I cannot believe that People magazine (at the top of your reading list, I'm sure) published an open letter by Suzanne Somers to Christina Applegate, who was recently diagnosed with breast cancer. Among other things, in this letter, Somers says "There are more options than the ones presented to you in the oncologist's office." Suzanne Somers is herself a breast cancer survivor who used herbal therapies during her own cancer treatment and is an outspoken advocate of crazy (in my opinion, take it for what you will) hormonal modulation to promote youth, including continuing to take her estrogenic hormones after her cancer diagnosis because she reportedly, "knew more about hormones than the doctor treating her for cancer." (Editorial comment from Noelle: !!!??!?!) This program is given the pseudo-scientific name of "bioidentical hormone replacement."

I feel that by giving her letter "big name" press coverage, you grant some legitimacy to her support of non-evidenced based medicine, further growing mistrust between cancer patients and their providers. The real goal should be to prove (or disprove) the efficacy of the herbal and other nontraditional therapies, then bring those that work into routine clinical practice. Rather than viewing conventional medicine and alternative therapies as mutually exclusive, we should view all possibly effective therapies as the same thing: drugs which need to undergo rigorous clinical trial evaluation to be proven effective.

In a much shinier and happier update, remember that Olympic swimmer with testicular cancer who was delaying his cancer treatments to participate in the games? He will be swimming tonight, 200 breast, Eric Shanteau. He's not favored to medal, but I am still rooting for him.

As a gastrointestinal oncologist, I use irinotecan and 5-FU a lot. We also have in trial at my institution S-1, an oral compound which is a 5-FU prodrug, used primarily in Asia. A lot of the abstracts at ASCO GI every year revolve around S-1. I was somewhat surprised however when I came across a Japanese article about efficacy with S-1 and irinotecan in non–small cell lung cancer from Clinical Cancer Research. This article, by Okamoto, was published today.

This phase-2 study reported that amongst 56 chemotherapy-naïve patients, they found a response rate of 29% and an additional 43% with stable disease, and a median progression free survival of 4.9 months. The side effects were to be expected, with neutropenia, anorexia and leucopenia topping the grade-3 and 4 list. Surprisingly, only 8.9% experienced diarrhea of any grade, but I suspect that is because irinotecan (CPT-11) was only given at 150 mg/m² every three weeks. The S-1 dose was 80 mg/m² days 1-14.

I had seen prior data with cisplatin and irinotecan in small cell lung cancer, but at least at my institution, I don't think that regimen has clearly trumped standard cisplatin and etoposide. But this trial looks more compelling. I wonder if it will make its way into a head-to-head comparison with a platinum doublet in front-line treatment? I'm recalling also that first bevacizumab moved into lung cancer from its previous stronghold only in GI cancers, then cetuximab made the same move, and now this. I'm beginning to feel like a lung cancer doctor!

[Read to the tune of "Making Love Out of Nothing at All" by Air Supply]

Dear grant I am trying to write (can I call you Granty?),

You know I love you. You know I have given you hours and hours of my time, both at work and at home. I even thought about you at my daughter's birthday party, while the kids were whacking away at a piñata. I have thought about you day and night, finessed you, rewritten you over and over. So, Granty, why are you trying to kill me?

You told me you wouldn't take a lot of work. "I'm only 7 pages," you said, the light of the computer monitor shining in your eyes like moonlight. I should have known better. But instead, like a fool, I trusted you again. And so here I sit, my back aching from too many hours of tick-tick-ticking away at the computer. My desk is about a foot deep in Medline search results. I have revised and re-revised and re-re-revised parts of you. And now I am so far in, I have to finish you. It would be a waste not to. You are due next week, and come heck or high water, you're going over for the required signatures, warts and all.

Others who have been here longer than me, been through more grants than years I am old, tell me to get a thick skin. To not be attached to any one grant, because the odds are always against you. But when it happens, when you get that grant acceptance you have been working so hard for, what a high. That's what keeps me hanging on. Granty, you had better not disappoint.

Love,

Noelle