Vanessa Wasta

Vanessa Wasta

It's been a game-changing year in cancer research.  Doctors and scientists don't typically like to use those words, but here's why I think this is a turning point.  Scientists are churning out the genetic code of cancer cells as quickly as the cost of sequencing technology plummets.   Teams of researchers are looking for ways to add the new armory of cancer cell-targeted drugs with the traditional therapies of surgery, chemotherapy and radiation.  Studies continue on ways to widen the pool of donors for bone marrow transplant patients -- work being led by Johns Hopkins investigators.  New collaborations are being formed between national and international institutions and within our own institutions, between departments such as engineering and mathematics, not ordinarily considered partners in cancer research.

These and many other advances bode well for a future of better prevention, tests, and therapies for cancer.  To get a better understanding of the direction of cancer research, I polled a group of Johns Hopkins cancer center members for their opinions on the top research trends this year.  

Researchers identified trends in creating molecular tests based on genetic and epigenetic profiles of patient that define whether a new drug may or may not be effective.  Some pointed to research questioning the value of screening methods for cancer, which made national headlines for its polarizing viewpoints by U.S. and Canadian task forces specifically on mammography screening.   Several studies, including those at Johns Hopkins, continue to validate so-called "active surveillance" programs for prostate cancer, which carefully monitor men who are at low risk for harmful cancers rather than treating them with surgery or radiation.

In breast cancer, experts pointed to results of a Canadian study that showed dramatic reduction of new breast cancer cases among post-menopausal women who took a drug called exemestane.  Doctors also pointed to improvements in treatment outcomes of early stage breast cancer by adding radiation to axillary lymph nodes.  This finding goes hand-in-hand with results published earlier this year on decreasing the use of axillary lymph node surgery for certain breast cancer patients. 

Finally, this year, six new cancer drugs were approved by the FDA -- all for treatment of advanced or metastatic cancers.  They include treatments for melanoma, Hodgkin's lymphoma, thyroid, prostate and lung cancers.   Melanoma specialist and Seize the Days blogger Evan Lipson, M.D., cited this year's approval of the immune-based drug ipilumumab (Yervoy) as a major milestone in cancer treatment, not just for melanoma, but for cancer treatment in general, he says.  There is likely much more to come from researchers seeking ways to use a patient's own immune system to attack cancer.  Listen to Lipson's podcast below discussing this topic. 

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Evan Lipson

Evan Lipson, M.D.

Jamie Galloway is a retired microbiologist who volunteers her time supporting other breast cancer survivors. She provides them comfort and companionship, just as she was supported during her own battle with the disease.

Click below to hear her story.

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Evan Lipson

Evan Lipson, M.D.

Jeffrey Liss was a natural leader whose work as an attorney was often dedicated to advocating for the public interest. In addition to helping those in need, Jeffrey was passionate about music and, in it, found great comfort and empowerment, especially during his fight against pancreatic cancer. He shared his passion by creating a music library to benefit other patients being treated at Johns Hopkins.

Click below to hear Jeffrey's wife Susan tell the story.

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John Fetting

John Fetting, M.D.

***The following post was written by Dr. John Fetting at the Johns Hopkins Kimmel Cancer Center.

Another successful Breast Cancer Awareness Month is coming to a close. We have raised the national consciousness, encouraged screening, touted the benefits of treatment, celebrated an ever-growing number of survivors, and honored those who fought bravely but died.
 
Still, the number of women around the world who have their lives suddenly and forever changed by this terrible disease continues to increase. This must stop. A steady increase in the incidence of breast cancer is not inevitable. Preventing breast cancer is not too hard, too big, or too expensive.

Curing breast cancer has a face. It is the face of our wife, our mother, our sister, our daughter. We take curing breast cancer personally. Not so, with prevention. For the most part, we can’t identify those who are destined to get breast cancer. Until they are diagnosed with it, they are faceless.

Preventing breast cancer will be hard work. First, we need to identify strong risk factors that predict who will develop breast cancer. Some of the risk factors we identify today, such as early onset of menstruation and first pregnancy after age 30, are not all that predictive or helpful. They are only indirectly related to the development of breast cancer and account for such modest increases in risk that most women with these risk factors will not develop the disease.
 
