Less invasive treatments. More cures.
Yuman Fong, M.D., chair of the Department of Surgery at City of Hope, has adopted this as more than a mantra. He’s made it his life’s work. Penning the leading textbooks and manuals in liver surgery, delving into gene therapy to find innovative new approaches to use viruses to attack cancer, and exploring robotic means to improve surgeries and make them less invasive, Fong doesn’t limit himself to a single medical discipline in his quest to fight cancer.
“Many advanced cancers are curable,” he says. “Seeing an expert makes a difference.”
Fong uses the example of liver cancer, saying that often patients who have multiple tumors don’t recognize effective treatments are available for even advanced and complex cancers. About half of patients who have had colorectal cancer will develop a tumor in their liver. Of these, Fong estimates as many to 50 percent to 60 percent of these cases are curable – if patients can get to surgeons with the expertise to handle their disease.
He has been a leader in performing liver cancer surgeries that primarily use a needle to ablate the tumor – often allowing patients to go home on the same day.
While currently no broad screening regimen exists for liver cancer, doctors know two groups who are at highest risk, he says: colorectal cancer survivors and hepatitis C patients – especially those who have liver cirrhosis.
Fong’s point is that where you seek treatment for cancer care matters. That point is backed up by recent City of Hope research finding that being treated at a comprehensive cancer center does, in fact, improve survival. The study, recently presented at the American Society of Clinical Oncology’s annual meeting, also found that ethnicity, insurance type and socioeconomic status could all be barriers to getting treatment at a comprehensive cancer center.
The first step is for people to recognize that cancer is often more curable than they think, says Fong, and to seek the experts in curing it.
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting us online or by calling 800-826-HOPE (4673). Our staff will explain what previous medical records we’ll need for your first appointment and help you determine, before you come in, whether or not your insurance will pay for the appointment.
Learning and memory are regulated by a region of the brain known as the hippocampus. New research from City of Hope has found that stimulating a specific gene could prompt growth – in adults – of new neurons in this critical region, leading to faster learning and better memories.
Understanding the link between this gene and the growth of new neurons – or neurogenesis – is an important step in developing therapies to address impaired learning and memory associated with neurodegenerative diseases and aging. The new research was published June 9 in the Proceedings of the National Academy of Sciences.
The study, which used an animal model, found that overexpressing the gene – a nuclear receptor called TLX – resulted in smart, faster learners that retained information better and longer.
“Memory loss is a major health problem, both in diseases like Alzheimer’s, but also just associated with aging,” said Yanhong Shi, Ph.D., lead author of the study and a neurosciences associate professor at City of Hope. “In our study, we manipulated the expression of this receptor by introducing an additional copy of the gene – which obviously we cannot do outside the laboratory setting. The next step is to find the drug that can target this same gene.”
The discovery creates a new potential strategy for improving cognitive performance in elderly patients and those who have a neurological disease or brain injury. » Continue Reading
A quarter of children in remission from acute lymphoblastic leukemia, or ALL, are tripling their risk of a relapse because they are missing too many doses of an essential maintenance medication, according to findings from a recent City of Hope study .
The research, published in the journal Blood, also reports maintenance medication adherence was lower in minority groups. About 46 percent of African-American children and 28 percent of Asian children are not taking enough doses to prevent relapse, compared with 14 percent of white children.
Acute lymphoblastic leukemia, a cancer of the white blood cells, is the most common form of childhood cancer. While more than 95 percent of children with ALL enter remission within a month of receiving initial cancer therapy, one in five will relapse. Additionally, relapsed disease is often harder to treat and may involve costlier, most toxic therapies.
In order to remain cancer-free, children in ALL remission must take a form of oral chemotherapy, called 6-mercaptopurine(6MP), every day for two years to protect against the disease coming back.
Despite 6MP’s proven benefit, previous studies have suggested pediatric ALL patients have difficulty taking it consistently. Other studies reported survival rates vary greatly among racial groups – prompting investigators to begin studying race-specific patterns of adherence in children with ALL.
“While we don’t yet know why children of different races have significantly different survival rates for ALL, we know that their adherence to their maintenance medication is a critical factor in their survival,” said first author Smita Bhatia, M.D., M.P.H. “With this in mind, we sought to explore the potential linkages that may exist between several key race-specific sociodemographics of these children and their adherence to 6MP.”
