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Cancer, Imaging, In the News, Patient Care, Stanford News, Technology

New technology enabling men to make more confident decisions about prostate cancer treatment

New technology enabling men to make more confident decisions about prostate cancer treatment

To watch and wait, or operate? There’s quite a bit of confusion, and a variety of differing opinions from the medical community, regarding prostate cancer treatment – so it’s no wonder that some men question whether the treatment path they’ve chosen is the right one. A new technology at Stanford, though, is hoping to alleviate some of the confusion and help with the decision-making process.

By using a combination of ultrasound and MRI imaging, Stanford physicians can use the resulting 3D images to get a far more detailed look at the level of cancer and its aggressiveness than they were able to in the past. Patients, in turn, will be empowered with the knowledge to make more confident decisions about how, and whether, to proceed with treatment. ABC7 News recently aired a story on the new technology.

Previously: Six questions about prostate cancer screening, Ask Stanford Med: Answers to your questions on prostate cancer and the latest research and Making difficult choices about prostate cancer

Cancer, Patient Care

“As a young lung cancer patient, I had to find my own path”: Fighting stage IV with full force

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s bonus column comes from patient advocate Emily Bennett Taylor.

When I was diagnosed at age 28 with stage IV lung cancer (yes, you read that right: 28. Non-smoker, college athlete, lung cancer), I wanted to shout it from the rooftops. No, not in the joyous, “share-my-news” type of way. The concept was so unfathomable that I sometimes felt the only way it would really sink in is if I screamed it out loud in public. I didn’t, of course. While many social norms, like dressing to leave the house or even showering, went completely out the window as I underwent treatment, I’m happy to report that I managed to maintain at least a semblance of sanity in public. And I’ve thankfully found better venues – such as this article – to share my story.

I learned very quickly that as a young lung cancer patient, I had to find my own path. In a cancer normally associated with older smokers, I was constantly telling my doctors: “I’m different. I’m strong. I want to be as aggressive as possible.” Standard of care is to treat stage IV patients palliatively, but that didn’t sit well with me – I wanted a cure. I was told “no” to surgery countless times. I kept seeking second, third, multitudes of opinions in order to find a doctor who would see me as the young, strong person I was with my whole life ahead of me.

While I tested negative for all known genetic mutations (I know one is out there – please find it for me!), I was fortunate to be part of a small percentage of patients who respond to traditional chemotherapy. After six rounds of carboplatin, Alimta and Avastin, and two additional infusions of Avastin, I found my white knight in Raja Flores, MD, of Mount Sinai Hospital. My husband and I relocated from our home in California to New York City for three months, and on February 8, 2013, Dr. Flores removed my entire right lung, pleura, half my diaphragm, all mediastinal lymph nodes, and the pericardial sac (around my heart), which he rebuilt with Gore-Tex.

Three weeks into my recovery, I began a follow-up course of 28 rounds of high-dose radiation to my right lung cavity. If there were any cancer cells left, Dr. Flores and I intended to fry them into oblivion – even if side effects had me vomiting and nauseated for the better part of six weeks, and exhausted for another six months.

My reward? Dr. Flores declared me N.E.D. – No Evidence of Disease. I’ve lived with that diagnosis for almost a year and a half now, and it feels fantastic.

Is life with one lung difficult? Sometimes. But the most important thing to me is that it’s still life. Lots of surgeons told me “no” because they believed removing a lung would diminish my “quality of life.” For me, losing a lung meant gaining my life, and that’s a trade-off I think any patient would make if given the choice.

If you’re a medical student looking for an area where you can make a serious impact, consider lung cancer. In the past few decades, survival rates for other major cancers (breast, prostate, colon) have increased to well above 50 percent, some reaching the upper 90s. Lung cancer, the nation’s No. 1 cancer killer? A dismal 16.8 percent.

This is a field ripe for advancement. We need researchers developing better treatments and methods of early detection. We need doctors who both understand that the face of lung cancer is changing and are also willing to push the envelope with their patients to find an individualized, aggressive cure.

Every lung cancer is different, and every patient deserves a treatment plan with the goal of preserving life. You can be the difference. You can make an impact. And you can change the course of someone’s life, just like Dr. Flores did for me.

Emily Bennett Taylor, a former state track champion, college volleyball player, and finance manager, is now a Stage IV lung cancer survivor and spokesperson/patient advocate for the Bonnie J. Addario Lung Cancer Foundation. Her story has been highlighted on the Steve Harvey Show, the Atlantic Monthly, and on her blog - embenkickscancer.wordpress.com - named to Healthline’s Top Lung Cancer Blogs in 2013 and 2014.  She writes candidly about her treatment and life with one lung, as she works to raise awareness about the leading cancer killer.  Emily lives in Southern California with her husband Miles and their two lovable mutts, Ginny & Tonic.

