If you are going through chemotherapy or radiation treatment, then Kenny Perkins podcast “All Talk Oncology” is a must-listen for your personal health!
https://podcasts.apple.com/us/podcast/experience-power-nutrition-during-cancer-treatments/id1506594584?i=1000489683858
Certain chemo drugs are more likely to cause CIPN. Some of the more common ones include:
You are just recovering from the shock from being diagnosed for cancer. Your physician tells you the good news that with today’s modern treatment that your survivability and chance to enjoy a long life are very high. You endure the challenges of treatment and are cancer free, but now have chemotherapy induced peripheral neuropathy from certain chemo drugs. Can you do anything to prevent or reduce the impact of CIPN?
If you are motivated to try to prevent or reduce the damage to your nerves. There are some treatments such as acupuncture and nutritional supplements that could potentially help. Nutronco has developed PowerOnco, a nutritional supplement to address the many negative side effects from treatment including nerve damage. PowerNerve is a specific nutritional supplement for nerve pain and uses ingredients that have shown good results.
If you have been diagnosed with cancer, the shock and the unknown can be overwhelming. Who has time to think about peripheral neuropathy? There are specific chemotherapy modules that have a high percentage of triggering this horrible damage to your nerves. So many cancer patients have a great chance at beating cancer, but then they wake up with peripheral neuropathy for the rest of their lives which for some can be debilitating if not addressed properly.
Peripheral neuropathy is a set of symptoms caused by damage to the nerves that are outside the brain and spinal cord. These distant nerves are called peripheral nerves. They carry sensations (a feeling in different parts of your body) to the brain and control the movement of our arms and legs. They also control the bladder and bowel.
If you have peripheral neuropathy, you may notice some of these sensations in your hands or feet:
Chemotherapy is the cancer treatment most likely to weaken the immune system. Chemotherapy medicines target rapidly dividing cells, which cancer cells are — but so are many of the normal cells in your blood, bone marrow, mouth, intestinal tract, nose, nails, vagina, and hair. So chemotherapy affects them, too. Cancer cells are destroyed by chemotherapy because they can’t repair themselves very well. Your healthy cells typically can repair the damage from chemotherapy once treatment ends. (One notable exception is nerve cells in your hands and/or feet, which can be permanently damaged by certain chemotherapy medications — a condition known as peripheral neuropathy.)
As chemotherapy medicines damage the bone marrow, the marrow is less able to produce enough red blood cells, white blood cells, and platelets. Typically, the greatest impact is on white blood cells. When you don’t have enough white blood cells, your body is more vulnerable to infection.
Although most chemotherapy medications can have an impact on your immune system, how much of an impact depends on many factors, such as:
Some chemotherapy medicines are taken by mouth, in pill form, while others are given intravenously — through a vein in the chest, arm, or hand — at a hospital or clinic. If you’re having intravenous treatment, ask that it be given on the opposite side of the body from where you had your surgery. The injection site poses some risk of infection, and since breast cancer surgery usually removes lymph nodes, you definitely want to minimize that risk on the affected side of your body. (If you had cancer in both breasts, choose the side of the body that had less extensive surgery or fewer lymph nodes removed, if possible.)
The timing of different chemotherapy regimens varies. Typically, you would take the medication(s) for one day to several days, wait a couple of weeks to give the body time to recover, and then start the cycle again. Treatment can last for anywhere from 3 to 6 months. During that time, you would be considered to be immunocompromised — not as able to fight infection. After finishing chemotherapy treatment, it can take anywhere from about 21 to 28 days for your immune system to recover.
If chemotherapy is part of your treatment plan, you and your doctor should review the medications you’ll have and discuss potential effects on your immune system.
Before, during, and after chemotherapy, do your best to follow the common-sense ways to take care of your immune system, such as getting enough rest, eating a healthy diet, exercising, and reducing stress as much as you can. Some chemotherapy medicines can reduce your appetite and make you feel tired, so ask your doctor about ways to manage those side effects.
Before you start chemotherapy, your doctor should order a complete blood count (CBC) to check your baseline levels of different blood cells, including white blood cells. You’ll continue to have this blood test done periodically throughout your treatment. When your white blood cell count is lower than normal, you’re more prone to infection. Especially important is a type of white blood cell known as neutrophils, which are first responders to infection that can gobble up bacteria, fungi, and germs. Your test results will include an absolute neutrophil count, or ANC. Usually, your neutrophil levels start to drop about a week after your chemotherapy cycle begins, reach a low point in another week or so, and then slowly begin to climb again before your next cycle of treatment. Blood tests will help your doctor know if your neutrophil levels have bounced back enough in between treatments.
