Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

The American Cancer Society

Who Will Lead Us As We Embrace Personalized Medicine And Cancer Care And Turn The Tide Against Cancer?

by Dr. Len June 14, 2012

Earlier this week I had the opportunity to attend and participate in a conference "Turning the Tide Against Cancer Through Sustained Medical Innovation" in Washington DC. . The conference organizers brought together a stellar list of experts (present company excepted) to discuss the coming revolution in cancer care through personalized medicine, as well as the barriers and risks we face as science moves us forward towards what I consider a brave new world of cancer research and treatment.

 

With all of the intellect that was present at that meeting-and there was a lot-there was a theme that crystallized for me and others as the day progressed: we have developed incredible science and incredible opportunities to understand and treat cancer. But with all of the issues that have to be dealt with, the reality is that there is no singular leader-organization or individual-who has the clout and the heft to accelerate all the changes that need to happen if the vision of personalized medicine is going to be a success. More...

Through The Fog Of New Cancer Research Information, The Enthusiasm Of Youth Meets The Wisdom Of Elders

by Dr. Len June 05, 2012

I had trouble sleeping this morning, so I got up and took a look at the tweets on my smartphone that focused on yesterday's sessions at the annual meeting of the American Society of Clinical Oncology in Chicago.

 

There were literally hundreds of bits of information that covered the span of sessions, from science to quality of life to other topics of interests. I wondered how much of the information we have heard over the past several days will actually make a difference in the lives of cancer patients in the days and months ahead. And while sitting in a less well-attended session hearing an update on another once promising approach, the sad reality struck me squarely: not much.

 

This is the premier clinical cancer meeting in the country, if not the world. Thousands of doctors and researchers come to this meeting to learn the latest information about clinical cancer research and cancer treatment. There are thousands of abstracts presented and discussed, and constant chatter about the newest drug or the newest test or the newest way to diagnose cancer. The drug companies, the lab test companies, the computer companies are all here to advance their drugs and their tests and their wares. There are receptions, dinners, private meetings all over the place. There are sessions where literally thousands of doctors sit and listen to the top ranked research presentations, which represent the best of our science. There is certainly no lack of buzz, or excitement, or opportunity to learn. This is truly a festival of information about what is new in cancer treatment.

 

And then I go to a session late on Monday afternoon tucked in a back corner of this vast complex known as McCormick Place and hear a group of presentations reflecting on ten years experience with drugs that we thought blocked blood vessel growth to tumors. There are a couple of hundred people in the room, and the presenters acknowledge that the initial promise of those drugs hasn't been realized. In fact, they note, there are even still controversies over how the drugs actually work. But no one is there to give the story prominence, since it is "yesterday's news."

 

I can't help but think about the excitement that surrounded these drugs ten years ago when they were to "great new thing." I recall sitting in one of those megasessions where thousands hung on the words that one of these drugs significantly prolonged survival in colorectal cancer. Then, the news was greeted with sustained applause. Today, there is barely a whisper among those listening to the latest information. More...

Genomics Leads To An "Aha!" Moment And Closes The Loop On Tanning Beds And Melanoma Risk

by Dr. Len June 04, 2012

Yesterday I wrote a blog discussing how meetings like the current annual gathering of the American Society of Clinical Oncology (ASCO) gives me a chance to think about big picture questions.

 

Well, there is another side to the experience that is also interesting and important, such as getting information that helps put together pieces of a larger puzzle, and perhaps even gives closure to a nagging question. When you have one of those "Aha!!!" moments, it can truly solidify your thoughts and maybe even save a few lives in the process. In this case, the same presentation that led to yesterday's comments about the emerging complexities of the diagnosis of cancer also produced another enlightening moment.

 

Dr. Levi Garraway is a highly regarded genomics researcher from Dana Farber Cancer Institute in Boston who presented a lecture on the topic of how genome sequencing is bringing new insights to the biology and treatment of cancer. As part of his presentation, Dr. Garraway offered information on areas where genomics has already offered us definitive information that has direct implications in understanding cancer.

 

The #1 item on Dr. Garraway's list was a topic of intense interest to me and several of my skin cancer colleagues.

 

According to Dr. Garraway, genetic analysis of cancers from patients with melanoma show an overwhelming number (my words) have a signature genetic marker proving their melanomas were caused by ultraviolet (UV) radiation. He elaborated that there have been questions in the scientific literature as to whether or not this was the case, and acknowledged that we have had to rely on relatively indirect research to prove the case that melanoma is caused by UV light. However, he continued, because of genomics it is now essentially "case closed" and essentially proven: melanoma is caused by exposure to UV light. More...

Will Genomics Lead Us To A Brave New World Of Cancer Diagnosis?

by Dr. Len June 03, 2012

 

One of the things I enjoy about coming to meetings like the current annual session of the American Society of Clinical Oncology (ASCO) is that it gives me a chance to give thought to some larger questions that face cancer care. A presentation I attended Friday afternoon on the impact of genomics on cancer diagnosis and treatment in the future has offered just such an opportunity.

