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“Change is the only constant in life.” – Heraclitus, Greek philosopher

While the universal flux theory is 2,700 years old, in oncology, it is as applicable today as it was when the “weeping philosopher” first uttered his paradoxical doctrine.

Oncology has experienced more constant change in the last 30 years than from the late 20th century to the time cancer was first identified in 440 B.C. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

The rapid pace of innovation in oncology has been fueled by an immense knowledge explosion about cancers, how they grow and how to treat them in different subpopulations. In fact, from May 2018 to May 2019, the U.S. Food and Drug Administration (FDA) approved almost 60 new oncology drugs.

And while the advances we see in oncology today—targeted therapies, precise diagnostics and a better patient experience—are powering a consistent drop in cancer death rates, they also require oncologists to know more than any one person possibly can.

How, then, should medical oncologists and their practices stay up to speed on advancements to ensure patient receives the right treatment at the right time?

  • Harness technology: Oncologists and their practices cannot get overwhelmed by the promise of artificial intelligence or any other aspect of technology and instead should focus on two vital deliverables: 1) an agile platform that turns data clinical, operational and financial data inputs into actionable insights; and 2) a platform for real-time peer-to-peer communication offering a virtual second opinion. Technology must work to improve physician workflow and efficiency. By engaging physicians and focusing on meeting their needs, technology and the analytical insights it reveals should help oncologists, not exacerbate physician burnout.
     
  • Stay flexible locally: Former House Speaker Tip O’Neill’s adage about all politics being local applies to healthcare, too. Every market in the U.S. is different, and it requires practices looking to thrive to have the flexibility to form partnerships that make sense locally. One-size-fits-all does not work for oncology practices or their patients today. Rather, practices need flexibility to form relationship with hospitals or other provider networks that make sense for their patient populations.
     
  • Having scale to negotiate: While flexibility is important locally, practices cannot survive without the scale to negotiate on drug purchasing, payer contracts or employer relationships. Practices don’t have to sacrifice independence for scale, but they cannot go it alone and expect to be able to offer their patients services along the continuum of care from clinical trials to palliative treatments. Practices must figure out partnerships that work so care options, most notably access to clinical trials, are expanded for patients. 
     
  • Embrace value: Fee-for-service care will soon be akin to skiing in jeans—a relic of the 20th century. Medicare’s voluntary—and risk free—value-based payment model in oncology will soon give way to a two-sided risk model. And while entering into two-sided risk now might not be right for every practice immediately, ignoring the tectonic shift in payment comes with peril. Practices need to understand value-based models through implementing them so their patients can benefit from better care coordination, drug utilization and communication between the care team and their patients outside the clinic. 

The practice of oncology has changed immensely since I’ve been treating patients.

My overarching advice to practices trying to negotiate the constant change that oncology offers is to not be complacent, because your patients are receiving the best care possible today. Understand where oncology is headed and how today’s trends will impact your ability to deliver care tomorrow. Do what makes the most sense for your patients and colleagues by always anticipating change rather than reacting to it.   

Jeff Patton is acting CEO and president of physician services at OneOncology. He is also a member of FierceHealthcare’s Editorial Advisory Council.

Welcome to this week’s Chutes & Ladders, our roundup of hirings, firings and retirings throughout the industry. Please submit the good news—or the bad—from your shop, and we will feature it here at the end of each week.


Cigna

Dave Queller
(Cigna)

Dave Queller was named president of Express Scripts, the pharmacy benefit management company acquired by health insurance giant Cigna in 2018. Queller will oversee PBM services alongside oversight of supply chain and drug procurement, officials said.

Queller has overseen the company’s sales and account management organization since 2014.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Brian Seiz
(Cigna)

Cigna also named Brian Seiz president of pharmacy, where he will oversee pharmacy operations including Express Scripts’ home delivery options and its Accredo specialty pharmacy business. Seiz has worked at Express Scripts for 15 years and became president of Accredo in 2017. 

Both will work within the insurer’s health services segment, according to the announcement. 

“Dave and Brian have both played an integral role in positioning health services as the partner of choice for health plans,” Tim Wentworth, president of health services and former president and CEO of Express Scripts, said in a statement. “In their new roles, they will work together with our talented Health Services leadership team as we deliver more affordability, predictability and simplicity to those we serve,” he said. 


