Types of Cancers

If you everave a company to a person who has been diagnosed by any type of cancer, his facial expressions can tell you how chronic this disease is. The word cancer reiterates the rise of the tumors due to the uncontrolled distribution of cells. This harmful illness can be cured today but only if it is diagnosed with in time, otherwise this can lead to death. It was a common perception a decade ago that it can not be treated even at early stages of tumor growth. Now there are plenty of treatments available which help a person live a healthy and long life.

This terrible disease has many faces such as Skin cancer, Bladder, Breast cancer, Colon and Rectal, Lungs, Renal or Kidney cancer, Endometrial, Leukemia, Melanoma, and Non-Hodgkin Lymphoma, Pancreatic cancer, Prostate, Thyroid and Cervical cancer. Starting from the most common type that is skin cancer, this harmful disease is formed around the cells of skin. This skin disease is most common in the areas where people are more subject to harmful rays of the sun.

Bladder cancer, this infection forms its roots in the bladder of the host; the muscles of the bladder are affected by it. Breast cancer is developed in the ducts of the breast. This cancer is most commonly seen in women though men can also develop this form of infection.

Colon cancer arises in the longest component of the large intestine. It is developed in the tissues of the intestine releasing mucus and other fluids. Endometrial cancer is a specifically developed in the female uterus. As its name suggests kidney cancer is formed in the kidney. However to be more specific this infection arises in the small tubes of the kidney which separate waste material from blood. Leukemia is the blood cancer that arises in the bone marrow and results in unnecessary formation of blood cells into the blood stream.

Non Hodgkin Lymphoma is developed due to the unnecessary growth of white blood cells in the body. Prostate cancer is the cancer in the male penis. There are many types of cancers and forms. Cancer can be malignant carcinomas (the one which starts its formation from the tissues).

McDermott Shares Insight on Immunotherapy in RCC

David McDermott, MD
David McDermott, MD

Immunotherapy has made an incredible impact on the treatment of patients with metastatic renal cell carcinoma (RCC), and is now beginning to make waves in other settings of the disease.

However, though drugs such as nivolumab (Opdivo) have proven their worth as both a single agent and in combination, immunotherapy is not ideal for every patient with RCC, according to David F. McDermott, MD.

“We need to do a much better job of identifying predictive biomarkers—not just looking at immunohistochemistry, but RNA sequencing, and whole-exome sequencing,” said McDermott, director of the Biologic Therapy and Cutaneous Oncology Programs at Beth Israel Deaconess Medical Center.

McDermott chaired the Immunotherapy of Genitourinary Cancer session during the 2017 SUO Annual Meeting, which covered data on both single-agent immune checkpoint blockade and combination immunotherapy in RCC.

In an interview with OncLive during the meeting, McDermott shared some of the successes with immunotherapy in RCC and gave his insight on the future treatment of these patients.

OncLive: Can you please provide an overview of your talk?

McDermott: There are a lot of new interesting data in both kidney cancer and bladder cancer for immune-based therapies. We have established that single-agent immune checkpoint blockade with either PD-1/PD-L1 is active in both diseases, and now people are looking at other questions, such as, “How can you overcome resistance to treatment by adding new agents in?” For example, does CTLA-4 in addition to PD-1 add benefit? Does blocking VEGF in addition to blocking PD-1/PD-L1 add benefit? Importantly, how can we figure out which patients should get which combination? This is because most combinations add adverse events and costs, so it is up to us to try to identify who should get which new combination therapy ahead of time.

Combinations have been very successful in the metastatic setting. Could you comment on some of these combinations?

The newest and probably most exciting data come from the CheckMate-214 study, which looked at the combination of PD-1 blockade with nivolumab, and CTLA-4 blockade with ipilimumab (Yervoy), which is FDA approved in melanoma. However, this trial established its role in kidney cancer, particularly in the intermediate- and poor-risk population of patients based on clinical criteria. In that subgroup, patients who received the combination did better in terms of response, had a longer progression-free survival (PFS), and significantly longer overall survival. There was a higher complete response rate at approximately 9%, which is very exciting. 

The toxicity is an issue; obviously, with combinations, it can be an issue. There were more treatment-related deaths on the CTLA-4/PD-1 combination of ipilimumab plus nivolumab, but there were actually fewer grade 3/4 toxicities. Approximately 60% of the patients who received this combination required steroids. Therefore, you must educate your team and your patients about managing these side effects. They can be managed, but they pose a challenge. The efficacy data are very exciting. We haven’t seen anything like this for frontline treatment and we are looking forward to its potential FDA approval in early 2018.

What are your thoughts on nivolumab as a single agent in RCC?

As you know, it is FDA approved for patients who have failed VEGF-targeted therapy in the second-line setting. We have long advocated to try to move it up to the frontline setting because it has a preferable therapeutic index and it has a pretty good toxicity profile for most patients with less than 10% having to come off for toxicity.

