” External validation was performed by logistic regression, discrimination, and calibration statistics. The team found that all four staging systems were lacking in the ability to predict who would and who would not develop metastases.

“A staging system for [cutaneous squamous cell carcinoma] has to be suitable for use in everyday clinical practice,” revealed Dr. Roscher and colleagues. “Variables included in the four staging systems validated in this study may be difficult to assess accurately, which give them limited value for clinicians.”

Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults.


BACKGROUND: Olanzapine as an antiemetic represents a new use of an antipsychotic drug. People with cancer may experience nausea and vomiting whilst receiving chemotherapy or radiotherapy, or whilst in the palliative phase of illness.

OBJECTIVES: To assess the efficacy and safety of olanzapine when used as an antiemetic in the prevention and treatment of nausea and vomiting related to cancer in adults.

SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase for published data on 20th September 2017, as well as ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform for unpublished trials. We checked reference lists, and contacted experts in the field and study authors.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) of olanzapine versus any comparator with or without adjunct therapies for the prevention or treatment, or both, of nausea or vomiting in people with cancer aged 18 years or older, in any setting, of any duration, with at least 10 participants per treatment arm.

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. We used GRADE to assess quality of evidence for each main outcome. We extracted data for absence of nausea or vomiting and frequency of serious adverse events as primary outcomes. We extracted data for patient perception of treatment, other adverse events, somnolence and fatigue, attrition, nausea or vomiting severity, breakthrough nausea and vomiting, rescue antiemetic use, and nausea and vomiting as secondary outcomes at specified time points.

MAIN RESULTS: We included 14 RCTs (1917 participants) from high-, middle- and low-income countries, representing over 24 different cancers. Thirteen studies were in chemotherapy-induced nausea and vomiting. Oral olanzapine was administered during highly emetogenic (HEC) or moderately emetogenic (MEC) chemotherapy (12 studies); chemoradiotherapy (one study); or palliation (one study). Eight studies await classification and 13 are ongoing.The main comparison was olanzapine versus placebo/no treatment. Other comparisons were olanzapine versus NK1 antagonist, prokinetic, 5-HT3 antagonist or dexamethasone.We assessed all but one study as having one or more domains that were at high risk of bias. Eight RCTs with fewer than 50 participants per treatment arm, and 10 RCTs with issues related to blinding, were at high risk of bias. We downgraded GRADE assessments due to imprecision, inconsistency and study limitations.Olanzapine versus placebo/no treatmentPrimary outcomesOlanzapine probably doubles the likelihood of no nausea or vomiting during chemotherapy from 25% to 50% (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.59 to 2.47; 561 participants; 3 studies; solid tumours; HEC or MEC therapy; moderate-quality evidence) when added to standard therapy. Number needed to treat for additional beneficial outcome (NNTB) was 5 (95% CI 3.3 – 6.6).It is uncertain if olanzapine increases the risk of serious adverse events (absolute risk difference 0.7% more, 95% CI 0.2 to 5.2) (RR 2.46, 95% CI 0.48 to 12.55; 7 studies, 889 participants, low-quality evidence).Secondary outcomesFour studies reported patient perception of treatment. One study (48 participants) reported no difference in patient preference. Four reported quality of life but data were insufficient for meta-analysis.Olanzapine may increase other adverse events (RR 1.71, 95% CI 0.99 to 2.96; 332 participants; 4 studies; low-quality evidence) and probably increases somnolence and fatigue compared to no treatment or placebo (RR 2.33, 95% CI 1.30 to 4.18; anticipated absolute risk 8.2% more, 95% CI 1.9 to 18.8; 464 participants; 5 studies; moderate-quality evidence). Olanzapine probably does not affect all-cause attrition (RR 0.99, 95% CI 0.57 to 1.73; 943 participants; 8 studies; I² = 0%). We are uncertain if olanzapine increases attrition due to adverse events (RR 3.00, 95% CI 0.13 to 70.16; 422 participants; 6 studies). No participants withdrew due to lack of efficacy.We are uncertain if olanzapine reduces breakthrough nausea and vomiting (RR 0.38, 95% CI 0.10 to 1.47; 501 participants; 2 studies; I² = 54%) compared to placebo or no treatment. No studies reported 50% reduction in severity of nausea or vomiting, use of rescue antiemetics, or attrition.We are uncertain of olanzapine’s efficacy in reducing acute nausea or vomiting. Olanzapine probably reduces delayed nausea (RR 1.71, 95% CI 1.40 to 2.09; 585 participants; 3 studies) and vomiting (RR 1.28, 95% CI 1.14 to 1.42; 702 participants; 5 studies).Subgroup analysis: 5 mg versus 10 mgPlanned subgroup analyses found that it is unclear if 5 mg is as effective an antiemetic as 10 mg. There is insufficient evidence to exclude the possibility that 5 mg may confer a lower risk of somnolence and fatigue than 10 mg.Other comparisonsOne study (20 participants) compared olanzapine versus NK1 antagonists. We observed no difference in any reported outcomes.One study (112 participants) compared olanzapine versus a prokinetic (metoclopramide), reporting that olanzapine may increase freedom from overall nausea (RR 2.95, 95% CI 1.73 to 5.02) and overall vomiting (RR 3.03, 95% CI 1.78 to 5.14).One study (62 participants) examined olanzapine versus 5-HT3 antagonists, reporting olanzapine may increase the likelihood of 50% or greater reduction in nausea or vomiting at 48 hours (RR 1.82, 95% CI 1.11 to 2.97) and 24 hours (RR 1.36, 95% CI 0.80 to 2.34).One study (229 participants) compared olanzapine versus dexamethasone, reporting that olanzapine may reduce overall nausea (RR 1.73, 95% CI 1.37 to 2.18), overall vomiting (RR 1.27, 95% CI 1.10 to 1.48), delayed nausea (RR 1.66, 95% CI 1.33 to 2.08) and delayed vomiting (RR 1.25, 95% CI 1.07 to 1.45).