Northwest Georgia Oncology Centers

Madhurima Uppalapati
(NGOC)

Madhurima Uppalapati, M.D., was named president and medical director of Northwest Georgia Oncology Centers in Atlanta.

As president, Uppalapati will oversee the strategic direction for the centers and internal operations of the facilities.

Uppalapati is a board-certified oncologist with 15 years of experience in oncology and hematology. Previously, she served as medical director for the organization during 2019 and was instrumental in the development and implementation of a professional services agreement with WellStar Healthcare System, officials said. 

Uppalapati completed her fellowship training at Georgetown University Hospital and has also received an Executive MBA from Terry College of Business at the University of Georgia.


Dan Peterson
(Sutter Health)

Sutter Health

Dan Peterson was named CEO of Sutter Santa Rosa Regional Hospital. 

Peterson has been chief administrative officer for Sutter Lakeside Hospital since 2017. In his new role, Peterson will manage administrative and healthcare activities for the hospital and provide overall leadership for physicians and staff, officials said. He will also lead facility growth efforts, including a $173 million hospital expansion and renovation.

Peterson was formerly director for ambulatory services at UCLA Health System in Los Angeles as well as CEO and administrator at the Surgery Center of Santa Rosa for five years.

Researchers at the University of California, Riverside, have completed a cross-sectional human study that compares biomarkers and metal concentrations in the urine of e-cigarette users, nonsmokers, and cigarette smokers.

They found that the biomarkers, which reflect exposure, effect, and potential harm, are both elevated in e-cigarette users compared to the other groups and linked to metal exposure and oxidative DNA damage.

Our study found e-cigarette users are exposed to increased concentrations of potentially harmful levels of metals — especially zinc — that are correlated to elevated oxidative DNA damage.”

Prue Talbot, professor of cell biology, University of California, Riverside

Zinc, a dietary nutrient, plays key roles in growth, immune function, and wound healing. Too little of this essential trace element can cause death; too much of it can cause disease. Its deficiency, as well as its excess, cause cellular oxidative stress, which, if unchecked, can lead to diseases such as atherosclerosis, coronary heart disease, pulmonary fibrosis, acute lymphoblastic leukemia, and lung cancer.

Electronic cigarettes consist of a battery, atomizing unit, and refill fluid. Metals in e-cigarette aerosols come mainly from the metal components in the atomizer– nichrome wire, tin solder joints, brass clamps, insulating sheaths, and wicks — as well as the e-fluids that the atomizers heat.

The study, which appears in BMJ Open Respiratory Research, marks the first time researchers have examined and quantified urinary biomarkers of effect and potential harm in relation to metals in e-cigarette users.

A biomarker is a quantifiable characteristic of a biological process. Biomarkers allow researchers and physicians to measure a biological or chemical substance that is indicative of a person’s physiological state. Previous e-cigarette studies with humans have examined biomarkers of exposure — for example, nicotine or nicotine metabolites — but none have studied biomarkers of potential harm or shown how this harm correlates with metal exposure.

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The biomarkers studied by the UC Riverside researchers were 8-hydroxydeoxyguanosine (8-OHdG), a biomarker of oxidative DNA damage; 8-isoprostane, an indicator of the oxidative degradation of lipids; and metallothionein, a metal response protein. All three biomarkers were significantly elevated in e-cigarette users compared to the concentrations in cigarette smokers.

“Our findings reaffirm that e-cigarette use is not harm free,” said Shane Sakamaki-Ching, a graduate student in the Cell, Molecular and Developmental Biology Graduate Program and the research paper’s first author. “Indeed, prolonged use may lead to disease progression.”

The researchers advise physicians to exercise caution when recommending e-cigarettes to their patients. Electronic cigarette aerosols contain potentially harmful chemicals, cytotoxic flavor chemicals, metals, ultrafine particles, and reaction products. E-cigarette use has been linked to adverse health effects such as respiratory diseases, increased risk for cardiovascular disease, and impaired wound healing following surgery.

“Pregnant women, especially, should not be encouraged to use e-cigarettes,” Talbot said. “Excess of zinc in their bodies can lead to nausea and diarrhea. Given the recent deaths and pulmonary illnesses related to e-cigarette usage, everyone should be made aware of the potential health risks linked to e-cigarette usage.”

