In today’s news, former President Jimmy Carter, who has metastatic melanoma, revealed that he has responded well to treatment. We asked melanoma expert Evan J. Lipson, M.D., for his thoughts:

“I was pleased to hear President Carter’s report that his most recent MRI brain scan did not reveal any signs of the original cancer spots nor any new ones. While we don’t know whether President Carter is completely free of melanoma, it’s encouraging to see a 91-year-old man tolerating his treatments well and continuing to work at his foundation.

“My understanding is that the president has been treated with surgery, radiation therapy and a drug called pembrolizumab (anti-PD-1). Pembrolizumab is a relatively new medication that activates the body’s immune system to fight melanoma. In some patients, when the immune system is activated using pembrolizumab or another similar medication, nivolumab, it can attack the cancer and bring about a remission that can last for months or sometimes years. These medications have also demonstrated efficacy in some tumor types other than melanoma.

“I hope that positive outcomes like this one will be encouraging for other patients battling cancer.”

More information about melanoma and immunotherapy is available from the Johns Hopkins Melanoma Program. Look for the next issue of Promise & Progress, which will feature immunotherapy

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“We are at a crossroads, a time of discovery that’s transforming the ways we manage lung cancer,” says radiation oncologist Russell K. Hales, M.D. of the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus. “Lung cancer is simply not the same disease we had 10 years ago, in terms of the tools that we have available to help patients. “

Hales notes that, “Here at Johns Hopkins, we have over 25 clinical trials that evaluate innovative therapies in patients with lung cancer.  These therapies, if found to be effective, will become future therapies that benefit patients around the world.  But beyond these 25 clinical trials, we have hundreds of pre-clinical projects underway, by basic scientists, clinicians, and others, that are discovering new pathways to improve future therapies.”

All of those new research projects and findings mean that “hope is on the rise that new therapies will be available and with innovation, we can continue to improve outcomes in patients with lung cancer,” Hales says.  If you are a patient, or would like more information on management or treatments of lung cancer, call 410-955-LUNG.  To find clinical trials in which you might participate, use our search engine for cancer clinical trials and read the frequently asked questions about cancer clinical trials at the Johns Hopkins Kimmel Cancer Center.

Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

 

 

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Chemotherapy is a systemic therapy, and “in the past, lung cancer treatment was really a one-size-fits-all care,” says Russell K. Hales, M.D.  “Thanks to advances in treatment, we’ve been able to transition to more personalized care.  We can assess the tumor for changes that can be targeted with customized therapy, also known as molecular profiling.  These subtle changes in individual patients can then be targeted, and these targeted therapies can sometimes be very effective.”

Hales, who is a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, shares an example of a mutation called EML for ALK, found in just one in 20 non-small-cell lung cancers, or 5 percent of patients.  The mutation leads to the tumor cell constantly making a protein that helps it to survive.  Knowing that this happens in 5% of patients, researchers several years ago developed a drug that uniquely targeted ALK, called Crizotinib and taken in pill form. The research, published in New England Journal of Medicine, showed a reduction in tumor size and other dramatic improvements in nearly every patient, he says.

“These target therapies are helping us to better identify unique therapies to personalize care for each patient,” Hales says. Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

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This blog post was written by intern Amanda Garrison, a student at Florida State University. In this series, we aim to help readers understand certain scientific concepts about cancer. The concepts are topics from the Johns Hopkins Kimmel Cancer Center’s annual lecture series Fundamentals of Cancer, Cause to Cure which is directed by oncologist Leisha Emens, M.D., Ph.D. and available to researchers and staff working in the cancer center.

Most people have heard of and have a basic understanding of genetics, but have you ever heard of epigenetics? If not, then you’re in the same spot I was a few days ago.

By definition, the term epigenetics refers to heritable changes in gene expression that do not involve changes to the underlying DNA sequence; a change in phenotype without a change in genotype. It’s a regular and natural occurrence but can be influenced by several factors, such as age, lifestyle, and disease state. Epigenetic modifications can display as commonly as the manner in which cells differentiate to end up as skin cells, liver cells, brain cells, etc. Or, epigenetic change can have more damaging edicts that can result in diseases, such as cancer.

So, how does this scientific process apply to cancer treatments, and what are scientists finding out about it? Here’s some of the latest research underway at the Johns Hopkins Kimmel Cancer Center.

Drs. Stephen Baylin, Cynthia Zahnow, and Drew Pardoll studied patients with advanced lung, breast, and colon cancers in which an immune system-related gene called PDL1 was activated. Laboratory studies indicated that its expression in lung cancer cells may be enhanced by therapies that target epigenetic processes. Dr. Pardoll believes that using a drug to block PD-L1 or a similar gene called PD-1 in unison with epigenetic therapy could change the balance of immune effects of the treatment.

Scientists have also found that cancer cells play a bit of hide-and-seek with the immune system. But new research is revealing how to find cancer’s hiding spots.

