Easter was good, mom is okay... but new treatment side effects are kicking in

Easter mom and John and Darinka went to church which was really nice. After that I met them for brunch and we ate at the Egg and I. It was good and of course it was a beautiful day!! Mom went home and spent the remainder of the day resting. Her second round of chemo IV infusion was last wednesday and so now the side effects are kicking in. This round of chemo is Taxol (taxotere) and Carboplatin combined. It is extremely fatiguing to the body and her hair has officially come out and so on monday she buzzed the rest of it. I think she looks really cute like a young Sinead O'Conner. She is still working half days and resting at home in the afternoons.

Tomorrow we have a doctors appointment where she will get IV fluids with iron and some medicine that helps red blood cells (I forgot the name). Anyway, this is to prevent her from having another blood transfusion. We will also be scheduling her biopsy of the lymph node that is kinda protruding from her neck. The biopsy will confirm what is going on with her lymphatic system and see if the cancer has moved there or not officially.

She is well, but she is really tired. Please contact me if you need to get a hold of her and are not able to get through. She hasn't really been answering her phone much. Thats okay though. Anyhoo, well good luck and God bless!!!

-Vanessa

Its hard keeping up with everything that needs to be done...

I apologize for my delay in posting over the last month... Other than my mom going through cancer, I am having other difficulties in my life. I understand that it is my responsibility to be here and help (which I do), but I have lacked a bit in giving updates. I hope that all our readers can appreciate that it is difficult and I am doing what I can. It is easier to update on facebook, so those of you who have a facebook account you can like our Cindy Sue Hudson's Cancer Fighters page. I will post here weekly until things settle down in my life a bit more. I am trying to get situated and move back in with mom (as my marriage has failed), I am also in school again taking my prereqs for nursing school, I have started a wonderful part time job, and am still taking care of mom and helping her with her work and everything else.

Mom is doing well this weekend and we hope to have a great Easter Sunday! God bless!

-Vanessa

Treatment 5, round 2 of intravenous chemo was a tough start for the week

Well last week we were in the hospital for fluids because of dehydration and this week we wound up in the hospital for blood transfusion.

Mom is doing much better, but wednesday was really tough. Its been an emotional rollercoaster and we all have frustrations in fighting this cancer. Its just really difficult knowing that mom is in pain and is uncomfortable all the time.

Anyway, wednesday I picked up mom and drove her to the START center for IV chemo treatment of carboplatin and taxol. It takes time to get set up and started with the chemo treatment and they do bloodwork first to check her vitals. Well, her vitals came back and showed her hemoglobin was really really low. Since her red blood count was so low we were informed that she needed a blood transfusion. She's never had one and it was a little scary to think about, but we had to get through the chemo treatment for the day.
Mom was feeling pretty bad and was hurting and weak. They hooked her up for chemo, but the iv drip was too fast and mom wound up having an allergic reaction. Her blood pressure and oxygen dropped and her heartrate rose very high. She became flushed and dizzy and couldn't breathe. She began to crash from anaphylactic shock. My older brother was by her when it happened and it was certainly hard to see her go through it. The nurses immediately stopped the chemo drip and gave her intravenous benadryl. Her body was able to recover and we waited to try the chemo again when she stabilized. The benadryl knocked her out pretty good and she was able to sleep after that. After a while they started the chemo drip again, but at a slower pace and she was good. We were there all day long and I think we finished at the START center around 6:30/7pm. From there we left and headed over to the Methodist hospital off Medical drive to get her admitted for the blood transfusion.

We were on the first floor in the Clinical transition Unit and we had a comfortable nook for her lie in and they drew more blood to match for the transfusion. Its a very interesting process and I wish I could've given my blood, but my mom is A positive and my blood is A negative. She wouldn't have been able to use it. I will still donate, but I've been pretty exhausted and busy the last couple weeks. Just a lot going on.

Anyway, they didn't start the transfusion till around 10pm and we were done around 5:30am, but we were able to leave around 6am. We stopped for breakfast tacos and then went home. I tried to nap for a little while, but I was unsuccessful. Its been a long day, but I hope to get a lot done this weekend. There's just so much to do and not enough time or help.

Please if anyone has any questions don't hesitate to email or respond. I do put up more updates on the facebook page, but I know not everyone has a facebook.

Thank you all again for your love and support!

-Vanessa Hudson

The San Antonio Ladies Empowering Group on Friday Night!!!

Hope to see you there!
Friday, March 30, 2012
7:00pm until 10:00pm
Al Bustan Mediterrenian Resturant, 4841 Fredricksburg Rd San Antonio, TX 78229 (210) 525-1231

Start of the week was in the hospital, but everything is good and mom is okay!!!

