Archive for the ‘Cancer Treatment’ Category

Conversant Medical Director | News | Breast Cancer

Thursday, October 22nd, 2009

Cancer doctor says he’s ‘lucky’ because he sees people at their best

By Lee Roop of the Huntsville Times

Dr. Marshall Schreeder

Mike Mercier / The Huntsville TimesDr. Marshall Schreeder

HUNTSVILLE, AL — He spends his days helping people fight a disease whose name — cancer — may be the scariest word in the English language, but oncologist Dr. Marshall Schreeder is one of Huntsville’s biggest optimists.

Optimism is almost a job requirement, Schreeder said recently, but it’s more than that. It’s the natural result of what he sees every day.

“I’m astounded by the soul of man,” Schreeder said.

The soul of man?

Perhaps an unexpected observation from a man of science who first wanted to be a systems engineer, then ended up Huntsville’s best-known breast cancer doctor.

Schreeder, 63, discussed his life path late last month at Clearview Cancer Institute, the state of the art cancer clinic he, Dr. Jeremy Hon, and several other oncologists opened in 2006.
Hon and Schreeder have practiced together since the early 1980s at Clearview’s predecessor, the Comprehensive Cancer Institute.

The soul isn’t what Schreeder was looking for when he entered Tulane University medical school. But it’s close.

“I liked engineering, but I liked working with people a good bit more,” Schreeder said. “I thought that, maybe, I could do both by doing medicine.”

Why cancer?

“I picked oncology because I thought it had a long way to go,” Schreeder said, “and I thought I might be able to play a role in that development in my lifetime.”

The first decade “was pretty slow-going,” Schreeder conceded, but things have accelerated rapidly. He ticked off major developments in the field:

  • Improvements in chemotherapy making intense nausea almost a thing of the past.
  • Earlier detection at a time when a “cure” is a realistic expectation.
  • An increase in active cancer-fighting drugs from four or five when Schreeder started to “a hundred or more” today.
  • The development of targeted drugs, or “the concept that you can identify the critical target in a disease, hit nothing but that and have an excellent result.”

Even now, after a career that began in Phoenix in the 1970s, Schreeder still leans forward in excitement when he talks about the future.

“This last 10 years has really been a watershed,” he said, “and there’s a lot of excitement in the years to come.”

He plans to be a part of it. He knows where he wants oncology to go. That’s the big picture.

But how does an oncologist handle the daily disappointments, the inevitable death?

For Schreeder, it starts with his sense of the physician’s role.

“Oftentimes, I see myself as an educator,” Schreeder said, “and then let (the patients) tell me what they want to do.”

“We can’t guarantee the result,” he said. “All I can do is guarantee that, patient by patient, we’ll do the best we can.”

Rather than annoyed, Schreeder is fine when patients come armed with information about their malignancy gleaned from the Web.

“That’s what we want,” Schreeder said, “People to be informed, people to look at the options.

“When everything is said and done, peace of mind is part of the outcome. I think that’s very important to satisfaction.”

There are bad days, no doubt.

“Sometimes, it’s overwhelming,” Schreeder said. “And sometimes you have periods that you are humbled by how helpless you really are.

“On the other hand, it’s almost as if, those people you help, they make it all worthwhile,” he said, “even if they have an extra six months, or an extra year, an extra two years, an extra two decades.”

Cancer patients have “a greater appreciation for life,” Schreeder said, and they teach him every day.

“I get to know people at their very best,” he said, “and at a level that you don’t know in a different way … in a sense where everything is stripped off.”

The people. They get Schreeder up at 4 a.m. — still — for a half-hour’s hard bicycle ride on dark streets before breakfast. They fuel the morning hospital rounds, patient appointments at Clearview, administrative duties and research.

Two of his sons chose medicine as a career, Schreeder said, “and I did not encourage them at all. I said, ‘You see what I do. You see what the cost is. You’d better be sure this is really what you’d like to do, because you’re not going to be doing a whole lot else.”

“Maybe I’ve made it more than it needs to be,” he admitted, “I think I’ll just say I am what I am. As Popeye would say.”

And what is he?

“I’m lucky,” Schreeder said. “I’m lucky to be associated with the type of people I meet. You’d just be astounded at how wonderful people are and how brave they are and how every day it’s like that.”

Human Cancer Plasma and Serum | Oncology Solid Tumor Samples | Conversant

Monday, September 7th, 2009

Systematic exploration of human plasma and serum for circulating proteins as biomarkers for cancer, hematologic diseases, rheumatoid arthritis, and lupus has been actively pursued for decades.

The problem is, not much has been found that holds up to the rigors of sensitivity and specificity on a large scale.

