End of the First Cycle

Well, my first cycle did not have much to contribute to the state of my wellness. We had a brief discussion of the treatment and its side effects, including the chemo brain. Unfortunately, the was a screw up and I didn't get any blood tests results until until after the oncologist's visits. I'll get the blood tests results next week. In the meantime, I'll start another cycle next Monday. The chemo brain will be treated by the temodar, whether its caused by cancer or is a result of fatigue.

The best news of the week is our acquisition of "Angel," a Cairn Terrier rescue pup from a kennel in Brevard, NC.



Angel is a 3-year old female, who has had 2 maybe 3 litters, and has had no training. We'll have plenty to do to get get her up to speed, but a super-abundance of love to repay for the efforts.

Day 23: Ending the Third Week ...

Ending the third week tomorrow; I'll be seeing my oncologist this Thursday. I have something something new to talk about with her. I discovered a new (to me) side effect, which I've been informed is called "chemo brain."

While I was at a mid-day "pig pickin' party" yesterday, I found I was having difficulty recalling certain words and became hung up completing sentences. I didn't think it was drink related -- less than than three ounces of a white wine, but it felt a bit like I'd had 5-6 glasses of a 14%+ red many, many years ago, except the effects where limited to my brain. A friend told me it sounds like "chemo brain."

Thanks to the Internet, it was discovered at UCLA in 2006, but didn't really hit the public press until July 8, 2009, where chemo brain was described as "... a trend between chemotherapy and cognitive abilities, but it hasn’t identified a cause." (L. Fayed, How to Manage Chemo Brain)

At that time, the ACS estimated that about 25% of patients who show these symptoms do so because of chemotherapy, now referred to as a "cognitive deficit." Seems it that it carries over into word processing too. Doesn't seem to effect my listening and reading vocabulary.

Wonder how it will effect my golf game?

Days 10 & 11: So, so ...

Hit some golf balls yesterday and will probably got out again later today. The fatigue factor seems to have settled in at about 75%. I do well when not exercising, but tire fairly quickly doing anything moderately strenuous. I also have cold-like symptoms, many sneezes.

This morning, I took Cookie on a long walk, longer than intended when I got lost in an unfamiliar part of town. If you know anything about Pinehurst, you probably know that many of the streets are circular, which makes it pretty easy to get turned around. Eventually, I hit one of the few straight radial streets going 180 degrees from the way I thought I was walking. Fortunately, I made a good guess which way to turn and got going toward home again.

Day 9: Great Day ...

Fabulous day here - Carolina blue skies and and mild weather! As promised yesterday, I went golfing this morning. As hoped for yesterday, my stamina was not not. I did OK for the first seven holes, then the bottom fell out and I quit after nine.

I'll just keep nicking away at it and see how long it takes to come back.

Day 8: Progress ...

Feeling reasonably good today; no evident symptoms. About 10:30 AM, I went over to the golf club and hit 50-60 practice balls. Afterward, I did feel some fatigue, but not enough to prevent me from booking a tee time for tomorrow. I'll take a cart in case I feel the need to bail out.

Later, on the Internet, PLX4032 was in today's OncologySTAT with a repeat of the prior Phase I trial and a more recent article from the 2009 October 1 Elesvier Global Medical News, "Targeted Therapy PLX4032 Takes Center Stage in Metastatic Melanoma." Like Gleevec, PLX4032 requires a gene mutation, BRAF/V600. Unlike Gleevec which requires requires C-KIT mutation which occurs in about 5% of melanoma sufferers, the V600 mutation occurs in about 60% of patients.

A Phase II trial is expected to be completed by the end of 2009, with a randomized Phase III trial to begin shortly thereafter. Something to keep in mind for possible next steps.

Day 7: Fatigue ...

Well, I do have to admit to some fatigue today. I went to the Fitness Center this morning and found my normal workout to be a bit too much. I managed everything but the second set of reps came down from 15 to 12 on three of the 8 machines and I was puffing more than usual after the elliptical run.

I'm home now and will shower after finishing this blog post - feels like a return to bed would be welcome after the shower, but I'm going to to try to maintain my normal routine. It's not a nap if I fall asleep in the chair while reading, is it?

