Precision medicine: It’s here – now to make it a norm, not an exception

March 28, 2015 | by

Precision medicine holds promise – on that doctors, especially cancer specialists, can agree. But this sophisticated approach to treatment, which incorporates knowledge about a person’s genetic profile, environment and lifestyle, isn’t yet standard for all cancers. It can’t be. Researchers and scientists are still amassing as much information as possible, in order to better understand the best avenues of research and the resulting treatment options.

Precision medicine potential

Precision medicine is here. Now we must make it the norm, not the exception. That means knowledge and information must be shared, not hoarded, among institutions.

The National Institutes of Health (NIH) sums up the status of precision medicine in this way: “While significant advances in precision medicine have been made for select cancers, the practice is not currently in use for most diseases. Many efforts are underway to help make precision medicine the norm rather than the exception.”

Steven T. Rosen, M.D., provost and chief scientific officer at City of Hope, is an expert on precision medicine, understanding the potential that comes with increased knowledge of diseases such as cancer and what it will take to help the field evolve.

Here he answers questions about the current, and future, state of precision medicine at City of Hope: » Continue Reading

As stem cell therapy research advances, so does nursing

March 25, 2015 | by

The promise of stem cell therapy has long been studied in laboratories. Now, as medicine enters an era in which this therapy will be increasingly available to patients, the nurses who help deliver it will be in the spotlight.

stem cell

Nurses in the Alpha Clinic for Cell Therapy and Innovation at City of Hope will develop new nursing standards for stem cell therapies.

City of Hope, which has launched its Alpha Clinic for Cell Therapy and Innovation (ACT-I), is among the first to have a dedicated clinic for leading-edge stem cell therapy. The clinic’s nurses will bridge two disciplines that have long been separate: compassionate care, for which City of Hope is known worldwide, and protocol-heavy stem cell clinical trial research.

“In the Alpha Clinic, we will have staff who are seasoned in working with inpatient units for stem cell transplants, and we will combine that with excellent clinical research nursing support in a much more coordinated fashion than we’ve seen in any place else to date,” said Shirley Johnson, R.N., senior vice president, chief nursing and patient services officer at City of Hope. » Continue Reading

Not all conditions should be treated at end of life, study suggests

March 24, 2015 | by

Just because you can treat a condition, such as high cholesterol, at the end of life — well, that doesn’t mean you should. That’s the basic lesson of a study to be published March 30 in JAMA Internal Medicine. The ramifications go far beyond that.

drugs and end-of-life care

Some conditions, such as high cholesterol, might not need to be treated at the end of life. A new study found that stopping statin treatment for high cholesterol actually improved quality of life.

The research, in which City of Hope’s Betty Ferrell, Ph.D., R.N., participated, found that stopping the use of statins in patients with late-stage cancer and other terminal illnesses can actually improve quality of life, without doing harm to the patient. That’s no small finding. Statins are one of the most commonly prescribed medications in the United States, as the press release about the study points out, and many patients for whom cure is no longer an option will be affected if doctors take the lesson to heart.

To summarize: The study on end-of-life care involved 381 patients — with a mean age of 74.1 years — about half of whom continued their cholesterol medication and about half of whom stopped. More than a fifth were cognitively impaired, and almost half had cancer. The researchers found that the number of study participants who died within 60 days was about the same for both the statin-taking and statin-forgoing groups but, of special significance, the quality of life was better for those who stopped taking statins. » Continue Reading

Discovering tools for genetic testing – and teaching others to use them

March 23, 2015 | by

The understanding of the relationship between genetics and cancer risk continues to grow, with more genetic testing than ever before available to patients.

genetic testing

City of Hope leaders have created a program to teach clinicians nationwide and worldwide how to use available genetic testing tools.

However, the adage that a little knowledge is a dangerous thing is applicable: Without context for what a test result means, and without meaningful guidance from genetic counselors, genetic tests don’t do patients much good.

Case in point: In addition to those better-known mutations contributing to breast cancer, such as BRCA1 and BRCA2, researchers have identified about 20 other genes that may be implicated in causing cancer, many of them rare or having more discreet effects. People who carry those other mutations – and who test negative for the BRCA mutations – may face a higher risk than they realize.

