Tag Archives: Oncology

Oncologists, Genetic Testing and How To Target Cancer Tumors

Cancer Research is going in an entirely new direction based on genetic testing where tailored treatments can now focus on and cancer and genetic testingtarget specific cancer tumors.

And to demonstrate this, we will review a recent (2014) success story from a young man (23-years) who submitted by faith and determination to the investigative process of genetic testing with tailored drug treatments for cancer cure.

Original story:  Wall Street Journal: March 28, 2016 

In February 2014, after a lengthy struggle with a head-cold, nosebleeds and body fatigue, Evan Johnson, a senior student at the University of North Dakota, decided to visit the Mayo Clinic when he began to have bruises and chest pain.

Genetic testing at the Mayo Clinic discovered an acute form of Myeloid Leukemia; a cancer disease that forms, grows, and can  spread quickly through out the body.

Fortunate for Mr. Johnson, oncologists today are taking new directions with genetic testing to discover ways to make strong  offensive action against cancer.  The doctors know cancer can evolve to resist treatment(s), and they now use these complications as potential advantages to identify alternate cancer targets they can use different drug treatments on, as the cancer changes.

(Related Science)

The medical team working at the Mayo Clinic on Johnson’s case moved quickly in their investigative research to discover several effective treatments to use against the cancer genetic mutations that were pushing his disease.  While his end story is successful, Evan had to endure a failed stem cell transplant, six various  prescribed courses of medical treatment,  four cancer relapses and other life-threatening problems that occurred when treatment went beyond the desired effect.

For Evan’s mother, Carol Johnson:

We truly felt like we were in a war.  We didn’t know where the [cancer] enemy was at any given moment and what means [the cancer] was going to use to attack us next.

After nine months into his cancer treatment, Evan’s leukemia evolved and developed a new mutation, unexpectedly!  The change allowed the cancer to escape the cure of the treatment being administered.  But, the deviation in the cancer gave his oncologists  a new target that was vulnerable to other cancer fighting drugs.  Mr. Johnson’s doctors modified and fine-tuned their treatment for him and managed to defeat the leukemia; which cleared the way for Evan to receive a second, successful stem cell transplant. Consequently, Evan Johnson has been cancer free for more than a year.

Genetic Testing: Cancer Treatment’s
New Direction

Dr. Pashtoon Kasi, an oncologist at the Rochester,Minn.-based Mayo Clinic, is a team-member that assisted in Evan Johnson’s medical care.  Dr. Kasi says the medical team could see the cancer evolution  happen by regular genetic testing, which allowed Mr. Johnson’s treatment to be customized to his particular need.  “Personalization in real time… This is where oncology is headed down the line,” says Dr. Pashtoon Kasi.

According to Dr. Jose Baselga, chief physician at Memorial Sloan Kettering Cancer Center in New York:

A decade ago, we were shooting in the dark.  If first-line or second-line treatments failed, we either had nothing to do next, or what we did was totally disconnected with the biology of the disease.

With today’s technology cancer patients with advanced forms of the disease can be treated at major health centers, expecting their tumors to be genetic sequenced.  The genetic testing provides a Genetic Testing Targets Cancer Mutationshope in finding a match to the many new drugs that target exactly and stop the cancer mutations that stimulate the cancer’s growth.  Good matches can produce excellent results with dramatic effect at reducing tumors, but “precision drug treatment” is not always a cure.  Sometimes the treatment is thwarted when a tumor evolves.  This forces oncologists to seek the identity of new mutations that can be stopped with effective treatment.

Oncologists, Genetic Testing and New Cancer Treatments: A Game of Whack-a-Mole

The research process of identifying new mutations and matching the next precision drug treatment to stop cancer growth is.. “like a Whack-a-Mole game,” according to Dr. Baselga.  Each attempt to solve the cancer problem is piece-meal resulting only in temporary or minor improvement.  And as new mutations occur, the medical strategy is to find a new treatment (hammer) to hit it with.