[Additionally] there is a small group of patients who get durable responses with treatment, sometimes even after the treatment stops. That percentage is low—it might only be 5% or 10%—but it would be exciting and important to move it up to the frontline setting for those patients so they might be able to skip some of the more toxic treatments. However, to do that, we need to do a much better job of identifying predictive biomarkers—not just looking at immunohistochemistry, but RNA sequencing and whole-exome sequencing, as well. 

Grief – A Universal But Unique Human Experience

My wife was diagnosed with glioblastoma in 2007. She battled the stage 4 brain cancer for nearly four years. As her caregiver, I learned about the myriad of issues that family's face when caring for someone with a life-threatening disease. Understanding human emotion is a difficult area of ​​study. The emotion of grief is no exception. However, experts have provided frameworks that enable discussions about grief.

While different challenge models exist, proposed by many experts, in 1969, Kübler-Ross published the first, widely accepted model of grief. This work provided insight into the emotions that people experience when facing death. Later, other researchers extended or revised the model to include other people who experience grief, not only to those facing death. The Kübler-Ross model includes five stages: 1) shock and denial, 2) anger, 3) bargaining, 4) depression, and 5) acceptance.

Most people move through these phases of grief. The length of time a person spends during each phase depends on the circumstances and is unique to each individual. It is very easy to compare ourselves to other people, and judge that something might be wrong with us, when we do not handle the grief similarly. Just remember, you are unique. Take comfort that yourrief recovery is also unique to you. I learned about the grieving process during my studies several years before Lynne's diagnosis and death. That understanding helped me to recognize my emotions and my feelings as well as to accept that they were normal, and to be expected, during a significant loss.

I observed many families over time that lost a loved one. One of the most substantial losses a person experiences is that of a spouse because of the relationship depth and the additional potential for economic losses. Based on discussions with those losing a spouse, I believe that losing a spouse affects the relationship within the social circles that the couple shared. I believe there are two contributing factors. First, the surviving spouse drawers closer to their own family for support. Second, others within the social circles struggle with the surviving spouse due to a partial loss of identify, that is, the transition from a "couple" to that of a widow or widower. Observations also indicate an increased mortality rate among the surviving spouses, especially in older people due to the major stressor (Gass, 1987, as cited by Harvard Medical School).

In our society, most people recognize the inevitable nature of death but many rarely experience the process because societalorms tend to hide death behind the walls of health care facilities. This tends to deemphasize the process of grieving. This potentially decreases our ability to cope. Sometimes during a terminal illness, a struggle exists between health care providers and families, relating to the disclosure of all the facts surrounding the illness. Health care facilities and health care providers maintain various and different ideologies. This is understandable because some people want the facts and others try to avoid the facts. This simply demonstrates the differences in the ability to cope with illness and the potentially impending death.

At some point, each of us will face a significant loss resulting in grief. While this is a universal human experience, each individual experience is unique. My grief recovery was influenced by observing the experiences of other people and training. I hope that by sharing my personal experience that other people will benefit as well. I am writing several articles adapted from a chapter in my upcoming book "Suddenly a Caregiver. The chapter covers a variety of topics about my experience with justification and include information about grief models, anticipating grief, and preparation for grief.

References

Harvard Medical School. (2011). Beyond the five stages of grief. The bereavement process is seldom linear and variations from one person to the next. The Harvard Mental Health Letter / From Harvard Medical School, 28 (6), 3.

Practical Questions on Checkpoint Agents Arise

Elizabeth Plimack, MD
Elizabeth Plimack, MD

Although the advent of checkpoint blockade immunotherapies has inspired more excitement among oncologists than any other recent anticancer therapeutic development,1,2 researchers and clinicians alike are wrestling with an array of questions concerning how best to translate this new modality into practice.

Despite the promising developments in this arena, many patients with cancer respond inadequately to immune checkpoint monotherapy, and others develop serious (grade 3-4) toxicities that require treatment cessation.3 Understanding the evidence and questions concerning dosing, treatment schedules, efficacy, and safety of immune checkpoint inhibitors as monotherapy and in combination regimens is essential to optimize their use in clinical practice.

Monoclonal antibodies that inhibit the CTLA-4 and PD-1/PD-L1 pathways significantly extend survival compared with conventional treatment in patients with targetable malignancies. The list of immune-responsive cancers now spans melanoma, non–small cell lung cancer (NSCLC), urothelial bladder cancer, head and neck squamous cell carcinoma, gastric cancer, hepatocellular carcinoma, Hodgkin lymphoma, Merkel cell carcinoma, renal cell carcinoma (RCC), and tumors with high mutational loads in patients with germline mutations involving DNA mismatch repair, particularly colorectal cancer (CRC).3

As of December 5, the FDA had approved 6 checkpoint inhibitors to treat 1 or more of these malignancies: ipilimumab (Yervoy), a CTLA-4 inhibitor; nivolumab (Opdivo) and pembrolizumab (Keytruda), both PD-1 inhibitors; and atezolizumab (Tecentriq), avelumab (Bavencio), and durvalumab (Imfinzi), all PD-L1 inhibitors.