The strongest risk factors are biological and genetic changes occurring in the breast, which mark the path from normal breast to breast cancer. An example of a strong risk factor is a mutation in BRCA1 or BRCA2 genes. About five to ten percent of breast cancers are caused by a mutation in these genes. Most women with one of these mutations will get breast cancer. There is no doubt about their risk; there is no doubt about their need for prevention.  
 
Most breast cancers, however, will be caused by multiple genetic and biologic changes, and finding the right combinations of these changes for predicting high risk for the disease is our task.

Once we identify these changes and the women at highest risk, we can develop and test interventions to prevent the disease. Whether an intervention is a dietary supplement or drug, it can’t be burdensome—in cost or side effects. Prevention drugs used today, including tamoxifen, raloxifene, and exemestane, halve the risk of breast cancer but come with troublesome side effects.

Make no mistake, to prevent breast cancer we need to make the kind of single-minded, determined effort that has characterized our effort to cure breast cancer. Anything less will take a very long time or fail altogether. Support for basic and applied prevention research will be expensive, and government and pharmaceutical funding cannot be the sole sources of funding. Private philanthropy and grassroots fundraising will be essential.

I attended the Maryland Susan G. Komen Race for the Cure last Sunday. And as I watched the runners and walkers stream past the start line, I was impressed that this group was on a mission. They are out to cure breast cancer. As the T-shirts of one team proclaimed: “Defeat is not an option.”

There were thousands of girls and young women walking or running. Why were they there?  Some had a very personal stake because a loved one had been affected. Others supported a friend or classmate whose mother, sister, or grandmother was affected. I saw groups representing their school or church in an expression of commitment to this cause. They radiated enthusiasm and camaraderie. They did not seem afraid or to feel particularly at risk. But some of them are at risk. We need to figure out who they are and take steps to prevent their breast cancer. These are the faces of prevention. We owe it to them.

John Fetting, M.D.
Associate Director for Clinical Practice
Associate Professor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

***Note: The John Fetting Award in Breast Cancer Prevention has been established to fund the most promising research in breast cancer prevention. Applications will be granted to the most promising work for a two-year period.  The John Fetting Award is led by breast cancer survivor and advocate Leslie Ries.  Her video documentary, Letters to My Daughters, chronicles her inspiring story and mission to help prevent breast cancer. 

Additional Resources:

Preventing Breast Cancer

C-Answers video series: Dr. Fetting discusses breast cancer prevention

Support Breast Cancer Prevention Research at Johns Hopkins

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Evan Lipson

Evan Lipson, M.D.

Deb Stewart has battled breast cancer twice. A nurse by training, she now works with breast cancer survivors at the Avon Foundation Breast Center here at Johns Hopkins, lending her support and wisdom gleaned from experience. Her work is not only valuable to patients, it’s rewarding for Deb. Or, as she puts it, “You get more than you give.”

Click below to hear her story.

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Elissa Bantug

Elissa Bantug

On September 14, 2011, I was invited to a special premiere of the movie 50/50.  A group of cancer care providers packed into a movie theater in Georgetown anxiously awaiting the film to begin.  I’ve been hearing about this movie for months; there’s been quite a buzz in the young survivors’ community about its startlingly accurate portrayal of a young patient’s transition from vitality and strength to illness and dependence.

In this movie, a young man fights cancer, but the story is told through the lens of Hollywood slapstick comedy.  Before I saw the movie, I felt a bit unnerved by this.

Based on a true story, 50/50 screenwriter Will Reiser recounts his experiences of diagnosis and treatment of a spinal sarcoma (referred to in the movie as “back cancer.”)  Produced and co-starring Seth Rogen as the best friend of a cancer patient played by Joseph Gordon-Levitt, this very intimate, personal portrayal had me laughing out loud many times throughout the film.  It was an incredible sense of release to find the ridiculousness and absurdities rooted in a frightening diagnosis—embedded in the indignities faced by one person struggling with uncertainty, fear, frustration, and sadness. 

The film is a powerful reminder that, even though many people survive longer and often with a better quality of life today than cancer patients of the past, the advances in detection, technologies, and treatment are not the same as developing ways to deliver patient-centered care through the disease and its aftermath. 

