Archive for August, 2009

CORT Raising Funds for Susan Komen in Race-for-the-Cure

August 8, 2009

Dear Friends,

CORT has recently accepted the challenge to raise funds to support the 2009 Komen Dallas Race for the Cure®  on October 17th. 

Please join us in the fight by donating in support of my participation in the Race.  Your tax-deductible contribution will fund local outreach and awareness programs for underserved communities in the Dallas County area and national breast cancer research.

Donating is quick and easy.  Click here to visit my personal page and pledge your support.  If you would prefer you can mail a check or money order to my attention to the address below.  No donation is too small.  I truly appreciate your support.


Barry Mirtsching
7777 Forest Land B242

Dallas, TX 75230-2525

To sponsor my participation online, click here.

Proleukin (Interleukin-2) Therapy for Renal Cell Carcinoma: Treatment Option for Select Patients

August 6, 2009

Therapy options for patients with metastatic renal cell carcinoma has expanded significantly, with the FDA approval of sunitinib (Sutent), sorafenib (Nexavar), everolimus (Affinitor), temsirolimus (Torisel), and bevacizumab (Avastin).  These drugs have significant anti-tumor and anti-angiogenic effects.  Progression-free survival (PFS) is improved when compared to placebo or alpha-interferon (Intron-A) therapy.  Many patients will respond to more than one of these agents, and therefore overall outcomes for patients receiving sequential treatments may be improved.   These therapies have expected and manageable toxicities and risks, and are delivered on an outpatient basis.  Nonetheless, these new therapies do not offer curative potential to any patient when used in patients with established metastatic disease.   Patients with reduced overall health and function (performance status) can be treated with these agents.

Interleukin-2 (IL-2, Proleukin) is an FDA approved therapy for metastatic renal cancer.   It is a potent immune stimulator, and it may have anti-angiogenic activity.  Since its clinical development nearly two decades ago, it remains the only therapy with a known curative potential for patients with metastatic renal carcinoma.  Treatment with IL-2 has substantial toxicity, priniciply secondary to capillary leak syndrome and vasodilation, which can result in serious hypotension, fluid accumulation, edema, pulmonary congestion, renal dysfunction, or other organ failure.  Patient selection for this form of therapy is critical.  Only patients with good performance status and adequate kidney, heart, and lung function are potential candidates for IL-2 treatment.  Treatment is delivered on an inpatient basis, under carefully-monitored circumstances, usually in the intensive care unit.  Treatment is delivered by a specialized team of oncologists and nurses, who are familiar with the specific program of IL-2 therapy, and have experience in management and prevention of toxicities.   A critical care physician (ICU physician) is also engaged in management.  Therapy lasts for 5 days, with several additional days potentially required for resolution of treatment-related lab or clinical changes.  Most of the treatment-related side effects abate rapidly after the therapy is completed.  A second cycle of inpatient IL-2 therapy is given after the patient has had a brief period of outpatient recovery.   In studies of IL-2 in metastatic kidney cancer, the overall response rate (out of 255 patients) = 15% (7% complete, 8% partial). That is not higher than other recently-approved medications.  However, the median duration of complete response (CR*) is 6.7+ years (range 7 months – 10+ years).  Those long-term results are not achieved by other treatments for metastatic renal cancer.

Additional information about IL-2 therapy is available at  CORT is a provider for IL-2 therapy in the North Texas area.  Our patients are treated in Medical City Dallas Hospital.

For information about CORT, or to schedule a consultation about treatment of renal cancer, call 972-566-5588 to speak with a Patient Care Coordinator.  Additional information about CORT and directions are available at

Study Tests Extension of Anti-Her-2 Therapy Beyond Herceptin for Early Stage Breast Cancer Patients

August 5, 2009

The Wyeth Study 3144A2-3004-WW testing a new oral drug, neratinib, is active and enrolling at CORT.  This study is open to early-stage, her-2 positive patients who have completed adjuvant therapy and one year of trastuzumab (Herceptin), the current standard-of-care.  Such patients are generally followed without further treatment.  The relapse risk of these patients is reduced by the one year of trastuzumab (see Figure 1: Analysis of Relapse Risk over Time, adapted from Herceptin Product Literature).  

Annual Relapse Risk for Her-2 Positive Early-Stage Breast Cancer Patients, Treated with or without Trastuzumab

As can be seen from the figure, the AC>TH arm has a lower risk of annual recurrence that begins during the first year (the time the treatment with trastuzumab is given), and that benefit continues, when compared to patients treated with chemotherapy alone (AC>T).  However, the risk for recurrence does rise in the trastuzumab-treated patients after the therapy is completed at one year, and that risk remains increased for another 2 or 3 years, at approximately 4.9% per year. 

To address that continued risk, studies testing the extension of anti-her-2 therapy are being conducted.  The Wyeth study at CORT tests the oral anti-her-2 drug neratinib (HKI-272).  The study is a randomized comparison of neratinib versus a neratinib placebo, given daily by mouth for one year.  Neratinib may reduce cardiac function (similar to other her-2 blockers), so function must be monitored.  Other risks include rash, diarrhea, and nausea.  Based on experience with the drug to date, these risks can be managed with supportive care medication and/or dose reduction in most circumstances. 

Patients who have completed one year of adjuvant therapy with trastuzumab (Herceptin), and who are within 2 years of completion of that therapy are eligbile for the Wyeth study at CORT. 

For more information about this study, or to schedule a consultation about management of breast cancer, call 972-566-5588, and ask to speak with a Patient Care Coordinator.   Additional information about this study, and directions to the office are located at:

Prostate Cancer Immunotherapy Study Open at CORT

August 5, 2009

CORT is actively enrolling patients with metastatic hormone-refractory (androgen-independent) prostate cancer in the BMS 184-043 study of ipilimumab (versus placebo).   The study is open to patients who have at least one bone metastasis, and who have progressed after prior therapy with docetaxel (Taxotere).  Other inclusions and exclusions are required.   Ipilimumab is a monoclonal antibody that inhibits the cellular function of CTLA-4.  CTLA-4 inhibits the T-cell immune response to cancer cells, and by blocking this molecule, T-cells are activated.  Ipilimumab is in clinical development in melanoma (also at CORT).  Responses in both metastatic prostate cancer and melanoma have been demonstrated.  The drug is given every 3 weeks IV for four treatments (induction).  Thereafter, for patients with improvement or stability in their disease, the drug is continued every 3 months (maintenance).  The most common risks are rash and diarrhea.  Other risks include changes in pituitary, thyroid, and adrenal function.  Rare auto-immune reactions (some severe and potentially life-threatening) have occurred.

CORT enrolled the first US patient to the prostate cancer study in 6/09. 

To learn more about this study, or to schedule consultation regard this and other treatments for prostate cancer, call 972-566-5588.   Additional information, including directions to the office are located at