This is the first blog in a three-part series about Genome Sequencing and Predicting Cancer.

Valerie Mehl

Valerie Mehl

Technology called next generation sequencing can be used to reveal an individual’s complete and entire DNA (whole genome).  Right now, it costs about $5,000 to sequence an individual’s whole genome, but the price tag is decreasing rapidly. With its increasing affordability, many have suggested that it could be used to identify individuals who were likely to develop cancer in the future as well as those who would be safe from the disease.  But, will it?

Our whole genome is the DNA we’re born with. For some of us, that DNA contains the code for cancers that occur in our families.  These cancers are directly attributable to inherited genetic alterations. In this scenario, whole genome sequencing can be extremely beneficial in identifying the specific gene and mutation that is causing these familial cancers and potentially in determining how best to treat them.

However, most cancer is not related to an inherited genetic mutation. Most cancers develop in people with no hereditary predisposition. For the majority of the population, who were not born with a cancer-promoting alteration in their DNA, whole genome sequencing won’t predict whether they will get cancer. The reason is that our inherited DNA is not the final manuscript of our life and all of the health events we will face. Each of us plays an important part in editing and interpreting the script with the foods we eat, the air we breathe, and the habits we acquire. Other things, like random mistakes cells make as they divide, also play a role but are out of our control.

In fact, Kimmel Cancer Center cancer prevention and control expert Dr. Elizabeth Platz says that heredity accounts for only about one percent of cancers.  For most people, lifestyle behaviors are far more damaging.  While we can’t change heredity, fortunately,  we can change our behaviors. You may be surprised to learn that we already know how to prevent the majority of cancers. Diet, obesity, and lack of exercise, she says, contribute to 35 percent of cancers, and smoking is a factor in 30 percent of cancers.

Stay tuned to Part 2 of Sequencing Our Genes, which will cover what gene sequencing does and doesn't do.

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Michelle Potter

Michelle Potter

Right about now, parents are scrambling to enroll their kids in various area summer camps. The choices abound, and for many kids, it’s the highlight of their summer.

Last year, I had the opportunity to visit our own Camp Sunrise, a week-long summer camp, hosted by Johns Hopkins, for children and young adults with cancer.  It’s a special camp that serves as a get-a-way for kids with cancer and lets them push aside their illnesses for a week.  Many of our patients have told me how much they love and look forward to camp; it’s the highlight of their year.  It was the highlight of my summer too.

At a typical day  in Camp Sunrise, there are cabins for the campers, a swimming pool, pavilions, camp fire pits, and of course, the dining hall. Campers swim, sing, dance and play basketball.  Each child can participate, regardless of limitations from their illnesses. Watching these campers swim, dance and sing, you soon forget they battled or are battling cancer. This is exactly the point.

For parents, the camp is a safe retreat for their children, staffed with doctors and nurses from Johns Hopkins.  Camp staff take personal vacation time, leaving work and attending camp. What’s even better for parents is that Camp Sunrise is funded by donors, which makes camp free of charge to families.

Dedicated volunteers will hold the first Camp Sunrise Gala on May 12 at The Grand Lodge in Hunt Valley, MD, to continue raising funds for Camp Sunrise.  Camp Sunrise is a reminder of the importance in continuing our fight to find cures for childhood cancers.  I am hopeful that in the future, as great and fun as it is, we will no longer have a need for Camp Sunrise.

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Evan Lipson

Evan Lipson, M.D.

In 2009, while studying at Johns Hopkins University, Tao Wang, now age 40, was diagnosed with stage one breast cancer. After diagnosis, she began to focus on helping other patients with some of the questions she, herself, faced during treatment. ”Somehow, I want to make a difference in my life,” she says. Now Wang volunteers in the “Survivors Helping Survivors” program at Hopkins. She especially likes discussing treatment options with newly diagnosed cancer patients. ”Life is deeper now anyway,” she says. ”I now will do work in a different way.”

Click below to hear her story.

