Oncologists often use the phrase “clinically meaningful benefit” to describe the effect of an experimental treatment. But is the benefit meaningful for patients? A new paper suggests that benefit claims in journal articles often fall short.
A safe and effective vaccine to prevent cancers caused by human papillomavirus became available more than 10 years ago, yet today less than half of Oregon teenagers complete the series of shots recommended for 13- to 17-year-olds. And that coverage looks even worse when examined by geography. Rates of completed vaccination in rural Oregon counties were as low as 16 percent for teen girls and 6 percent for teen boys as of May 2016.
OHSU researchers are aiming to improve HPV vaccination rates by exploring the unique reasons for high and low uptake in adjacent rural areas. “We want to understand both the barriers to vaccination and also the factors that may be informing and driving the successes,” says project leader Jackie Shannon, Ph.D., a professor in the OHSU-PSU School of Public Health and the Knight Cancer Institute’s director of community engaged research.
Targeted therapy drugs transformed the outlook for people with the rare cancers known as gastrointestinal stromal tumors, enabling some to survive a decade or longer. A fraction of GIST patients, however, never respond to treatment. And most of those who do respond eventually relapse because cancer cells evolve and become resistant to the drugs designed to stop them. It’s the big limitation of targeted therapies.
But researchers now have found a way to retarget GISTs that have evaded targeted therapy. The new agent is being tested in a phase 1 clinical trial at OHSU and other medical centers, and the company developing it has announced plans to begin a phase 3 trial in the first half of 2018.
“We have seen many patients with a good response to treatment, even after many failed prior treatment attempts with conventional drugs,” said Michael Heinrich, M.D., an OHSU Knight Cancer Institute scientist and VA Portland Health System oncologist. “Some of the lesions disappear. It’s really quite dramatic.”
For many cancers, five-year survival rates approach 99 percent if the disease is detected early, when tumors are small and not yet spreading.
But efforts to detect cancers early have led to a quandary. Current screening tests too often fail to find high-risk cancers while at the same time raising too many alarms about essentially harmless growths. The technologies used for early detection can’t reliably distinguish aggressive, life-threatening abnormalities from those that are unlikely to ever become dangerous.
At the OHSU Knight Cancer Institute, Sadik Esener, Ph.D., is building a multidisciplinary team seeking to overcome this dilemma. In a Marquam Hill Lecture in November, he’ll explain how Knight Cancer Institute scientists are probing cancer’s initiating events and early malignant changes, and applying this knowledge to develop low-cost screening tests, determine which cancers to vigorously treat, and direct precision therapies to minimize toxicity.
Esener is the Wendt Family Chair professor of biomedical engineering in the OHSU School of Medicine and director of CEDAR, the Knight Cancer Institute’s Early Detection Advanced Research Center.
The cancer diagnosis, a rare sarcoma, was devastating for an old friend of Gordon Mills. “We spent lots of time trying to understand his disease, trying to characterize it, and he went to my colleagues to ask about what was the next therapy for him,” Mills says. The proffered advice was a searing reminder of the limits of cancer medicine. Between them, the consulted experts recalled an approach that had benefited a “somewhat” comparable patient two years earlier.
“That’s not acceptable,” says Mills, who has just been hired as director of precision oncology at the OHSU Knight Cancer Institute. “We need to know enough about every single patient so that we can pick what’s right for them, rather than saying, gee, I once saw somebody like you,” he says. “We need to do this better.”
Mills has covered a lot of ground since he landed at the MD Anderson Cancer Center in Houston in 1994. Among many leadership roles there, he founded the first cancer systems biology department in the U.S. He oversaw the institute’s breast cancer and ovarian cancer programs. He established a center for molecular markers that evolved into the Institute for Personalized Cancer Therapy, which he co-directed. He has authored or co-authored close to 900 scientific papers, becoming one of the most widely cited medical scientists in the world.
Cancer translated met with Mills to talk about his vision for precision cancer medicine at OHSU.