If you haven’t heard the term “precision medicine,” you will. If you don’t have an opinion about access to it, you will.
On Friday, President Obama unveiled details of the Precision Medicine Initiative, an effort intended to accelerate cancer research in a powerful way, giving doctors new knowledge and new therapies to help them better treat individual patients much more effectively than is generally currently possible.
The specific goal of the $215 million plan is the creation of more targeted treatments for individual patients, not general-approach therapies that doctors then try to modify to the best of their abilities. As the White House said in a briefing:
“Most medical treatments have been designed for the ‘average patient.’ As a result of this ‘one-size-fits-all-approach,’ treatments can be very successful for some patients but not for others. This is changing with the emergence of precision medicine, an innovative approach to disease prevention and treatment that takes into account individual differences in people’s genes, environments, and lifestyles. Precision medicine gives clinicians tools to better understand the complex mechanisms underlying a patient’s health, disease, or condition, and to better predict which treatments will be most effective.”
The lack of a practical way to produce and store enough stem cells for larger-scale therapies and clinical trials is creating a bottleneck in stem cell research. A new grant to City of Hope from the California Institute for Regenerative Medicine will help solve that problem.
The $899,728 grant, awarded Thursday to City of Hope researchers, will enable researchers to adapt current cell culture techniques to a more scalable and controllable system that reflects Good Manufacturing Practices.
Existing cell production methods allow for pluripotent stem cells and progenitor cells, but these methods simply can’t be scaled up, from a practical perspective, to the level necessary for clinical trials and for some of the stem cell products expected to be in high demand. For example, cardiomyocytes – heart muscle cells – derived from stem cells show promise as a treatment for heart failure, which is occurring at epidemic rates. However, large doses of these cells would be required for sufficient therapeutic use, and current production practices don’t support that type of increase. » Continue Reading
Despite advances in surgery, radiation and drug therapy, brain tumors remain particularly challenging to treat. This is due to the tumor’s location, which can limit localized therapies’ effectiveness, and the blood-brain barrier, which blocks many cancer-fighting drugs’ passage from the bloodstream to the tumor site.
City of Hope scientists are currently researching a new method that can overcome these barriers, using nanoparticles that can activate the immune system to attack tumor cells in the brain.
Within these nanoparticles are CpG, small snippets of DNA molecules that can stimulate a localized immune response. The problem with CpG is that, when the snippets are administered on their own, they can disperse throughout the body, prompting immune cells to attack healthy tissues as well.
To address this issue, researchers Behnam Badie, M.D., director of the Brain Tumor Program and Jacob Berlin, Ph.D., assistant professor in the Department of Molecular Medicine, came up with the idea of packaging CpGs within carbon nanotubes (CNT), small structures that resembles a bacteria or virus in size. Because their structure mimics those of invasive microorganisms, they should be rapidly taken up by immune cells in the injection site, localizing their attack response.
In animal studies, Badie and Berlin have shown this is the case, and those injected with CNT-CpG had significantly better outcomes than the CpG-only and control groups. In their three-month measurement period, 100 percent of the CNT-CpG group survived versus 0 percent of the other two groups.
Further, the CNT-CpG group also remained tumor-free when injected with new brain tumor cells after the initiation treatment, showing that this treatment can provide long-term anti-tumor immunity.
Given the promising results of this novel therapy, Badie and Berlin are working with the Food and Drug Administration to develop the criteria for a Phase I trial using CNT-CpG and hope to begin an in-human study within the next two years.
Equipping the immune system to fight cancer – a disease that thrives on mutations and circumventing the body’s natural defenses – is within reach. In fact, City of Hope researchers are testing one approach in clinical trials now.
Scientists take a number of steps to turn cancer patients’ T cells – white blood cells that are part of the immune system’s defenses – into smart cells that can locate elusive cancer cells. They also get help from nature, using the natural properties of what most people consider agents of infection.
First, they use bacteria to help the patient’s own T cells grow in the lab – because cell reproduction is something bacteria do very well. Then they use a harmless virus to manipulate the DNA of the T cell so it can recognize certain markers on a cancer cell that flag them as targets for attack.
KPCC recently reported on this research, explaining how the immune system might be mobilized to attack cancers that are good at hiding from the body.
Bacteria, viruses, a patient’s own immune system and a team of top scientists all working in concert against cancer … Sound complicated? In about two and a half minutes, the above video artfully sums up the process step by step.
So far, City of Hope is studying this approach in a number of blood cancers through the Hematologic Malignancies and Stem Cell Transplantation Institute.
Learn more about T cell immunotherapy at City of Hope.
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what’s required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.
As treatments for lung cancer become more targeted and effective, the need for better technology to detect lung cancer mutations becomes increasingly important. A new clinical study at City of Hope is examining the feasibility of using blood and urine tests to detect lung cancer mutations, potentially allowing for targeted cancer treatments without an invasive biopsy.