So mom was doing alright over the weekend after getting fluids last week, but was really fatigued and feeling weak. Then on Sunday she was having difficulty breathing and was having pain. We called the on call doctor at the START center and they told us to go ahead and go to the Methodist hospital ER. They also called ahead and let them know we were coming. The difficulty breathing was brought on by fluid building up again around the lung. When we arrived they brought us to the back and put us in a room where mom was able to get IV fluids, be put on oxygen, an ekg was done, and x-rays were done. The consensus was that the fluid needed to be drained, but being that it was a Sunday night in the ER they wanted to go ahead and admit mom for the night so that she could easily have the procedure done the next day. Monday morning, our oncologist confered with the hospital and it was decided that not only would the fluid be drained but an outpatient surgery where they install a pleural tap (a tube that is inserted through the back in the pleural space outside the lung). This pleural tap will provide a constant drain for the fluid being produced so that it won't build up and crush the lung. She is feeling sore and it is uncomfortable, but it has helped her to be able breathe easier. They kept her overnight on monday again for observation. She was released tuesday morning and then she was off downtown to work that afternoon. She is strong and continues to fight.

Please if you have any questions don't hesitate to ask.

God bless and good night!

-Vanessa

Dehydration is a major issue, here's why...

So, last wednesday (the 14th) mom started chemotherapy again because the trial drugs just haven't been working. Her cancer has grown in her lungs and all the medications she had been taking were affecting her liver. Her liver is okay though. Its just been working really hard to process all the medications. She is very dehydrated, and so the doctor has ordered her to get fluids every couple days when she feels up to it. Her vitals also show that she is malnutritioned- low albumin levels (when they test for albumin levels in your blood, they are checking your protein levels in the blood plasma that are water soluble).

*Dehyrdation: "The two types of dehydration, chronic dehydration and acute dehydration, can be caused by many things. The most common are: flu, vomiting, diarrhea, blood loss, malnutrition, and plain old failure to replenish liquids lost from sweating and urination (Not drinking enough water). Many illnesses and diseases can trigger acute dehydration due to the increased body temperature and sweating that usually occur. This is why your doctor tells you to drink plenty of fluids when you are ill. Your body uses fluids to expel toxins as well as to keep your system flexible, lubricated and running smoothly. Dehydration and blood pressure problems often go hand in hand due to the loss of electrolytes.

If the dehydration is allowed to continue unabated (without reduction in strength or intensity), when the total fluid loss reaches 5% the following effects of dehydration are normally experienced:

• Increased heart rate
• Increased respiration
• Decreased sweating
• Decreased urination
• Increased body temperature
• Extreme fatigue
• Muscle cramps
• Headaches
• Nausea
• Tingling of the limbs

(information from http://www.symptomsofdehydration.com/ )"-all legit information.

Let it be known that mom has been experiencing all of these side effects. This morning I picked her up and drove her to START so that she could get IV (intravenous) fluids to help rehydrate her. Every time we arrive the first thing the nurses do is take blood to check her vitals and they get her blood pressure, heart rate, and O2 (oxygen) levels. Her heart rate was at 181. This is an extremely high heart rate for someone who isn't at the gym and doing an extremely hard cardio workout. To give you an idea of what this means I will explain maximum heart rate:
Maximum heart rate is the highest heart rate an individual can safely acheive through exercise. Maximum heart rate depends on a persons age. To find your maximum heart rate subtract your age from 220; e.g. 220 - 39 = a maximum heart rate of 181 for a person age 39.
Mom is 56, so you can see that 181 is way too high of a heart rate for her age as well as the fact that she was in a state of rest and has been very weak. Needless to say, the nurses gave her a liter of fluids and that really helped. Her heart rate lowered and when we left they checked her again and her HR (heart rate) was at 108. 108 is not ideal, but it is A LOT better. They only gave 1 liter of fluids because really when you are trying to hydrate a person, you don't want to give more than that as the person will just pee it out. That is why 1 liter a day or every other day is good as it will slowly absorb into her organs. If we were trying to flush her liver or get something out of her system then the nurses would give more than that and then the goal would be to pee it out. So, we will go back tomorrow and get more fluids in the afternoon. She is feeling much better this evening and I will pick her up in the morning and take her to work. She's fighting this with all that she is!!!!
God bless her!!!

Thank you all.

-Vanessa

Walk, Run, Wag 5K by the Petco Foundation on April 1st

Mom and I will be walking this 5K on April 1st, 2012 (a sunday) at 8am. I encourage everyone and anyone who like to join us to come out. It is in support of local charities for animals. We are animal lovers and will be out there to help support and of course it will be wonderful to just be outside with mom and our German shepherd/lab doggie, Bathsheba.

