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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Reduce Caffeine’s Impact on Kidneys
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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
❝Avid coffee drinker so very interested in the results Also question Is there something that you could take or eat that would prevent the caffeine from stimulating the kidneys? I tried to drink decaf from morning to night not a good result! Thanks❞
That is a good question! The simple answer is “no” (but keep reading, because all is not lost)
There’s no way (that we yet know of) to proof the kidneys against the stimulating effect of caffeine. This is especially relevant because part of caffeine’s stimulating effect is noradrenergic, and that “ren” in the middle there? It’s about the kidneys. This is just because the adrenal gland is situated next to them (actually, it’s pretty much sitting on top of them), hence the name, but it does mean that the kidneys are about the hardest thing in the body to have not effected by caffeine.
However! The effects of caffeine in general can be softened a little with l-theanine (found in tea, or it can be taken as a supplement). It doesn’t stop it from working, but it makes the curve of the effect a little gentler, and so it can reduce some unwanted side effects.
You can read more about l-theanine here:
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Yoga that Helps You on the Loo
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How This Video Helps You Poo
When you’re feeling a bit bloated, Yoga With Bird’s 10-minute yoga routine promises to help you release…your gas. And, perhaps, more.
From a tabletop flow to soothing twists, each pose allows you to sync your breath with movement, helping to promote organic relief.
With options to modify with pillows for extra support, this video (below) caters to everyone needing a digestive reset.
Other Toilet Tricks
If yoga isn’t your thing, or you’re interested in trying to use different methods to make your visits to the bathroom a bit easier, we’ve spoken about the ways to manage gut health, and use of probiotics or fiber, and even the prevention of hemorrhoids.
Namaste and goodbye to bloat!
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Banana Bread vs Bagel – Which is Healthier?
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Our Verdict
When comparing banana bread to bagel, we picked the bagel.
Why?
Unlike most of the items we compare in this section, which are often “single ingredient” or at least highly standardized, today’s choices are rather dependent on recipe. Certainly, your banana bread and your bagels may not be the same as your neighbor’s. Nevertheless, to compare averages, we’ve gone with the FDA’s Food Central Database for reference values, using the most default average recipes available. Likely you could make either or both of them a little healthier, but as it is, this is how we’ve gone about making it a fair comparison. With that in mind…
In terms of macros, bagels have more than 2x the protein and about 4x the fiber, while banana bread has slightly higher carbs and about 7x more fat. You may be wondering: are the fats healthy? And the answer is, it could be better, could be worse. The FDA recipe went with margarine rather than butter, which lowered the saturated fat to being only ¼ of the total fat (it would have been higher, had they used butter) whereas bagels have no saturated fat at all—which characteristic is quite integral to bagels, unless you make egg bagels, which is rather a different beast. All in all, the macros category is a clear win for bagels, especially when we consider the carb to fiber ratio.
In the category of vitamins, bagels have on average more vitamin B1, B3, B5, and B9, while banana bread has on average more of vitamins A and C. A modest win for bagels.
When it comes to minerals, bagels are the more nutrient dense with more copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while banana bread is not higher in any minerals. An obvious and easy win for bagels.
Closing thoughts: while the micronutrient profile quite possibly differs wildly from one baker to another, something that will probably stay more or less the same regardless is the carb to fiber ratio, and protein to fat. As a result, we’d weight the macros category as the more universally relevant. Bagels won in all categories today, as it happened, but it’s fairly safe to say that, on average, a baker who makes bagels and banana bread with the same levels of conscientiousness for health (or lack thereof) will tend to make bagels that are healthier than banana bread, based on the carb to fiber ratio, and the protein to fat ratio.
Enjoy!
Want to learn more?
You might like to read:
- Should You Go Light Or Heavy On Carbs?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Wholewheat Bread vs Seeded White – Which is Healthier?
Take care!
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How Does Fat Actually Leave The Body? Where Does It Go?
