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Prostate cancer: Doctors excited about forthcoming therapy

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Dale Cousins was thrilled when he saw his body scans from before and after a new prostate cancer treatment.

“(The doctor) said, ‘Do you see any difference?'” the 79-year-old from Petrolia, Ont., recalled.

“I said, ‘all these spots around my abdomen, they’re gone.'”

Cousins is part of a clinical trial of radioligand therapy, or RLT — a precise targeting of cancer cells with radiation given intravenously. Oncologists say RLT is poised to become a new “pillar” of cancer care, alongside surgery, chemotherapy and radiation. But unlike Cousins, prostate cancer patients who aren’t in a clinical trial don’t have free access to it.

“We’re able to deliver this very specific therapy to specific cells in the body,” said Dr. David Laidley, a nuclear oncologist with Western University and London Health Sciences Centre.

“We’re able to deliver lethal radiation therapy specifically targeted to cancer cells and at the same time generally sparing the normal tissues,” said Laidley, who is the principal investigator for the London, Ont., site of the Canada-wide clinical trial comparing RLT to chemotherapy.

Cousins was diagnosed with prostate cancer in 2010 and has been through many treatments, including surgery. After being stable for several years, a scan last year revealed his cancer had spread and he was enrolled in the trial.

With the last of his six RLT infusions coming on July 10, Cousins has already had a “dramatic reduction” in cancerous lesions and his prostate specific antigen levels have decreased significantly, suggesting an “excellent response,” Laidley said.

Past clinical trials have already shown RLT’s effectiveness, leading to Health Canada approving Pluvicto — the radioactive drug that kills the targeted cancer cells — in August 2022 for patients whose prostate cancer has spread and chemotherapy has failed.

But almost two years later, advanced prostate cancer patients still can’t get public access to radioligand therapy because negotiations on how much it should cost government health plans are ongoing.

While waiting for that decision, there are men with prostate cancer who need the treatment to improve their quality of life and live longer, Laidley said.

“Oncologists are asking ‘can we refer patients or is this an option?’ And unfortunately, we have to say that it’s not available.”

Right now, radioligand therapy for cancer is only publicly available for patients with neuroendocrine tumours, an uncommon but not rare cancer that starts in neuroendocrine cells in the gastrointestinal system or the pancreas, said Dr. Simron Singh, a medical oncologist at Sunnybrook Health Sciences Centre in Toronto.

Singh was the global principal investigator for a recent international clinical trial that found another radioactive drug delivered through RLT, called Lutathera, reduced neuroendocrine tumour progression and death by 72 per cent when given early after a patient’s diagnosis.

Like Pluvicto, Lutathera was already approved in Canada as a last line of cancer treatment but the trial results, published in The Lancet last month, were the first to show that RLT could be used as a “starting treatment,” said Singh, who is the co-founder of Sunnybrook’s Susan Leslie Clinic for Neuroendocrine Tumours.

In addition to neuroendocrine and prostate cancer, radioligand treatment using different radioactive drugs is currently in clinical trials for other types of cancers, he said.

“This is a new pillar (in cancer care) that we’re developing,” Singh said.

“It’s going to revolutionize the way we treat cancer completely in the years to come.”

RLT works by finding a target, which is usually a receptor on the surface of cancer cells that doesn’t exist in healthy tissue, he said.

Successful radioligand therapy depends on identifying that receptor in each patient’s cancer cells using a PET scan, then delivering the right radioactive medication — like Pluvicto for prostate cancer and Lutathera for neuroendocrine tumours — that will bind to the cancer cells and kill them without harming healthy cells, he said.

The Canadian Cancer Society calls radioligand therapy “a remarkable breakthrough” that started with Lutathera for neuroendocrine cancer around 2018.

”We saw patients having metastases all over their body and then with one or two treatments completely cleared up. It’s incredible,” said Stuart Edmonds, a pharmacology expert and the cancer society’s executive vice-president of mission, research and advocacy.

RLT also has “considerably lower” side-effects compared to traditional radiation because it minimizes harm to healthy cells, Edmonds said.

Now that RLT’s effectiveness in prolonging life for patients with metastatic prostate cancer who have run out of other treatment options has been proven, the cancer society is funding clinical trials across Canada looking at whether Pluvicto can be used for prostate cancer patients in much earlier stages of the disease.

In the meantime, Edmonds said it’s “tremendously important” to make Pluvicto publicly accessible for advanced prostate cancer patients.

“I just want it to be available in Canada as soon as possible,” he said.

Global pharmaceutical company Novartis manufactures both Pluvicto and Lutathera.

Both the company and the agency in charge of negotiating drug pricing confirmed to The Canadian Press that they have not yet reached an agreement on how much Pluvicto should cost.

The negotiations began in August of last year, but then had “an unanticipated delay,” said Dominic Tan, acting CEO of the pan-Canadian Pharmaceutical Alliance in an emailed statement.

“The pCPA always strives to complete the process as quickly as circumstances allow,” Tan said.

“However, negotiations are a two-way street, and as such we are unable to provide a precise timeline for when the process will be complete.”

Novartis said it recognizes the “high unmet need” of advanced prostate cancer patients.

“It is with these patients in mind that we continue to actively collaborate with the pCPA with the goal of achieving timely and responsible access to this therapeutic advance,” Novartis Canada spokesperson Rosa D’Acunti said in an emailed statement.

“We are hopeful that an agreement with pCPA that recognizes the significant innovation Pluvicto represents and the value it brings to patients is within reach.”

This report by The Canadian Press was first published July 6, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content. 

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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