AUTHORS’ CONCLUSIONS: There is moderate-quality evidence that oral olanzapine probably increases the likelihood of not being nauseous or vomiting during chemotherapy from 25% to 50% in adults with solid tumours, in addition to standard therapy, compared to placebo or no treatment. There is uncertainty whether it increases serious adverse events. It may increase the likelihood of other adverse events, probably increasing somnolence and fatigue. There is uncertainty about relative benefits and harms of 5 mg versus 10 mg.We identified only RCTs describing oral administration. The findings of this review cannot be extrapolated to provide evidence about the efficacy and safety of any injectable form (intravenous, intramuscular or subcutaneous) of olanzapine.

High doses of vitamin C aggressively kill cancer cells, research confirms


 

Image: High doses of vitamin C aggressively kill cancer cells, research confirms

If you’ve heard that high doses of vitamin C can kill cancer, there’s a good chance you’ve also heard some official-sounding organizations claiming that there is no science to back this up. However, new research shows that high doses of vitamin C can indeed fight cancer, underscoring the findings of countless other studies like it that are widely ignored by the medical industry.

Detractors choose to focus on those studies that showed it didn’t work, conveniently ignoring the fact that many of the studies that were inconclusive in this regard simply weren’t testing big enough doses to unlock its effectiveness.

Research carried out at the University of Iowa confirms that vitamin C does kill cancer cells selectively without damaging normal cells. One study showed that the vitamins can reduce mutations that cause cancer in mice, while another study showed it can kill as much as 50 percent of human lymphoma cells.

Another study, this one from the Perlmutter Cancer Center, found that injecting mice with high doses of vitamin C stopped leukemia cancer stem cells from humans from growing, probably by telling the faulty stem cells in bone marrow to die. A different study found that adding vitamin C via IV to typical chemotherapy drugs extended the average survival times of pancreatic cancer patients from 5.65 months to 12 months.

Then there’s the University of Kansas study that injected high doses of vitamin C into ovarian cells from humans. They found that the vitamin targeted the ovarian cancer cells without harming healthy cells, and they went on to repeat the study on mice and human subjects.

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These findings wouldn’t be surprising to the researchers who worked on a review that was published in the Puerto Rico Health Sciences Journal in 2008. After looking at studies that used extremely higher amounts of vitamin C intravenously, they concluded that it can be effective against tumors, although they said that its efficacy could not be judged when it was administered orally.

Even though the authors called for further research into vitamin C’s cancer-fighting power, nothing was done about it at the time. After all, chemotherapy has been so profitable for the medical and pharmaceutical industries, and it would be hard to profit off of something as cheap, widely available, and unpatentable as vitamin C .

