Tuesday, November 28, 2017

Cancer drug starts clinical trials in human brain-cancer patients

From Science Daily.
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A drug that spurs cancer cells to self-destruct has been cleared for use in a clinical trial of patients with anaplastic astrocytoma, a rare malignant brain tumor, and glioblastoma multiforme, an aggressive late-stage cancer of the brain. This phase Ib trial will determine if the experimental drug PAC-1 can be used safely in combination with a standard brain-cancer chemotherapy drug, temozolomide.

The trial is approved for patients who have seen their cancer progress after first-line therapy. This is an extension of an ongoing human phase I clinical trial of PAC-1 alone in patients with various late-stage cancers. Phase I trials are designed to test the safety of new drugs in human patients.

PAC-1 is unusual in that it is able to cross the blood-brain barrier, a formidable obstacle to most anti-cancer drugs. The drug targets procaspase-3, an enzyme that is overexpressed in many cancer cells, said University of Illinois chemistry professor Paul Hergenrother, who discovered PAC-1's anti-cancer effects more than a decade ago. After tests in human cell lines and rodents proved promising, Hergenrother and veterinary oncologist Dr. Timothy Fan, a professor of veterinary clinical medicine at Illinois, tested PAC-1 in pet dogs with a variety of naturally occurring cancers.

"Most cancers have elevated levels of procaspase-3," Hergenrother said. "When it is turned on, procaspase-3 kills cells."

Cancer cells override this normal cell-recycling pathway, however, he said.

"PAC-1 restores the activation of procaspase-3 and, because this enzyme is elevated in cancer cells, targets cancer cells over noncancerous cells," he said.

PAC-1 has been evaluated in pet dogs with naturally occurring osteosarcoma, lymphoma and, most recently, glioma -- a brain cancer similar to glioblastoma in humans. One 2016 study found that the combination of PAC-1 with doxorubicin, a chemotherapeutic agent that also is used in humans, saw tumor reductions in four of four dogs with lymphoma and in three of six dogs with osteosarcoma. The trials in dogs continue and, so far, have found PAC-1 to be safe, with few observable side effects apart from occasional gastrointestinal distress. The researchers report their latest findings in rodents and in dogs with brain cancer in the journal Oncotarget.

Dogs with certain naturally occurring cancers may be better than other animal models of human cancers because mice and rats used in many cancer drug-testing models must be implanted with human cancer cells to mimic specific types of tumors, Fan said.

"This requires that the rodents be immunocompromised to mitigate rejection of human cells," he said. "As such, most rodent tumor models do not faithfully recapitulate the tumor microenvironment -- in particular, the body's immune surveillance of the tumor.

"Rodent models are limited, but they are still useful," Fan said.

Certain cancers in dogs are genetically similar to those in humans and respond to the same medications. Dogs also are more similar in size to humans, and so can be better models to evaluate how well drug agents perform on larger tumor masses.

"I look at pets with spontaneous tumors as being complementary to rodent models and recognize that not all discoveries in pet dogs will necessarily translate similarly to people," Fan said.

The ongoing clinical trial of PAC-1 in human patients with late-stage solid tumors and lymphoma has shown that the drug is well-tolerated at tested doses up to 450 milligrams per day, said medical oncologist Dr. Arkadiusz Dudek, who chairs an advisory board for Vanquish Oncology, which is funding the clinical trials.

The extension of the phase I trial to brain-cancer patients will begin with a PAC-1 dose of 375 mg per day and will increase the dose incrementally to test its safety in combination with the standard brain-cancer chemotherapy agent, temozolomide, he said.

So far, the clinical trials of PAC-1 alone have seen no significant side effects in humans. None of the human patients in the first five dose levels of the single-agent trial has dropped out as a result of side effects, the researchers report. The team cannot report on clinical outcomes in a phase I clinical trial, since such trials are designed to measure safety, not efficacy.

