Spinalonga: The Greek Island of Lepers

The island of Spinalonga, officially known as Kalydon, is located in the Gulf of Elounda in the north-eastern of Crete. In 1903, a leper colony was established on Spinalonga, to isolate people suffering from Hansen’s Disease from the healthy population. The cure for leprosy had not yet been discovered, and the contagious disease was regarded with horror. Hansenites, as lepers are known, were quarantined in leper colonies outside towns, living off the charity of passers-by.

The patients of Spinalonga were entitled to a small monthly allowance, which was often not enough to cover their food and medicine. These were hard times, when Greece was rocked by successive wars (Macedonian Struggle, two Balkan Wars, two World Wars, the Civil War), worsening the position of the lepers on Spinalonga. Living conditions were extremely poor, and some lepers’ accounts paint a picture of utter squalor.

The great change came about in 1930, when Epameinondas Remoundakis was brought to Spinalonga. Remoundakis was a third-year law student when he fell ill, and he seems to have been the person the others were waiting for in order to demand humane living conditions. The last inhabitant form Spinalonga flew to the continent in 1962. Now, Spinalonga is a place visted by thousand of tourist every year.

Photo of Spinalonga Island.

 

Leprosy or Hansen’s Disease

Hansen’s Disease is still a scourge today. In many countries, such as Greece, the disease has been eradicated, but this is not true of India, Africa and Latin America. In 2001, 763,000 new cases of leprosy were recorded, mainly in southeast Asia (668,000), while in 2005 the number of new cases fell to 300,000. Leprosy is caused by the bacterium Mycobacterium leprae, which is related to the tuberculosis bacterium. This microorganism was discovered by Doctor G. A. Hansen in 1873, which is why leprosy is officially known as Hansen’s Disease. The disease is contagious through prolonged contact with a sufferer, but most of the population (95%) is naturally immune. Today leprosy is curable and sufferers can lead a normal life without transmitting the disease. However, the world “leper” still carries a social stigma, and this is the main reason some patients do not seek medical assistance in the early stages of the disease.

 

By Luis Mendoza, MD, PhD

07 September 2017

Detection of PD-L1 in cell surface vimentin positive circulating tumor cells is associated with poor survival in cancer patients

UT MD Anderson Cancer Center, Houston, TX.

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA

Abstract 1596

Circulating tumor cells (CTCs) are the cells that detach from the primary tumor of patients and enter in to the blood stream and these can be represented as the seeds of metastasis. Increasing evidence has shown the detection of circulating tumor cells (CTCs) from blood of cancer patients parallels with tumor burden and is associated with poor prognosis. Although CTC counts change indicates a good modality to detect therapeutic response to drug treatments, there is an increasing need of a reliable marker that can be used to predict survival in cancer patients. One of the most prevalent markers detected in cancer patients is the cell surface glycoprotein called PD-L1 (also called B7-H1 and CD274). Aberrant expression of PD-L1 has been reported in several cancer types. Here in this study we tested the hypothesis that detection of PD-L1 in CTCs is associated with poor prognosis. To validate the hypothesis, we isolated cell-surface vimentin (CSV) positive CTCs from colorectal cancer patients using 84-1 method and analyzed for PD-L1 expression. Our results indicated that PD-L1 detection in CTCs was associated with poor overall survival (HR, 2.43; 95% CI, 1.11 to 5.35; p, 0.0264) in colorectal cancer patients undergoing treatment. These findings thus suggest that PD-L1 detection in CSV CTC could serve as a new prognostic tool. We further extend our observations in other types of cancers including breast, prostate and sarcoma. 

Citation Format: Arun Satelli, Zachary Brownlee, Hyangsoon Noh, Qing H. Meng, Scott Kopetz, Michael Overman, Shulin Li. Detection of PD-L1 in cell surface vimentin positive circulating tumor cells is associated with poor survival in cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1596. doi:10.1158/1538-7445.AM2015-1596 

• ©2015 American Association for Cancer Research.

IMBRUVICA® (ibrutinib) Phase 3 RAY Data Show Significant Improvements in Progression-Free Survival Versus Temsirolimus in Patients with Relapsed or Refractory Mantle Cell Lymphoma

ORLANDO, Fla. and HORSHAM, Pa., Dec. 7, 2015 /PRNewswire/ -- Data from the Phase 3 RAY (MCL3001) study, an investigational clinical trial, showed oral IMBRUVICA^® (ibrutinib) significantly improved progression-free survival (PFS; the primary endpoint) versus intravenous temsirolimus in patients with relapsed or refractory mantle cell lymphoma (MCL). Janssen Biotech, Inc. announced IMBRUVICA was associated with a 57 percent reduction in the risk of disease progression or death with a median follow-up of 20 months. These data were published online in The Lancet today and presented in an oral session at the 2015 American Society of Hematology (ASH) meeting in Orlando, FL. IMBRUVICA is jointly developed and commercialized by Janssen and Pharmacyclics LLC, an AbbVie company.

NEW TECHNOLOGY IN MEDICINE IS AWESOME!

New technology in medicine is awesome! 

https://www.youtube.com/watch?v=27eUg20QRVI

NEW MEDICAL ACHIEVEMENT FOR THE CURE OF KIDNEY CANCER: FDA approves Opdivo to treat advanced form of kidney cancer

The U.S. Food and Drug Administration today approved Opdivo (nivolumab) to treat patients with advanced (metastatic) renal cell carcinoma, a form of kidney cancer, who have received a certain type of prior therapy.

“Opdivo provides an important therapy option for patients with renal cell carcinoma,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “It is one of few therapies that have demonstrated the ability to extend patients’ survival in treating this disease.” Torisel (temsirolimus), approved in 2007, is the only other FDA-approved therapy that has demonstrated overall survival in renal cell cancer.

Renal cell carcinoma is the most common form of kidney cancer in adults and forms in the tissues of the kidney that make urine. The National Cancer Institute estimates 61,560 new cases and 14,080 deaths from kidney and renal pelvis cancer in the United States this year. 

“Additionally, Opdivo’s extended indication, from melanoma and non-small cell lung cancer to renal cell cancer, demonstrates how immune therapies can benefit patients across a wide range of tumors,” continued Dr. Pazdur.

Opdivo works by targeting the cellular pathway known as PD-1/PD-L1 (proteins found on the body’s immune cells and some cancer cells). By blocking this pathway, Opdivo may help the body’s immune system fight cancer cells. Opdivo is intended for use in renal cell carcinoma in patients who have received prior anti-angiogenic therapy (treatments that interfere with the blood vessels that contribute to the growth of cancerous cells).

The safety and efficacy of Opdivo for this use were demonstrated in an open-label, randomized study of 821 patients with advanced renal cell carcinoma whose disease worsened during or after treatment with an anti-angiogenic agent. Patients were treated with Opdivo or another type of kidney cancer treatment called everolimus (marketed as Afinitor). Those treated with Opdivo lived an average of 25 months after starting treatment compared to 19.6 months in those treated with Afinitor. This effect was observed regardless of the PD-L1 expression level of patients’ renal cell tumors. Additionally, 21.5 percent of those treated with Opdivo experienced a complete or partial shrinkage of their tumors, which lasted an average of 23 months, compared to 3.9 percent of those taking Afinitor, lasting an average of 13.7 months.

The most common side effects of Opdivo for this use are conditions relating to abnormal weakness or lack of energy (asthenic conditions), cough, nausea, rash, difficulty breathing (dyspnea), diarrhea, constipation, decreased appetite, back pain and joint pain (arthralgia).

Opdivo also has the potential to cause serious side effects that result from the immune system effect of Opdivo (known as “immune-mediated side effects”). These severe immune-mediated side effects involve healthy organs, including the lung, colon, liver, kidneys, hormone-producing glands and the brain.  

The FDA granted the Opdivo application a breakthrough therapy designation, fast track designation, and priority review status. These are distinct programs intended to facilitate and expedite the development and review of certain new drugs in light of their potential to benefit patients with serious or life-threatening conditions.  

Opdivo is marketed by Bristol-Myers Squibb based in Princeton, New Jersey. Torisel is marketed by Pfizer, based in New York, New York. Afinitor is marketed by Novartis Pharmaceuticals of East Hanover, New Jersey.

Source: FDA web page