But the real challenge to this approach of medical treatment is finding drugs that treat cancer-causing mutations; there just aren’t that many, yet.  For example, a drug found that works on a patient with melanoma might not be successful on a colon-cancer patient, even if they have the same mutation.  And, sometimes a drug that is not yet approved for the type of cancer being treated is suggested based upon DNA tests that match the tumor mutation, which jeopardizes the possibility of compensation for expensive drugs.

Regarding this method of cancer treatment, Dr. Kasi says:

It’s not for every patient or [form of] cancer.  But as we develop more drugs and understand more [treatment] pathways, it would be a reasonable option for a lot of our patients.

Evan Johnson returned to his home after spending 17 months at the Mayo Clinic enduring medical Whack-a-Mole, being released with a good chance of sustained, durable remission of Myeloid Leukemia and the cancer’s genetic mutations.

An account of Evan’s case has been published by Dr. Pashtoon M. Kasi, Mark R. Litzow, Mrinal M. Patnaik, Shahrukh K. Hashmi, and Naseema Gangat in the journal:

Leukema Research Reports (January 2016)

 

New Drug Targets Cancer Caused By Asbestos

May 26, 2014

Mesothelioma lung cancer can come to those persons who loved, and simply hugged their parent who worked around asbestos.  For example, now at age 45, Heather Von St. James recalls her father working as a building demolition employee around materials containing asbestos.  He would return home each day thoroughly covered by dirt and dust. She remembers how much she enjoyed hugging her father each night.mesothelioma-studies

By age 36, Heather was diagnosed with mesothelioma, the deadly yet to be cured cancer connected with exposure to asbestos particles.  Mesothelioma can take decades to develop and it often kills within months after symptoms appear. Heather was a new mother to a 3-month-old daughter, and she was told her only chance to live was by having a lung removed.

In 2013, more than 107,000 people died worldwide from mesothelioma.  However, Heather opted for the surgery instead, and removed the disease in time to stay alive.   According to Ms. St. James, “There’s a lot of people who don’t.”

Fortunately for other people with mesothelioma, or those that will discover they have the deadly disease, a new wave of drugs developed and being tested are giving new hope that mesothelioma cancer may be slowed or stopped.  Drug researchers, like Verastem Inc. (VSTM), GlaxoSmithKline Plc (GSK), and Dr. Parkash Gill of the USC Norris Comprehensive Cancer Center have announced that they are testing new cancer fighting drugs.

According to Dean Fennell, a lead researcher doing a trial study with a new drug by Verastem:

“[Mesothelioma] is not a curable cancer; it’s not a disease that can be wiped out completely by surgery as you see with lung cancer. Finding ways to stop that process or slow it down can have big implications for patient survival.”

Unlike lung cancers, Mesothelioma affects the cell tissues that cover the lungs.  It can also affect the tissues around the heart and abdominal organs.  Like all cancers, mesothelioma is treated by doctors with cutting the cancer tissue out, or irradiating it, but both methods sometimes have dangerous side effects.

New Drugs Offer New Hope to Replace Old Treatments

Verastem (based out of Cambridge, Massachusetts) has developed a drug (VS-6063) that is now in late-stage human testing. Consecutively, Glaxo (based out of London) has a compound that is being tried in combination with another product in an early-stage study. The drugs from these two companies each target an enzyme involved in cell movement that permits the cancer to spread.

The enzyme is a key marker of aggressive cancers and is overabundant in many tumors that spread quickly. Also, patients with an inactive gene called Neurofibromatosis 2 (NF2) respond well to the test drugs being developed where nearly half of mesothelioma patients have inactive NF2s.

In the U.S. and Europe, the VS-6063 treatment has been granted orphan drug status.  This means that Verastem with their VS-6063 product is given seven (7) years of exclusive marketing.  A Bloomberg report states that according to four (4) analysts, the VS-6063 drug could possibly generate $450 million in sales by 2019 if the product is cleared for public use.

Earliest Stage

Defactinib is the medicine that targets early stage cancer stem cells.  These are considered to be theorigin of the cancer and frequently are resistant to existing therapies.   The cancer stem cells for mesothelioma are known to be particularly resistant to chemotherapy.