IV may not be the only way to deliver high doses of vitamin C

Some people have been getting these treatments on their own at alternative cancer clinics, but it’s not widely accepted. In addition, those who are wary of IVs find it extremely difficult to get the high blood concentration needed for this treatment to work its magic when they take it orally.

Now, however, there is a new form of vitamin C that could change everything. Liposomal vitamin C can create vitamin C levels in the blood that are 100 to 500 times greater than those normally achieved by oral ingestion, making it easier for people to fight cancer.

Liposomal vitamin C is encapsulated in lecithin, which shields it from digestive enzymes that would normally break it down. It makes its way through the digestive system with ease and is absorbed by the intestines before being transported into the liver, where it is released into the bloodstream.

This approach does away with the waste and gastric upset seen with conventional vitamin C tablets while maintaining high blood concentrations. Whether it will one day make its way into the mainstream and give riskier treatments like chemotherapy a run for their money remains to be seen, however.

Sources for this article include:

NaturalHealth365.com

NaturalNews.com

NaturalNews.com

90% of breast cancer could likely be prevented if everyone did some of these 12 things


By Dr. Mercola

Breast cancer is probably one of the most feared diagnoses a woman can get. The mere mention of it conjures up images of death, despair, or at best, disfigurement.

According to breastcancer.org,1 one in eight women will develop invasive breast cancer in her lifetime, and nearly 40,000 women lose their lives to the disease each year.

With such odds stacked against you, what, if anything, can you do to prevent becoming a statistic? In truth, there are many measures you can take—each of which will help decrease your risk.

It’s important to realize that less than 10 percent of all breast cancer cases are thought to be related to genetic risk factors.2 The remainder—90 percent—appear to be triggered by environmental factors.

I strongly believe that cancer is preventable through appropriate lifestyle changes, such as cleaning up your diet, optimizing your vitamin D levels, exercising, and avoiding toxins from every source you can.

This means taking careful inventory of the household and personal care products you use, and the furnishings and other potentially toxic items you get into contact with on a daily basis. Toxic overexposure undoubtedly play a major role in cancer development, and recent studies are finally starting to shed light on the worst offenders.

Scientists Identify ‘Highest Priority’ Toxins for Breast Cancer Prevention

According to recent research published in the National Institutes of Health (NIH) journal, Environmental Health Perspectives,3 you can reduce your risk of breast cancer by avoiding certain chemicals found in common, everyday products. As reported by Rodale:4

“Because the study found that animal tests are able to predict likely human breast carcinogens, the new report could serve as a major step forward in breast cancer prevention, expanding the list of possible breast cancer triggers. That’s especially important because only about 10 percent of breast cancers are genetic in nature—scientists believe environment plays a huge role…

‘Every woman in America has been exposed to chemicals that may increase her risk of getting breast cancer. Unfortunately, the link between toxic chemicals and breast cancer has largely been ignored,’ says Julia Brody, PhD, study author and executive director at Silent Spring Institute. ‘Reducing chemical exposures could save many, many women’s lives.’”

In a previous study, the researchers had identified 216 chemicals that increase mammary gland tumors in rodents. In this paper, they narrowed the focus to 102 chemicals that large numbers of women are exposed to on a regular basis, through food, medications, air pollution, or consumer products.

They then prioritized the chemicals, and grouped them based on exposure, carcinogenic potential, and chemical structure. This sorting resulted in 17 chemical groups of related chemicals, which were flagged as “high priority” due to their ability to consistently produce mammary tumors in animal tests.

Top Offenders

Their list of cancer-causing chemical groups to avoid, and their most common sources of exposure, includes the following. Another 27 different carcinogens that do not fit into the chemical categories listed below are also considered high priority. These chemicals include certain ones found in pesticides, consumer products, and food.

Two examples of the latter are methyl eugenol, which is used in processed food as a natural and artificial flavoring, and nitrosamines in smoked meats. The researchers also list obesity and medical radiation as preventable risk factors, the latter of which would include unnecessary mammograms.

