Breaking through the limits of cancer medicine

Gordon Mills, M.D., Ph.D., the new director of precision oncology at Oregon Health & Science University, outlines his vision for the field

 

Gordon Mills, M.D., Ph.D. (OHSU/Kristyna Wentz-Graff)

 

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.

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Radiation medicine’s evolving role in cancer care

nci-vol-4483-72(NCI/Rhoda Baer)

 

Expanding treatment options for breast cancer. Enhancing immunotherapy. Addressing disparities in access to cutting-edge treatment.

These are some of the highlights from ASTRO, the largest scientific and educational forum for radiation oncology. Members of OHSU’s Department of Radiation Medicine made 11 research presentations and contributed to many more at the annual meeting of the American Society for Radiation Oncology in San Diego.

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Unmasking the cost of cancer drug development

Cancer drug R&D spending may be a fraction of the estimate cited by the biopharmaceutical industry.

 

R&D spending

Sales revenue compared with total company R&D spending including an opportunity cost, or cost of capital, of 7 percent per year, as estimated by Prasad and Mailankody. (Joe Rojas Burke/OHSU)

 

The average price of anticancer drugs has been rising by about 10 percent annually in recent years, with annual costs for a single drug now routinely running to $100,000 or more. The burden is falling hard on people with cancer. In one study, 34 percent of survivors went into debt (and 9 percent who went into debt filed for bankruptcy) even though 97 percent had health insurance. And when patients face unaffordable copayments, they’re more likely to delay or discontinue treatment.

One justification for the high price of cancer drugs is the required investment in research and development. But a new study co-authored by an OHSU physician estimates that R&D spending is a fraction of the cost cited by drug companies.

“What I would want patients to take away from it is to check your assumptions that these drug prices are warranted,” says Vinay Prasad, M.D., M.P.H., an assistant professor of medicine in the OHSU School of Medicine and member of the OHSU Knight Cancer Institute. “We have to speak up, and make our opinions known that we want drugs to be affordable, profits fair and R&D costs truthfully conveyed to us.”

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Surviving sarcoma: a free educational conference for patients, families

sarcoma art

Sarcoma patients and their families are invited to participate in an interactive panel discussion and have their questions answered by OHSU physicians and surgeons who focus on the cancer, which is rare in adults but accounts for about 20 of all childhood cancers.

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An evergreen ‘topping out’ for the Knight Cancer Research Building

L1160535(OHSU/Joe Rojas-Burke)

 

Ironworkers placed the final steel beam onto the Knight Cancer Research Building on Monday. And in the “topping out” tradition, members of Ironworkers Local 29 signed the beam and affixed a live fir tree and a U.S. flag before hoisting it into position seven stories above Portland’s South Waterfront District.

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When evidence contradicts entrenched medical practices

‘Medical reversal’ harms patients and undermines faith in the medical system. Hematologist-oncologist Vinay Prasad is pushing to change how medicine adopts new technologies.

 

Vinay screenshot

Medical reversal is the phenomenon when a medical practice falls out of favor not by being surpassed, but when researchers discover that it didn’t really work all along.

“I think the lesson of reversal is we need robust, large-scale, pragmatic, randomized control trials,” said OHSU assistant professor Vinay Prasad, M.D., M.P.H. “That should be the rule of biomedicine and not the exception.”

Prasad, a hematologist-oncologist with the Knight Cancer Institute and a senior scholar in the Center for Health Care Ethics at OHSU, asserted the case for ending medical reversal in a video interview with MedPage Today.

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Zeroing in on drug combos against a formidable form of leukemia

Darker red color (lower CR values) indicates drug combinations exhibiting higher efficacy than either single agent alone.

A heat map by Kurtz et al. comparing the sensitivities of leukemia cells to drug combinations. Darker red color indicates drug combinations exhibiting higher efficacy than either single agent alone.

 

Targeted cancer therapies work by singling out gene mutations that drive tumor growth, then using a drug to block the effects of the mutant gene. But tumors consist of millions of cells that may collectively harbor hundreds of different “driver” mutations. That means therapies for some cancers will have to target more than one mutation at a time to be successful. To help solve the problem, researchers at Oregon Health & Science University devised a way to rapidly screen combinations of drugs to identify pairs of agents most likely to work synergistically against some of the most difficult to treat forms of leukemia.

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Surprising variability in melanoma diagnostic findings

Elmore et al. figure

In one case, 36 pathologists used 18 different diagnostic terms to define the same tissue section, shown here at two magnifications.

Although pathologists are likely to agree when evaluating skin biopsies that are benign or highly malignant, they often disagree when lesions fall into intermediate categories, new research finds. Pathologists’ diagnostic interpretations of melanoma in situ and early stage invasive melanoma – categories that are not well characterized – were neither reproducible nor accurate. And this may be creating the potential for both overdiagnosis and underdiagnosis of melanoma, according to the new study with two OHSU co-authors, Heidi D. Nelson, M.D., M.P.H., and Patricia Carney, Ph.D.

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New funding for a dire need: Pancreas cancer early detection

With a $250,000 award from the Pancreatic Cancer Action Network, researchers will seek to validate biomarkers able to detect pancreas cancer months or years before patients experience overt symptoms of the disease.

 

Brett Sheppard, M.D.

Brett Sheppard, M.D.

Pancreatic ductal adenocarcinoma is the deadliest of the major cancer types, with a five-year survival rate of less than 10 percent. Unlike the other major causes of cancer mortality, pancreatic cancer is increasing in both incidence and number of deaths each year.

Principal investigator Brett Sheppard, M.D., is a professor of surgery in the OHSU School of Medicine. Co-principal investigator Rosalie Sears, Ph.D., is a professor in the Department of Molecular and Medical Genetics. The two are co-directors of the Brenden-Colson Center for Pancreatic Care as well as members of the Knight Cancer Institute.

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Nerve damage from chemotherapy may persist for years, worsening risk of falls

neuropathy image(Getty Images)

In a study that kept in touch with more than 500 women cancer survivors for an average of six years, nearly half continued to experience chemotherapy-induced peripheral neuropathy and a heightened risk of falling.

The findings, published in the Journal of Clinical Oncology, challenge the widely held assumption that chemotherapy-induced neuropathy will mostly cause no serious long-term effects.

“Many cancer survivors are told these chemo-related symptoms will eventually go away. Our study found that’s just not the case,” said first author Kerri Winters-Stone, Elnora E. Thompson Distinguished Professor in the OHSU School of Nursing and co-leader of the Knight Cancer Institute’s Cancer Prevention and Control Program.

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Targeting leukemia with drug combinations

Targeting leukemia with drug combinations

Cancer researchers have devised a way to rapidly screen combinations of drugs to identify pairs of agents most likely to work synergistically against some of the most difficult to treat forms of leukemia.