Bhatia, who is also the Ruth Ziegler Chair in Population Sciences, and her team began their research studying differences in medication adherence among different racial groups of children in remission from ALL in 2012, reporting that Hispanic children did not follow their prescribed maintenance regimen as consistently as non-Hispanic whites. » Continue Reading
For premenopausal, hormone-sensitive breast cancer patients, the estrogen blocker tamoxifen is often prescribed after surgery to help prevent the cancer from returning. But new research data may change this longstanding practice since it found the aromatase inhibitor exemestane (trade name Aromasin) to be more effective this role.
These findings came from a joint analysis of two phase III breast cancer clinical trials, called TEXT and SOFT, and were presented during the plenary session of the American Society of Clinical Oncology annual meeting.
Reporting on the study, lead author Olivia Pagani, M.D., said that the exemestane group were 34 percent less likely than the tamoxifen group to develop a subsequent breast cancer.
“For years, tamoxifen has been the standard hormone therapy for preventing breast cancer recurrences in young women with hormone-sensitive disease. These results confirm that exemestane with ovarian function suppression constitutes a valid alternative,” said Pagani, clinical director of the Breast Unit at the Oncology Institute of Southern Switzerland, in a press release.
For this study, Pagani and her team looked at data from almost 4,700 women in both trials. The women had all undergone initial breast cancer surgery and were then randomized to receive five years of either tamoxifen or exemestane. Additionally, all women were given ovarian function suppression therapy, which can include oophorectomy (surgical removal of the ovaries), ovarian irradiation or drugs that stop the ovaries from working.
After follow-up and analysis, the researchers found that breast cancer-free survival was 88.8 percent in the tamoxifen group and 92.8 percent in the exemestane group. Significant improvements were also seen in overall cancer-free survival (87.3 percent in tamoxifen, 91.1 percent in exemestane).
Anyone who’s been around children knows how resilient they can be. Most of them bounce far more than they break. Perhaps that’s one reason why most children who are diagnosed with cancer face strong odds of surviving the disease.
But their survival is not without cost; treatments can be aggressive and result in lingering health issues. Saro Armenian, D.O., M.P.H., medical director of City of Hope’s Pediatric Survivorship Clinic, studies the long-term adverse effects of cancer treatment in survivors of childhood cancers. In particular, he focuses on damage to heart tissue.
Rally and The Truth 365 are nonprofit organizations that raise awareness and funds for childhood cancer research. Rally in particular funds studies that address long-term side effects of treatment, a topic that has interested Armenian for years. » Continue Reading
Results from a large-scale study found that four commonly-prescribed drug regimens are equally effective for most types of colorectal cancer. The findings were presented during the plenary session at the American Society of Clinical Oncology’s annual meeting.
The researchers reported that, for metastatic colorectal cancer patients who do not have a KRAS 12/13 gene mutation, nearly identical results were seen from taking chemotherapy with either bevacizumab (trade name Avastin) or cetuximab (trade name Erbitux).
According to Marwan Fakih, M.D., director of City of Hope’s gastrointestinal medical oncology program, these results mean that patients and their doctors can choose a regimen based on other factors — such as side effects — without having to worry about a reduction in effectiveness.
“For now, this report’s message is simple: no change in standard practice in the United States,” said Fakih, who is not involved in this study.
For this federally funded phase III clinical trial, more than 1,100 metastatic colorectal cancer patients are randomized to receive one targeted therapy (bevacizumab or cetuximab) and one chemotherapy combination (FOLFIRI or FOLFOX). The researchers hypothesized that bevacizumab and cetuximab may have varied in efficacy due to their different mechanisms of action. Bevacizumab prevents tumor growth and spreads by blocking the formation of new blood vessels while cetuximab works by inhibiting a growth factor that is used for cancer cells’ uncontrolled division.
After patient follow-ups and data evaluation, the researchers found that there were no significant differences between the bevacizumab+chemotherapy and cetuximab+chemotherapy groups in either overall survival (29 months versus 29.9 months, respectively) or progression-free survival (10.8 versus 10.4 months, respectively.)
Although comprehensive cancer centers — including City of Hope — are recognized by the National Cancer Institute for their robust clinical care, research and education programs, patients have had little way to compare those centers’ outcomes and patient populations against other facilities’. Until now.
This question is addressed in a new City of Hope study which found that receiving cancer care at a comprehensive cancer center does indeed improve survival. The study also found that multiple factors — including ethnicity, insurance type and socioeconomic status — can affect a person’s likelihood of being treated at a comprehensive cancer center.
