Hot Hot Hot!

Washington, D.C. is in the middle of a heat wave. It was over 100 degF yesterday and today it is the same only the humidity is higher. My hair is poofy no matter what products I put into it in an attempt to keep it straight. Just a few seconds after I step out the door, I can feel the makeup sliding off of my face. Going outside, it feels like I'm underwater because as I move, I can feel the air being pushed away from me because it is so thick and humid. In short, it is miserable outside. Last night, after spending an hour swimming, I was making myself dinner and a bottle of merlot on the kitchen counter caught my eye. As much as I like a nice glass of red wine with dinner, it was just too hot and I needed something more refreshing. I began to wonder why on earth someone hasn't marketed and sold wine popsicles. So I emptied out an ice cube tray and decided to try it. I'm not sure of the alcohol content and how that correlates with the freezing temperature of a liquid. I do know that liquor, for example, freezes on dry ice but not in a regular kitchen freezer. When I go home today, hopefully I will have four ice cube-sized merlot popsicles to enjoy. If not, then I will need to get some dry ice :)

Recently, I’ve been trying to work my way through a sizable stack of magazines that have accumulated in my apartment. So while walking on the treadmill in the gym, I’ve been catching up on the fashion and beauty articles in Glamour, Elle, and Marie Claire. Mostly I like to look at the columns devoted to new beauty products and the pictorials telling me what heel height is “in” for the next season. One of my favorites is the splurge vs. steal section where one magazine throws up pics of trendy outfits including jewelry and shoes and tells you what was a splurge and what was a steal. I like to see if I have anything resembling these trends at home. I am a product of my generation. I really can’t explain the appeal to anyone that didn’t spend his or her teens hanging at the mall.

I’ve noticed lately that these magazines also attempt to highlight issues in women’s health beyond the regular articles featuring questions you are too embarrassed to ask your doctor. I was about 20 minutes into my walk when I turned the page and skimmed over a headline that caught my attention in the May 2010 issue of Marie Claire. Anne Wojcicki, one of the co-founders of 23andMe, a genetic testing firm was interviewed about her life as an entrepreneur in the biotech industry. I read through the article and my first thought was disappointment. I was so disappointed. I felt that the author should have focused on the controversy surrounding the impending sales of these test kits at retailers such as Walgreen’s. Instead, the focus was on Wojcicki—her hair color and clothing preferences, the way she and her husband live in a humble home considering their measurable wealth, and her background and ultimate success as a businesswoman. While I applaud the journal for highlighting her as an individual, they glossed over the controversy surrounding the release of this technology and presented a completely one-sided account. I suppose that given the magazine I found it in, I shouldn’t have expected riveting journalism.

I think that if I had not read an article earlier the same week announcing the sale of the kits, produced by a few companies including 23andMe, then I wouldn’t have been nearly so disappointed with the Marie Claire piece. I had no idea that such tests were in development let alone ready to be stocked in pharmacies. I think the principle is a good one—using a swab, you collect some saliva and send it off to the company for analysis and find out if you are at risk for heart disease, diabetes, some cancers, etc. Each company is a bit different, but using your DNA, they determine if you have genes for a host of diseases including ones that are not preventable, such as Alzheimer’s. You get a report from the company giving you the statistics and your risks for developing these conditions in the future based on your unique gene profile.

While I am a proponent of what is being called “personalized medicine,” I understand why these at-home gene test kits are currently a subject of debate with the FDA. First, I would like to note that you can easily undergo genetic testing by a licensed doctor and speak with a genetic counselor. I know this because I’ve had friends who are pregnant and it seems like all of them have gone in for tests because of a history of miscarriage or other reproductive issues. So tests like these are not novel. They have been around in the healthcare community for quite awhile. In Marie Claire, Wojcicki is quoted as saying, “the paternalism of the medical industry is insane. But scientific advances are changing all that." You have got to be kidding me! I personally think that her company and others like 23andMe are offering a service without proper support for their customers. The information that they are giving to people is potentially life altering and could also cause great emotional distress. If I found out that I had a gene that increased my risk for Alzheimer’s, for example, I would have to take that into account when I considered getting married and having a family. Furthermore, a small study by the Coriell Institute for Medical Research in New Jersey, gave 44 participants a genetic screen much like the ones the FDA is currently scrutinizing. Interviews with the study participants found that one-third had shared their results with a doctor. Of these, half received behavior or lifestyle recommendations from their doctors based on the test results, but a quarter of these patients said that their physicians “didn't know what to make of the information.” I think that the customers of these at-home kits may not completely understand the results because even clinicians aren’t 100% clear on the role that behavioral factors like diet have on many of the conditions these tests examine. Also, similar studies have shown that the participants didn’t make any significant changes in their lifestyles based on genetic test results that they hadn’t already begun to make.

The bottom line for me is that it is irresponsible to give a person this information without proper education and a medical support system that could help the individual make lifestyle changes. Wojcicki’s assertion that the medical community is attempting to somehow control patients by not supporting these gene-testing kits is absurd. I think that if these kits were offered and used under the direction of knowledgeable healthcare professionals equipped to help counsel the patient, the controversy would be hampered or not exist at all. For me the controversy is in giving this information to someone who won’t know what it means or what to do with it in order to try to prevent developing disease.