Source:

University of California – Riverside

Journal reference:

Sakamaki-Ching, S., et al. (2020) Correlation between biomarkers of exposure, effect and potential harm in the urine of electronic cigarette users. BMJ Open Respiratory Research. doi.org/10.1136/bmjresp-2019-000452.

The 7th annual Metastatic Breast Cancer Research Conference will be hosted by Huntsman Cancer Institute (HCI) at the University of Utah (U of U) in partnership with Baylor College of Medicine and Theresa's Research Foundation on September 10 and 11, 2020. Participants from around the world are invited to discuss metastatic breast cancer including ongoing research and new ideas from early career scientists.

Conference attendees include clinicians, researchers, advocates, and patients who hope to share information and shed light on the need for improved research focus and funding toward metastatic breast cancer, also known as stage IV breast cancer.

The 2020 conference will be held in Salt Lake City under the leadership of Alana Welm, PhD, breast cancer researcher at HCI and professor of oncological sciences at the U of U. "This is one of the most important conferences every year for those of us who focus on metastatic breast cancer research," says Welm. "The unique medley between state-of-the-art clinical and laboratory research, along with incorporation of important patient perspectives, makes it a stimulating and motivating experience for all of us."

The conference will feature sessions on metastatic breast cancer therapy, predictive models, drug development, and more. Invited speakers from around the world will bring their knowledge and expertise to the conference and seek to inspire conversation and collaboration to new approaches to address this challenging disease. Daily keynote address will focus on systemic regulation of metastasis and immunotherapy.

A cure for metastatic breast cancer requires a dedicated, long-term effort to find curative approaches. This conference helps to benchmark these efforts and create the collaborative research environment that is essential for success."  

Matthew Ellis, MB, BCHIR, BSC., PHD, FRCP , professor and director of the Lester and Sue Smith Breast Center at Baylor College of Medicine and Conference Co-Chair

Abstract submissions are encouraged. Limited travel stipends are available for early career investigators who have an abstract accepted. The poster session will be held in partnership with the Metastasis Research Society and GRASP (Guiding Researchers and Advocates to Scientific Partnerships), so that scientists and advocates can view and discuss posters together.

The Metastatic Breast Cancer Research Conference was established as a medical conference in 2014 by Theresa's Research Foundation. Past host institutions include Baylor College of Medicine, Johns Hopkins School of Medicine, the University of Kansas Medical Center, and the Mayo Clinic. The conference received philanthropic support from The Breast Cancer Research Foundation and Huntsman Cancer Foundation.

Source:

Huntsman Cancer Institute

Research from Rutgers Cancer Institute of New Jersey shows administering the immunotherapy drug pembrolizumab together with chemotherapy given at the same time as radiation treatment (chemoradiation) is safe and tolerable as a first-line therapy for patients with stage 3 non-small cell lung cancer (NSCLC). The work, stemming from a multi-center phase 1 clinical trial led by Rutgers Cancer Institute, is published in the February 20 online edition of JAMA Oncology.

“Locally advanced NSCLC accounts for 20 to 25 percent of all new diagnoses of NSCLC, with five-year overall survival rates of between 25 to 30 percent when standard therapy is given. Current standard treatment in which an immunotherapy drug is administered after chemoradiaton offers a 57 percent progression-free survival rate compared to 43.5 percent when chemoradiation is given alone. Our team wanted to examine the safety and tolerability of the immunotherapy drug pembrolizumab when administered concurrently with chemoradiation, as we’ve learned from first-line treatment of stage 4 disease that we see better patient outcomes the earlier immunotherapy is given,” shares Rutgers Cancer Institute radiation oncologist Salma Jabbour, MD, who is the lead and corresponding author of the current work.

Typically, the human body’s immune system recognizes abnormal cells in the body and destroys them. Cancer cells frequently create proteins (PD-L1, programmed cell death ligand-1) on the cell surface that act as signals to turn off this part of the immune system. Pembrolizumab is a drug approved by the Food and Drug Administration to treat melanoma and other forms of cancer that targets PD-1 receptors, which act as a signaling ‘switch.’ Pembrolizumab blocks this action and turns the ‘switch’ back on, allowing the immune system to recognize cancer cells as foreign and attack them.

