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Opinion: A route to safer chemotherapy

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Opinion: A route to safer chemotherapy

I have been a cancer doctor for 40 years and have seen our treatments evolve to embrace precision medicine and immunotherapy, which can be less harmful to patients than conventional forms of chemotherapy. And yet conventional cytotoxic chemotherapy — designed to attack and kill rapidly dividing cells — is still a mainstay of cancer treatment for millions of patients globally.

Cytotoxic drugs kill cancer cells, but they also kill normal cells, leading to a host of serious and even life-threatening side effects. Bone marrow suppression, a common side effect of chemotherapy, reduces the number of white cells needed to fight bacterial infections. Chemotherapy can destroy cells lining the bowel and around the mouth, making eating and even drinking nearly impossible.

Generally, these side effects are reversible as the normal white blood cells are replenished, but in the most severe cases, they can be fatal if, for example, bacteria from the gut escape into the bloodstream through a weakened bowel wall and white cell counts are too low to fight the infection. Sepsis in such a case could be catastrophic.

The toxic death rate, where chemotherapy is directly responsible for a patient’s death, can range from 0.5% to 3.1% but has been reported as high as 13%, depending on the intensity of the chemotherapy regimen, age and fitness of the patient and their genetic makeup.

We can reduce this terrible result with greater use of pharmacogenetics, which studies how our genes affect the way we respond to medications in terms of toxicity and effectiveness. It is becoming more possible to devise genetic tests that can indicate whether an individual would be likely to suffer very serious side effects. This would permit healthcare providers to tailor dosages to avoid the worst hazards of chemotherapy drugs and lessen the number of patients dealing with potentially deadly side effects.

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One prominent example involves two related and widely used anticancer drugs, 5-fluorouracil, or 5-FU, and capecitabine (which functions like 5-FU), often used to treat colorectal, breast, stomach and pancreatic cancer.

In the United States, about 275,000 patients with cancer receive 5-FU each year. As many as 25% of those patients require hospitalization with severe side effects, and more than 1,300 patients are estimated to die each year from the drug’s toxicity.

The side effects are most severe for patients who have low levels of dihydropyrimidine dehydrogenase, an enzyme that is produced by the liver and that breaks down 5-FU in the body. This enzyme, also known as DPD, is usually caused by inherited changes in a particular gene. Currently, there are internationally accepted dosing guidelines for 5-FU, adjusted according to DPD genetic test results, ranging from avoiding the drug completely (risk of death is high) to conventional dosing.

While the genetic DPD tests are not perfect — they may miss some patients — nevertheless they have been shown to save lives, reduce the number of patients admitted to hospitals and reduce healthcare costs.

In the United Kingdom, the National Health Service now requires that all new patients receiving 5-FU or capecitabine take some form of a pharmacogenetic test, a policy change that was driven by pressure from families who lost a loved one and advocacy from professional medical societies.

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In March, the U.S. Food and Drug Administration approved safety labeling changes regarding DPD deficiency for 5-FU, but that alone isn’t sufficient. It did not issue a national policy to require pharmacogenetic or related tests to detect the problem.

The National Health Service sets a sound example that the FDA could follow. Mandating a simple genetic blood test could help cancer patients get the care they need and better protect them from medical tragedies brought on by the treatment itself.

David Kerr is a professor of cancer medicine at the University of Oxford in Great Britain.

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Two Private Moon Landers Are Launching at Once: What to Know

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Two Private Moon Landers Are Launching at Once: What to Know

A space twofer is scheduled to take place early Wednesday morning — two lunar missions for the price of one rocket launch.

A SpaceX Falcon 9 will lift off from the Cape Canaveral Space Force Station in Florida, carrying the Blue Ghost lander built by Firefly Aerospace of Austin, Texas, and the Resilience lander from Ispace of Japan.

The launch is scheduled for 1:11 a.m. Eastern time on Wednesday. Forecasts predict a 90 percent chance of favorable weather.