High Priority Chemicals to Avoid for Breast Cancer Prevention

Flame retardants: Flame retardant products, polyester resins, plastic polymers, and rigid polyurethane foams Acrylamide: Diet (especially starchy foods, such as French fries, cooked at high temperatures), tobacco smoke, and polyacrylamide gels in consumer products, such as diapers
Aromatic amines: Polyurethane, pesticides, Azo dyes, and many other products Benzene: Gasoline (riding in a car, pumping gasoline, and storing gasoline in a basement or attached garage), tobacco smoke, adhesive removers, paints, sealants, finishers, and engine fuel and oils
Halogenated organic solvents: Dry cleaning, hair spray propellant, soil fumigants, food processing, gasoline additives, and paint and spot removers Ethylene (EtO) and propylene oxide (PO): EtO is a gas used to sterilize medical equipment, food and spices, clothing, and musical instruments. Also found in tobacco smoke and auto exhaust. PO is a sterilant and fumigant. Also found in automotive and paint products
1,3-Butadiene: Cigarette smoke, automobile exhaust, gasoline fumes, and emissions from industrial facilities Heterocyclic amines: Meat cooked at high temperatures, and tobacco smoke
Endogenous and pharmaceutical hormones and other endocrine disrupting chemicals:Estrogens, progesterone, and DES, along with other hormones Non-hormonal pharmaceuticals that have hormonal activity: These include four chemotherapeutic agents, two veterinary drugs possibly present in food, the diuretic furosemide, the anti-fungal griseofulvin, and several anti-infective agents
MX: One of hundreds of genotoxic by-products of drinking water disinfection Perfluorooctanoic acid PFOA: Non-stick and stain-resistant coatings on rugs, furniture, clothes and cookware; fire-fighting applications, cosmetics, lubricants, paints, and adhesives
Nitro-PAHs: Air pollution, primarily from diesel exhaust PAHs: Tobacco smoke, air pollution, and charred foods
Ochratoxin A (a naturally occurring mycotoxin): Contaminated grain, nuts, and pork products Styrene: Food that has been in contact with polystyrene; consumer products and building materials, including polystyrene, carpets, adhesives, hobby and craft supplies, and home maintenance products

Flame Retardants Do FAR More Harm Than Good…

While it’s difficult to single out any particular chemical grouping as being “the worst,” fire retardants may fit the bill by the fact that they are used in so many furnishings, including your mattress, where you spend a significant portion of your life. Last year, I wrote about the deceptive campaigns that led to the proliferation of fire retardant chemicals. As reported in an investigative series “Playing With Fire” by the Chicago Tribune:5

“The average American baby is born with 10 fingers, 10 toes and the highest recorded levels of flame retardants among infants in the world. The toxic chemicals are present in nearly every home, packed into couches, chairs and many other products. Two powerful industries — Big Tobacco and chemical manufacturers — waged deceptive campaigns that led to the proliferation of these chemicals, which don’t even work as promised.”

An estimated 90 percent of Americans have flame-retardant chemicals in their bodies, and many studies have linked them to human health risks, including infertility, birth defects, lower IQ scores, behavioral problems in children, as well as liver, kidney, testicular, and breast cancers.

Flame-retardant chemicals belong to the same class of chemicals as DDT and PCBs (organohalogens), and like the former, they, too, build up in the environment. These chemicals also react with other toxins as they burn to produce cancer-causing dioxins and furans. The chemical industry claims that fire-retardant furniture increases escape time in a fire by 15-fold.

In reality, this claim came from a study using powerful, NASA-style flame retardants, which provided an extra 15 seconds of escape time. But this is not the same type of chemical used in most furniture, and government and independent studies show that the most widely used flame-retardant chemicals provide no benefit for people while increasing the amounts of toxic chemicals in smoke.

A flame-retardant chemical known as chlorinated tris (TDCPP) was removed from children’s pajamas in the 1970s amid concerns that it may cause cancer, but now it’s a ubiquitous addition to couch cushions across the United States. As for your mattress, I recommend getting one that’s either made of 100% wool or Kevlar, both of which are natural flame retardant without added chemicals.

Antiperspirants and Cosmetics—Other Major Culprits

Parabens are chemicals that serve as preservatives in antiperspirants and many cosmetics, as well as sun lotions. Previous studies have shown that all parabens have estrogenic activity in human breast cancer cells. Research published in 20126 found one or more paraben esters in 99 percent of the 160 tissue samples collected from 40 mastectomies. The consistent presence of parabens in cancerous human breast tissue suggests antiperspirants and other cosmetics may also increase your risk of breast cancer.

