Clinical trials need older adults, ASCO says. City of Hope’s Arti Hurria explains

July 30, 2015 | by

Few clinical cancer trials include older adults – and yet, more than 60 percent of cancer cases in the United States occur in people age 65 and older. The result is a dearth of knowledge on how to treat the very population most likely to be diagnosed with cancer.

older adults in clinical trials

Older adults don’t respond to cancer treatment the same way that younger adults do. Further, their functional age, not just their chronological age, must be taken into account.

Now, the American Society of Clinical Oncology (ASCO) has issued landmark recommendations directed at ending this inequity. The organization is urging federal agencies and the cancer research community to include more older adults in clinical trials. The call to action was published July 20 in the Journal of Clinical Oncology.

City of Hope’s Arti Hurria, M.D., director of the Cancer and Aging Research Program at City of Hope, was a co-author of the ASCO position statement, “Improving the Evidence Base for Treating Older Adults with Cancer.”

“We need to see clinical trials enroll a patient population that mirrors the age distribution and health risk profile of patients with cancer,” Hurria said. “ASCO has laid out a multipronged approach to expand the participation of older adults in clinical trials, ensuring that we will develop the evidence base so that patients across all ages can receive high-quality, evidence-based cancer care.”

The statement highlights these core recommendations: » Continue Reading

Scientists at City of Hope and UCLA stop tumor growth with nanoparticles

July 29, 2015 | by
Carlotta Glackin lab

Scientists in the lab of Carlotta Glackin, second from right, have taken the first step in developing a potential new therapy for some of the deadliest cancers. Even more remarkable, they’ve done so with a novel, nondrug delivery approach.

Scientists at City of Hope and UCLA have become the first to inhibit the expression of a protein, called TWIST that promotes tumor invasion and metastasis when activated by cancer cells. As such, they’ve taken the first step in developing a potential new therapy for some of the deadliest cancers, including ovarian cancer and melanoma.

Carlotta Glackin

Researcher Carlotta Glackin is known as the “mother of TWIST,” for her role in isolating the gene responsible for the protein’s production.

Perhaps even more remarkable, they’ve done so with a novel, nondrug delivery approach.

Using extremely small particles, called nanoparticles, of coated silica, the researchers successfully delivered a nucleic acid known as small interfering RNA (siRNA) into tumor cells of mice. The result was a dampening of TWIST’s action – and a dramatic reduction in tumor size.

“Not only did we reduce the size of the tumors,” said Carlotta Glackin, Ph.D., associate professor of neurosciences at City of Hope, “but we also inhibited angiogenesis, which is the formation of blood vessels inside the tumor … And we didn’t even use a drug. » Continue Reading

Some breast cancer survivors face increased risk of weight gain

July 25, 2015 | by
weight scale

A recent study suggest women who have survived breast cancer tend to gain more weight than women who are cancer-free.

As breast cancer survivors know, the disease’s impact lingers in ways both big and small long after treatment has ended. A new study suggests that weight gain – and a possible corresponding increase in heart disease and diabetes risk – may be part of that impact.

In the first study to evaluate weight change in women with a family history of breast cancer, those who had survived breast cancer were found to gain more weight than women who remained cancer-free. The research, comparing 303 breast cancer survivors with 307 cancer-free women matched by age and menopausal status, was published July 15 in the journal Cancer Epidemiology, Biomarkers & Prevention.

According to the study, from Johns Hopkins Bloomberg School of Public Heath in Baltimore, breast cancer survivors gained significantly more weight than their cancer-free counterparts in the first five years after diagnosis – an average of about 4 pounds. Women who had been diagnosed with estrogen receptor-negative breast cancer gained an average of 7 pounds more than women who had never had cancer.

Further, women who had received chemotherapy were twice as likely, compared to cancer-free women, to have gained at least 11 pounds. The findings raise new questions about life after cancer and how to better prepare women for new challenges and risks.

Laura Kruper, M.D., director of the Rita Cooper Finkel and J. William Finkel Women’s Health Center at City of Hope and head of breast surgery service, put the findings in perspective in an interview with HealthDay» Continue Reading

Independent scientific research starts with funding – and mentors

July 24, 2015 | by

K grantsBecoming what’s known as an independent scientific researcher is no small task, especially when working to translate research into meaningful health outcomes. Yet that independent status is vital, enabling researchers to lead studies and avenues of inquiry that they believe to be promising.

Clinicians, especially, can find themselves with little training in the intricacies of research studies and analyses.

“While training as a fellow, you are busy learning the clinical side,” said Joanne Mortimer, M.D., vice chair and professor of Medical Oncology & Therapeutics Research at City of Hope. “Having enough time to learn research so that you can be independent is not realistic.”