SpaceX will provide coverage of the launch on the social media platform X beginning about one hour before liftoff, or around 12:10 a.m. NASA will start a live video stream at 12:30 a.m. of Blue Ghost and the payloads it is carrying for the agency, which you can watch in the video player above. Ispace will provide coverage of its Resilience lander in English and Japanese starting at 12:20 a.m.

If needed, a backup launch time is available on Thursday at 1:09 a.m., although the weather is less favorable.

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That is the result of fortuitous scheduling by SpaceX and not something that was planned by Firefly or Ispace.

Firefly had purchased a Falcon 9 launch to send its Blue Ghost lander to the moon. At the same time, Ispace, to save on the costs for the mission, had asked SpaceX for a rideshare, that is, hitching a ride as a secondary payload on a rocket launch that was going roughly in the right direction to get its Resilience lander to the moon. That turned out to be Blue Ghost’s trip.

“It was a no-brainer to put them together,” Julianna Scheiman, the director for NASA science missions at SpaceX, said during a news conference on Tuesday.

After the Falcon 9 rocket reaches orbit, the second stage will fire again for a minute so that it can deploy Blue Ghost in an elliptical orbit around Earth about one hour after launch. Then the rocket stage will fire once more, for just one second, to adjust the orbit for the deployment of Resilience about 1.5 hours after launch.

Firefly Aerospace is one of the new space companies that have popped up over the past few years. It has developed and launched a small rocket called Alpha several times. In 2023 Firefly demonstrated that it could prepare and launch a payload for the United States Space Force within days — a capability that the Department of Defense is looking to develop so that it could quickly replace satellites that come under attack.

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Blue Ghost — named after a species of fireflies — is a robotic lander that Firefly has developed to take scientific instruments and other payloads to the surface of the moon.

This mission is headed to Mare Crisium, a flat plain formed from lava that filled and hardened inside a 345-mile-wide crater carved out by an ancient asteroid impact. Mare Crisium is in the northeast quadrant of the near side of the moon.

NASA will pay Firefly $101.5 million if it takes 10 payloads to the lunar surface, and a bit less if it does not fully succeed. The NASA payloads include a drill to measure the flow of heat from the moon’s interior to the surface, an electrodynamic dust shield to clean off glass and radiator surfaces, and an X-ray camera.

The lander will operate for about 14 days — the length of a lunar day — until darkness descends at the landing site.

This is Ispace’s second attempt to place a commercial lander on the surface of the moon. Its Hakuto-R Mission 1 lander tried to set down near the Atlas crater on the near side of the moon. But the landing software was confused when it passed over the crater rim, which is two miles higher than the surrounding terrain. The spacecraft ended up hovering far above the ground after thinking it had landed and then crashed when it ran out of propellant.

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Resilience — also known as the Hakuto-R Mission 2 lander — is essentially the same design as the Mission 1 spacecraft, but with different payloads. Ispace officials said they were confident that the mistakes that led to the crash in 2023 had been fixed.

The payloads on Resilience include a water electrolyzer experiment, which splits the hydrogen and oxygen molecules, from the Takasago Thermal Engineering Company in Japan, and a small rover named Tenacious that was developed and built by Ispace’s European subsidiary.

Although this is not a NASA mission, it will collect two soil samples — one scooped up by the rover, the other just soil that settles on the landing pads — and sell them to the agency for $5,000 each.

The transactions have no scientific value, because the samples will remain on the moon. Instead, they are meant to help strengthen the view of the United States government that while no nation on Earth can claim sovereignty of the moon or other parts of the solar system under the Outer Space Treaty of 1967, nations and companies can own and profit from what they extract from the moon.

Resilience and Tenacious are also designed to operate for one lunar day, or 14 Earth days.

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Blue Ghost should get to the moon first on March 2. For the first 25 days, it is to circle around Earth as the company turns on and checks out the spacecraft’s systems, before heading on a four-day journey to the moon. Then it will orbit the moon for 16 days before trying to land, 45 days after launch.