The trial, a collaboration with Trovagene Inc., focuses specifically on mutations that make EGFR proteins (for epidermal growth factor receptor) grow and divide faster than they should. The protein is normally found on the surface of cells, but nonsmall cell lung cancer cells can have too much of this protein.
Sometimes, a patient can require two procedures to obtain an adequate biopsy that determines the presence of EGFR mutation. In this first clinical study, patients who have been biopsied will also get specific blood and urine tests to determine if those tests are as effective as a traditional biopsy to determine an EGFR mutation.
“Tracking various alterations in the EGFR oncogene has potential to improve therapeutic strategies for treating patients with nonsmall cell lung cancer,” said Mihaela Cristea, M.D., lead investigator and associate professor in City of Hope’s Lung Cancer and Thoracic Oncology Program. “We look forward to evaluating Trovagene’s molecular diagnostics for the monitoring of circulating tumor DNA found in both urine and blood, with the goal of delivering highly personalized cancer treatment to improve patient outcomes.” » Continue Reading
When it comes to breast cancer risk, insulin levels may matter more than weight, new research has found.
The study from Imperial College London School of Public Health, published in the journal Cancer Research, indicates that metabolic health – not a person’s weight or body mass index – increases breast cancer risk in postmenopausal women. Although high insulin levels frequently occur in women who are overweight or obese, women at normal weights may have unhealthly insulin levels, as well, putting them at a perhaps unexpected increase in breast cancer risk. Likewise, some obese women may have normal levels of the hormone.
The study of insulin and breast cancer risk included 3,300 women without diabetes, 497 of whom developed breast cancer during the study’s eight years. The study analyzed weight, fasting insulin levels and insulin resistance. Insulin is a hormone that aids in using digested food for energy. An inability to produce insulin or use it properly leads to diabetes. Insulin resistance occurs when the body is unable to use insulin efficiently, resulting in hyperglycemia. The condition is often a precursor to type 2 diabetes. » Continue Reading
Surgery is vital in the treatment of cancer – it’s used to help diagnose, treat and even prevent the disease – so a new colorectal cancer study linking a decrease in surgeries for advanced cancer to increased survival rates may raise more questions than it answers for some patients.
The surgery-and-survival study, conducted by researchers at MD Anderson Cancer Center and published recently in JAMA Surgery, found that although surgery is still the most-used treatment for Stage 4 colorectal cancer, it has become less common. Surgical rates decreased from 74.5 percent in 1988 to 57.4 percent in 2010, with survival rates doubling from 8.6 percent in 1988 to 17.8 percent in 2009.
The trend reflects a greater use of new chemotherapy drugs and targeted treatment options and highlights the overall improvements made in the treatment of colorectal cancer. But Stephen Sentovich, M.D., M.B.A., a board-certified colon and rectal cancer surgical expert at City of Hope, cautions against making broad assumptions about the best treatment options.
Treatment choices aren’t always black and white, he says. Decisions needs to be individualized, based on the unique needs of each patient. » Continue Reading
When Homa Sadat found a lump in her breast at age 27, her gynecologist told her what many doctors say to young women: You’re too young to have breast cancer.
With the lump dismissed as a harmless cyst, she didn’t think about it again until she was at a restaurant six months later and felt shooting pain. She went back to her doctor and asked for a biopsy. The biopsy confirmed her fear: She had breast cancer. A biopsy of a suspicious lymph node in the underarm area confirmed that the cancer had spread.
Sadat was diagnosed with what’s known as triple-negative breast cancer.
When pathologists test breast cancer cells, they look for the presence of estrogen and progesterone hormone receptors and the overexpression of receptors for a type of protein called HER2. Breast cancer that is positive for one of the hormone receptors can be targeted with hormonal therapy such as tamoxifen or aromatase inhibitors. Other therapies, like trastuzumab (Herceptin) or its newer versions, have been developed to target HER2 overexpressive – that is, positive – breast cancers.
Cancers that are negative for all three receptors are often referred to as triple-negative cancers. They’re the toughest to treat.
What most people call a “bone marrow transplant” is not actually a transplant of bone marrow; it is instead the transplantation of what’s known as hematopoietic stem cells. Such cells are often taken from bone marrow, but not always.
Hematopoietic stem cells are simply immature cells that can develop into any type of blood cells, including white blood cells, red blood cells and platelets. They’re used to treat blood cancers and other hematologic disorders, and they can come from bone marrow, peripheral blood (blood that circulates through the arteries and veins) or even umbilical cord blood banked at the time of a baby’s birth.
Transplantation follows a fairly similar process: First, a donor (or in some cases, the patient himself) provides stem cells that match the patient’s blood cells in key ways. Then the patient is treated with chemotherapy and radiation to prepare him for the transplant, and the new cells are infused.
Having access to all options for stem cell transplantation is important for patients with a blood cancer or other hematologic malignancy, said Chatchada Karanes, M.D., director of the Cord Blood Transplant Program in City of Hope’s Hematologic Malignancies and Stem Cell Transplantation Institute, because many factors must be weighed when choosing the best transplantation option for a patient.