Dear Dr. Roach: I鈥檓 writing to you regarding my husband鈥檚 cancer. He has thymic carcinoma, diagnosed January 2014. It was stage 4. The disease was kept stable with a targeted-therapy drug called Sutent for 15 months, based on cancer genomic sequencing. When that stopped working, we moved on to Stivarga. Last month, PET results revealed greatly increased activity and tumour size. He began Opdivo infusion therapy last Thursday. While there, I heard about something called 鈥渃ar T.鈥� Can you explain what this is? I am so scared.
D.C.
I am very sorry to hear about your husband.
The thymus is an organ in the neck. It is much larger in children than in adults, and it has a role in maturing the immune system (the thymus is the 鈥淭鈥� in T cells, which are the main regulators of cell-based immunity). Thymus cancer is rare and aggressive. People who present in stage 4 are not amenable to surgical therapy, and only about half of this group survived for 10 years in a trial a few years ago. However, your husband has had newer therapies (Stivarga and Opdivo, which are used in other cancers, such as melanoma and colon and lung cancers) that weren鈥檛 available then.
CAR (chimeric antigen receptor) T cells are an example of adoptive cell transfer, an exciting new type of cancer treatment with the potential to dramatically change the way we treat cancer. They enable the person鈥檚 own immune system to better attack the tumour. As of this writing, they have been approved only for a few cancers: a type of childhood leukemia and a type of lymphoma, but studies are ongoing on other cancers. I did not find any trials available for CAR T cell treatment for thymus cancer. I did find some trials recruiting patients with thymus cancer at clinicaltrials.gov.
It sounds to me as if the doctors treating him are going about his treatment in a thoughtful way, and are trying new therapies. Breakthroughs in cancer research can come at any time. I hope your husband has success with one of the existing treatments, or that a new treatment comes in time to be helpful for him.
Dear Dr. Roach: A reader recently asked about chronic bad breath. I hope I can help. I had very bad breath for years, as verified by my wife. Brushing my tongue didn鈥檛 help. Two years ago, my dental hygienist gave me a tongue scraper, which has completely eliminated the problem.
The scraper is white, 7.5 inches long, and is serrated on both sides. The label says 鈥淏reathRx.鈥� I use it every morning, and my wife says she never detects bad breath.
The scraper has holes at each end. Bend the scraper so the ends meet, then hold the ends between two fingers and scrape the tongue from back to front a couple of times. It is amazing the amount of mucous that comes off the tongue onto the scraper. It makes no difference which side of the scraper is used (one side is marked 鈥渞egular,鈥� while the other says 鈥渟oft鈥�).
J.S.
I thank you, J.S., for writing. This is a question I am commonly asked about, so I am pleased to pass on any potential solution.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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