Surgery is a first-line therapy for anaplastic astrocytoma, followed by treatment with temozolomide, a chemotherapy drug that is one of the few effective treatments for brain cancer, Dudek said. Humans with glioblastoma multiforme usually undergo surgery to remove as much of the cancerous tissue as possible, followed by radiation and oral treatment with temozolomide.

It is almost impossible to find and remove all glioblastoma cancer cells in surgery, however, Dudek said.

"Glioblastoma multiforme has this feature of spreading silently along the blood vessels inside the brain," he said. "That's a reason why most patients will unfortunately have disease coming back later on after surgery and radiation."

The median survival time for human patients with glioblastoma undergoing the standard treatment is about 15 months.

The three dogs in the glioma trial received daily oral doses of PAC-1 in combination with temozolomide and "curative-intent" radiation.

Temozolomide is normally too expensive to use in canine patients, Fan said. The dogs tolerated the combination treatment very well and responded well to the therapy, he said.

"All three dogs had, at the very least, what we call a partial response, which means more than a 30 percent reduction in the tumor," he said. "And one of the dogs had a complete response, as identified with serial MRI scans, with a 100 percent reduction in the tumor mass 84 days after combination therapy."

Fan said a much larger study in dogs would be needed to determine whether the therapeutic effects were consistent and reproducible, and to quantify how much PAC-1 contributed to the positive results.

Vanquish Oncology, a drug-development startup company Hergenrother helped found in 2011, has licensed the technology from the University of Illinois and is focused on moving PAC-1 into the clinic. As with any investigational agent, determining the true safety and efficacy profile of PAC-1 will take several years of human clinical trials.

An example of the importance of considering tradeoffs

Matt Ridley's blog entry "Beware The Fall Armyworm" shows the consequences of failing to consider tradeoffs.

Yes, beware the fall Armyworm - but also beware single issue thinking.
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An even more dangerous foe than Robert Mugabe is stalking Africa. Early last year, a moth caterpillar called the fall armyworm, a native of the Americas, turned up in Nigeria. It has quickly spread across most of Africa. This is fairly terrifying news, threatening to undo some of the unprecedented improvements in African living standards of the past two decades. Many Africans depend on maize for food, and maize is the fall armyworm’s favourite diet.

Fortunately, there is a defence to hand. Bt maize, grown throughout the Americas for many years, is resistant to insects. The initials stand for a bacterium that produces a protein toxic to insects but not to people. Organic farmers have been using the bacterium as a pesticide for more than five decades, but it is expensive. Bt maize has the protein inside the plant, thanks to genetic engineers, who took a gene from the bacterium and put it in the plant.
Bt maize has largely saved Brazil’s maize crop from fall armyworms.

However, influenced by European environmentalists, most African countries forbid the growing of genetically modified crops. This is a pity, because unless they change their attitude fast, they will face the prospect of using far more pesticides, which small-scale farmers cannot afford, and which come with environmental and safety risks, or suffering famine, relieved by expensive imports of food.

Fortunately, inch by inch Africa is changing its mind on biotech crops, though only South Africa has approved Bt maize. Nigeria, Uganda, Ethiopia and Kenya are slowly changing their legislation. But bureaucrats with empires to build keep putting roadblocks in the way of change, and environmental pressure groups are campaigning to undermine the efforts.

Some years ago I spoke to the leaders of a large charity working with African farmers and asked them why they did not come out in support of biotechnology. They replied that they dared not do so for fear of retribution from the big environmental pressure groups, such as Greenpeace, for which opposition to biotechnology is a totemic issue when fundraising in Europe.

Money came before humanity, in other words. Greenpeace’s former director, Stephen Tindale, changed his mind about biotechnology and said two years ago, before his death: “I worry for Greenpeace and the other green groups because they could, by taking such a hard line . . . be seen to be putting ideology before the need for humanitarian action.”

