ALL WOMEN SHOULD KNOW THEIR BRCA STATUS

Linda (in therapy) with baby

Never happier than when holding a baby

Here is some very encouraging news for women suffering from ovarian cancer, and who have a mutation in either BRCA gene.  It is not a cure, but it promises much longer remission times.  It concerns a “maintance drug”, specifically Olaparib.

Olaparib (trade name Lynparza) is a PARP inhibitor.  You know what that is, right?  It was developed in Cambridge, UK, and currently is manufactured by AstraZeneca.  A clinical trial indicates that it is very effective at prolonging PFS, which stands for Progression-Free Survival.  If Olaparib had been available in 2010 I might have had Linda for many more months, even years, more.  I say “might have had” because I still don’t know about her BRCA status.  I think it is criminal not to test every woman for BRCA.

Ask your gynecologist about it.

http://www.cancernetwork.com/ovarian-cancer/maintenance-olaparib-yields-impressive-results-advanced-ovarian-cancer 

ORGANIC FOOD?

Linda in Egypt

Look carefully and see Horus in the background, molesting Ramses II

Faithful readers of my blogs will know that I tend to be skeptical about most claims of miracle diets, especially when they concern cancer.  Well, what then am I to make of a massive new study in France, comparing the incidence of two kinds of cancer in people who ate an organic diet with people who didn’t?  Why don’t I admit that this settles the deal?  In other words, why don’t I recant?  Don’t worry: I’ll tell you.

First, the study:  Nearly 70,000 French people, mostly female, were asked to report on their eating habits.  Participants were sorted into categories: always ate organic; often ate organic; only ate organic by accident; never touched the stuff.  Since people who eat organic tend to be, in comparison with ordinary mortals, more health conscious, richer, more likely to get exercise, less likely to have big families, less likely to drink rot-gut red wine or Budweiser, etc., etc. , the researchers attempted to use statistical magic to account for these factors.  The 25% difference that remained, then, was assumed to be caused by diet.  Here is a description of the study:

https://www.nytimes.com/2018/10/23/well/eat/can-eating-organic-food-lower-your-cancer-risk.html

Still, I remain unconvinced.  My principal problem with the study is that the participants “self-reported”; they simply described their diets to the researchers.  You know as well as I do that diet-health hawks often harbor a statistical propensity to  lie about their intake.  “Oh, that hot dog I scarfed down at the Mariners game really doesn’t count.”  Nobody lies about eating less organic food, except maybe me.  Thus the study has a built in bias – which, it seems, would be difficult to eliminate. 

Anyway, here are some caveats.

https://qz.com/1435958/a-new-study-suggests-organic-food-can-prevent-cancer-but-read-the-fine-print/

The notion is that certain pesticides may promote certain cancers, and that is certainly true.  It also is held that GMO food stuffs cause cancer; this is almost certainly not true.  Every expert agrees that one’s state of health is enhanced by eating more fruit and vegetables, less red meat, and cutting down on alcohol, and that includes cancer. Insofar as eating organic entails more apples, oranges and beets it may be beneficial - but because of what is eaten, not whether or not it is organic.  So, phooey!  Also - can you really trust a Frenchman?*

All that aside, I am now going to construct my dinner: chorizo burrito (carry-out), washed down with Red Hook ESB.  I’m 85, so who the heck cares?

*You know you can't always take me seriously, right?

SMALL-BATCH PHARMACEUTICALS

                     LINDA, IN THERAPY, WITH SOMEONE'S BABY

They used to make gin in the bathtub, and now lots of people make beer in the garage and/or wine in the cellar.  So, why not biopharmaceuticals on the kitchen table?

Well, some smart folks from MIT have done just that.  They have designed and assembled a three-stage process than can produce what you might call “small-batch” drugs.  They have tested it on several well-known concoctions, and found that it turns out the real thing very quickly and, I would guess, relatively economically.  The hope is that these units, which eventually may be miniaturized to a kit about the size of a standard ink-jet printer, can be used by researchers to produce experimental drugs, as well as by hospitals to create remedies for rare conditions.  It seems to me that it might also bring down the price if pharmaceuticals in general, but -  don’t hold your breath.

This is all well and good, but I can foresee problems.  For instance, the first drug the MIT team produced using their kitchen-table still was human growth hormone (hGH).  hGH has many beneficial applications, but isn’t it also a banned substance used by cheating athletes?  If you can turn it out in quantity using a gadget that can be hidden in the attic, the game is up.  You will know there is a problem when slender lasses from Lithuania start flinging the shot over 85 ft.!

https://directorsblog.nih.gov/2018/10/08/how-to-make-biopharmaceuticals-quickly-in-small-batches/ 

WHY CANCER? MORE TO THE POINT, WHY NOT CANCER?

Linda and Amanda, a very long time ago.

