In a recent letter to Cancer Investigation, David Steinberg, a hematologist at Lahey Clinic, Burlington, Mass, wrote:

“A $1,000 lottery ticket for a Porsche Boxster automobile was offered to the investigator who accrued the most patients to a Southwest Oncology Group prostate cancer protocol.”

“This was done” Dr. Steinberg says,” with the admirable intention of increasing patient accrual and improving the outlook for men with high risk prostate cancer.”

From the point of view of the patients pulled in as “bodies” for this trial, a skeptic might say, the intention was not necessarily admirable. How is a doctor going to give a patient a fair and unbiased evaluation of whether a trial is good for that indivual to enter when a Porsche beckons - And the patient doesn’t know about this? At the very least, the doctors should have been obliged to disclose their chance of winning the Porsche among other information required for the patient’s informed consent.

The Boxster is the fastest selling Porsche in history with a base price of $42,000, nicely loaded for $9,000 more.

Kudos to Dr. Steinberg for protesting this sleaze.
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Vitamin E succinate suppresses prostate tumor growth by inducing apoptosis.
Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL. Int J Cancer. 2005 Dec 27; [Epub ahead of print]

Vitamin E (VE) has been under intensive study as a chemopreventive agent for various types of cancers. Preclinical studies suggest that vitamin E succinate (VES) is the most effective antitumor analogue of VE, yet there are scarce studies of VES in prostate cancer. In this study, we investigated the effects of VES on a panel of prostate cancer cells, and a xenograft model of prostate cancer. Our results indicate that VES significantly inhibited proliferation and induced apoptosis of prostate cancer cell lines in a dose and time dependent manner. The results of microarray analysis followed by real-time RT-PCR and inhibitor analyses indicated that the VES-induced apoptosis is mediated by caspase-4 in prostate tumor cells. In our animal model of prostate cancer in SCID mouse, daily injection of VES significantly suppressed tumor growth as well as lung metastases. These results suggest a potential therapeutic utility of VES for patients with prostate cancer.

African American men have the highest prostate cancer incidence and mortality rates in the world.

African-American women who develop breast cancer are more likely to die from the disease than white women of the same age.

Survival rates are worse among African-Americans for colon and ovarian cancers as well.

And now a new study from Dana-Farber has found that even when they have equal access to specialized care, blacks with potentially curable lung cancer are about half as likely as whites to undergo surgery that could save their lives.

These findings point to a subtle and complex “communications problem” underlying the inequality, said Christopher Lathan, MD, of Dana-Farber and lead author of the report that is published online by the Journal of Clinical Oncology and will be in the journal’s Jan. 20 print issue.

“Something’s not happening. There was no specific reason that could be found, but there needs to be more attention paid to the doctor-patient interaction.” Full story:

Blacks’ lower rate of lung cancer surgery not just due to access to care

Study suggests racial disparities stem from doctor-patient interaction

A study from Fred Hutchinson Cancer Research Center, the University of Alberta, Canada and in Ankara, Turkey has found that for women whose diet is already high in folic acid, adding a folic acid supplement weakens the immune system. The women’s natural killer cells function fell below that of women deficient in folate who were not taking any supplement.
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“Mounting evidence indicates that the amount and type of fat in the diet can have important effects on bone health. Most of this evidence is derived from animal studies. Of the few human studies that have been conducted, relatively small numbers of subjects and/or primarily female subjects were included. The present study assessed the relation of dietary fat to hip bone mineral density (BMD) in men and women … ”

“Models were adjusted for age, sex, weight, height, race, total energy and calcium intakes, smoking, and weight-bearing exercise. Data from women were further adjusted for use of hormone replacement therapy. Including dietary protein, vitamin C, and ß-carotene in the model did not influence the outcome.”