We’re aware of the myriad theories about the “why”… like…- selection of appropriate patient poulations

- availability of accurately matched controls

- sample collection

- sample handling and storage

- quality and depth of available clinical information

- variable profiling techniques

- etc.

Standard Operating Procedures and Quality Control/Quality Assurance checks are necessary because there is really no standard out there to guarantee reproducability of new procedures.  It’s almost like flying blind, there are so many new variables.  From a technical and economic viewpoint, every assay has to be sufficiently robust to be completed in community-based hospitals, physician clinics, and must be transportable over long distances and even days.

From a patient perspective, there is a real feeling that drugs and treatments should be highly adaptable and ultimately relevant to the patient.  The days of treating cancer patients with drugs of low toxicity or of high tolerance regardless of their efficacy are quickly coming to an end.  In much the same way, there is a growing trend to utilize a panel of biomarkers in the hopes that there will be a marker among the group that works effectively to identify disease in every patient.

Attention do detail makes all the difference.

Cancer Stem Cells | Human Cell Research | Drug Discovery | Conversant

Monday, August 31st, 2009

Most chemotherapeutic drugs today are targeting mature cancer cells…  are these cancer drugs targeted at the wrong kinds of cells?

This is a pretty tough problem.  While we know that currently available cancer drugs dramatically reduce the size of tumors, we also know that MOST cancers will eventually recur.  There is some amazing, pioneering work being done in universities, non-profits (like HudsonAlpha), and biopharma to address this issue.  Some research we’ve reviewed points toward small populations of cells — “cancer stem cells” or “CSC”s  — that are ultimately responsible for the growth of tumors and are resistant to current therapies.

Most of our existing cancer treatments have been developed based on animal models, where therapies that can show ability to promote tumor shrinkage were considered effective.  Most mice do not live beyond 1-2 years so using that model to assess relapse is not practical.

Also, the efficacy of cancer treatments is, in the initial stages of testing, often measured by the ablation fraction of tumor mass (fractional kill).  Since the theory is that CSCs form a very small proportion of a given tumor, this may not necessarily select for drugs that act specifically on the cancer stem cells.  Since conventional chemotherapies kill differentiated or differentiating cells – which form the bulk of the tumor but are unable to generate new cells – a population of CSCs, which gave rise to it, could remain untouched and cause a relapse of the disease.

More next time…

HER2 / Neu and Breast Cancer | Refractory Cancer | Conversant

Monday, August 24th, 2009

Can you collect clinical specimens from Herceptin non-responders?  That’s a question we get often.  Let me give you a little background then address that question directly…

Breast cancer – including ductal carcinoma in situ, invasive/infiltrating ductal, and invasive/infiltrating lobular – is a common diagnosis at Conversant’s clinical cancer Sites (a “Site” to us is any place where we consent patients and collect samples ie. a hospital, clinic, or physician practice).  For example, in 2008 our Sites saw over 275 newly diagnosed breast cancer patients, 25 (or 9%) of which were pre-chemotherapy Stage IV Breast Cancer patients.

9% Stage IV disease is a significant improvement versus previous years.  That points to a successful, new, aggressive push for screening plus some major advances in diagnostic technology.

Improved diagnosis is one part; the other part is improved treatment.  That’s why I’m posting this blog…

Treatment Options
Everyone who has been around the cancer research world for any period of time has heard about HER2/Neu (also known as ErbB-2, ERBB2) which stands for “Human Epidermal Growth Factor Receptor 2″; a protein giving higher aggressiveness in breast cancers.

We also know Trastuzumab (“Herceptin”) – developed by Genentech and FDA approved in 1998 – is a monoclonal antibody that interferes with the HER2/neu receptor and reverses the effects of an overactive HER2 receptor.  In order to be used, physicians will score breast cancer tissue with IHC and FISH… scores of 0 and 1+ are negative (don’t treat), scores of 3+ are positive (treat).

Studies conducted by academia and industry both show that approximately 25% of breast cancer patients have tumors that are HER2+.  Herceptin is a highly effective treatment for many of these patients.

What About Herceptin “Non-Responders”
Because the fight for better therapies in breast cancer is always ongoing, many researchers are focused on improving upon the currently available treatment options.  That’s where we can help.

Conversant collects clinical specimens from patients at initial diagnosis and follows them throughout their treatment course.  Using the Herceptin non-responders example, we can (and do) collect clinical specimens (like PBMC, Serum, Whole Blood, and even Circulating Tumor Cells) from these patients… enabling our research clients to study refractory or n0n-responder patient population.

There’s a whole lot more to it and – if you are interested – I would love to talk with you.  Give us a call anytime at (866) 838-2798.

More next week…