The doctors and counselors who deal with patients every day need training in order to help as many people as possible benefit from such knowledge and from today’s scientific advances. Scientists, clinicians and genetic experts at City of Hope are committed to bridging the gap between the technology that’s available and the number of professionals who know how to use and interpret the results of that technology.

Led by Jeffrey Weitzel, M.D.,  director of the Division of Clinical Cancer Genetics, City of Hope recently hosted a cancer genetics and genomics conference, “From Evidence to Action: Next-Generation Approaches to Cancer Risk Assessment and Research.” Nearly 200 physicians and clinicians from across the nation and abroad attended the conference.  » Continue Reading

Stem cell therapy clinic will fight incurable disease in new ways

March 20, 2015 | by

In the field of cancer, patients have had surgery, chemotherapy and radiation therapy as options.

Now, as City of Hope officially opens the Alpha Clinic for Cellular Therapy and Innovation, patients battling cancer and other life-threatening diseases have another option: stem-cell-based therapy.

stem cell clinic

City of Hope’s Alpha Clinic for Cell Therapy and Innovation will bring stem cell and other cell-based therapies to patients through clinical trials. The clinic opened officially March 19.

The Alpha Clinic, which officially opened March 19, is funded by an $8 million California Institute for Regenerative Medicine (CIRM) grant. It will combine the uniquely patient-centered care for which City of Hope is known with the most innovative, stem-cell based therapies available to date. In short, the stem cell therapy clinic is expected to revolutionize not just the treatment of cancer, but also AIDS and other life-threatening diseases.

“We are in a new era of cellular therapy,” said John Zaia, M.D., the Aaron D. Miller and Edith Miller Chair in Gene Therapy, chair of the Department of Virology at City of Hope, and principal investigator for the stem cell therapy clinic. “The California Institute for Regenerative Medicine recognizes this, and they have been leading the field. Alpha Clinics like ours aim not only to provide research to benefit patients in the future, but get these innovative treatments running in real-life clinics to benefit patients now.” » Continue Reading

End-of-life nursing care has evolved worldwide. Here’s how …

March 18, 2015 | by
Betty Ferrel

Betty Ferrell, director and professor of nursing research and education at City of Hope, is the principal investigator of ELNEC, a palliative-care education program that has helped end-of-life care evolve worldwide.

Nurses and other medical professionals have come to understand that it’s not enough just to fight disease. They also must provide pain relief, symptom control, and an unrelenting commitment to improve patients’ quality of life — especially at the end of life. Not too long ago, this was a relatively novel concept.

That’s why ELNEC matters.

ELNEC is the End-of-Life Nursing Education Consortium, pioneered by City of Hope in partnership with the American Association of Colleges of Nursing. It was created in 2000 after groundbreaking research at both institutions pointed to a serious lack of comprehensive, rigorous, systematic and high-quality, end-of-life care education.

The training raises awareness of patients’ end-of-life needs, even as it teaches the specialized nursing skills required when patients’ goals shift from a cure to ensuring that their remaining days hold as much meaning as possible for themselves and their families.

» Continue Reading

Cancer Insights: The dawn of precision medicine for cancer

March 17, 2015 | by

“Tonight, I’m launching a new precision medicine initiative to bring us closer to curing diseases like cancer.” These were the words of President Barack Obama on Jan. 20, 2015, during his State of the Union address. So what is precision medicine, and how close are we to making it a reality for patients?

Potential of precision medicine

Precision medicine is rapidly becoming a reality. With it comes an unprecedented potential to treat patients as the individuals they are.

Let’s begin with some definitions. Precision medicine entails two general tenets: (1) understanding the biology of an individual patient’s cancer, and (2) treating the patient according to this biology. When I was in medical school, both elements would have been perceived as a pipe dream. Now, they are slowly becoming a reality.

