Thursday, October 28, 2010

Breast Cancer Use of Science in Treatment Decision-Making FDA Tool




October 29, 2010 By Robert Graham -- Bethesda Marriott Conference Center



Joshua Sharfstein, MD, of the FDA Today at the Mid-Atlantic BIO Conference spoke about FDA Issues Assessments of the 510(k) Program and Use of Science in Decision-Making Recommendations focus on innovation, regulatory predictability, and patient safety

Hybrid Pharma Panoincell qX CIO says that Assessment of the 510(K) will help Hybrid Pharma Panoincell qX.

Hybrid Pharma Panoincell qX also uses a Visualize Real-Time Breast Cancer Data using Signal Stochastic Resonance Units Neurons Detection and Analysis for Breast Cancer model after McCulloch-Pitts.

Panoincell qX computer-assisted diagnosing of breast cancer from mammograms. How Panoincell qX works is a genetic network simulation trained with tumor incidence data from knockout experiments.

The genetic network is implemented using a neural
network; knockout genotypes are simulated by removing
nodes in the neural network. Two analyses are used to
interpret the resulting network weights. We use a novel
approach of fixing the network topology that allows knockout
TSG (tumor suppressor gene) data from multiple studies to
overlap and indirectly inform one another. The trained
simulation is validated by reproducing qualitative mammary
cancer susceptibilities of ATM, BRCA1, and p53,p63 TSGs. The work
Panoincell qx is valuable because it allows TSG mammary cancer
susceptibility to be quantified using genetic network
topology and in vivo knockout data.



The U.S. Food and Drug Administration today issued two comprehensive evaluations containing recommendations that address three key objectives of the agency’s public health mission as it relates to medical devices – foster device innovation, create a more predictable regulatory environment, and enhance device safety.

The FDA’s Center for Devices and Radiological Health assessment consists of two preliminary reports. One report focuses on ways to strengthen and clarify a premarket review process called the 510(k) program for medical devices that do not need to undergo a full premarket approval review. The other evaluates CDRH’s use of science in decision-making, with an eye toward adapting to new scientific information, while maintaining regulatory predictability necessary for innovation.

The two documents overlap in several places and cross-reference information. The documents can be found online.

CDRH established two staff committees on these issues in late 2009 as part of its 2010 strategic plan. The committees collected and reviewed input from public meetings, open dockets, data analyses, and input from CDRH staff over the course of several months to prepare the complementary evaluations.

In recent years, concerns have been raised both inside and outside of the FDA about whether the current 510(k) program achieves its goals of making safe and effective devices available to the public while fostering innovation. Concerns about the program have centered on whether it allows devices to enter the market without sufficient safety and effectiveness evidence and whether a lack of predictability, consistency, and transparency is hindering device development.

CDRH uses science to guide its regulation of medical devices across the total product lifecycle. At any stage of that lifecycle, new, unfamiliar or unexpected scientific information may arise that warrants a change in the FDA’s thinking, expectations, and actions. CDRH is seeking to strike the right balance between the ability to adapt its approach as new science emerges and to provide predictable regulatory pathways.

“Taken together, these preliminary reports show a smarter FDA – an agency that recognizes both sides of our mission to protect and promote public health,” said CDRH Director Jeffrey Shuren, M.D. “The agency is ready to make necessary improvements to support device innovation while assuring patients receive safe and effective devices.

“Even with our significant outreach, it’s important to remember that these recommendations are preliminary,” said Shuren. “CDRH opened another public docket to receive additional comments on both reports. We will make a decision on which recommendations to adopt only after a thorough review of additional comments.”

Selected recommendations and the key public health objectives they address include:

Fostering Device Innovation

* The 510(k) report recommends major improvements to the regulatory pathway for lower-risk novel devices that cannot be cleared through 510(k) but which do not warrant the more rigorous premarket approval review applied to higher-risk devices. The report calls for major reforms in the implementation of this process – called the de novo classification process. The recommendations include streamlining the process and clarification of CDRH’s expectations for submissions that undergo this type of review.
* The science report recommends that CDRH make better use of scientific experts outside of the agency by developing a web-based network of external experts using social media technology. This network would help CDRH staff leverage outside knowledge without serving in an advisory capacity.


Enhancing Regulatory Predictability

* The 510(k) report recommends that CDRH develop a guidance document defining a subset of moderate-risk (Class II) devices, called Class IIb, for which clinical or manufacturing data typically would be necessary to support a substantial equivalence determination. This guidance document would help clarify what information submitters should include in their 510(k) submissions so that they can plan accordingly. In addition, this would also help the center’s review staff obtain the type and level of evidence necessary to make well-supported decisions without as much need for time-consuming follow-up requests for information.
* The science report recommends use of a standardized “Notice to Industry” letter that would generally be issued as a "Level 1 - Immediately in Effect" guidance document to quickly communicate when CDRH has changed its premarket regulatory expectations due to scientific information that has emerged about a certain device type. CDRH currently communicates this kind of information through individual interactions during the review process, which can lead to delays. These letters would provide greater clarity to affected manufacturers, in a timelier manner, about CDRH’s expectations with respect to a particular group of devices.


Improving Patient Safety

* The 510(k) report recommends that CDRH consider revising regulations to explicitly require 510(k) submitters to provide a summary of all scientific information known or that the submitter should reasonably know regarding the safety and effectiveness of the device under review. This is not required now for 510(k) submissions and, as a result, relevant information may not be included in an initial submission. This summary would help CDRH review staff to more efficiently make decisions, and potentially avoid extensive follow-up inquiries and questions.
* The 510(k) report recommends that CDRH develop a guidance document that clarifies when a device should not be used as a predicate, such as when the device has been removed from the market because of safety concerns. The report also recommends that the center consider issuing a regulation that would clarify the circumstances under which the center would exercise its authority to rescind a 510(k) clearance to remove an unsafe device from the market and preclude its use as a predicate and also consider whether additional authority is needed.
* Both reports recommend that CDRH build upon public databases to include meaningful, up-to-date information that supports good decision making and promotes the safe use of devices. This could be accomplished by improving the current 510(k) database so that it includes summaries of FDA review decisions, current labeling and photos. In addition, the science report recommends that CDRH build upon the existing transparency website to provide more immediate information on how devices are regulated.

Saturday, October 23, 2010

The p53, p63 and p73 genes is the heart of the war on Breast Cancer


October 25, 2010 By Robert Graham -- Washington DC /Businesswire/
The p53, p63 and p73 genes is the heart of the war on Breast Cancer.When p53 is suppressed, as it is in many cancers, defective cells multiply, fueling Breast Cancer. p53 can't order a bad cell to kill itself without p63 and p73 also being active.

When metastatic Breast Cancer occurs p63 is inactive.The reactivation of TAp63 could benefit patients with metastatic breast cancer.

Viral transduction of a few genes for the reprogramming of
human somatic cells into induced pluripotent stem (iPS) cells.Identifying conditions that can replace viral transduction of oncogenic transcription factors (TFs) and enhance reprogramming efficiency. Hybrid Pharma have found that neural progenitor cells can be reprogrammed with fewer genetic manipulations than previously reported somatic cells, and in the other we have found
that small molecules may be able to replace viral integration of
certain transcription factors and promote the reprogramming process.

Genomic Science indicates that we have to change the breast cancer culture to find a cure. Stem cells and progenitor cells has shown promise. Like stem cells, progenitor cells have a tendency to differentiate into a specific type of cell. In contrast to stem cells,
however, they are already far more specific: they are pushed to
differentiate into their "target" cell. The most important difference
between stem cells and progenitor cells is that stem cells can
replicate indefinitely, whereas progenitor cells can only divide a
limited number of times. Controversy about the exact definition
remains and the concept is still evolving.

Hybrid Medical first direction of research aims to determine
what cell becomes transformed; in other words, the cell of
origin of a breast tumor. In the mammary gland, mammary stem
cells, which can self-renew and differentiate, generate rapidly
dividing progenitors that in turn generate differentiated cells
of the mammary gland epithelial lineages: the luminal and myoepithelial lineages. Cancer is thought to originate in these stem cells or in progenitor cells that have acquired self-renewal. Thus, a first degree of heterogeneity comes from whether a tumor comes from a stem cell or a progenitor cell.

Hybrid second direction aims to determine what genetic alterations
transform a normal breast cell and make it cancerous. The repertoire of genetic alterations can be found by using high-throughput, large-scale methods, such as mass sequencing and array comparative genomic hybridization (aCGH) . These have
revealed a number of alterations – mutations, deletions,
amplifications and fusions – that target hundreds of genes,
suggesting a high level of heterogeneity. Some tumors can
have a high level of genetic instability whereas others can
have an apparently normal genome.


Panoincell qX also uses a Visualize Real-Time Breast Cancer
Data using Signal Stochastic Resonance Units Neurons
Detection and Analysis for Breast Cancer model after McCulloch-Pitts.
Panoincell qX computer-assisted diagnosing of breast cancer from mammograms. How Panoincell qX works is a genetic network simulation trained with tumor incidence data from knockout experiments.

The genetic network is implemented using a neural
network; knockout genotypes are simulated by removing
nodes in the neural network. Two analyses are used to
interpret the resulting network weights. We use a novel
approach of fixing the network topology that allows knockout
TSG (tumor suppressor gene) data from multiple studies to
overlap and indirectly inform one another. The trained
simulation is validated by reproducing qualitative mammary
cancer susceptibilities of ATM, BRCA1, and p53,p63 TSGs. The work
Panoincell qx is valuable because it allows TSG mammary cancer
susceptibility to be quantified using genetic network
topology and in vivo knockout data.

Wednesday, October 13, 2010

Virtually all risk prediction for breast cancer assumes that breast cancer is a homogeneous disease

October 14, 2010 By Robert Graham Reporting -- From New York City at NYU /Businesswire/


Hybrid Medical research shows that Virtually all risk prediction
for breast cancer assumes that breast cancer is a homogeneous disease, i.e. all types of breast cancer have the same risk profiles.

Genomic Science indicates that we have to change the breast cancer culture to find a cure. Stem cells and progenitor cells has shown promise. Like stem cells, progenitor cells have a tendency to differentiate into a specific type of cell. In contrast to stem cells, however, they are already far more specific: they are pushed to differentiate into their "target" cell. The most important difference between stem cells and progenitor cells is that stem cells can replicate indefinitely, whereas progenitor cells can only divide a limited number of times. Controversy about the exact definition remains and the concept is still evolving.

Hybrid Medical first direction of research aims to determine what cell becomes transformed; in other words, the cell of origin of a breast tumor. In the mammary gland, mammary stem cells, which can self-renew and differentiate, generate rapidly dividing progenitors that in turn generate differentiated cells of the mammary gland epithelial lineages: the luminal and myoepithelial lineages. Cancer is thought to originate in these stem cells or in progenitor cells that have acquired self-renewal. Thus, a first degree of heterogeneity comes from whether a tumor comes from a stem cell or a progenitor cell.

Hybrid second direction aims to determine what genetic alterations
transform a normal breast cell and make it cancerous. The repertoire of genetic alterations can be found by using high-throughput, large-scale methods, such as mass sequencing and array comparative genomic hybridization (aCGH) . These have
revealed a number of alterations – mutations, deletions,
amplifications and fusions – that target hundreds of genes,
suggesting a high level of heterogeneity. Some tumors can
have a high level of genetic instability whereas others can
have an apparently normal genome.

For an example when monitoring the activities of a protein
created by a gene associated with breast cancer,
called "ABCC11." By studying this gene and its
complex cellular and molecular interactions in
the body, researchers have discovered a distinct
link between the gene and excessively smelly
armpits and wet, sticky earwax.

Panoincell qX also uses a Visualize Real-Time Breast Cancer
Data using Signal Stochastic Resonance Units Neurons
Detection and Analysis for Breast Cancer model after McCulloch-Pitts Panoincell qX computer-assisted diagnosing of breast cancer from mammograms.

How Panoincell qX works is a genetic network simulation trained
with tumor incidence data from knockout experiments.
The genetic network is implemented using a neural
network; knockout genotypes are simulated by removing
nodes in the neural network. Two analyses are used to
interpret the resulting network weights. We use a novel
approach of fixing the network topology that allows knockout
TSG (tumor suppressor gene) data from multiple studies to
overlap and indirectly inform one another. The trained
simulation is validated by reproducing qualitative mammary
cancer susceptibilities of ATM, BRCA1, and p53 TSGs. The work
Panoincell qx is valuable because it allows TSG mammary cancer
susceptibility to be quantified using genetic network
topology and in vivo knockout data.

Sunday, October 3, 2010

Breaking Ground: Improving the Quality of Life for Cancer Patients



October 04, 2010 By Robert Graham Reporting -- From NIH Washington DC /Businesswire/
Mei R. Fu: A Pioneering Approach to Lymphedema


When Mei R. Fu, RN, PhD, began studying lymphedema, patients received little information on how to treat this common after-effect of breast-cancer treatment or reduce the risk of its occurrence. In fact, Dr. Fu says, it was practically taboo to talk about the condition with patients or to suggest that they had any control over developing it.

Now, Dr. Fu’s groundbreaking research has been credited with starting to change the way the health care system educates patients about controlling this debilitating and feared syndrome. Lymphedema, caused by abnormal accumulation of lymph fluid in the affected areas and arms, leads to persistent and painful swelling, as well as multiple distressing symptoms. It can occur at any time after breast cancer treatment, eventually affecting up to 65 percent of survivors in the United States.

“People used to think that lymphedema was the result of poor surgical techniques and that there was little they could do about it—both of which are untrue,” Dr. Fu says.

In the past 5 to 10 years, there has been growing awareness that lymphedema is a chronic problem that can be controlled and managed. In the past 2 years alone, technology and the availability of information online have significantly changed the attitudes of healthcare providers (including surgeons, oncologists, nurses, physical therapists) and patients.

Dr. Fu’s research, funded by the Avon Foundation, was the first to show that patient education has positive effects on patients’ cognitive-behavioroutcome in lymphedema risk reduction and patients’ symptom outcome, offering patients a major benefit. An abstract, “Lymphedema Education and Risk Reduction in Breast Cancer Survivors,” presented by Dr. Fu with Dr. Judith Haber, Dr. Amber Guth, and Dr. Deborah Axelrod at the Oncology Nursing Society 2008 Annual Congress, was chosen as one of the top 10 highest scoring abstracts among 500 entries, and their manuscript went on to win the Oncology Nursing Society Excellence in Cancer Nursing Research Award in 2009. This study was published in Annals of Surgical Oncology, a prestigious peer-reviewed journal in surgical oncology field and Journal of Nursing Scholarship, a prestigious nursing journal . Dr. Fu has also won the Young Investigator Award from International Lymphology Society for her three qualitative research studies on lymphedema and received the Excellent Service Award from the American Cancer Society for her long committed service and quality speech for cancer patients.]

Based on the findings, Dr. Fu and her research team have developed an intervention called The Optimal You to help patients reduce the risk of lymphedema or improve their symptom experience if they already experience it. With additional funding from Avon, she is testing the intervention with two groups of 120 patients each at the NYU Clinical Cancer Center. The intervention focuses on teaching patients to prevent inflammation and fluid accumulation—the major risk factors—through daily fluid drainage and other symptom-management strategies. The first group is receiving the risk-reduction intervention prior to cancer surgery and is being followed at three intervals after surgery to test its efficacy.
A second group of patients, who already demonstrate lymphedema symptoms, is receiving an intervention to help control their symptoms. This study is the first to focus on fluid drainage and other strategies to manage symptoms. It is also the first to make use of a new, state-of-the-science technology, the perometer, which calculates and tracks very small limb-volume changes, thereby identifying fluid build-up in the arm. The device located at NYU Clinical Cancer Center is one of only several in the country.

“The beauty of this study is that it focuses on risk reduction for people before surgery, so that we can take steps immediately to prevent the onset,” Dr. Fu says.

Is lymphedema still taboo? The culture is changing, according to Dr. Fu, and NYU’s Clinical Cancer Center is leading the way by talking about this difficult syndrome.

The next phase of Dr. Fu’s research involves looking at genetic variations that may put some patients at greater risk for developing lymphedema. She is the principal investigator on a pilot study with colleagues at the University of Pittsburgh, funded by the Pless Center for Nursing Research at the College of Nursing, aiming to explore the effect of r inflammatory genes and those genes related to the lymphatic system.

“We believe that some patients are more prone to inflammation and accumulation of fluid,” Dr. Fu says. “That’s why it’s very important to explore genetic variations, to see who is at greater risk.” Dr. Fu reports that nearly 100% of those patients who have been asked have willingly contributed genetic samples. “This information will give us a clearer idea of how to implement personalized care for those patients who are at greater risk,” she says.

For those patients who have developed lymphedema, Dr. Fu is collaborating with physical therapists at NYU Rusk Rehabilitaiton Center Physical Therapy Department to offer an innovative approach to treat this chronic condition by testing the effectiveness of low level laser therapy through a double-blind, randomized, placebo-controlled study.

Dr. Fu’s collaborators include nationally well-known breast surgeons at NYU Cancer Center, Dr. Deborah Axelrod and Dr. Amber A. Guth; Nurse Scientist, Dr. Francis Cartwright; nationally well-known geneticist, Dr. Yvette Conley at University of Pittsburgh; Physical therapists, Teresa V. Denham PT, MA and Ting Ting Kuo PT,DPT,WCS,CLT at NYU Rusk Rehabilitaiton Center Physical Therapy.
Dr. Fu also serves on the Board of Directors for the Lymphology of North American Association, the Medical Advisory Committee of the National Lymphedema Network, where she has co-chaired the research committee. She serves on the Steering Committee for the American Lymphedema Framework Project, a national partnership with the International Lymphedema Framework (ILF), where she has co-chaired the research and dissemination committee. She also serves as the Editorial Director and the Research Director for Stepup-speakout Organization, a patient advocacy organization to promote lymphedema research, education, and practice. She is on Education Advisory Panel and the Editor for Lymphedema Management Special Interest group for Oncology Nursing Society. In addition, she is also on the editorial board for several peer-reviewed journals, including Advances in Nursing Science, Austral-Asian Journal of Cancer: The International Cancer Journal of Australia and Asia, and Journal of Lymphedema.