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Cancer headlines this past month included two studies on colonoscopy, a screening tool for colon cancer.  The first study looks at the long-term benefits of colonoscopy and found that 50 percent of colon cancer cases were avoided by a single colonscopy.  In the Cancer News Review podcast, William Nelson, M.D., Ph.D., director of the Johns Hopkins Kimmel Cancer Center reminds us that colonoscopy is used for both screening and treatment, when precursor cancer lesions called polyps are snipped off during the procedure.  The second study compared fecal occult blood tests with colonoscopy.  Researchers found that one-third of people prescribed fecal occult tests are compliant in taking the test as compared with one-quarter of people scheduled for colonoscopies.  Nelson says people may be more likely to engage in a program that invovles stool testing rather than colonoscopy.  Both of the tests detected equal cases of colon cancers, but colonoscopy found twice the number of adenomas (polyps that can later become cancer).  Nelson says that new technologies are needed to improve on these tests.

Nelson also reviews a study of a drug called venurafenib, which "stops the 'go' switch that drives melanoma cells to divide, accumulate in large numbers and spread throughout the body."  Half of melanoma patients have this "go" switch.  The study shows that melanoma cells become resistant to the drug within an average of six to seven months, and new additive treatments are needed to improve survival.

Finally, Nelson notes a new study from Johns Hopkins scientists that adds to the rapidly changing environment of cancer genome sequencing.  The study introduces a tool called pyromaker that helps make sense of certain sequencing results.

Program notes:

0:20  Colonoscopy reduces colon cancer death
1:20  At least fifty percent of expected deaths avoided
2:22  In cancer world how can we say disease is eradicated
3:20  Fecal occult blood versus colonoscopy
4:23  Colonoscopy found about twice as many polyps
5:14  Melanoma and venurafenib
6:14  How long to become resistant?
7:04  Enables gene sequencing on the go
8:03  Can make sense of the 3 billion pieces of information
9:43  End

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Yesterday afternoon, at the American Association for Cancer Research Meeting in Chicago, more than 150 people crowded a room to hear updates on research funded by Stand Up 2 Cancer (SU2C) and meet the new prostate cancer Dream Team.

Arnold Levine, Ph.D., professor of pediatrics and biochemistry at the UMDNJ-Robert Wood Johnson Medical School opened the event, attended by journalists and SU2C leaders and members.  According to Levine, $125 million has been committed to research by SU2C since their original broadcast in 2008.  Some 34 clinical trials were facilitated by this research. 

“Our dream team is to make everyone a survivor,” said Levine.

Actor Terrence Howard, who co-starred in the movie Iron Man and most recently in Red Tails, said his mother’s death from colon cancer at age 56 had a lasting impact on his family. “We’re all being held hostage to cancer, and we pay a ransom with each of our family members,” he said.

Roger Lo, M.D., Ph.D., from UCLA, gave an update on research into new treatments for melanoma aimed at making patient responses to targeted therapies more long-lived by blocking more than one “stop” in a cancer-promoting pathway.  He is investigating mutations in two genes – BRAF and MEK – as a way to overcome acquired drug resistance.

Johns Hopkins’ Stephen Baylin, M.D., Ph.D., presented updated data on epigenetic drugs being tested in lung and other cancers. A recent report in Cancer Cell describes how these drugs work. Some 62 patients have been treated with epigenetic drugs.  Three percent of them have had “robust responses to the epigenetic drugs alone,” according to Baylin.  Their surprise finding, he said, is “when these patients begin other therapies [after the initial epigenetic drugs], they experience more robust responses – about 21 percent of them.” Adding immunotherapy to epigenetic drugs may also raise the response rate, he said. 

Jean-Pierre Issa, M.D., from Temple University, a member of SU2C’s Epigenetics Dream Team, led by Baylin, is designing a clinical trial on an epigenetic drug that is paired with laboratory testing to find the “maximum laboratory toxicity” rather than standard measures of “maximum tolerated dose,” which may be too high for patients.   

SU2C’s new prostate cancer Dream Team, co-funded by the Prostate Cancer Foundation, will be led by Charles Sawyers, M.D., of the Memorial Sloan-Kettering Cancer Center and Arul M. Chinnaiyan, M.D., Ph.D., from the University of Michigan.  Their research will focus “precision therapy for advanced prostate cancer.”  They will define the mutational landscape of prostate cancer patients and direct those patients into clinical trials using combinations of drugs potentially linked to better response rates of tumors with the same genomic landscape.

