Michael Benjamin, MD, Inc

OMG Alecensa (alectinib) wasn't just a little better than Xalkori (crizotinib) for advanced ALK-positive lung cancer. Hopefully FDA expands indication soon for first line! NEJM article today: http://www.nejm.org/doi/full/10.1056/NEJMoa1704795 We hardly ever get these Coke vs. Pepsi studies in oncology, and when we do, they aren't blockbuster results like this one. Right now Alecansa is only FDA approved for after a failure of Xalkori. Unlike Alecensa, Zykadia (ceritinib)... is approved in the front line setting but wasn't studied in this paper. Zykadia shows a longer response duration, almost two years vs. Xalkori's one year though these are apples-to-oranges comparisons. We may never see that head-to-head study. Alecansa had a median progression free survival (PFS) that wasn't reached in the publication. This means the 68% of patients who made it out to a year without a relapse may have achieved long term remission. I think that's the first time I've ever been able to say that about lung cancer. We had similar news for the PDL1 therapies in melanoma and now it appears we can tell a similar story in some lung cancers. The even better news is that Alecansa prevented CNS (brain) metastases way better. While ALK-positive lung cancers are not common, I do a profile on every new lung cancer patient to identify these. My current panel includes ALK, ROS1, PDL1, and EGFR. Positive findings in any of these markers can be life-altering in advanced lung cancer. See more

Exciting results from ASCO 2017: Abiraterone (Zytiga) delays progression of advanced prostate cancer by over 1 year when added to conventional hormonal therapy. Chemo had been found to work in this setting also, so it's great we now have proof that a pill works at least as well.

Today came the ongoing question: has there been a study on giving Xarelto for Hughes' Syndrome? Traditionally we treat these patients who have a benign propensity for blood clots, with warfarin, an older blood thinner. While there have been a ton of studies comparing the newer blood thinners such as Xarelto, Eliquis, and Pradaxa to warfarin (Coumadin) in settings such as pulmonary embolism, stroke prevention in atrial fib, and postop orthopaedic surgery, we don't have many s...tudies looking at their use in Hughes' Syndrome. Hughes' Syndrome accounts for up to 10% of all DVT, blood clots that usually start in the calf. This syndrome is also known as antiphospholipid syndrome, an autoimmune condition where the immune system produces antibodies that thicken the blood and can cause clots. Looking into this further as a result of a patient question, we do find a small British study comparing the use of warfarin to Xarelto in these patients. It was known as the RAPS study and it only involved about 100 patients that were followed for 8 months. There were no differences in clots between the two groups, and the Xarelto appeared to work as well as the warfarin in lab testing. There is a nice talk by Dr. Hannah Cohen, the lead author of the study, linked here: https://www.youtube.com/watch?v=i3En-dnqerE Anyway, I think I'd still like to see more information before concluding that xarelto is as safe as warfarin in this setting. The conclusion of this video talk agrees. For most patients with a clot, Xarelto is an excellent treatment. For patients with higher risk due to antiphospholipid antibodies, we are still waiting for more data. Xarelto has been out now for about six years now so hopefully we will get more information as time goes by. See more

We had a standing room only crowd for a great Continuing Medical Education lecture today at West Hills Hospital. Dr. Joe Pierre from UCLA informed the docs about recreational and medical cannabis. There were a ton of questions and hopefully he'll return again! I am looking forward to upcoming talks by our LA County Coroner and topics like e-cigarettes, men's health, and immunotherapy for cancer.

CART therapy coming soon to an oncology office near you? We do not have an approved agent as yet. Kite Pharma has an agent called tisagenlecleucel that got a favorable review by the FDA's Oncology Drug Advisory Committee (ODAC) on July 12th of this year. The committee recommended approval, though FDA is not obligated to follow the recommendation. FDA deadline for approval is October 2017 though the word can come at any time and FDA is typically cryptic about any guidance a...head of approval. ODAC only reviewed the drug in the setting of relapsed B-cell acute lymphoblastic leukemia in pediatric and young adult patients, a pretty narrow indication. The drug, though, has gotten an inordinate amount of press because of its unique mechanism of action and good effectiveness. It's a combination of an antibody that binds to CD19 in conjuction with the patient's own T-cells, along with other protein fragments to activate the T-cells to kill cancer cells. Similar to other forms of immunotherapy, the drug is an attempt to activate the host immune system to seek out and destroy cancer cells. There were 90% complete responses seen in the clinical trial so far. That's an amazing result for a drug used in the setting of very advanced leukemia and lymphoma. The responses appear to last between 6 and 12 months but more followup of patients on the study will clarify how long the responses last. The caveats with this treatment start right away with severe possible side effects including something called cytokine release syndrome, which can manifest as a low blood pressure and seizures. There were no deaths reported in the clinical trial but careful management will probably be needed, including hospital admission and ICU care in some cases. In addition, these medications only seem specific to hematological malignancies such as leukemias and lymphomas, and use in the solid tumors seems limited pending further research. We have not had a good answer of what to use in this setting, and the dramatic responses represent welcome progress. I had someone ask me the other day if I have found my practice changing based on the availability of CAR-T therapy and I have to admit being a little amused by the question. At least now, these results are tantalizing and exciting and represent a sorely needed new treatment. The difficulty of using the medication and limited patient population, at least now, may limit how useful it ends up being. Of course pending an FDA approval, speculation is moot, but with the positive ODAC findings, we may see an approval soon. See more

Keep your hair during chemo! We are a week away from treating our first patient using the only @Dignicap scalp cooling system in the San Fernando Valley. Thanks Dignitana for producing and making available to the community the only FDA approved product for preventing hair loss during chemo. Thanks also to our amazing nurses and clinical staff, pictured here from the left are Julie Ayala, MA, Fanny Garcia, RN, Yvonne Casaletta, NP, Elissa Menne Stubblefield, RN, and Karen Ballantyne, RN, and modeling the scalp cooling headwear, Michael Benjamin, MD.

"Debunking Alkaline Water" I haven't written a lot of "boring" science-y stuff here but I thought I would try posting on recurring "alternative medicine" questions I get in the practice now and then. Today's topic: alkaline water. This one has come up a few times over the years, more lately. The "logic" behind alkaline water in cancer prevention states that cancer prefers an acidic environment, so if we just neutralize the acid with alkaline water, it can prevent or treat c...Continue reading

Happy National Mens' Health Week! Some tips from the CDC: Get Good Sleep - 7-9 hours at least Toss out the Tobacco - It's never too late to quit! Move More - at least 2.5 hours of aerobic activity a week Eat Healthy - eat a variety of fruits and vegetables every day... Tame Stress - maintain social connections Stay on Top of Your Game - see a doc once in a while for a checkup especially if you note new symptoms See more

Another BRCA test sent today! Did you know that BRCA1 and 2 mutation carriers have up to an 80% lifetime risk of breast and ovarian cancer? We have been sending tests for over 10 years and the results are helping prevent cancer in our community. Ask your doctor if testing is right for you!

https://www.flickr.com/photos/lorenkerns/14040516887 Modified by Micahel Benjamin from Creative Commons Licensed photo by Loren Kerns.

First Zejula dispensed this week! So happy to have a great new tool in the fight against ovarian cancer! Thanks to all my partners and staff who help me make advanced cancer treatment available in the community!