Comprehensive genetic tests that used to take days to weeks to run can now be done in minutes; these tests can point an oncologist toward specific medications that target proteins at the cancer cell surface, while sparing normal cells. In contrast to chemotherapy (which attacks cells indiscriminately), targeted therapies may potentially have fewer side effects. » Continue Reading

Drug could boost chance of pregnancy after breast cancer, study suggests

March 11, 2015 | by

Breast cancer treatment can damage a woman’s ability to become pregnant, making the impact on fertility one of the key factors that many consider when choosing a therapy regimen. Now a study has found that breast cancer patients treated with a hormone-blocking drug in addition to chemotherapy were less likely to experience ovarian failure and more likely to have successful pregnancies.

breast cancer treatment's effect on fertility

Breast cancer  and fertility: Breast cancer patients treated with a hormone-blocking medication in addition to chemotherapy were less likely to have ovarian failure and more likely to become pregnant after treatment.

Although the study on breast cancer and fertility has some limitations, it could suggest an alternative strategy for women who hope to become pregnant after breast cancer treatment, said George Somlo, M.D., a professor of breast oncology and staff physician at City of Hope. He was not involved in the study, but provided outside expert commentary in an interview with Medpage Today.

The Cleveland Clinic study, published in the New England Journal of Medicine, found that women who received goserelin – a synthetic version of a naturally occurring hormone – during chemotherapy experienced an 8 percent ovarian failure rate, compared to 22 percent among women who did not receive the drug. In addition, 21 percent of women who received goserelin became pregnant within five years post-treatment, compared to 11 percent of women in the control group during the same time frame.

Somlo elaborated on his perspective in this Q and A. » Continue Reading

Cancer Insights: The real link between prostate cancer and hair loss

March 10, 2015 | by
Sumanta Pal, M.D.

Sumanta Kumar Pal: The connection between prostate cancer and hair loss is not coincidence, but it might not be exactly what many men think either.

My colleagues in the clinic know I’ve got a soft spot. Last week, a patient of mine offered me a fantastic compliment. “You’re looking younger these days, Dr. Pal!” she said, offering me a big hug as she proceeded out of the clinic room.

Lovely, I thought. The early morning workouts are paying off.

She continued: “Now if you’d just consider using some Rogaine, I think you’d set the dial back about 10 years!”

Ouch. My nurse gave me a somber look, understanding the pain these words had inflicted. I wouldn’t consider myself to be vain by any means, but my hair loss has created increasing conflict between me and my bathroom mirror. With every passing morning, I notice a little less hair up front, and a bit less up top. This pattern, termed frontal and vertex balding respectively, plagues nearly half of American males, albeit to different degrees. Until recently, the major toll of this hair loss for me has been cosmetic, chipping away at my self-image as a youthful oncologist.

A recent study published in the Journal of Clinical Oncology, however, suggests a more significant price. The study authors, based at several U.S. institutions, utilized a database of over 39,000 male patients who were involved in a trial to assess cancer screening. These men were asked to recall their pattern of hair loss at the age of 45, characterizing the degree of frontal and vertex balding. » Continue Reading

Specific protein may be powerful indicator of liver cancer, study finds

March 9, 2015 | by

Liver cancer is terribly difficult to cure. Despite significant treatment advances, five-year survival rates remain at about 15 percent overall — and they rapidly approach zero when the disease is found too late. Findings by City of Hope’s Peiguo Chu, M.D., Ph.D., and a team of scientists may help better those odds.

protein glypican 3

Those at risk of liver cancer may find hope of early detection in a protein called glypican 3.

Scarring of the liver, called cirrhosis, is a major risk factor for liver cancer. It’s caused most often by infection with the hepatitis B or C viruses, alone or together, as well as alcohol abuse and a build-up of fat in the liver known as fatty liver disease.

Determining if cancer has developed in a cirrhotic liver is difficult, and early detection is particularly challenging. Unlike breast and colon cancers, liver cancer appears to have no precancerous lesions that might indicate cancer is imminent, according to Chu, a professor in the Department of Pathology. Various abnormal cells in the scarred liver can hint at the presence of disease, but they are unreliable.

Chu believes a protein called glypican 3 may offer a better answer. In a study recently published in the journal Carcinogenesis, his research team found that glypican 3 was present at much higher levels in liver cancer than in normal liver tissue and in cirrhotic liver tissue that was not cancerous.

» Continue Reading