How does the drug abemaciclib treat breast cancer?
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The anti-cancer drug abemaciclib (also known as Vernezio) has this month been added to the Australian Pharmaceutical Benefits Scheme (PBS) to treat certain types of breast cancer.
This significantly reduces the cost of the drug. A patient can now expect to pay A$31.60 for a 28-day supply ($7.70 with a health care concession card). The price of abemaciclib without government subsidy is $4,250.
So what is abemaciclib, and how did we get to this point?
It stops cells dividing
Researchers at the pharmaceutical company Eli Lilly developed abemaciclib and published the first study on the drug (then known as LY2835219) in 2014.
Abemaciclib is a type of drug known as a “cyclin-dependent kinase inhibitor”. It’s taken as a pill twice a day.
To maintain our health, many of the cells in our bodies need to grow and divide to produce new cells. Cancers develop when cells grow and divide out of control. Therefore, stopping cells from dividing into new cells is one way that cancer can be fought.
When cells divide, they have to make a copy of their DNA to pass onto the new cell. “Cyclin-dependent kinases” (CDKs for short) are essential for this process. So, if you stop the CDKs, you stop the DNA copying, you stop cells dividing, and you fight the cancer.
However, there are different types of CDKs, and not all cancers need them all to grow. Abemaciclib specifically targets CDK4 and CDK6. Thankfully, a lot of cancers do need these CDKs, including some breast cancers.
But abemaciclib will only be effective against cancers that rely on CDK4 and CDK6 for continued growth. This specificity also means abemaciclib is fairly unique, so it can’t easily be replaced with a different drug.
Two other CDK4/6 inhibitors were developed around the same time as abemaciclib, and are called ribociclib and palbociclib. Both of these drugs are also on the PBS for specific types of breast cancer. As the drugs differ in their chemical structures, they have slight differences in the way they are taken up and processed by the body. The preferred drug given to a breast cancer patient will depend on their unique circumstances.
What are the side effects?
Research is still ongoing into the differences between each of these CDK4/6 inhibitors, but it is known that the side effects are largely similar, but can differ in severity.
The most common side effects of abemaciclib are fatigue, diarrhoea and neutropenia (reduced white blood cells). The gastrointestinal issues are generally more severe with abemaciclib.
If these side effects are too severe, abemaciclib treatment can be stopped.
What types of cancer has abemaciclib been approved for?
In 2017, the United States Food and Drug Administration (FDA) approved abemaciclib for the treatment of patients with metastatic HR+/HER2- (hormone receptor-positive and human epidermal growth factor receptor 2-negative) breast cancer who did not respond to standard endocrine therapy.
Australia’s Therapeutic Goods Administration (TGA) similarly approved abemaciclib in 2022 as an “adjuvant” therapy (after the initial surgery to remove the tumour) for patients with HR+/HER2- invasive early breast cancer which had spread to lymph nodes and was at high risk of returning.
As of May 1 2024, the PBS covers this use of abemaciclib in combination with endocrine therapy such as fulvestrant, which is also listed on the PBS. Endocrine therapy, also known as hormonal therapy, blocks hormone receptor positive (HR+) cancers from receiving the hormones they need to survive.
Could abemaciclib be used for other cancers in the future?
Abemaciclib is of great interest to scientists and medical practitioners, and testing is ongoing to assess the effectiveness of abemaciclib in treating a range of other cancers, including gastrointestinal cancers and blood cancers.
Abemaciclib may even be usable in brain cancers, as it has long been known to be capable of crossing the blood-brain barrier, a common stumbling block for potential anti-cancer drugs.
Time will tell whether the role of abemaciclib in health care will be expanded. But for now, its inclusion on the PBS is sure to bring some relief to breast cancer patients nationwide.
Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute and John (Eddie) La Marca, Senior Resarch Officer, Walter and Eliza Hall Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Heart Rate Zones, Oxalates, & More
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I think the heart may be an issue for lots of us. I know it is for me due to AFib. When I’m in my training zone like on a treadmill, I’m usually around 110 to 120. But there are occasionally times when I’m at 140 or 150. How dangerous is that? If I use that formula of 180 minus age, thats 103. I get nothing from that. My resting heart rate is in the 50 to 60 range.❞
First, for safety, let us draw attention to our medical disclaimer at the bottom of each email, and also specifically note that we are not cardiologists here, let alone your cardiologist. There’s a lot we can’t know or advise about. However, as general rules of thumb:
For people without serious health conditions, it is considered good and healthful for one’s heart rate to double (from its resting rate) during exercise, with even more than 2.5x resting rate being nothing more than a good cardio workout.
As for “180 minus age” (presuming you mean: to calculate the safe maximum heart rate), more common (and used by the American Heart Association) is 220 minus age. In your case, that’d give 143.
Having atrial fibrillation may change this however, and we can’t offer medical advice.
We can point to this AHA “AFib Resources For Patients and Professionals”, including this handy FAQ sheet which says:
“Am I able to exercise?” / “Yes, as long as you’re cleared by your doctor, you can perform normal activities of daily living that you can tolerate” (accompanied by a little graphic of a person using an exercise bike)
You personally probably know this already, of course, but it’s quite an extensive collection of resources, so we thought we’d include it.