Cancer, Research, Science, Stanford News, Stem Cells

Radiation therapy may attract circulating cancer cells, according to new Stanford study

Radiation therapy may attract circulating cancer cells, according to new Stanford study

Localized radiation therapy for breast cancer kills cancer cells at the tumor site. But, in a cruel irony, Stanford radiation oncologist Edward Graves, PhD, and research associate Marta Vilalta, PhD, have found that the dying cells in the breast may send out a signal that recruits other cancer cells back to the site of the initial tumor. Their work was published today in Cell Reports. As Graves explained in an e-mail to me:

Cancer spreads by shedding tumor cells into the circulation, where they can travel to distant organs and form secondary lesions.  We’ve demonstrated with this study that cancer radiation therapy may actually attract these circulating tumor cells, or CTCs, back to the primary tumor, which may lead to the regrowth of the tumor after radiation therapy.

The researchers studied mouse and human breast cancer cells growing in a laboratory dish, as well as human breast cancer cells implanted into mice. They found that irradiated cells secreted a molecule called granulocyte macrophage colony stimulating factor, or GM-CSF. Blocking the expression of GM-CSF by the cells inhibited (but didn’t completely block) their ability to recruit other cells to the cancer site. The finding is particularly interesting, since physicians sometimes give cancer patients injections of GM-CSF to enhance the growth of infection-fighting white blood cells that can be damaged during chemotherapy. As Graves explained, “This work has important implications for clinical radiotherapy, and for the use of GM-CSF in treating neutropenia in cancer patients during therapy.”

The researchers say, however, that cancer patients shouldn’t eschew radiation therapy. Rather, the finding may help clinicians devise better ways to fight the disease – perhaps by blocking GM-CSF signaling. Graves concluded:

It should be emphasized that radiation therapy remains one of the most effective treatments for cancer. Our findings will help us to further optimize patient outcomes following this already potent therapy.

Previously: Using 3-D technology to screen for breast cancer, Blood will tell: In Stanford study, tiny bits of circulating tumor DNA betray hidden cancers and Common drug class targets breast cancer stem cells, may benefit more patients, says study

Cancer, Clinical Trials, Pediatrics, Public Health, Research

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Findings published today in the Lancet Oncology highlight the need to increase the flexibility of age limits for cancer trials so that more teenage patients have access to experimental treatments. “Right now too many of our young patients are needlessly falling through the gap between paediatric and adult cancer trials,” said Lorna Fern, PhD, who led the study and co-ordinates research for the Teenage and Young Adult Clinical Studies Group of the UK-based National Cancer Research Institute.

In the study (subscription required), researchers examined strategies to boost participation of teens and young adults diagnosed with cancer in clinical trials. The study involved 68,275 patients, aged 0-59 years, who were diagnosed with cancer within a five-year window. According to a release:

The study showed [trials designed with broader age limits] led to a 13 per cent rise in 15-19 year old cancer patients taking part in clinical trials between 2005 and 2010 (from 24 to 37 per cent), and a five per cent rise in 20-24 year olds (from 13 to 18 per cent). Children under 14 taking part in trials rose by six per cent (from 52 to 58 per cent).

This rise was due to the increase in availability and access to trials for young people, increased awareness from healthcare professionals, patients and the public about research and importantly the opening of trials with broader age limits which allow older teenagers and young adults to enter trials.

Fern added, “By encouraging doctors to take into account the full age range of patients affected by individual types of cancer, we’ve shown that it’s possible to design trials that include teenage cancer patients and, importantly, that better match the underlying biology of the disease and the people affected.”

Previously: High rates of incarceration among black men could be skewing study results, Stanford researchers examine disparities in use of quality cancer centers and NPR explores the need for improving diversity in clinical trials

Cancer, Research, Stanford News

Tool to identify the origin of certain types of cancer could be a “boon to doctors prescribing therapies”

Tool to identify the origin of certain types of cancer could be a "boon to doctors prescribing therapies"

A team of Stanford scientists has developed a tool to identify the biological signatures in cancer cells that can be traced back to the original cancer gene. As noted today in a Stanford Report story, the tool could help unravel the secrets of cancer and be “a boon to doctors prescribing therapies for their patients.”