While antiperspirants are a common source of parabens, the authors note that the source of the parabens cannot be established and that seven of the 40 patients reportedly never used deodorants or antiperspirants in their lifetime. What this tells us is that parabens, regardless of the source, can bioaccumulate in breast tissue. And the sources are many. Parabens can be found in a wide variety of personal care products, cosmetics, as well as drugs. That said, it appears the dermal route is the most significant form of exposure. Another component of antiperspirants, aluminum chloride, has been found to act similarly to the way oncogenes work to provide molecular transformations in cancer cells.

Other Breast Cancer Prevention Strategies

In the largest review of research into lifestyle and breast cancer, the American Institute of Cancer Research estimated that about 40 percent of US breast cancer cases could be prevented if people made wiser lifestyle choices. I believe these are low-ball estimates. More than likely, 75 percent to 90 percent of breast cancers could be avoided by strictly applying the lifestyle modifications recommended below.

Key Dietary Guidelines

Avoid sugar, especially fructose. Reduce or eliminate processed foods, sugar/fructose, and grain-based foods from your diet. All forms of sugar are detrimental to health in general and promote cancer. Fructose, however, is clearly one of the most harmful. As a general guideline, limit your total fructose intake to less than 25 grams daily. If you have cancer or are insulin resistant, you would be wise to restrict it to 15 grams or less.
Limit protein and increase healthy fat: Consider reducing your protein levels to one gram per kilogram of lean body weight. It would be unusual for most adults to need more than 100 grams of protein and most likely close to half of that amount. Replace the eliminated protein and carbs with high-quality fats, such as organic eggs from pastured hens, high-quality meats, avocados, and coconut oil. There’s compelling evidence that a ketogenic diet helps prevent and treat many forms of cancer.
Get plenty of natural vitamin A. There is evidence that vitamin A plays a role in helping prevent breast cancer.7 It’s best to obtain it from vitamin A-rich foods, rather than a supplement. Your best sources are organic egg yolks, raw butter, raw whole milk, and beef or chicken liver. However, beware of supplementing as there’s some evidence that excessive vitamin A can negate the benefits of vitamin D. Since appropriate vitamin D levels are crucial for your health in general, not to mention cancer prevention, this means that it’s essential to have the proper ratio of vitamin D to vitamin A in your body.Ideally, you’ll want to provide all the vitamin A and vitamin D substrate your body needs in such a way that your body can regulate both systems naturally. This is best done by eating colorful vegetables (for vitamin A) and by exposing your skin to safe amounts of sunshine every day (for vitamin D).
Get sufficient amounts of iodine. Iodine is an essential trace element required for the synthesis of hormones, and the lack of it can also cause or contribute to the development of a number of health problems, including breast cancer. This is because your breasts absorb and use a lot of iodine, which they need for proper cellular function. Iodine deficiency or insufficiency in any of tissue will lead to dysfunction of that tissue, and tumors are one possibility.However, there’s significant controversy over the appropriate dosage, so you need to use caution here. There’s evidence indicating that taking mega-doses, in the tens of milligram range may be counterproductive. One recent study suggests it might not be wise to get more than about 800 mcg of iodine per day, and supplementing with as much as 12-13 mg (12,000-13,000 mcgs) could potentially have some adverse health effects.8
Nourish your gut: Optimizing your gut flora will reduce inflammation and strengthen your immune response. Researchers have found a microbe-dependent mechanism through which some cancers mount an inflammatory response that fuels their development and growth. They suggest that inhibiting inflammatory cytokines might slow cancer progression and improve the response to chemotherapy. Adding naturally fermented food to your daily diet is an easy way to prevent cancer or speed recovery. You can always add a high-quality probiotic supplement as well, but naturally fermented foods are the best.
Avoid GMOs: Avoid genetically engineered foods as they are typically treated with herbicides such as Roundup (glyphosate), which are likely to be carcinogenic. A French research team that has extensively studied Roundup concluded it’s toxic to human cells, and likely carcinogenic to humans. Choose fresh, organic, preferably locally growth foods.
Avoid charring your meats. Charcoal or flame broiled meat is linked with increased breast cancer risk. Acrylamide—a carcinogen created when starchy foods are baked, roasted, or fried—has been found to increase breast cancer risk as well.
Avoid unfermented soy products. Unfermented soy is high in plant estrogens, or phytoestrogens, also known as isoflavones. In some studies, soy appears to work in concert with human estrogen to increase breast cell proliferation, which increases the chances for mutations and cancerous cells.
Drink a quart of organic green vegetable juice daily. Please review my juicing instructions for more detailed information.
Add cancer-fighting whole foods, herbs, and spices to your diet, such as broccoli. To learn more about how anti-angiogenetic foods fight cancer, please see our previous article: “Dramatically Effective New Natural Way to Starve Cancer and Obesity.”
Curcumin. This is the active ingredient in turmeric and in high concentrations can be very useful in the treatment of breast cancer. It shows immense therapeutic potential in preventing breast cancer metastasis.9 To learn more about its use for the prevention of cancer, please see my interview with Dr. William LaValley.
Avoid drinking alcohol, or at least limit your alcoholic drinks to one per day.