A normal neutrophil count is around 2,500-6,000. If yours is lower than that, and especially down to 1,000 or lower, your risk of infection is increased. If the count falls below 500, you have a condition called neutropenia, which greatly raises your risk of a serious infection.
Whatever your situation, it’s very important to follow specific steps for protecting yourself against infection and to promptly report any signs or symptoms of infection to your doctor. When your immune system is weak, an infection can worsen quickly and even turn life-threatening. If you have a fever higher than 100 and suspect infection but you can’t reach your doctor, seek emergency medical attention.
If your neutrophil levels don’t bounce back quickly enough between treatments or you develop neutropenia, your doctor may decide to:
If chemotherapy causes neutropenia accompanied by a fever, your doctor may prescribe medications called colony-stimulating factors (CSFs) or white blood cell growth factors to be given along with your remaining chemotherapy treatments. These medications can help the body produce more neutrophils and other types of white blood cells, which strengthens your ability to fight off infection. Examples include:
These are given as a series of shots in between treatment cycles. Although CSFs can reduce the risk of hospitalization due to infection, they can cause side effects such as aches in the bones, low-grade fever, and fatigue. Generally, CSFs are used in people who are on a chemotherapy regimen that more commonly causes neutropenia or for those who aren’t helped by an adjustment in the chemotherapy dose. Talk to your doctor to find out what is recommended for you.
Even after you finish treatment, it is important to follow steps for protecting yourself against infection until your immune system returns to normal.
Source: Breastcancer.org
Bispecific antibodies, as the name suggests, simultaneously target 2 or more tumor antigens on the same or separate cells to disrupt cancer development or progression. Others engage and tether cancer cells and immune cells together to increase cancer-cell destruction.
No matter the strategy researchers take, however, interest in these bioengineered antibodies has been rekindled by the striking success seen in the treatment of some cancers with immunotherapy — notably, checkpoint inhibitors and chimeric antigen receptor T-cell (CAR-T) therapy — in the past few years.
“Bispecific antibodies were stalled for a bit, but in this new era of immunotherapy, there’s definitely renewed interest,” said Nikhil Munshi, MD, a medical oncologist at Dana Farber Cancer Institute and director of basic and correlative science at the Jerome Lipper Multiple Myeloma Center in Boston, Massachusetts. “And, we have newer, more modern methodologies that have propelled the field forward.”
An estimated 50 clinical trials using bispecific antibodies for various malignancies are now underway, while biotechnology companies and academic labs purportedly have hundreds of different products in development and awaiting testing.1
Still, the US Food and Drug Administration (FDA) has approved only 1 bispecific antibody with a cancer indication so far, underscoring the need for further research, before these targeted biologics can emerge as viable and less costly alternatives to other types of immunotherapy that are highly tailored to an individual’s cancer.
In July 2017, the FDA approved Amgen’s bispecific antibody, blinatumomab (Blincyto) for acute lymphoblastic leukemia (ALL) in adults and children with advanced disease.2 Blinatumomab targets and binds 2 proteins, one, CD19, that is found on the surface of B-lineage cells and the other, CD3, that is found on T cells — essentially bringing the 2 in close enough proximity that T cells better recognize leukemic cells to kill them.
Other investigators are using similar tacks in creating these dual-targeting agents.
Researchers at The Ohio State University Comprehensive Cancer Center in Columbus, for example, used an approach comparable to blinatumomab in a humanized mouse model for multiple myeloma, according to Ilan Zipkin, PhD, a vice president at the Parker Institute for Cancer Immunotherapy in San Francisco, California. But the investigators extended the approved drug’s approach, he says, by tethering a common tumor antigen in this cancer, CS1, to a receptor, NKG2D, expressed on several types of immune system cells that kill.
Dr Zipkin wrote in an email that the Ohio researchers “are showing activity with a bispecific that promotes several different cell types to kill the myeloma cells,” including, importantly, natural killer cells. Results of that study were among those highlighted at the American Association for Cancer Research Annual Meeting in Chicago, Illinois, earlier this year.3
In multiple myeloma, CS1 is considered a well-defined antigen, which investigators already are targeting with CAR-T therapy, according to Dr Munshi. “But this group put it together with NKG2D, an interesting molecule, which is scientifically intriguing,” he says. “They showed a good response.”
