Video Q&A about Cancer Immunotherapies

Wed, Feb 6, 2019
9:30am to 10:00am CT

Description

Dr. Roxana Dronca is chair of the Hematology/Oncology department at Mayo Clinic's campus in Jacksonville, FL. She is speaking to a group interested in immunotherapies for women's cancers and has invited the public (via Connect and Facebook Live) to watch her presentation and participate in a Q&A session.

Location

Online

Thanks so much!

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@ihnsbc @jeanadair123 @farmgirl1556 great questions about aromatase inhibitors (AIs) and decision-making. It's not a simple equation. The percentage risk factor is different for every woman and which side effects one gets or can manage varies too, and will vary depending on which AI being used. Each person, along with their oncologist hopefully, has to do their own calculus and figure out what is right for them.

There are quite a few members talking about managing side effects of AIs and choosing to take them or not or to discontinue them in the Breast Cancer group here: https://connect.mayoclinic.org/group/breast-cancer/
I encourage you to join the conversations or start a new discussion specifically about deciding about AIs.

@wildapple50 I hope you'll join members in the breast cancer group too. I see you've just recently joined Connect.

@gemma1960 I look forward to your joining the conversations in the Genecologic Cancers group: https://connect.mayoclinic.org/group/gynecologic-cancer/

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My question is for my mother. My mother had colon rectal cancer 3 years ago. She went for a critical surgery and removed the colon and a few lymph nodes. My mother is now 80 years old. She is slowly recovering since the surgery. She did not have to go for chemo or radiation. She has been careful with her diet since then. She eats more vegetables and fruits than before. She went back to PET/ CT scan every year and the result is always “Clear”. She and her family does not have cancer gene. I wanted to know whether her diet can be a great change for her life. Is there any other factor ? I would appreciate your advice how to live on to keep the same result when my mother goes for PET scan. Thank you.

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@soul

My question is for my mother. My mother had colon rectal cancer 3 years ago. She went for a critical surgery and removed the colon and a few lymph nodes. My mother is now 80 years old. She is slowly recovering since the surgery. She did not have to go for chemo or radiation. She has been careful with her diet since then. She eats more vegetables and fruits than before. She went back to PET/ CT scan every year and the result is always “Clear”. She and her family does not have cancer gene. I wanted to know whether her diet can be a great change for her life. Is there any other factor ? I would appreciate your advice how to live on to keep the same result when my mother goes for PET scan. Thank you.

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Hi @soul. This question is more suited for Dr. Dawn Mussallem, who did a Q&A last year on this very topic! Check it out: https://connect.mayoclinic.org/webinar/cancer-fighting-foods/

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@audreylaine

Hi @soul. This question is more suited for Dr. Dawn Mussallem, who did a Q&A last year on this very topic! Check it out: https://connect.mayoclinic.org/webinar/cancer-fighting-foods/

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Dear Audrey, thank you so much for your quick response. I will check it out. Thanks again. Have a great day. Best regards, Soul

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Is Car-T used or approved for any type of solid tumor, or is it only blood cancers at the moment?

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@annmillercarr @raemark @raemark2010 @greta_k @valerie912 @grandpabob please join us for a live presentation from Mayo Clinic talking about CAR-T therapy and immunotherapy. You can watch it now or later. The archive can be found here: https://connect.mayoclinic.org/webinar/video-qs-cancers/

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@gemma1960

Is Car-T used or approved for any type of solid tumor, or is it only blood cancers at the moment?

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Gemma,
Currently, CAR-T cell therapy may be a treatment option for:
– Relapsed, refractory B-cell acute lymphoblastic leukemia
– Relapsed, refractory B-cell non-Hodgkin's lymphoma

Other types of cancer and medical conditions undergoing clinical studies. See more info here: https://www.mayoclinic.org/departments-centers/car-t-cell-therapy-program/sections/overview/ovc-20404319

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In September 2017 I went for my yearly mamo/ultrasound and something showed up in both. I immediately went to my breast surgeon who had done a lumpectomy in my other breast 11 years ago (DCIS). He sent me for an MRI and I had that in October 2017. The report from that said it was a birads 3…probably benign and to repeat the MRI in six months. I went for the six month MRI in April 2018 and the report was birads 2…benign. At that point I told my surgeon that I wanted a biopsy which he immediately scheduled. So, less than 2 weeks later, I had the biopsy which showed invasive ductal cancer and DCIS. My surgeon was also excellent in getting me in for another lumpectomy by the end of April 2018. In 3 weeks I went from benign diagnosis from MRI to invasive breast cancer and DCIS. Has anyone else had this experience? Needless to say that not only did I have to deal with the physical and psychological affects of this event, I had huge anger issues at the radiologist that read both MRIs and got neither right. How many other people has he misdiagnosed who have not felt they had to peruse the issue? Other than my two questions, I advise people with the same circumstances to go for the biopsy immediately if it is possible. It may just save your life. I hope I have put this in the right place.

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I am so sorry that you had to go through this. I had an incompetent gyne who did not take my symptoms seriously and I was dx with stage 1a grade 3 serous endometrial cancer. As a result, I question everything.

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@audreylaine

Hi everyone! I just spoke to Dr. Dronca and her presentation focus has changed from (very broad) "Women's Cancers" to "Cancer Immunotherapies." I updated the title of this Video Q&A accordingly. For those of you who have posted questions, I'll send them to the appropriate physicians to answer. Thank you!

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Thank you. I did listen to the presentation by Dr. Dronca as I am interested in any research on women's cancers, however, I appreciate your letting us know that you will be sending our questions to the appropriate physicians for answers. My focus is ovarian clear cell research.

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@odette

I am very interested in ovarian clear cell cancer. As HGSC is far more prevalent in the United States, that is the focus of most research. Much of the research I encounter about OCCC is from Europe and Asia (more prevalent there). Clear cell is known to originate from lesions of ovarian endometriosis and it would seem that focusing on that condition would allow for early detection. A large percentage of women are found in an early stage OCCC as it is and has the characteristics of Type 1 cancer (grows locally, indolent behavior, etc.). When found early, the OS is high. It would seem with its unique genetic signature, its association with endometriosis, biomarkers, and so on, that early detection is possible and it could be avoided with the removal of endometriomas prior to menopause (although I've encountered women in their thirties with clear cell). Even the updated 2018 version of the NCCN for ovarian cancer references Japanese articles that state that fertility sparing surgery is an option for Stage 1A OCCC and that adjuvant chemotherapy is not necessary. Despite that, the NCCN continues to recommend the platinum based therapy which is not effective. I understand there is limited funding for the rare ovarian cancers (Gershenson, etc), but with its association with endometriosis perhaps funding would be available. I have tremendous confidence in the Mayo Clinic and their research. Thank you.

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Hi @odette, I sent your question to Dr. Gerardo Colon-Otero. Here is his response: I agree there is a need for more research on clear cell carcinomas of the ovaries. I saw 2 patients this week. Early detection will remain a challenge since there is early dissemination through the peritoneum.

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@gemma1960

When endometrial cancer metastasizes, are the mets always the same genetic makeup of the original tumor or is there a possibility of further mutations? In other words, if my original tumor has had genomic testing through an organization like Foundation One, how can I be sure that the mets that have spread to my lungs have the same abnormalities and, therefore, might benefit from an immunotherapy suggested by the genomic testing of the original tumor?

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Hey @gemma1960, your question was sent to Dr. Gerardo Colon-Otero. Here is his response: Recent data suggest marked tumor heterogeneity in many different tumors including ovarian cancer, renal cell clear cell carcinoma and lung cancers, which makes treatment decisions based on tumor genetic analysis difficult.

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@cmd03

My question… is high cholesterol and breast cancer.. I have been reading there can be some correlation..
Even with diet and exercise, some of us continue to have high cholesterol due to genetics.
How about statin use? Is there an alternative?, as a cholesterol lowering agent? that does not increase breast cancer risk?
Is metformin an option to target high cholesterol while not increasing breast cancer risk?

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Hey @cmd03, I sent your question to Dr. Dawn Mussallem. She had several deadlines she was up against and apologized for the delayed response. Here's what she said:
Great question! This is one that physicians and cancer researchers are interested in too. To date, the relationship between cholesterol and breast cancer risk has not been a consistent finding in high quality human studies. IN other words some research suggests high cholesterol may be protective when other studies suggest the opposite. This is because when known breast cancer risks such as postmenopausal obesity and diet are factored into the research it is really challenging to make a conclusion specific to cholesterol and breast cancer risk. The UK ACALM Big Data registry is the most recent, comprehensive well designed study on the topic. In this study of over 16,000 patients, those with hyperlipidemia were almost half as likely to develop breast cancer and in those that did there was a 40% reduction in mortality and improved long-term survival. Statins are suggested to be the possible link. Other studies have suggested similar benefit of statins however due to conflicting evidence to date it would be misleading to suggest that statins prevent or treat breast cancer. Bottom line: the importance of maintaining a healthy body weight, regular exercise and a low fat diet should be emphasized first and if one continues to have high cholesterol despite lifestyle change then statins should be considered when recommended by your physician.

It is important to know that natural products are not standardized and can cause harm. Just because something is natural doesn’t mean it is safe. So replacing a statin with something natural isn’t necessarily better for you.

Metformin has been used for over 50 years to improve blood sugar levels in patients with type 2 diabetes. It may also lower LDL-cholesterol levels and reduce the risk of cardiovascular disease and cancer. Research is ongoing.

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@susu2

I take a statin for high cholesterol and metformin for diabetes. I had a hystetectomy in 2016 which has now returned a very small dot in my abdomen now beginning a single carboflatin chemo-one dose yesterday with nausea med drips and no re2action except tired. I did have a couple of small breast lumps last year but had the m removed by lumpectomy of breast cancer dr. My question: does diabetes encourage cancer? I don’t know what to tackle first! I am 77.

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Hey @susu2, I sent your question to Dr. Dawn Mussallem. She was delayed in her response due to some pressing deadlines, but she just sent her response:
So your question, does diabetes cause cancer….

Type 2 diabetes either on its own and when combined with being either overweight or obese is associated with an increased risk for several cancers, including colon, gallbladder, pancreatic, liver, esophageal, postmenopausal breast, ovarian, endometrial, renal, bladder, and thyroid cancers, non-Hodgkins lymphoma and multiple myeloma. Lifestyle factors including dietary intake, physical activity, and body fatness appear to promote or inhibit cancer development.

Here are some healthy living suggestions:

–It is important to eat a low fat, sugar free diet rich in whole foods including an abundance of vegetables, non-sweet fruit especially berries, whole grains that are high in fiber, legumes, low fat dairy, and fish. Avoid anything white, this includes sugar, white flour, white potatoes, white rice, etc. Also avoid processed meat and try to reduce consumption of red meat too. Include healthy fats in your diet such as extra virgin olive oil, avocado and a small serving of nuts especially walnuts, almonds, and cashews. But if you are overweight/ obese, don’t eat too many nuts because these are high in calories.

–Be active. Move your body every single day!

–Practice relaxation/ deep breathing exercises, pray and/or meditate 10-20 minutes every day.

–Good sleep hygiene is important, aim for 7 hours sleep a night.

Lastly, you mention that you take a statin and metformin. Studies suggest both these medications have favorable benefits in patients with cancer!

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