Reunion videos make me cry!

First, we had Christian the Lion. It was a video that went viral on youtube a while ago. I actually watched the documentary on Animal Planet. I have it saved on my DVR. The two men that raised Christian bought him at Herrod's Department Store in London sometime in the 70's and released him into the wild in Africa after they realized that London wasn't a good place to keep a full grown lion. Someone posted the reunion video with Aerosmith's song, "Don't Want to Miss a Thing," but I've also seen it with Whitney Houston's "I Will Always Love You" playing in the background. To see that grown lion bound toward his former owners and lick and paw at them makes me cry every time I see it.

Then today, I was introduced to Kwibi. Kwibi is a gorilla that was released into the wild at age 5. Five years later, his former owner went back to Gabon, West Africa to reunite with his dear friend. This video chronicling the reunion made me smile. What struck me was not only the fact that Kwibi responded to a call from Damian as he drifted in a boat down the river, but that he introduced Damian to his new family!

The fact two different potentially dangerous animals were able to recognize their past owners is amazing to me. To me, it clearly shows the bonds that we make with the animals in our care. I think it also demonstrates how intelligent these animals are as well.

My Work

The following is an author's commentary that I wrote in September 2009 for the website, www.MDlinx.com. It's a website for physicians and patients that is dedicated to provide users with the most recent, innovative published research on a variety of topics. I was asked to provide a brief commentary on my paper that was published in Cancer Immunology, Immunotherapeutics.

Commentary for “Concurrent vaccination with two distinct vaccine platforms targeting the same tumor antigen generates phenotypically and functionally distinct T-cell populations” by A. L. Boehm, et al. 2010. Cancer Immunol Immunother 59:397-408.

Combination therapy is not a new concept for the treatment of cancer. For years, oncologists have combined chemotherapeutic drugs, radiation, and most recently small molecule inhibitors to achieve maximum therapeutic efficacy. The first FDA-approved therapeutic cancer vaccine will be approved at the end of this year, while several other therapeutic cancer vaccines are in the late stages of development. It is foreseeable that the combination therapy trend will continue and as is the case with currently FDA-approved anti-cancer therapies, therapeutic cancer vaccines will be combined to target a single tumor-associated antigen. Our study is the first to show that two vaccine platforms targeting the same antigen can be concurrently administered due to their induction of distinct T-cell populations. Furthermore, our data show that this combination of therapeutic vaccines results in significantly increased antitumor effects in vivo, setting the stage for future studies employing combination therapy for cancer with two vaccines targeting the same tumor-associated antigen.

I would like to note that since this paper was published, the first therapeutic vaccine for cancer, Provenge, has been approved by the FDA. My work demonstrates that two vaccines can be administered at the same time without deleterious effects on the immune system. Given that Provenge may quickly become the standard of care therapy for prostate cancer, in the future, it will be important for researchers to study the combined effects of provenge with other vaccines to improve survival. My work provides evidence that this may be possible through the development of a more diverse T-cell population to target the cancer cells.

A long wait...

Sometime this week, the first therapeutic vaccine for cancer is going to be approved by the FDA to treat prostate cancer. The vaccine, Sipuleucel-T, is being marketed by Dendreon as Provenge. The company has shown that the vaccine extends the lives of advanced prostate cancer patients by an average of 4.5 months. Some of the participants in the trial lived for an additional 2-3 years. The side effects observed in the clinical trials were limited to mild flu-like symptoms—a key advantage to Provenge over conventional therapies.

It is being reported that the vaccine will cost approximately $75,000 per patient. When I first read this, sadly, I wasn’t shocked. I had just read an article in the Washington Post by Sandra G. Boodman that told the story of three different cancer patients who had to decide between dying of their cancer or putting their families into debt to pay for their cancer medications. One patient’s insurance company refused to pay for an oral chemotherapeutic medication ($4000 per month) when the i.v. version was cheaper. The patient had surgery to implant a port into her chest for the i.v. When the port sprang a leak, she was rushed to the ER. She bitterly remarks that if the insurance company had paid for the pill version of the drug, it would have been less expensive than the surgery and ER visit, and she is probably correct. This article went on to talk about another man with a form of leukemia that filled a prescription for the drug Gleevec at his pharmacy. The total charge was $10,000 for a 30-day supply. In her article, Boodman uses these stories to frame her report on the greed of pharmaceutical companies and the lack of federal guidelines and legislature that addresses these very real financial issues that are literally forcing people to choose between dying or diving into deep financial ruin in order to live. Of course, the companies cite that the development of these drugs cost billions and years to gain FDA approval. They legitimately have a lot invested and do deserve to profit off of these drugs. I have hard time reconciling the needs of the patient and the rights of the companies. I know that it can take about 10 years and about $1 billion for a drug to be developed, tested, approved, and marketed. It is a significant investment on the part of the company, which includes not only the individuals on the business end, but also scientists and doctors who literally devote their entire careers. The companies like to site that they have programs to cover the costs for patients who can’t afford their treatment. While this is an outstanding service that they provide to their community, many patients will never know about this option or live long enough to maneuver their way through the paperwork.

