Cancer treatments becoming more focused, effective
Date posted: April 4, 2013
SHERIDAN — Even though Sheridan’s new Welch Cancer Center just opened last year, Dr. Gregory Marino, medical oncologist, can’t wait until the day it closes its doors.
“I look forward to the day the Welch Cancer Center is not a business anymore because there is no more cancer to treat,” Marino told a crowd of nearly 50 people gathered in the conference rooms at Sheridan Memorial Hospital Wednesday evening.
Marino and Lekan Ajayi, pharmacist at the cancer center, presented an overview of new cancer treatments used in 2012. They looked at the history of cancer treatment to show progress has been made and looked ahead to show there is still a long way to go.
In his opening remarks, Ajayi mentioned a recent interaction with a patient who asked, simply, “Have we found the cure to cancer yet?”
“We’re all asking that question,” Ajayi said. “But it’s a loaded question.”
Less than 10 percent of more than 100 cancers can be considered curable cancers, Ajayi said. Marino, however, warned against using the term “cured,” favoring “continuous complete remission” to encourage continued vigilance by the patient and doctor. It is estimated that one-third of cancer cases can be prevented through lifestyle and dietary changes and early detection through screening.
“There is a lot of hope and there is a lot of progress being made, on the one hand,” Marino said. “On the other hand, we’re not curing cancer; we’re not adding any more tumors to the cure pile than what we had 30 years ago, basically, but we’re helping people to live longer and longer and longer, and better and better and better, avoiding a lot of the toxicities that we would see classically.”
In 2012, it became more evident that treatments need to be precise and targeted to prevent the widespread toxicity of traditional chemotherapy.
“No two tumors are the same, just like you and I are not the same,” Ajayi said.
Cancer research is focusing on using combinations of specific drugs and chemotherapy that are tailored precisely to a patient’s cancer cells.
Marino said current research is focusing on what is happening on the surface of the cancer cell since, at their most basic, cancer cells have a lack of respect for tissue boundaries. They invade surrounding tissues because their receptor experience a loss of contact inhibition.
They spread, or metastasize, because they maintain their own microenvironment in order to live in other tissues and evade the body’s surveillance system. They are immortal because they feed themselves and cancel apoptosis, or programmed cell death.
On the surface of cancer cells are various receptors that seem to be responsible for the cell’s survival. The Vascular Endothelial Growth Factor receptor helps the cell maintain its own microenvironment so it can live and spread in other tissues. The Epithelial Growth Factor receptor is responsible for cell to cell communication and tissue invasion. New treatments are being aimed at these specific receptors as well as specific levels of the tumor cell.
One of the newest drugs is Kadcyla, which wages a two-pronged attack on cancer cells by targeting a specific cell then releasing a drug directly into that cell rather than blasting the whole affected tissue area with chemotherapy, which kills good cells and cancer cells alike. Many of the new cancer treatments are taking a similar approach, producing less toxicity and overall cell destruction.
By pairing chemotherapy with other drugs that target cancer cells specifically, response rates are going up, progression rates are slowing down, and patients are living months and even years longer.
“A few months doesn’t seem like much, but with cancer you celebrate a few months because it is one step closer,” Marino said.
Following the presentation, Marino reminded Sheridan County residents that one of the most important aspects about new cancer treatments is that they can be done in their hometown.
“For the overwhelming majority of what cancer patients need, it all can be provided here,” Marino said. “Probably 90 percent of oncology from the radiation standpoint, the surgery standpoint, the medical standpoint can be done right here. People don’t have to leave town.”