Recent studies show some promise in understanding chemo-caused neuropathy, and perhaps in using a common medicine to ease the worst symptoms in some people.

Study shows neuropathy relief for some using antidepressant

 A well-designed clinical study has provided the first evidence that the antidepressant Cymbalta® (duloxetine) can provide some patients with significant relief from peripheral neuropathy caused by chemotherapy.

From 20 to 40 percent of cancer patients given neurotoxic chemotherapy–taxanes, platinum-based including Eloxatin® (oxaliplatin), vinca alkaloids, bortezomib–will develop painful peripheral neuropathy (numbness, tingling, burning in hands or feet). If the pain is severe, colorectal cancer patients often have to reduce the dose or stop taking Eloxatin. Even then, this painful condition can persist for months, even years, after chemotherapy is stopped.

Previous studies have found that Cymbalta eases the neuropathy pain caused by diabetes, but this is the first comprehensive trial testing whether Cymbalta could ease neuropathy from chemotherapy. As reported in the April 3, 2013 JAMA (Journal of the American Medical Association), the trial enrolled 220 patients at 8 different cancer centers across the U.S. who still had significant neuropathy (at least 4 on a pain scale of 10) at least 3 months after chemotherapy. (Over half, 129 patients, had taken Eloxatin, mostly for colorectal cancer.) In this randomized, double-blind (neither patients nor clinicians know who’s getting the test drug), crossover trial, one-half the group received Cymbalta for 5 weeks while the others took a placebo, and then the groups switched treatments.

Of those taking Cymbalta, 59% reported at least moderately decreased pain (minimum 1 point on the 10-point scale)—usually within the first week. Among those taking a placebo first, 38% reported decreased relief. Interestingly, Cymbalta-associated pain relief was significant only in feet, not hand, symptoms. Also, 11% of people taking Cymbalta had to stop due to side effects—mostly severe fatigue.

Experts theorize that the antidepressant might help because it reduces the neurotransmitters serotonin and noradrenaline, which deliver pain messages to the brain. The study authors pointed out limitations in this first study: relatively small numbers, the effects measured by patient self-report, and the study only followed patients for 5 weeks on Cymbalta.

However, “This is not just about improving quality of life by decreasing pain, but potentially it’s helping patients live longer because they can get their full chemotherapy treatment,” noted lead author Ellen M. Lavoie Smith, Ph.D., APRN, AOCN, of the University of Michigan Comprehensive Cancer Center.

Another expert not connected to the study, Marie Bakitas, D.NSc., at the University of Alabama at Birmingham School of Nursing, noted that the trial results weren’t surprising, because duloxetine is already being used in clinics. But, she also told Medscape, other treatments such as physical therapy, acupuncture and massage “are often neglected but can be very useful.”

Sources: “Effect of Duloxetine on Pain, Function, and Quality of Life Among Patients With Chemotherapy-Induced Painful Peripheral Neuropathy,” April 3 JAMA Network; “Drug for Depression Mutes Chemo Nerve Pain,”April 2 Medscape; “Antidepressant helps relieve pain from chemotherapy, study finds,” April 2 Univ. of Michigan Health Systems press release.

Searching for genes that could predict peripheral neuropathy

 Mayo Clinic researchers have reported that they’ve found that patients with mutations in  three specific genes were more likely to suffer peripheral neuropathy from chemotherapy.

Currently, doctors have no way to predict who will have the side effect, how severe it will get, nor how long it will last.

At the recent meeting of worldwide cancer researchers (AACR, or American Association of Cancer Researchers), scientists described how they studied more than 20,000 specific genes in 119 patients—over half of whom had developed peripheral neuropathy during chemotherapy. They pinpointed three genes, in which mutations were clearly associated with developing neuropathy. Their next step will be to expand their study of the entire genome in as many as 1000 patients. The ultimate goal would be to use these types of genetic clues to potentially predict which patients might suffer side effects from specific drugs.

Fight Colorectal Cancer’s Board Chair Nancy Roach noted that these first findings are a long way from proving cause-and-effect, creating a test, and actually being able to get a reliable test to doctors and patients.

Source: “Gene Variations Predict Chemotherapy Side Effects,”April 9 2013 Science News.

Disclosure: Fight Colorectal Cancer has accepted funding from Sanofi, manufacturer of Eloxatin, in support of its programs. Fight Colorectal Cancer has ultimate authority over website content.

) photo by ThinkProgress

The annual scientific meeting of the American Association for Cancer Research took a little lunch break on Monday, April 8th in Washington, D.C., while the attendees streamed outside to join a crowd of several thousand gathered across the street for a loud street rally.

“When [Congress] sees a grassroots movement rising up from doctors, from scientists, from advocates, and patients, you become impossible to ignore,” cancer survivor Rep. Rosa DeLauro (D-CT) told the cheering crowd. (Watch video of the speakers here.)