Day 6: After the Chemo...

My first day without chemo meds the night before began at 3:30 AM when I woke up with major stomach cramps, followed by five hours of distress. I'd been told to expect fatigue on the sixth day. I don't have any fatigue, unless you call voiding your bowels repeatedly fatigue - I certainly got tired of that concept quickly.

I called off my 12:30 golf game at 8:00 AM, but by noon I was thinking, well, I probably could have played. It was raining, so I didn't pursue this thought very long. I'll be monitoring progress and post anything of interest. October 19th starts the week that I should expect negative impact on my blood counts. My next doctor's appointment is October 22, 2009.

Day 5: Last Day with Temodar

Here we are, on Sunday morning. I took my last dose of chemo meds last night; no evident side effects as of 10:14 AM. Walked Cookie, followed by grooming (not her favorite event), then I went to the Fitness Center.

After lunch, we're going to the movies to see "The Informant," then home for the golf matches on TV. Tough day.

I'm waiting to see what happens tomorrow and the next day when I've been told I will feel very fatigued. If I don't, I will really wonder if I got $2,500 worth of drugs or just some empty capsules.

Stay tuned.

Day 4: Normal, normal, normal...

Sorry I missed the post yesterday. A normal day, a long walk with Cookie, then 18 holes of golf. I slopped around the front nine with three pars in the middle surrounded by 6's and 7's for a 47. I was more consistent on the back nine, which I think is more difficult, for a 44.

Renee sauteed a very nice trout for dinner and I snitched a glass of 2007 Firestone Riesling, very good at a ridiculously low cost.

Day 3: Same-o, Same-o

Again, a good nights sleep followed, today, with a trip to the Fitness Center. Still no evident side effects, although I'm feeling a little less energetic at the moment. So far, I'm finding this an interesting experience.

I've stopped aspirin - I didn't know it, but it take two weeks to get it out of your system. The third week in the four week temodar cycle is when your blood system takes the biggest hit, if it is going to happen. I'll see the doctor for tests in the fourth week to determine what's needed next.

Day 2: More of the Same with Golf

The second administration went well; good night's sleep and up early for a round of golf. The golf was OK, but inconsistent. Couldn't seem to score well, missing more putts from 3' - 4' that I was making on Monday. I seem to be coming down with a cold that I've been avoiding for several days.

So far, Temodar has produced no side effects. Let's hope it's doing something good.

Day 1 Is Lots of Fun

Not a problem. There I was, all prepared for projectile vomit, with a waterproof wastebasket and towel by the bed, and nothing happened. What a relief. The only apparent side effect is constipation.

Turns out this is a side effect of the anti-nausea medication, Zofran. I learned this little tidbit during a visit to my radiation oncologist today in Chapel Hill. I also learned that the Cyberknife radiation treatment three months ago did what it was supposed to do - shrunk the tumor on my heart very significantly, from 1.6 cm to 1 cm. Yea!

The temodar treatment continues for 4 more days. Based on last nights experience, I'm planning on playing golf tomorrow morning.

Beginning Treatment

Fed Ex is on the job - the chemotherapy drugs arrived today. Temodar (temozolomide), the jet fuel based chemo drug, Zofran (ondansetron HCL) and Prochlorper, both anti-nausea drugs. Zofran is taken before the Temodar to prevent nausea and vomiting, the other afterward, as needed, to prevent "breakout out events."

Since I haven't taken any drugs yet, there's not much to report. I will say how blessed I feel to have Medicare Part D and my supplemental insurance covering the Temodar costs - $2,500 for five days worth of pills.

Drum roll ...

Finally...

Yesterday, after seven weeks of waiting, I finally heard from Dana-Farber that my tumor tissue did not show evidence of the C-KIT mutation needed to participate in the Gleevec trial. The news was anti-climactic, because I had a CT scan on Thursday which showed continued tumor growths and my doctor and I felt more aggressive treatment was needed now.