Last year 129 winners of the Nobel prize signed a letter, saying: “We urge Greenpeace and its supporters to re-examine the experience of farmers and consumers worldwide with crops and foods improved through biotechnology.” Yet Greenpeace remains opposed to biotech crops. The European Parliament also voted to accept a Green Party report arguing against involvement in a new international agricultural technology initiative in Africa because of the involvement of biotech firms. A Kenyan farmer, Gilbert Arap Bor, wrote: “They want us to remain agricultural primitives, stuck with technologies that were antiquated even before we entered the 21st century.”

More than half of the two billion people who will be added to the world’s population by 2050 will be Africans. Yet feeding the continent’s growing population, largely from African farms, is possible. And, like Asia before it, Africa can initially prosper through agriculture more than any other industry, but only if there is a green revolution of farming modernisation comparable to what happened in Asia in the Sixties.

The average yield of an African maize crop is less than a quarter of that of a North American crop, even before the effect of the fall armyworm. This is largely down to a lack of fertilisers, pesticides, hybrid seeds and biotechnology, and frequent drought. Hybrid seeds alone, produced by conventional breeding, can deliver improvements in yield of 20 to 30 per cent, I’m told. Drought-resistant varieties, also conventionally produced, can double the yield. But neither helps against the fall armyworm.

The African Agricultural Technology Foundation is co-ordinating a public-private partnership called Water Efficient Maize for Africa (Wema). Its aim is to develop drought-tolerant and insect-protected maize using both biotechnology and modern techniques of conventional breeding. Its first product, a drought-tolerant, white maize hybrid seed, was delivered to farmers in Kenya four years ago. It resulted in a harvest of 4.5 tons per hectare, compared with 1.8 tons normally. The Wema project has the support of industry to make the varieties available royalty-free to smallholder farmers in sub-Saharan Africa through African seed companies. Monsanto, for example, is giving away its intellectual property in the region.

Ah, say its critics, but Monsanto is hoping that Africans will use its hybrids and thus become rich enough to buy more seeds from it one day. Yes, and what is wrong with that? Suppose Wema does result in many African smallholders earning enough money to buy a tractor, put a child through school and go into the market in search of the best seeds, as well as sufficient fertiliser? Where’s the problem? All right, say the critics, but resistance to the Bt toxin is already developing in fall armyworms in Brazil. True, but so is resistance to insecticides. Agriculture is an arms race against the other species, and newer techniques should keep us easily one step ahead, so long as we do not prevent them.

The next technology to help farming will be gene-editing, different from the transgenic technique that produced Bt maize, and involving the introduction of no foreign DNA, the thing that critics say they most object to. A tweak to the genes of maize can make it resistant to maize lethal necrosis, a viral disease hurting yields in parts of Africa. There is an opportunity for Britain here. Freed from Europe’s deadly precautionary principle, British plant scientists could be well placed to support their colleagues in Africa.

Those who think poverty a price worth paying for nostalgia say we should go back to traditional agriculture, in better harmony with the land. Not if we want wildlife. Globally, if we had the yields of 1960 we would need more than twice as much land to feed today’s population. In which case, you could kiss goodbye to all rainforests, nature reserves and national parks.

North Korea: a high price now or an even higher price later?

Here is Zev Chafets in the Jewish World Review.

ZC is a journalist and author of 14 books. He was a senior aide to Israeli Prime Minister Menachem Begin and the founding managing editor of the Jerusalem Report Magazine.

ZC is on target.

People who characterize consequences as "unthinkable" are people who simply refuse to think and address reality.  It's a version of "peace in our time" that ignores that the "unthinkable" can become way worse.
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Israel and North Korea are on opposite sides of the Asian landmass, separated by 5,000 miles as the ICBM flies. But Israelis feels close to the nuclear standoff between Washington and Pyongyang. They have faced this sort of crisis before, and may again.

In the mid-1970s, it became clear to Israel that Iraq's Saddam Hussein was working on acquiring nuclear weapons and missiles to deliver them. Saddam had already demonstrated an uninhibited brutality in dealing with his internal enemies and his neighbors. He aspired to be the leader of the Arab world. Defeating Israel was at the top of his to-do list.

