FOOD FOR THOUGHT

* A trial has shown that Doxepin rinse may reduce pains from oral Radiation induced Mucositis.

*Radiation post lumpectomy does improve survival even in the elderly
*Memantine 20 mg daily did alleviate loss of cognitive functions post whole brain Radiation
* Now that Tamoxifen can be given for 10 Years, people are still suggesting that switching at 5 years to Letrozole in postmenopausal women, is better but may be we need another clinical trial?  It is reported that switching to Letrozole lead a a 48% drop of Recurrence and 24% drop in chance of death!

*Should maintenance alpha interferon be given in Esophageal and gastric cancer with Non-mutated Interferon receptors? or cancer with over expressed NF-kB.
does overexpression of FOS predict response to Interleukin or Interferon.

*It is wrong to stop inhibitor to VEGF IN CANCER TREATMENT UNTIL DISEASE PROGRESSION, AND INSTEAD OF STOPPING, REPLACE IT BY AN MTOR INHIBITOR, THIS WILL ADD AN OPTION TO COLON CANCERS!
ESMO DID SHOW THAT UPFRONT COMBINATION OF AVASTIN AND MTOR FAILED TO IMPROVE RESULTS (renal cancers) BUT GIVING MTOR AFTER AVASTIN FAILURE IS STILL BELIEVED TO BE BETTER (PROOF OF CONCEPT.  DOES THE ESCAPE MECHANISMS TO AVASTIN OFFER AN OPPORTUNITY TO MTOR INHIBITOR FOR ACTION OR ACTIVITY? WHAT ARE THE PREDICTORS TO MTOR INHIBITORS 'ACTION?  IS TISSUE HYPOXIA SECONDARY TO ENDOTHELIAL DISTURBANCES RESULTING FROM AVASTIN A PREDISPOSITION TO MTOR INHIBITOR ACTION?

*SHOULD WE GO AHEAD AND USE NAB-PACLITAXEL AND GEMZAR IN ADJUVANT SETTING NOW?(PANCREATIC CANCER)

*ADDING ERLOTINIB TO AVASTIN AS MAINTENANCE THERAPY AFTER FIRST LINE CHEMOTHERAPY OFFERED BETTER PROGRESSION FREE SURVIVAL (1 MONTH BETTER) IN A PHASE III TRIAL PRESENTED AT ASCO 2012! (COLON CANCER)

RANDOM NEWS with updates for Letrozole

*BIG 1-98 showed that LETROZOLE was more effective in post-menopausal patient with any histology of breast cancer that is ER positive and Her-2 Negative, with the effect being greater in lobular type of Carcinoma.  And in Luminal B versus Luminal A.

* In HER-2 positive, one year Vs 2 Years.
"2 year long treatment not recommended",
finding of the HERA trial remains the standard of care.

In the study of 6 months Vs 12 months of Herceptin, there was a trend toward better results with 12 months also statistically no difference was detected.

*In Early Breast cancer, High Baseline of Vitamin D level was a predictor of 3 things:
1. better prognosis
2. low risk bone relapse
3. better outcome with use of Zometa.

recommendation is to measure Vit D at diagnosis and to replenish it!

*In triple negative breast cancer, the disease would be amenable to new type combinations of medications such as
A/  Cisplatin /PARP (olaprib) and Vandetanib (EGFR/VEGF).
B/  Cisplatin/PARP inhibitor and   Vorinostat (Histone deacetylase inhibitor)
C/  Androgen Inhibitors and MTOR

*PD 0332991, an oral Cyclin dependent Kinase (CDK 4/6) inhibitor added to Letrozole  increased the progression free from 7.5 months to 26.1 months.  This is an impressive performance if confirmed. 
 *PIM-1 may be a surrogate of c-MYC  amplification, and is being targeted.

* Routine Breast MRI still not recommended

*32mg IV Ondansetron  can cause Arrhythmia and has been withdrawn.