Dear Subscriber, As winter 2012 gives way to spring, we have been busy on several fronts.  On March 26, I participated in the Cincinnati Combats Cancer Conference. The event included discussions on radiation, chemotherapy, immunology and new surgical techniques. My presentation on the management of ovarian cancer was well attended. Joining me were two long-term survivors who reside in the Cincinnati area. At the end of my prepared material, each volunteered their own story of survival in the face of metastatic disease. It is hard to believe that one of our platinum refractory ovarian cancer patients is now celebrating her 13th anniversary of complete remission. While another patient, with metastatic breast cancer that had spread to the liver, has just rounded the corner of eight years after diagnosis. The following week, I presented our findings on the duel kinase  inhibitor BEZ235 at the American Association of Cancer Research. This novel compound is undergoing clinical trials in human cancer. Our presentation examined the activity profile and combinatorial potential of this interesting small molecule with activity against the phosphoinositol kinase and mTOR targets. We are excited to see this new therapy move toward clinical application. More recently, I was honored to receive the Los Angeles Business Journal Healthcare Award for the Research Executive of the Year. The ceremony held at the Los Angeles Biltmore Hotel convened leaders in the Los Angeles healthcare community to honor those who had made substantive  contributions to the field. I felt flattered and delighted to receive this award amongst this august group of physicians and healthcare professionals. One of the most gratifying aspects was the opportunity to join so many of my successful patients who turned out to support and congratulate me on this award. The upcoming American Society of Clinical Oncology meeting in Chicago will include our presentation on the optimal therapy for advanced colorectal cancer. In this study, we utilized the EVA-PCDŽ platform to compare the most widely used chemotherapy combinations. The observations identified highly favorable interactions between EGFR inhibitors and the topoisomerase-I inhibitors, consistent with the excellent clinical outcomes that we have observed using these treatment regimens. Thank you for your continuing interest in our work. In addition to this newsletter you can stay in touch through our blog, Facebook page and Twitter account.  Robert A. Nagourney, MD Rational Therapeutics
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Persistence Over Acceptance
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He's young, tall and handsome, exercises regularly and eats nutritious meals. The picture of health . . . or so he thought. This is the "shortened" version of Ryan's story and his battle with cancer.
Shortly after Ryan Kuper and his girlfriend moved to their new home in Glendale, California, Ryan s tarted experiencing occasional shooting pains in his lower abdomen.
A few weeks later, while visiting his family in Omaha, Nebraska for Thanksgiving, he consulted his father, a retired physician, about the discomfort. Dr. Kuper examined Ryan but was unable to determine what might be amiss, and suggested he receive a more detailed examination upon his return. The next week, based on his otherwise overall health, his Urgent Care physician surmised that the pain might be a muscular issue and he was given some ibuprofen and told to get some rest. For a while the pain subsided.
But on January 11, he returned to that same physician with renewed pain and with a quickly deteriorating issue with breathing. This time the doctor heard very different lung sounds and the chest x-ray he ordered revealed a sizable build-up of fluid (pleural effusion) in his right lung.
Ryan just 38, was a vegetarian, had never smoked, and had just started his new job. But a diagnosis of cancer is rarely expected and never welcomed. And like too many others, on January 17, Ryan heard those dreaded words, "You have cancer."
Given that Ryan was so young and had never smoked, his local oncologist, Dr. Raul Mena surmised his cancer might be the result of a rare genetic mutation. Biopsies from his lung and lymph tumors were tested, but multiple analyses showed no presence of the genetic mutation that Dr. Mena thought he might have. This unfortunately eliminated using targeted agents for Ryan's cancer. Perplexed, Mena reached out to a lung cancer specialist at Cedars-Sinai Medical Center, who responded that there really was nothing he could do for him. (Ryan's cancer had already spread, and there were so many tumors and lesions they couldn't be removed surgically.) He recommended Ryan try standard therapy.
After much research, Ryan's girlfriend suggested visiting Rational Therapeutics. Ryan asked Dr. Mena about getting a chemosensitivity test done there, and was encouraged to do so.
Learn how assay-directed therapy gave Ryan hope.
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Size Does Matter: The "No-Go"
| Shari Burt, Director Patient/Physician Relations
Informing patients after they have undergone a procedure that there is insufficient tumor to setup an EVA-PCD analysis is heartbreaking. Plus, to just cover our costs we have to charge for the processing. We stress to everyone that inquires, that fine needle aspirations (FNAs) or even multiple core needle biopsies DO NOT provide the quantity of tumor we need to perform an accurate EVA-PCD analysis. Remember:
1. We do not grow your tumor in the laboratory.
2. We must maintain the cells in their microenvironment.
Therefore, we require a minimum of 1 centimeter (1 gram) piece of viable tumor (or cytologically positive pleural or ascites fluid) to provide the most accurate and complete analysis. The more tumor we receive, the better analysis we will be able to provide.
In addition, it is important to note that not every area of a biopsy or fluid sample may contain live cancer cells. So more is always better. We don't want to have to call you, a friend or your loved one to say, "No Go."
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Recent Gift
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A Gift From the Heart 
Michal Poe, of Ann Arbor, Michigan, came to
Rational Therapeutics last December for a consultation and to have a sample of her breast cancer obtained for the EVA-PCD assay. In appreciation for our work, she recently sent us a lovely note with the beautiful latch work art you see here, currently hanging in our office.
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Your Survey
Questions Answered
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1. My disease isn't listed on your website, can you test my cancer?
The EVA-PCD functional profile is applicable to any cancer where there are questions as to what chemo or targeted therapies are the most likely to provide the best benefit, and where we can easily obtain a sample for analysis. In the case of rare or less common diseases, the functional profile developed by the EVA-PCD test may be even more valuable, as it is possible there are no standard therapies, or extensive clinical trial data on which to base treatment decisions.
3. Do you ever recommend clinical trials?
When patients have been heavily pre-treated, they may develop resistance to standard chemotherapuetics. With our ever expanding database of new targeted and novel therapies, we look forward to testing new compounds in the laboratory. If we identify in vitro activity for a new compound, we may recommend that the patient pursue those treatments if they are only available through clinical trials.
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Our Blogs
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Dr. Nagourney's Blog
Written by Robert Nagourney, MD, this blog is for scientists, physicians, and patients interested in the science behind cancer therapies.
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