For a 27 month period between 2016 and 2018, 23 participants were enrolled (52 percent were women; median age 69 years). Five cohorts evaluating different timing and dosing of pembrolizumab combined with chemotherapy (carboplatin and paclitaxel weekly) and definitive radiation therapy (60 Gy in 2 Gy/day x 30 fractions) for unresectable, locally advanced, stage 3 disease were examined. Median follow-up time was 16 months.

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Results show the combined treatment is feasible and well tolerated with a 12-month progression-free survival of 69.7 percent. Clinical benefit accounted for 94.6 percent at a median of 12.6 months. Of 19 evaluable patients (those who received 2 or more cycles of pembrolizumab) for response, the best response to therapy was a partial response seen in 73.7 percent, followed by 15.8 percent with a complete response, and 5.3 percent with stable disease. Local progression occurred in one patient, and of the six who developed metastatic disease, the median time to metastatic disease was 14.7 months. While there was an increased rate of pneumonitis, the authors note that patients with this form of lung inflammation responded to high-dose steroid treatment.

This study demonstrates that the combination of immunotherapy with chemoradiation has the potential to improve cure rates for patients with stage 3 non-small cell lung cancer.”

Dr. Salma Jabbour, professor of radiation oncology at Rutgers Robert Wood Johnson Medical School

Given the risk of pneumonitis when pembrolizumab is given with chemoradiation, the authors note further evaluation of the treatment combination through clinical trials is warranted, where careful radiation design to limit key lung parameters and biomarkers can be implemented. They add study limitations include the small sample size and limited follow-up duration.

Source:

Rutgers Cancer Institute of New Jersey

Journal reference:

Jabbour, S.K, et al. (2020) Phase 1 Trial of Pembrolizumab Administered Concurrently With Chemoradiotherapy for Locally Advanced Non–Small Cell Lung Cancer. JAMA Oncology. doi.org/10.1001/jamaoncol.2019.6731.

When you're facing a cancer diagnosis with an average survival span of 12 to 18 months, every milestone is a victory. That makes each wedding invitation, graduation announcement and birthday photo that UCI neuro-oncologist Dr. Daniela Bota receives from her patients a cherished validation of her 12 years of groundbreaking research on glioblastoma multiforme, the most aggressive form of brain cancer. "Because of our work, these people have been able to move on with their lives," she says.

Bota has pushed the boundaries of innovation in her quest to increase the survival rates of individuals with brain tumors, especially glioblastomas. The esteemed physician-scientist has taken a truly comprehensive approach to battling this rare disease, which has a five year survival rate of only 10 percent and claimed the lives of U.S. Sens. Ted Kennedy and John McCain. Bota has conducted clinical trials of multiple cutting-edge treatments that are improving the quantity as well as the quality of life for glioblastoma patients at UCI and beyond.

'So much potential, so much growth'

Bota grew up in Romania, in a family of engineers. It was assumed she'd follow them into the profession – she was a national mathematics champion in her youth – but Bota had another path in mind. "I wanted to make a more significant contribution," she says. "I wanted to combine my analytical side with a place where I could help others. I ended up becoming an M.D.-Ph.D. to blend both."

At USC, Bota earned a doctorate in molecular biology, focusing on neural degeneration. She then went to the University of Kansas for medical school and a residency in neurology. During her shifts, Bota found herself caring for people with brain tumors – and discovered a new direction for her medical career.

The generosity and gratitude of brain tumor patients make it so rewarding to care for them. I see it again and again at UCI. Many of these patients have a terminal diagnosis, but they're volunteering their time and energy to participate in our clinical trials to help us build a better treatment and, hopefully, in the future, a cure."

Dr. Daniela Bota, UCI neuro-oncologist

After a neuro-oncology fellowship at Duke University, Bota joined the faculty of UCI's School of Medicine and the Chao Family Comprehensive Cancer Center in November 2007. "Both my career and UCI in general have grown so tremendously over the dozen years since," says Bota, who's now co-director of the UCI Health Comprehensive Brain Tumor Program. "There has been so much potential, so much growth, so many changes and so much scientific revolution helping us move forward in so many different directions. It's a very exciting time."

A comprehensive approach

The word "comprehensive" carries significant weight in the realm of cancer care centers. The "comprehensive" designation from the National Cancer Institute recognizes an added depth and breadth of research that bridges multiple scientific areas. Just 51 cancer centers in the U.S. carry the designation; the Chao Family Comprehensive Cancer Center is the only one in Orange County. "We offer one of the most innovative and complex portfolios of clinical trials anywhere in the world," Bota says.