 

Other Lifestyle Strategies for the Prevention of Breast Cancer

Optimize your vitamin D. Vitamin D influences virtually every cell in your body and is one of nature’s most potent cancer fighters. There are well over 800 references in the medical literature showing vitamin Ds effectiveness against cancerVitamin D is actually able to enter cancer cells and trigger apoptosis (cell death). Research has shown vitamin D kills cancer cells as effectively as the toxic breast cancer drug Tamoxifen, without any of the detrimental side effects and at a tiny fraction of the cost. Vitamin D works synergistically with every cancer treatment I’m aware of, with no adverse effects.According to Carole Baggerly, founder of GrassrootsHealth, as much as 90 percent of ordinary breast cancer may in fact be related to vitamin D deficiency. Most recently, a meta-analysis of five studies published in the March 2014 issue of Anticancer Research10 found that patients diagnosed with breast cancer who had high vitamin D levels were twice as likely to survive compared to women with low levels.11, 12, 13 The high serum group had an average vitamin D level of 30 nanograms per milliliter (ng/ml). Women in the low serum group averaged 17 ng/ml, which is the average vitamin D level found in American breast cancer patients.14

The researchers urge physicians to make vitamin D monitoring and optimization part of standard breast cancer care. According to the featured findings, you need at least 30 ng/ml of serum 25-hydroxyvitamin D (25(OH)D) to prevent cancer from spreading. That said, other research suggests you’d be better off with levels as high as 80 ng/ml. One 2011 study15, 16 found that a vitamin D level of 50 ng/ml is associated with a 50 percent lower risk of breast cancer.

Maintain a healthy body weight. This will come naturally when you begin eating right for your nutritional type and exercising. It’s important to lose excess body fat because fat produces estrogen, which can fuel breast cancer.
Improve your insulin/leptin receptor sensitivity. The best way to do this is by avoiding sugar and grains and making sure you are exercising regularly, ideally by incorporating the principles of Peak Fitness.
Avoid xenoestrogens. Xenoestrogens are synthetic chemicals that mimic natural estrogens. They have been linked to a wide range of human health effects, including reduced sperm counts in men and increased risk of breast cancer in women. There are a large number of xenoestrogens, such as bovine growth hormones in commercial dairy, plastics like bisphenol A (BPA), phthalates and parabens in personal care products, and chemicals used in non-stick materials, just to name a few.
Breastfeed exclusively for up to six months. Research shows this will reduce your breast cancer risk.17
Avoid wearing underwire bras. There is a good deal of data that metal underwire bras increase your breast cancer risk.
Avoid electromagnetic fields as much as possible. Limit your exposure and protect yourself from radiation produced by cell phones, towers, base stations, and Wi-Fi stations, as well as minimizing your exposure from radiation-based medical scans, including dental x-rays, CT scans, and mammograms. Items such as electric blankets can be particularly troublesome and increase your cancer risk.
Get enough sleep: Make sure you are getting enough restorative sleep. Poor sleep can interfere with your melatonin production, which is associated with an increased risk of insulin resistance and weight gain, both of which contribute to cancer’s virility.
Employ effective stress management tools: Stress from all causes is a major contributor to disease. Even the CDC states that 85 percent of disease is driven by emotional factors. It is likely that stress and unresolved emotional issues may be more important than the physical ones, so make sure this is addressed. My favorite tool for resolving emotional challenges is Emotional Freedom Technique (EFT).

Taking Control of Your Lifestyle Can Significantly Reduce Your Odds of Cancer

Preventing breast cancer is far more important and powerful than simply trying to detect it, and avoiding chemical hazards such as those reviewed above are a big part of any cancer prevention strategy. The question is, how do you avoid them when there are so many? My answer is to clean up your life to where your food, water, clothes, furnishings, and other products you come into regular contact with are as close to natural and unprocessed as possible.