Resilience will take a longer, winding path that consumes less energy and propellant, gradually stretching out its elliptical orbit until the farthest point of the orbit reaches beyond the moon. As a secondary payload on the Falcon 9, it will need to perform a flyby of the moon to get into the correct position to be captured into lunar orbit.

The vehicle is to land on a plain named Mare Frigoris about four to five months after launch.

Both Blue Ghost and Resilience might be beaten by a spacecraft from Intuitive Machines of Houston that is not scheduled to launch until late February. Despite its later start, it will take a direct, quicker path to the moon.

Intuitive Machines placed Odysseus, its first lander, on the moon in a trip sponsored by NASA last year. It was still successfully able to contact Earth despite tipping over.

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By hiring private companies, NASA hopes to send more devices to the moon at a lower cost to perform experiments and test new technologies. A second aim of the Commercial Lunar Payload Services program, or C.L.P.S., is to jump-start a commercial industry there that would not otherwise develop.

NASA officials expect failures along the way, and that is what has happened. The first C.L.P.S. mission by Astrobotic Technology of Pittsburgh suffered a catastrophic propulsion failure soon after launch and never made it close to the moon. The tipping of the second Intuitive Machine lander during the second C.L.P.S. mission prevented the scientific instruments aboard from collecting the data they were sent to measure.

The American subsidiary of Ispace is collaborating with Draper Laboratory in Cambridge, Mass., for a C.L.P.S. mission that is scheduled to launch next year.

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What threats lurk in the smoke and ash of L.A.-area fires? New health warnings

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What threats lurk in the smoke and ash of L.A.-area fires?  New health warnings

As Santa Ana wind conditions continue to stoke fears of resurgent wildfires across Los Angeles County, health officials are warning of yet another wind-borne threat: ash and dust from active fire zones and burn scars.

On Tuesday, the county Department of Public Health issued a windblown dust and ash advisory until 7 p.m. Wednesday.

During this time, ash may be dispersed from the Palisades and Eaton fire areas, as well as from the Hurst, Kenneth, Line, Airport and Bridge fire burn scars, according to the South Coast Air Quality Management District.

“Windblown ash particles may be too large to be detected by air quality instrumentation and will not influence Air Quality Index levels,” the advisory stated. “However, ash particles are typically visible to the naked eye either in the air or on outdoor surfaces.”

Experts say that wildfire smoke is unsafe for everyone and that all area residents should be worried about the potential health effects from this pollutant.

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The cause for concern is, “the main component of smoke is particulate matter and that can penetrate deep into the lungs, which directly causes respiratory issues, but it can also enter the bloodstream where it can cause a range of other health issues,” said Anne Kelsey Lamb, director of Regional Asthma Management and Prevention.

Wildfire smoke can be extremely harmful to the lungs of at-risk people, who include children whose lungs are still developing, pregnant women, older adults, and those with asthma, chronic obstructive pulmonary disease, chronic heart disease or diabetes, according to the American Lung Assn.

Exposure to air pollution such as wildfire smoke can also lead to the onset of asthma in otherwise healthy people, Lamb said.

As wildfires have become more common researchers have been learning that wildfire smoke, depending on what it consists of, can be even more dangerous to public health than other types of air pollution.

Last year the UCLA Luskin Center for Innovation published a study in the journal Science Advances that found an estimated total of more than 55,000 premature deaths in an 11-year span from inhaling fine particulate matter known as PM2.5, or soot, from wildfires.

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Air pollutants from wildfires are dangerous to the immediate fire zone and surrounding communities, but the harm can reach out farther.

Lamb noted that during the 2018 Camp fire in Butte County, researchers found smoke with lead in it 150 miles away from the fire zone.