The official website is www.walkrunwag.com
Walk or run a 5K or 1 Mile course with your dog, or without a dog. Register for either 5K or 1 mile. A portion of the proceeds from your registration will benefit local pet charities in the San Antonio area through the Petco Foundation.

Be sure to sign-up and receive your member DISCOUNT CODE for 20% off any registration through the website early!

Additional Date Information

5km & 5K9 Run/Walk - 8am
1MI & 1MI K9 - 9am

Address

PETCO Headquarters
654 Richland Hills Drive San Antonio, TX

Fees

5k9 & 5km-$39/ 1M K9 & 1M - $24

Enjoy and we hope to see you out there!

-Vanessa

Chemotherapy again - 5th line treatment.

Today I picked mom up and took her to the doctors for chemotherapy again. No more clinical trials right now because of the growth of the cancer and the pain she has been experiencing. We believe that because she did so well with the chemo last year, she will again have success with it. This time she is getting Carboplatin (she had it last time as well and worked) combined with Taxol (she has not tried this one and I will post info later). She did well today. They gave her pain medicine and she was a little loopy, but she seemed better today than she has in a couple days. The chemo does wear you down and she may loose all her hair now (they told her she would last year, but she didn't lose it all. It does fall out so it most likely will, but after chemo is out of her system, it will grow back!). I don't know how many rounds of it she will have to do and radiation may become a suggestion down the road for a few hot spots where most pain is, but for now we wait and see what happens. She will also experience nausea (which has already started) and a side effect of the Taxol is mouth sores. She may not be able to talk as much because of the dehydration and dryness, but her energy is up and she looked great this morning and of course she is still going everywhere in her high heels!!!!

-Vanessa

More obstacles this week, the most pain yet, but doctor is positive about finding a solution!

Hello everyone, I apologize first for the delay in posting. I have been having a problem with my laptop the last week and a half, besides helping mom in the current battle against her constant pain and frustration.

Today I picked up mom at the house at 7am and we made it to the Doctors for an 8am bloodwork. Mom has been in so much pain that it has been really difficult for her to get up and get ready. The pain is really taking a lot out of her. Perhaps part of the problem is finding a solution for managing the pain and trying to stay ahead of it rather than waiting for the pain to get so bad that she waits to take it.
When we made it to the doctors, the nurses saw how much pain she was in and even though our doctor appointment wasn't for another 2hours the doctor came out and ordered CT scans. She wasn't supposed to get the CT scans for a couple more weeks with the clinical trial she was on, but the amount of pain she was having suggests that the cancer has grown. We waited a few hours to get the scans and sure enough the cancer has grown rather aggressively. Fortunately it has not metasticized elsewhere though. So the cancer is not attacking any other organs or bone or brain! Though it has gotten bigger and is encroaching on the liver and rib. The doctor said no more of this trial drug and tomorrow I pick her up in the morning again to take her back to the doctors so that she can start conventional chemotherapy again. This time she is going to take a combination of carboplatin and taxol! Both are very good. She will have side effects, but as we have seen throughout this journey she is kicking cancers butt!!!

Anyway I am tired and will edit this post tomorrow. I haven't had much sleep in.... I couldn't even say. So, till tomorrow.. may everyone have a good night and keep your spirits up! God is with us and with my mom!!!

-Vanessa L. Hudson

Last weekend was the most difficul yet. 3/8/12

Friday night was okay with mom. We had a good night together talking and hanging out and spending time on the computer. Saturday, I was at house and was doing yard work while mom rested and was having pain and fever. Sunday, mom was not able to get out because the pain was becoming too much. It was hard to see her cry because of the pain. Monday, mom was not able to get up and go to work. It was very hard to see her so frustrated and hurting. I know she is sad and feeling awful. I know she is angry and depressed. There is no answer why, there is no answer of how this happened. Her cancer is the rarest of the rare and so is she is. She is fighting and has surpassed so much through all of this ordeal. She is amazing.
We went to the doctors on tuesday and we met with Dr. Rassco. He is a wonderful doctor at the START center and he informed us that "tumor fever" isn't necessarily good or bad because it is hard to determine what the cause is actually. He also noted the pain and suggested getting CT scans next week is a good idea see what is going on in her. She did receive fluids and was remarkably better on wednesday!!! She was able to get out and go downtown for work.
She is strong and stubborn! And determined to beat this!!!!

God bless!

-Vanessa Hudson

Hmmm....its friday night and this weather isn't helping..

