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Sarah's Bit

Welcome to the second newsletter of Ovacome. The organisation is growing and we now have a network of women around the country who are talking to each other, sharing their experiences and giving each other support and encouragement. We have an impressive committee of motivated, talented people who are dedicated to the success of Ovacome. We have the support and involvement of health professionals and of other relevant charities. All in all I am amazed and excited that what started as one quiet voice speaking out has so quickly been joined by so many, and with such enthusiasm.

I completed my second course of chemotherapy 6 weeks ago and said a welcome farewell to my Hickman line. Michèle was delighted that Mummy could at last venture into the swimming pool with her. Unfortunately, within a few days of having my stitches removed I was back in the Marsden being replumbed, as my kidneys had failed. More treatment is needed. I'm just waiting for Martin Gore to decide which delightful cocktail to try me with this time.

Meanwhile, we're moving out of the big smog and into beautiful Bucks where the air is fresh. I hope we will go sailing soon - the British Virgin Islands are beckoning to me!

Sarah and Michèle in their new home

Tips

Managing a Hickman Line

In normal wear I made several 'holsters' out of pretty cotton hankies - folded in half and stitched along 2 sides. These held the pump and surplus line, and were pinned to my bra under my right arm. Result - pump hidden and two hands free, pockets not cluttered and no danger of the pump falling down the loo!

In the bath or shower Small plastic zipped up make-up bag, big enough to accommodate the pump, fitted with a string and worn round the neck. The pump was totally enclosed, and again both hands free, giving complete independence.

Post-chemo nausea

I found it useful to have paper-mâché bowls, (obtainable from the hospital ) strategically placed in every room to cope with the suddenness with which the sickness came.

Eileen, Manchester

Music for relaxation

• The Fairy Ring Mike Rowland
• Even Wolves Dream Anthony Miles
• Music for Relaxation Chapman, Miles, Rhodes
•  Just Relax Matthew Manning
  

Books

• Love - Medicine and Miracles Bernie S Siegel M.D. $5.99 - To order from W.H. Smith

If you have any advice to offer, please share it with us. Likewise, if you have any problems or questions, be they medical, practical, emotional or whatever, let us know, and the team will endeavour to answer.

Research

The Hammersmith Antibody Trials For Ovarian Cancer

One of the most fascinating problems for cancer doctors is the recurrence of tumours even after all evidence of cancer has been eradicated by surgery and chemotherapy. This is particularly distressing with tumours such as cancer of the ovary, which is very sensitive to chemotherapy. The Imperial Cancer Research Fund group at Hammersmith Hospital has been involved in tackling this problem for some years. Our approach is to use monoclonal antibodies - MAbs. Antibodies are produced by our immune systems to help protect us against foreign material, for example to fight infections. Our immune systems are, in general, unable to produce antibodies to help us destroy our cancers. Monoclonal antibodies are produced synthetically, initially by immunising mice against human cancer cells. We are then able to produce these MAbs in large amounts and to a level of purity which makes it safe to give them to patients. When injected into someone with cancer, the antibodies recognise and bind preferentially to the cancer cells. This alone does not seem to be enough to kill the cancer cells. We are therefore exploiting MAbs in two ways, to try and make them into useful drugs.

The Randomized Trial of Radioactive MAb

One way in which MAbs can be used is in delivering radiation to tumour tissue in a very localised way. This should enable a relatively high dose of radiation to reach the tumour, leaving normal tissue unharmed. The early studies conducted by this unit suggested that a single dose of radioactively-charged MAb may protect against recurrence of ovarian cancer if given once all tumour had been eradicated. The larger, randomised trial began 2 years ago. Everyone who enters the trial receives a laparoscopy, where the peritoneal cavity (the abdominal space where the tumour originates) is examined using a kind of telescope. If no remaining cancer is found, patients are randomly assigned to two groups: one group has nothing more done (the standard approach), while the other group has a single dose of MAb instilled into the peritoneal cavity. This treatment has none of the side-effects of traditional chemotherapy, and because the amount of radiation used is very small, it has none of the problems associated with traditional radiotherapy, either. The most that patients suffer is a rash and/or aches and pains in the muscles and the joints. This study was very slow to get going, but patients are now being entered at an ever increasing rate. The target is 120 patients and so far we have just over 30.

Using MAbs as a cancer vaccine

An alternative way of using MAbs exploits the fact that they are originally derived from mice, and that our immune system therefore recognises them as foreign. Consequently, when MAbs are put into the human body, the immune system starts to work to remove them. Put simply, it is believed that this may be able to focus the immune system to destroy or suppress cancer cells. Using MAbs in this way, small doses are given monthly by injection under the skin. This trial only started recently, and at present we are only using this treatment in ovarian cancer patients whose cancer has recurred, or in whom chemotherapy was unable to eradicate all the tumour in the first place.

Steve Nicholson ICRF Clinical Research Fellow

Patients who are interested in joining the trial should contact their own consultant.

Topotecan

SmithKline Beecham's Hycamtin (topotecan hydrochloride) received marketing clearance at the end of May from the U.S. Food and Drug Administration (FDA) for the treatment of patients with metastatic ovarian cancer after failure of initial or subsequent chemotherapy. This drug is currently on trial in Britain.

Hycamtin is the first topoisomerase I inhibitor to be approved for marketing in the U.S. This new class of drugs kills cancer cells by inhibiting the enzyme topoisomerase I, which is essential in the replication of DNA in human cells.

The main side effect demonstrated by Hycamtin in clinical trials was supression of blood cells produced in the bone marrow that was predictable, noncumulative, reversible and manageable. The most frequently reported non- hematologic side effects were gastrointestinal, including nausea and vomiting.

The Funny Side

My grandmother was never very good at remembering long words, and this often got her into trouble. I once had a very confusing conversation with her about 'lesbians' when what she had meant to say was 'librarians'...

She was always trying to cheer people up, and on one particular occasion she found herself in a ward bed next to a young lady who was in hospital for her first dose of chemotherapy. My grandmother had just had a hysterectomy and had already been through several doses of chemotherapy herself. In an attempt to help the tearful woman and her husband, she announced bravely that the young lady mustn't worry too much, that she herself had just had a vasectomy and although the chemotherapy she had previously undergone had not made her lose her hair at all, she had lost her marbles...

Kerry       

Cancer doesn't destroy your sense of humour and sharing a joke often helps. Please tell us your light-hearted stories or funny incidents - anything to make us smile or laugh.

Poem for the Day

Footprints

One night a man had a dream,
He dreamed he was walking along the beach with the Lord.
Across the sky flashed scenes from his life
For each scene, he noticed two sets of footprints in the sand;
One belonging to the him and the other to the Lord.
When the last scene of his life flashed before him,
He looked back at the footprints in the sand.
He noticed that many times along the path of his life
There was only one set of footprints.
He also noticed that it happened
At the very lowest and saddest times in his life.
This really bothered him and he questioned the Lord about it.
'Lord, you said that once I decided to follow you,
You'd walk with me all the way.
But I have noticed that
During the most troublesome times in my life,
There is only one set of footprints.
I don't understand why when I needed you most
You would leave me.'
The Lord replied, 'My precious, precious child,
I love you and I would never leave you.
During your times of trial and suffering
When you see only one set of footprints
It was then that I carried you.'

Contributor: Andrea