An exciting new oral agent has recently become available to treat patients with metastatic castration-resistant prostate cancer (mCRPC) who have received prior chemotherapy containing docetaxel.
Abiraterone is an androgen biosynthesis inhibitor which acts at 3 sources of testosterone production: the testes, adrenal glands and prostate tumor tissue.
Hopefully, the indications for this once daily 250mg tablet will be expanded to include other patients who never received chemotherapy.
Monday, March 19, 2012
Saturday, December 10, 2011
We're moving
We are looking forward to moving our office just 1 mile down Northfield to the Atkin's Building at 1500 Pleasant Valley Way in West Orange. The office will be ready for occupancy in early 2012!!
Wednesday, July 6, 2011
IMMUNOTHERAPY for prostate cancer
A number of articles in the NYT and WSJ have addressed the treatment of prostate cancer using immunotherapy. Provenge (Dendreon Corp) has recently received the most publicity particularly in reference to Medicare's decision to cover this costly drug.
How does immunotherapy work?
Certain immune cells are collected from a patient's blood in a procedure known as leukapheresis. The immune cells are processed to combine with a protein found in most prostate cancers and another compound that stimulates the immune system to make Provenge. When given intravenously, the drug is believed to activate other immune cells to see the cancer as a threat and attack it.
Several companies are exploring this modality for the treatment of other solid tumors. More to come.
How does immunotherapy work?
Certain immune cells are collected from a patient's blood in a procedure known as leukapheresis. The immune cells are processed to combine with a protein found in most prostate cancers and another compound that stimulates the immune system to make Provenge. When given intravenously, the drug is believed to activate other immune cells to see the cancer as a threat and attack it.
Several companies are exploring this modality for the treatment of other solid tumors. More to come.
AVODART warning
As with Proscar (finasteride), new warnings have been released regarding the incidence of high grade prostate cancers in men taking Avodart and the combination drug Jalyn (avodart +flomax). The incidence is 1% with avodart versus placebo of 0.5%. This data was presented in the 4 year REDUCE (reduction by dutasteride of prostate cancer events study). The data for for proscar was slightly higher at 1.8% versus placebo of 1.1%).
Therefore, close monitoring of PSA is important in this group of patients taking Avodart as well as Proscar in those patients who require these medications for the treatment of symptomatic benign prostatic hyperplasia (BPH).
Therefore, close monitoring of PSA is important in this group of patients taking Avodart as well as Proscar in those patients who require these medications for the treatment of symptomatic benign prostatic hyperplasia (BPH).
Monday, January 24, 2011
DIET, HEALTH AND FITNESS
I was saddened to hear of the death of Jack LaLanne at the age of 96. I vividly remember his black and white television shows during my childhood. Although, he was fanatical and regimental in his daily exercise routines and obviously had a good genetic make-up, there is a lot to learn from his habits. In his obituary in the New York Times 1/24/2011, he outlined his eating habits..."he ate two meals a day and shunned snacks. Breakfast, following his morning workout, usually included several hard-boiled egg whites, a cup of broth, oatmeal with soy milk and seasonal fruit. For dinner he took his wife, Elaine, to restaurants that knew what he wanted: a salad with raw vegetables and egg whites along with fish-often salmon-and a mixture of red and white wine. He sometimes allowed himself a roast turkey sandwich, but never a cup of coffee." He was definitely a forward thinker way ahead of his time.
He would famously like to say. "I can't die, it would ruin my image."
He was a true icon.
He would famously like to say. "I can't die, it would ruin my image."
He was a true icon.
Tuesday, November 30, 2010
Vitamin D and calcium supplements
It didn't surprise me one bit when an article appearing on the front page of the New York Times nixed the benefits of megadoses of vitamin supplements. Out of nowhere everyone seems to be getting bloodwork for vitamin D levels and prescribed supplements for low levels. Today's article makes us reconsider whether all these supplements are indicated. It's been known for some time now that megadoses of calcium contribute to kidney stones.
Report: Skip the Megadose of Vitamin D
Report: Skip the Megadose of Vitamin D
(Nov. 30) -- Dietary guidelines being released today call for a slight increase in the amount of vitamin D people need every day for good health but warn against megadoses of the "sunshine vitamin," saying there's no proof they prevent cancer and that they could in fact be harmful.
