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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Evan Lipson

Evan Lipson, M.D.

For Carrie Wells, a powerful and positive part of surviving breast cancer was attending a retreat with women who shared similar journeys. Being surrounded by other survivors was a chance for connection, education, relaxation and healing. So moved was Carrie by the retreat experience, she felt compelled to help other cancer survivors find equally valuable opportunities. Carrie launched SurvivorsRetreat.com, a website that offers a comprehensive, searchable database of cancer survival retreats.

Click below to hear her story.

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We completed three days of filming for a new C-Answers video series on cancer survivorship. In one of the video segments, we feature nutritionist Lynda McIntyre discussing how to stay healthy through diet and nutrition. Each time I listen to Lynda speak on these issues, I feel like my diet needs a complete makeover. But when Lynda gave us her "power" list of fruits and veggies, I was happy to note that many of them are on my weekly grocery list. Are they on yours?

Lynda McIntyre's Power List of Fruits and Veggies

Apples
Berries
Citrus
Beans
Broccoli
Nuts
Seeds
Whole grains

Expect to see Lynda's video on our YouTube site in about a month. In the meantime, watch Kimmel Cancer Center director Bill Nelson discuss the role of diet and nutrition in cancer.

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I entered uncharted territory when I began the feature story for the latest issue of the Kimmel Cancer Center's magazine Promise & Progress.  I was unaware that Johns Hopkins engineers had joined our cancer experts in the fight against cancer and equally unaware of the great body of work that was coming from this new kind of cancer collaboration.  With just a basic understanding of the principles of engineering, I was a kid in a candy story of science. We are talking amazing feats of technology, such as Kinect gaming systems used in cancer treatment, robots with snakelike devices that can get inside bones and dig out tumors, light-emitting cancer cells, blood cells transformed into heart cells, cancer-drug filled nanoparticles, and so much more.
 
I invite you to read the new issue to get a glimpse of some of these innovative approaches to cancer treatment and explore, for yourself, this exciting new world of cancer science and medicine.
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Rangos and Finalists

John Rangos Sr. (third from left); His Excellency Vassilis Kaskarelis, Ambassador of Greece (fourth from left); and finalists Brian Ladle, Kevin Cheung, Andrew Sharabi, Cheng Ran "Lisa" Huang and Diane Heiser.

Last Friday, the historic Hurd Hall at Johns Hopkins was filled to capacity with students, faculty and staff waiting to hear five scientists – all in the early part of their careers – describe their novel ideas on how to cure metastatic cancer.  It was part of a competition on creative thinking named for John Rangos Sr., chairman of the Rangos Family Foundation, who funded the awards.  Rangos worked with Johns Hopkins faculty members Donald S. Coffey and Horst Schirmer in the Department of Urology to develop the competition.

Each scientist had 10 minutes to present their idea and answer questions from a panel of Johns Hopkins faculty judges.

Master of creative thinking, Coffey, whose theory on killing cancer by weakening its DNA scaffolding continues to spur innovative research, opened the event, describing it as the “Olympics” of research competitions at Johns Hopkins.

The finalists were awarded the John G. Rangos Medal of Honor in Creative Thinking and the top three winners received cash prizes.

First up to the podium was medical oncology fellow and fifth place winner Kevin Cheung who proposed turning back the clock on cancer cells, reprogramming them into germ cells. He suggested that the reason testicular and other germ cell tumors have high cure rates is because of their undifferentiated state. Just as scientists have created immature pluripotent stem cells from adult cells, Cheung says that the same could be done with cancer cells.  By age reversing resistant cancer cells, he proposes to make them sensitive to conventional chemotherapy.

Third-place winner Diane Heiser, a doctoral candidate in Cellular and Molecular Medicine, proposed that more metastatic cancers can be cured by understanding how cancer cells repair their own DNA. She suggests that metastatic cancer cells are able to survive the severe DNA breaks that occur with DNA damaging agents like chemotherapy by repairing themselves quickly and efficiently. Heiser says that determining the specific proteins which help metastatic cancer cells repair their DNA could reveal new targets for drugs that sensitize cancer cells to chemo or radiation therapy.

Genetics postgraduate student and second-place winner Cheng Ran "Lisa" Huang described cancer as a “fight between two parasites – cancer versus transposons.” She noted that nearly half of the human genome is made up of “jumping” DNA – short sequences of DNA that get inserted into the genome at various points.  Too many transposons can lead to genomic instability and kill the cell.  Huang says that germ cell tumors have the highest level of transposon activity, making them more prone to cell death, and thus, more easily killed by chemotherapy drugs.  There is potential, she says, of using drugs to target proteins that normally suppress transposon activity in most cell types.

Brian Ladle, a pediatric oncology fellow and fourth-place winner, presented his idea that cancer cures rates depend on the level of uniformity between cancer cells.  Low-risk pediatric leukemias are mostly curable, he says, and most of the cells have uniform qualities and certain genetic abnormalities in common.  Cancers that are more difficult to cure are less uniform. Ladle suggests that targeting different populations of cells within cancers could result in fewer relapses and more cures.

The overall prize went to radiation oncology resident Andrew Sharabi for his idea entitled “Specific Immune Response against Testicular Cancer: A Proposed Mechanism for Long Term Remission.” Sharabi suggests that metastatic testicular cancer is largely curable in most patients because immune cells zero in on testicular cancer cells with far more accuracy than other cancers. He proposes that testicular cells are essentially recognized as foreign to the immune system because the testes are protected by the so-called blood-testis barrier, much like the blood-brain barrier. Testicular cancer cells can spread to the rest of the body and may initially go undetected by immune system cells. However, when patients receive chemotherapy, he believes that this causes testicular cancer cells to die, releasing many targets for the immune cells. At that time, the immune system kicks into high gear, generating large numbers of circulating immune cells, whose task is to seek the testicular cancer cells and destroy them. Sharabi believes that after chemotherapy, testicular cancer cells may be essentially recognized as foreign by the immune cells because the blood-testis barrier had, until then, kept testicular cells hidden from the immune system.

Sharabi proposes further investigations of how the immune system responds to testicular cancer cells to identify specific immune system targets common to testicular cancer as well as other types of cancer. The research could lead to development of vaccines that prime the body to defend against and fight cancers.

Just before Sharabi was announced the top winner, John Rangos Sr. called Hopkins a “beacon of light in the measurement of medicine.”  It is here, he said, that we’ll find the next generation of scientific leaders.

Congratulations to the Rangos award finalists and all those who value creativity and innovation.

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Evan Lipson

Evan Lipson, M.D.

Several years after Annie Applegarth battled sarcoma, she joined the Mermaids, a group of swimmers that raises money for cancer research. Before her diagnosis she had never spent much time in the water. Now her friends and family cheer as she finishes up a mile.

Click below to hear her story.

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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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