April 04, 2008
|Pre-Chemo Fasting May Protect Healthy Cells||Health Science/Technology|
One of the reasons it's hard to kill cancer is that it's hard to create treatments that distinguish between cancer cells and normal cells, so it's hard to kill cancer without also killing the patient. Most chemotherapy agents broadly target all cells that are dividing, on the theory that cancer cells divide more often than most normal cells so you'll kill more cancer cells on average. But lots of normal cells become collateral damage in the process, leading to the well-known toxic side-effects of chemo. Hair follicle cells and cells lining the intestinal tract divide especially rapidly, which is why hair loss and nausea are common.
Ideally, the body's own immune system would kick in and selectively kill cancer cells, but there's a problem. The immune system is very good at detecting foreign invaders, but cancer cells are the body's own cells — good cells gone bad — so their external markers are largely indistinguishable from those of normal cells. A lot of research has gone into finding ways to differentiate between normal cells and cancer cells in the hopes of creating "targeted" therapies — chemotherapy agents that attack only cancer cells — but success, so far, has been very limited.
Some researchers have taken an entirely different tack: instead of trying to detect which cells are which and attack only cancer cells, find instead a way to protect healthy cells against chemotherapy. And it turns out there may be a very simple, drug-free way to pull this off. USN&WR:
Fasting for two days before chemotherapy might protect cancer patients against the toxic side effects of these powerful drugs by shielding healthy cells while dooming malignant cells to destruction, new research suggests. [...]
Although not yet replicated among patients, the preliminary animal research is encouraging: As little as 48 hours of starvation afforded mice injected with brain cancer cells the ability to endure and benefit from extremely high doses of chemotherapy that non-starved mice could not survive.
The finding was published in the March 31 online issue of the Proceedings of the National Academy of Sciences.
Longo noted that the idea first came from a different field of research: anti-aging science.
"We had found that healthy cells have a 'shield mode' -- a kind of protective strategy that allows the organism to be resistant to not just one but dozens of threats and stresses, including starvation," he said. "So we thought this characteristic might be a way to distinguish between normal cells and cancer cells when applying chemotherapy. And it turns out that it works for yeast, for human cells in test tubes, and here, in mice."
Following genetic manipulation of yeast to show that mimicking starvation could confer a life-prolonging protection against stress, the researchers induced glucose deprivation among a series of rat and human cell lines, some cancerous, some healthy.
This protected the healthy cells against exposure to toxic compounds, while leaving cancer cells unprotected.
In turn, the researchers then tested mice injected with brain cancer cells to see how they faired upon exposure to a high dose of the chemo drug etoposide. Noting that just one-third of this amount is considered to be the maximum for what is allowable for human treatment, Longo and his team compared results among mice starved for 48 hours and 60 hours pre-treatment with mice that were not starved.
While 43 percent of the non-starved mice died within 10 days of treatment, only one of the 48-hour starved mice died in that time. As well, while starved mice had lost 20 percent of their weight before treatment, most regained it back within four days of chemo exposure while the non-starved mice actually lost 20 percent of their weight post-treatment.
Non-starved mice also suffered toxic side effects, such as impaired movement, ruffled hair and poor posture. The 48-hour starved mice displayed no such problems.
Mice starved for 60 hours were exposed to even higher chemo doses. At that level, all non-starved mice died by the fifth day, at which point all the starved mice continued to survive. Again, almost all starvation weight loss was regained post treatment, and no signs of toxicity were evident.
Longo and his colleagues concluded that short-term starvation does appear to guard healthy cells and allow cancer treatment to attack only diseased cells. They said they are now organizing a human trial.
"We hope this works with patients, and we have reason to think it will," he said. "I think I'm more enthusiastic about this than anything else I've done. And you can see the potential for this being turned into something very, very useful. But we won't know until we do it."
Dwayne Stupack, an assistant professor of pathology with the Moores Cancer Center at the University of California, San Diego, described the current effort as a "reasonable" approach toward mitigating the undesirable effects of chemotherapy.
"We all know that people can go for a few days without eating, and it's not going to kill them, because the cells in our body are able to adjust and make do," he noted. "It's an intrinsic evolutionary stress response that is designed to keep those cells alive. And it turns out that this response also works to keep those healthy cells alive during chemotherapy."
"So, I think what they've done is very interesting and exciting, in the sense that the tumor they looked at is very aggressive, very lethal, and they were able to use what I would call relatively high chemotherapy without causing toxicity -- because the cells have already been conditioned to sort of shut down," Stupack said.
Stupack cautioned, however, that the starvation technique might not work for everyone. "There are certain tumors that may already be altering metabolism to normal tissue, and certain populations of cancer patients among whom an intrinsic stress response to the cancer is already under way," he noted. "In these cases, this approach might not achieve anything further. Those are the kinds of limitations that should be considered."
Very interesting, obviously. And it's free, non-toxic, and largely harmless. It will be interesting to hear what my oncologist has to say about it. One possible issue: getting chemo is an unpleasant process as it is. How much worse will it feel when one is ravenously hungry? Still, if it works...
January 29, 2008
Starting chemo tomorrow. First of six infusions, three weeks apart. Some people feel like crap during this process, some don’t. I hope I'm one of the lucky ones. It's all somewhat unreal, since I continue to have no symptoms whatsoever. On the contrary, I feel better than I have in a long time. Let's hope that's a good sign. After tomorrow, I'm guessing, it’s going to start seeming a lot more real.