Although these agents broadly share similar adverse event (AE) profiles, each has a unique dosing recommendation and schedule (Table4-10) Several experts discussed relevant questions concerning the administration of these agents in interviews with OncologyLive®.

Table. FDA Recommendations for Checkpoint Immunotherapies4-10

Dosing

Historically, most monoclonal antibodies were dosed according to body weight because body size was thought to affect pharmacokinetics (PKs).11 Early studies of pembrolizumab used the same approach, but as more PK data became available, researchers revisited the need for weight-based dosing. Pembrolizumab, nivolumab, and atezolizumab are now approved at fixed doses for treating several tumor types.

Evidence supports fixed checkpoint inhibitor dosing. In one recent study, researchers combined PK data on pembrolizumab with response data for patients with advanced melanoma or NSCLC.11 Comparing individual areas under the exposure curve with exposure ranges from pembrolizumab doses in early trials, 2 mg/kg every 3 weeks (Q3W) and 10 mg/kg Q3W or every 2 weeks (Q2W) showed that a 200-mg fixed dose pharmacokinetically resembled weight-based dosing among patients with CRC, head and neck cancer, NSCLC, and urothelial cancer. Although patients weighing more than 90 kg had the lowest PK exposure, they still fell well within the range associated with near-maximum efficacy in prior studies.11

Such findings make sense, according to Elizabeth Plimack, MD, MS, chief of genitourinary medical oncology and director of genitourinary clinical research at Fox Chase Cancer Center in Philadelphia. For inhibitors of the PD-1 pathway, “there’s no dose–response relationship,” she said. “We’re using much higher doses than are needed to saturate the receptors. An immune checkpoint inhibitor is training the immune system. The immune system has memory, and so we see that the durability of the antitumor effect continues after we stop treatment.”

Multiple studies’ findings have shown that dosing PD-1 agents above 1 mg/kg does not boost efficacy.12 In one systematic review and meta-analysis of data on patients with advanced melanoma or RCC, nivolumab doses of 2 or 10 mg/kg yielded similar objective response rates (ORRs) but significantly better progression-free survival (PFS) and overall survival (OS) than 0.3 mg/kg.13 Nivolumab is approved at 3 mg/kg or 240 mg, depending on the indication.7

Patients who received pembrolizumab had similar outcomes at either 2 or 10 mg/kg.13 “[Past] a certain dose [of either agent], no further improvement was observed in patient outcomes,” the reviewers concluded. “Therefore, effective and minimum doses need to be determined so that patients can achieve maximum therapeutic benefit with minimum adverse effects.”13

Discover Why You Should Quit Smoking By Hypnosis

If you smoke then you know how hard it can be to quit. But you should also know that it is very important that you do quit. Smoking will shorten your life span and affect your health in many ways. One of the best methods to help you kick the habit is to quit smoking by hypnosis.

Your lungs contain tiny hairs that cover the lining of your lungs. These tiny hairs are responsible for cleaning debris and other harmful things that enter your lungs. When you are a smoker, the chemicals in the smoke will destroy these hairs and allow harmful substances to become trapped in your lungs. This will lead to lung disease and cancer. Smoking will also affect your ability to fight off infection. A smoker will have a higher incidence of colds and other respiratory infections.

Cigarettes contain carbon monoxide which will deplete the blood of much needed oxygen. This decrease in oxygenated blood will cause plaque to form on the arterial walls and put you at a high risk for a heart attack.

Smoking also affects your digestive system by increasing acid secretions from your stomach that can cause heartburn and ulcers. Smokers are also at a higher risk for pancreatic cancer, bladder cancer and kidney damage than high blood pressure.

So now that you know just a few of theaging effects that smoking can have on your whole body, it's time you get serious about quitting. Accept the fact that smoking can kill you and you have to quit for your health and the health of your loved ones. It will be hard to do, but the health that you regain will make it worth it.

There are many methods to help you quit. You can try the nicotine patch, nicotine gum or prescription medications. But if you have tried these methods before without success, maybe it's time you tried to quit smoking by hypnosis.

Hypnosis has become a widely accepted form of treatment for many physical and mental conditions. It has been very successful in the treatment of addictions. It is safe and can be very effective when used correctly.

The best way to quit smoking by hypnosis is to become accepting. Get yourself ready to quit by listing all the ways that quitting smoking will benefit you. Think of the money you will save and how you will be able to breathe easier. Remember that you will not be affecting the ones around you anymore with your second hand smoke.

Once you have become determined to quit, find a good hypnotherapist. Ask your doctor or check with your local hospital for a recommendation. A lot of hospitals and clinics will provide free hypnosis sessions to help you quit smoking.

Once you have made a decision to quit smoking with hypnosis, follow through. It may take more than one session to completely overcome the battle with your smoking addiction. But if you are determined to quit you will be successful.