The bottom line is that I will be starting on Temodar (temozolomide) on Monday. Temodar is an alkylating agent most active in the resting phase of a cell, but is non-cycle non-specific. It is classed as a Hydrazine or Triazine, which also include Altretamine, Procarbazine, and Dacarbazine. Like Dacarbazine, Temodar is a "pro-drug," which needs to be transformed to its active state by the patient's metabolism.

After nearly two months of waiting, it's pretty cool how fast things moved once the decision was made. A lab tech appeared and took blood samples for analysis, followed by a nurse who gave me a flu shot, then the nurse navigator took me down to the person who handles chemo prescriptions, who had already figured out how this was going to be paid for. All she needed to know was when I wanted to start. If I had said, "today,' she would have had the scrips (Temodar, plus two anti-nausea drugs) couriered over from the provider. Since I opted for Monday, the drugs will be sent to me at home.

Treatment consists of three 100 mg capsules taken two hours after my last meal each day for five consecutive days, preceded by a Zofran tab (anti-nausea) thirty minutes before the Temodar. There is also another anti-nausea drug to be taken every six-hours. (Guess what's a major side effect of Temodar). The five-day pill-taking cycle is followed by 23 days of doing nothing, other than recuperating from any side effects. I've been told I will be very fatigued on days 6 and 7.

Other side effects include the possibility of hair thinning, anorexia, headache, constipation, and myelosuppression (low blood counts). The last could lead to anemia and a weakened immune system, hence, the flu vaccination.

The plan is to do two 28-day cycles of Temodar, then, depending upon the outcome, decide what to do next. Stay tuned for progress reports.

Side Effects II

It's all in the timing,

I've been waiting over five weeks to hear whether or not I have the appropriate tumor gene mutation (C-KIT) to participate in a Gleevec trial. I was supposed to know within three weeks.. This was to be my first choice of treatments.

This morning, the Wall Street Journal published an article on "Living with a Lifesaving Drug's Side Effects" (WSJ, Thursday, September 15, 2009, D3). The gist of the article is that some lifesaving cancer treatments produce side effects that "... threaten the quality of their prolonged lives" and we're not talking about minor changes in lifestyle.

Wouldn't you know it, the featured example was -- Ta Dah -- Gleevec. I'm living a normal, symptom-free life, despite the presence of melanoma mets in my lungs, liver, and heart area. When I start chemo, clearly, my life will no longer be "normal." How different life will be cannot be predicted in advance, but neither can the efficacy of the treatment.

At age 74, which is better - a few good months or a few more lousy months/years?

I've added several web links, prefaced by SE, in the sidebar, where you can find more information about the side effects of specific drugs; however, you won't know your actual side effects, or their severity, until you begin treatment.

Timing? If I had received the gene analysis as originally proposed, I would already be committed to treatment or no longer considering Gleevec and this brain twister would be academic.

Guided Imagery for Self-Healing

"Truth in Advertising" - this post tells you why imagery is important to healing, not how to do it.

Guided Imagery for Self-Healing is the title of a book by Martin L. Rossman, M.D. (see "Books & Articles" sidebar). The title also serves well as an introduction to another aspect of the mind-body connection.

Can you heal yourself by using your imagination?

We know that we can be "worried sick," why not imagined healthy?

Ever had a nightmare and awakened terrified, in a cold sweat, with a pounding heart?

The images created by your brain (imagination) produce the same physiological fight-or-flight response that would occur when confronted by the real thing. Film and TV images cause us to laugh, cry, sweat, faint and other emotional responses. Imagined images can, and do, produce the same physiological effects as externally generated images. From here, it is a small step to see how imagery can support wellness, too.

Research in psychoneuroimmunology (PNI) (cf my August 31, 2009 post) has identified a number of mechanisms that help us to understand how images affect the immune system. For example, research at Georgetown University by Nichols Hall has shown that visualizing an active immune system produces increased levels of the hormone alpha-thymosin which increases production and activation of T-cells, an essential immune system function. A 1996 meta-research review by Dr. Karen Olness at Case Western Reserve, found 18 out of 22 studies investigating whether or not the use of imagery can affect the production and activation of T-cells reported positive results.