“Saturated fat intake was negatively associated with BMD at several hip sites. The greatest effects were seen among men below 50 y old (linear trend P = 0.004 for the femoral neck). For the femoral neck, adjusted mean BMD was 4.3% less among men with the highest compared with the lowest quintile of saturated fat intake … These data indicate that BMD is negatively associated with saturated fat intake, and that men may be particularly vulnerable to these effects.

Abstract and link to full article: American Society for Nutrition J. Nutr. 136:159-165, Corwin et al. January 2006

Dr Debra L. Bemis of Columbia University College of Physicians and Surgeons, New York, seems to be promoting an herbal mix called Zyflamend on the basis of lab tests even while she is running a Phase I trial of the same commercial product.

Bemis’s press release about her preclinical study of Zyflamend has created a lot of buzz (Google calculates 598 references). Some media (like the UK Daily Mail) are touting Zyflamend with the headline “Olive Oil Pill Can Cut Prostate Cancer Risk.” The study was published this month in Nutrition and Cancer 52(2):202-12. Zyflamend, a unique herbal preparation with nonselective COX inhibitory activity, induces apoptosis of prostate cancer cells that lack COX-2 expression.

Bemis’s lab found that Zyflamend “suppresses the growth of prostate cancer cells and induces prostate cancer cells to self-destruct.” She says Zyflamend “in culture at least,” had the ability “to reduce prostate cancer cell growth by as much as 78 per cent.”

“Together, these results suggest that Zyflamend might have some chemopreventive utility against prostate cancer in men,” Bemis says.
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December 27, 2005 -Taking 1,000 international units (IU) of vitamin D3 daily appears to lower an individual’s risk of developing certain cancers – including colon, breast, and ovarian cancer – by up to 50 percent, according to cancer prevention specialists at the Moores Cancer Center at the University of California, San Diego (UCSD) Medical Center. The researchers call for prompt public health action to increase intake of vitamin D3 as an inexpensive tool for prevention of diseases that claim millions of lives each year. Full story

$50m pledge will help Therion develop drug

By Stephen Heuser, Globe Staff | December 26, 2005

In an unusual effort by a single wealthy investor to keep a medical idea alive, a German billionaire is promising $50 million to Therion Biologics Corp., a small Cambridge company trying to develop the first-ever therapeutic vaccine for cancer. ….

ts lead product, Panvac-VF, is a series of injections designed to fight pancreatic cancer, which strikes 30,000 Americans each year and is almost always fatal.

Early tests of Panvac showed it extended the lives of patients with late-stage pancreatic cancer, and the company expects results from a larger trial on 250 patients early next year. If it shows significant benefits, the company will apply for FDA approval.

‘’We’re all figuratively holding our breath waiting for the results of this trial,” said Leuchtenberger.

Like shots for flu or measles, cancer vaccines are designed to train the body’s immune system to fight a specific disease.

Unlike a traditional vaccine, however, the drug being tested by Therion is not preventive. Rather, it is given to people who already have cancer, in the hopes that their immune cells can learn to recognize and attack the cancer as it tries to grow and spread in the body.

A success in the trial would let Therion enter the lucrative niche of last-chance cancer therapies, among the most expensive drugs in modern medicine.

Full story at the Boston Globe’s boston.com business section

John Isaacs in an overview this month in BJU of “New strategies for the medical treatment of prostate cancer” brings up:

novel treatments that target prostate-specific antigen (PSA), human glandular kallikrein-2, or prostate-specific membrane antigen. An inactive prodrug with a thapsigargin analogue, a sesquiterpene lactone from the plant Thapsia garganica, is currently under investigation specifically for the targeted therapy of HRPC. Preclinical data suggest the PSA-targeting abilities of this novel therapy are associated with a nearly complete cessation of tumour growth with minimal toxicity.

When a researcher offers this kind of review you can guess it is a pet project. In this case Isaacs ostensibly talks about all available strategies for treating HRPC, but then he zones in on one rather obscure-sounding novel therapy.
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PSAD is determined by dividing the PSA number by the prostate volume (its size as measured by transrectal ultrasound). Johns Hopkins doctors recommend this measurement “to help differentiate between cancer and BPH in men with moderately high PSA levels (4 to 10 ng/mL) and normal DRE results.”