It’s certainly a good idea for everyone to be aware of their healthy heart rate ranges, regardless of having a known heart condition or not, though!
American Heart Association: Target Heart Rates Chart
❝I would like to see some articles on osteoporosis❞
You might enjoy this mythbusting main feature we did a few weeks ago!
The Bare-Bones Truth About Osteoporosis
❝Interesting, but… Did you know spinach is high in oxylates? Some people are sensitive and can cause increased inflammation, joint pain or even kidney stones. Moderation is key. My sister and I like to eat healthy but found out by experience that too much spinach salad caused us joint and other aches.❞
It’s certainly good to be mindful of such things! For most people, a daily serving of spinach shouldn’t cause ill effects, and certainly there are other greens to eat.
We wondered whether there was a way to reduce the oxalate content, and we found:
How to Reduce Oxalic Acid in Spinach: Neutralizing Oxalates
…which led us this product on Amazon:
Nephure Oxalate Reducing Enzyme, Low Oxalate Diet Support
We wondered what “nephure” was, and whether it could be trusted, and came across this “Supplement Police” article about it:
Nephure Review – Oxalate Reducing Enzyme Powder Health Benefits?
…which honestly, seems to have been written as a paid advertisement. But! It did reference a study, which we were able to look up, and find:
In vitro and in vivo safety evaluation of Nephure™
…which seems to indicate that it was safe (for rats) in all the ways that they checked. They did not, however, check whether it actually reduced oxalate content in spinach or any other food.
The authors did declare a conflict of interest, in that they had a financial relationship with the sponsor of the study, Captozyme Inc.
All in all, it may be better to just have kale instead of spinach:
- 20 Foods High in Oxalates to Limit if You Have Kidney Stones
- The Kidney Dietician: The Best Low Oxalate Greens
We turn the tables and ask you a question!
We’ll then talk about this tomorrow:
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Fluoride Toothpaste vs Non-Fluoride Toothpaste – Which is Healthier?
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Our Verdict
When comparing fluoride toothpaste to non-fluoride toothpaste, we picked the fluoride.
Why?
Fluoride is indeed toxic; that’s why it’s in toothpaste (to kill things; namely, bacteria whose waste products would harm our teeth). However, we are much bigger than those bacteria.
Given the amount of fluoride in toothpaste (usually under 1mg per strip of toothpaste to cover a toothbrush head), the amount that people swallow unintentionally (about 1/20th of that, so about 0.1mg daily if brushing teeth twice daily), and the toxicity level of fluoride (32–64mg/kg), then even if we take the most dangerous ends of all those numbers (and an average body size), to suffer ill effects from fluoride due to brushing your teeth, would require that you brush your teeth more than 23,000 times per day.
Alternatively, if you were to ravenously eat the toothpaste instead of spitting it out, you’d only need to brush your teeth a little over 1,000 times per day.
All the same, please don’t eat toothpaste; that’s not the message here.
However! In head-to-head tests, fluoride toothpaste has almost always beaten non-fluoride toothpaste.
Almost? Yes, almost: hydroxyapatite performed equally in one study, but that’s not usually an option on as many supermarket shelves.
We found some on Amazon, though, which is the one we used for today’s head-to-head. Here it is:
However, before you rush to buy it, do be aware that the toxicity of hydroxyapatite appears to be about twice that of fluoride:
Scientific Committee on Consumer Safety Opinion On Hydroxyapatite (Nano)
…which is still very safe (you’d need to brush your teeth, and eat all the toothpaste, about 500 times per day, to get to toxic levels, if we run with the same numbers we discussed before. Again, please do not do that, though).
But, since the science so far suggests it’s about twice as toxic as fluoride, then regardless of that still being very safe, the fluoride is obviously (by the same metric) twice as safe, hence picking the fluoride.
Want more options?
Check out our previous main feature:
Less Common Oral Hygiene Options
(the above article also links back to our discussion of different toothpastes and mouthwashes, by the way)
Take care!
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When And Why Do We Pick Up Our Phones?
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The School of Life’s Alain de Botton makes the argument that—if we pay attention, if we keep track—there’s an understory to why we pick up our phones:
It’s not about information
Yes, our phones (or rather, the apps therein) are designed to addict us, to draw us back, to keep us scrolling and never let us go. We indeed seek out information like our ancestors once sought out berries; searching, encouraged by a small discovery, looking for more. The neurochemistry is similar.
But when we look at the “when” of picking up our phones, de Botton says, it tells a different story:
We pick them up not to find out what’s going on with the world, but rather specifically to not find out what’s going with ourselves. We pick them up to white out some anxiety we don’t want to examine, a line of thought we don’t want to go down, memories we don’t want to consider, futures we do not want to have to worry about.
And of course, phones do have a great educational potential, are an immensely powerful tool for accessing knowledge of many kinds—if only we can remain truly conscious while using them, and not take them as the new “opiate of the masses”.
De Botton bids us, when next we pick up our phone. ask a brave question:
“If I weren’t allowed to consult my phone right now, what might I need to think about?”