While Gleevec and other drug therapies simply require the patient to take a pill, Provenge is unique. It is not a pill. Actually, it isn’t a drug at all. Patients undergo leukapheresis, a procedure in which blood is collected and the white blood cells are separated out. These white blood cells include antigen-presenting cells (APCs). APCs are immune cells responsible for the recognition, processing and presentation of foreign antigens to the T-cells. The APCs are sent to a Dendreon facility, where they are kept alive in culture and exposed to a recombinant fusion protein that contains prostatic acid phosphatase (PAP). PAP is an enzyme produced by the prostate and found at elevated levels in the blood of prostate cancer patients, much like prostate-specific antigen (PSA), because the cancer cells produce it and it sheds from the cell surface into the blood stream. Cancer cells have multiple mechanisms by which they can avoid detection by T-cells. The APCs process and present PAP on their surface. Two days after the initial blood draw, the patient returns to the hospital/doctor’s office and the APCs are infused back into their body through an i.v. They undergo this process three times over the course of a four-week period and then the treatment is complete. The PAP-presenting APCs interact with other types of immune cells in the body. Essentially, the APCs are “telling” your T-cells that the PAP protein is “bad” so that they target and kill any cells in the body that express this protein on their surface. The result is that your own immune system is manipulated and used to kill your cancer. It is unlike any other FDA-approved cancer therapy. Every man diagnosed with prostate cancer will undergo this treatment, just as chemotherapy and hormone therapy are the standard today. For these men, the key will be how they pay for it.

From this point on, labs will be writing clinical trials for prostate cancer that will combine their drug with Provenge, as it will eventually become the standard of care for metastatichormone-refractory prostate cancer. This will undoubtedly be a complex undertaking as the workings of the immune system are intricate and easily influenced. It is well established that some chemotherapy drugs are immunosuppressive. It is reasonable to question if other drugs will effect the immune system’s ability to respond to Provenge or some other therapeutic vaccine. This is a question that I ask everyday in my own studies. Clearly, this is a truly exciting development that will benefit patients. However, the FDA approval of the first therapeutic vaccine for prostate cancer is also a significant event for the field of cancer biology. It is going to create an unbreakable bridge between the fields of immunology and cancer biology and will hopefully encourage the development and approval of future innovative immunotherapeutic approaches to treat cancer, leading to treatment options for patients with fewer side effects and better outcomes.

Knitting Rut

I am a knitting machine. I have made countless numbers of socks, hats, mitts, and even some sweaters. Most of my knitting is given as gifts throughout the year, but especially at Christmas. I start a project and I become obsessed with finishing it. Because of this, I typically have only two or three projects going at one time, just to break up the monotony. I have found that knitting gave me something interesting to do when I am watching TV. Or I’ll pull it out when my mind is overloaded with all the things that are going on in my life—it feels good to have something else to focus on. But the past month, I have had no interest in knitting. I have three projects that are just sitting in their bags by my couch. I don’t know what is going on with me! It’s not that I don’t like the socks, shawl and tank. I love the yarn I’m using for each, so that isn’t contributing to this knitting block either. Maybe it’s the weather? All I do know is that this is a huge problem. I have several friends expecting babies this fall and I have to start on these projects soon. I have got to get my knitting mojo back!

There are so many things that I love about spring. Tulips! I have always loved tulips! When I was a kid, I would inspect the progress of the tulips in the front yard on a daily basis. When they were emerging from the ground, I would speculate on what colors we would get. I love all of the colors. I think a big vase full of multi-colored tulips is perfection. In college, I lived on the tiny campus of Washington and Jefferson College in Washington, PA. In 1998, when I began my freshman year, the campus was little more than a 6 square block area. I would walk to my 8am biology and chemistry classes and find the best tulips that week. Then under the cloak of darkness, I would take a study break around 10 or 11pm, grab a pair of scissors, and go cut down the tulips I had pre-screened earlier that day. I’m sure that the grounds people were wondering what was happening to all of their tulips. They would last a week or so, and in the meantime, I would keep an eye out for the next flowerbed that was in bloom. I have no regrets that I was a tulip-bandit. I think that having those flowers on my desk while I was studying was a comfort. It reminded me of a time when I didn’t place my self worth on a grade from a biology exam. And it made me smile.

I think that spring holds the potential for provoking a lot of smiles. It’s said that spring is a time of rebirth. After the cold dark winter, spring comes along and everything is made new again. Flowers bloom, trees are leafy green, and the birds are chirping first thing in the morning. The beautiful weather in D.C. is enough to make me smile. It’s been absolutely gorgeous the past few weeks. Other things that make me smile this time of year: squirrels (I just think they are cute), little kids in sunglasses, and local farmers’ markets. Also, Cadbury Eggs. Love love love Cadbury Eggs. I hope that everyone else can take a minute or two and find something to smile about. Happy spring!