After coming to office in 1977, Israeli Prime Minister Menachem Begin tried to convince the U.S. and Europe that Saddam was a clear and present danger to the Jewish state, and that action had to be taken. Begin was not taken seriously.

But Begin was serious, and in 1981 he decided that Israel would have to stop the Iraqi dictator all by itself. His political opponents, led by the estimable Shimon Peres, considered this to be dangerous folly. Foreign Minister Moshe Dayan, the legendary former military chief of staff, voted against unilateral action on the grounds that it would hurt Israel's international standing. Defense Minister Ezer Weizmann, the former head of the air force (and Dayan's brother-in-law) was also against a military option. He thought the mission would be unacceptably risky.

Begin had no military expertise. But his family had been wiped out in the Holocaust. He looked at Saddam, who was openly threating Israel, and saw Hitler. To Begin, sitting around hoping for the best was not a strategy; it was an invitation to aggression. If there was going to be a cost -- political, diplomatic, military -- better to pay before, not after, the Iraqis had the bomb.

In the summer of 1981, Begin gave the order. The Israeli air force destroyed the Osirak reactor. The United Nations Security Council condemned the attack. The Europeans went bonkers. The New York Times called it "inexcusable." But the Israeli prime minister wasn't looking to be excused by the Times or the Europeans or even the usually friendly Ronald Reagan administration. He enunciated a simple rationale that would come to be known as the Begin Doctrine: Israel will not allow its avowed enemies to obtain the means of its destruction.

The wisdom of this doctrine became clear a decade later, during the Gulf War, when Saddam made good on his threat to fire Russian-made SCUD missiles at Israeli cities. The SCUDs landed, and caused some damage and a fair amount of panic, but they were not armed with unconventional warheads. Israel had taken that option off the table.

Similarly, in 2007, Israel confirmed what it had suspected for five years: Syria, with North Korean help, was trying to build a nuclear reactor. Prime Minister Ehud Olmert, a Begin disciple, sent Mossad chief Meir Dagan to Washington, to ask for American intervention. The CIA chief, Michael Hayden, agreed with Israel's contention that Damascus (with Iranian financing) was constructing the reactor. But Hayden convinced President George W. Bush that bombing the site would result in all-out war, and who wants that?

Acting on its own, Israel destroyed the Syrian site (reportedly killing a group of North Korean experts in the process). Hayden was wrong about how Syria would react, as he later admitted. If Israel had been reasonable and listened to the CIA, Bashar al-Assad would have nuclear weapons right now.

Sunday, November 26, 2017

Thomas Jefferson on Government and the General Welfare

Thomas Jefferson was, unfortunately, prescient.  We are no longer free.
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“They are not to do anything they please to provide for the general welfare…. [G]iving a distinct and independent power to do any act they please which may be good for the Union, would render all the preceding and subsequent enumerations of power completely useless. It would reduce the whole instrument to a single phrase, that of instituting a Congress with power to do whatever would be for the good of the United States; and as they sole judges of the good or evil, it would be also a power to do whatever evil they please.”

Judge Learned Hand

JLH got it right, unfortunately.

Too many of today's citizens prefer handouts to liberty.
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“Liberty lies in the hearts of men and women; when it dies there, no constitution, no law, no court can save it; no constitution, no law, no court can even do much to help it.”

James Madison in 1788

James Madison got it right - unfortunately.
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“There are more instances of the abridgment of the freedom of the people by gradual and silent encroachments of those in power than by violent and sudden usurpations.”

Benjamin Franklin knew it back then

Too bad, too many don't know this today.
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“I am for doing good to the poor, but I differ in opinion of the means. I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it. In my youth I travelled much, and I observed in different countries, that the more public provisions were made for the poor, the less they provided for themselves, and of course became poorer. And, on the contrary, the less was done for them, the more they did for themselves, and became richer.”

John Adams in 1774

We have arrived, too bad.
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“Nip the shoots of arbitrary power in the bud, is the only maxim which can ever preserve the liberties of any people. When the people give way, their deceivers, betrayers, and destroyers press upon them so fast, that there is no resisting afterwards. The nature of the encroachment upon the American constitution is such, as to grow every day more and more encroaching. Like a cancer, it eats faster and faster every hour. The revenue creates pensioners, and the pensioners urge for more revenue. The people grow less steady, spirited, and virtuous, the seekers more numerous and more corrupt, and every day increases the circles of their dependents and expectants, until virtue, integrity, public spirit, simplicity, and frugality, become the objects of ridicule and scorn, and vanity, luxury, foppery, selfishness, meanness, and downright venality swallow up the whole society. “

Walter Williams scores yet again

Walter E. Williams is a professor of economics at George Mason University.
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A common feature of our time is the extent to which many in our nation have become preoccupied with diversity. But true diversity obsession, almost a mania, is found at our institutions of higher learning. Rather than have a knee-jerk response for or against diversity, I think we should ask just what is diversity and whether it’s a good thing. How do we tell whether a college, a department or another unit within a college is diverse or not? What exemptions from diversity are permitted?

Seeing as college presidents and provosts are the main diversity pushers, we might start with their vision of diversity. Ask your average college president or provost whether he even bothers promoting political diversity among faculty. I’ll guarantee that if he is honest — and even bothers to answer the question — he will say no. According to a recent study, professors who are registered Democrats outnumber their Republican counterparts by a 12-1 ratio (http://tinyurl.com/gpp4svq). In some departments, such as history, Democratic professors outnumber their Republican counterparts by a 33-1 ratio.

The fact is that when college presidents and their diversity coterie talk about diversity, they’re talking mostly about pleasing mixtures of race. Years ago, they called their agenda affirmative action, racial preferences or racial quotas. Not only did these terms fall out of favor but also voters approved initiatives banning choosing by race. Courts found some of the choosing by race unconstitutional. That meant that the race people had to repackage their agenda. That repackaging became known as diversity. Some race people were bold enough to argue that “diversity” produces educational benefits to all students, including white students. Nobody has bothered to scientifically establish what those benefits are. For example, does a racially diverse student body lead to higher scores on graduate admissions tests, such as the GRE, LSAT and MCAT? By the way, Israel, Japan and South Korea are among the world’s least racially diverse nations. In terms of academic achievement, their students run circles around diversity-crazed Americans.

There is one area of college life where administrators demonstrate utter contempt for diversity, and that’s in sports. It is by no means unusual to watch a Saturday afternoon college basketball game and see that the starting five on both teams are black. White players, not to mention Asian players, are underrepresented. Similar underrepresentation is practiced in college football. Where you find whites overrepresented in both sports is on the cheerleading squads, which are mostly composed of white women. If you were to explore this lack of racial diversity in sports with a college president, he might answer, “We look for the best players, and it so happens that blacks dominate.” I would totally agree but ask him whether the same policy of choosing the best applies to the college’s admissions policy. Of course, the honest answer would be a flat-out no.

The most important issue related to college diversity obsession is what happens to black students. Black parents should not allow their sons and daughters to fall victim to the diversity hustle, even if the diversity hustler is a black official of the college. Black parents should not allow their sons and daughters to attend a college where they would not be admitted if they were white. A good rule of thumb is not to allow your children to attend a college where their SAT score is 200 or more points below the average of that college. Keep in mind that students are not qualified or unqualified in any absolute sense. There are more than 4,800 colleges — a college for most anybody. The bottom-line question for black parents and black people in general is: Which is better, a black student’s being admitted to an elite college and winding up in the bottom of his class or flunking out or being admitted to a less prestigious college and performing just as well as his white peers and graduating? I would opt for the latter. You might ask, “Williams, but how will the nation’s elite colleges fulfill their racial diversity needs?” My answer is that’s their problem.