Cancer has an immune evasion signal and, in order to survive, cancer cells need to partially adapt to their environment. When treated with epigenetic drugs, the ability to evade the immune system is broken and cancer cells are tricked into sending out signals for the immune cells to identify and destroy them. But they also express PD-L1 proteins to shield against immune attack. After going back to the lab with this knowledge, Drs. Baylin, Zahnow, Nita Abuja, and John Wrangle found that many genes get reactivated, but about 20 percent of them are related to immune regulation, which is a much bigger component than they thought, according to Dr. Ahuja.

They found a small subset of the genes they identified constitute a viral defense pathway that are epigenetically programmed to avoid detection by the immune system. By using a drug to reverse this programming, essentially performing a form of “viral mimicry,” scientists may be able to force the cancer cells out of hiding and make them more vulnerable to treatment, or better yet, allow the immune system to kill the cancer altogether.

Read more about epigenetics.

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This blog post was written by intern Amanda Garrison, a student at Florida State University. In this series, we aim to help readers understand certain scientific concepts about cancer. The concepts are topics from the Johns Hopkins Kimmel Cancer Center’s annual lecture series Fundamentals of Cancer, Cause to Cure which is directed by oncologist Leisha Emens, M.D., Ph.D. and available to researchers and staff working in the cancer center.

Between 1991 and 2011, an estimate of the number of cancer deaths that were avoided has increased such that nearly 1.5 million Americans are living who might have died from these cancers. But why? Is it because of better treatment? Earlier diagnoses? In a lecture held by John Groopman on "Environmental Causes of Cancer" as a part of the Fundamentals of Cancer lecture series, he asked a group of students to answer this question. Although no student had the complete answer, he says that 15 to 20 years ago, students may have been more likely to answer it correctly, because younger generations of that era were more familiar with the main culprit: the use of tobacco products.

Groopman says that the reason U.S. residents avoided more cancer deaths in recent years is because of the decline of tobacco use. This is a real success, he says, because these statistics provide essential evidence that preventive actions can be taken against cancer. He says that 54.5 percent of all cancer is preventable. Tobacco use and obesity are some examples of factors that, if controlled, can be preventive actions against cancer.

Tobacco consumption was at its peak in 1963, and since then has drastically declined. Today, we have about the same rate of tobacco consumption as we did in 1935, but Groopman says, we still have a long way to go. Fortunately, with the developing successes in early detection and screening these numbers will only get better in the near future.

He says that people in countries with emerging economies often become addicted to tobacco. The country collects a tobacco tax — and then pays the health consequences for decades to follow, he says. He says the most effective means of curbing tobacco addiction is the taxation of tobacco products. If the price is too high, most people will stop smoking cigarettes. But some strategies still used today lure people to the addiction. He says an example of this is chocolate cigarettes for children which are still sold in the U.S. even in 2015.

In fact, Maryland had a large tobacco industry until about 2002. Until recent years, Maryland had the second-highest cancer mortality rate in 1985. Our state ranked number 4 in 1995, but plummeted to number 40 in 2015 due to a number of factors including hospital, city and state-led tobacco cessation, screening and education programs.

With the knowledge that tobacco addition has declined among younger generations in the U.S., this raises the question: what is going to be the next great battle for millennials in terms of environmental causes for cancer?

“Tobacco use may play a small part of the bigger emerging issue here: air pollution,” says Groopman. The most recent data, he says, shows that air pollution causes 7 million deaths per year in the world. This is a major public health challenge for many developing economies who can avoid this developing economic burden through the control of these pollutants.

The World Health Organization classified outdoor air pollution as a carcinogen, which is a substance capable of causing cancer in living tissues. Since the 1940s, scientists have suspected a correlation between air pollution and lung cancer, and Groopman says, there is much more work that needs to be done to understand this connection.

 

 

 

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Photo credit: Glenn Miller

Photo credit: Glenn Miller

*This blog post was written by the Kimmel Cancer Center's development specialist, Allison Rich.

On October 10, 2015, rock and roll legend Paul Rodgers, the driving force of Bad Company, Free and the Firm performed at the Modell Center for the Performing Arts at the Lyric in Baltimore, Maryland. Not your typical concert, this performance places Paul Rodgers within an assemblage of artists, including such infamous names as Santana, the Doobie Brothers, Derek Trucks and Journey, who have joined Paul Reed Smith Guitars in supporting cancer patients and their families as they strive to live well in the midst of this difficult disease.

Over the past 16 years, the annual PRS One Night, One Show, One Cause benefit concert has raised significant funds for the Living with Cancer Resource Program at the Johns Hopkins Kimmel Cancer Center, which offers supportive, no-cost programming and education to cancer patients and their families as they undertake the most arduous chapter of their lives. By partnering with this critically important program, artists like Paul Rodgers and Paul Reed Smith are bringing much-needed attention to the fact that cancer medicine isn’t solely about our quest for a cure – it is also about pursuing and delivering the best possible treatments while never losing sight of the person in each patient. It is about providing the most cutting-edge care to all of the facets of a patient’s life and the lives of their loved ones, addressing their inevitable concerns about topics like finances, nutrition, palliative care, and caretaker wellness while also doing all that we can to defeat their disease.