Finally, yesterday’s event featured breast cancer patient Jeanette Daniel, who enrolled in an SU2C-funded clinical trial at Vanderbilt.  “Doing what you do is keeping me alive one day at a time…I believe in my lifetime, we will find the key and take this monster down,” she said.

Video including Johns Hopkins Kimmel Cancer Center director, Bill Nelson:

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Prostate cancer topics abound in the latest Cancer News Review podcast.  Dr. Bill Nelson, director of the Johns Hopkins Kimmel Cancer Center, discusses Hopkins-led research, published in the New England Journal of Medicine, looking at the genetic similarities of men with a family history of prostate cancer. By looking at their genes, investigators were able to find a genetic marker for prostate cancer risk.  Nelson also comments on a study of prostate cancer screening methods that evaluated impact on lives saved and new statistics released by the National Cancer Institute. 

Reacting to an opinion piece written about proton beam therapy,  Nelson asks the same question of the the more costly therapy: is it better than conventional radiation?  He says the answer is not clear.  There is a lack of research comparing conventional and proton beam therapy, and still, the therapy is being used for many cancers.  Nelson says the field is ready for more research on this topic.

Program notes:
 
0:19  Genes deficient in some men with prostate cancer
1:07  Does knowledge of this help others with prostate cancer?
2:09  We’ll learn a lot about the disease through genes
2:55  Prostate cancer screening impact
3:54  Study has been criticized
4:53  Need to be a lot smarter about who is screened
5:52  Cancer deaths are decreasing
6:53  Will the rate of decline slow?
7:24  Proton beam radiation therapy
8:27  Field of radiation oncology needs research on this
9:34  End

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Michelle Potter

Michelle Potter

I never thought I’d be exposed to such a wide variety of expert musicians and performers working as a communications coordinator in the Cancer Center.  Through the Cancer Center’s Art of Healing Performing Arts Series, I have the exciting opportunity to work with high caliber musicians from the Peabody Institute, local ballet dancers, and even a former Temptation, all showcasing their talents to our patients, families and staff. And I never imagined how one hour of music every month could touch so many lives.

Think about the impact a favorite song or musician has on you. Music has the power to calm and console or to energize and invigorate. Now, think about the impact music can have in a cancer center. Many patients and families have told me how our Art of Healing concerts have impacted their lives.  One story of music’s power was told by oncologist Evan Lipson in his podcast with Susan Liss, spouse of a pancreatic cancer patient who created a music library for other patients.

The inspiration for the Art of Healing Program came from the Kimmel Cancer Center’s former director, Martin Abeloff, M.D. in 1998 and is funded by the Emmert Hobbs Foundation. When our new clinical facility, the Weinberg Building, was opened more than a decade ago, Dr. Abeloff wanted an uplifting environment, mixing scientific and medical expertise to heal the human body while comforting the human spirit. 

Together with inspirtational artwork hand-selected for the building, the Art of Healing Performing Arts Series has continued each year. And though Dr. Abeloff died from leukemia in 2007, the legacy of his Art of Healing Program continues to comfort patients and families.

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Valerie Mehl

Valerie Mehl

I was listening to the radio as I was driving in my car, and the lyrics in the song struck me.  It went something like this, “Cancer doesn’t discriminate or care if you’re just 38.”  I thought to myself, “Well, yes it does.”  Cancer has always been and remains a disease of aging.  Perhaps the greatest risk factor for cancer, in general, is old age. As I wrote in an article a few years ago, “the real face of cancer has wrinkles.”  According to National Cancer Institute data, the average age at cancer diagnosis is 66.  Less than six percent of cases are diagnosed in people age 35 to 44, and for those younger than 35, cancer rates are lower still. 

This song also made me think of a question about ovarian cancer my colleague recently received from a reporter.  The reporter wanted to know if ovarian cancer treatment affected a woman’s ability to have children.  Of course, it does, but what the reporter failed to recognize was that the majority of women diagnosed with ovarian cancer are beyond their childbearing years.  

