Glenn Tisman, MD Heme/Onc Blog

Active B12 may be the cause of your poor memory or your tiredness or that burning in you feet. How can that be? What is active B12 anyway? Victor Herbert, M.D. (he should rest in peace) dedicated his life's research work to confirm the importance of active B12 in human health. I bet you that if you asked your private MD what active B12 is he would tell you he has no clue. Active B12 is that part of vitamin B12 in your blood that is usable; active as it were. That represents a small fraction of the total B12 and when a physician sends your blood to test for vitamin B12 deficiency the lab is not measuring the active fraction of B12 so there is no way your physician knows for sure whether you are vitamin b12 replete or deficient. Active vitamin B12 is actually that portion of B12 that is bound to a polypeptide called transcobalamin and when so bound the complex is termed holotranscobalamin II or just plain old holotranscobalamin . It is now apparent that patients with normal to...

I frequently see patients with prostate cancer that want to know how long they will respond if they choose to be treated with intermittent androgen deprivation therapy (IADT). This involves the injection of a drug such as Lupron or Zoladex (LHRH agonist) usually on a 1-3 month basis plus or minus the ingestion of pills such as Celebrex, Flutamide, Nilutamide (anti-androgens) and Proscar or Avodart (inhibitors of activation of testosterone). A study by A. De La Taille et al. from France attempts to answer the question. From 1989 through 2001 these researchers studied 146 patients who had never receive hormone therapy before. They were treated in an intermittent fashion with LHRH agonist (Lupron, Zoladex) + non-steroidal anti-androgen (Flutamide, Casodex) = 28, LHRH alone = 42, non steroidal anti-androgen alone (i.e. Casodex, Flutamide) = 86. Disease Extent: Localized + locally advanced + metastatic prostate cancer = 72. Prostate-specific antigen (PSA) recurrence after radical pro...

Amgen Corporation developed a new biological drug called VectiBix and demonstrated by clinical trial that the drug was capable of extending the life of colon cancer patients. That won them FDA approval for the use of VectiBix in cancer patients that were resistant to the usual chemotherapy drugs, 5-FU, LV , Oxaliplatin, and Irinotecan. Blue Cross of Southern California arbitrarily enacted a rule restricting patient access to the drug if a patient received a similar drug called Erbitux. They are assuming that patients with prior exposure to Erbitux would be resistant to an entirely different drug targeting the “same” tumor cell receptor. The assumption is scientifically absurd and Blue Cross knows it. However their rule of financial convenience has been effective in denying my and probably other cancer patient’s access to VectiBix and to the potential extension of life. I inquired with Amgen if they were prepared to fight this ruling based on assumption and not on clinical tria...

If you have Blue Cross of Southern California and if you have advanced cancer then you may be in serious trouble. I say this because of the experiences my patients have been having in getting reimbursed for expensive cancer chemotherapy drugs. It is no surprise that the newer biological chemotherapy drugs are very expensive but it is a big surprise when you find that the medical insurance company, which you have been paying for years, refuses to reimburse you for treatment. These newer chemotherapy drugs are expensive but very effective. The insurance carriers are very sneaky in how they delay payment. They actually torture you as you try to fight your cancer. Here is how they do it. You may get a letter from the insurance carrier stating that they have decided that you do not qualify for the expensive cancer fighting drug. Mean time you may very well be responding positively to the drug. This allows the insurance company to initiate a time consuming and stalling tactic that will ...

Just a brief note about a patient with hormone resistant prostate cancer who was started on Revlimid (lenalidomide) 10 mg daily. He developed a severe rash and fluid retention and the dose was stopped to be restarted after symptoms abated. The drug was decreased to 10 mg every other day. The rash subsided and the PSA decreased for a period of many months. This patient represents one of three Revlimid treated patients who has had a PSA reponse to the drug (the other two have failed). I suspect that similar to Thalidomide, Revlimid is active in this disease. If a patient can get the drug ($250.00 per daily 10 mg capsule) it may be worth a try. Though Celgene (CELG) stock is down in recent trading I suspect that it will recover and go up in the future. The drug is also active in chronic lymphocytic leukemia (new finding), multiple myeloma and of course some myelodysplastic syndromes (5q deletion and others) to name a few indications.

Pagophagia (a form of pica, a craving to eat unnatural articles such as rocks, paint or dirt) is a little known term that is not known by many physicians. It describes the act of ingesting excessive amounts of ice cubes. An initial study of pagophagia appeared in the JAMA " Pica, pagophagia, and anemia " by L. G. Keith; C. D. Rosenberg; E. Brown JAMA. 1969;208:535. When I first saw this article I chuckled because I had seen a case of pagophagia two years before in medical school in Buffalo , New York with my mentor in hematology Dr. Ben Fisher and we were unaware of the phenomenon at the time. We had seen a young girl who was severely iron deficient from blood loss anemia and she so eloquently described to us how she so adored to eat ice cubes and how she would eat two to three trays of ice cubes daily. She said that the best part of an ice cube was the opaque center where the small bubbles coalesced. We walked away chuckling and assumed that the girl was a bit nuts. Howeve...

A study done in my medical oncology practice revealed that close to one of every three and seven of every 10 patients with cancer are deficient of vitamin B12 and vitamin D respectively. This is important because a deficiency of these vitamins has been associated with a higher incidence of cancer and replacement of vitamin D in some patients with cancer has been associated with a decrease in tumor growth. This work is to appear at the end of January 2007 in the International Journal of Nutrition and Cancer. We are currently using this information in treating patients with advanced prostate cancer with both chemotherapy and large doses of vitamin D. Other patients with cancer are closely monitored with serum vitamin levels as they are treated with vitamin replacement therapy. We believe that restoring vitamin metabolism to normal may be of value for patients undergoing observation and therapy. The importance of vitamin D and B12 in maintaining bone strength, immunity and bone marrow fun...