Now, Mr. Dean Fennell does not have an economic connection with Verastem, nor is he a paid consultant to the company.  And yet, Mr. Fennell (who is chairman of thoracic medical oncology at the University of Leicester in England) stated during an interview:

“The hope is we can suppress the cancer in such a way that it becomes a more chronic disease, rather than have a disease that’s going to progress relentlessly and kill the patient”

Verastem with a market value of about $215 million is developing the drug assisted by several renowned pharmaceutical companies providing guidance. The development team includes former Genzyme Corp. CEO Henri Termeer; Human Genome Project leader Eric Lander; and Phillip Sharp, a Nobel laureate at Biogen Idec Inc.

Other Drug Combinations

Under a license from Pfizer Inc., AstraZeneca Plc of London is testing a drug called tremelimumab, on mesothelioma in a mid-stage trial. The treatment works differently from the other developmental drugs in that it helps the patient’s immune system to recognize and kill cancer cells.  According to

Carolyn Buser-Doepner (VP for tumor signaling at Glaxo, the U.K.’s biggest drugmaker), there are plans to combine a new drug GSK2256098 with some other medicines to potentially make cancer treatments more effective.  In one early-stage trial, it will be paired up with Glaxo’s Mekinist, which is approved for melanoma.  She said, “The pre-clinical data are very encouraging. We’re very excited about it.”

Boehringer’s Drug

A fourth drug, nintedanib from Germany’s Boehringer Ingelheim GmbH, is in early-stage testing for mesothelioma, according to a spokesman. Unlike the previous mentioned medicines, this one works by targeting proteins directly related to the formation of blood vessels that feed tumors.

According to the director of research at the British Lung Foundation, Noel Snell, the kind of research studies most likely to yield improvements in cancer care are those that investigate the nature of the disease itself.  Still, treatments being tested today on mesothelioma are most encouraging.

Snell said in a statement:

“It is shameful that this kind of fundamental research remains so drastically underfunded, and that the number of trials available for mesothelioma patients is still dwarfed so dramatically by the number available to other cancer patients.”

Dr. Gill and EphB4 Treatment

For several years, Dr. Parkash Gill of the USC Norris Comprehensive Cancer Center has proceeded with Phase I Clinical Trials with the new cancer fighting drug Eph-B4 made available to qualifying mesothelioma patients. With generous support from the Mesothelioma Research
Foundation of America
, the initial Phase I Trial Eph-B4 has been available to newly diagnosed patients who have not Ask Dr. Gill about the most recent clinical trials avaialbleundergone any conventional lung cancer treatment options, as well as those patients who have exhausted all other treatment options such as surgery and chemotherapy.

The results of these recent clinical trials have truly been exciting as Dr. Gill reports that Eph-B4 is showing great promise as a solo treatment, or in conjunction with other drugs like Alimta, Cisplatin and Carboplatin.

The research of Dr. Gill, in conjunction with similar studies by other Oncologists, have improved the understanding among Primary Care physicians about the detection process, and given them better options to offer patients with lung cancer including mesothelioma.

Eph-B4 as a Better Treatment

Treatments have also gotten better because we now understand two principles: a)molecular changes in lung cancer with very specific mutations; and b)medication (like Eph-B4) that is specific to addressing the treatment of only one cellular abnormality.

As Dr. Gill with the Mesothelioma Research Foundation of America continues the goal to make mesothelioma a disease of the past, our understanding of the human body immune system has also improved.    From this we have Eph-B4, an immune specific treatment that assists a patient with lung cancer to live longer with fewer side effects.

His studies have contributed to the evolution of mesothelioma cancer research over the last decade.  Collectively, researchers are producing a canonical story in which the range of research works has grown a consensus among recognized oncologists and Primary Care physicians of a “great” or “major” break through with the two principles mentioned above.  Basically, we can now identify subsets of cancer in a patient at the molecular level and bring a retardant treatment (immunity) to that cancer in those patients.  And this observation continues to this day to be repeated by many research projects.  More than ever before, researchers continue to identify specific cancer mutations and use similar drugs to shut down these cancers and improve patient survival.

Asbestos: The Miracle Fiber That Kills

Asbestos was named the “miracle fiber,” but has become the topic and issue of many lawsuits claiming losses as well as damages from illness caused by asbestos products.  It was commonly used in building materials such as insulation for years because it was cheap, abundant and heat-resistant.