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Fat loss is often misunderstood, with many believing it simply “vanishes” through exercise, is simply excreted in solid form in the bathroom, or materially disappears when converted for energy. However, the principle of conservation of mass plays out here, in that the mass in fat doesn’t disappear—it changes its arrangement:
In and out
Fat is composed of carbon, hydrogen, and oxygen atoms, with an example common form of fat in the body being C55H104O6. That’s a lot of Cs and Hs, and a few Os.
When fat leaves the body, it has been primarily converted into carbon dioxide (CO2) and water (H2O).
According to a 2014 study by the University of South Wales, 84% of the mass of fat exits the body as CO2 exhaled through breathing, while 16% leaves as water through sweat, urine, and other bodily fluids (all of which contain H2O).
You’ll notice there are a lot more Os going out, proportionally, than we originally had in the C55H104O6. For this reason, the process requires oxygen intake; for every 10 kilograms of fat burned, by simple mathematics the body needs around 29 kilograms of oxygen.
Physical activity plays a crucial role in fat loss. When the body exerts itself, it naturally switches to a higher oxygen metabolism necessary for fat breakdown. This effect is amplified during intermittent fasting, which boosts human growth hormone (HGH), a hormone that aids in fat metabolism.
However, simply hyperventilating won’t work; exercise is essential to activate these processes—otherwise it’s just a case of oxygen in, oxygen out, without involving the body’s chemical energy reserves.
Consequently, one of the best diet-and-exercise combinations for fat loss is intermittent fasting with high-intensity interval training.
And, as for what to eat, this video says raw vegan, but honestly, that’s not scientific consensus. However, a diet rich in unprocessed (or minimally processed) fruits and vegetables definitely is where it’s at, with the plant-heavy Mediterranean diet generally scoring highest—which can be further improved by skipping the mammals to make it pesco-Mediterranean. Current scientific consensus does not give any extra benefits for also omitting moderate consumption of fish and fermented dairy products, so include those if you want, or skip those if you prefer.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
Are You A Calorie-Burning Machine? (Calorie Mythbusting)
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From banning junk food ads to a sugar tax: with diabetes on the rise, we can’t afford to ignore the evidence any longer
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There are renewed calls this week for the Australian government to implement a range of measures aimed at improving our diets. These include restrictions on junk food advertising, improvements to food labelling, and a levy on sugary drinks.
This time the recommendations come from a parliamentary inquiry into diabetes in Australia. Its final report, tabled in parliament on Wednesday, was prepared by a parliamentary committee comprising members from across the political spectrum.
The release of this report could be an indication that Australia is finally going to implement the evidence-based healthy eating policies public health experts have been recommending for years.
But we know Australian governments have historically been unwilling to introduce policies the powerful food industry opposes. The question is whether the current government will put the health of Australians above the profits of companies selling unhealthy food.
benjamas11/Shutterstock Diabetes in Australia
Diabetes is one of the fastest growing chronic health conditions in the nation, with more than 1.3 million people affected. Projections show the number of Australians diagnosed with the condition is set to rise rapidly in coming decades.
Type 2 diabetes accounts for the vast majority of cases of diabetes. It’s largely preventable, with obesity among the strongest risk factors.
This latest report makes it clear we need an urgent focus on obesity prevention to reduce the burden of diabetes. Type 2 diabetes and obesity cost the Australian economy billions of dollars each year and preventive solutions are highly cost-effective.
This means the money spent on preventing obesity and diabetes would save the government huge amounts in health care costs. Prevention is also essential to avoid our health systems being overwhelmed in the future.
What does the report recommend?
The report puts forward 23 recommendations for addressing diabetes and obesity. These include:
- restrictions on the marketing of unhealthy foods to children, including on TV and online
- improvements to food labelling that would make it easier for people to understand products’ added sugar content
- a levy on sugary drinks, where products with higher sugar content would be taxed at a higher rate (commonly called a sugar tax).