This means seeking out organically-produced items—be it a piece of food, clothing, bed linens, laundry detergent, or shampoo. All of it counts, as it’s the accumulated exposure from all these varied sources that end up wreaking havoc. In the case of household cleansers and personal care items, you can inexpensively replace most or all of them with just a few simple, non-toxic ingredients. Coconut oil, for example, has countless uses around the house. Ditto for baking soda and vinegar. Many of the recommendations listed above will also automatically reduce your exposure to cancer-causing toxins.

A Prescription for Healthy Living: How Diet and Exercise Can Help Cancer Patients


A patient’s treatment plan for fighting cancer doesn’t stop at the hospital door. Adopting a healthy lifestyle, in terms of diet and exercise, is especially important for cancer patients in reducing stress, minimizing side effects, and boosting energy levels to power through treatment and recovery.

More than 93 million American adults could be counted as obese in 2016, according to the most recently available data from the Centers for Disease Control and Prevention.  “Obesity not only increases the risks of developing cancer; it also increases the risks of complications in diagnosed patients,” says Jennifer Ligibel, MD, director of Dana-Farber’s Leonard P. Zakim Center for Integrative Therapies and Healthy Living.

Plus, in some common cancers, such as breast cancer and prostate cancer, many patients now tend to gain—rather than lose—weight during treatment.

“That contradicts a common misperception that people have had for many years,” Ligibel continues. “Some patients think, ‘I have cancer. I have to make sure I don’t lose weight,’ so they bulk up. But we have much better medications to help patients avoid nausea and weight loss during treatment now than we did even a few years ago.

“Many people become less active during their cancer treatment, and even afterward,” says Ligibel. “Some cancer treatments can also contribute to weight gain.”

Jennifer Ligibel, MD.

How Patients Can Evaluate and Manage Their Diet

Ligibel recommends following the American Cancer Society’s guidelines on nutrition and weight management. They emphasize a plant-based diet with most nutrients coming from fruits, vegetables, whole grains, lean meats and fish.

“When you look across a population of people who have healthy behaviors—they eat a plant-based diet, their weight is in the normal range—we know that those people are less likely to get cancer in the first place,” Ligibel says. “In some cases, they are also less likely to have it comes back after it develops.”Blueberries.

Why Exercise is Important

Exercise is crucial in helping patients lose and manage weight and also provides other critical health benefits.

“If you exercise during your cancer treatment, and afterward, that can help prevent some of the long-term side effects that patients can develop from cancer treatment,” Ligibel says. “Exercise has been shown to reduce side effects like fatigue and joint pains from cancer treatments. Patients also feel better when they exercise and experience less anxiety and depression.”

Exercise also helps to preserve muscle; muscle loss often happens during cancer treatment, and can make recovery difficult, Ligibel says.

Those very side effects—especially fatigue—can make it difficult for patients to feel motivated to exercise in the first place. What’s important is to start now, wherever you are in your treatment, and to start slowly.

“I tell patients that 10 percent of something is better than 100 percent of nothing,” says Nancy Campbell, a clinical exercise physiologist at the Zakim Center. “Patients don’t have to go to a gym, start training for a marathon or buy expensive equipment. All it takes is a walk out your door or around your house to get started.”

Campbell suggests using a fitness tracking device, be it a basic pedometer, a smart phone app or Fitbit. After wearing it for a few weeks, you should have a baseline of your activity during treatment weeks, non-treatment weeks and weekends.

“It gives patients a good gauge of how much activity they are doing and how to gradually increase it,” she explains. “As people start to feel better, they get excited and do more and sometimes may do too much too soon. The device gives you feedback to let you know if you need to add more activity. If patients are sedentary, some of the apps buzz to remind you to move around every hour.”

To rebuild your muscle tone, Campbell suggests signing up for the free Live Strong program offered by YMCA locations across the country. This 12-week physical fitness program is designed specifically for cancer patients.

“There are also plenty of things you can do on your own at home,” she says. “You can get creative with light weights, such as soup cans, at home. But get some professional guidance before you start.”

Yoga, too, has been shown to have significant benefits for cancer patients in terms of reducing fatigue, improving sleep and improving quality of life.

“The data shows us that staying active during treatment definitely helps,” Campbell says. “Just doing a little something can take the edge off the nausea and fatigue, improve your mood and help take your mind off of it all.”

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