Many countries have banned asbestos mining.  However, the World Health Organization estimates that as many as 125 million people worldwide continue to be exposed to asbestos either at work or in their homes because it continues to be mined and made into  products from in RussiaChina and India.

Unfortunately, mesothelioma cancer can lay dormant for as long as 50 years before spreading, which explains why rates have risen long after many countries have banned the asbestos.

New cases of mesothelioma cancer in the United Kingdom, where asbestos was restricted starting in the 1980s and outlawed fully in 2006, were 2,125 in 2012.  These numbers are expected to peak in 2015.  In the United States, the number of new cancer cases has been stable, hovering around 3,000 per year since 2000.  This stability was expected because of extensive efforts put into public education.  Still, a complete ban of Asbestos in the U.S. was overturned in the courts.  One of the world’s largest asbestos exporters, Canada, closed its remaining mines in 2011.

An Asian Asbestos Mesothelioma Cancer ‘Tsunami’

In Japan, asbestos was banned in 2006, the Japanese government pays the full cost of treatment for related illnesses, and rate of new cases of cancer are predicted to continue rising until 2027.  The director of a World Health Organization occupational health group, Ken Takahashi, has warned Asian governments to prepare themselves for an “asbestos tsunami.”

Again, Dean Fennell reminds us:

 “In the early ’70s, this was an incredibly rare disease. Now my clinic is full of patients with mesothelioma. Because the rates are increasing, we have a real need now to identify effective treatment.”

A cure for mesothelioma can not be found fast enough.  Still, there are survivors like Heather Von St. James, who breaths with great effort during Minnesota winters with her one remaining lung, and she volunteers her time to be a coach to other mesothelioma patients.   By her personal experience with mesothelioma, she wants other victims of mesothelioma to understand:

 “If they can keep it under control,
that’s the first hope.”

 

Dr. Gill brings Phase III clinical trials in 2011

Mesothelioma Treatments begin with better therapy research and an area that has received increased scientific attention is targeting biological pathways that appear to be specific to cancer.  The Mesothelioma Research Foundation of America is particularly interested in the biological pathways that are specific to malignant Mesothelioma cancer.

Our lead researcher, Dr. Parkash Gill, M.D., Ph.D. at USC Norris has spent years growing our understanding of both the genetics and the cellular biology of cancer.  This allows us to try different targeted approaches where we use a therapeutic drug that interferes with a part of the pathway.

In order to test these various approaches, cell line models are frequently deployed.  The cancer cell lines are derived from human patients and grown in the USC Norris laboratories.  However, when these cancer cell lines are grown outside of a patient’s infected body, they sometimes acquire other characteristics that change the test results observed when applying drugs being investigated.  Our objective is to obtain reliable results.

Therefore, it becomes very important to couple our discovery of new targets very closely with carefully executed clinical trials under FDA monitoring to ensure predictive, reliable cancer cure therapies.

Since 2008, Dr. Parkash Gill and his research team of Ph.D.s have developed an antibody that finds a glucose-regulated protein on the cancer tumor cell surface and inactivates it.  Treatment with this antibody has shown marked inhibition of tumor growth with no toxicity to vital organs.

Dr. Gill has also been involved for many years in the study of another protein found on the tumor surface of many cancer types.  He says the protein is critical to the formation of new blood vessels that feed the cancer tumor.  “It doesn’t matter what makes the tumor-blood-vessels grow, we can stop it,” says Gill.  “The nice thing is that all the other blood vessels in the body are fully established [as opposed to weaker, newly formed tumor-blood-vessels], so that his antibody will not effect them.”

Gill and his team have had positive results with the antibody in recent tests, and are preparing for clinical trials to begin this year, 2011.  So, the next step in therapy research for a cure to malignant Mesothelioma cancer is clinical trials on patients.

Clinical trials progress in waves of three phases monitored by the FDA, and is a critical part of drug therapy development.  Trials are the critical next step in validating the research findings made in the laboratory leading to the ultimate truth about the drug therapy.  Discovering this truth is not possible without the cooperation of volunteer patients infected with malignant Mesothelioma, who are willing to participate in clinical trials for the good will to future generations of cancer patients. Many volunteers discover an inner peace that makes it all worth it because they are willing to submit to a clinical trial that may someday provide a cancer cure for another person with cancer, and that someone could very well be their child!