Well, mom is resting after a long week of pulling through and getting downtown to help others. She is having this fever at night and it is now every night with night sweats and chills. Tonight she has started a cough. Its hard for her to sleep because she is in discomfort always. We see the doctor on tuesday and will find out what her vitals were from the blood draw this week and of course she will have more blood drawn and we will talk with the doctor about what this fever is. Mom wants to work tomorrow, but I feel that getting some rest will be good. We are planning on going to CBC on sunday to the 11am service. Continue with prayers. I'm hoping its just the weather....

Thank you

-Vanessa

Tumor Fever ... what is it? and does mom have it?

So we are in week 3 of the 4th treatment and the second clinical trial drug. Mom is probably taking 15 pills a day and that doesn't include the vitamins she should be taking (or the 7 that I want her to take anyway) and she definitely needs to hydrate more. Anyway, she's been having fever at night and last night it rose to 102.6. The fever is relatively new. It has been off and on, but it is now more frequent. Mom called the doctor this morning and he said it could be "tumor fever".

I am trying to research what "tumor fever" is and so far I'm not coming to a very conclusive discovery of what it is. I have discovered that it is difficult to diagnose because there are too many potential causes and it is hard to exclude them. Some of the potential causes include all the different meds she is taking and how they react with each other as well as individually their side effects alone could cause fever. Another possibility to include is the dehydration. Anyway, the point is that it may not actually be "tumor fever" and just a fever.

Now that I have said that, I will first explain the negative meaning of "tumor fever" and then I will give the good explanation, but try to keep in mind that it may not be "tumor fever" and know that mom is still getting up every day and continuing to stay strong and fight. She is in control of her life and this cancer is not controlling her. She will not succumb to it and she knows that God is with her and healing her too.

The bad:  'In solid malignancies, tumor fever is commonly associated with rapidly progressive metastatic disease and a limited survival. Liver metastases are present in many of these patients and some of them may display significant systemic inflammation. We report two unique patients with adenocarcinoma of the lung associated with tumor fever, necrotic liver metastases and granulocyte-colony stimulating factor (G-CSF) driven leukocytosis(Conn Med. 2010 Aug;74(7):389-91).' This basically is just saying that when fever is caused by the tumor it means that it may reflect the growth or spread of a tumor and meaning it has spread to the liver.
*I would like to point out that mom's vitals show that her liver enzymes are in range and that is a good thing.

The good: I found one site where a patient noted that their oncologist stated that "tumor fever" is when the tumor cells start "melting" the toxins are released and that can cause fever. I also found another patient who has stated that "tumor fever" is a good thing and it means that the tumor is dying and that the dead tissue ends up in your liver and colon and this is what causes the fever.

Finally, the immune system in cancer patients is compromised and weakened so it could be caused by environmental factors. Right now in San Antonio the weather has been weird and its a cool humidity, wet, and overcast which is a perfect environment for bacteria and molds in the air and plenty of people are feeling sick and being affected by allergies.

If you have any more questions, concerns, or your own input I welcome it always.

Thank you and God bless!

-Vanessa

Lent and the Episcopal Church of the Advent in Brownsville, Texas

Rector's Reflections
Here it is, it's Lent.  I don't believe that it's a coincidence that it begins at a time of year that is unstable.  The coming of Spring is a season that seems to be trying to give birth to itself  The days are cold one day, hot the next, wet one week, dry the next, cloudy, sunny - you get the picture.  In a way, it's not unlike our spiritual lives at times, our relationship with God.  Actually, Spring is the perfect time to jump into the season of Lent for exactly that reason.  It matches us.

The goal, the plan for Spring is to produce beauty.  So is the heart of Lent.  When all the turmoil and vacillations of Spring and Lent are over, hopefully, something of joy and beauty will have arisen in us.  the important thing to remember here is that all this takes intentional effort.  Nature, God's skilled gardener, knows just what to do each year in preparing the soil, softening up the seeds, awakening the trees and flowers; each plant responds in its own way to the prodding of life with a steady and determined growth.

Our Lenten disciplines are much like the hand of that skilled gardener shaping and coaxing our souls to respond to what God has already planted in our souls and is now hoping will grow.  It is a real time of discovery.  It is a time of becoming who we were created to be.                
 
Faithfully,
 Fr. Reese+

ABOUT LENT                                                                                                  
Lent is the 40-day period of repentance and renewal preceding Easter.  It begins on Ash Wednesday and ends at Easter.  Holy Week, the week before Easter, is commemoration of the last days in the life of Jesus on earth.  Lent is the time set aside for meditation, prayer, fasting, self-denial, seeking forgiveness and holy works in God's Name.  Lent is several weeks in the church year for increased understanding of the life of Jesus of Nazareth -- his ministry, sacrifice, and death.  Lent is a special opportunity in which baptismal vows may be renewed and a new commitment may be made in one's faith and life.  Lent is a liturgical season that can help one prepare and experience the full joy of the resurrection of Jesus Christ on Easter Day. 