The theory is that cancer causes a greater elevation in PSA per prostate volume than BPH. If so, PSA density should be higher in men with cancer. To find PSA density, doctors divide the PSA results by prostate volume (as estimated by transrectal ultrasound). This method is imperfect, according to the Hopkins experts; but, they add, “studies showing that PSA density levels over 0.15 indicate a high risk of cancer have led doctors to use PSA density tests for men with PSA levels between 4 and 10 ng/mL.”

Some recent studies have shown however that PSA density is not a very useful measurement.
A Spanish teams a couple of years ago said: “We conclude that PSAD and PSADTZ are not excessively useful for adequately discriminating between patients with prostate cancer and those with non-malignant disease, particularly when digital rectal examination is normal.” (Garcia Sisamon F, et al, 2003). Now a study in Kuwait, published this month, has found similarly:
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By GINA KOLATA Full story, NYTimes Health (requires free registration), December 27, 2005

Also online at Detnews.com. Excerpt:

In other genetic diseases, gene alterations disable cells. In cancer, genetic changes give cells a sort of superpower.

At first, as scientists grew to appreciate the complexity of cancer genetics, they despaired. “If there are 100 genetic abnormalities, that’s 100 things you need to fix to cure cancer,” said Dr. Todd Golub, the director of the Cancer Program at the Broad Institute of Harvard and M.I.T. in Cambridge, Mass., and an oncologist at the Dana-Farber Cancer Institute in Boston. “That’s a horrifying thought.”

Making matters more complicated, scientists discovered that the genetic changes in one patient’s tumor were different from those in another patient with the same type of cancer. That led to new questioning. Was every patient going to be a unique case? Would researchers need to discover new drugs for every single patient?

“People said, ‘It’s hopelessly intractable and too complicated a problem to ever figure out,’ ” Dr. Golub recalled.

But to their own amazement, scientists are now finding that untangling the genetics of cancer is not impossible. In fact, they say, what looked like an impenetrable shield protecting cancer cells turns out to be flimsy. And those seemingly impervious cancer cells, Dr. Golub said, “are very much poised to die.”

In the end, all those altered genes may end up being the downfall of cancer cells, researchers say.

“Cancer cells have many Achilles’ heels,” Dr. Golub says. “It may take a couple of dozen mutations to cause a cancer, all of which are required for the maintenance and survival of the cancer cell.”

Gleevec, researchers say, was the first test of this idea. The drug knocks out a gene product, abl kinase, that is overly abundant in chronic myelogenous leukemia. The first clinical trial, which began seven years ago, seemed like a long shot.

Fish is protein rich and contains Omega-3 essential fatty acids, which are heart-healthy and may protect against some cancers. But many fish are contaminated, in short supply and endangered through overfishing. Farmed fish is no simple solution. Farmed salmon, for example, contains high levels of PCBs.

Oceans Alive is a non-profit organization offering a list of best and worst seafood choices. Their guide claims to show “which fish are healthy for the oceans” and offers to help consumers “choose fish that are safe to eat.”
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Pizza has been accepted as one food which perhaps helps protect men against the risk of prostate cancer in North America.

But according to cancer researchers in Italy, pizza’s home territory, not much information exists about pizza-eating and risk of other sex-hormone related cancers (breast and ovarian).

Nor is much known, these researchers say in an article to be published in February 2006 European Journal of Cancer Prevention, about how pizza eating affects risk of cancer in people beyond the USA.

Using data from 4864 patients and the same number of people without cancer in three hospital-based case-control studies conducted in Italy between 1991 and 2002, they found no strong link.

People who ate one or more slices of pizza a week were counted as “regular eaters.”

“Our results do not show a relevant role of pizza on the risk of sex hormone-related cancers.,” the authors write in their summary. “The difference with selected studies from North America suggests that dietary and lifestyle correlates of pizza eating vary between different populations and social groups.”