While some of your family members may be concerned, even scared, for you by the idea of participating in a mesothelioma clinical trial, most cancer patients can not find a negative issue associated with giving it a try. The mesothelioma cancer patient is generally doing everything they can to get cured of the disease, looking for all the most current methods of treatment, and clinical trials provides increased monitoring as a bonus to the treatment at no cost.

So, the immediate benefit to a mesothelioma patient who participates in a clinical trial is that the oncologist researcher ensures by writing the trial protocol, the trial will provide the most modern and current standards-of-care. Even when the researchers may not know if the treatment itself is going to work, they can assure patients are receiving top-notch standard-of-care treatment and monitoring beyond what they would normally encounter.

Finally, in addition to labor time, researcher determination, and cancer patient participation, clinical trials cost a lot of money. It is estimated that $100 million to $1 billion is spent in getting a single drug from discovery to the public. It can be very frustrating for the researcher, in our case Dr. Gill, and very hard to get funding once the study has passed the discovery phase. Many good ideas emerge, but then the drug companies play it “safe” and will not invest in something unless it’s well proven. This is a huge gap!

The Mesothelioma Research Foundation of America serves to help donors bridge this gap. Our purpose is connect mesothelioma cancer patients with clinical trials, and their family members and friends who wish to demonstrate their support by donating money needed to fund the clinical trials. One hundred percent of every dollar received through the Mesothelioma Research Foundation of America is channeled directly into projects like Dr. Gill’s. We believe there is great promise and hope in Veglin and our Foundation has funded 100% of Dr. Gill’s research on Veglin through the FDA approved Phase I and Phase II clinical trials.. Dr. Gill says, “Clinical trials are a very methodical way to tell what a drug really works, and then to also determine that it’s better than what’s out there — without which, we don’t make any progress.”

We are now ready to launch into the final and critical Phase III trials, but this will require your financial support to help us fund the research that will lead to the quickest cure for mesothelioma. We believe that Mesothelioma, a cancer of the lining of the lungs caused by asbestos exposure, can be cured with Veglin.

So, please help us bring a cure from this dreadful disease to patients. Give generously, you and your friends, to the Mesothelioma Research Foundation of America.

What kind of Doctor treats Mesothelioma?

Mesothelioma is a cancer disease and cancer is treated by an Oncologist.

Dr. Parkash S. Gill is an Oncologist, and a professor of Medicine and Pathology who leads the research team at the Mesothelioma Research Foundation of America.

Ask Dr. Gill about mesothelioma cancer treatment
Dr. Packish Gill

You are welcome to Ask Dr. Gill questions here for free.

Surgeons who specialize in cancer surgery are called Oncologic surgeons who may be responsible for your treatment when surgery is required.

How to find a doctor for a second opinion about Mesothelioma

Do not be afraid to ask your doctor for a recommendation to get a second opinion, particularly when you have a good relationship with them.  Sometimes an internist or family doctor knows a practitioner who sees patients with Mesothelioma when there is Mesothelioma Care Center near by.

When your doctor cannot assist you in finding a second opinion, you can find one when you ask Dr. Gill the oncologist here at the Mesothelioma Research Foundation of America.  Dr. Gill will  help you find the closest doctors who are experts in this field.   Another option is to check local medical schools to discover if they treat Mesothelioma.  You can use our web page to find additional references and links to government cancer websites.

Finally, you are welcome to post comments, ask questions and share your insights here which allows other individuals to respond and share information.

How can I be sure about a correct diagnosis of Mesothelioma, and who tells me about the biopsy results?

The doctor who began your evaluation for cancer will generally be the one responsible to provide the diagnosis.  This could be your primary care provider. Those persons who were referred to an oncologist will probably receive their diagnosis from that specialist.  The doctor that delivers the diagnosis message should inform you about the certainty of the pathologist regarding your biopsy.  Ask for all the information that is available.  The best doctors will share any doubts.