 

Most of you I suspect give little thought to the actual processes that we use to diagnose cancer. One has a tumor somewhere in the body, the doctors take a specimen, send it to the pathologist and the pathologist makes the diagnosis. Simple and straightforward. Get it done and get on with treatment.

 

But in fact it isn't so simple and straightforward. And in the world we live in, it is getting more and more complex.

 

Looking at cancer tissue under the microscope is something that has been done for over a century. More recently, we have seen the advent of special additional tests that tell us for example whether or not a cancer such as breast cancer is hormone sensitive or whether it has other markers such as HER2. We can send specimens of the cancer to a lab to find out whether or not it is more or less aggressive and we can even do tests to find out whether or not--for example--a woman with a breast cancer really needs to take traditional cancer chemotherapy. There are even special stains that can be applied to tumor tissue through a variety of techniques that can further refine the characteristics of a particular tumor and help us determine what kind of cancer it may be, or what subgroup of a family of cancers, such as lymphoma, a particular cancer fits in to.

 

All of that is well and good, but unfortunately that simple explanation does neither justice to how doctors diagnose cancer, nor does it say much about the problems that can occur in making cancer diagnoses, especially with all of the new tests that are available. I suspect that many physicians will agree that simply looking at the tissue under the microscope just doesn't tell us anymore all the things we should know about a particular individual's cancer. More...

A Blast From The Past Meets A Drug From The Present To Create A Vision Of The Future: A New Treatment For Breast Cancer That Makes A Difference

by Dr. Len June 03, 2012

 

This is the stuff of science fiction, a dream, something you could envision but were skeptical it could be done. But now it has been done, and raises the question of whether we are headed "back to the future" in the treatment of cancer.

 

The drug in question here is called T-DM1. It is an "antibody drug conjugate" between trastuzumab--which is a monoclonal antibody drug commonly used today to treat selected women with aggressive breast cancer--bound to a derivative of another more traditional cancer chemotherapy drug called maytansine.

 

Maytansine was a cancer chemotherapy drug evaluated in the 1970's and found to be effective in treating breast cancer, but its side effects were so severe that it could not be used clinically. As a result, it became a laboratory curiosity, banned from patient care.

 

Trastuzumab is one of the really positive stories of the modern targeted therapy era. It is an antibody drug that has effectively treated women with advanced breast cancer that is positive for HER2, which results in a protein "key" being formed on the surface of certain breast cancer cells. Trastuzumab attaches to that key and aborts the internal processes of the HER2 positive breast cancer cells. About 30% of women with breast cancer are HER2 positive, and those women tend to be younger and have more aggressive forms of the disease. Not only does trastuzumab help treat advanced breast cancer in these women, it has had a remarkable impact on reducing recurrences after primary treatment when  used as part of adjuvant therapy in HER2 positive breast cancer.

 

But there are serious side effects from the drug combinations that are used with trastuzumab in these circumstances. And then there are the limited treatment options availalable once the HER2 breast cancer recurs, which happens all too frequently.

 

Fast forward, and the chemistry wizards found a way to bind the trastuzumab to the maytansine derivative. The theory was that the trastuzumab could hone in on the breast cancer cells with the HER 2 receptor, and that the attached chemotherapy drug could find its way into the cancer cell where it could do its damage. And because the delivery of this antibody-drug conjugate was so specific to the breast cancer cells that have this HER2 receptor on their surfaces, a lot of the adverse effects previously seen in using both drugs might be reduced. Think of a cargo rocket making a delivery to the space station, then docking with the space station, and moving the cargo into the space station.

 

Sounds simple, but it's not. More...

Promising New Approach To Treating Cancer Means Hope For Many, But Remember This Is Just The Start Of The Journey

by Dr. Len June 02, 2012

Every year at this time cancer specialists and researchers from around the world descend on Chicago for the annual meeting of the American Society of Clinical Oncology (ASCO) to hear the latest breakthroughs in cancer research and treatment.

 

Through all the fog of all the information--which is impossible for any one individual to evaluate much less comprehend--there is always the search for the "buzz," or the next "big thing" that will make a huge impact on cancer treatment and the lives of the patients we care for and the people we love who are affected by cancer.

 

This year, it is apparent already that one of this year's "big things" are the reports of new success in an old and ongoing effort to harness the body's own defense mechanisms to fight cancer. And--being the skeptic that I can be at times--I will throw my hat in the ring that maybe this is going to be one of those events that truly will impact cancer care. But despite the enthusiasm, we must always temper our expectations with reality and lessons we have learned from the past that early success doesn't always tell us the whole story.

 

Without going into great detail here, the reality is that in early stage trials an antibody drug now called "BMS-936558" produced significant responses in a number of patients who had certain advanced cancers and had failed multiple prior treatments. In these studies, patients with melanoma, kidney cancer and non-small cell lung cancer showed responses to this new drug and some of those responses lasted for over a year.

 

When you see these kinds of results in cancers that are ordinarily difficult to treat, and in patients who have failed multiple other therapies, that becomes news. More...

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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