William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

Prostate cancer is extremely common in the U.S. “It’s the most common life-threatening cancer in men, responsible for 26,000 deaths per year,” says William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. But there are a lot of prostate cancers that are not life-threatening, he says. “In autopsies done for causes not related to cancer, we find small cancers in an unimaginably large fraction of men. By the time men reach 60-70 years old, two-thirds of them are harboring small cancers in their prostate; the lifetime risk of a prostate cancer diagnosis is about 1 in 8. Yet the lifetime risk of dying from prostate cancer is only about 1 in 37. What this means is many, many more men are going to die with prostate cancer than from it.”

Listen to the Cancer News Review podcast with Dr. Nelson.

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Southern magnolia

Southern magnolia

In your Facebook feed, in conversations with friends, in a magazine article—the talk about natural remedies for preventing and treating breast cancer seems to pop up everywhere. But which natural products are actually being tested in the lab and in clinical trials, and what’s the evidence for their effectiveness?

Saraswati Sukumar, Ph.D., Johns Hopkins oncology professor and founding director of the Kimmel Cancer Center’s Breast Cancer Program, has been studying natural compounds and their effects on cancer, and she says it’s too early to tell yet whether certain natural remedies can reduce the number of women who develop breast cancer, or whether any of them can help women with breast cancer live longer. But there are a few of these remedies that are being tested at Johns Hopkins and elsewhere, with promising results.

Curcumin: Curcumin is the active ingredient in turmeric, the yellow spice in curry powder, that has been used in the Indian Ayurvedic medicine tradition for centuries, according to Sukumar. “We have studied it extensively for many years in cells and in animals, and eventually it is ready to make the big jump into human clinical trials,” she says.

One of curcumin’s “most important effects is that it reduces inflammatory reactions,” says Sukumar. For breast cancer patients, this means that curcumin pills taken during and after radiation treatment could help heal burns and deep wounds, as studies conducted at the University of Rochester have shown. Sukumar and her colleagues are also testing curcumin in mice, to see if small doses of the compound can prevent cancers from growing, or possibly shrink the size of breast tumors that are already present. So far, these studies haven’t turned up any harmful side effects of curcumin; in fact in several mouse models of breast cancer, curcumin has helped reduce the number of tumors, and aided chemotherapy and hormone therapy to shrink the tumors. Sukumar cautions that it does act as a blood thinner, so it wouldn’t be a safe choice for patients who are already taking blood-thinning medications like heparin or Coumadin.

Honokiol: Another natural compound being studied by Johns Hopkins researchers is honokiol, a compound extracted from the seed cones and bark of the magnolia tree. Dipali Sharma, MS, Ph.D., an associate professor of oncology, is testing honokiol in mice to see whether it can slow the growth of breast cancers fueled by leptin, a hormone closely connected with obesity and cancer in humans.

Broccoli sprouts: Johns Hopkins cancer prevention expert Kala Visvanathan, M.D., is conducting clinical trials of a broccoli sprout compound called sulforaphane in women who have been treated for breast cancer and in women and men at high risk for the cancer. In animal studies, sulforaphane has been shown to “turn on” proteins that protect cells against breast cancer. Others scientists are studying similar compounds called isothiocyanates, found in things like horseradish and cruciferous vegetables like broccoli, cabbage and Brussels sprouts, to see if they can protect against breast cancer as well.

Red wine and soy: Natural compounds found in red wine and soybeans have been studied by breast cancer researchers for decades, with some positive results, Sukumar says. In particular, the red wine chemical resveratrol has been shown to suppress tumor growth in studies of breast cancer cells and cancers in animals. In soybeans and soy products, compounds called isoflavones also have been successful in animals to prevent breast cancer and slow tumor growth. Isoflavones are plant estrogens, so researchers are positive about its cancer preventive properties, but cautious about its use in women with cancer, since the breast cancers use estrogen to grow, Sukumar says.

One more thing to remember about natural remedies is that scientists are often testing the pure form of these compounds, rather than how they appear in our foods. However, adding a handful of broccoli sprouts to your salad regularly or mixing a teaspoonful of turmeric into your meal can help to reduce your risks of cancer, Sukumar says.

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William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“PSA, or prostate specific antigen, is an enzyme that normally appears in the ejaculate or central reproduction but when there’s a cancer present, it leaks into the circulation system so you can detect it in the bloodstream, where it becomes a marker of prostate cancer and other prostate diseases,” explains William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “Studies show that PSA starts to rise many years before prostate cancers are diagnosed, so finding an abnormal PSA that increases year after year might be a hint that prostate cancer is afoot.”

Listen to the Cancer News Review podcast with Dr. Nelson.

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Food PyramidIf the phrase “Meatless Monday” has you staring blankly into your fridge, take heart. There may already be a few “power foods” lurking in there that can help you get your week off to a healthy start, says nutritionist Lynda McIntytre.