Nevertheless, for this and other bispecific antibodies to work best in patients, Dr Munshi said there is a prerequisite: a functional immune system must be present. CAR-T therapy has a clear advantage over bispecific antibodies right now, he explained, because “you can overcome some of the immune-suppressive environment” that occurs. Still, given the prohibitive costs of CAR-T’s customized approach, Dr Munshi and others believe bispecific antibodies could provide an economical alternative for patients in the future, broadening access to treatment.
Michael Verneris, MD, director of bone marrow transplant and cellular therapy at Children’s Hospital in Denver, Colorado, also sees an evolving role for these next-generation designer antibodies. Although the need for intact immunity and a lack of persistent therapeutic effect pose barriers right now, he says, bispecific antibodies have considerable upside, as well.
“These are modular, relatively small molecules that can be quick to produce,” he said. “If ‘A’ and ‘B’ don’t work, you can keep on mixing and matching until you can create whatever you want.” One obvious advantage to patients is that if complications arise, they can be addressed quickly, he said.
“The great hope is that these will be in the deck of options for patients,” as an integral part of a multipronged strategy against cancer, Dr Verneris said.
Although no bispecific monoclonal antibodies in the first-line setting exist yet, he is confident that clinical trials in patients with early-stage cancers eventually will take place, when chemotherapy damage to their immune systems is not so extensive.
Dr Verneris said he has watched unlikely strategies in immuno-oncology gradually unfold successfully before, and the same could happen with bispecific antibodies. “It’s been hugely gratifying to see some of these ideas come raging forward.”
References
Susan Jenks
August 22, 2018
Click here for full article: Cancer Therapy Advisor
By Nikki Ross
06/25/2018
As if chemotherapy isn’t hard enough on its own, patients who undergo this course of cancer treatment also have the added struggle of maintaining a nutritious diet.
Now these patients have access to a nutritional supplement specifically designed to give them the nutrients they need when they find it hard to keep down their meals.
“This is the baby we have been working on for two years,” said Dr. Peter Acs, founder and chief medical officer for Nutronco.
The goal for the supplement, Poweronco, is to improve nutrition, rebuild muscle, support the immune system, decrease inflammation and overall to help with chemotherapy side effects. The product was developed and produced by the emerging nutrition company Nutronco.
“It bothered me to see patients struggle to find a nutritional product that they could keep down,” said Acs, who also is a board-certified hematologist and oncologist.
“I had been wanting to do something like this for years and now it’s here.”
Poweronco is a chocolate flavored powder that chemotherapy patients can mix in six to eight ounces of water once or twice a day.
It costs $99.99 for a one month supply which equals $3.75 per serving. It can be purchased on Nutronco’s website. They are hoping to soon have it available in nutritional stores.
“This is something that they can drink easily because it dissolves nicely in the water,” said Hayes Milani, CFO of Nutronco.
“It’s filling but we also always recommend taking it with a healthy diet.”
Milani and Acs stress that Poweronco is not an alternative treatment though it does help patients tolerate their chemotherapy treatment better then those who don’t take it.
“The main thing for patients undergoing chemotherapy is to eat well and maintaining weighing during treatment,” said Padmaja Sai, hematologist and oncologist at Florida Hospital. “If they are not really getting enough nutrients through their diet then we recommend patients take some nutritional supplements.”
There are several factors that contribute to nutritional deterioration in chemotherapy patients.
The treatment causes cells to stop multiplying in the body, even the good ones.
Patients who undergo chemotherapy may be subject to bed rest and, according to Acs, patients on bed rest lose 10 percent of muscle mass per week.
“Fifty to 80 percent of cancer patients have nutritional issues,” Aces said.
“Forty percent of cancer patients die from malnutrition or cachexia.”
The supplement contains ingredients that help to combat the negative side effects of chemotherapy treatment. It has nucleotides that boost the immune system, help with healing and decreases the chance of infection.
It also contains probiotics that help with the development and stability of the good bacteria in the body, strengthens the immune system and prevents the chemotherapy side effect of diarrhea.
“I don’t see anything wrong with it as long as it ties into everything else we mentioned maintaining a healthy lifestyle, organic diet, no smoking and limited alcohol intake,” Sai said. “As far as I know there is no other nutritional supplement that caters to chemotherapy patients.”
Prebiotics also have been added to the supplement to give good bacteria the surface to grow. Ginger and other ingredients are also there to reduce nausea. It also includes protein. “Many oncologists will be skeptical,” said Dr. Michael Epitropoulos, oncologist, chiropractic and natural medicine physician.