Thank you for taking the time to read the Advent E-pistle.  If you have any comments or suggestions or would like to submit an article, please contact the church office at 542-4123 or secretary@adventbrownsville.org.

Side effects are really kicking in this week and its been painful for mom

I think mom is having a stronger mix of emotions this week. I think we all are. Mom is starting her 4th week of this new trial drug tomorrow and the side effects have started and are taking a toll. She has been in even more pain and is struggling more with keeping upbeat. She is doing her best and trying so hard. It is difficult to go about each day with the pain and changes. She is so wonderful to be around and is always helping others, but I see her trying to hide what she is really feeling and overall we just feel like crying.We, also, lost a good friend and a great man of God this last week who has been an ispiration for all humanity. He prayed with mom and was comforting, but he has returned home. He left behind a wonderful family and we are praying for them and know they will get through this and honor him.

There are just so many questions and confusion. There is depression and lonliness. There is a loss of identity. We all suffer in some way or another, but this by far the most difficult we are facing.

Mom will answer texts if you have her number and she will check email. Thank you all so much for your continued support and prayers.

-Vanessa

Jeff Markin: Back from the Dead, Reborn Into the Light

Jeff Markin: Back from the Dead, Reborn Into the Light

God's message is clear and understood. Thank you.

This week went by really fast and I am thankful for that because mom starts her next treatment on tuesday. She goes in tomorrow just to give blood and then Valentine's day we will just be there in the morning. I really hope this one works.

I know God is working and is healing her. She is faithful, humbled, trusts in the Lord and is waiting patiently. Today we went to church at Oak Hills Church with Max Locado and is really wonderful. It was a little emotional for us because the theme was accepting, dealing with, and getting through trouble times and that here in this life we are in God's "waiting room". We must all be patient and trust in Him, and that He is working while we wait.

It was perfect and it was a perfect example of God's work. We needed to hear this message. Even though we believe and trust in His work, it was the icing on the cake just to hear the message through Locado and be comforted by his message.

So even though we are all waiting, we must accept the things we cannot change, have courage to change the things we can, and have faith in God's wisdom that he will guide us and direct our path.

Have a wonderful Sunday! Thank you.

-Vanessa

New Information on ALK resistant NSCLC

New Research in Resistance to Xalkori (crizotinib) for ALK-driven NSCLC

• By CraiginPA · Today at 1:34 am · 8 replies
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[Note: This is not a professional opinion, but a report of some very interesting research I read.]

There’s valuable information on resistance to Xalkori (crizotinib) in a newly-published article by Katayama & Shaw (as lead co-authors) and their colleagues in their article titled “Mechanisms of Acquired Crizotinib Resistance in ALK-Rearranged Lung Cancers” in the research journal Science Translational Medicine: http://www.ncbi.nlm.nih.gov/pubmed/22277784
(Yes, that’s Alice Shaw, MD, PhD again, my oncologist at the Harvard-affiliated MGH in Boston.)

The research looked at just 18 patients with crizotinib-resistant cancer, but that’s enough to gain a lot of insight because of the deep lab analysis work done on those cancers. Although the odds of an individual having the different kinds of resistance won’t be reliable across all crizotinib patients, the value comes from being directionally insightful, not numerically precise.

For starters, only 28% (5/18) had either a resistant ALK mutation or an amplification of the ALK-fusion mutation. These are cases we’d hope would benefit from a 2nd generation ALK inhibitor. We don’t know if this percentage is representative of all crizotinib-resistant patients, but if it were it would imply only a “fair to good chance,” not a “likely chance,” that a 2nd generation ALK inhibitor would be helpful for crizotinib-resistant cancer.

The insights don’t end there, though. For example, the 2nd generation ALK inhibitors were found to vary in their effectiveness against the various resistant ALK mutations and might be less effective on the resistant cancer than crizotinib had been before resistance. And a couple of cases (2/18) developed an additional simultaneous route to bypass ALK inhibition via a gene called KIT.

Hmmm . . . That doesn’t sound so good. Is that all there is? Um, . . .

“There's one more thing” . . . (said in my best understated Steve Jobs / Detective Columbo voice*): . . .

If I’m reading the study correctly, most crizotinib-resistant ALK-driven cancer may have something you didn’t expect, and it might offer hope of being somewhat co-treatable with an additional inhibitor drug: EGFR! Not an EGFR mutation, but an over-active *normal* EGFR gene, pushing the cancer along. And it looks like this was found to some degree in almost every case they could test.