This may be especially true in the young cancer community.  A population that often feels lost between two worlds--too old to fall under the care of pediatricians, but way too young to relate to survivors who may be 50 years and older. 

There were several “teachable moments” in this film that hopefully shed light on some of the adversities faced by young people grappling with this disease.  Humor was a powerful inspiration, urging more thoughtful consideration of how to care for people going through the ordeal of cancer.  For example, the relationship between Gordon-Levitt and his doctor in this film lacked any empathy and compassion.  When delivering the diagnosis of cancer, the oncologist failed to even look up from Gordon-Levitt's medical chart and rattled off figures and technical terms using medical jargon that would be difficult for anyone to follow.  This failure to connect with Gordon-Levitt and his family was a reoccurring theme in the movie.   

Within moments of the movie ending, I overheard several audience members comment that “doctors are not that bad” and “I would never treat a patient that way.”  Except that it does happen. 

This over-the-top depiction gave many of us something to think about.  We should focus on the importance of making eye contact, reading non-verbal cues, having patients be part of the decision-making process, explaining the diagnosis and treatment options slowly and in simple terms, allowing for questions, and how a gentle touch can make a world of difference to someone who is receiving devastating news.  

I do have one criticism of this movie: it is occasionally formulaic and predictable.   The components of a Hollywood comedy are in evidence: the  twenty-something year-old break-up turning into a taboo love story with the unlicensed social worker, the over-bearing mother who feels the need to offer all the wrong kinds of support, and the over-the top stereotypical medical oncologist who lacks humanity or compassion.  At the same time, the budget was small, and Reiser and Rogen decided to make the film without the backing of a major production company; they clearly have a story they want to share.

The screening event was sponsored through the Lance Armstrong Foundation whose mission is to improve the lives of those living with (and through) cancer.  The Foundation has promoted this film, hoping it will help challenge the social construct of the face of cancer.  Throughout the movie, you feel that these two men are on a mission to convey an important story, but with humor.    What matters most is that it is an important social intervention.  Reiser and Rogen are capitalizing on their star power to tell a powerful and evocative story.  And by telling this story, they’re making other patients laugh, and making people who may someday have cancer aware of the importance of laughter.

More on Breast Cancer Survivorship

Elissa Bantug's Why I Walk series

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Harry and his team captain, Annie

When former Olympian Patrick Kennedy fired the starter gun yesterday morning to officially begin the Swim Across America Baltimore event, I nervously jumped in a 50 meter lane at Meadowbrook Aquatic Center, and started my one mile swim journey. I’d never done anything like it before, and there were a few moments – around lap 8 - when I considered getting out of the pool. But, given why I was really swimming on a chilly Sunday morning in September – to help raise funds for cancer research at the Johns Hopkins Kimmel Cancer Center - I thought the challenge was worth it. After all, my mother died of cancer, as did my grandmother, and I have close friends who have lost loved ones to the disease. Then, there are the patients I’ve met as part of my work here at the Cancer Center – people I’ve grown to care about deeply, who are courageous and inspiring.

So, I swam. So did my eleven-year-old son, Harry. I watched as he held his own among accomplished swimmers and then cheered on others – like popular radio DJ Jackson Blue. I was thrilled when Harry told me after the swim: "I’ve really learned to have a greater appreciation for Hopkins and cancer research."  Wow. What more could a mother (and PR person) want!

Then, there were the Olympians. Yes, they swam and yes, they’re really good and really fast! I just hope I can remember Craig Beardsley’s freestyle form the next time I’m in the water. But, that’s not what really impressed me about them. Instead, it was their humble attitude to help a great cause.  Each of them, as former and current champions, lends a high level of swim celebrity cache, no doubt about it. But, when they spent their Saturday evening with parents and children on our pediatric oncology inpatient unit, it was all about the kids. I was honored to be with them and struck by their selfless contributions of their talent and accomplishments.

How many “waves” did we make?  More than $400,000 thanks to dedicated teams of swimmers, donors, corporations and cancer survivors. Read more about the Swim Across America Lab at Johns Hopkins.