“Even people who aren’t in the immediate vicinity of the fire are likely still facing some of the impacts of the smoke from it,” she said. “I encourage everyone in the broader area to take the same precautions that we would recommend for someone who’s really right there in the midst of it.”

What’s possibly in the air? In the ash?

We know that wildfire smoke can include toxic materials such as lead, asbestos and arsenic, which can lead to additional health harms, Lamb said.

Part of the reason wildfire smoke from the Los Angeles-area fires is particularly concerning is because — in addition to PM2.5 — the smoke from this disaster can include harmful components that were part of houses, items inside the home, buildings and cars that burned.

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Toxic chemicals from plastics, paint from the house and furniture are a few examples of what has been burned and is being released in the air, said Anthony Wexler, director of the Air Quality Research Center at UC Davis.

Researchers are still working to understand the relative toxicity of these specific chemical pollutants during a fire event.

“We’ve done some experiments, some early experiments in my lab showing that it’s more toxic, the building materials than burning wooded material,” Wexler said. “But again, we have just a little bit of data.”

In the face of uncertainty, he said, “people should protect themselves as much as they can.”

Local and regional public health officials are recommending that at-risk people stay indoors with the windows and doors closed — while keeping the indoor air clean.

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“You have permission to be a couch potato, as long as you have electricity so you can watch the tube,” Wexler said.

The more you do outside the more you’re going to expose yourself to all the harmful air pollutants.

Wexler advises you whip out the protective gear that you had for the pandemic: air purifiers, N95 masks, gloves and protective eyewear in case you have to go outside.

If I have to be outside, what can I do to stay safe?

If people need to be outside, experts recommend wearing an N95 mask.

That’s because those are really the only masks that are going to filter out the damaging fine particles, Lamb said.

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“The surgical masks allow too much air to get in, because it’s not the tight fit,” she said. “It doesn’t filter out as fine of particles as the N95 does.”

Researchers have looked into wearing cloth masks during wildfire smoke and found that it “led to more exposure because some of the smoke sort of settled in the material and then it was continuously breathed in,” Lamb said.

There are a lot of Los Angeles residents who are out in surrounding communities volunteering their time to local disaster relief efforts, providing essential services and working.

“We want people to volunteer and help out, because we need that,” Wexler said.

But there are further safety steps that men with beards should take, he said.

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Bearded men need to shave or at least cut back facial hair as much as possible so that a protective mask makes a firm seal around the face, keeping pollutants out.

Experts also urge everyone to remove clothes worn while working outside, including shoes, before entering home. Put the clothes in the wash right away, because some of the particulate they carry can come inside the home and affect other people, Lamb said.

One thing to remember, Lamb said, is that the components of the pollutants, including ash, will settle on the ground and can be aerosolized again when disturbed as part of the cleanup efforts.

“There may be no way to avoid that happening, but to avoid exposure, make sure you’re wearing a mask, and I would even have on eyewear, gloves and change clothes,” she said.

I have pets. How can I protect them?

As irritating as smoke can be for people, it can cause health problems for your pets too.

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Animals with cardiovascular or respiratory disease are especially at risk from smoke and should be closely watched during all periods of poor air quality, according to the American Veterinary Medical Assn.

Experts share the following information to keep your beloved animals safe during a poor or unhealthy air quality event:

  • Keep pets indoors as much as possible, and keep your windows shut.
  • Smoke is especially tough on your pet birds. Keep them inside when smoke is present.
  • Let dogs and cats outside only for brief bathroom breaks if air quality alerts are in effect.
  • Avoid intense outdoor exercise during periods of poor air quality. Exercise pets when dust and smoke have settled.

When can I stop wearing a mask and safely open my windows?

In regards to the current windblown advisory, experts advise you check for updates from local officials and follow their safety guidance.

How can I check the air quality in my area?

Even though windblown ash particles may be too large to be detected by air quality instrumentation and officials warn it will not influence Air Quality Index levels, you should still keep an eye on the air quality in your area.

