Living without Hope - Not an Option

by Flora Krasnoshtein

 

It was unthinkable and devastating when in 2009 at a young age of 23, Andrew was diagnosed with cancer, and all his life’s plans come to an abrupt halt. No longer able to think about university, career, social life, travelling, and other things 23-year olds think about, Andrew’s focus shifted from planning his life to fighting for his life, and he became a patient at the Princess Margaret Hospital in Toronto, Ontario, Canada.

After 2 successful surgeries, Andrew was in remission for 2.5 years. But this joy did not last, because in May 2012, at the age of 26, Andrew’s cancer returned. The worst part was that this new cancer was different from the first one – it was rare, more aggressive and difficult to treat. This cancer is called primitive neuroectodermal tumour or PNET for short, which affects only about 3 to 6% of people.

Andrew started chemo, and was treated from May–July 2012, but unfortunately, the treatment did not shrink his cancer enough to operate. Doctors decided to try another chemo, hoping that stronger drugs will be able to kill the cancer. After being on the new chemo from October 2012–January 2013, doctors decided to stop the treatment because this chemo did not work either. Andrew is now receiving another chemo treatment, and is hopeful that this time the tumours will shrink. This toxic and emotional rollercoaster ride has not weakened Andrew’s resolve. He is hopeful that this time the chemo will work in eradicating his tumours, and he can once again resume his life where it came to an abrupt halt when he was 23. For Andrew, living without hope is simply not an option!

 

Ways to Donate to Andrew’s Health Fund:

You can make a contribution at any CIBC branch in either Canadian or US funds to Andrew’s Trust Account.

To donate in Canadian funds, please make cheques payable to: 00122/59 – 12091 (Andrew Avetikov)

To donate in US funds, please make cheques payable to: 00122/94 – 72037 (Andrew Avetikov)

The cheques can be sent to:   CIBC Investor Services Inc. 302 ─ 7501 Keele Street. Concord ON, CANADA   L4K 1Y2

To make a contribution via PayPal, please visit Help Support Andrew Avetikov Health Fund website and click on Donate button.

Please visit Andrew Avetikov’s Health Fund page on Facebook

All unused funds will be donated to the Princess Margaret Hospital in Toronto and the Canadian Cancer Society.

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Andrew Avetikov is a 26-year old, living in Thornhill, Ontario, Canada. An avid basketball fan, Andrew does not miss an opportunity to cheer for his favourite basketball team, The Toronto Raptors, and his favourite player, Lebron James! A wiz with electronic devices, Andrew is always ahead of the game in the world of technology. Born in Toronto, Canada in 1986, Andrew attended Montessori School, Kumon, Toronto French School, University of Western Ontario and York University. Hobbies abound, Andrew is an accomplished swimmer and skater, played hockey and tennis, and even figure skated. Andrew is fluent in multiple languages including English, French, and Russian. Always surrounded by friends, Andrew is popular and loved by everyone. Sidelined by cancer from the age of 23, Andrew’s life now revolves around cancer treatments, chemo appointments, CT scans, and blood tests.  Andrew is battling a rare, treatment-resistant form of cancer called primitive neuroectodermal tumour (PNET), and is currently on his third chemo regimen at the Princess Margaret Hospital in Toronto. 

 

Help Support Andrew's Health Fund

 

 

CANCER. It touches all our lives ― either directly or indirectly. My cousin Andrew is battling cancer, and we need help to raise funds for his cancer treatments not available in Canada. Please read and share his story. While there is no expectation for you to donate, if you are able to give any amount you feel appropriate to Andrew’s Health Fund, we will greatly appreciate it.

Web Page  http://www.oncleanicepro.com/andrew/andrew.html

Facebook
https://www.facebook.com/pages/Andrew-Avetikovs-Health-Fund/487664297941785

Pennies in Action 2012

The Search For The Cure

Avastin: Advisory panel recommends FDA to remove advanced breast cancer indication

GAITHERSBURG, Md. – In a vote of 12 to 1 a recommendation has been issued by the Oncologic Drugs Advisory Committee advisory panel that the FDA remove the advanced breast cancer indication from Avastin (bevacizumab), after two large clinical trials failed to demonstrate a clinically significant benefit of the drug, which is associated with serious side effects. When used in combination with standard chemotherapy, Avastin did not extend progression-free survival (PFS) long enough to be clinically significant in HER2-negative, metastatic breast cancer.


In 2008, the FDA granted special, fast-track approval to Genentech, manufacturer of Avastin, to begin marketing the drug for patients with metastatic breast cancer in combination with the chemotherapy agent paclitaxel. This "accelerated" approval was based on positive early findings from a large Genentech-sponsored clinical trial that found Avastin added 5.5 months PFS vs. paclitaxel alone. However, the data from two new clinical trials (AVADO, RIBBON-1) of almost 2,000 breast cancer patients that Genentech submitted to move from accelerated approval to standard approval failed to demonstrate the PFS to the extent seen in the earlier study.* The PFS in the two trials ranged from a little less than a month, to just under three months. The results failed to demonstrate that the benefits of using Avastin outweigh the potential risks, which include a small risk of death, bleeding, febrile neutropenia and hypertension.

"Survival trumps everything, and we haven't shown a survival benefit here"

- Ronald Richardson, MD, a medical oncologist at the Mayo Clinic

Genentech argued that even small gains in progression-free survival are clinically meaningful and that additional weeks where tumors don't worsen translate to improved quality of life.

The FDA usually follows the advice of its advisory committee, and if they do this time, Avastin would still be approved to treat lung, kidney, and colon cancer. Avastin is also used treat recurrent glioblastoma under accelerated approval. The FDA will make a decision by September 17, 2010.

*For details of the studies see Avastin did not improve progression-free survival in patients with breast cancer. Available at http://medwritehealthcarecommunications.blogspot.com/2010/07/avastin-did-not-improve-progression.html. Posted July 19, 2010.

Source
FDA Panel Nixes Bevacizumab for Breast Cancer. By Emily P. Walker, Washington Correspondent, MedPage Today Published: July 20, 2010. Available at http://www.medpagetoday.com/HematologyOncology/BreastCancer/21276?utm_content=Group_&utm_medium=email&impressionId=&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid= Accessed July 21, 2010.

Avastin did not improve progression-free survival in patients with breast cancer

Two new studies demonstrated that Avastin (bevacizumab), in combination with chemotherapy did not extend progression free survival (PFS) in patients with advanced breast cancer to the same levels observed in a previous trial used to garner approval of the drug in this indication in 2008. The FDA approved Avastin for treatment of breast cancer was based on results from the E2100 clinical trial, which demonstrated that Avastin in combination with paclitaxel slowed the spread of breast cancer and extended PFS by 5.5 months vs. paclitaxel alone.[1-2]


Data from two post-approval trials told a different story. A first, the AVADO clinical trial involving 736 patients with locally recurrent or metastatic HER2-negative breast cancer who had not previously received chemotherapy for their disease showed that a high dose of Avastin used in combination with docetaxel extended PFS by 0.9 months vs. docetaxel alone. Patients receiving a lower dose of Avastin had PFS extended by 0.8 months.[3]

A second post-approval trial, RIBBON-1 study involving 1237 women with locally recurrent or metastatic HER-2 negative breast cancer who had not received prior treatment for the disease demonstrated that Avastin in combination with taxane or anthracycline-based chemotherapies extended PFS by 1.2 months vs. chemotherapy alone. Patients receiving Avastin in combination with Xeloda (capecitabine) lived 2.9 months longer than patients receiving chemotherapy alone.[4]

Currently, Avastin is indicated for the use in: (1) first-line treatment of a subgroup of women with metastatic breast cancer known as HER2-negative breast cancer, in combination with the chemotherapy drug docetaxel; and (2) first-line treatment of HER2-negative metastatic breast cancer in combination with one of two classes of chemotherapy drugs, known as taxanes and anthracyclines, or with the chemotherapy drug, capecitabine. FDA approval is pending of additional indication for the treatment, in combination with the chemotherapy drug paclitaxel, of patients who have not received chemotherapy for their locally recurrent or metastatic HER2 negative breast cancer. The FDA may ultimately decide to withdraw its approval for Avastin based on results from the post-approval trials.

