The promise of early detection

Drawings of human vaginal smearsNearly a century ago, a Greek immigrant physician in New York City began refining microscopy techniques for examining cells gently scraped from the female reproductive tract. The results were profound. George Papanicolaou’s Pap smear test gave the world a minimally invasive means to screen healthy women to reveal abnormally growing cervical cells that could be removed before any turned cancerous. And with it came the realization that cancer truly might be defeated by early detection.1

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Jay Leno talks with Brian Druker and other cancer experts about the promise of early detection

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The inaugural Sondland-Durant Early Detection of Cancer Conference featured an appearance by comedian and television host Jay Leno. He led a discussion with Brian Druker, M.D., director of the OHSU Knight Cancer Institute, Sir Harpal Kumar, chief executive officer of Cancer Research UK, and Sanjiv Gambhir, M.D., Ph.D., a professor at Stanford University School of Medicine.

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How a formidable leukemia subverts blood stem cells

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New findings open a path for developing desperately needed therapies for the most frequently diagnosed leukemia in adults.


Leukemia paves the way for its deadly advance by manipulating the micro-environment within the bone marrow, triggering changes that suppress healthy, blood-forming stem cells while favoring the growth of cancer. The loss of hematopoietic stem cells results in bleeding, shortness of breath, fatigue, and infections.

Researchers led by OHSU’s Peter Kurre, M.D., now have uncovered one of the specialized weapons deployed by acute myeloid leukemia to subvert hematopoietic stem cells. The cancer cells secrete membrane-bound vesicles, or exosomes, that are loaded with microRNA molecules that target and disrupt a pivotal control system in the blood-forming stem cells.

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After breast-conserving surgery, how much radiation therapy is enough?

radiotherapy

Clinical trials have long since proved that breast-conserving surgery combined with radiation therapy is an effective alternative to mastectomy. But uncertainty persists about the required doses of radiation, and whether some breast cancer patients can forego “boost” doses to the tumor bed after whole-breast radiotherapy.

OHSU’s Charlotte Dai Kubicky, M.D., Ph.D., an associate professor in the Department of Radiation Medicine, brings some clarity to the issue in an editorial in JAMA Oncology co-authored with Laurie Cuttino, M.D., of Virginia Commonwealth University.

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Finding lessons in a failed pancreatic cancer clinical trial

chemoradiotherapy (1)

The LAP07 study, comparing chemoradiotherapy vs chemotherapy in patients with locally advanced pancreatic cancer, was stopped early for futility.

Nearly a third of people diagnosed with pancreatic adenocarcinoma have locally advanced tumors that cannot be removed by surgery. A longstanding and critical question for these patients is whether adding radiation to chemotherapy provides any benefit.

Alas, the answer appears to be no, according to the recently completed LAP07 study, which was stopped early when an interim analysis failed to demonstrate a benefit in overall survival. While disappointing, the finding fits with the emerging view that pancreatic cancer is a disease with a multitude of subtypes responding in diverse ways to therapy.

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First evidence that PD-1 antibody could help men with metastatic prostate cancer

tumor responses

Restoring tumor-specific immunity is a treatment strategy that works well in melanoma and lung cancer patients. A new study is reviving hope that the approach also may help men with life-threatening prostate cancer.

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This is what a ‘game changing’ cancer therapy looks like

Gleevec structure - Structure of Gleevec bound to the kinase domain (1)Gleevec binds to the kinase domain of the mutant enzyme BCR-ABL1

 

Life expectancy in patients with chronic myeloid leukemia has soared to a level almost equal to that of the general population, according to a Swedish study quantifying the life-saving impact of Gleevec, the targeted therapy ushered from lab bench to clinical success by Brian Druker, M.D., director of the OHSU Knight Cancer Institute.

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Digging in to questions that matter for men with prostate cancer

Tom Beer at ASCO

Cancer researchers presented more than 5,200 study findings at the American Society of Clinical Oncology meeting in June. Amid the hubbub, Knight Cancer Institute Deputy Director Tom Beer, M.D., observed, “All of the progress that we see here at ASCO is largely the result of patients who are courageous enough to volunteer for clinical studies.”

With three expert colleagues at the meeting in Chicago, Beer led an online discussion digging in to questions that matter for men with prostate cancer: how shorter courses of radiation therapy can maintain effectiveness but reduce the burden on men with localized prostate cancer; how chemotherapy improves long-term quality of life and life expectancy in patients with advanced disease; how inherited genes may be driving a much larger share of aggressive prostate cancers than anyone assumed.

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Advancing a potential blood test for pancreatic cancer

immunoviaImmunovia’s “IMMray” technology uses an antibody microarray to detect the protein signature of pancreatic cancer in blood samples.

 

The Swedish biotech firm Immunovia reached another milestone with the OHSU Knight Cancer Institute in developing a blood test to speed the diagnosis of pancreatic cancer.

Immunovia’s antibody microarray correctly classified 96 percent of patients with stage I or II pancreatic ductal adenocarcinoma in a retrospective study using samples from North American pancreatic cancer patients. These results match those in a previous retrospective study using Scandinavian patient samples.

“We have data now from three different sets of specimens, and it all seems to support the same thing — that the assay is picking up cancer even down to stage I,” the Knight Cancer Institute’s Chris Corless, M.D., Ph.D., told GenomeWeb.

As it stands, less than one in ten cases of pancreatic cancer in the U.S. are diagnosed at the local stage and the relative survival rate – around six percent at five years – is by far the worst among major cancers.

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How shortcut clinical trials may be misleading oncologists

surrogate approvals (2)Among 55 cancer drugs recently approved on the basis of a surrogate endpoint, less than one-fifth have been shown to improve survival in follow-up clinical trials.

 

Fully two-thirds of new cancer drugs in recent years gained regulatory approval based on a so-called surrogate end point, such as tumor shrinkage, rather than a clinical end point directly measuring how patients feel, how well they function or how long they survive.

This shortcut strategy makes sense if the surrogate reliably predicts improvements in survival or quality of life. But that connection remains unknown for a surprisingly large share of surrogate-approved cancer drugs in the U.S., according to a study appearing this week in Mayo Clinic Proceedings.

The authors analyzed cancer drug approvals by the Food and Drug Administration between January 1, 2009, and December 31, 2014. They found that 55 of 83 approvals were based on a surrogate end point. In 25 of the 55 surrogate approvals, the authors were unable to find any published research addressing whether the surrogate correlated with survival.

“How can you say it’s reasonably likely to predict true clinical efficacy if nobody has ever studied it?” says senior author Vinay Prasad, M.D., M.P.H., an OHSU Knight Cancer Institute hematologist-oncologist and assistant professor of medicine. “How can you say a surrogate is established when nobody can find a paper?”

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Engineering precision in cancer early detection

Engineering precision in cancer early detection

Sadik Esener, Ph.D., is leading a new Center for Early Detection Research at the OHSU Knight Cancer Institute.