CANCER OVERVIEW FOR FIRST RESPONDERS

A STARTER REVIEW ABOUT CANCER TREATMENT OPTIONS
Transcribed from the  presentation to the RMA/FDNY (Retired Member's Association of Firefighters)- by Keynote Speaker, Dr. Jesse A. Stoff / June 25, 2019


As a brief overview of my perspective on how I look at cancer and how we address this in a more comprehensive sort of way, I'd like to start with the basics. Where we are right now (New York) is known as a cancer cluster. Here is where we have the highest incidence of prostate cancer and breast cancer in the United States; and yes, men have breast cancer too.  So as a result of that, there is a lot of research going on because this is a highly populated area, there's money in the area and there's people that want answers as to why this is.

The common denominator is our exposure to various kinds of toxins. Now, when you're on the job, you have that added risk of the toxins that you're exposed to at the time... things that you inhale... and as the chief said earlier, clean is the new salty.  These toxins can even be absorbed right through your intact skin. You don't have to eat or swallow this stuff.  It's not just about inhaling the toxins; just touching a lot of these things is enough to increase your risk of getting cancer.

Nobody wants to hear any of this and nobody wants cancer. Is can be a hell of a thing to try to fight. So there's ways that one can approach this in a comprehensive way, before you have cancer, to see what's going on. And if you are diagnosed there are ways of looking at this in a comprehensive way to generate treatment options.

There is no one answer to cancer. That's a very important take-home message. If you hear nothing else from me tonight, hear that. There is no one answer to cancer.


So if you have cancer, God forbid, and the doctor says, "This is THE treatment program," well that's just not true. There are many different strategies for approaching and dealing with cancer. For example, a very common cancer is non-small-cell lung cancer, and I'm sure that you all know people who have had it, or have passed from it. It's a very common sort of cancer. But with the new medicines that we have available now, the statistics for this disease have improved dramatically.

For example, straight up chemotherapy gives you a overall survival rate of about 3% with certain forms of non-small-cell lung cancer. But with the newer immunotherapies that are available, just two of those medicines, OPDIVO + YERVOY, raises the survival rate to over 35%. Add that to other small-cell target therapies that we have available, and now you're in the 90 percent area; so overall survival with this kind of, what used to be, almost a death sentence type of cancer.

But these medicines that come out, that are available now are relatively new. Some of these medicines have only been available in the last three or four or five years. So it's very important that if you are diagnosed, that you're working with a doctor, that you're working with a team, who is aware of the latest breakthroughs in medicine.

As a member of ASCO, the American Society of Clinical Oncology, and SITC, the Society of Immunotherapy of Cancer, I get updates on a weekly basis of new medicines that are in the pipeline, new clinical trials that are going on, new medicines that have been approved by the FDA, new indications for medicines that were approved last week, so on and so forth. You take this information and can begin to build a comprehensive treatment program that greatly improves overall survival. And that's what the bottom line is. You want to get through this in one piece.

So how do I work with people who have a concern about cancer? Number one; I ask them a lot of questions. My initial appointment with them is two hours long, asking a lot of questions. Then we do blood tests. The blood tests are looking at the following things. I look at biochemical factors; how's their liver doing, how's their kidneys doing, what's up with the thyroid? Because the thyroid is the critical organ, those hormones, for supporting the function of the immune system.

Now, Long Island has the highest incidence of thyroid disease in the United States as well, so we're already behind the eight ball just by having a glass of tap water. So we take that information, add it to what you're exposed to on the job, and I would start to see where the problems are.

So the blood tests look at what's going on biologically, biochemically. Then we look at the structure and function of the immune system. The immune system is the organ system in our body that's designed to protect us from cancer, because every single day, every single one of us produces a certain number of cancer cells. If you look at any tumor marker, like PSA, the normal range is zero to 4.0. It's not zero to zero. Why not? Because every single day we produce some abnormal prostate cells that the immune system recognizes as foreign, and destroys them. When it destroys them, it releases these proteins into the blood that we can measure, and that's true for every form of cancer that's out there, which is why all the cancer markers have a normal range. And it's not zero to zero.

So you want to have a good set of blood tests looking at the structure and function of your immune system, because the risk of getting cancer is inversely related to the strength of your immune system. The stronger the immune system, the lower your risk. The stronger your immune system, the better the overall outcome if you're fighting cancer. So this is a very, very important piece of information.