"More is not necessarily better," Dr. Joann Manson of Harvard Medical School, who co-authored the report, told The Associated Press.
The report from the prestigious Institute of Medicine says most people in the U.S. and Canada from ages 1 to 70 need 600 international units of vitamin D daily. That's up from the 400 IUs under today's government-required food labels and above the 1997 guidelines from the institute that called for 200 to 600 IUs, AP noted.
Most people are getting the amount of calcium they need from their diets, the report found, and supplements are not needed, The New York Times reported. Calcium and vitamin D work together to help build strong bones.
"For most people, taking extra calcium and vitamin D supplements is not indicated," Dr. Clifford J. Rosen, a member of the panel, told The Times.
The guidelines could slow the vitamin D craze. The sale of supplements has soared as some scientists recommend 2,000 IUs a day amid studies suggesting low vitamin D levels increase the risk of cancer and heart disease, AP said. The report out today suggests an upper limit of 4,000 a day.
"This is a stunning disappointment," Dr. Cedric Garland of the University of California, San Diego, who was not part of the study, told AP. The risk of colon cancer could be cut if people got enough vitamin D, he said.
Low levels of vitamin D have also been linked to stroke, diabetes, breast cancer, auto-immune diseases, infections and depression, and studies have suggested many Americans don't get enough vitamin D because they spend time inside and wear sunscreen when they go out, according to The Wall Street Journal.
But the institute didn't find enough evidence to prove a link to those chronic diseases, the newspaper said. The new guideline was created solely to promote bone health, the Journal said.
The new guidelines will affect the recommended daily allowances listed on food packages and the makeup of school lunches and other federal nutrition programs, according to the newspaper.
Some experts were disappointed.
The recommended 600 IUs of vitamin D is "way too low," Creighton University professor of medicine Robert Heaney told USA Today. Heaney, who has studied the benefits of D, says people should consider getting about 4,000 IUs daily.
"For me, it's a no-brainer," he told the newspaper. "There is a large body of evidence for benefit at intakes above the IOM recommendations. There is no risk, and very little cost, so why not take a chance of a benefit if there's any possibility?"
The latest study to report no cancer protection from vitamin D, and the possibility of a greater risk of pancreatic cancer, came last summer from the National Cancer Institute, AP said. A megadose of more than 10,000 IUs daily is known to cause kidney problems, AP said.
"Everyone was hoping vitamin D would be kind of a panacea," Dennis Black, a University of California, San Francisco, professor of epidemiology and biostatistics, told the Times.
The guidelines may dampen enthusiasm for the vitamin, he said. "I think this will have an impact on a lot of primary care providers," he told the paper.
For calcium, the report recommended the levels that are already accepted, about 1,000 milligrams for most adults, 700 to 1,000 mg for children, and 1,300 mg for teens and menopausal women, AP said.
"More is not necessarily better," Dr. Joann Manson of Harvard Medical School, who co-authored the report, told The Associated Press.
The report from the prestigious Institute of Medicine says most people in the U.S. and Canada from ages 1 to 70 need 600 international units of vitamin D daily. That's up from the 400 IUs under today's government-required food labels and above the 1997 guidelines from the institute that called for 200 to 600 IUs, AP noted.
Most people are getting the amount of calcium they need from their diets, the report found, and supplements are not needed, The New York Times reported. Calcium and vitamin D work together to help build strong bones.
"For most people, taking extra calcium and vitamin D supplements is not indicated," Dr. Clifford J. Rosen, a member of the panel, told The Times.
The guidelines could slow the vitamin D craze. The sale of supplements has soared as some scientists recommend 2,000 IUs a day amid studies suggesting low vitamin D levels increase the risk of cancer and heart disease, AP said. The report out today suggests an upper limit of 4,000 a day.
"This is a stunning disappointment," Dr. Cedric Garland of the University of California, San Diego, who was not part of the study, told AP. The risk of colon cancer could be cut if people got enough vitamin D, he said.
Low levels of vitamin D have also been linked to stroke, diabetes, breast cancer, auto-immune diseases, infections and depression, and studies have suggested many Americans don't get enough vitamin D because they spend time inside and wear sunscreen when they go out, according to The Wall Street Journal.
But the institute didn't find enough evidence to prove a link to those chronic diseases, the newspaper said. The new guideline was created solely to promote bone health, the Journal said.