Her own multipronged attack against glioblastoma multiforme reflects the center's comprehensive approach. Bota's work on the experimental drug marizomib has generated significant attention and hope. Unlike traditional chemotherapy drugs, marizomib can penetrate the blood-brain barrier – the filtering mechanism that prevents many blood-borne substances from passing into brain tissues – and inhibit cancer growth without causing damage to other parts of the brain.

Over the past 12 years, Bota has shepherded marizomib from preclinical development all the way through a 700-person international phase III clinical trial now underway. "We have a number of patients from our clinical trials who are surviving this tumor for longer periods of time than usually expected," she says.

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Amanda Johnson, a 32-year-old freelance writer in Mission Viejo, has been receiving marizomib for two years under Bota's care. Her large glioblastoma tumor – which straddled both sides of her brain – has shrunk so much that it's no longer measurable. She has returned to work on her novel and even joined a gym. "I feel so happy just to be alive," Johnson says.

Larry Johnson, her father, told Fox News, "I don't think [Amanda] has come to realize how important her survival is to other people and families who are going to find themselves in a similar situation."

Bota strives to reach a point where such cases will be so commonplace that they don't make the news. "That's what success looks like – not having a prominent publication or being part of a game-changing discovery," she says. "It's having patients like Amanda still be here and doing well."

Vaccine trials and right to try

To achieve that goal, Bota tenaciously pursues multiple avenues of treatment. She has been a leader in the use of Optune, a device worn on the head that generates an electrical field that disrupts the growth of cancer cells. "We were among the first in the country to explore and use this technology," Bota says. "Now we're working with physicians from other countries to help them adopt it in their practices."

She is also spearheading two clinical trials on cancer vaccines. "Brain tumors hide behind the blood-brain barrier, so the body doesn't recognize them as not being a normal part of the body," Bota explains. "With our vaccines, we extract cellular markers from the patient's tumor and inject them back into the patient to stimulate the immune system to recognize those tumors, attack them and, if possible, eliminate them."

She adds: "Both studies have been well-received in our neuro-oncological community, which is highly promising. And a significant benefit is that the vaccines function with minimal or no toxicity."

In January 2019, one of Bota's patients who was ineligible for both clinical trials was able to access one of the vaccines through the first successful application of the national Right to Try Act. Passed in May 2018, it allows people with terminal illnesses, in consultation with their doctors, to seek treatment with experimental drugs not yet approved by the Food and Drug Administration directly from pharmaceutical companies. "The law puts patients in charge of their care; they initiate contact with the manufacturer and request therapy," Bota says. "It gives patients who don't qualify for clinical trials another option."

"We offer one of the most innovative and complex portfolios of clinical trials anywhere in the world."

Sharing her expertise

Bota eagerly offers her knowledge beyond the doors of the Chao Family Comprehensive Cancer Center. Whenever she and her husband, Robert, a local psychiatrist, travel back to their home country of Romania, she consults with medical colleagues there, as there are no certified neuro-oncologists in the nation. On days when the couple work on their farm in the Transylvanian Alps, locals come to them – often on foot – for medical advice. The two hope to eventually establish a clinic in the area. "I want to make sure that Romania also benefits from my medical expertise," Bota says.

Back on campus, in her capacity as senior associate dean for clinical research, she uses her vast clinical trial experience to help colleagues in UCI's School of Medicine advance their own research projects into the clinical arena.

"I'm excited by the ability to impact the lives of so many people through this role," Bota says. "Whether it's for burns or vascular disorders or other conditions, people come to UCI for the same reason: We can offer what community hospitals cannot. Being able to make that happen, to create new options for our patients, is what wakes me up in the morning."

Source:

University of California, Irvine

Earlier this year, doctors and researchers celebrated the news that the five-year survival rate for pancreatic cancer had crossed into double digits for the first time -; up from just 6% in 2011.

And while researchers at the University of Michigan Rogel Cancer Center and elsewhere continue to pursue scientific insights into the disease and develop new therapeutic approaches, surgeons on the front line of patient care are also working hard to improve outcomes.

Hari Nathan, M.D., Ph.D., an assistant professor of surgery at Michigan Medicine, sat down with the Michigan Health blog to talk about recent advances in surgical care for patients with pancreatic cancer, and some things patients should look for when evaluating where to seek treatment.

