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Dr. Keith Roach

Dear Dr. Roach: I'm writing to you regarding my husband's 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 tumor size. He began Opdivo infusion therapy last Thursday. While there, I heard about something called "car T." Can you explain what this is? I am so scared.

-- D.C.

A: 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 "T" 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't 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's own immune system to better attack the tumor. 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 www.clinicaltrials.gov.

It sounds to me like 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.

Remedy for bad breath

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't 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 "BreathRx." I use it every morning, and my wife says she never detects bad breath.

The scraper has holes at each end. Merely 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 "regular," while the other says "soft").

-- J.S.

A: 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. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email ToYourGoodHealth@med.cornell.edu.

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