In addition to direct effects, such as immune system support, imagery can be used for stress reduction, too. Stress has negative physiological effects, which lead to high blood pressure and other heart diseases, over-eating and obesity, diabetes, asthma, cramps and muscle pain, insomnia, headaches, and many other physical symptoms. Cancer patients, as I can attest, suffer from stress. Stress reduction using guided imagery or other relaxation techniques (breathing techniques, hypnosis, meditation, chanting, etc)are a useful first step toward attaining "right-mindedness" for the effective use of imagery for self-healing.

Everyone has the capacity to improve wellness through imagery; not everyone is willing to make the effort. The first requirement is the "willing suspension of disbelief;" the second is proper technique; and, the third is practice, practice, practice.

It's just like golf. Anyone can hit a golf ball; the hard part is to consistently hit it well. First, you have to believe you can hit the shot (visualize it); next, you strike the ball well, and lastly you practice doing the first two over and over again until you achieve automaticity - that is, to be able to repeat the stroke without conscious thought - the golfer's mantra: "Empty mind, Loose body"

Like golf, to use imagery to promote self-healing, you must believe that it can help the healing process,or at least willingly suspend disbelief; learn to practice effective techniques for relaxation and visualization; and, practice, practice, practice.

There are dozens of books, tapes, CD's, and DVD's available to assist in learning effective techniques, but beware, there is a lot of woo-woo stuff out there, so choose carefully. For those of us who need a "pro" to guide our practice, I suggest seeking out a licensed practitioner (M.D., Ph.D.)who is associated with a teaching hospital and specializes in pain management and cancer therapy, or an established center of practice, such as the Simonton Cancer Center.

Here is a non-exhaustive list of practitioners/authors/researchers for your use in seeking resources: Jeanne Achterberg,PhD; David Bresler,PhD,LAc; Hyla Cass,MD; James S. Gordon,MD; Stanley Krippner,PhD; Lewis Mehl-Madrona,MD,PhD; Emmett Miller,MD; Dean Ornish,MD; Kenneth R. Pelletier, PhD,MD(hc); Martin Rossman,MD; Francine Shapiro,PhD; C. Norman Shealy,MD; David Sobel,MD; Andrew Weil,MD.

Keep your eye on the ball and practice, practice, practice.

The Mind-Body Connection

Google "mind-body connection" and you'll get more than 4.7 million hits covering everything from affective response to yoga. Too funky a reference, try "integrative medicine," or"psychoneuroimmunology."

Belief that the mind contributes to illness and wellness has existed least as long as there has been recorded history. "Writing near the time of the birth of Christ, the Stoic Lucius Seneca allowed that "it is part of the cure to wish to be cured." (Felten)

In 1981, neurobiologist David Felten and researchers at the Indiana University School of Medicine "...discovered a hard-wire connection between the human body's immune system and the central nervous system under control of the brain." (Felten). This finding gave substance to earlier research at the Rochester University Medical Center by pychologist Prof. Robert Ader (1974) who in rat studies, demonstrated the capacity of the rat-brain to shut down the immune system.

More than twenty years later there is still resistance from the traditional medical community to so-called "alternative medicine" based on the mind-body connection. The general response seems to be, "I doubt that it will help, but it probably won't hurt you either, so go ahead if you think it will help."

There is an interesting twist, probably unintended, within that comment. According to proponents of alternative medicine involving the mind-body connection, "...if you think it will help" is precisely when it will help. The opposite is true too, if you think it won't help, it won't. This is essentially the same premise on which Viktor Frankl's theory described in his Man's Search for Meaning (1956), is based, as well as the many books about the importance of "hope" for surviving cancer (see "books" sidebar).

In 2007, during my 50th University of Pennsylvania undergraduate reunion, I attended one of many seminars offered to alums. This one was at the Medical School, home of the Abramson Family Cancer Research Institute. During the presentation on new trends in cancer treatment, the following "story" was told;

The patient, an older man, was in the final stages of cancer, within days, weeks at most, of dying. The doctors didn't want to admit him to a clinical trail that had received very favorable initial reports, but the patient and his family insisted until finally he was admitted. Within days, his tumors began to shrink, and within months there was no evident disease. Shortly, thereafter, a more detailed research study of the drug effects was published showing the initial optimism was not justified and the new drug was no better than the standard treatment. After being made aware of the new data, the patient's tumors returned within days and the patient died with a few weeks.