*(BTW, if you don’t understand the Steve Jobs / Detective Columbo reference, see: http://en.wikipedia.org/wiki/Stevenote#.22One_more_thing....22)

=== Resistant ALK Mutation Variants ===

The first form of resistance is the emergence (in survival-of-the-fittest style) of drug-resistant variants of the ALK mutation (4/18 cases) and “amplification” of the ALK fusion mutation (1/18).

The four crizotinib-resistant ALK variant sequences in these patients are named L1196M (an important ‘gateway’ mutation), S1206Y, G1202R, and “1151T insertion”. (These would be in addition to some previously-reported ones named C1156Y and L1152R.) In the lab, S1206Y wasn’t as resistant as the other three, suggesting crizotinib might still slow some weakly resistant variants even if unable to stop them.

The team lab-tested three 2nd generation ALK inhibitor drugs (TAE684, CH5424802, and ASP3026) against some ALK mutations. I might be misinterpreting the data, but against the original ALK these three drugs and crizotinib looked comparably effective. Against the four resistant ALK mutations, their effectiveness varied and the best wasn’t always the same. None were as effective against the resistant mutations as crizotinib had been against the original ALK mutation (and none was very effective against 1151T ins).

At first glance this might suggest shrinkage might be less common when treating resistant mutations with 2nd generation ALK inhibitors, but neither LDK 378 nor Ariad AP26113 were tested or mentioned and only a few mutations were tested. So for now, I’ll remain hopefully optimistic that at least one drug will be found effective enough to do the job for a particular resistant ALK mutation for a while.

(BTW, the marketing material from Ariad on their own early lab work for AP26113 suggested it might work on many ALK variants, including T1151, L1152, C1156, I1171, F1174, V1180, R1181, L1196, L1198, G1202, E1210, E1241, F1245, I1268, G1269, Y1278, and S1206 [that last one requiring a very high dose]. I think most of these were synthetically mutated using lab techniques rather than naturally occurring in patients, but clearly some show up in patients and any of them potentially could.)

=== Amplified ALK Mutation ===

One patient had resistance from amplification of the original “ALK fusion” mutation. (I think this might be what some studies refer to as gene “copy number gain” (CNG).) Basically, it’s the same original ALK mutation, but just more of it, too much for the crizotinib to block it all.

Hypothetically, I’d guess this might mean that a higher dose of crizotinib might help a little more for a while if the patient’s health can tolerate the side-effects and the FDA allowed it, or maybe a 2nd generation ALK inhibitor might help for a while (if one is more potent or more narrowly targeted to the ALK mutation, e.g., maybe the TAE684 column in article’s graph 1E ). Your oncologist should be able to discuss whether something like this could be testable or treatable in an ALK-targeted way.

=== HSP90 Inhibitor ===

With that as context, the research team’s lab work also found that a different kind of inhibitor might sometimes be more effective than the ALK inhibitors they were testing. HSP90 (heat shock protein 90) assists ALK fusion proteins. HSP90 inhibitors are being tested in clinical trials. The research team tested the HSP90 inhibitor 17-AAG (a derivative of natural geldanamycin) and found it was highly effective against the ALK mutations they tested. At the concentration they used, it seemed more potent than all the other drugs they tested, but it also was potent against the normal non-mutated ALK gene, which could mean stronger side effects, too. Other clinical research studies will have to determine the right HSP90 inhibitor and dose level to balance effectiveness vs. tolerable level of side effects.

=== KIT Amplification ===

Two of the 18 ALK resistance cases also had a second simultaneous resistance mechanism: amplification (e.g., copy number gain) of the KIT gene which led to over-expression of both KIT protein and a KIT-assisting ligand called “stem cell factor” (SCF). In engineered cells this combination made the cells resistant to crizotinib, yet sensitive to crizotinib if KIT were inhibited using Gleevec (imatinib).

So apparently there can be multiple simultaneous mechanisms of resistance in crizotinib-resistant cancer cells. For patients whose resistance is known to involve KIT/SCF, it sounds promising that an existing drug might eventually be available to help control the KIT route.

=== EGFR Activation (Phosphorylation) ===

The big surprise was phosphorylated EGFR (pEGFR) mediated resistance, detected in all but one of the cases that could be tested. This is not an EGFR mutation, nor EGFR amplification (e.g., copy number gain), but EGFR activation (phosphorylation, i.e., charged up and working). FWIW, according the article this might possibly be caused by up-regulation of the EGFR receptor itself and two ligands (EGFR ligand amphiregulin and ErbB3 ligand NRG1).


From that data presented, it seems the EGFR activation is usually present even before starting crizotinib and might limit response to crizotinib. In an experiment on a patient’s pre-crizotinib cells which were sensitive to crizotinib but less than normal, treatment with both Xalkori (crizotinib) and Iressa (gefitinib) suppressed cell growth more potently and induced significant apoptosis. In another experiment, it appeared an improved response might be possible by inhibiting both ALK and EGFR, even though the effect wasn’t as potent as crizotinib alone had been on cells that didn’t have EGFR activation. (This suggests there’s more going on here than just these two tyrosine kinases.)