An earlier study from this group (European Journal of Cancer Prevention. October 2004.) found that “Regular consumption of pizza, one of the most typical Italian foods, showed a reduced risk of digestive tract cancers. Pizza could however simply be an indicator of a typical Italian diet.”

Blinded by the light: Irofulven chemotherapy trials

By JACQUELINE STRAX December 16, 2005 /PSA Rising/ The chemotherapy drug Irofulven, a drug based on a poison in the jack o’lantern fungi, is in clinical trials in the USA, Canada and Europe for prostate, ovarian, hepatic and other cancers. A surprising side effect is retinal damage.

Higher Vitamin D Daily Dose Could Halve Colon Cancer Risk, UCSD researchers say

December 20, 2005 - Taking 1,000 international units (IU) of vitamin D 3 daily appears to lower an individual’s risk of developing colorectal cancer by 50 percent, according to cancer prevention specialists at the Moores Cancer Center at the University of California, San Diego (UCSD) Medical Center. Full story

Latest Business News and Financial Information | Reuters.co.uk
Body backs Sanofi’s Taxotere in prostate cancer

LONDON (Reuters) - A cost-effectiveness watchdog said on Friday it was provisionally recommending that Sanofi-Aventis SA’s chemotherapy drug Taxotere should be used to treat prostate cancer on the state health service.

A spokesman for the National Institute for Clinical Excellence said final guidance was likely to be issued around July next year, covering the use of the drug in men with advanced hormone refractory prostate cancer.

Until then, about 800 men in Scotland who could benefit from Taxoterer to releive pain and progression of advanced prostate cancer are on hold. Some of them may die waiting.
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“Men with prostate cancer who are initiating ADT have a 5- to 10-fold increased loss of bone density at multiple skeletal sites.” They also lose lean body mass and gain fatty tissue.

Men taking anti-androgen drug therapy to suppress their male hormones are at risk for loss of bone mineral density (BMD) . This puts the men at risk of fractures including of rib, spinal, and/or hip. Until recently, no information was available to patients from the drug manufacturers nor from doctors about how soon after starting after starting on androgen blockade this condition is likely to start.
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Forbes has a story this month about a Cox-II inhibitor, Celebrex. While mostly used for arthritis pain, this drug is of high interest to cancer patients as a possible tumor inhibitor (for background on the cancer connection see
Cancer Patients … and Celebrex in Anti-Cancer Trials Nov 2004
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Dr. Zvi Fuks, a renowned radiation oncologist, is one of the principal developers of 3-D conformal radiation therapy, a system for delivering radiation that permits precise shaping and targeting of radiotherapy beams. He has worked for many years at MSKCC (memorial Sloan-Kettering Cancer Center).

Last month Dr. Fuks and a friend agreed to pay a total of $2.77 million to settle a lawsuit accusing them of insider trading in shares of a pharmaceutical company. The drug involved, ImClone’s Erbitux, was tested in clinical trials at MSKCC. A clinical trial of Erbitux for prostate cancer ran at MSKCC starting in 1996.
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By GARDINER HARRIS
Published: December 21, 2005
WASHINGTON, Dec. 20 - Despite promising discoveries and multibillion-dollar investments, cancer research is quietly undergoing a crisis. Federal drug regulators will soon announce several initiatives that they hope will help salvage the field.

Few drugs are being marketed, and most of those that have been introduced are enormously expensive and provide few of the benefits that patients expect. Officials of the Food and Drug Administration suggest that the failures may result from an obsolete testing system.

There is growing evidence that X-rays, long the standard, may not accurately assess a patient’s disease. The drug agency is creating collaborations to develop imaging, blood and other tests that better signal the progression of cancer.

“We need to develop cancer drugs differently,” the chief operating officer of the agency, Dr. Janet Woodcock, said in an interview. “The tools we have to develop these treatments are not what we need in cancer.”
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