Photo credit: Glenn Miller

Photo credit: Glenn Miller

A cancer diagnosis affects every part of a person’s life. Thanks to the support of PRS Guitars and some of the top names in the music industry, we can provide our patients with the tools they need to not only manage the changes brought about by a cancer diagnosis, but to live well throughout the course of their journey.

Learn more about the Living with Cancer Resource Program

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DSC_0301On October 29, Marines from the 4th Combat Engineer Battalion, in Parkville, Maryland visited our pediatric oncology patients. The Marines handed out specially made military tags and presented inpatients and outpatients with "honorary super kid Marine" certificates. They also performed a customized military salute and flag presentation to our childhood cancer director, Donald Small, M.D., Ph.D. and our clinical director, Ken Cohen, M.D.

IMG_3639For one patient, the military tag was just what he needed to complete his Halloween costume, a pilot.

Thank you for not only serving our country, but taking time to visit our patients and making them feel extra special.

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In patients who, with early stage lung cancer, the normal treatment is a surgery, says Russell K. Hales, M.D. “But some patients can't tolerate that surgery, and for them, we use radiation to treat their cancer.”  Over the past five years, three major areas of radiation therapy for lung cancer patients have seen important innovations and advances, says Hales, a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus. They include:

  • Stereotactic body radiotherapy (SBRT), also known by such brand names as Cyber Knife or Cinergy.  SBRT is an outpatient treatment that delivers highly focused radiation to a small lung tumor in four to five treatments, using multiple beams from many directions to pinpoint the tumor and increase the likelihood that the tumor will be destroyed.  Hales notes that major studies have been done to investigate how effective SBRT, or radiosurgery, is in patients with early stage lung cancer, showing that 90% of patients had their tumor controlled as of four years after surgery.  Another large study, published in The Journal of the American Medical Association showed a 97% local control rate at three years.
  • Image-guided radiation therapy: “When a patient comes for treatment, a CT scan is done that is compared with a scan that is used to plan the radiation treatment,” Hales notes. “When the patient is positioned on the table, these scans are overlaid on top of one another, and fine adjustments are made to make sure that the patient is in their exact position.” He says that this fine image guidance allows better accuracy and fewer side effects in radiation treatment.
  • Motion management: Some lung cancer patients receive a 4DCT scan that shows how the tumor moves as the patient breathes.  The new technology allows radiation oncologists like Hales to track exactly where the tumor moves during breathing. As a result, physicians can treat an even smaller area, resulting in fewer side effects.

Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

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This week, the FDA approved a new therapy called talimogene laherparepvec, which goes by the trade name, Imlygic, for the treatment of certain types of melanoma. Suzanne Topalian, M.D., professor of surgery and oncology, and director of the melanoma program at the Johns Hopkins Kimmel Cancer Center offered the following insights on the drug's approval:

“This approval further expands treatment options for patients with a particular profile of metastatic melanoma. Imlygic (talimogene laherparepvec) may help control melanoma that has spread to other locations in the skin and lymph nodes, which can be directly injected with the oncolytic virus. However, it has not been shown to have a significant impact on melanoma that has spread internally.”

Note: Topalian’s husband, Dr. Drew Pardoll, also of Johns Hopkins, is a consultant for Amgen, manufacturer of Imlygic.

Read more about Kimmel Cancer Center research on melanoma.

 

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A new procedure called video assistant thorascopic surgery is changing how physicians find and treat lung cancer tumors in dramatic ways, says Russell K. Hales, M.D.

Hales, who is a radiation oncologist at the Johns Hopkins Kimmel Cancer Center on the Johns Hopkins Bayview campus, says that in the past, a type of surgery called open thoracotomy would be done, making a large incision to fully expose the chest and to help remove the tumor, leaving a large scar.

Today, video assistant thorascopic surgery or VATS offers a number of benefits, such as:

  • Smaller incisions and a shorter surgery overall;
  • Less chest wall trauma for patients;
  • Better tolerance of this surgery in elderly patients;
  • Patients are more likely to succeed in getting chemotherapy in its entirety after surgery;
  • Patients have shorter stays in the intensive care unit, and shorter overall stays in the hospital; and
  • Side effects of surgery are often reduced.

“We're now moving to new frontiers,” Hales says, noting the use of minimally invasive robotic surgery for lung cancer.  “This surgery can be done with a surgeon next to the patient.  His hands are on robotic controls, and the robot itself is doing the work, within the patient.  This allows even more precise therapy, and we're doing studies here at Hopkins to evaluate the role of robotic surgery in patients with lung cancer.”

Find out more from Dr. Hales about lung cancer, treatments for it, and innovative new research to help lung cancer patients in the free webinar, Lung Cancer: Serious Treatment for a Serious Cancer.

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