=== It’s So Complicated ===

Yes, it’s complicated. Some ALK inhibitor resistance is due to a resistant ALK mutation, some is due to amplification … amplification … amplification (yes, I’m repeating myself more times than you can handle), some is due to KIT amplification, some is due to EGFR activation, and sometimes inhibiting multiple resistance routes still isn’t enough to lock down the cancer. (We obviously don’t know all the biochemical players in the cancer orchestra yet.)

This sounds like an example of how amazingly adaptable the human body is. You can inhibit or break a gene and you’re your body will try to compensate; you inhibit something more, and it tries to compensate again. That makes it hard to stop cancer, but research like this gives me hope that someday science will learn all the things we’ll need to do to control this beast for many years (most of the time).

=== So What Do We Do? ===

So what should we do when we develop crizotinib resistance?

Ask your oncologist (once they’ve had a chance to read the article). If they have questions, they can contact one of the authors.

For myself, I’d ask my oncologist if it’s possible to have a fresh biopsy of my resistant cancer tested for resistant or amplified ALK mutations, phosphorylated EGFR, and other possible mutations (e.g., KIT), and then treat the resistance accordingly.

Even without testing, I might ask my oncologist if he/she would consider giving ALK+EGFR combo inhibition a try (if the FDA would allow it), especially if my initial response to crizotinib was less than good. If not, I’d hunt for a combo-drug trial of it if one exists. Maybe one of us will find that answer and share it.

Sooner or later, a jump from the ALK inhibitor track to another track will be needed. In this research article, the HSP90 inhibitor experimental trial track seemed promising for crizotinib-resistant ALK-driven lung cancer. Your oncologist may be able to suggest which HSP90’s look most promising. (Other possible tracks: surgery, radiation, chemo, other chemo, immunotherapy, or other experimental things, if time permits.)

This summary and the abstract at http://www.ncbi.nlm.nih.gov/pubmed/22277784 may suffice for most, but your oncologist and some of you will want to buy and read the full article. It’s available by just following the below-the-abstract “LinkOuts” expandable-menu to the publication. (And if you find errors in my summary, please let me know so I can fix it promptly.)

Best hopes

The History of Cancer

The History of Cancer

By Lisa Fayed, About.com Guide
Updated July 08, 2009

About.com Health's Disease and Condition content is reviewed by our Medical Review Board
See More About:
hippocrates
cancer causes
cancer treatment
diagnosing cancer

"The History of Cancer"

The History of Cancer: How Cancer was First Discovered and Treated
Believe it or not, cancer has afflicted people for several centuries. It is not a new disease. It is because of the early research that we hold a greater knowledge of cancer today.

Origin of the Word "Cancer"
The word cancer came from the father of medicine, Hippocrates, a Greek physician. Hippocrates used the Greek words, carcinos and carcinoma to describe tumors, thus calling cancer "karkinos." The Greek terms actually were words to describe a crab, which Hippocrates thought a tumor resembled. Although Hippocrates may have named "Cancer," he was certainly not the first to discover the disease. The history of cancer actually begins much earlier.

The First Documented Case of Cancer
The world's oldest documented case of cancer hails from ancient Egypt, in 1500 b.c. The details were recorded on a papyrus, documenting 8 cases of tumors occurring on the breast. It was treated by cauterization, a method to destroy tissue with a hot instrument called "the fire drill." It was also recorded that there was no treatment for the disease, only palliative treatment.

There is evidence that the ancient Egyptians were able to tell the difference between malignant and benign tumors. According to inscriptions, surface tumors were surgically removed in a similar manner as they are removed today.

What Early Physicians Thought Caused Cancer
Today, we know so much about the human body; however early Greek physicians weren't so fortunate. Hippocrates believed that the body was composed of four fluids: blood, phlegm, yellow bile and black bile. He believed that an excess of black bile in any given site in the body caused cancer. This was the general thought of the cause of cancer for the next 1400 years.

In ancient Egypt, it was believed cancer was caused by the Gods.

The Birth of the Pathological Autopsy
Autopsies done by Harvey in 1628 paved the way to learning more about human anatomy and physiology. Blood circulation was discovered, opening the doors for more research on diseases. It wasn't until 1761 that autopsies were performed to research cause of death in ill patients. Giovanni Morgagni of Padua was the first to do such autopsies.

