7 pain management options for cancer patients you might not know about

"Embarrassingly Simple" Tag Puts IV Chemotherapy Drugs In Pill Form

Taking a pill is the easiest, least invasive way to take medicine, but unfortunately, not all drugs work that way. Now, Stanford scientists have found "an embarrassingly simple solution" that could make almost any drug molecule effective in oral pill form, testing it in mice with chemotherapy drugs that are normally administered through IV infusion.

In essence, what the team has developed is a small molecular tag that can be attached to most drug molecules that makes them more effective as oral pills. This means that not only can current pills work the same with smaller or fewer doses, but other drugs that can't currently be given orally might now be viable in that form.

"This is an embarrassingly simple solution to an old problem," said Mark Smith, lead author of the study. "With this strategy, we can accelerate a huge variety of new drugs through the clinic."

The problem with many oral drugs is bioavailability – how much of the dose is available for the body to absorb. Ideally, drugs need to be both water-soluble, to dissolve in the stomach and pass into the bloodstream, and oil-soluble to get into the cells to do their work. Doing both is tricky, so many drugs skip the water problem and focus on oil solubility, requiring IV infusion instead.

But the new tag is cleverly designed to change the solubility of the drug molecule it's attached to. It starts off water soluble, but as the drug passes through the stomach or intestinal wall, enzymes there snip off the tag. As such, by the time the drug reaches the bloodstream it's become oil soluble instead, ready to get to work.

The Stanford team demonstrated the technique in mice by giving them pill versions of chemotherapy drugs that usually need to be given intravenously. The first target was a drug called vemurafenib, which is used to treat melanoma and other cancers. Unfortunately, it's extremely insoluble in water, so patients need to take four large pills twice a day to wring out even a tiny amount of the drug.

But once the researchers added their tag to the molecule, its bioavailability jumped from almost nothing to 100%. That means much smaller doses would be needed, and more patients would respond better to the therapy.

"At the outset of the project, we were merely hoping to make drugs soluble in water," said Smith. "With this example, we went way beyond our expectations."

So the scientists took it to the next level. They attached the tag to paclitaxel, an IV-infused chemotherapy drug long used to treat breast, lung, prostate, ovarian, bladder and pancreatic cancers. Then they administered oral pills to mice with pancreatic cancer.

Sure enough, this oral paclitaxel performed well – even better than a standard IV dose. This marks the first report of the drug being effective orally, and the team saw no signs of toxicity.

"This could transform the way millions of patients around the world receive chemotherapy," said Smith. "They'll have the convenience of staying home to receive care, and they won't have to do long infusions or receive steroids."

Of course, it's still very early days for the research, with human tests required before any conclusions can be drawn. But the team is hopeful that the tag could make a huge range of drugs more viable in pill form, reducing discomfort and side effects of IV administration.

The research was published in the journal Nature Communications.

Source: Stanford University

My Bitter Chemotherapy Pills For Chronic Lymphocytic Leukemia

I've recently started on chemotherapy pills instead of infusions and the bitterness reminds me to accept not only the bitterness of the pill, but in life too.

Chester Freeman was diagnosed with bladder cancer and most recently with chronic lymphocytic leukemia (CLL). Read Chester's blogs here!

Not all chemotherapy is by infusion. There are also oral chemotherapies.

That is what my oncologist is having me do for the next two weeks.

We stopped the intravenous infusions, which gave me a break from that experience. There is an expression we commonly use in our casual conversations that goes something like "Take the bitter and the sweet," or "That was a bitter pill to swallow."

Well, I am here to tell you that I am taking a bitter chemotherapy pill! As soon as it touches my tongue, my face begins to cringe. There is also a misguiding assumption that we can taste certain things better in different places on our tongue, but that is untrue. We can taste everything on all parts of our tongue. There are five types of taste buds (bitter, sweet, sour, salty and savory) and mine are working just fine. However, that is not true for my spouse. He has metastatic prostate cancer and went through target-specific radiation and his taste buds have not recovered yet. I have learned that everyone reacts differently to changes in the taste buds with radiation therapy.

For some people, they can recover as quickly as two months but for others, it can take up to two years or more. Unfortunately, my spouse is one of the latter. He went to the local farmer's market and purchased some fresh raspberry and peach homemade jam. When he got home, he realized he could not taste it. When I put some of the jam on my toast with butter the flavor was subtle but good. I could clearly taste the peach and raspberry flavor. He has been noticing this side effectmore and more as we eat fresh fruits and vegetables. It is frustrating when you like something and can't taste it. So I try to empathize with him.

The bitter pill that I take has to be taken with food. There is no wonder about that issue. Normally I take this pill first thing in the morning.

So, I have been making my breakfast with cereal and fresh fruit. I am rotating each day with fresh strawberries, peaches and blueberries. Now, I fill my stomach with cereal and fruit and then take the bitter pill with a slice of peach or a strawberry. That makes it tolerable. But there are a few occasions when it slips on my tongue, and I can immediately taste the bitterness blasting through my mouth! I am learning to take the bitter and the sweet in my mouth and in my life! It is the only way that we can get through our trials and tribulations. We have to accept the good and the bad. We have to embrace the positive and the negative.

We have to accept the happy times and the sad times. The bottom line is we must embrace the life we have been given. All we can do is try to find the balance in our life and be as resilient as possible. We have to strive for a positive outcome in our treatment and put up with the bitter pill!

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MCRC Treatment Access: IRA Cost Cap Impact And Final Insights

In this episode of Managed Care Cast, Nihar Desai, MD, MPH, cardiologist and vice chief of Cardiology at the Yale School of Medicine, discusses therapies for cardiovascular conditions as they relate to patient adherence, polypharmacy, and health access.

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