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Interview with Dr. Vincent Devita, Jr. "Death of Cancer" on NPR's Fresh Air

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#1 hannibellemo


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Posted 28 October 2015 - 12:00 PM

I had the opportunity to listen to this interview while I was avoiding a very boring workshop at a conference I am attending. Dr. Devita made mention of a comment that Dr. Druker made and we have referred to several times on this board. That is that for most of us with CML we have a very great chance of living a normal life span. He went on to say, and I'm paraphrasing, "that is of course as long as new drugs are being developed to move on to when resistance to the current drug develops."

Several years ago I think Trey mentioned when addressing the same statement by Dr. Druker, that he was referring to the use of all three (at the time) TKIs. I'm sure you will correct me if my memory is incorrect, Trey.

I also believe that someone has recently posted about becoming resistant to Sprycel after several years? Is this something we all have to look forward to? Am I misinterpreting these statements?

If you are interested, Dr. DeVita's book will be released on Nov. 3.



"You can't change the direction of the wind but you can adjust your sails."

DX 12/08; Gleevec 400mg; liver toxicity; Sprycel 100mg.; CCyR 4/10; MMR 8/10; Pleural Effusion 2/12; Sprycel 50mg. Maintaining MMR; 2/15 PCRU; 8/16 drifting in and out of undetected like a wave meeting the shore. Retired 12/23/2016! 18 months of PCRU, most recent at Mayo on 7/25/17 was negative at their new sensitivity reporting of 0.003.<p>

#2 Trey


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Posted 28 October 2015 - 12:55 PM

The Borg said: "Resistance is futile". 




We have come to see that the seeds of resistance are in the Philadelphia Chromosome's BCR-ABL from the beginning.  If it does not materialize during the first two years, it will likely never occur, although we cannot quite say never due to random events.  This is why I have often repeated that if a CML patient gets through the first two years of TKI therapy and is doing well, then that person will likely have a normal lifespan.


In my view the "death of cancer" is not just one thing.  It is one thing at a time, repeated thousands of times.  Cancer is not a single entity.  It is thousands of separate entities and must be attacked individually or at best in small groups.


The "Death of Cancer" is hyperbole, as one might expect.  If a person lives long enough, they will inevitably get cancer.  Telomere shortening.  (Billie: still NOT used for baking).  If the telomeres get short enough, as they do with age, the cells will inevitably mutate.  So saying "death of cancer" is also saying "The End of Ageing". 


Edited by Trey, 28 October 2015 - 01:03 PM.

#3 kat73


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Posted 28 October 2015 - 01:51 PM

Pat - I, too, have been disturbed by the recent stories here about being PCRU for many years and becoming suddenly detectable, all the while on full treatment.  Just the other day I posed a version of your question to my onc and he said he had some transplant patients who have become detectable again after 20 years, and some patients who had been on interferon, ditto.  (Rescued very well by current TKI's BTW, but still, not happy dance news.)  What gives? I asked.  "It's why we can't ever say, 'cured'" he answered.  "We can't ever be sure it's gone."  Period.  I asked about the 40% successful cessation trial patients - some perhaps really cured - is there any thinking as to how that was accomplished, if so?  Nope, he said.  "We. do. not. know."  Maybe the immune system keeps it tamped down, best guess.  So, as always with CML, a rethink on my part is required.  AGAIN.  How to wrap my mind around the thought that this (swear words) thing is never, ever going to leave my body for the rest of my life?  And to realize that probably the attack on this cancer is going to always be focused on finding new drug treatments (new TKI's) and not on fixing the great-great-great grandmother matriarchal monarch supreme of them all stem cell.  Does it really matter whether these late recurrences come about because of "resistance"? (whether you use the term literally - like antibiotics and bacteria - or metaphorically: something - who knows what - changes and the TKI you've been successful on doesn't work anymore).  Does it matter?  The game is a race, that's all.  A race to the finish line before you run out of drugs to try.  Somehow, I find this profoundly depressing.  But, I will ponder it and rally, probably.  After all, bottom line is, we have no choice.  We've got it, it's got us, we must get along, keep it in its place, and move forward.

Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.

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