Riveting survival stories from the early clinical trials of Gleevec

(Left to right) Judy Orem, 73, of Lake Oswego, Oregon, Doug Jenson, 83, of Canby, Oregon, and Dori Mortensen, 79, of Bend, Oregon, inside Multnomah Pavilion at Oregon Health & Science University in Portland, Oregon on Thursday April 20, 2017.

(Left to right) Judy Orem, Doug Jenson and Dori Mortensen were diagnosed with chronic myeloid leukemia in the 1990s, when few survived more than five years. They were among the earliest participants in clinical trials of Gleevec. (Stat News/Meg Roussos)

Medicine had never seen anything like it before, Brian Druker, M.D., recalled. “These are people who’d been told to get their affairs in order. And now their blood counts are normal,” the director of the OHSU Knight Cancer Institute told Stat News reporter Bob Tedeschi.

“But here’s the problem: When can you celebrate? I felt a little bit like walking on eggshells, because it’s like, OK, is this going to be a flash in the pan, or is this going to last? And there’s only one way to find out: wait and see.”

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Oregon’s precision medicine pioneer targets earlier cancer detection

OHSU Knight Cancer Institute Director Brian Druker talks with Medscape about breaking out of one-size-fits-all thinking in cancer screening and prevention

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Brian and Eric

Knight Cancer Institute Director Brian Druker, M.D., recorded an interview in La Jolla, California, with Medscape Editor-in-chief Eric Topol, M.D.

“We are now in the process of building an entire program on what I call precision early detection of cancer,” said Brian Druker, M.D., “We are trying to be more accurate in taking the same precepts of precision medicine for advanced cancer and using them earlier.”

If it works, Druker told Medscape’s editor-in-chief, Eric Topol, M.D., the early detection initiative at OHSU will find a way out of the big conundrum of cancer screening: technologies that too often fail to find dangerous cancers while at the same time raising too many alarms about essentially harmless tumors and driving overdiagnosis and unnecessary treatment.

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Oregon’s Death with Dignity Act, 20 years later

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Number of prescriptions and assisted deaths under the Oregon Death with Dignity Act. (Blanke et al. from Oregon Health Authority data)

In 1997, Oregon became the first state to make it legal for terminally ill patients to self-administer a prescription to hasten death.

A review of 991 cases of lethal self-medication through 2015 shows that the law’s impact has remained largely predictable. Three-fourths of the people were dying of cancer, nearly all were white and around 70 percent had attended college. More than 90 percent had health insurance, were receiving hospice care and died at home.

Still, some findings surprised first author Charles Blanke, M.D., a professor of medicine in the OHSU Knight Cancer Institute and chair of the SWOG research consortium.

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A new way to guide cancer immune therapy

Scrutinizing the immune cells infiltrating a tumor may reveal the cancer’s vulnerability or resistance to immune-based therapies.

 

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Lessons from Oregon about end-of-life care

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Deaths among Medicare enrollees in Oregon, Washington, and the rest of the U.S. (Tolle and Teno)

At the end of life, people in Oregon are more likely to have their care wishes honored, less likely to be hospitalized and more likely to use home hospice services compared with people in Washington and the rest of the U.S.

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With foundation help, an Oregon doctor roots out low-value medical practices

Vinay Prasad (OHSU/Kristyna Wentz-Graff)

Vinay Prasad (OHSU/Kristyna Wentz-Graff)

Physicians have started to face up to an uncomfortable truth: their profession has often embraced new treatments that don’t really help patients.

“When you look at the balance of benefit and harm, some therapies provide no net benefit,” says OHSU assistant professor Vinay Prasad, M.D., M.P.H., who has landed a $2 million grant to go after the problem.

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A Native American health focus at the OHSU Knight Cancer Institute

Knight Cancer physician Amanda Bruegl, M.D., is leading an effort to understand health issues among Native American tribes and communities in the Pacific Northwest, with a special focus on gynecologic cancer.

 

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Amanda Bruegl, M.D. (OHSU/Fritz Liedtke)

Throughout medical training, Amanda Bruegl’s commitment to work with Native Americans never faltered. As a member of the Oneida and Stockbridge-Munsee tribes, she is one of two Native American gynecologic oncologists in the United States.

“When I was looking for a job,” she says, “it was really important to me to do something to advocate for Native American women’s health.” She saw a need for that in the Pacific Northwest.

“I was looking for places where there was a significant Native American population and the opportunity to do outreach,” she says.

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The cancer drug that “changed everything”

Understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.

 

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Years of life expectancy at age 55 for people diagnosed with CML compared with the general population, from the work of Bower et al. (OHSU/Joe Rojas-Burke)

It transformed the outlook for people diagnosed with chronic myeloid leukemia. A disease with a three- to five-year life expectancy became, for most patients, a chronic, long-term condition managed with a daily pill.

And this week, researchers published the outcomes of people treated for more than 10 years with the drug imatinib (Gleevec), ushered from lab to clinical success by Brian Druker, M.D., director of the OHSU Knight Cancer Institute. The findings stand as a testament to the idea that understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.

Estimated overall survival at 10 years was 83 percent among patients receiving first-line imatinib treatment, Druker and co-authors reported in the New England Journal of Medicine. Many of the recorded deaths of people in the imatinib group were unrelated to CML. Among 134 patients with cytogenetic assessments at 10 years, 92 percent had a complete cytogenetic response, that is, they had no measurable sign of the chromosome alteration that causes CML.

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Oncology knows no borders: Unintended impact of the new U.S. travel ban

Nabavizadeh, Nima _16 (CAN)

Nima Nabavizadeh, M.D.

The travel ban issued by President Donald Trump could bring an unintended consequence for U.S. citizens: the loss of medical care givers serving rural communities and poor neighborhoods. “Immigrants have always done what no one else wants to do – and this includes providing high-quality medical care for underserved patients,”  say OHSU Knight Cancer Institute physicians Nima Nabavizadeh, M.D., and Charles Thomas, Jr., M.D., in a commentary in JAMA Oncology.

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When it’s time to stop a lifesaving cancer drug to find out if you are cured

Gleevec structure - Structure of Gleevec bound to the kinase domain (1)The depth of remission achieved with the targeted therapy imatinib (Gleevec) raises a tough new question for some leukemia patients: is it ever safe to stop taking the breakthrough drug developed at OHSU?

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A new way to guide cancer immune therapy

A new way to guide cancer immune therapy

Scrutinizing the immune cells infiltrating a tumor may reveal its vulnerability or resistance to immune-based therapies—and perhaps improve treatment success. Knight Cancer scientist Lisa Coussens and colleagues describe the work in a new paper.