To bridge that gap, and help develop clinical scientists, the National Institutes of Health (NIH) offers mentored career-development awards, known as K awards, for young researchers and clinicians. These awards are intended to develop scientists who can be a connection between the lab bench and the patient bedside. That connection, and the people who create it, are at the heart of what’s known as translational medicine.

As a leader in translational medicine, City of Hope has been home to a significant amount of K12 funding – with the “12” referring to the method of distribution, that is, through the institution, rather than to individuals – for the past 20 years. » Continue Reading

Neurosurgeon receives Breakthrough Award for study of brain metastases

July 21, 2015 | by
Rahul Jandial headshot

Rahul Jandial, assistant professor in the Division of Neurosurgery at City of Hope, received the Department of Defense Breakthrough Award, which will support his research to further understand why women with HER2-positive breast cancer have higher rates of brain metastases.

For the past four years, neurosurgeon and scientist Rahul Jandial, M.D., Ph.D., has been studying how breast cancer cells spread, or metastasize, to the brain, where they become life-threatening tumors. Known as secondary brain tumors, these cancers have become increasingly common as treatment advances have enabled more women to survive their primary cancer.

Jandial’s goal is to find out how to find more effective treatments for these tumors, which eventually take the lives of thousands of women in the U.S. each year.

His expertise in the field recently helped him obtain a prestigious $700,000 grant from the Department of Defense Breast Cancer Research Program (BCRP), part of the Medical Research Programs directed by the U.S. Congress.

Jandial, assistant professor in the Division of Neurosurgery at City of Hope, received what’s officially known as the Breakthrough Award, which will support his research to further understand why women with HER2-positive breast cancer have higher rates of brain metastases than women with other breast cancer subtypes.

The award highlights just how crucial Jandial’s work is. Approximately 40 percent of all women with HER2-positive breast cancer will develop brain metastases.

» Continue Reading

Discovery of gene’s link to survival could aid breast cancer treatment

July 17, 2015 | by
genes and breast cancer

Expression of the SERPINA1 gene appears linked to survival outcomes in women whose breast cancer tumors are both ER positive and HER2 positive, researchers have found.

Women diagnosed with breast cancer quickly learn their tumor’s type, meaning the characteristics that fuel its growth. That label guides the treatment of their disease, as well as their prognosis when it comes to treatment effectiveness.

Sometimes, however, doctors can’t accurately predict treatment effectiveness because their knowledge about tumor types has gaps. Each tumor genome is unique, and small variations in gene expression can affect how a particular tumor type responds to particular treatment regimens.

Women whose tumor types are both ER positive and HER2 positive, for instance, generally have more negative outcomes than women whose tumors are ER positive and HER2 negative. Estrogen receptor, or ER, positive tumors are fueled by the hormone estrogen. HER2 positive tumors make excessive amounts of a protein called HER2/neu and tend to be aggressive and fast-growing.

Researchers and physicians have known that women with tumors that are both ER positive and HER2 positive have poorer survival outcomes. What they haven’t known is how to predict how these women might fare.

The question is an important one because approximately 10 percent of breast cancer patients have such tumors. What researchers and physicians need are biomarkers – biochemical signs that can be reliably measured and analyzed for changes – that could help them predict outcomes for women with that particular tumor type.

They appear to have found one. » Continue Reading

Bladder cancer treatment is evolving. Here are 3 important advances

July 16, 2015 | by

In years past, Bladder Cancer Awareness Month has been a sobering reminder of a disease with few treatment options. For patients with metastatic disease (disease that has spread from the bladder to distant organs), average survival is typically just over one year. Fortunately, things are changing.

stages of bladder cancer

Bladder cancer treatment is advancing. Here are three of the most promising approaches. (Illustrated here, bladder cancer in stages.)

Academic institutions like City of Hope now have a wealth of clinical trials for patients with bladder cancer. These clinical trials are examining drugs that work through a number of mechanisms distinct from chemotherapy. Highlighted below are the top three research and treatment advances that I feel are the most promising:

1. Redirecting the immune system

We have several ongoing studies looking at a class of drugs called programmed death-1, or PD-1, inhibitors. In a patient with cancer, the immune system is often suppressed, making it challenging for the body to mount any response against cancer cells. PD-1 inhibitors (and a closely related class of drugs called PD-L1 inhibitors) cause dormant immune cells to reactivate, therefore overcoming this suppression.

Not every patient will respond to PD-1 or PD-L1 inhibitors, but those who do often have extremely prolonged responses, with existing studies documenting survival of up to several years.