For the study, researchers examined an oncogene that is related to lymphoma and responsible for roughly 50 percent of all human cancers. An oncogene is a gene that can cause a normal cell to become cancerous when mutated, or be expressed at abnormally high levels. The team hoped to find a biological signature that would trace the mutating cancer cells back to the original oncogene. More from the article about the work:

Using an elegant statistical method from Robert Tibshirani, [PhD,] professor of health research and policy (biostatitstics) and of biostatistics, the team was able to identify not just one but 86 lipids that can be traced back to the oncogene.

“It’s not just diagnostic,” [postdoctoral researcher Livia Eberlin, PhD,] said. “It gives extra information that could be prognostic.”

Depending on the bio-signature of the cancer cells, physicians will have a better idea of the aggressiveness of a patient’s cancer. In the future, this research may lead to a better knowledge of cancer in general.

“The next step,” said [Dean Felsher, MD, PhD,] professor of medicine (oncology) and of pathology, one of the team members from Stanford School of Medicine, “is to use this as a way to figure out the causal mechanism.” Though the connection between the cancer cells and their origin is clear, the actual cause of cancer – the biological trigger that pushes cancer to progress – is still mysterious.

The study is scheduled to be published in Proceedings of the National Academy of Sciences.

Previously: Smoking gun or hit-and-run? How oncogenes make good cells go bad, Cellular culprit identified for invasive bladder cancer, according to Stanford study and Blood will tell: In Stanford study, tiny bits of circulating tumor DNA betray hidden cancers

Cancer, FDA, Genetics, Research, Science, Stanford News

Another blow to the Hedgehog pathway? New hope for patients with drug-resistant cancers

Another blow to the Hedgehog pathway? New hope for patients with drug-resistant cancers

6825694281_dfb79615d6_zIf you’re a regular reader of this blog, or follow cancer literature, you’ll have heard of a signaling pathway called Hedgehog that is activated in many cancers, including brain, skin and even bladder. It’s a cute name for cellular cascade that can kill when inappropriately activated.

Neurologist Yoon-Jae Cho, MD, treats children with brain tumors called medulloblastomas. He and postdoctoral fellow in his lab, Yujie Tang, PhD, published a study yesterday in Nature Medicine that could one day help some patients whose Hedgehog-driven tumors have become resistant to available therapies.

As Cho explained in an e-mail to me:

Medulloblastomas are the most common malignant brain tumors in children. They are comprised of various subgroups, including one with activation of a strong oncogenic signal called the Hedgehog pathway. Notably, the Hedgehog pathway is also activated in several other cancers including basal cell carcinoma, the most common cancer worldwide. Therefore, pharmaceutical companies and several research groups have developed drugs to target this pathway.

The most common of these drugs targets a downstream protein component of the pathway called Smoothened, including one currently marketed by Genentechcalled vismodegib (trade name Erivedge) and an investigational drug produced by Novartis called LDE225. Blocking the activity of Smoothened stops the chain reaction leading to division of the cancer cells. You can think of it (in simplified terms) as a line of dominoes standing on end, waiting for an eager finger to begin the chain reaction. Removing one domino (nixing Smoothened activity) can sometimes stop the rest of the row from falling and block the cancerous cell from dividing. But, as Cho explained:

Unfortunately, many cancers activate the Hedgehog pathway downstream of Smoothened and are inherently resistant to these therapies. Other cancers that are initially responsive to these drugs develop resistance through activation of downstream Hedgehog pathway components.

Cho and his colleagues have now described a new, novel way to interfere with the Hedgehog pathway. They’ve found that compounds that inhibit a protein called BRD4 can stop the growth of human Hedgehog-driven cancers – even when they’re resistant to drugs blocking Smoothened activity. This is particularly interesting because the BRD family of proteins recognizes and binds to particular chemical tags on chromatin that control whether (and when) a gene is made into a protein. It’s the first time such an epigenetic regulator has been implicated as a target in the Hedgehog pathway. Additionally, it’s a new avenue to explore for patients with Hedgehog-driven medulloblastomas – as many as half of whom will be resistant to Smoothened inhibition, according to a previous study co-authored by Cho and members of the International Cancer Genome Consortium’s Pediatric Brain Tumor Project. Cho concludes, “Our study offers a promising new treatment strategy for patients with Hedgehog-driven cancers that are resistant to the currently used Smoothened antagonists.”

