Two new studies identify whether cancer patients will respond to chemotherapy

Two new studies might have identified whether or not patients will respond to chemotherapy.

boy receiving chemotherapy drugs
Mitchell Xayapraseuth receives chemotherapy at Providence Alaska Medical Center in Anchorage, Alaska in April 2012. (Marc Lester/Anchorage Daily News/MCT via Getty Images)
  • Using radiomics, two new studies identified whether patients would respond to chemotherapy or not.
  • This breakthrough occurred by investigating tissue around the tumor, instead of only looking at the tumor itself.
  • This could lead to the cessation of much suffering for patients that will not respond to chemo.

We can thank warfare for one of the most important medical discoveries of the 20th century. An article published in The NY Times in 1946 sums up a fascinating study on the usage of "nitrogen mustards"—mustard gas used by the Germans in Italy, which exposed over 1,000 people to the effects of the bombs—that led to trials conducted in New Haven on the potential of utilizing this chemistry in the treatment of Hodgkin's disease (among other cancers).

The word 'chemotherapy' was coined by German-Jewish physician Paul Ehrlich over a century ago. It initially referred to the usage of chemicals to treat any disease, including antibiotics. Ehrlich was a bit of a medical savant, helping create treatments for syphilis and trypanosomiasis. He called his discoveries "magic bullets," denoting the mortal specificity these drugs had on their biological targets. Beginning in 1904, he used a variety of arsenics, bromides, and alcohols to try to kill cancer cells.

In 1915, Ehrlich fell ill with tuberculosis. He was frustrated that his nation was using the chemicals he studied for healing in order to create weapons of war. Right before he died he looked out over plants operated by Bayer and Hoechst, which were creating what would become known as mustard gas, frustrated that his nation, on the eve of World War I, had gone so far astray.

While Ehrlich remained skeptical that a cocktail of lab-produced drugs could effectively combat cancer—his research resulted in weak or ineffective drugs—time proved to be his only problem. Trials conducted in America in 1942 showed efficacy in the treatment of lymphomas. From this research came mustine (chlormethine), first sold under the name Mustargen, to be employed in the treatment of prostate cancer.

Downsizing the fight with cancer | Efstathios Karathanasis | TEDxCWRU

Chemotherapy is a mixed bag—every cancer patient knows this. As with mustard gas bombs dropped over villages in hopes of rooting out enemies amid a civil population (and inevitable civilian casualties), chemo is often more of a guess than a specific application (though more targeted chemotherapies have been developed over the decades). Chemo doesn't only destroy cancerous cells, it also halts the division of normal cells, resulting in immunosuppression, inflammation of the digestive tract, and hair loss.

While not a perfect medicine, few—though perhaps too many, at least in the conspiratorial holistic corners of the internet—doubt chemo's efficacy, though they remain concerned about the side effects. When I went through testicular cancer five years ago, I was given three post-surgery options: one to two rounds of chemotherapy; radiation therapy (which can lead to a secondary cancer); or monitoring. I chose one round as prevention. There was nothing pleasant about it. Those who endure a dozen rounds for more aggressive cancers face a myriad of consequences from the suppression of their immune systems.

Yet the alternative is even less appealing. You can't beat cancer as it's an embedded part of us. Humans don't exist without cancer cells. As physician and oncologist Siddhartha Mukherjee writes in his biography of cancer, The Emperor of All Maladies, cancer cells are "more perfect versions of ourselves." To root them out entirely means to also destroy the cells necessary for making us human.

Every one of us lives with cancer cells. Whether or not the disease forms is dependent upon a host of factors, including genetics, diet, fitness level, exogenous factors (such as living near chemical plants or underneath flight pathways).

Regardless, having cancerous cells is a fate none of us escape. Mukherjee continues:

"The secret to battling cancer…is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth."

Dr. Siddhartha Mukherjee: Genetically Mapping the Future of Cancer

There's an art to the science of choosing the chemotherapy drugs included in a regimen; oncologists do not always choose correctly. This professional hurdle is slowly being overturned, thanks to research such as recent studies at Cape Western Reserve University that appear to have identified clues to whether or not a patient will respond to chemotherapy.

By scanning regions outside of the tumor observed on MRI and CAT scans, biomedical engineering professor Anant Madabhushi says that certain insights reveal whether lung and breast cancer patients will be benefited by chemotherapy.

One study sought a "signature," known as HER2-positive, that is included in 20 percent of all breast cancers. Through radiomics, which uncovers quantitative features invisible to the naked eye, researchers can discover HER2 by analyzing tissue around the tumor. Instead of undergoing a "one-size-fits-all" course of chemotherapy, patients with this signature could be better targeted—though the researchers state a definitive breakthrough is a few years away.

In a corresponding study using radiomics, lung cancer researchers are on the verge of an important discovery. As biomedical engineering doctoral researcher, Mohammadhadi Khorrami, states, only one in four lung cancer patients respond to chemotherapy, meaning that 75 percent will endure unnecessary consequences and considerable pain because research thus far has been limited to investigating the tumor itself.

Through these investigative techniques, Khorrami identified, with 77 percent accuracy, which patients would benefit from chemotherapy, a nine percent increase over just looking inside the tumor. Considering 228,000 Americans will be diagnosed with the disease this year, that's over 20,000 patients receiving better health care. As this particular regimen comes with a $30,000 price tag, a lot of financial and emotional strain can be saved through this new technique.

That we haven't figured out a specific cure to the range of cancers we face is not surprising, but the fact that we're gaining ground brings hope in the face of our species' greatest killers. Cancer might be an inherent part of us, yet if we can mitigate the pain and suffering it wreaks, such research will be worth it.


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A landslide is imminent and so is its tsunami

An open letter predicts that a massive wall of rock is about to plunge into Barry Arm Fjord in Alaska.

Image source: Christian Zimmerman/USGS/Big Think
Surprising Science
  • A remote area visited by tourists and cruises, and home to fishing villages, is about to be visited by a devastating tsunami.
  • A wall of rock exposed by a receding glacier is about crash into the waters below.
  • Glaciers hold such areas together — and when they're gone, bad stuff can be left behind.

The Barry Glacier gives its name to Alaska's Barry Arm Fjord, and a new open letter forecasts trouble ahead.

Thanks to global warming, the glacier has been retreating, so far removing two-thirds of its support for a steep mile-long slope, or scarp, containing perhaps 500 million cubic meters of material. (Think the Hoover Dam times several hundred.) The slope has been moving slowly since 1957, but scientists say it's become an avalanche waiting to happen, maybe within the next year, and likely within 20. When it does come crashing down into the fjord, it could set in motion a frightening tsunami overwhelming the fjord's normally peaceful waters .

"It could happen anytime, but the risk just goes way up as this glacier recedes," says hydrologist Anna Liljedahl of Woods Hole, one of the signatories to the letter.

The Barry Arm Fjord

Camping on the fjord's Black Sand Beach

Image source: Matt Zimmerman

The Barry Arm Fjord is a stretch of water between the Harriman Fjord and the Port Wills Fjord, located at the northwest corner of the well-known Prince William Sound. It's a beautiful area, home to a few hundred people supporting the local fishing industry, and it's also a popular destination for tourists — its Black Sand Beach is one of Alaska's most scenic — and cruise ships.

Not Alaska’s first watery rodeo, but likely the biggest

Image source:

There have been at least two similar events in the state's recent history, though not on such a massive scale. On July 9, 1958, an earthquake nearby caused 40 million cubic yards of rock to suddenly slide 2,000 feet down into Lituya Bay, producing a tsunami whose peak waves reportedly reached 1,720 feet in height. By the time the wall of water reached the mouth of the bay, it was still 75 feet high. At Taan Fjord in 2015, a landslide caused a tsunami that crested at 600 feet. Both of these events thankfully occurred in sparsely populated areas, so few fatalities occurred.

The Barry Arm event will be larger than either of these by far.

"This is an enormous slope — the mass that could fail weighs over a billion tonnes," said geologist Dave Petley, speaking to Earther. "The internal structure of that rock mass, which will determine whether it collapses, is very complex. At the moment we don't know enough about it to be able to forecast its future behavior."

Outside of Alaska, on the west coast of Greenland, a landslide-produced tsunami towered 300 feet high, obliterating a fishing village in its path.

What the letter predicts for Barry Arm Fjord

Moving slowly at first...

Image source:

"The effects would be especially severe near where the landslide enters the water at the head of Barry Arm. Additionally, areas of shallow water, or low-lying land near the shore, would be in danger even further from the source. A minor failure may not produce significant impacts beyond the inner parts of the fiord, while a complete failure could be destructive throughout Barry Arm, Harriman Fiord, and parts of Port Wells. Our initial results show complex impacts further from the landslide than Barry Arm, with over 30 foot waves in some distant bays, including Whittier."

The discovery of the impeding landslide began with an observation by the sister of geologist Hig Higman of Ground Truth, an organization in Seldovia, Alaska. Artist Valisa Higman was vacationing in the area and sent her brother some photos of worrying fractures she noticed in the slope, taken while she was on a boat cruising the fjord.

Higman confirmed his sister's hunch via available satellite imagery and, digging deeper, found that between 2009 and 2015 the slope had moved 600 feet downhill, leaving a prominent scar.

Ohio State's Chunli Dai unearthed a connection between the movement and the receding of the Barry Glacier. Comparison of the Barry Arm slope with other similar areas, combined with computer modeling of the possible resulting tsunamis, led to the publication of the group's letter.

While the full group of signatories from 14 organizations and institutions has only been working on the situation for a month, the implications were immediately clear. The signers include experts from Ohio State University, the University of Southern California, and the Anchorage and Fairbanks campuses of the University of Alaska.

Once informed of the open letter's contents, the Alaska's Department of Natural Resources immediately released a warning that "an increasingly likely landslide could generate a wave with devastating effects on fishermen and recreationalists."

How do you prepare for something like this?

Image source:

The obvious question is what can be done to prepare for the landslide and tsunami? For one thing, there's more to understand about the upcoming event, and the researchers lay out their plan in the letter:

"To inform and refine hazard mitigation efforts, we would like to pursue several lines of investigation: Detect changes in the slope that might forewarn of a landslide, better understand what could trigger a landslide, and refine tsunami model projections. By mapping the landslide and nearby terrain, both above and below sea level, we can more accurately determine the basic physical dimensions of the landslide. This can be paired with GPS and seismic measurements made over time to see how the slope responds to changes in the glacier and to events like rainstorms and earthquakes. Field and satellite data can support near-real time hazard monitoring, while computer models of landslide and tsunami scenarios can help identify specific places that are most at risk."

In the letter, the authors reached out to those living in and visiting the area, asking, "What specific questions are most important to you?" and "What could be done to reduce the danger to people who want to visit or work in Barry Arm?" They also invited locals to let them know about any changes, including even small rock-falls and landslides.

Harvard study finds perfect blend of fruits and vegetables to lower risk of death

Eating veggies is good for you. Now we can stop debating how much we should eat.

Credit: Pixabay
Surprising Science
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The common cuttlefish

Credit: Hans Hillewaert via Wikicommons
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  • Scientists recently ran the Stanford marshmallow experiment on cuttlefish and found they were pretty good at it.
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