Anti-cancer progress continues.
It’s a terrific trend: In April, the National Cancer Institute released its latest statistics on overall cancer deaths in the U.S. Cancer mortality is dropping at yearly rates of 1.8 percent for men, 1.4 percent for women and 1.4 percent for children. Better prevention, earlier detection, an explosion of genetic knowledge and improved treatments all play a part. See how these innovations — some in earlier stages than others — can enhance survival and quality of life, individualize treatment, reduce side effects and expand therapy options to empower people with cancer.
Gathering U.S. genomes
The All of Us research program is looking for you — and 999,999 other people — to share personal health information for a unique new database. On May 6, the National Institutes of Health kicked off open enrollment for this novel research program. Some participants will undergo genome sequencing to find out more about their DNA. Speeding up health research and medical breakthroughs is the program’s mission. Enabling precision medicine, a way to target treatments to individuals with conditions like cancer, is an important All of Us goal.
Precision cancer medicine
Precision medicine represents the opposite of one-size-fits-all treatment. Also known as personalized medicine, it’s about individualizing the right treatment to the right patient at the right point in the course of his or her condition. While giving patients the most effective treatment has always been a goal in medicine, the tools to do so keep advancing. Precision medicine takes each patient’s medical history, test results, genetic makeup, lifestyle and environment into account. The ability to pinpoint genetic abnormalities in a tumor by genomic sequencing allows oncologists to appropriately use targeted therapies. One example is breast cancer. HER2 is a protein that promotes the growth of breast cancer cells. HER2-positive cancers are caused by a genetic mutation resulting in overproduction of the protein. The drug Herceptin, or trastuzumab, is effective for cancers that are HER2-positive. For breast cancers that are HER2-negative, Herceptin doesn’t work.
Immunotherapy: defense system
Unfortunately, tumor cells are good at adapting to their surroundings and evading detection as dangerous foreign objects. Training the body’s immune system to better fight cancer is the premise of immunotherapy. Laboratory scientists analyze a patient’s tumor to identify biomarkers that indicate whether a specific immunotherapy could succeed at turning on the immune system’s “attack” switch. In 2011, the drug ipilmumab (brand name Yervoy) was introduced to treat advanced melanoma, the most lethal form of skin cancer. Now, immunotherapy drugs are being used to treat bladder cancer, non-small cell lung cancer, head and neck cancer, Hodgkin lymphoma and kidney cancer in appropriate patients.
Radioactive elements
[Brachytherapy involves planting and leaving radioactive pellets or “seeds” at the site of a malignant tumor. It’s used to treat cancer of the prostate, cervix, brain and other parts of the body. Traditionally, this internal form of radiation involves radioactive materials such as iodine or palladium. Cesium is No. 55 on the periodic table of elements. In a small study, 13 patients received cesium-131 brachytherapy after previous radiation treatments failed to control their spreading brain cancer. The implants provided stable tumor control and limited the risk of radiation side effects, according to the April 2017 Journal of Neurosurgery study. Cesium-131 brachytherapy implants result in less damage to healthy brain tissue than whole-brain radiation or stereotactic radiosurgery — high-dose, ultraprecise radiation such as Gamma Knife and CyberKnife — says study co-author Dr. Theodore Schwartz, a professor of neurosurgery with New York-Presbyterian and Weill Cornell Medicine. The next step? “We need multicenter trials showing their efficacy,” Schwartz says. “We need to convince the neuro-oncology community at large that they’re useful.” ]
Consumer BRCA testing
Consumers can now use at-home genetic testing kits to learn whether they have three BRCA gene mutations linked to breast, ovarian and possibly other types of cancer. In March, the Food and Drug Administration gave the go-ahead for the test, for which users provide a saliva sample to be analyzed by the company 23andMe. However, as more than 1,000 known BRCA mutations exist, the tests are far from comprehensive. While a positive result indicates increased risk, a negative result does not guarantee that someone is only at average risk. Direct-to-consumer genetic testing is about prompting a discussion rather than making treatment decisions. Consumers should consult with their doctors and genetic counselors to explore whether more thorough testing is needed.