When you are looking at the air quality reading, keep in mind the harmful particles that are not being recorded.

You can do so with the following tools:

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  • AirNow, the website and the app, created by the U.S. Environmental Protection Agency includes information from its permanent air quality monitors as well as temporary air quality monitors that will be put in place in incidents like this. It has an updated “Fire and Smoke” map, or you can enter your ZIP Code and check the air in your community.
  • Purple Air is a company that helps monitor air quality by selling easy-to-install sensors with real-time data on various particulate matter levels. Purple Air has a free online map with real-time air quality data.
  • The South Coast Air Quality Management District issues advisories, guidance and warnings in regards to air quality impacts. It has a current hourly air quality index map and a dedicated webpage to news releases of such advisories.

All resources will provide a number for the air quality index. If it’s greater than 100, that is considered unhealthy for sensitive and at-risk groups. If it’s greater than 150, it is considered unhealthy for all people.

Where can I find free N95 masks in Los Angeles County?

Here is a list of locations where you can pick up free N95 masks.

This list will be updated as more organizations, local agencies and others post their offerings.

  • L.A. Care Health community resource centers. There is an extended list of locations and contact information online.
  • All Los Angeles Public Library branches. The branches will be offering free masks while supplies last. Check online for branch address and hours; it’s encouraged you call ahead to check on supply inventory.
  • Los Angeles city recreation and senior centers, aquatic facilities, golf courses, museums, and the Cabrillo Marine Aquarium will all be providing free masks. A complete list of locations and contact information is online.

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Moderate Drinking Raises Cancer Risks While Offering Few Benefits

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Moderate Drinking Raises Cancer Risks While Offering Few Benefits

Among both men and women, drinking just one alcoholic beverage a day increases the risk of liver cirrhosis, esophageal cancer, oral cancer and various types of injuries, according to a federal analysis of alcohol’s health effects issued on Tuesday.

Women face a higher risk of developing liver cancer at this level of drinking, but a lower risk of diabetes. And while one alcoholic drink daily also reduces the likelihood of strokes caused by blood clots among both men and women, the report found, even occasional heavy drinking negates the benefits.

The report, prepared by an outside scientific review panel under the auspices of the Department of Health and Human Services, is one of two competing assessments that will be used to shape the influential U.S. Dietary Guidelines, which are to be updated this year.

The government has for several decades recommended a limit of two standard alcoholic drinks per day for men and one for women.

In December, a review of the data by the National Academies of Sciences, Engineering and Medicine supported this advice, finding that moderate drinking was linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with no drinking.

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But some experts fear that the harms of moderate drinking have been understated, particularly the risk of cancer, which is the leading cause of death among people under 85, according to the American Cancer Society.

In 2020, the last time the dietary guidelines came up for review, scientific advisers suggested lowering the recommendation to one drink daily for both men and women. That advice did not appear in the final guidelines.

The analysis from the National Academies tied moderate drinking in women to a small but significant increase in breast cancer, but said there was insufficient evidence to tie alcohol to other cancers.

This month, however, the U.S. Surgeon General, citing mounting scientific evidence, called for labeling alcohol with cancer warnings similar to those that appear on cigarettes. The report issued on Tuesday found that the increased cancer risk comes with any amount of alcohol consumption and rises with higher levels of drinking.

Drinking is linked to a higher risk of death for seven types of cancer, including breast cancer, colorectal cancer, liver cancer as well as cancers of the oral cavity, pharynx and larynx and esophagus.

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Men and women are both vulnerable to these health harms, but women are much more likely to develop a cancer linked to drinking, the report said.

“Among the U.S. population, the risk of dying from alcohol use begins at low levels of average use,” the report said. “Higher levels of alcohol consumption are linked with progressively higher mortality risk.”

Those who consume more than seven drinks per week have a one in 1,000 risk of dying from a condition related to alcohol. The risk increases to one in 100 if consumption is more than nine drinks a week.

This article will be updated.

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