References:
1. FDA staff release review of Roche's Avastin in breast cancer. First Word. Light Edition. July 16, 2010. Available at http://www.firstwordplus.com/Fws.do?articleid=F731F4EE99584F0FB11A106C99246301 Accessed July 19, 2010.
2. July 20, 2010: Oncologic Drugs Advisory Committee Meeting Announcement. FDA U.S. Food and Drug Administration. Available at http://www.fda.gov/AdvisoryCommittees/Calendar/ucm213724.htm Accessed July 19, 2010.
3. Miles D, Chan A, G. Romieu G, et al. Randomized, double-blind, placebo-controlled, phase III study of bevacizumab with docetaxel or docetaxel with placebo as first-line therapy for patients with locally recurrent or metastatic breast cancer (mBC): AVADO. J Clin Oncol 26: 2008 (May 20 suppl; abstr LBA1011). Available at http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=34482 Accessed July 19, 2010.
4. Robert NJ, Dieras V, J. Glaspy J, et al. RIBBON-1: Randomized, double-blind, placebo-controlled, phase III trial of chemotherapy with or without bevacizumab (B) for first-line treatment of HER2-negative locally recurrent or metastatic breast cancer (MBC). J Clin Oncol 27:15s, 2009 (suppl; abstr 1005). Available at http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=65&abstractID=34532 Accessed July 19, 2010.

Blood pressure drugs, angiotensin-receptor blockers, and risk of cancer: meta-analysis of randomized controlled trials

A recent study by Sipahi et al. published in The Lancet Oncology suggests that angiotensin-receptor blockers (ARBs) may be associated with a "modestly" increased risk of cancer. However, conclusions about the exact risk of cancer associated with each particular drug were not possible to draw due to study limitations.

ARBs are a widely used drug class approved for treatment of hypertension, heart failure, diabetic nephropathy, and, recently, for cardiovascular risk reduction. Experimental studies implicate the renin-angiotensin system, particularly angiotensin II type-1 and type-2 receptors, in the regulation of cell proliferation, angiogenesis, and tumour progression.

This study assessed whether ARBs affect cancer occurrence with a meta-analysis of randomized controlled trials of these drugs by searching Medline, Scopus (including Embase), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the US Food and Drug Administration website for studies published before November, 2009, that included any of the seven currently available ARBs.* Randomized controlled trials with an ARB given in at least one group, with a follow-up of at least 1 year, and that enrolled at least 100 patients were included. The following information was available:

• New-cancer data for 61, 590 patients from five trials
• Data on common types of solid organ cancers for 68, 402 patients from five trials
• Data on cancer deaths for 93, 515 patients from eight trials.

Telmisartan was the study drug in 30, 014 (85.7%) patients who received ARBs as part of the trials with new cancer data. Patients randomly assigned to receive ARBs had a significantly increased risk of new cancer occurrence compared with patients in control groups (7.2% vs 6.0%, risk ratio [RR] 1.08, 95% CI 1.01—1.15; p=0.016). When analysis was limited to trials where cancer was a prespecified endpoint, the RR was 1.11 (95% CI 1.04—1.18, p=0.001). Among specific solid organ cancers examined, only new lung cancer occurrence was significantly higher in patients randomly assigned to receive ARBs than in those assigned to receive control (0.9% vs 0.7%, RR 1.25, 1.05—1.49; p=0.01). No statistically significant difference in cancer deaths was observed (1.8% vs 1.6%, RR 1.07, 0.97—1.18; p=0.183).

This meta-analysis of randomized controlled trials suggested that ARBs were associated with a modestly increased risk of new cancer diagnosis. The researchers concluded that due to the limited data, it was not possible to draw conclusions about the exact risk of cancer associated with each particular drug, and these findings warranted further investigation.

*Drugs in this class include:

• Atacand (candesartan) (AstraZeneca)
• Avapro (irbesartan) (sanofi-aventis and Bristol Myers Squibb)
• Benicar (omesartan) (Daiichi Sankyo) 
• Cozaar (losartan) (Merck & Co.)
• Diovan (valsartan) (Novartis)
• Mycardis (telmisartan) (Boehringer Ingelheim and Astellas)
• Teveten (eprosartan) (Solvay)
  

Reference
Sipahi I, Debanne SM, Rowland DY, et al. Blood pressure drugs, angiotensin-receptor blockers and risk of cancer: meta-analysis of randomized controlled trials. Lancet Oncol, Early Online Publication, 14 June 2010, doi:10.1016/S1470-2045(10)70106-6 .