Sunday, April 8, 2007

Clinical innovations - Cancer Innovation Prospects

A reader with breast cancer asks, “How should I think about cancer innovation for my problem and for cancer in general?”

To begin with, as a pathologist , editor of Oncology Practice Options, and a member of the medical advisory board of America’s Top Doctors for Cancer (A Castle Connolly Guide, New York City, 2005), I have a more than fleeting knowledge of cancer.

Fighting cancer is like a guerilla war. Many terrorist cells exist out there, and members of terrorist cells can strike at any time – stealthily, unpredictably, with deadly results. In many cases, their activities can be controlled, even stamped out. But in others, it’s a grueling unpredictable battle.

Why haven’t we won the war on cancer?

• The cancer war is a huge sprawling battleground – in 2004, 1.5 million new cancer cases were diagnosed. Cancer accounted for one of four deaths. Each day 1500 cancer victims died. But there’s hope – 9.6 million Americans are cured or living with their disease.

• Cancer is a complex disease. It’s not one disease, but many diseases. Advances are likely to be one type of cancer at a time rather than total victory over all cancers. The big enemies are cancers of breast, colon, lung, pancreas, gastrointestinal tract, bone marrow, lymph glands, and prostate, but there are scores of other types of cancer as well.

• There isn’t enough money to go around for cancer -- $150 million is now spent on trials for all kinds of cancer, but the budget of the National Cancer Institute has been cut by 10%. Spending on cancer includes $5 billion from the National Cancer Institute, $4.5 to $5.0 billion from drug companies, and $1.5 billion from private funds – a total of $11.5 billion. Americans’ different priorities make raising more money tough. Compare the $11.5 billion devoted to cancer to the $15.5 billion the tobacco industry spends on ads, and the $68 billion spent on promoting soft drinks.

But there’s hope. More than 50% now survive their cancers. Biomarkers, often packages of multiple genes, are being developed to detect early cancers, to predict how tumors will behave, and to signal how to best treat them. These cancers are now listed as curable or potentially curable: most types of skin cancer, acute lymphocytic leukemia in children, Burkitt’s lymphoma, Ewing’s sarcoma, Wilms tumors in children, Hodgkin’s disease, rhabdomyosarcomas, testicular tumors, chroriocarcinomas of the placenta, osteogenic sarcomas, and many breast and colon cancers.

What do I suggest when it comes to cancer innovation? Nurture and maintain hope, search for clinical trials you can participate in, trust your oncologist, and visit the website. This website lists the latest innovations for detecting, managing, and treating many types of cancers. You may also want to consult America’s Top Doctors for Cancer, a 678 page book containing biographies of over 2000 oncologists, information of identifying and accessing clinical trials, descriptions of many of the nation’s leading cancer centers, and guidance of how to identify a top doctor cancer.

I’m optimistic. So isHarold Varmus, MD, president of Memorial Sloan-Kettering Cancer Center, director of the National Institutes of Health during the Clinton Administration, and sharer of a Nobel Prize. Varmus says,

The Food and Drug Administration has recently approved the use of a relatively simple test to assess breast cancers for their propensity to metastasize, by measuring the activities of 70 genes. While not perfect, such tests are welcome harbingers of a more rational basis for making crucial decisions about treatment. These enhanced prospects for cancer care persuade me that the nation has invested wisely in the science of cancer. While we have succeeded in curing or controlling only a few advanced cancers, there is reason to believe that a new era of gene-based approaches to many cancers is at hand – especially if we have the political will to maintain the investment

So hang in there. Keep your wits about you. Prepare for the best. Some of America's best scientists are leading the fight to cure you, or to make your cancer and other cancers just another chronic, manageable disease.


robert smith said...

I'd like to see more treatments that target glycolysis without killing the patient. Cancer cells run on it and it supports their rapid growth rate. Rapid use of sugar is a benefit of glycolysis. Telomerase activates glycolysis in cancer cells per Sabet at UCSF in his melanoma study. Targeting telomerase ,, and discovering it 18 years ago won the highest research award you can win in the U.S. last year, the Lasker Prize. Geron has 2 therapies in the clinical trials pipeline:
1 GRNVAC1, produced the strongest immune response ever seen in a cancer vaccine at Duke in phase 1/2 human trial. Cleared circulating cancer cells in hormone refractory cancer patients who had been through the mill of treatments. Flatlined their PSA numbers, projected, no growth in 5 years.

2. GRN163L , Geron's telomerase inhibitor, at 4 N.Y.hospitals, trials now for CLL, but like the vaccine, should work for about 90% of human cancers. No toxicity in animal studies till 8 times the expected MTD. Also now at U of Chicago , all comers trial, all tumor types. Kills cancer stem cells (Johns Hopkins work). They need telomerase to survive. Telomerase upregulates 70 cancer genes, downregulates over 140 genes associated with differentiation and stability, grants replicative immortality to cancer cells, activates telomerase, and the degree to which it is expressed is a direct measure of the propensity to spread, and thus patient survival.

There are many compounds that inhibit telomerase, here are a few. Also, what do you think of a co-treatment with dichloroacetate to defeat glycolysis and rapamycin to mess with AKT, etc.? Try it for two weeks in one of your transplant patients who can't do chemo. He will see the difference in 2 weeks, out of bed, and doing some walking.
existing telomerase inhibitors actual research. I am hopeful tha t someday these compounds will be tested for synergy in patients.

Richard L. Reece, MD said...

This is wonderful news about telomerase. I was unaware of this promising innovation. Consider me educated.