I wish I had the time and talent to write about this whole experience in depth. It's been an education. First, University of Wisconsin Hospital, then Mayo Clinic, now back to UW. Everybody's well-meaning, everybody's trying to do the right thing, but it's startling to see the degree of tunnel vision in the doctors I've encountered. It's all about the technology. I've talked to five oncologists of various flavors and not one has ever asked me a single question about what I eat, how I live, etc. It's just not on their radar screen. But to me it seems axiomatic that it's essential to make my body my ally in this, to enlist its abilities to heal itself, and that anything that promotes my overall health is crucial. Not to my docs, though. They've got three tools in their bag – surgery, chemo, radiation – and that's it. Given the extreme toxicity of chemo and radiation, it's hard to believe there's not a better way. Someday there will be. In the meantime, I'm doing everything I can to make myself as healthy as I can, and my doctor will do what he knows how to do.
More to come.
December 12, 2007
|Where I've Been||Health|
Regular readers will have noticed that posts have been conspicuously absent the past couple of weeks. Here's what's been going on. I've got issues.
A couple of weeks ago, I had an intestinal polyp removed that came up positive for two kinds of non-Hodgkins lymphoma (cancer of the lymph system). Since then, I've had a number of tests and scans to determine the extent of the cancer. The good news is that no cancer has been found anywhere else so far. It could easily have spread to one or more lymph nodes, which is what typically happens with lymphoma, but that's not what the tests (PET scan, CT scan, bone marrow biopsy, blood work) have shown. I'm getting a few more tests done next week, and they may still turn up something, but so far it's all very encouraging. I have no symptoms whatsoever and generally feel great, which is also very encouraging.
My hematologist hasn't decided on a recommended course of treatment yet, but he says it's likely that he'll recommend chemotherapy. As I said, no cancer has shown up on the tests so far (other than what was in the polyp that was removed) but he's concerned about the possibility that there may still be tiny amounts present, possibly in multiple sites, so chemo now would be the prudent thing to do. If that's what the treatment turns out to be, it'll probably start soon after New Year's. It would last 18 weeks – six infusions three weeks apart. It would be a moderate dosage, not the really aggressive dosage that is used in some cancers, so he anticipates that I'll still be able to go to work and so on. There may be a few days in each three week period where I'll feel like I've got the flu, but overall he doesn't expect it to be debilitating. It's also possible that he'll decide instead to recommend a wait-and-see approach.
All in all, I feel extremely optimistic. I'm in good health and have been eating well and exercising regularly and taking good care of myself generally, so I think my body will be my ally in this. Meanwile, I'm trying to learn as much about cancer as I can as quickly as I can, including possible treatment options in addition to the mainstream ones of surgery, radiation, and/or chemo. If any of you has experience with cancer that you want to share with me, I'd love to hear about it. As I said, my attitude is completely upbeat, and I don't consider my cancer a taboo subject that people need to tiptoe around. I intend to take as active a role as I can in getting healthy and staying that way and then to go on to live the rest of my life. I'm more grateful than I can say for the love and support of family and friends and especially of my daughters Molly and Ali and my wonderful life partner Carie. I'm a very lucky man.
November 30, 2007
WSJ has an article about a Mr. Jim Dawson, who was hit with a $1.2 million hospital bill after his insurance maxed out at $1.5 million. Excerpts:
Part of the problem: Even as medical progress and new technologies raise health-care costs, health plans have been slow to raise their caps. Mr. Dawson's $1.5 million cap was relatively generous by today's standards. The Segal Company, an employee-benefits consulting firm, says the average health-plan cap among companies it advises is $1 million a person — the same as it was in the 1970s, when the purchasing power of $1 million was the equivalent of nearly $6 million today.
Another issue is the widespread practice of bill padding by hospitals and other health providers. While hospitals say bill padding is their only defense against the aggressive cost-reduction efforts of insurers and government programs, the end result is that individuals can, with little warning, be left stuck with wildly inflated medical bills.
For instance, CPMC charged Mr. Dawson $791 for stockings designed to improve blood circulation. The same pair can be purchased on the Internet for as little as $12.
Allan Pont, CPMC's chief medical officer, acknowledges that the charges on Mr. Dawson's bill are "Disneyland numbers" that health insurers and government programs like Medicare and Medicaid never pay. But he says they reflect the hospital's operating costs, such as paying for doctors, nurses and medical equipment, as well as markups to compensate for the fact that CPMC collects only a fraction of what it bills every year. [...]
Hoping to stall CPMC, Mrs. Dawson sent the hospital two checks for $30. Bills were also piling up from doctors, so Mrs. Dawson also sent them small sums to keep them at bay. The Dawsons weighed whether to declare personal bankruptcy.
Before they made any decision, Mrs. Dawson asked to see an itemized bill from CPMC. When she received it, she was shocked by how much the hospital had marked up inexpensive items like the stockings. CPMC charged Mr. Dawson between $2,225 and $6,675 a night for an oxygen mask to help him breathe while he slept. After he was discharged from the hospital, the Dawsons rented one from a medical-supply store for $250 a month. [...]
"I do not deny that our charges look insane," says Dr. Pont, CPMC's chief medical officer. But all hospitals operate the same way, he says. "It's the reality of the industry."
Once its operating costs are factored into an item's charge price, Dr. Pont says the hospital marks up that price by threefold to account for the fact that it only collects on average a third of what it bills in any given year. [...]
In her quest to know exactly what she was being billed for, Mrs. Dawson also asked the hospital for copies of all her husband's medical records. A copy service used by the hospital called to say the copies would cost $1,030. Mrs. Dawson was outraged. Further angering her, a letter from CPMC's foundation soliciting a donation came in the mail.
That's how we roll here in the
greatest country on Earth USA.