31 december 2016: Bronnen: clinical trials, NPO, NKI

Vandaag in het NPO nieuws minister Schippers die meedeelt dat een experimentele therapie voor borstkanker met zogeheten BRCA-like status voorlopig vergoed gaat worden uit de basisverzekering. Hier wat meer infomatie over deze vorm van behandelen en de studie waar het omgaat. Volgens dr. Sabine Linn stijgt met deze aanpak de 10-jaarsoverleving naar 70% tot 80%, aangetoond in drie onafhankelijk van elkaar uitgevoerde fase II studies. 

31 december 2016: Vooraf mijn commentaar: is dit een verkapte regeringssteun aan de farmacie? Is dit handjeklap met de zeiktekostenverkeraars en oneigenlijk gebruik maken van haar positie wat Minister Schippers doet? Want betalen voor een placebo gecontroleerde studie betekent dat niet iedere patient uit deze studie hiervan profiteert. En in geval van vergoedingen vanuit de basisverzekering, die toch voor alle borstkankerpatienten met die specifieke mutatie zou moeten gelden al helemaal niet want alleen de patienten die meedoen aan de studie krijgen dit vergoed. Alle andere borstkankerpatienten met BRCA-like mutatie dus niet. Ik heb hier grote vraagtekens bij. Want gaat ten koste van de premies voor de ziektekostenverzekeringen m.i.. Maar voor betrokken patienten is het natuurlijk wel goed nieuws.

Als eerste zoals dit bericht wordt gemeld op de website van het NKI waar deze studie wordt uitgevoerd:

Experimentele behandeling erfelijke borstkanker in basispakket

29dec 2016

20161229 Borstkanker

De NOS berichtte vandaag, donderdag 29 december, dat een experimentele behandeling bij erfelijke borstkanker en hieraan verwante borstkanker in het basispakket komt van de zorgverzekering. Het is een behandeling voor vrouwen met BRCA1-like, stadium III borstkanker. Vrouwen die in aanmerking komen krijgen een hoge dosis chemotherapie en stamceltransplantatie.

Vanaf komende zondag zit deze behandeling in het basispakket, heeft minister Schippers besloten. Omdat het een experimentele behandeling is, wordt die voorwaardelijk tot het basispakket toegelaten. 'De kans is groot dat deze experimentele behandeling uiteindelijk voorgoed tot het basispakket wordt toegelaten omdat verschillende terugkijkende studies een positief resultaat laten zien: van de patiënten die een standaard behandeling krijgen is 30 tot 40% van de patiënten ziektevrij na 10 jaar. Van de patiënten die deze experimentele behandeling hebben ondergaan is dat 78%', aldus prof. dr. Sabine Linn, internist-oncoloog in het Antoni van Leeuwenhoek. Lees verder het hele artikel>>>>>>>>>>

In het NPO journaal (29 december 2016 om 18.00 uur en 20.00 uur) wordt dr. Sabine Linn geïnterviewd en het valt mij op hoe ongelukkig zij zich voelt dat deze studie een placebo gecopntroleerde studie is. Zij weet heel goed dat de helft van de deelnemende patienten dus niet deze experimentele behandeling krijgen, terwijl ze daarmee dus de kans op overall overleven zouden kunnen verdubbelen van 30% tot 40% naar 70 tot 80%. Dit zou toch anders moeten kunnen zie je haar bijna hardop denken.

Hier vindt u het studieprotocol van deze studie: 

Substantially improving the cure rate of high-risk BRCA1-like breast cancer patients with personalized therapy

Uw behandelend arts kan hier informatie vragen en eventueel aanmelden:

B.5.1

Name of organisation NKI-AVL
B.5.2 Functional name of contact point Study Coordinator
B.5.3 Address:
B.5.3.1 Street Address Plesmanlaan 121
B.5.3.2 Town/ city Amsterdam
B.5.3.3 Post code 1066CX
B.5.3.4 Country Netherlands
B.5.6 E-mail s.vliek@nki.nl

Tekst gaat verder onder dit beeld:

BRCA-like
Bron foto: Cytotoxic and targeted therapy for hereditary cancers

Een interessant studierapport in dit verband is dit volledige studierapport: 

Cytotoxic and targeted therapy for hereditary cancers

gratis in te zien met interessante referentielijst, zie onderaan dit artikel:

Aan dit artikel is vele uren gewerkt. Opzoeken, vertalen, op de website plaatsen enz. Als u ons wilt ondersteunen dan kan dat via een al of niet anonieme donatie. Elk bedrag is welkom hoe klein ook. Klik hier als u ons wilt helpen kanker-actueel online te houden Wij zijn een ANBI organisatie en dus is uw donatie in principe aftrekbaar voor de belasting

Borstkanker stamcel onderzoek

Interessant over deze vorm van behandelen met stamcellen staat op deze Amerikaanse website met enkele video's waarin uitgelegd wordt hoe gewerkt wordt met stamcellen bij borstkanker en ook waarom deze zo goed werken: 

Breast Cancer Stem Cell Research

Breast cancer stem cells were discovered in 2003 by scientists at the U-M Comprehensive Cancer Center

In the fight against breast cancer, there is good news and bad news. The good news is that, since 1990, there has been a steady decline in the death rate from breast cancer. Earlier detection and better treatments are bringing hope to people with both early and advanced disease.

The bad news is that more than 40,000 people die from breast cancer every year in the United States alone. It is still the second-leading cause of deaths from cancer in women. The survival rate for those with advanced, metastatic breast cancer has not changed significantly for decades. In spite of more effective therapies, many patients still experience recurrences of breast cancer after treatment. Read more and watch the video's>>>>>>>>>>

Cytotoxic and targeted therapy for hereditary cancers

Hered Cancer Clin Pract. 2016; 14(1): 17.
Published online 2016 Aug 23. doi:  10.1186/s13053-016-0057-2
PMCID: PMC4994296

Cytotoxic and targeted therapy for hereditary cancers

Abstract

There is a number of drugs demonstrating specific activity towards hereditary cancers. For example, tumors in BRCA1/2 mutation carriers usually arise via somatic inactivation of the remaining BRCA allele, which makes them particularly sensitive to platinum-based drugs, PARP inhibitors (PARPi), mitomycin C, liposomal doxorubicin, etc. There are several molecular assays for BRCA-ness, which permit to reveal BRCA-like phenocopies among sporadic tumors and thus extend clinical indications for the use of BRCA-specific therapies. Retrospective data on high-dose chemotherapy deserve consideration given some unexpected instances of cure from metastatic disease among BRCA1/2-mutated patients. Hereditary non-polyposis colorectal cancer (HNPCC) is characterized by high-level microsatellite instability (MSI-H), increased antigenicity and elevated expression of immunosuppressive molecules. Recent clinical trial demonstrated tumor responses in HNPCC patients treated by the immune checkpoint inhibitor pembrolizumab. There are successful clinical trials on the use of novel targeted agents for the treatment or rare cancer syndromes, e.g. RET inhibitors for hereditary medullary thyroid cancer, mTOR inhibitors for tumors arising in patients with tuberous sclerosis (TSC), and SMO inhibitors for basal-cell nevus syndrome. Germ-line mutation tests will be increasingly used in the future for the choice of the optimal therapy, therefore turnaround time for these laboratory procedures needs to be significantly reduced to ensure proper treatment planning.

Conclusions and perspectives

The number of known hereditary cancer syndromes will rapidly grow within next several years, thanks to the invention of whole exome sequencing [131]. Many of already identified hereditary cancer types are represented by exceptionally rare instances of the disease, and future investigations are likely to reveal even more uncommon cancer syndromes. In addition, unlike many other medical conditions, genetic diseases are often population-specific, i.e. their spread is limited by a few ethnic groups. It is unrealistic to expect that each hereditary cancer type will be subjected to systematic laboratory investigations and comprehensive clinical trials. There are some approaches which may facilitate search for novel treatment strategies for orphan and/or hereditary cancer types. For instance, collection and analysis of biological material from these patients deserve to be encouraged. In addition, some ex vivo testing for tumor drug sensitivity may turn out to be particularly practical in this clinical setting [156]. There are also some bioinformatic tools pretending to predict drug sensitivity of the tumor based on its molecular characteristics [157]. Finally, several potentially practice-changing investigations in this field became possible due to availability of large clinical databases [16, 27, 120]. Well-designed retrospective studies may help to significantly improve the use of existing cancer therapies.

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