Comments for Dr. Robert A. Nagourney - Rational Therapeutics - Blog

Comment on The Future of Cancer Research by Lois Pervier

Lois Pervier — Tue, 07 May 2013 22:03:31 +0000

I am a 2 year and 8 month Ovarian Cancer Stage 2b survivor, 2 years and a couple months in remission. I have been told my response to cisplatin and paclitaxel IV/IP was very good. I am in a trial. I fear the return of this disease and just want to thank you for all you are doing… IF it returns I will do all I can to get you involved in what treatments I would choose. Thank you ever so much and keep on keeping on!

Comment on Why Some Patients Refuse Chemotherapy – And Why Some of Them Shouldn’t by Ablahanan

Ablahanan — Sat, 27 Apr 2013 10:40:45 +0000

Thank you for clarifying that, Dr. Nagourney, and also for your rapid reply. I hope that patients will take the time to educate themselves. You work in a very difficult field but with God’s will, you will save many lives.

Comment on Cancer as a Metabolic Disorder by robert nagourney

robert nagourney — Fri, 26 Apr 2013 23:50:29 +0000

I thank you for your interesting comments. Warburg described “aerobic” glycolysis, as the preferential process of glucose consumption and metabolism through to lactate (glycolysis) in tumor cells, despite the apparent adequacy of O2. Thus, the glucose molecule capable of providing 36 ATP via oxidative phosphorylation yielded a mere 2 molecules of ATP per molecule of glucose. The seeming paradox may reflect many processes, one of which is the need to pass glucose to the pentose shunt. A related area is the use of amino acids to replenish Kreb’s cycle intermediates, as the pyruvate pathway to acetyl-CoA is diminished. This is known as anaplerosis and is in part reflected by glutaminolysis to alpha-ketoglutarate. This is a wonderful area of investigation and will certainly provide many therapeutics options in the future. Thank you.

Comment on Why Some Patients Refuse Chemotherapy – And Why Some of Them Shouldn’t by robert nagourney

robert nagourney — Fri, 26 Apr 2013 23:31:07 +0000

I used the term “Refusenik” only in the context of the article from Time magazine, in which Ruth Davis Konigsberg described cancer patients who refuse to take potentially lifesaving therapy. Her article, titled “The Refuseniks – why some cancer patients reject their doctor’s advice,” was the basis of my blog topic.

I did not intend to offend anyone and did not choose the term. It was the subject and title of her article. My point being that in the absence of objective data upon which to make sound judgments, patients my take more treatment than they need or decide against therapies that might be helpful simple because they have so little to go on.

Comment on Why Some Patients Refuse Chemotherapy – And Why Some of Them Shouldn’t by Ablahanan

Ablahanan — Thu, 25 Apr 2013 18:49:35 +0000

Dr. Nagourney, I am not appreciative of your term “refuseniks”. It is patronising and condescending when used in reference to individuals being dealt the rather poor choice “poison or death?” don’t you think? The reasons you give for these mostly “intelligent” human beings declining is the no guarantees of success rate. There are other reasons, many, not the least of which is that chemo is known to diminish the immune system and also that studies show that cancer returns after chemo at a later date in a more aggressive and resistant form. True? What would you do if you were in the hot seat, I wonder. Illness doesn’t always happen to others. I am an amateur, of course, and you are highly educated, well-informed and experienced. To lighten this up, I, personally, would rather be prescribed an overdose of propofol than chemotherapy but I guess that’s not on offer! Keep on saving people’s lives, thanks for those you have.

Comment on Cancer as a Metabolic Disorder by Neil Feldman

Neil Feldman — Sun, 21 Apr 2013 13:47:19 +0000

Greg, I thought it was considered “aerobic” because even in the presence or restoration of adequate oxygen the tumor cell will not revert back to OxPhos (Oxidative Phosphorylation – i.e. normal respiration of oxygen). I thought that anaerobic glycolysis was what happens when a normal cell temporarily lacks sufficient oxygen (i.e. as, perhaps, during a strenuous workout by muscle cells) but then returns to normal respiration once sufficient oxygen is restored to the cell.

Also, I think you meant to say that the relative uptake of radioactive glucose by normal tissue (compared to tumor tissue) is relatively LESS and tumors show up as “hot” spots.

Comment on Cancer as a Metabolic Disorder by Gregory Pawelski

Gregory Pawelski — Sun, 21 Apr 2013 04:07:04 +0000

Dr. Nagourney

My understanding is that “aerobic glycolysis” is an oxymoron. Glycolysis is “anaerobic” and not “aerobic.” The Warburg hypothesis was simply that tumor cells had a metabolic abnormality which made them rely more on glycolysis than on aerobic (Krebs Cycle) metabolism, the principle behind PET scans. You inject radioactive glucose, which is preferentially taken up by tumor cells, as glycolysis can only use glucose to create energy (ATP).

Non-tumor (normal) cells use more aerobic, Krebs Cycle activity, which burns fat, in addition to glucose; so the relative uptake of radioactive glucose by normal tissue (compared to tumor tissue) is relatively greater and tumors show up as “hot” spots. So glycolysis is always anaerobic, not aerobic. One does not have to qualify glycolysis as being anaerobic.

And then there is the thought that cancer cells burn through much more glucose – that’s visible on FDG PET scans – than normal cells. But not all cancers show up on FDG PET scans, because some use glutamine metabolism rather than glycolysis, or they could depend on another nutrient, amino acid glycine. Researchers know very little about how the body regulates glycine metabolism, yet its contribution to tumor cell proliferation only increases the evidence that changes in metabolism are a cause of cancer, not just a consequence of it.

Comment on Cancer Patients: Cure the Curable, Treat the Treatable and Avoid Futile Care by Paul Battle PA-C

Paul Battle PA-C — Wed, 10 Apr 2013 02:21:17 +0000

One of the most logical sensible statements made by an oncologist regarding cancer and treatment with chemotherapy I have ever heard or read. I agree with this totally but there are other interventions in cancer treatment we should consider not just do not treat. Thank you . The issue is there is too much profit in the chemo business even if it fails.

Comment on Cancer Patients: Cure the Curable, Treat the Treatable and Avoid Futile Care by hphblog1

hphblog1 — Wed, 03 Apr 2013 03:30:12 +0000

Reblogged this on Hope Practiced Here and commented: Cancer Patients: Cure the Curable, Treat the Treatable and Avoid Futile Care

Comment on Gee (G719X) Whiz: Novel Mutations and Response to Targeted Therapies by gpawelski

gpawelski — Mon, 01 Apr 2013 16:04:26 +0000

Dr. Nagourney, hasn’t there been several occasions were findings from functional analysis have disagreed with the gene profiles? In fact, one previous example that was posted on your blog, failed to identify an ALK mutation by error (thereby nearly disqualifying the young man from a life-saving therapy) only to be reversed at RT’s insistence when the Mass General repeated the result.

Another similar experience in reverse came from Caris, had a woman with recurrent lung cancer on schedule to receive Crizotinib when findings from functional analysis of resistance demanded a retest, again done at Mass General and this time truly negative as found in the functional profiling test. Functional analyses can examine both conventional and targeted therapies simultaneously.