Growing evidence that starting chemo before surgery could improve survival

The best approach for treating pancreatic cancer remains physically removing the cancer through surgery, also called resection, in combination with chemotherapy and sometimes radiation therapy, Nathan says.

"It's been known for decades that adding chemotherapy to resection for pancreas cancer improves survival," he says. "It's a very difficult disease to begin with, and the survival rates are still unacceptably low compared to the progress we have made in a variety of other cancers. But rates are improving -; and part of the reason they're improving is the development of more effective chemotherapy regimens over time."

Recently, surgeons at Michigan Medicine have adopted an emerging practice of administering some or all of a patient's chemotherapy before they undergo an operation.

One recent study, for example, found that patients who underwent chemo before surgery -; known as neoadjuvant chemotherapy -; had a two-year survival rate of 63.7% compared to 53.5% in those who received surgery first.

That difference is driven by multiple reasons. Even in the best hands, these operations are challenging and can be fraught with complications. And we know that when we give chemotherapy after an operation, roughly half of patients aren't healthy enough to complete the intended course."

Hari Nathan, M.D., Ph.D., assistant professor of surgery at Michigan Medicine

Giving chemotherapy on the front end -; before a major operation takes a toll on a patient's body -; increases the likelihood they'll complete more of their chemotherapy, which, in turn, is correlated with better outcomes, he notes.

For some patients, earlier administration of chemotherapy could spare them from going through an operation if there are signs it won't be effective.

"A small percentage of patients will develop additional disease during chemotherapy, or have progression of the tumor," Nathan says. "That's a warning sign that their disease is more aggressive and putting them through a major operation may not be helpful to them."

Helping more patients become candidates for surgery

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In addition to improving the number of patients who complete their course of chemo, the neoadjuvant approach is also expanding the number of patients who are candidates for surgery, Nathan says.

"What we often find with these newer chemotherapy regimens is that they actually can kill parts of the tumor that will make an operation more viable," he says.

In the past, a patient may have been told that their tumor wasn't resectable because it was wrapped around a vital artery.

"But if we can kill off the part of the tumor that was a barrier to a successful surgery, then it makes it possible to go in and do the operation," Nathan says.

"In a lot of ways, what we're doing in pancreatic cancer now mimics what we've been doing in other cancers for a while," he adds. "The difference is that in colorectal cancer, for example, we've had more effective chemotherapy agents, and so we've been willing to be more surgically aggressive. And now with pancreatic cancer, we're finally getting to that point where we have these more effective chemotherapy regimens."

Where patients get care can make a big difference

There are a number of reasons why receiving care at a nationally ranked hospital or academic medical center, like Michigan Medicine, can also make a big difference for patients, Nathan says.

The first is access to new, otherwise unavailable experimental treatments through clinical trials.

For example, Nathan says, U-M is a site for a trial enrolling patients who are not initially eligible for surgery because their pancreatic cancer involves major blood vessels or other tissue in the abdomen. The trial is to test an investigational medicine that helps chemotherapy to better attack the tumor, with a goal, ultimately, of making the patients candidates for surgery.

Second, larger, high-volume, multidisciplinary centers will have more experience in specifically treating pancreatic cancer (Michigan Medicine was recently designated a National Pancreas Foundation Center of Excellence for Pancreatic Cancer, one of just two in the state.)

"I would argue that medical centers like U-M, by virtue of the breadth and depth of the system as a whole, can provide the highest quality care," Nathan says. "In addition to the quality of our surgeons, our medical oncologists, radiation oncologists, radiologists, geneticists and nutritionists all have expertise in pancreatic cancer. Everybody in our multidisciplinary pancreatic clinic has a large focus of their practice devoted to taking care of patients with pancreas cancer. That's not the case everywhere."

Source:

Michigan Medicine – University of Michigan

The Cancer Prevention and Research Institute of Texas (CPRIT) has awarded new grants totaling $1.8 million to two University of Texas at Dallas scientists for their research related to lung and kidney cancers.

The Individual Investigator Awards are among 55 new grants totaling more than $78 million that the institute announced Feb. 19. To date, CPRIT has awarded $2.49 billion in grants to Texas research institutions and organizations through its academic research, prevention and product development research programs.