These key recommendations echo those prioritised in a range of reports on obesity prevention over the past decade. There’s compelling evidence they’re likely to work.
Restrictions on unhealthy food marketing
There was universal support from the committee for the government to consider regulating marketing of unhealthy food to children.
Public health groups have consistently called for comprehensive mandatory legislation to protect children from exposure to marketing of unhealthy foods and related brands.
An increasing number of countries, including Chile and the United Kingdom, have legislated unhealthy food marketing restrictions across a range of settings including on TV, online and in supermarkets. There’s evidence comprehensive policies like these are having positive results.
In Australia, the food industry has made voluntary commitments to reduce some unhealthy food ads directly targeting children. But these promises are widely viewed as ineffective.
The government is currently conducting a feasibility study on additional options to limit unhealthy food marketing to children.
But the effectiveness of any new policies will depend on how comprehensive they are. Food companies are likely to rapidly shift their marketing techniques to maximise their impact. If any new government restrictions do not include all marketing channels (such as TV, online and on packaging) and techniques (including both product and brand marketing), they’re likely to fail to adequately protect children.
Food labelling
Food regulatory authorities are currently considering a range of improvements to food labelling in Australia.
For example, food ministers in Australia and New Zealand are soon set to consider mandating the health star rating front-of-pack labelling scheme.
Public health groups have consistently recommended mandatory implementation of health star ratings as a priority for improving Australian diets. Such changes are likely to result in meaningful improvements to the healthiness of what we eat.
Regulators are also reviewing potential changes to how added sugar is labelled on product packages. The recommendation from the committee to include added sugar labelling on the front of product packaging is likely to support this ongoing work.
But changes to food labelling laws are notoriously slow in Australia. And food companies are known to oppose and delay any policy changes that might hurt their profits.
Health star ratings are not compulsory in Australia. BLACKDAY/Shutterstock A sugary drinks tax
Of the report’s 23 recommendations, the sugary drinks levy was the only one that wasn’t universally supported by the committee. The four Liberal and National party members of the committee opposed implementation of this policy.
As part of their rationale, the dissenting members cited submissions from food industry groups that argued against the measure. This follows a long history of the Liberal party siding with the sugary drinks industry to oppose a levy on their products.
The dissenting members didn’t acknowledge the strong evidence that a sugary drinks levy has worked as intended in a wide range of countries.
In the UK, for example, a levy on sugary drinks implemented in 2018 has successfully lowered the sugar content in UK soft drinks and reduced sugar consumption.
The dissenting committee members argued a sugary drinks levy would hurt families on lower incomes. But previous Australian modelling has shown the two most disadvantaged quintiles would reap the greatest health benefits from such a levy, and accrue the highest savings in health-care costs.
What happens now?
Improvements to population diets and prevention of obesity will require a comprehensive and coordinated package of policy reforms.
Globally, a range of countries facing rising epidemics of obesity and diabetes are starting to take such strong preventive action.
In Australia, after years of inaction, this week’s report is the latest sign that long-awaited policy change may be near.
But meaningful and effective policy change will require politicians to listen to the public health evidence rather than the protestations of food companies concerned about their bottom line.
Gary Sacks, Professor of Public Health Policy, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Why We Sleep – by Dr Matthew Walker
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- We all know sleep is important.
- We all know that without it, we’ll suffer rapid cognitive decline.
- We all know approximately what we’re supposed to do to get good sleep.
So what does this book bring to the table? Mostly, deep understanding (written from the perspective of a career in sleep science) presented in such a way as to be applicable, by you, in your life. Stop sabotaging yourself before you even get out of your bed in the morning!
Hustle culture champions early mornings and late nights, and either or both of those might be difficult to avoid. But to make what you’re doing sustainable, you’re going to have to make some informed decisions about looking after your #1 asset—you!
Dr. Walker writes in a clear and accessible fashion, without skimping on the hard science, and always with practical application in mind. All in all, we can’t recommend this one enough.
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