Avocado, beans, berries, broccoli, eggs, leeks, nuts, oats, spinach and yogurt make the top ten power list for McIntyre, R.D., L.D., a clinical dietician specialist at the Johns Hopkins Kimmel Cancer Center, along with spices such as cinnamon, ginger and turmeric.

“Power foods are foods that naturally contain vitamins, minerals and other nutritional benefits,” McIntyre explains. “They can energize you, boost your immune system and help you ward off disease. And incorporating these foods into your diet is a simple way to maintain a healthy lifestyle.”

McIntyre works with cancer patients before and after their diagnoses, and she recommends these power foods to them to help prevent cancer recurrence. But a diet full of these power foods contains the kinds of antioxidant and anti-inflammatory components that nutritionists also recommend to prevent other illnesses including diabetes, stroke, and heart disease, she says. Antioxidants in foods like blueberries, for instance, help to subdue damaging molecules in the body called free radicals that can make cells more vulnerable to cancer or heart disease.

And if you’re thinking a multivitamin might provide all these benefits without a trip to the produce section, think again, says McIntyre. “Eating the whole food insures that you are getting all the vitamins, minerals, fiber and nutrients important to health. It’s the synergy of all the nutrients in whole foods that work together to improve health.”

McIntyre’s power list has a few items that might surprise you, like eggs. “In the not-so-recent past, eggs were thought to increase cholesterol, but recent studies have proven this wrong,” she says. “Eggs are a power food that is versatile, inexpensive and a perfect source of protein for a Meatless Monday.”

“More people should include avocado in their diets regularly,” she adds. “Many people don’t include this food because they believe they are high in fat and therefore not healthy. But the fat in avocado is a very healthy form of fat, and eating this food with other power foods--like carrots dipped in guacamole, for example—helps increase the absorption of nutrients in those power foods.”

The Meatless Monday idea has been around for a little more than a decade, exploding in popularity and how observed by many in over 36 countries, McIntyre says.

“Meatless Monday is brilliant in its simplicity. It doesn’t ask a lot from you and the benefits to your health, the environment, and your wallet are significant,” McIntyre says. “The idea is simple: don’t eat meat on Mondays. That’s it. It is a small change in the way you eat, just one day a week, that brings about big benefits.”

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William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“If you look at the overall incidence of cancer in the U.S., 80% of all cancers are diagnosed in people older than 60, and 30% of cancers are diagnosed in people older than 80, so in general, more cancers appear in people as they get older,” explains William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “Screening men in their 50s for colorectal and prostate cancers makes sense because that’s when these diseases generally start to appear. There are certain populations of men who are more prone to develop these cancers. Many believe African-American men might be better starting screening at age 45 because their risk of dying of prostate cancer is about 1.7 times the risk of Caucasians. Men with a strong family history of prostate cancer also should consider PSA screening before age 50.”

Listen to the Cancer News Review podcast with Dr. Nelson.

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When doctors told Stefanie Joho that they had no options left, her sister scoured the internet to find "something" that could offer hope. She found a clinical trial at Johns Hopkins that looked promising, and little did Stefanie know that it would transform her life and become FDA approved. Listen to Stefanie tell her story:

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Breaking news today as, for the first time, a drug has been FDA-approved for cancer based on disease genetics rather than type. Developed from 30 years of basic research at Johns Hopkins and its Bloomberg~Kimmel Institute, pembroluzimab now can be used for colon, pancreatic, stomach, ovarian and other cancers if genetic testing reveals defects in so-called mismatch repair genes. Read more about the new approval.

Dung Le

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Patients and doctors received news this week of the FDA’s approval of the immunotherapy drug pembrolizumab in combination with platinum doublet chemotherapy as first-line therapy for all patients with non-small cell lung cancer, irrespective of patients’ tumor PD-L1 status.

Benjamin Levy, M.D.

Benjamin Levy, M.D.

The new approval follows the FDA’s decision last November to approve pembrolizumab as a first-line therapy for some patients with non-small lung cancer, but only if their tumors showed expression of a protein called PD-L1. The previous approval was based on an international trial led by the Kimmel Cancer Center’s Julie Brahmer, M.D.

This week’s approval was based on a small clinical trial of 160 patients, led by Corey Langer, M.D., director of thoracic oncology and professor of medicine at the University of Pennsylvania. The trial showed that the chemo-pembrolizumab combination can improve the response rates (meaning some evidence of tumor shrinkage) in more than 50 percent of patients with lung cancer compared with nearly 30 percent who received chemotherapy alone. There was a small average benefit of four months — referred to as a progression-free survival benefit — for patients who received the combination compared with those who received only chemotherapy.

