OHSU Knight Cancer Institute Director Brian Druker talks with Medscape about breaking out of one-size-fits-all thinking in cancer screening and prevention
“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.
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.
Scrutinizing the immune cells infiltrating a tumor may reveal the cancer’s vulnerability or resistance to immune-based therapies.
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.
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.
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.
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.
Understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.
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.