Fight Colorectal Cancer was one of 200-plus organizations who gathered and supported the  Rally for Medical Research, aimed at the politicians who have made, and are making,  decisions about budget cuts. The sequester alone will cut about $1.5 billion from the National Institutes of Health, and with overall budget cuts, NIH will lose about $12.5 billion over the year.

Penny-wise, pound-foolish: Research cuts mean lost jobs

Speaker Marc Tessier-Lavigne, Ph.D., president of Rockefeller University, pointed out that NIH total spending comes to about $100 per person in the U.S. each year, compared with that person’s yearly health costs totaling around $8000.

The main scientific organizations, including AACR (the American Association for Cancer Research) at its current annual meeting, point out that those NIH cuts alone will likely result in the loss of a half-million jobs, and an estimated $860 billion in economic growth over the next nine years. In fact,, federal investment in the largest-ever scientific collaboration, the Human Genome Project, paid off wildly: the economy gained $140 for every $1 in federal support over 5 years–not to mention the warp-speed increase in genetic knowledge about every major disease.

Scientists Honor Katie Couric

The AACR also took time to award colorectal cancer activist and journalist Katie Couric with its 2013 AACR Award for Distinguished Public Service, for all her work fundraising for research and drawing the public’s attention to cancer screening and treatment. She told the crowded hall, that “with 18,000 scientists gathered here, there are enough synapses firing in this room alone to power a nuclear reactor….To stand here in front of all of you is truly humbling….I consider myself the unofficial but highly enthusiastic cheerleader for the people who do research in cancer.”

Five years ago, she said, ” We could not tolerate the fact the NCI could only fund 1 in 10 of grant proposals,” so a dozen “truly Type A women” founded Stand Up To Cancer, emphasizing teamwork, tight time frames, and true collaboration with five “dream teams” (now grown to 10) taking on out-of-the-box ideas to beat cancer. (See the video about Katie Couric, followed by her speech, here.

Stay tuned…more to come

Fight Colorectal Cancer is well represented at AACR: stay tuned.

Sources: The Rally for Medical Research, reported on by The Hill, by HealthWatch , and “Thousands Rally for Medical Research in Washington, DC”, Apr. 8 Medscape Oncology News; news from AACR Annual Meeting, Tuesday Daily Alert. 

The American Association for Cancer Research (AACR) says that declining budgets at the National Institutes of Health a crisis standing in the way of bringing cancer research to patient’s lives.

For the past ten years, NIH budgets have been essentially flat.  Factoring in rising research costs, flat funding means a loss of nearly $6 billion dollars in purchasing power.

AACR is calling on its members and the advocacy community to work even harder with Congress to invest in medical research.  The AACR board of directors said,

Therefore, the AACR announced this morning that it plans to redouble its efforts to engage with Congress to make research funding a higher national priority, raise public awareness of the importance of continued investment in cancer research, and call on its 34,000 members and broader advocacy community constituencies to join together to help better explain and illustrate the value of cancer research and biomedical science to the economic health and well-being of this nation.

AACR President Judy E. Garber, MD, MPH said,

We already see the effects on our most precious resource, young investigators. This is potentially disastrous, as we are relying on them to ensure the continuing pipeline of new discoveries that will have ever greater impact on the welfare of patients and the public health.

AACR is holding its 2012 annual meeting in Chicago this week – Accelerating Science: Concept to Clinic.

Watch Nancy Roach tell AACR members and advocates how they can join the effort for cancer research funding.

Speaking at the 2011 annual meeting of the American Association for Cancer Research, Nancy said,

If public funding for biomedical research matters to you, get involved.

Nancy represented the voice of advocates in an AACR discussion of The Outlook for Cancer Research Funding in the Coming Years: The Importance of Advocacy and Government Relations.

She was joined by former Illinois Congressman John Edward Porter, Shannon K. Bell from the NCI Office of Advocacy Relations, and Jon G. Retzlaff who is the managing director of Science Policy and Government Affairs for AACR.

You can also hear John Edward Porter and Shannon Bell on the AACR website.

Jon Chung PhD

The 2011 Fight Colorectal Cancer-AACR Fellowship, in memory of Lisa Dubow, has been awarded to Jon H. Chung, PhD  from the Johns Hopkins University School of Medicine.

His proposed research is Hedgehog Pathway Targeted Therapeutics for Metastatic Colorectal Cancer.

With the award, Dr. Chung will study alternatives to the traditional Hedgehog signaling pathway in colon cancer cells.  He will explore crosstalk within the cell between the Hedgehog and Wnt pathways and screen for drugs that block both pathways at the same time, potentially stopping cancer development. Read the rest of this entry »