More Theories on the Causes of Cancer
The lymph theory developed in the 17th century, replacing Hippocrates' black bile theory on the cause of cancer. The discovery of the lymphatic system gave new insight to what may cause cancer. It was believed that abnormalities in the lymphatic system was the cause.

It wasn't until the late 19th century that Rudolph Virchow recognized that cells, even cancerous cells, derived from other cells.

Other theories surfaced, such as cancer being cause by trauma, parasites, and it was thought that cancer may spread "like a liquid." It was later concluded that cancer spread through malignant cells by German surgeon, Karl Thiersch.

In 1926 a Nobel Prize was wrongfully awarded for the discovery of the cause of stomach cancer a worm.

The 20th century saw the greatest progression in cancer research. Research identifying carcinogens, chemotherapy, radiation therapy and better means of diagnosis were discovered.

Today, we are able to cure some types of cancer, and research is ongoing. Clinical trials and research studies are our key to finding a cure, or a definitive method of prevention.


Sources:
American Cancer Society - History of Cancer.
The Chemical Heritage Foundation -Chemotherapy Timeline.
National Cancer Institute - Closing in on Cancer: Solving a 5000-Year-Old Mystery).

http://cancer.about.com/od/historyofcancer/a/cancerhistory.htm

Prostate Cancer Found in Egyptian Mummy

This is an interesting article. Of course, some cancers are genetic and some cancers are due to environmental impressions. My mom's cancer is not genetic, but we don't know what environmental factor or factors have mutated her genetic DNA causing this to happen. We may never know. It is in God's hands.
-Vanessa



Prostate Cancer Found in Egyptian Mummy

Posted by Caitlin Bronson on January 30, 2012 9:08AM Boomer Health and Lifestyle.

A 2,200-year-old mummy was found to have prostate cancer, leading scientists to question whether genetics played a role.

The world’s second oldest case of prostate cancer was found in a 2,200-year-old mummy, the Canadian Press reports. According to American University in Cairo professor Salima Ikram, extensive testing of the mummy revealed that the disease was not caused by environmental influences, but rather by genetics.

“Living conditions in ancient times were very different,” Ikram explained. “There were no pollutants or modified foods, which leads up to believe that the disease is not necessarily only linked to industrial factors.”

Whether prostate cancer is caused by genetics or environmental factors is a big question in the field of cancer research, the Canadian Press said. While scientists often link cancer to diet and industrial toxins, older cases of cancer suggest that genetics may play a role as well.

Ikram and her team have been studying the ancient Egyptian mummy in Portugal for the past two years. The prostate cancer was discovered by using a high-resolution computerized tomography (CT) scan, which revealed lesions on the mummy’s lumbar spine.

The man died in his forties, researchers say. The mummy is kept at the National Archaeology Museum of Lisbon.

The oldest known case of prostate cancer was found in a 2,700-year-old skeleton of a Scythian king in Russia, AUC said in a statement. His skeleton was found in a steppe in Southern Siberia.

http://www.thirdage.com/news/prostate-cancer-found-in-egyptian-mummy_01-30-2012

Ups and downs, ups and downs... but always end up : )

Okay, so this week has been a bit of a roller coaster, but mom is staying strong and taking one day at a time. Last weekend was good. Saturday mom went over to my older brother John's house for salmon burgers. Mom said they were very good and she had a nice time. Sunday we went to a wonderful new church on the Southeast side of town for a really nice Healing service. We had a good time and everyone there was so kind and loving and expressed their faith and belief in God. It was a beautiful experience and mom really felt great afterwards. So did I. It was really comforting and was a good release. On Monday, the pain in mom's back subsided and it felt miraculous. It was amazing because it was the first day that mom had no constant discomfort or pain for at least 2 weeks. Tuesday the pain came back and was pretty strong by evening. It really scared me and affected me to hear her in that much pain. It was difficult that night emotionally. Wednesday, mom was up and out and trying to do everything she can and did very well for most the day, but after a while the pain can get to be too much and its hard on her. Oh then she got a flat tire that afternoon. Nice. It was okay though triple A came out and changed the tire. I was going to it, but mom didn't want me to. Besides the triple A guy came very quickly after about 15 minutes. So, after that mom went home and I came over a little later and stayed the night. Thursday (today), mom rested this morning and then made her way to the courthouse. Her case was reset and she stayed for a little while downtown, but came home after. It was a little rough with some people there, but we forgive those who trespass against us. Anyway, I picked up some dinner which was good, but I think I'm going to buy a juicer and try to get more fresh vegetables in our diet. I've read so much about juicing and its just really good for you all around. Perhaps we can find some concoction that we will enjoy. Anyway, I am here with mom tonight and she is feeling better. We are enjoying each others company and having a nice night.

Thank you all for your prayers and compassion.

-Vanessa