Previously: New skin cancer target identified by Stanford researchers, Humble anti-fungal pill appears to have noble side-effect: treating skin cancer and Studies show new drug may treat and prevent basal cell carcinoma
Photo by Phillip Taylor

Big data, Cancer, Research, Science, Stanford News, Videos

Will hypothesis or data-driven research advance science? A Stanford biochemist weighs in

Will hypothesis or data-driven research advance science? A Stanford biochemist weighs in

The 2014 Big Data in Biomedicine conference was held here last month, and keynote speakers, panelists, moderators and attendees are now available on the Stanford Medicine YouTube channel. To continue the discussion of how big data can be harnessed to benefit human health, we’ll be featuring a selection of the videos this month on Scope.

Julia Salzman, PhD, a Stanford assistant professor of biochemistry, is concerned that significant amount of data is being thrown in the trash “because the data don’t fit our sense of what they should look like.” At Big Data in Biomedicine 2014, she explained how giving her computers a long leash led her down an unexpected path and the discovery of a new, and probably noteworthy, biological entity. My colleague Bruce Goldman highlighted her findings in a news release:

Using computational pattern-recognition software, her team discovered numerous instances in which pieces of RNA that normally are stitched together in a particular linear sequence were, instead, assembled in the “wrong” order (with what’s normally the final piece in the sequence preceding what’s normally the first piece, for example). The anomaly was resolved with the realization that what Salzman and her group were seeing were breakdown products of circular RNA — a novel conformation of the molecule.

In its circular form, she noted, an RNA molecule is much more impervious to degradation by ubiquitous RNA-snipping enzymes, so it is more likely than its linear RNA counterparts to persist in a person’s blood. Every cell in the body produces circular RNA, she said, but it seems to be produced at greater levels in many human cancer cells. While its detailed functions remain to be revealed, these features of circular RNA may position it as an excellent target for a blood test, she said.

In the above Behind the Scenes at Big Data video, Salzman discusses her work and addresses a question asked during the Single Cells to Exacycles panel: In this next era of science, will science advance mainly through hypothesis or data driven research? She comments, “I think that’s a fundamental question moving forward, whether the scientific method is dead or whether it’s still alive and kicking. I think that’s a really important question for us as to answer and deal with as scientists.” Watch the interview to find out the rest of Salzman’s thoughts on the issue.

Previously: Rising to the challenge of harnessing big data to benefit patients, Discussing access and transparency of big data in government and U.S. Chief Technology Officer kicks off Big Data in Biomedicine

Cancer, NIH, Public Health, Research, Stanford News, Videos

NIH associate director for data science on the importance of “data to the biomedicine enterprise”

NIH associate director for data science on the importance of "data to the biomedicine enterprise"

The 2014 Big Data in Biomedicine conference was held here last month, and interviews with keynote speakers, panelists, moderators and attendees are now available on the Stanford Medicine YouTube channel. To continue the discussion of how big data can be harnessed to benefit human health, we’ll be featuring a selection of the videos this month on Scope.

During his keynote speech at Big Data in Biomedicine 2014, Philip Bourne, PhD, the first permanent associate director for data science at the National Institutes of Health, shared how the federal agency hopes to capitalize on big data to accelerate biomedicine discovery, address scientific questions with potential societal benefit and promote open science.

In the above video, he talks about how data “is becoming increasingly important to the biomedical enterprise” and the NIH’s effort to coordinate strategies related to computation and informatics in biomedicine across its 27 institutes and centers, which effectively form the basis of improvements in health care across every major medical condition. “Our goal is to create interoperability between these entities,” he says in the interview. “We see data as the catalyst to create this cross talk across these respective institutes.”

Previously: Rising to the challenge of harnessing big data to benefit patients, Discussing access and transparency of big data in government and U.S. Chief Technology Officer kicks off Big Data in Biomedicine

Cancer, Health and Fitness, Stanford News

The ride of his life: Local cyclist races across the country to benefit Stanford Cancer Institute

John Tarlton big

Menlo Park businessman John Tarlton is on the ride of his life, attempting to bike 3,000 miles across the country in 12 days. He’s competing in the Race Across America (RAAM), one of the world’s most extreme endurance events. RAAM originated in 1982 as four cyclists raced from the Santa Monica Pier to the Empire State Building.

“I have dreamed of competing in RAAM since childhood,” Tarlton told me by e-mail prior to the race. As of this post, he is more than halfway through, having biked more than 1,800 miles in about six and a half days.