Olympic Champions visit the Johns Hopkins Kimmel Cancer Center before the Baltimore swim on September 18, 2011.
L-R:  Alex Meyer, Craig Beardsley, Wendy Weinberg Weil, Brenda Borgh Bartlett, and Janel Jorgensen, Executive Director of Swim Across America

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With less than a week to go before hundreds of swimmers take to the open water of the Magothy River on Maryland’s Western Shore, we’re spotlighting a few of the teams that are participating. Today, we feature the Merritt Eldersburg Team and why they swim!

We've become friends by swimming together regularlyat the Eldersburg fitness club. We're really excited to be part of the second annual Swim Across America Baltimore event on September 18. The money we raise will support the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Our team captain, Lynn McKain, received aggressive treatment for breast cancer at Hopkins. Swimming with us was her salvation before, during, and after treatment. Others on our team have been touched much too closely by cancer. We are participating in the SAA Baltimore open-water event to honor the survivors among our friends and family.

We hope that the money we raise will in some way help to put an end to this horrific disease and comfort those who have and are struggling with its devastation. With our participation, we send special healing energies to Joe and Toni.

We are looking forward to the swim as a day of thanks for our own health, a day of celebrating our friendship through swimming, a day of honoring teamwork as an example of strength, and a day to honor the larger mission of Swim Across America.

Read more about the research in the Swim Across America Lab at the Johns Hopkins Kimmel Cancer Center.

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Evan Lipson

Evan Lipson, M.D.

Coming up later this month is the 3rd annual Semi-Colon Crawl - a 5K walk here in the Baltimore area to spread the word about colon cancer. It's the brainchild of Edel Blumberg, who was diagnosed with colon cancer at age 47. Despite undergoing surgery and chemotherapy, the disease returned three years later. After another course of treatment, Edel founded the Semi-Colon Club, an organization dedicated to spreading awareness about colon cancer prevention, screening and treatment. Or, as Edel likes to say, colon cancer is preventable, treatable and beatable.

Click below to hear his story.

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This month, Kimmel Cancer Center director William Nelson reviewed four major cancer research stories ranging from pets that sniff out cancer to a reminder of the dangers of cigarette smoking.

The first story is one that has been reported for several years.  A variety of reports have shown that dogs can detect cancer in people by sniffing their breath, in the case of lung cancer, and urine, for genitourinary cancers.  The question, says Nelson, is what cancer-related molecule(s) are the dogs detecting?  If we can determine the specific marker the dogs are identifying, we can study these markers for broader use, he says. As for using Fido now as a detection tool, Nelson says these studies are small and have not been compared in studies to any other detection tool, so stick with the proven methods.

Nelson also discussed, what he calls, "extremely exciting" news for metastic melanoma.   The drug, vemurafenib, marketed by the name Zelboraf, was recently approved by the FDA for metastatic melaoma.  It works by interfering with a growth signal in cells that gets turned on by the BRAF gene. When the gene is defective, the signal becomes stuck in a chronic "on" state and leads to uncontrollable growth of cells, resulting in cancer.  Vemurafenib interferes with this growth signal.  In studies of the drug, half or more of patients had "tremendous shrinage of tumors," according to Nelson, who says the approval is a "giant first step." He says the drug may have potential as a treatment for earlier stage melanoma and possibly in combination with immune-stimulating drugs currently being studied. 

In a recent study evaluating whether inherited genes affected the course of cancer, researchers identified five variant genes that seem to be associated with aggressive prostate cancer.  Nelson says that understanding how these genes contribute to cancer could help define why some cancers are more deadly than others and help tailor aggressive therapies to patients at higher risk for it.

Finally, cigarette smoking remains one of the largest factors that drives cancer, according to Nelson, and the relationship between lung cancer and smoking has been well known, but it is also known that smoking increases the risk for other cancers, including bladder cancer in men.  A recent study reveals that smoking-related risk for bladder cancer may be even higher than previously thought.  The study also shows that people who quit smoking reduce their risk of bladder cancer significantly. Nelson says, as the number of women who smoke has risen throughout the years, the number of smoking-related bladder cancers in women also has increased.  Study authors point out that changes in the contents of cigarettes may have contributed to the rise in bladder cancer risk.

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