When, I hear or read such things, I worry that there is a misperception that cancer is more common among younger adults than is factually true.  I worry because misperceptions about cancer create fear, and fear causes people to take actions that may not be medically necessary or even beneficial.

Now I recognize that even though the odds are most definitely in favor of those under 66, if you happen to be one of the rare but unfortunate individuals diagnosed at a younger age, these odds do not bring much comfort.   This, however is where personalized cancer medicine  may have its greatest impact.  It has the potential to use science to identify those who need and will benefit from intervention—the six percent, if you will—and, at the same time, identifies who can be left alone. Currently, many cancer experts suspect that the general population is being over screened, and those at the greatest risk for cancer are under screened. Kimmel Cancer Center scientists are working to set a new standard, using their discoveries to develop a model that would appropriately screen those at greatest risk but move away from over screening those who don’t need it.

Similar progress can be made in treatment.  In the latest issue of Promise & Progress I write about a study led by urologist Dr. H. Ballentine Carter that finds no harm in delaying treatment in men over 65 who have low-grade prostate cancer.  Instead, he says, the best option may be a watch and wait approach  in which the patient’s cancer is closely monitored.  More than 200,000 men in the U.S. are diagnosed each year with prostate cancer, and the majority of them have a low risk of dying from their disease if treatment is deferred, Dr. Carter says.  Yet, shockingly, more than 90 percent of these men choose some form of treatment. 

It is important to understand that excessive screening and treatment does not save or improve lives.  Every intervention comes with its own set of risks.  Personalized cancer medicine strives to reduce risks and enhance benefits.  As our Kimmel Cancer Center Director says, “it gets the right treatments to the right people at the right time.”

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Researchers from the Vanderbilt-Ingram Cancer Center and other institutions reported more data today on studies of a new melanoma drug that target products of a cancer-causing mutation in the BRAF gene. The study, published in the New England Journal of Medicine, tracked patients with metastatic melanoma who have been followed for more than a year now, on average. More than half of the patients had a response to the drug, and the investigators report median overall survival of almost 16 months.  The drug was approved by the FDA last fall.

These small steps in improving cancer therapies are encouraging to doctors. Johns Hopkins melanoma specialist Evan Lipson, M.D., said the following about today's report:

"The NEJM study is another important step in what is a rapidly changing landscape for melanoma and cancer therapy in general. Some cancers are formed when, inside a cell, a signal is passed from one molecule to another, like a game of telephone. Vemurafenib (Zelboraf) stops that signal from being sent and, in doing so, stops the growth of the cancer. This study provides important information on how likely and for how long the drug will keep the cancer at bay. It’s also a stepping stone to another exciting prospect in cancer research: combining drugs like vemurafenib with other therapies, where two treatments used together might be more effective than each one by itself."

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Consider taking two hours of your time to donate platelets, and you may save a patient’s life.  Platelets are components found in your blood that help it to clot. Cancer patients may need transfusions of platelets because their bone marrow has become too crowded with cancer cells, or their cells become damaged from chemo- and radiotherapy.  In addition to cancer patients, organ transplant, trauma victims, and cardiac surgery patients can also benefit from platelet donations.  Donated platelets have a shelf-life of five days. Cancer patients need anywhere from two to 100 transfusions of platelets during their treatment, which is why there is a constant need for donations. Here are four tips to remember when donating platelets.

Sonja Vozniak, R.N. with the platelet donation machine

  1. Eat a healthy meal and drink plenty of fluids the day before and the day of your scheduled donation.
  2. Wear comfortable clothes. It takes about 1 ½ to 2 hours to donate, so wear clothes that are comfortable.
  3. Bring something to do.  Bring your laptop, magazine or book to keep you occupied while you donate. 
  4. No aspirin or Ibuprofen.  Do not take aspirin or ibuprofen at least one day prior to donating.

The Johns Hopkins Blood Donation Center is located on the first floor of the Johns Hopkins Outpatient Center (JHOC) 601 North Caroline Street, Room 1144, Baltimore, Maryland 21287. For more information about donating or to schedule a donation appointment, call 410-955-TIME.

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