Medical Bulletin 25/December/2023

Here are the top medical news of the day:

Male breast cancer diagnosis fuels groundbreaking treatment tool

Breast cancer rates for men are much lower than women, the American Cancer Society (ACS) estimates that in 2023, about 2,800 men in the United States will be diagnosed with breast cancer and 530 men will die from the disease. Many are diagnosed when the disease has progressed to later stages because it is so rare. Most patients who have metastatic cancer receive palliative care, which does not attempt to cure the disease, but instead focuses on providing relief from the symptoms.

Doctors diagnosed Christopher Gregg, Ph.D., member of the Nuclear Control of Cell Growth and Differentiation Program at Huntsman Cancer Institute at the University of Utah (the U) and neuroscientist and professor of neurobiology and human genetics at the U, with stage 4 metastatic breast cancer in 2018. At that point, he started thinking of ways to improve his treatment.

“The core problem of metastatic cancer is it evolves,” says Gregg. “There may be a treatment that works today but eventually the disease will become resistant over time.” He sought to solve this with a groundbreaking approach called extinction therapy.

Working around the clock, Gregg’s team used data from his own breast cancer treatment to create a prototype. They created an algorithm that uses artificial intelligence to accurately measure patient symptoms detected from vocal and behavioral information captured via smartphone. This allowed them to precisely measure how a patient is doing during their treatments. Based on their symptoms, the algorithm predicts changes to future symptoms. Oncologists will then be able to adjust treatments to help avoid drug toxicity and dangerous side effects, ultimately designing the best plan for each patient.

Gregg identified ways to help with metastatic cancer. After finding a promising study, he asked the researchers to come to a symposium at Huntsman Cancer Institute. There, they all worked together to come up with Gregg’s first treatment plan, extinction therapy.

Reference: Male breast cancer diagnosis fuels groundbreaking treatment tool; HUNTSMAN CANCER INSTITUTE

Palliative care is underused for patients with malignant urinary obstruction

Less than half of patients with malignant ureteral obstruction (MUO) – a serious complication of advanced cancer, with a poor prognosis – receive palliative care (PC) for their condition, reports a paper in the January issue of Urology Practice, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Malignant ureteral obstruction is a condition in which the urinary tract is blocked due to advanced cancer. Patients with MUO have limited life expectancy, and some spend much of their remaining life in the hospital. Over time, MUO leads to buildup of urine within the kidneys, a condition called hydronephrosis. Decompression treatments can relieve the buildup, but these are invasive procedures with high complication rates and sometimes questionable benefits.

For patients with advanced cancer, palliative care aims to improve symptoms and mental and spiritual health while ensuring that any further cancer treatments reflect the patients' goals of care. Hospice care, a subset of palliative care, is an option for patients with expected survival of less than six months.

"Concurrent dedicated palliative care services and oncologic treatment is recommended for patients with advanced cancer," Dr. Felice and colleagues write. However, the use of palliative care by patients with MUO remains unclear. The researchers evaluated the use of palliative care and hospice care among 115 patients diagnosed with MUO between 2014 and 2020.

On review of medical records, only 39% of patients with MUO received palliative care. On average, there was a two-month delay between MUO diagnosis and palliative care evaluation. Just five of 45 patients were referred to palliative care before decisions regarding decompression treatment.

Reference: Palliative care is underused for patients with malignant urinary obstruction; Urology Practice

Researchers map how measles virus spreads in human brain

Mayo Clinic researchers mapped how the measles virus mutated and spread in the brain of a person who succumbed to a rare, lethal brain disease. New cases of this disease, which is a complication of the measles virus, may occur as measles reemerges among the unvaccinated, say researchers.

Using the latest tools in genetic sequencing, researchers at Mayo Clinic reconstructed how a collective of viral genomes colonized a human brain. The virus acquired distinct mutations that drove the spread of the virus from the frontal cortex outward.

"Our study provides compelling data that shows how viral RNA mutated and spread throughout a human organ — the brain, in this case," says Roberto Cattaneo, Ph.D. a Mayo Clinic virologist who is a co-lead author on a new PLOS Pathogens study. "Our discoveries will help studying and understanding how other viruses persist and adapt to the human brain, causing disease. This knowledge may facilitate the generation of effective antiviral drugs."

He first began to study the measles virus about 40 years ago and was fascinated by the rare, lethal brain disease called subacute sclerosing panencephalitis (SSPE), which occurs in about 1 in every 10,000 measles cases. It can take about five to 10 years after the initial infection for the measles virus to mutate and spread throughout the brain. Symptoms of this progressive neurological disease include memory loss, seizures and immobility. Dr. Cattaneo studied SSPE for several years until the lethal disease nearly disappeared as more people were vaccinated against measles.

The researchers discovered that, after the measles virus entered the brain, its genome — the complete set of genetic material for the virus — began to change in harmful ways. The genome replicated, creating other genomes that were slightly different. Then, these genomes replicated again — resulting in more genomes that were each a little different as well. The virus did this multiple times, creating a population of varied genomes.

"In this population, two specific genomes had a combination of characteristics that worked together to promote virus spread from the initial location of the infection — the frontal cortex of the brain — out to colonize the entire organ," says Dr. Cattaneo.

Reference: Researchers map how measles virus spreads in human brain, MAYO CLINIC; PLoS Pathogens