Intraoperative radiation for breast cancer
If you were being treated for breast cancer, would you prefer surgery plus several weeks of daily hospital visits for radiation treatment, or a single dose of radiation delivered during the surgery? “Intraoperative radiation therapy allows a properly selected woman to get all of her local regional treatment with one trip to the operating room,” says Dr. Shawna Willey, director of the MedStar Regional Breast Health Program and chief of surgery at MedStar Georgetown University Hospital. However, Willey emphasizes, women must meet tight treatment criteria in terms of age, type and size of cancer, whether it can respond to hormone therapy drugs, a lack of spreading to the lymph nodes and single versus multiple tumors. An international study involving 33 medical centers in 11 countries compared IORT to standard whole-breast radiation. Following some 3,450 women ages 45 and older, researchers found similar breast cancer mortality but fewer serious radiation complications and lower overall death rates among those who received IORT. However, among women with more advanced breast cancer, recurrence was higher in the IORT group. Therefore, IORT should only be recommended for women who can receive it as they undergo lumpectomy (surgery used in earlier-stage cancer), researchers concluded.
Oncoplastic surgery
After surgery to treat breast cancer, many women are left with distorted breast tissue. In the affected breast, the nipple and areola may be destroyed or damaged. The shapes of the affected and opposite breast may no longer match. Oncoplastic surgery simultaneously combines two types of surgery, and can involve one or two surgeons. The surgical oncologist removes cancerous and surrounding tissue from the breast. The breast or plastic surgeon restores a natural appearance by sculpting the remaining tissue. Oncoplastic surgery may include the opposite, healthy breast. For example, among women with large breasts, oncoplastic surgery offers an opportunity to do a bilateral breast reduction or lift, performed on both sides to restore symmetry. “Oncoplastic surgery is surgery that is considerate to what we leave women to live with for the rest of their lives and should be an integral part of treatment for all women with breast cancer,” according to the authors of a May 2016 article in Current Breast Cancer Reports.
Liver cancer prevention via hepatitis-C drugs
Hepatitis C is a liver disease that can morph into liver cancer. The baby boomer generation disproportionately suffers from hepatitis C, since the blood supply was not screened for the disease until 1992. In late 2013, an antiviral drug called sofosbuvir, the first oral hepatitis C treatment, received Food and Drug Administration approval for use in adults. In October 2014, the FDA approved a pill combining sofosbuvir and ledipasvir (brand name Harvoni). In April 2017, Harvoni was approved to treat children ages 12 to 17. A typical adult treatment regimen is one tablet a day for 12 weeks, although an eight-week course is sometimes used instead. These antivirals are highly effective and highly expensive: The wholesale price for a 12-week regimen of Harvoni is about $94,500.
CT scans to detect early lung cancer
People who quit smoking have traditionally worried about their risk of developing lung cancer. And this has traditionally been a neglected group because X-rays have not been able to pick up small nodules that could morph into cancer. Now a CT scan provides 3D images of lungs. The scan has “strong prognostic value as to whether you are likely to get lung cancer,” says Dr. Michael Roizen, an internist who chairs the Wellness Institute at Cleveland Clinic. “It’s helping a group of people who have quit smoking stay well. It will spot [nodules] early enough to treat and doesn’t lead to adverse effects for the individual. That’s a real psychological benefit.”
Controlling our oncogenes
We all have oncogenes in us, says Dr. Brian Bolwell, chair of Cleveland Clinic’s Taussig Cancer Institute. Only in some people, however, do these cancer-causing genes reach their full potential as cancer cells. And while most treatments have focused on killing these cells, recent research has focused on changing the nature of cancer cells. “Can you in fact take a cancer cell and turn it from being malignant into something that doesn’t grow uncontrollably?” Bolwell asks. Recent findings on oncogenes include a study, published in the July 2017 issue of the journal Nature, which revealed new suspected oncogenes involved in medulloblastomas, a type of brain tumor that primarily affects young children.
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10 Innovations in Cancer Therapy originally appeared on usnews.com
Update 05/09/18: This article was originally published on Nov. 3, 2014.