Apocryphal? Possibly, even probably, but not uncommon of the kind of anecdotal evidence widely available and used to justify further research and to support a variety of mind-body practices.

Next post: Self-healing through Guided Imagery

Beer and Pizza?

I workout three times a week. Here I am this morning grinding away on the elliptical and watching CNN on the TV to help pass the time. A medical segment comes on - "The Beer and Pizza Diet - a Cancer Cure" turns out it really isn't, but the segment is about the effect of diet generally on cancer prevention. View it at CNN.com (sorry about the commercial lead-in).

Coincidentally, I was planning my next posts on so-called "alternative therapies," so I'll begin with food. First off, there are no magic silver bullets, but there are some very interesting avenues for exploration. One is the effects of food as a form of chemotherapy; another is food and the mind-body connection - food today, mind-body tomorrow.

All foods consist of chemical components which are absorbed into the body with beneficial or detrimental effects. Green leaf vegetables like spinach, kale, and broccoli, root vegetables such as carrots, and fruits, notably blue berries, are associated with positive effects. High fat foods, red meat, and fried foods are associated with negative effects.

Generally, the positive effects work through supporting one or more essential bodily functions, notably, the immune system. As I learned from posting about immunotherapy, the immune system and its ability to generate T-cells is critical to the bodies defenses against cancer. It may play a less significant role than was once thought, but with costimulation or inhibition the performance of the immune system can be significantly improved. The bottom line, give your immune system all the support you can by eating healthily.

Conversely, combinations of foods consumed in quantities which lead to obesity are bad. When I was (much) younger and competing at an international level, I consumed 6,000 to 8,000 calories a day and had trouble keeping my weight up to 175 lbs. Within three months of retiring from competition, I was eating less than 2,500 calories a day and still ballooned to 220 pounds.

At the time I retired from work the first time in 2000, I weighed 195 and was leading an active life skiing in the winter and working outdoors in the summer. I decided to go to my high school 50th reunion in 2003; coincidentally, the year I first learned that I had melanoma. I decided that I would make the effort to get down to my high school graduation weight, 185 lbs - ah, vanity. It took about six months, but I did it.

When I learned I had melanoma, one of the first treatments I considered was chemotherapy that involved a toxic cocktail the side effects of which were so devastating and the reward so small, that I did not choose it. The experience did, however, convince me this was going to be a physical fight, so I'd better get into the best shape possible. Six years later, my weight is stable at 185, I've lost 4" around my waist, and I'm hitting my drives 15-20 yards farther - good stuff. The melanoma has spread, but I still feel healthy and mentally prepared for whatever the next treatment brings.

Next post: the mind-body connection.

My Treatments

I've posted about the chemicals and vaccines. Now it's time to put the information to use to clarify my treatment options that I posted on August 13, 2009.

Option 1: Gleevec (Imatinib Mesylate). This drug is a protein-kinase inhibitor, specifically tyrosine kinase. It has been FDA-approved previously for the treatment of chronic myeloid leukemia (CML). It specifically targets an enzyme that allows the growth of cancer cells. This drug has been shown to significantly reduce the number of CML cells in treated patients within one to three months. The purpose of this trial is to determine how effective Gleevec is for melanoma that has spread from the skin to other parts of the body. The spread of melanoma cells is facilitated by the protein C-KIT, which is expressed as the result of a genetic defect in the tumor cells.

Gleevec is thought to bind to these defective cells and stop the spread of cancer. Side effects include fluid retention and edema, rashes, nausea and vomiting, diarrhea, heartburn, and headache. More serious side effects, which occur less frequently, include liver toxicity and internal bleeding.
This trial is available in Boston or Chapel Hill, NC. About one person in five whose melanoma began on the skin (as mine did)is expected to manifest the C-KIT mutation. My tumor tissues have been sent to a lab to determine if I have the C-KIT mutation present. If not, I'll proceed to Option 2.