With the latest grants to the researchers in the School of Natural Sciences and Mathematics, UT Dallas has received nearly $18.5 million from CPRIT to support cancer studies.

CPRIT continues to be an important source of funding for efforts aimed at the prevention and treatment of cancer. The institute's ongoing support of basic research allows UT Dallas scientists to make important contributions toward the fundamental understanding of disease and the improvement of outcomes for cancer patients."

Dr. Joseph Pancrazio, vice president for research and professor of bioengineering at UT Dallas

Dr. Li Zhang, professor of biological sciences and the Cecil H. and Ida Green Distinguished Chair in Systems Biology Science, received $900,000 for lung cancer research. In previous studies, Zhang and her colleagues discovered that cells of the most common type of lung cancer — non-small cell lung cancer — consume substantially more oxygen than normal cells. The lung cancer cells also outpace their normal counterparts in synthesizing a critical chemical called heme, which helps transport and store oxygen. These elevated levels of oxygen and heme fuel tumor growth and progression.

With the new CPRIT grant, Zhang will use advanced imaging techniques in animal models to investigate whether drugs that target heme synthesis and uptake can be a successful strategy for suppressing lung tumors and improving the effectiveness of chemotherapy, radiotherapy and immunotherapy.

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Zhang previously received a CPRIT grant of $900,000 in 2015.

Dr. Jie Zheng, professor of chemistry and biochemistry and the Cecil H. and Ida Green Professor in Systems Biology Science, also received $900,000 for his research, which is aimed at improving the accuracy of computerized tomography (CT)- and fluorescence-guided kidney cancer surgery.

With more kidney cancers being diagnosed in the early stage, partial kidney removal is becoming an increasingly important treatment, in particular for those patients who have poor kidney function or cancer in both kidneys. In current clinical settings, CT is used first to noninvasively localize and stage kidney cancers, followed by fluorescence imaging of normal renal tissue to guide surgery. However, due to the limitations of current contrast agents, no significant improvement in reducing positive margin rates in kidney cancer surgery has been achieved, Zheng said.

Zheng's project will focus on developing a single material, based on gold nanoparticles, that can achieve high contrast in both CT and fluorescence imaging of kidney cancers. His approach takes advantage of the unique physiological microenvironment associated with kidney cancer in a way that allows the tumor margins to be more accurately differentiated during surgical removal. His nanoparticles also have the potential to effectively and selectively deliver anti-cancer drugs to tumors that cannot be treated surgically.

Zheng received three previous CPRIT grants in 2011, 2014 and 2016 totaling nearly $2.4 million.

Source:

University of Texas at Dallas

A broad coalition is calling for Congress to ensure that Medicaid patients are guaranteed coverage to participate in potentially life-saving clinical trials.

In a letter (PDF) to Congressional leaders, the coalition urged Congress to include the bipartisan Clinical Treatment Act in a healthcare extenders package, which is expected to pass this spring.

The letter was signed by leaders of 106 organizations representing patients, providers, medical researchers, survivors, and families. It urged lawmakers to include H.R. 913 in the upcoming “must-pass” healthcare extenders package to ensure clinical trial coverage for Medicaid patients.

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

See how

Organizations backing the bill include the Association for Clinical Oncology, the American Medical Association, the American Heart Association and the American Cancer Society Cancer Action Network. 

The legislation, introduced by Rep. Ben Ray Luján (D-NM) and Rep. Gus Bilirakis (R-FL), would ensure states cover routine care costs of participation in an approved clinical trial for Medicaid enrollees with life-threatening conditions. It currently has 28 cosponsors from both political parties.

In the letter, the organizations noted that Medicaid insures nearly one-fifth of the U.S. population and is the only major payer that is not required by federal law to cover routine costs, such as physician visits and laboratory tests, associated with participating in a clinical trial.

Only 11 states require their Medicaid programs to cover the costs, leaving as many as 42.2 million Medicaid patients potentially without coverage.

“Importantly, clinical trials often provide patients with the best—perhaps only—treatment options for their condition,” the organizations wrote. “Without the guarantee of coverage, however, many Medicaid beneficiaries do not have the latest technological and scientific advancements as a treatment option.”

