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.
Sadik Esener, Ph.D.
Thursday, Nov. 16, 2017 at 7 p.m.
Register to attend
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.
Gordon Mills, M.D., Ph.D., the new director of precision oncology at Oregon Health & Science University, outlines his vision for the field
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.
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.
Cancer drug R&D spending may be a fraction of the estimate cited by the biopharmaceutical industry.
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.”
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.
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.
‘Medical reversal’ harms patients and undermines faith in the medical system. Hematologist-oncologist Vinay Prasad is pushing to change how medicine adopts new technologies.
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.