In addition to that, I do a bunch of tests looking at toxicology issues. What toxins are in this person? We look at blood tests for toxins, we look at urine tests for toxins; because if we can find these toxins, and we almost always can, there are specific treatment strategies for pulling these chemicals out of the body before they can trigger a cancer, or if you already have a cancer, pull these chemicals out so they don't continue to fuel the cancer. It makes it much easier to treat.

All of these tests are commonly available. Any doctor can order them. All these tests are FDA approved. Very few of these tests are included in the WTC screening. It's up to you to seek out doctors and groups that are working with these more advanced technologies, to see what's going on in your system, to see what your risks are, and see what the best way is to prevent a disease or to treat a disease down the road.

If you're diagnosed, nowadays there are many treatment strategies. Yes, we have chemo, radiation, surgery. That's been around for decades and decades. Immunotherapy has been around for decades too, but it has only come to the forefront in the last 20 years or so with the advent of many new pharmaceuticals that we have that can create a lightning-fast response, with much less toxicity, and much better overall survival. But as these medicines are coming out, unless the doctor is up to date with what's going on, reading the journals, going to the medical societies... When I go to the SITC conference in November in Washington DC every year, there's over 3000 doctors there from all over the world, for a week, hearing about the latest research, seeing the latest medicines that are available, all to help strengthen the immune system and fight the cancer using the immune system as a primary weapon. It's a very powerful weapon.

But there's other weapons too. There's biochemical strategies, there's a whole field of oncology using targeted small-molecules, as they are called. These are medicines... not chemo's... these are medicines that inhibit or stop certain enzyme pathways in cancer cells, and can shut them down with very few side effects. But unless you're working with somebody who is aware of these kind of breakthroughs, and knows how to test for their use, then you're going to be looking at old therapies off-the-shelf generic therapies for whatever disease we have, that have much poorer overall survival. And that's not what you want.

To help identify what medicines could be useful, one can do a test that looks at the genetic structure of the cancer. The way that that's done is, we fill out some paperwork, they send it to the lab, the lab requests a piece of biopsy material that you've already had... no one's chasing after you with another needle... and they can take those slides, run it through a very sophisticated piece of machinery that looks at the genetics, and can sequence the genes of the cancer and see where all the genetic abnormalities are. Based upon those genetic abnormalities, there are medicines that can target those abnormalities, and nail them, and shut down the cancer very quickly; again, with far fewer side effects. You won't lose your hair unless you already have. Some of you have, but okay. You won't be throwing up in the corner. You won't be laying in bed for days and days after treatment. You'll get the treatment, it could be a pill, it could be an IV, and as long as you're staying well-hydrated, most of these medicines have essentially very few, if any, side effects or symptoms of taking them.

These breakthroughs are coming through literally on a weekly basis, and it's important that you're working with people that are staying abreast of this information and can help you with it.

So when you get the blood tests, you're looking at the biochemistry, you're looking at the immune system, you're looking at the genetic structure of the cancer. With this information, you now have treatment options. In the old days we had what are called ASCO Protocols, protocols that were developed as a result of clinical trials from the American Society of Clinical Oncology, and these protocols were very generic. In other words, if you had lung cancer, you got this treatment; if you had liver cancer, you had that treatment; if you had, you know, whatever it was, it was an off-the-shelf generic sort of thing. It's not that way anymore. With this kind of information that I'm telling you that's available right now, covered by your insurance, this information will allow the doctors to target the cancer in a very individualized sort of way, giving much better outcomes.

So in my practice, I may be treating at any one time a dozen guys with lung cancer. And when I look at their treatment protocols, each one of them is going to have a little bit different protocol. Why? Because their blood tests are different, their immune system is different, the genetics of the cancer are different; and therefore the medicines that are going to be most effective for that individual will be different. So take home point number two, is get the testing. Find doctors who will do this sort of testing for you. Again, it's all FDA approved, covered by insurance, etc. It's out there. Ask for it. When you get this information, this gives you options. Important point number two, with options comes hope. Without options, there's very little hope. You're left to the statistics of the off-the-shelf protocol. And you guys deserve better than that.

So thank you very much for your time and attention. I'm not going to stand between you and dinner. Have a great evening. Be well.


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