However, there was no overall survival benefit of the drug combination. “Immunotherapy, at this point, doesn’t benefit all patients, and we need to be mindful of the drug’s costs and potential side effects,” says Benjamin Levy, M.D., clinical director of medical oncology and medical director of thoracic oncology for the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital in northwest Washington, D.C. “This new drug approval provides a broader opportunity to consider the role of immunotherapy in the treatment of all of our patients with advanced non-small cell lung cancer.”

Watch a video of Levy: A Mission to Lead.

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On a weekend before a business trip, Ken Brothers noticed some blood in his urine. He wondered if it was related his recent loss of 40 pounds on a medically-supervised diet and emailed his doctor about it. Blood in the urine is a common symptom of bladder cancer, but its presence is not always associated with cancer. Infections, kidney stones and other conditions can cause bloody urine.

Ken Brothers (right) with his son at Machu Picchu in Peru.

Ken Brothers (right) with his son at Machu Picchu in Peru.

Ken’s doctor said that it was highly unlikely that his diet caused blood in the urine and suggested he see a urologist ASAP. Within a week, his local urologist diagnosed him with bladder cancer. Ken requested the tissue samples be reviewed by Hopkins’ pathologists, who identified it as muscle invasive micropapillary, one of the most aggressive types of bladder cancer.

As the fifth most common cancer in the U.S., bladder cancer affects mostly men older than 75, but Ken was only 49 when he was diagnosed. Bladder cancer in its earliest stages are highly curable, but even the smallest tumors tend to recur often, requiring invasive exams of the bladder every six months. Ken’s cancer had progressed to invade the muscle wall of the bladder. Doctors at four different institutions unanimously advised Ken to have chemotherapy, then surgery to remove the compromised bladder. Despite the chemotherapy, Ken’s cancer spread beyond his bladder. When his bladder was removed, metastatic cancer was found in 12 lymph nodes.

When bladder cancer metastasizes, survival rates plummet. For decades, doctors have struggled to find highly effective treatments for these “Stage IV” patients. Ken had a second type of chemotherapy, but the cancer continued to spread. In early 2015, Ken joined a Hopkins-led clinical trial for an immunotherapy drug. Ken had a complete response, and today has no evidence of disease.

The recent development and approvals of immunotherapy drugs have encouraged patients and doctors alike. “We believe that, in the near term, we’ll make major progress in being able to better manage bladder cancer,” says David McConkey, Ph.D., director of the Johns Hopkins Greenberg Bladder Cancer Institute.

The goal, McConkey says, is to quickly implement projects that integrate science with medicine. For example, the Greenberg Institute plans to sequence the genome of every bladder cancer patient who comes to Johns Hopkins. In a research environment, the costs for genome sequencing are low – approximately $300 per patient – and the costs are covered by the Institute.

Genomic sequencing in bladder cancer can help guide therapies now that recent research has identified genomic features that predict which patients may benefit the most from chemotherapy, immunotherapy and other targeted agents. For example, McConkey says that one subtype of bladder cancer already identified may benefit more from frontline chemotherapy given to patients before surgery to remove the bladder.

Collaborations between the Greenberg Institute and other cancer centers are underway to identify other genetic cues to guiding therapy, including mutations in genes that repair DNA and using blood tests to find bladder cancer-linked DNA that might indicate worsening cancer or whether immunotherapy or other drugs are working.

McConkey reviewed these advances and other bladder cancer research during a plenary session at the Genitourinary Cancers Symposium sponsored by the American Society of Clinical Oncology, Society of Urologic Oncology and the American Society for Radiation Oncology.

“We’ve had plenty of successes, but they’re not nearly enough to reduce the extensive monitoring and recurrences that most patients with early disease experience and create long-term regressions in most bladder cancer patients with advanced disease,” says McConkey.

Five years after his diagnosis of advanced bladder cancer, Ken credits his longevity to good advice from his doctors, immunotherapy drugs, his own self-advocacy, and good luck. He continues to write Ken’s Cancer Blog, aimed at inspiring and educating other cancer patients and their caregivers. In our next bladder cancer blog, we’ll hear from Ken with questions and answers about his experiences and advice.

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William Nelson, M.D., Ph.D.

William Nelson, M.D., Ph.D.

“There are an increasing collection of tests that sample other aspects of prostate cancer in urine, blood or tissue, including acquired gene defects in the disease and acquired changes that cancers display that normal cells don’t,” says William G. Nelson, M.D., Ph.D., director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “I would argue that the collection of tests have just started. Some have just begun to get approval from the U.S. Food and Drug Administration, but none of them have yet been approved for screening purposes. In addition, there are modified PSA assays that increase the predictive value of PSA to diagnose higher-risk disease. The good news is that these screening processes are improving and will improve more as some of these new molecular tests become widely available.”

Watch an AACR Webinar about cancer screening.

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