Option 2: Temodar + ABT-888. Temodar (temozolomide) is classed as a lipid-soluble alkylating agent which crosses the blood-brain barrier, and has been used previously for treating certain brain tumors. ABT-888 is a PARP (Poly ADT-ribose polymerase) inhibitor. The PARP enzyme is active in cell growth and repair. Blocking PARP, may prevent the cancer cell from growing or repairing itself. Using the two in combination may make Temodar more effective.

This is a randomized, double-blind study with three arms, two of which use both agents in different dosages; the third (control) arm uses Temodar alone. Possible side effects include low platelet count increasing the possibility of bleeding, fatigue, constipation, nausea, diarrhea, vomiting, anorexia, and headaches.

This option is available in Charlotte, NC.

Option 3: Biovex. The lead product of Biovex Inc., now a part of Triathlon Medical Ventures, is OncoVEX, a manufactured, virus-containing vaccine to “carefully pollute cancer cells” while leaving other cells unaffected. The virus appears to be able to affect melanoma cells even after metastasis has begun. The assumption is that the cell pollution will lead to apoptosis or senescence.

The chief drawback of this trial is the there most be one or more tumors on or sufficiently near the skin surface for periodic biopsies to track the vaccine effect, a condition which I do not have at the moment. Side effects are unknown at this point. This treatment would be available in Chapel Hill.

Option 4: Avastin + Ipilimumab. Avastin (bevacizumab) is a monoclonal antibody produced in a laboratory and used in the treatment of colorectal cancers. It is classed as an Angiogenesis inhibitor. Avastin functions by blocking the action of the VEGF protein (vascular endothelial growth factor) which stimulates the growth of new blood vessels (angiogenesis); therby, denying new blood needed for tumor growth.

Avastin side effects include increased blood pressure, fatigue, muscle weakness, blood clots in veins, diarrhea, nausea, loss of appetite, low white cell count, headache, nosebleeds, and pain at the tumor site. More serious, less frequent effects include perforations, inability of wounds to heal, internal bleeding especially in patients with lung cancer, bleeding in the brain resulting in strokes, blood clots in arteries, uncontrolled high blood pressure, and kidney damage.

Ipilimumab is a human monoclonal antibody that binds to to a molecule on T cells (CTLA-4)that plays an important role in activating and regulation the immune system. Ipilimumab blocks CTLA-4 function, which otherwise suppresses the immune system. Maintaining an active immune system should make the Avastin treatment more effective and less debilitating.

In prior trial uses Of Ipilimumab, there has been about a 2% fatality rate and 20% auto-immune response. This trial is currently not recruiting, but might be available again in Boston in November.

Option 5: Temodar (temozolomide). This is currently the standard treatment for metastatic melanoma. Its function and effect would be the same as Arm 3 of Option 2 above.

This creates a quandary for me. If I chose Option 2, there is one chance in three of getting the same treatment as Option 5. The only differences are that I will have to go the Charlotte rather than Chapel Hill and participate in a significant number of procedures (exams, scans, blood tests) the only purpose of which would be to maintain the integrity of the double blind research design.

This point is irrelevant if my tumor profile shows the C-KIT mutation needed for participation in Option 1, so I’m holding my breath for another few days to get the answer.

Immunotherapy

Is Vaccination against Cancer the Answer?

Initially considered a part of chemotherapy, cancer immunotherapy is evolving into its own class of treatments. The basic purpose is to stimulate a person’s immune system to build up its defenses against cancer to prevent its spread and eventually eliminate cancerous cells. The process, which most of us have experienced in childhood, is vaccination with a laboratory-manufactured antigen (vaccine) which stimulates the creation of disease fighting antibodies. Cancer vaccines can be made from the patient’s own tumor antigens or cells (autologous vaccine) or from someone else’s (allogeneic vaccine).