As for where from there? There’s more in the video:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
Making Social Media Work For Your Mental Health
Take care!
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Oranges vs Lemons – Which is Healthier?
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Our Verdict
When comparing oranges to lemons, we picked the oranges.
Why?
In the battle of these popular citrus fruits, there is a clear winner on the nutritional front.
Things were initially promising for lemons when looking at the macros—lemons have a little more fiber while oranges are slightly higher in carbs, but the differences are small and both are very healthy in this regard.
However, alas for this writer who prefers sour fruits to sweet ones (I’m sweet enough already), the micronutrient profiles tell a different story:
In terms of vitamins, oranges have more of vitamins A, B1, B2, B3, B5, B9, E, and choline. In contrast, lemons have a (very) little more vitamin B6. You might be wondering about vitamin C, since both fruits are famous for that—they’re equal on vitamin C. But, with that stack we listed above, oranges clearly win the vitamin category easily.
As for minerals, oranges boast more calcium, copper, magnesium, potassium, selenium, and zinc, while lemons have more iron, manganese, and phosphorus.
Technically lemons also have more sodium, but the numbers are truly miniscule (by coincidence, we discover upon grabbing a calculator, you’d need to eat approximately your own bodyweight in whole lemons to get to the RDA of sodium—and that’s to reach the RDA, not the upper healthy limit) so we’ll overlook the tiny sodium difference as irrelevant. Which means, while closer than the vitamins category, oranges win on minerals with a 6:3 lead over lemons.
Both fruits offer generous helpings of flavonoids and other polyphenols such as naringenin and hesperidin, which have anti-inflammatory properties and more specifically can also reduce allergy symptoms (unless, of course, you are allergic to citrus fruits, which is a relatively rare but extant allergy).
In short: as ever, enjoy both; diversity is great for the health. But if you want to maximize the nutrients you get, it’s oranges.
Want to learn more?
You might like to read:
Lemons vs Limes – Which is Healthier?
Take care!
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Heart Smarter for Women – by Dr. Jennifer Mieres
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Dr. Mieres takes us through understanding our own heart disease risks as individuals rather than as averages. As the title suggests, she does assume a female readership, so if you are a man and have no female loved ones, this might not be the book for you. But aside from that, she walks us through examining risk in the context of age, other health conditions, lifestyle factors, and so forth—including not turning a blind eye to factors that might intersect, such as for example if a physical condition reduces how much we can exercise, or if there’s some reason we can’t follow the usual gold standard of heart-healthy diet.
On which note, she does offer dietary advice, including information around recipes, meal-planning, and what things to always have in stock, as well as what things matter the most when it comes to what and how we eat.
It’s not all lifestyle medicine though; Dr. Mieres gives due attention to many of the medications available for heart health issues—and the pros and cons of these.
The style of the book is very simple and readable pop-science, without undue jargon, and with a generous glossary. As with many books of this genre, it does rely on (presumably apocryphal) anecdotes, though an interesting choice for this book is that it keeps a standing cast of four recurring characters, each to represent a set of circumstances and illustrate how certain things can go differently for different people, with different things then being needed and/or possible. Hopefully, any given reader will find themself represented at least moderately well somewhere in or between these four characters.
Bottom line: this is a very informative and accessible book, that demystifies a lot of common confusions around heart health.
Click here to check out Heart Smarter For Women, and take control of your health!
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How to Use Topical Estrogen Cream For Aging Skin
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Dr. Sam Ellis, dermatologist, explains:
Tackling the cause
Estrogen is important for very many aspects of health beyond the sexual aspects. When it comes to skin, a drop in estrogen (usually because of menopause) leads to changes like collagen loss, dryness, reduced elasticity, and slower wound healing. Applying estrogen creams to the skin can reverse these changes.
If your estrogen levels are already within normal pre-menopausal female ranges, by the way, there isn’t so much science to indicate its benefit when used topically. If you are already on systemic HRT (i.e., you take estrogen already to raise your blood estrogen levels and affect your body in its entirety), you may or may not gain extra benefits from the topical cream, depending on factors such as your estrogen dose, your route of administration, your cardiovascular health, and other factors.
For those with lower estrogen and not currently on HRT, you may be wondering: can topical estrogen cream affect systemic estrogen levels? And the answer is that it mostly depends on the dose. In other words: it’s definitely possible, but for most people it’s unlikely.
As ever, if thinking of taking up any hormonal treatment, do consult an endocrinologist and/or gynecologist, and if you have an increased breast cancer risk (for example genetically or prior history), then an oncologist too, just to be safe.
That sounds like a lot of scary things, but mostly it’s just to be on the safe side. The dose of estrogen is very low in topical creams, and even then, only a tiny amount is used per day.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- “Why Does It Hurt When I Have Sex?” (And What To Do About It) ← because topical estrogen is not just for your face! Yes, you can use it down there too and it’s commonly prescribed for exactly this use.
- Hormones & Health, Beyond The Obvious
- The Hormone Therapy That Reduces Breast Cancer Risk & More
Take care!
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