The abstract of the study will be presented on June 2 by Julie Wolfson, M.D., M.S.H.S., assistant professor of City of Hope’s Department of Pediatrics and Department of Population Sciences, at the American Society of Clinical Oncology’s annual meeting in Chicago.
“To be designated as a comprehensive cancer center, an institution has to go through a rigorous approval process to ensure its quality in diagnosis, treatment, research and education,” Wolfson said. “However, there have not been any studies on treatment site’s effect on survival outcomes or demographic factors that can impact where a patient goes for treatment.”
To investigate this topic, Wolfson and her colleagues analyzed data from more than 53,000 cancer patients in the Los Angeles County cancer registry from 1998 to 2008. Of this patient population, approximately 7 percent were treated at a comprehensive cancer center; the team compared this subset against patients treated in other settings to determine whether there were any significant differences in demographics and overall survival. » Continue Reading
A plenary study presented at the American Society of Clinical Oncology’s annual meeting found that adding lapatinib (marketed as Tykerb) to trastuzumab (marketed as Herceptin) did not improve survival outcomes for women with early-stage breast cancer that is sensitive to HER2-targeted therapy.
This finding came as a shock and a disappointment for many breast cancer clinicians, researchers, patients and advocates, since lapatinib also acts upon the HER2 receptor, and an earlier trial on the lapatinib-trastuzumab combination showed promising results.
Despite this discouraging news, the study’s lead author, Edith A. Perez, M.D., did find a silver lining when reporting her results.
“We were encouraged to see that most patients with HER2-positive early breast cancer are doing well with standard trastuzumab therapy,” said Perez, a deputy director at large at the Mayo Clinic Cancer Center in Jacksonville, Florida, in a press release. “But we were surprised that adding lapatinib did not provide further benefit.”
In this phase III clinical trial, called ALTTO, Perez and her colleagues followed more than 8,000 women with early-stage, HER2-positive breast cancer. After these patients underwent surgery, they were randomized to receive standard chemotherapy in combination with either trastuzumab, lapatinib, trastuzumab followed by lapatinib or trastuzumab concurrent with lapatinib. » Continue Reading
For women with ovarian cancer, the results of recent study could mean new hope for future treatments. The findings, reported at the American Society of Clinical Oncology’s annual meeting, found that a combination of two experimental drugs, olaparib and cediranib, significantly lengthened the duration of progression-free survival compared to olaparib alone and standard chemotherapy.
The phase II trial is the first time that a PARP inhibitor is combined with an anti-angiogenic drug to treat ovarian cancer. PARP inhibitors such as oliparib work by thwarting cancer cells’ ability to repair their own DNA, while anti-angiogenic drugs such as cediranib halts growth of new blood vessels in tumors.
“The significant activity that we saw with the combination suggests that this could potentially be an effective alternative to standard chemotherapy,” said the study’s lead author Joyce Liu, M.D., M.P.H., in a press release.
Liu, an instructor in medical oncology at Dana Farber Cancer Institute, added that these findings showed that the two drugs worked synergistically and bolstered each other’s effectiveness against the cancer.
For this clinical trial, Liu and her colleagues randomized 90 patients with recurrent, platinum-sensitive ovarian cancer into either olaparib-only or olaparib+cediranib groups. In their analysis, they found that progression-free survival was significantly higher in the combination group, over 17 months compared to nine months in oliparib only. Meanwhile, previous trials with standard chemotherapy in this population showed a progression-free survival range from eight to 13 months.
Testicular cancer is the most common form of cancer in men 15 to 34 years old. Yet it accounts for only 1 percent of all cancers in men in the United States. According to the American Cancer Society, about 8,800 men are diagnosed with testicular cancer each year, and about 380 men die of the disease. However, if detected early, the disease has an overall five-year survival rate of 96 percent. For Stage 1 patients, the five-year survival rate is an astonishing 99 percent.
Here, urologist Jonathan Yamzon, M.D., assistant clinical professor and surgeon in City of Hope’s Division of Urology and Urologic Oncology, discusses how early detection and the use of advanced treatment options can help cure men of this rare disease and allow them to lead healthy, normal lives.
What is testicular cancer?
Testicular cancer occurs when cells in the testicles grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the testicle. If the disease spreads, it is still called testicular cancer.
The most common types of testicular cancer form in germ cells, where sperm is made. They fall into two categories: seminomas and nonseminomas. Seminomas are slow-growing and tend to stay within the testicle. Nonseminomas are faster-growing, tend to spread outside the testicle and strike younger men. More than 90 percent of testicular cancers begin in the germ cells. » Continue Reading