The elements of the immune system are your body’s soldiers. Dendritic cells act as scouts seeking out infections or diseases. When found the scouts capture data about the foreign cells and instruct the killer T-cells to attack and destroy it. The problem is that our “armies” are under-staffed, so the number of killer T-cells programmed to attack the tumor are insufficient to overwhelm it, unless the immune system can be stimulated to attack more aggressively (co-stimulation). The objective of immunotherapy is to get the immune system to direct a greater percentage of its killer T-cell army against the patient’s tumor to increase the probability of victory. Hoooah!

All T cells derive from haematopoietic stem cells in the bone marrow.

There are several types of T cells, each with its own function:

(1) Cytotoxic T cells (Tc), also know as C8+ T cells, destroy viral infections and tumor cells and are instrumental in transplant rejections.

(2) Helper T cells (Th) when activated divide rapidly and secrete small proteins (cytokines) that help the immune response. These cells are also the target of HIV infection.

(3) Regulatory T cells (Treg) act to shut down T cell mediated immunity toward the end of an immune reaction to prevent a body-damaging autoimmune response. Treg cells can be distinguished from other T cells by the presence of a FOCP3 intercellular molecule. Mutations of FOXP3 can prevent Treg development leading to a fatal autoimmune response.

(4)Natural Killer T cells (NKT) are lymphocytes that link the adaptive immune system with the innate immune system. Once activated these cells can perform the functions of Cytotoxic and Helper T cells, the release of cell killing molecules and cytokine production.

T cell Development and Activation

All T cells derive from haematopoietic stem cells in the bone marrow. The activation process begins with the release of hematopoietic (blood forming)progenitor stem cells populate the thymus and expand by cell division to create immature thymocytes - a lymphocyte that develops in the thymus and is the precursor of a T cell.

The thymocytes pass through a multi-stage process and emerge from the thymus into the surround tissue as immunocompetant T cells. Only 2% of thymocytes complete the process. The surviving cells are then activated through interaction with certain pre-existing antigen complexes or by molecular co-stimulation with antigen-presenting cells (APCs).

Certain cancer vaccines have added ingredients (adjuvents) that increases the antigenic response. Adjuvents include things like cytokines, proteins, bacteria, viruses, and chemicals. There have been promising results from studies in which vaccine has been used before or after treatment by other Cytotoxic treatments, as well as, vaccine alone.

Some vaccines, such as Ipilimumab, using monoclonal antibodies, identifiable by drug names ending in –mab, have shown promising results for some cancers, including melanoma.

The first vaccine approved in 1981 for cancer prevention protects against HBV infection (hepatitis B). Most children are vaccinated against HBV infection shortly after birth. In 2006 and 2008, Gardasil was approved for prevention of cervical cancer caused by human papillomavirus (HPV) types 6, 11, 16, and 18. Types 6 and 11 cause about 90% of genital warts; 16 and 18 cause about 70% of cervical cancers.

At this point, there are no other vaccines approved as mainline cancer treatments. There are many vaccines being tested in clinical trials, forty-five listed for melanoma. Here’s a typical example:

Vaccine Therapy in Treating Patients With Recurrent Stage III or Stage IV Melanoma That Cannot Be Removed by Surgery

Alternate Title: Pilot Study of a Peptide Vaccine Comprising MART-1:27-35 Peptide, gp100:209-217 (210M) Peptide, and Tyrosinase Peptide With Sargramostim (GM-CSF) and CpG 7909 Emulsified in Incomplete Freund's Adjuvant in Patients With Unresectable Recurrent Stage III or IV Melanoma.

Purpose: Vaccines made from peptides may help the body build an effective immune response to kill tumor cells. Giving vaccine therapy together with GM-CSF, CpG 7909, and incomplete Freund's adjuvant may make a stronger immune response and kill more tumor cells. This clinical trial is studying the side effects and how well vaccine therapy works in treating patients with recurrent stage III or stage IV melanoma that cannot be removed by surgery.

More information about vaccines and clinical trials can be found at cancer.gov.

So, forget all the mumbo jumbo, forget about looking for a quick fix, and support stem cell research. When the breakthrough in cancer treatment comes it will be huge and vaccines will be an important element.