» Continue Reading

Brain tumor patient is first person treated in new stem cell clinic

July 8, 2015 | by

A gliobastoma patient has become the first person to be treated by City of Hope’s new Alpha Clinic for Cell Therapy and Innovation (ACT-I), heralding a potential breakthrough in the treatment for brain tumors and in the use of stem cells.

clinical trail for brain tumors

A gliobastoma patient is the first person to be treated by City of Hope’s new Alpha Clinic for Cell Therapy and Innovation. The patient will receive injections of neural stem cells, which naturally home to cancer cells.

“Glioblastoma is the most aggressive-behaving, malignant primary brain tumor, and new treatments that target cancer cells in the brain are desperately needed,” said Jana Portnow, M.D., associate professor of medical oncology and associate director of the Brain Tumor Program at City of Hope, who is leading the current phase I neural stem cell study.

The patient underwent surgery for recurrent glioblastoma and was then treated in a clinical trial using genetically-modified neural stem cells – which naturally home to cancer cells – to help deliver chemotherapy to brain cancer cells. The aim of this neural stem cell research is to develop a treatment that is more potent and less toxic than existing treatments for brain tumors.

“We’ve genetically modified these cells to produce chemotherapy at the sites of the tumor in the brain,” said Karen S. Aboody, M.D., professor in the Department of Neurosciences and Division of Neurosurgery and co-leader of the Developmental Cancer Therapeutics Program at City of Hope. “Rather than putting chemotherapy through the whole body and possibly causing significant side effects that affect quality of life, the neural stem cells produce active chemotherapy only at the sites of the tumor, killing surrounding cancer cells.” » Continue Reading

Clinical trial offers islet cell transplantation for type 1 diabetes

July 7, 2015 | by

A strict diet and insulin shots can’t always control type 1 diabetes. What people with the immune disorder really need are insulin-producing cells of their own – currently only available through a still-experimental procedure known as islet cell transplantation.

A new clinical trial at City of Hope will make that possible for some patients, with physicians in the newly launched Diabetes & Metabolism Research Institute at City of Hope now providing this transplantation to suitable candidates. The trial, they say, could be the first step in a multipronged effort to permanently cure type 1 diabetes.

The new phase I/II trial is open to adults with type 1 diabetes who have had the disease for more than five years and who experience frequent episodes of hypoglycemia or hypoglycemia unawareness, in which blood sugar drops precipitously without corresponding symptoms. Diabetic patients who have hypoglycemic unawareness are at risk of injuries and accidents, because the drop in their blood sugar can go undetected until they suddenly lose consciousness.

“We are one of only a few islet cell transplant programs in the country,” said Fouad Kandeel, M.D., Ph.D., chair of the Department of Clinical Diabetes, Endocrinology & Metabolism at City of Hope, who is leading the islet cell transplantation trial. “This trial, in addition to providing a much needed potential cure for patients with severe type 1 diabetes, will also be vital in opening the door to other major studies to address the medical needs of these patients.”

The goal of the trial is to further evaluate the effectiveness of transplantation as a treatment and possible cure for type 1 diabetes. Researchers also hope to gain a better understanding of the mechanisms of islet cell rejection if it occurs.

» Continue Reading

Drug shows promise for patients with chronic lymphocytic leukemia

July 3, 2015 | by

Patients with chronic lymphocytic leukemia may soon find themselves with improved treatment options.

ibrutinib chronic lymphocytic leukemia

Patients with chronic lymphocytic leukemia may find interim results of new study encouraging. Ibrutinib, a drug targeting a protein diseased cells need to survive and proliferate, is showing promise in combination with standard therapies.

Interim results from a study not conducted at City of Hope suggest that, for patients with chronic lymphocytic leukemia, or CLL, a new oral drug given in combination with standard treatment significantly reduced the risk of disease progression or death. Although the results are interim, not final – meaning the study and its analysis are not yet completed – the study itself is a randomized, placebo-controlled study, considered a marker of high-quality methodology.

City of Hope’s Guido Marcucci, M.D., co-director of the Gehr Family Center for Leukemia Research, is watching the results of the study closely. He recently offered some measured perspective to other physicians in an interview with MedPage Today.

“The implications of this study are very broad, and certainly may impact how we will treat CLL patients in the next years to come,” he said.

The new study combined the current standard of care for CLL – a combination of bendamustine and rituximab – with a new oral drug called ibrutinib. Ibrutinib targets a specific protein that disrupts the signals the cancer cells need to survive and proliferate. Patients in the study received up to six cycles of the standard treatment and were randomized to receive either a placebo or a dose of ibrutinib.

The combination of ibrutinib and the standard therapy reduced risk of CLL progression or death by 80 percent compared to the placebo group. The ibrutinib group also had a higher overall response rate to the therapy, with 83 percent of cancers responding to the treatment versus 68 percent in the placebo group.


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