That tiny blob now is the mother of two of my ultra-cute great grand kids

We all know that cancer can be, and usually is, a result of genetic mutations.  Some glaring culprits – sometimes called oncogenes, have been known for decades.  Oncogenes cause the cell to divide without limit.  Opposing these bad actors are things we call tumor suppressor genes.  Too many of the former, or too few of the latter, can lead to active cancer growth.  Additionally, sequencing of many cancer types has shown that other (mutated) genes are involved in cancer growth, although just why or how are not always obvious.  But we have a list of these suspicious mutations in TCGA, The Cancer Genome Atlas, about  which I have blogged recently.  What?  You haven’t read it?  Well, here’s another chance:

https://ljb-quiltcutie.blogspot.com/2018/10/tcga.html

So, anyway, a bunch of learned Brits have shown that normal, healthy, non-cancerous cells ALSO display a panoply of these same mutations, yet remain pink, rosy and harmless  So, what gives?  No clue, it seems.  Some speculation based on evolutionary theory is advanced, but sheepishly.  It appears that this may be another promising avenue of research.  Expect more, later.

https://www.nytimes.com/2018/10/18/science/cancer-genetic-mutations.html

You may be interested to know that, by middle-age, your esophagus is coated by colonies of "mutant clones!"  Maybe that's why Vegan food  tastes so terrible!

FRED HUTCH NEWSLETTER

I still can't figure out where this is.

Any suggestions?

The Fred Hutch Newsletter is out.  It contains a half-dozen interesting articles, ranging from Immunotherapy to Circadian Rhythms.  You could do worse than to spend a few minutes reading it.  Here it is:

https://mail.google.com/mail/u/0/#inbox/FMfcgxvzLDxhTnZqJnfpNfVLRgGlBXNz

I particularly appreciated the piece on ovarian cancer, partly because I know, or at least have met, almost everyone mentioned.   I even have blogged about one of them:

https://ljb-quiltcutie.blogspot.com/2014/04/profiles-in-research-excellence-dr.html

Much of this article is about a “two-minute” questionnaire designed to determine whether or not one is suffering from OVCA.  It is the product of work by Dr. Robyn Andersen, a clinical psychologist.  Back in the day I proof-read several of Robyn’s papers.  Her questionnaire is given in the article.  Make sure your primary care doc knows about it.  Don't apply it to yourself and then obsess about it, though.

Another interesting (to me, at least) article examines some of the mysterious nuts and bolts of CAR-T immunotherapy.  I learned that in making the T-cell a “chimera” they festoon it with molecules that are stuck in and penetrate the cell wall.  The outer end of these things is the “antigen receptor”; it recognizes, and gloms onto, the cancer cell.  When this happens, the inner end activates “pathways” that turn the T-cell into a lethal weapon.  How all this happens, or how they even know it happens is not explained.  Just as well.

TCGA

The Canadian Empress

Queen of the St. Lawrence Seaway

I have just (10/12/18) returned from a delightful week touring the St. Lawrence river in a small funky boat (pictured), starting at Quebec City, visiting Montreal and other attractions, and terminating at Kingston, Ontario.  Overall, it was a blast; the scenery was very pleasant (fall colors were peaking), the food and accommodations were top-notch, the crew was a wonder to behold, and even the bar far exceeded expectations (and mine tend to be pretty high).  As to the river … it is the most impressive I have ever seen.  The Mississippi seems far smaller to me, and I have never seen the Amazon.  The Nile, Colorado, and even the Columbia are outclassed.  After all, the St. Lawrence drains the Great Lakes, as well as a vast (and soggy) swath of central North America.  Whatever: I was impressed, as you can tell.  I recommend the trip.  If you go, tell them Myrl sent you – they will give you a free liqueur. 

Oh, I should add something to my blog about travel when you’re old,

http://frivilousessays.blogspot.com/2017/12/travel-advice.html

Be sure to induce as many younger people to go with you as possible; they (being kind and overflowing with energy) will ensure that you don’t find yourself stranded on a dock or impossibly far from a wash room at a moment of urgency.  My helpers on this trip were my daughter Karen Beck, and Linda’s sister Carolyn Joyce.  It is impossible for me to thank them enough.

So, for my first blog back, I would like to turn you over to Dr. Francis Collins, Director of NIH,  for a brief summary of the history, philosophy, and promise of TCGA, The Cancer Genome Atlas,  I have written about this subject more than once over the years; the most complete (but oldest) treatment being

https://ljb-quiltcutie.blogspot.com/2013/05/the-cancer-genome-and-its-uses.html

I would like to turn you over to Dr. Collins – but I can’t, at least not directly – when I copy the Web address of the article and then open it, I am presented with another of these inscrutable computeroid “explanations” for my failure.  So, if you really are interested, Google NIH Director’s Blog and access his latest – something about frog hair.  Over on the side will be a columnar list of other topics, the bottom of which concerns the TCGA 2018 Symposium.  Click on that and you will be presented with a 15 minute U Tube video that is mildly interesting and informative, and easy to follow.

Knowing that you won’t:  here is what I got out of it.  Cancer is a condition ultimately caused by errors in the genome.  Fundamentally, then, the way to tackle it is to determine what those mistakes are and how they operate,  Only with this knowledge is it possible to counteract the effects of those mistakes – making precision medicine and immunotherapy possible.  The only feasible way to separate signal (the causative mutations) from noise (harmless, random mutations) is – as any good exploration geophysicist knows – to analyze huge data sets.  Hence the marriage of medicine and computer science – bioinformatics – and ultimately The Cancer Genome Atlas.

Constructing this blog was so laborious that I think I will post it on Facebook.  Remember, there are lots more - better, shorter, and with better pictures - at "Myrl'sBlog".