Coverage would have little to no impact on the overall cost of care to Medicaid programs, they said. The cost of any investigative device or drug would continue to be covered by the clinical trial sponsor. Routine costs only include the non-experimental costs of treating a patient who is participating in a clinical trial. These are part of standard care and would be incurred whether or not a patient participates in a clinical trial.

“Without fair coverage, patients with Medicaid are being excluded from potentially life-saving clinical trials. This is a simple fix and one that should be addressed by Congress as soon as possible,” said Monica Bertagnolli, M.D., chair of the Association for Clinical Oncology, an affiliated professional organization of the American Society of Clinical Oncology.

The organizations hope to get the legislation included as part of a package of health program extenders that Congress must fund before current funding expires May 22.

The supporters of the legislation said the bill would also improve the quality of clinical research and reduce health disparities as Medicaid insures a large portion of people from under-represented minority and ethnic groups who are not well represented in clinical trial enrollment.

Modern anticancer therapies aim to attack tumor cells while sparing healthy tissue. An interdisciplinary team of researchers at Helmholtz-Zentrum Dresden-Rossendorf (HZDR) and FU Berlin has made important progress in this area: the scientists have produced tiny nanoparticles that are designed to specifically target cancer cells. They can navigate directly to the tumor cells and visualize those using advanced imaging techniques. Both in petri dishes and animal models, the scientists were able to effectively guide the nanoparticles to the cancer cells. The next step is to combine the new technique with therapeutic approaches.

The HZDR researchers start out with tiny, biocompatible nanoparticles made of so-called dendritic polyglycerols that serve as carrier molecules.

We can modify these particles and introduce various functions. For example, we can attach an antibody fragment to the particle that specifically binds to cancer cells. This antibody fragment is our targeting moiety that directs the nanoparticle to the tumor."

Dr. Kristof Zarschler, research associate at HZDR's Institute of Radiopharmaceutical Cancer Research

The target of the modified nanoparticles is an antigen known as EGFR (epidermal growth factor receptor). In certain types of cancer, such as breast cancer or head and neck tumors, this protein is overexpressed on the surface of the cells. "We were able to show that our designed nanoparticles preferentially interact with the cancer cells via these receptors," confirms Dr. Holger Stephan, leader of the Nanoscalic Systems Group at HZDR. "In control tests with similar nanoparticles that had been modified with an unspecific antibody, significantly fewer nanoparticles accumulated at the tumor cells."

The scientists intensively studied the nanoparticles' behavior both in cell cultures and in an animal model. For this purpose, they provided the nanoparticles with additional reporter characteristics, as Kristof Zarschler explains: "We used two complementary possibilities. In addition to the antibodies, we attached dye molecules and radionuclides to the nanoparticles. The dye molecule emits in the near infrared spectrum that penetrates the tissue and can be visualized with an appropriate microscope. The dye thus reveals where exactly the nanoparticles are located." The radionuclide, copper-64, fulfils a similar purpose. It emits radiation that is detected by a PET scanner (positron emission tomography). The signals can then be converted into a three-dimensional image that visualizes the distribution of the nanoparticles in the organism.

Excellent properties in living organisms

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Using these imaging techniques, researchers have been able to show that nanoparticle accumulation in the tumor tissue reaches maximum two days after administration to mice. The labelled nanoparticles are subsequently eliminated via the kidneys without being a burden for the body. "They are apparently ideal in size and properties," says Holger Stephan. "Smaller particles are filtered out of the blood in just a few hours and thus only have a short-term impact. If, on the other hand, the particles are too big, they accumulate in the spleen, liver or lungs and cannot be removed from the body via the kidneys and bladder." The interplay between the nanoparticles with an exact size of three nanometers and the attached antibody fragments evidently has a positive influence on the distribution and retention of the antibody in the organism as well as on its excretion profile.

In future experiments, the HZDR researchers want to test whether they can modify their system to carry other components. Kristof Zarschler describes the plans: "You can take these nanoparticles and functionalize them with an active substance. Then you can deliver a drug directly to the tumor. This might be a therapeutic radionuclide that destroys the tumor cells." It is also possible to attach antibody fragments specific for proteins other than EGFR to target different types of cancer.

Source:

Helmholtz-Zentrum Dresden-Rossendorf

Journal reference:

Pant, K., et al. (2019) Active targeting of dendritic polyglycerols for diagnostic cancer imaging. Small. doi.org/10.1002/smll.201905013.