Saturday, March 15, 2014

Activity at CRBCM

As we plan another Visit to the Indianapolis Area this week-end the CRBCM has rapidly grown to meet an accelerating demand of immediate patient care and other positive administration requirements.  So much so that genetic work had suffered some delays.   But gene work is where the future is, and where our soul rest.  So do not be surprised that we shall comeback with a vengeance and progress.
The SBIR/NCI is currently reviewing one of the proposal submitted by CRBCM, and in this world of thousand hypotheses, catch the eyes of investigators is already a victory for CRBCM.

In the clinic, we continue to meet interesting new cases as we move deliberately with formulation of new Hypotheses.  This week, a 42 year hispanic  achondroplastic (malformation) woman  presented with bilateral breast cancer.  It is true that this case is the type that beg for gene evaluation first as to the presence of BRCA 1&2 because of her age and bilateral mastectomy needs.   How to raise issue of need of bilateral Oophorectomy for Breast-Ovarian cancer possibility, and potential interactions between the Achondroplastic gene and the BRCAs.  And how the Achondroplastic gene is linked to VEGF, how to bring in Avastin and the MTOR inhibitor eventually.   Her cancer is early and she is currently on Letrozole for adjuvant therapy.  But how to gear ourselves for an eventual progression. How the breast cancer biomarkers will behave in this case and how to best follow her, are unique questions.  Is the RELA gene involved?  These are unique questions making our current practice below what it should be in terms of current insurance limitations in terms of testing.  The future will be better.  Yes I could test BRCAs but the Achondroplastic gene relation with BRCA is out of Boundaries even though it could point to interesting driver Mutation genes that would have benefited this lady!  Is targeting the MEK a potential benefit in case progression to Metastasis occurred?  These are unanswered questions that may remain so under the current insurance pressures!

New challenges have also presented themselves as a 62 year old hispanic man walked in with a severe back pain with evidence of L1 involvement by a mass which turned out to be an Adenocarcinoma with GI features in a patient who was treated just 3 years ago for a locally advanced Prostate cancer.  The mass was negative for Alkaline Phosphatase and PSA markers.  The Colonoscopy is pending and so is the result of several biomarkers.  But the severity of the Back pain and knowledge of the impeding vertebral involvement wisked this man into Radiation's hand as we have yet to determine a final plan.  Will it be FOLFOX or a DCF model to include still Taxotere given the recent Prostate cancer fight.   Is this still a non hormone progression of prostate cancer despite the pathologist suggestions.  And yes a PET is not an option because the patient is uninsured and the family cannot pay for this.  Yet they feel he may qualify for a new P53 inhibitor which it will take another month to check if this is the driver mutation (can we ? is such a test necessary?).   Should we add Avastin in the setting of unknown primary?
 These are some of the clinical challenges met a CRBCM, and supputations continue to go on at CRBCM.

Next month we will be in Las Vegas to attend an update in Hematology, we will see what is cooking ....

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