“They have checked for a reaction between the ingredients and the chemotherapy and found that it will not harm treatment like other supplements.”
Acs said his main goal in developing this supplement is to help chemotherapy patients have a more positive outcome. “This is to help them take some control over their nutrition,” Acs said. “And to help them fight against cancer.”
For information on Nutronco and their products, visit nutronco.com.
To contact Dr. Peter Acs, call 352-672-4403.
To contact Hayes Milani, call 352-278-2526.
To contact Dr. Michael Epitropoulos, call 386-274-2520.
In a recent study, scientists found that breast cancer patients with decreased muscle mass may have a significantly higher risk of death compared to patients without it. This study, titled “Association of Muscle and Adiposity Measured by Computed Tomography with Survival in Patients With Nonmetastatic Breast Cancer” was published in JAMA Oncology on April 5, 2018*. They examined 3,241 women from Kaiser Permanente of Northern California and Dana Farber Cancer Institute of Harvard Medical School between January 2000 and December 2013. Very importantly, these patients did not have metastatic cancer but rather were diagnosed with stage II or stage III breast cancer that are potentially curable. According to their results, muscle characteristics appear to be important predictors of survival for those who have breast cancer. Patients who had decreased muscle mass were 41 percent less likely to have survived than those who did not. Patients with the highest amount of body fat were also linked to an increased mortality risk. Patients who had both were 89 percent more likely to have died. At Nutronco we have been emphasizing the utmost importance of nutrition and especially protein intake to help rebuild and maintain muscle mass in cancer patients. This is the largest study to date of patients with nonmetastatic breast cancer, and it demonstrated that decreased muscle mass (sarcopenia) is underrecognized, highly prevalent, and is associated with a significant increased risk of death. The authors of the study concluded that we should consider interventions to improve muscle mass such as protein supplementation. Our PowerOnco supplement provides high quality pure protein with high amount of branched chain amino acids, especially leucine, that has been shown to be the most powerful booster of muscle mass.
*Caan BJ, Cespedes Feliciano EM, Prado CM et al. Association of Muscle and Adiposity Measured by Computed Tomography with Survival in Patients With Nonmetastatic Breast Cancer. JAMA Oncol 2018 Apr 5.
Peter Acs, MD, PhD – Medical Oncologist
Updated 7:00 PM ET, Thursday June 21, 2018
Cancer cells are very different from normal cells. These differences typically allow them to escape from under control and grow wildly. Not only do they grow uncontrollably, but they are aggressive and become invasive. Normal cells will mature into specialized cell types with specific functions, whereas cancer cells do the opposite: they become less and less specialized as they lose control and become more aggressive. The way we describe how much they differ from normal cells is called: grade. A cancer that is low grade resembles more to its normal counterpart than a high grade disease (for more information see blog: What is Tumor Grade?). In addition to cancer cells’ ability to multiply without control, they are also able to ignore signals that normally tell cells to stop dividing or to die. Cancer cells may produce and secrete growth factors and other hormones that will stimulate normal cells to act in favor of the cancer, like forming blood vessels. Another important feature of cancer cells is that they may change in ways that help them evade the immune system and become “invisible” to the body’s natural ability to remove abnormal cells. Luckily, some of these features we can use in the fight against cancer. The rapid growth of cancer cells is the reason why we can use chemotherapy that typically targets dividing cells and due to the hormone dependence of some cancers, we can use hormonal manipulation.
Peter Acs, MD, PhD – Medical Oncologist
Updated 11:20 AM ET, Monday May 28, 2018
Cancer develops when cells start growing without control and spread into surrounding tissues. This can happen in any type of cell in any organ. Cells normally grow and divide to form new cells as the body needs them, and when cells become old or damaged they die. In cancer cells this mechanism gets impaired and cells continue to grow even when they should die or when they are damaged. The resultant tumor becomes malignant, and called cancer, when these abnormal cells start to grow into surrounding tissue. Eventually, some cells will acquire the ability to travel to distant places in the body and form new tumors at these locations. Once a cancer diagnosis is made the extent of the disease must be assessed. This is called staging. Typically stage I cancers are small and localized, stage II ones are larger but still localized. Stage III cancer has moved to lymph nodes, whereas stage IV disease means disease in distant organs. This is called metastatic cancer. Staging determines treatment options. Stage I cancer is usually curable with surgery, while the treatment of choice for stage IV cancer is systemic chemotherapy.
Peter Acs, MD, PhD – Medical Oncologist
Updated 4:30 PM ET, Monday April 23, 2018