The new guidelines will affect the recommended daily allowances listed on food packages and the makeup of school lunches and other federal nutrition programs, according to the newspaper.
Some experts were disappointed.
The recommended 600 IUs of vitamin D is "way too low," Creighton University professor of medicine Robert Heaney told USA Today. Heaney, who has studied the benefits of D, says people should consider getting about 4,000 IUs daily.
"For me, it's a no-brainer," he told the newspaper. "There is a large body of evidence for benefit at intakes above the IOM recommendations. There is no risk, and very little cost, so why not take a chance of a benefit if there's any possibility?"
The latest study to report no cancer protection from vitamin D, and the possibility of a greater risk of pancreatic cancer, came last summer from the National Cancer Institute, AP said. A megadose of more than 10,000 IUs daily is known to cause kidney problems, AP said.
Sponsored Links
These days, more people are taking vitamin D supplements and know their vitamin D levels through tests at medical checkups. Sales of vitamin D have risen from $40 million in 2001 to $425 million last year, the Journal said."Everyone was hoping vitamin D would be kind of a panacea," Dennis Black, a University of California, San Francisco, professor of epidemiology and biostatistics, told the Times.
The guidelines may dampen enthusiasm for the vitamin, he said. "I think this will have an impact on a lot of primary care providers," he told the paper.
For calcium, the report recommended the levels that are already accepted, about 1,000 milligrams for most adults, 700 to 1,000 mg for children, and 1,300 mg for teens and menopausal women, AP said.
Tuesday, November 2, 2010
New FDA warnings about Lupron and related meds
FDA Requiring GnRH Agonists To Carry Warnings About Potential Risk For Heart Disease, Diabetes.
The Wall Street Journal /Dow Jones Newswire (10/21, Dooren) reports that to shrink prostate tumors, the medical community relies on a group of products that reduce male hormone levels, but these gonadotropin-releasing hormone (GnRH) agonists may also increase the risk of diabetes and cardiovascular problems. Thus, the FDA is now requiring the drugs, marketed under generic and brand names like Zoladex (goserelin), Lupron (leuprolide), Trelstar (triptorelin), Vantas (histrelin), and Synarel (nafarelin), carry labels that highlight the potential risks.
In February, "the American Heart Association, the American Urological Association, and the American Cancer Society issued a joint advisory warning of the increased risks of diabetes, myocardial infarction, stroke, and sudden death among men who use androgen deprivation therapy (ADT) to treat prostate cancer," MedPage Today (10/20, Walker) reported. "GnRH is the most common form of ADT. However, the groups did not offer specific guidelines for clinicians on when to employ ADT therapy or when to avoid it."
Thus, the FDA stepped in May and "announced...that it was reviewing the" GnRH agonists, HealthDay (10/20, Reinberg) reported. "Speaking after the FDA's announcement earlier this spring," Dr. Nelson Neal Stone, of the Mount Sinai School of Medicine, "said studies have shown that men with advanced prostate cancer who take hormone therapy face a twofold increased risk of developing metabolic syndrome, a cluster of symptoms tied to the development of heart disease." And, "once patients understand that, Stone hopes they will be motivated to watch their diet and exercise." For the time being, however, "men should not stop taking their hormone therapy, but do everything they can to reduce their risk of developing cardiovascular disease and diabetes with lifestyle changes, he said."
Still, the "relationship between heart disease risk, diabetes, and androgen deprivation therapy has not been without controversy," Medscape (10/20, Mulcahy) pointed out. "A medical oncologist specializing in prostate cancer treatment recently defended the safety of the therapeutic approach in an interview with Medscape Medical News." Mark Scholz, MD, of the California-based Prostate Cancer Research Institute, said, "There is no convincing evidence that hormone blockade shortens life or causes excess heart attacks if weight gain is attended to and blood sugar levels are kept in check."
Nevertheless, even though "all of the drugs will stay on the market," they "will be required to carry new label warnings," WebMD (10/20, DeNoon) reported. "The risk that the drugs will trigger diabetes or heart disease/stroke appears small, the FDA says," but again, "recent studies suggest that doctors should monitor blood sugar levels and watch for signs of heart disease in men taking these drugs." Reuters (10/21, Richwine) also covers the story.
| From the AUA |
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