Monthly Archives: April 2013

“I got into the clinical trial… I was lucky”. A story about luck, drugs, and cancer treatments.

I had tears in my eyes searching through my emails from three years ago. One of my close friends (and brother of my cartoonist bff) had emailed my sister asking for medical advice. What my friend Junior was after, was a second opinion for his father. He said “our family is in panic since we heard the diagnosis… At home, we are all terribly anguished”, to which my sister replied, “call anytime and we’ll try to help – after all, you are part of the family.”

Junior’s father had been diagnosed with follicular lymphoma, the most common form of non-Hodgkin lymphomas, and they were after a treatment. This was Brazil, where not all drugs are readily available. That’s where my sister comes in: she is a doctor and searched around for hematologist colleagues and experimental treatments. My friend however, is the one who did all the legwork. After several doctors and opinions, he got his father Beco the treatment he needed.

Fast-forward to three years later, where Beco and I reminisce and he tells me more about the ordeal. He describes the initial warning signs of  the disease: “fever, night sweats, and rashes… I discovered my diagnostics by chance, during a tomography exam to find kidney stones.”

The recommended chemotherapy treatment for non-Hogdkin lymphoma (a form of cancer where B-cells are overactive) is a drug cocktail called CHOP. Each letter in the acronym represents a different drug, which are combined with the goal to attack cancer from multiple fronts (e.g., one drugs blocks DNA while another prevents B-cells from multiplying).

Rituximab is a new drug (an antibody that binds B-cell membrane proteins), which can be coupled with the CHOP regimen. Beco tells me on an email that “the difference of coupling rituximab with CHOP is that it gives the patient three extra years in remission.”

The drug targets CD20 proteins on the membrane of B-cells. We don’t know for sure what function those CD20 protein is performing, but it is believed that it acts as a gate for the passage of calcium ions into B-cells. Researchers have looked into that binding mechanism, in which rituximab binds to its target specifically on amino acids 170-173 and 182-185. To get a snapshot of the drug in action, Du et al. obtained an X-ray image of the crystallized rituximab bound with a piece of CD20. The researchers grabbed a small chunk of the CD20 protein corresponding to amino acids 163 to 187 (represented as the tiny string on the image below).

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A panel: Rituximab is represented in yellow and green ribbons. The blue string represents the peptide extracted from CD20. /15073.long B panel shows electron representations, and C panel, a close-up. Image credit: Du et al,

Beco got access to rituximab combined with CHOP, or R-CHOP. He was even able to get a newer generation of drugs, bendamustine. But that’s because my Junior and his family found and signed him in to a clinical trial managed by an American laboratory. “I got into the clinical trial to use rituximab combined with bendamustine, which is a more efficient chemotherapy drug with lighter side effects. The latter is not even available in Brazil – I was lucky!”

Because of his treatment, Beco tells “Since my son found the clinical trial I participated in, the lymphoma is under control. I’m still being treated with rituximab every two months for another year.” And a similar outcome is what we would like to see for other Brazilian patients.

Rituximab is available in Brazil, but not listed under the universal healthcare system. That means that lymphoma patients are treated with CHOP, but not R-CHOP, which increases their lifespan. “It is not a matter of cost, because those patients and the system will spend more money in extra chemotherapy drugs, and will die earlier.”

A Brazilian non-profit organization, Abrale, used a petition to collect signatures of rituximab supporters. The Brazilian ministry of health asked for at least 50.000 signatures to consider adding the drug to the universal health care system. As of the past few weeks, the petition gathered 61.000 signatures.

Beco is now in remission for the past three years. “We hope it stays quiet for a little longer”. And now, it may as well stay quiet for many more Brazilian patients.

Book Review – One Well and Tree of Life

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The water you drank today may have rained down the Amazon rain forest five years ago… A hundred thousand years ago, it may have been frozen solid in a glacier. And a hundred million years ago, it may have quenched the thirst of a dinosaur.”

The inevitable cycle of water in our planet was described above by Rochelle Strauss, in her book One Well: the Story of Water on Earth.

Rochelle is a museum designer and science aficionado. One of her main interests is bringing a message of conservation to children. She recently sent me her two books, One Well and Tree of Life: the Incredible Biodiversity of Life on Earth. The books are beautifully illustrated (by Rosemary Woods and Margot Thompson, respectively), and their clear and concise language reflect their target audience. Rochelle writes for kids of 8-14 years old, but her books can resonate with any of us.

Both books have an underlying theme: how everything is interconnected. In Tree of Life, the author emphasizes how all organisms (plants, lichens, plankton, mammals, and insects) are part of the same web. In One Well, she explains how water cycles through our planet, and highlights our fresh water consumption.

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Tree of life offers a great notion of diversity of life. The pages show increasing number of species, leading toward complexity. At the same time, the author never loses track  of the species relationship in the tree (almost like the “you are here” type maps). I can see Rochelle capturing a child’s attention by telling us of biggest or smallest species inside a tree “branch”. She tells us that “the largest butterfly to flutter by is the Queen Alexandra’s birdwing butterfly. Found in New Guinea, …it is bigger than a dinner plate.”

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In my work I write a lot of content for young audiences, specifically to high schoolers. It can be tricky to communicate science to such a young crowd. One of our solutions is to use concrete, vivid examples that describe science research. Rochelle Strauss does just that over her pages. She uses examples that reach young minds and impress older ones too. Rochelle tells us that a birch tree “drinks” 300 liters, or two bathtubs, of water. Or that there’s more water in earth’s soil and atmosphere than in all rivers combined. In an email, she wrote me that “as for the water usage facts – I know they are quite incredible aren’t they? I actually had so much fun researching and then finding equivalencies to help kids grasp the magnitude of some of the numbers.” I had a lot of fun reading them too.

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The books also carry a powerful message of conservation. That dinner plate butterfly above is endangered due to habitat destruction. We use a lot of potable water for mundane activities (e.g., “it took 130 liters of water to make your bike”) in comparison to other countries without as much water for their disposal. One of the most alarming facts depicted in the story is that North Americans use 55 buckets of water per day, while Indian use seven, and Ethiopians, one.

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Rochelle offers solutions (there is a “notes to parents, guardians, and teachers” section on how to help), but above all, she offers a stimulating account of our natural world.

In my favorite excerpt, we learn that “the average white cloud weigh about twice as much as a blue whale”. A blue whale is a good indicator of scale. That kind of analogy not only makes the topic more approachable, but memorable. “The water you brushed your teeth today may have been the spray of a beluga whale 10 years ago.” I believe these vivid images, more than facts, are what sparks a child’s interest in science.

Find Rochelle Strauss on twitter (@rochellestrauss), on her website, or on Amazon.

New post on PLOS Sci-Ed: Space Education

I have a new post for PLOS’ Science Education blog:

“Life Support Team! We only have 3 minutes of oxygen remaining on the Space Station!”, shouts Commander Libby. Wearing a blue flight suit with middle schoolers clinging to her arm, Libby Norcross is a space enthusiast and teacher at the Challenger Center. She takes groups through the space simulators at the center, while (why not) coming up with some emergencies like the one above.

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Libby Norcross, educator at the Challenger Center. Photo by nasafans tumblr.

Learning from immersive scenarios

The Challenger Center is a learning institution geared towards STEM (science, technology, engineering and math) and offers immersive experiences to children. According to the center, they are an “…educational space simulator and STEM resource center that positively impacts students, businesses, and our community by fostering real-world skills—teamwork, communication, problem solving—in a totally immersive learning environment.”

Continue reading after the jump…