Tarlton, 45, a lifetime cycling enthusiast, has been preparing for RAAM for several years. The RAAM course is nearly 50 percent longer than the Tour de France, though completed in about half the time. And unlike the Tour de France riders, who rest and refuel at their hotels each night, most RAAM riders can’t afford to sleep more than four hours a day, since every minute counts against the 12-day time limit. Eating presents an interesting challenge: Tarlton, a lean vegetarian, estimates he’ll need to consume 16,000 calories per day (and no, that’s not a typo!) during the race.

Like many RAAM riders and teams, Tarlton is using interest generated by this event to raise awareness and dollars for a cause – in this case, cancer, which has affected both his and his supports team’s families. Donations made in honor of Tarlton’s effort will support the Stanford Cancer Institute.

Since I mostly ride an indoor stationary bike with a TV screen affixed, I had a few questions for this ultra-driven athlete. Below are Tarlton’s answers provided by e-mail and lightly edited:

Describe your typical training day.

There really is no “typical” training day for me. Some days I only ride the bike for one hour, spend another hour weight training and then two hours doing recovery activities. Other days I will be on the bike for 14 hours straight.

What is the biggest challenge during the race?

It is hard to predict. Some years, there have been lightening storms that require riders to hide inside cars, while other years there are strong headwinds for extended periods of time. Our biggest challenge will be to adapt to whatever nature throws at us, in addition to any unexpected equipment failures, while sticking to our plan.

Besides finishing, what’s your goal for the race?

We hope to raise quite a bit of money for Stanford Cancer Institute. In all honesty, the goal of completing the race within the allotted 12 days is such an overarching goal, that any other athletic goals would pale in comparison.

Why did you choose to benefit the Stanford Cancer Institute (SCI)?

SCI is at the forefront of the cancer treatment effort, from cutting-edge primary research to new ways of focusing on the patient during recovery. My professional life revolves around buildings for life science research and commercialization. The partnership between Tarlton Properties and SCI seems a natural fit.

My family has been deeply affected by cancer and has strong ties to Stanford. My parents met in the Stanford Choir in 1954, and my father is a past president of Stanford Associates. My wife, Jenny Dearborn, graduated from the Stanford Teacher Education program; her father attended Stanford and her grandfather was a professor there.

Finally, Stanford doctors were central to the care of my mother and sister, as well as my crew chief’s wife, during their battles with cancer.

Continue Reading »

Cancer, Pediatrics, Research

Study highlights childhood cancer survivors’ increased risk of future health problems

Study highlights childhood cancer survivors' increased risk of future health problems

New research shows that childhood cancer survivors are hospitalized more frequently, and for longer durations, decades after their initial cancer diagnosis as compared to those without a history of cancer. Based on the findings, study author Anne Kirchhoff, PhD, MPH, assistant professor of pediatrics at the University of Utah, advised that patients and families “who have experienced childhood cancer should obtain a cancer treatment summary and recommendations for follow-up care from their oncologist, and coordinate their follow-up care with their oncology and primary care doctors to ensure their health care needs are being managed.”

For the study, which was published in Cancer Epidemiology, Biomarkers & Prevention, Kirchhoff and colleagues recruited nearly 1,500 childhood cancer survivors who were at least five years past their original cancer diagnosis and more than 7,000 individuals who did not have cancer, who served as the control group. According to an American Association for Cancer Research release, study results showed:

… survivors were 52 percent more likely to be hospitalized, and their number of admissions was 67 percent higher, compared with age and sex-matched individuals who did not have cancer. Survivors were also 35 percent more likely to have stayed longer every time they were hospitalized, compared with controls.

More than 10 percent of survivors of central nervous system tumors, neuroblastoma, or malignant bone tumors were hospitalized five or more times during the follow-up period, and the hospital admission rates were approximately two times higher for survivors of neuroblastoma and bone tumors, respectively, compared with controls. “We saw higher rates of hospitalization across most cancer types, but not for all cancers, which gives us clues as to which groups of survivors may need better surveillance in the long term,” said Kirchhoff.

Common reasons for hospitalizations for survivors compared with the controls included conditions like blood disorders (such as anemia) and cancer, although it is unclear if this was for their original cancer diagnosis or new cancers. Infections, nervous system problems, and respiratory problems were other leading reasons for hospitalization.

To follow up on these findings, researchers are planning to further study the reasons survivors are hospitalized and the costs associated with these visits.

Previously: New Stanford-developed method finds tumors in children without exposing them to radiation, Questioning whether physicians are equipped to care for childhood cancer survivors, Cancer survivor: The disease isn’t a “one-off, one-shot deal”, and Surviving pediatric brain cancer

Stanford Medicine Resources: