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Polaris Underwriting Blog

3/25/2020 0 Comments

Making sense of new cancer treatments

Research in the field of oncology has excelled in the last fifteen years.  The use of targeted agents (generic drugs end in -mab and -mib) has revolutionized the treatment of late stage cancers.  Targeted therapy chemo attacks specific cancer.  Gleevec, Tarceva and Sutent are common treatments.  Immunotherapy drugs stimulate the user’s immune system to recognize cancer cells as foreign bodies and attack these cancer cells.  If you search the internet for immunomolecular therapy, you will see an impressive number of companies manufacturing or endorsing new products.  Per Issels Immuno-Oncology website: The state-of-the-art, non-toxic immunotherapy cancer protocols… are designed to restore the body’s own complex immune and defense mechanisms to recognize and destroy cancer cells…

The FDA approved of nivolumab (Opdivo) in 2015.  At first the treatment was used for Stage IV melanoma, but the treatment range has expanded to include renal cell cancer, lung cancer, head and neck cancer, colon cancer, liver cancer and even the very aggressive small cell lung cancer.  Other immunomoleculars currently being utilized are ipilimumab, atezolizumab, cabozantinib, and durvalumab to name only a few.  As the above advertisement mentioned, the immunomolecular treatment is much more easily tolerated, and the likelihood of continuing the treatment is much greater that with more toxic agents.  Of course, unfortunately, these advanced treatments may not work in all cases.  A particularly aggressive form of leukemia, acute promyelocytic leukemia (APL), had a likely life expectancy of less than ten months, in fact, usually two to three months.  Clinical trials from the mid-nineties involving old treatment plus new drugs speculated that 75% could attain permanent remission.  It will take years to compile statistics on the impact these new medications will have on the mortality rates for the impairments regularly and frequently seen.  But these new and highly effective treatments must be accounted for when predicting mortality.

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3/18/2020 0 Comments

Tumor grades and differentiation, cytogenetics and tumor markers

Cancer biology proved each tumor has a cellular grade and differentiation. The tumor grade depicts how abnormal the tumor cells and tissue appear under a microscope, indicating the likelihood for rapid growth or spread. There are three grades, low grade cells are closer to normal than high grade cells. The differentiation of the tumor also tells how abnormal the cells are. Again, there are three categories; well differentiated cells more closely resemble the normal cellular structure. Moderately differentiated is more disarrayed, and poorly differentiated cells are the furthest from the normal state. This knowledge is essential for predicting life expectancies. For instance, a low grade, well differentiated tumor has a better chance for longevity than a high grade, poorly differentiated tumor. A mitotic rate may also be provided, often with melanoma impairments. As the name suggests, a higher rate indicates faster cellular division and therefore, faster tumor growth.

Tumor markers are also used for identifying cancers and predicting the response to specific agents. Information about tumor markers is sometimes noted on the pathology of a biopsy. A common example is the marker CD20, which indicates the tumor will respond to Rituxan. The Ki67 marker identifies the rate of cell growth. The lower the number, the slower the growth. Lab tests can also identify tumor markers. Each cancer has a specific cellular marker that will be elevated. These markers can increase to indicate the presence of cancer, and they may track the efficacy of treatment as they gradually decrease. Prostate-specific antigen (PSA) screens for prostate cancer. An elevated carcinoembryonic antigen (CEA) can indicate cancer of the colon or lung, in addition to other cancers. CA125 may be elevated with ovarian cancer; CA15-3 and CA27.29 may increase with breast cancer. There are other markers currently used, and as science continues to learn, and guide oncology, more markers will certainly be discovered.
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Fairly new in the oncology field is cytogenetics: the study of chromosomes. This department of pathology identifies broken, missing, rearranged or extra chromosomes (mutated). The research in cytogenetics has provided key elements in cancer cause and treatment. Some tumor markers currently making an impact on identifying cancers are the KRAS gene and BRCA gene (BReast CAncer). All human cells have a KRAS gene. KRAS genes work to keep cell proliferation and differentiation normal (like a regulator). When the KRAS gene becomes mutated, cells will not be regulated and will begin to multiply, frequently out of control. There are several types of KRAS mutations, specific for specific cancers. BRCA1 or BRCA2 are two different genes found to indicate the chances of developing breast cancer. As cytogenetics, tumor markers, immunomolecular therapy and specific targeting agents continue to advance, the impact on conventional underwriting is obvious. It will take years before the statistics catch up with the analysis and treatment. 
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3/11/2020 0 Comments

Evolution of Cancer Treatment

The advancements in the treatment of cancer have taken many decades to impact survival.  The once sought-after common cause and common cure proved elusive.  The medical community began to focus on prevention and early detection.  Early stage cancer was more and more frequently identified, thereby slightly improving the overall mortality.  Research began to prove that although a cancerous tumor was removed, the cancer may still be growing undetected.  With that concept at the forefront, oncology began prolonging the use chemotherapy and/or the adding of x-ray therapy (XRT).  Early detection and prolonged treatment combined to very slowly improve mortality.  

The evolution of chemotherapy was long and arduous.  As so often happens, many of the early agents were discovered “accidentally”.  Early chemo was cytotoxic, that is toxic to the cells.  It killed the cells in the body that divided the fastest, affecting not only the tumor but also the hair, blood formation and entire GI tract.  The drugs and the dosing schedules were so toxic that often the cancer patient did not survive.  Decades of trial and error gradually refined both to an improved, but still difficult to tolerate, level.  Despite the advances in treatment, as recent as the 2000’s, the cancer patient frequently elected to discontinue treatment for an improved quality of life.  Patients with advanced nodal involvement (T2N3) or distant metastases (T2N2M1) had very short life expectancies, generally 24 months or less.  With current advancements and knowledge as to cell type, tumor grades, differentiation and cytogenetics these predictably low life expectancies have been extended.  Astonishingly, even Stage IV cancers are being significantly impacted.  It is not unheard of to witness the life expectancies of Stage IV colon cancer and melanoma extended by years.  

Next week tumor grades and differentiation, cytogenetics and tumor markers

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3/9/2020 0 Comments

Simplifying Cancer Staging

Back in the 1940’s and 50’s, cancer was poorly understood.  It was believed back then (literally the dark ages!), that one medication would cure all cancers.  That cancer could be more advanced in one case than another, was totally unknown.  As research got more specific, stages were identified.  A simplified system used four stages, written in Roman numerals: Stage I and Stage II indicated the earliest stages, stage III was more advanced, and Stage IV demonstrated distant metastasis from the primary tumor.  As knowledge compiled through the decades, this system was modified with A, B and C, signifying the level of development in each stage.
As time and research progressed, a staging system was devised that provides more information at a glance. TNM stands for Tumor, Nodal involvement (lymph nodes) and Metastasis.  A T1 tumor is very small, and obviously a T4 tumor is much larger or has grown into nearby tissue.  The T1 tumor may be stage I and the T4 tumor may be Stage II.  N could be 1, 2 or 3, depending on the number of cancerous nodes.  M is 0 vs 1, depicting no metastasis versus metastasis (stage IV).  An x signifies unknown involvement (T1N1Mx).  Just to spice things up, a “c, p, or y” before the letters will tell you even more information.  It reads like this: cT1 would mean that a small tumor was identified per scans and physical exam (clinical); pT1 means the information came through a biopsy (pathology), and the yT1 means the staging information was AFTER treatment.
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3/9/2020 0 Comments

Coronavirus for Dummies

If you have not heard or read or listened to information regarding the outbreak of coronavirus (COVID-19), you must be living in a cave.  There is a daily onslaught from all forms of media, as to the dangers of this virus, the latest quarantines, and the number of worldwide cases (living 91,342 https://www.worldometers.info/coronavirus/).  There have been 3,120 reported deaths (six in the states, all in WA).  Of the active cases, 82% are mild disease.  COVID-19 stats pale in comparison the flu, which caused 18,000 deaths this season, and 32 million illnesses, according to the CDC (https://www.livescience.com/new-coronavirus-compare-with-flu.html).
The coronaviruses are a large family of virus, seven of which are known to have caused human illness, from cold like symptoms to the more serious respiratory syndrome (SARS).  COVID-19 is a new variant of this viral family.  The virus is spread mainly through respiratory transmission; symptoms include fever, cough and some shortness of breath.  But the virus is affecting more than just humans; global economy including China’s growth rate and exports; air transport, and oil and gas markets are also symptomatic of the virus. In this country, face masks and hand sanitizers are being snapped up along with nonperishable foods and oddly, toilet paper.
It is important to remember a few things about our health.  The human body is designed to continually search for balance, or what is known as homeostasis.  That is, the body strives to stay healthy.  The first line of defense to maintain health is to improve the immune system.  Good nutrition (less sugar and processed foods) is imperative to keep your immune system functioning at peak performance.  Drinking water throughout the day (instead of sugary drinks) can be a big help in balancing your system.  Good handwashing is essential during a situation like this.  Hands should be washed with soap, throughout the day and the minute you or any of your family enters the home.  Avoid touching your face until you are certain your hands are clean.  If you are immune compromised (prior transplant, on steroids or chemo, etc), avoid large crowds and be cautious on public transportation.   An attitude of optimism and gratitude (versus negativity) has been shown to improve our overall health.  We do not have to wait in fear but can take active participation in our own health. 
​Contrary to what my husband believes (and apparently others if we follow the stock), Corona beer does NOT cause Coronavirus.
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    Author

    Rita Loy, Managing Director and Chief Underwriter here at Polaris Underwriting Technologies.

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