From OHC, Specialists in the Treatment of Adult Cancers and Blood Disorders
March 17, 2023
We have come a long way in cancer care since the 1949 FDA approval of nitrogen mustard (mustard gas) as an anti-cancer drug, or chemotherapy. Still, cancer is the second leading cause of death in the U.S. While chemotherapy will remain a fundamental weapon against cancer, research discoveries have helped us to personalize our treatment approach. OHC cancer experts reflect on significant cancer treatment advances and discuss the future of cancer therapy.
Cancer is caused by gene changes, or mutations, that are inherited or acquired over time. Using genomic testing to evaluate changes in certain genes or proteins specific to an individual’s cancer cells, we can select treatments most effective for those changes. In other words, understanding a tumor’s biology allows us to select a treatment, or targeted therapy, that specifically attacks its genetic features.
“There is no longer a one-size-fits-all approach to cancer treatment,” said OHC gynecologic oncologist Ajit Gubbi, DO. “Every patient’s cancer is unique, and their therapy should be too. In the past, we treated cancer based on the location in the body where the tumor began to grow. Now, we treat the individual patient’s disease.”
“For decades, the ovarian cancer treatment arsenal consisted of various types of chemotherapy,” noted Dr. Gubbi. While effective in killing cancer cells, chemotherapy also attacks other rapidly dividing healthy cells leading to several side effects. “All recently approved ovarian cancer drugs have been targeted therapies,” said Dr. Gubbi.
In November, the FDA approved Elahere (mirvetuximab soravtansine) for patients with ovarian, fallopian tube, or peritoneal cancer resistant to platinum chemotherapy that expresses a specific protein, folate receptor alpha (FRα). Elahere delivers a targeted dose of chemotherapy directly to the cancer cells that have this receptor. To determine if patients are eligible, oncologists order genomic testing for the FRα protein, which up to 80 percent of new and recurrent ovarian cancer patients may carry.
“We are also excited about the August 2022 FDA approval of Enhertu (trastuzumab deruxtecan) for patients with a specific type of breast cancer,” said OHC medical oncologist and hematologist, Mark E. Johns, MD. After a patient is diagnosed with breast cancer, their cancer tissue is sampled and tested in a lab for biomarkers including the HER2 protein that might be fueling tumor growth. “As a result of the approval of Enhertu, we now have the HER2-low classification for patients with low levels of the HER2 protein on the surface of their breast cancer cells,” said Dr. Johns.
Recent years have delivered several advances in immunotherapies, treatments that harness the power of the body’s immune system to fight cancer. The immune system identifies and attacks foreign invaders like bacteria and viruses that can make us ill. However, cancer is smart and has figured out a way to evade this attack. Immunotherapies help the immune system recognize cancer cells and launch an attack on them.
OHC has had success with chimeric antigen receptor (CAR) T-cell therapies that have brought remission to several blood cancer patients. “To create the CAR-T, we extract immune system T-cells from a patient or healthy donor’s blood, genetically engineer them in a lab to detect and destroy cancer, and then infuse these cells into the patient,” said OHC medical oncologist, hematologist, blood and marrow specialist, and cellular therapy expert James H. Essell, MD. CAR-T therapies using donor T-cells also hold promise for treating solid tumor cancers. Infusing our first CAR-T patient in 2018, OHC is the first, most experienced, and only certified independent adult cancer practice in the region to offer CAR-T.
To date, the FDA has approved six CAR-T drugs. Last year gave us the second CAR-T approved for multiple myeloma (Carvykti), the approval of Kymriah for follicular lymphoma that has recurred or not responded to treatment, and the approval of Breyanzi as a second-line therapy for large B-cell lymphoma.
In 2022, OHC was the first cancer group to bring natural killer (NK) cell therapy to the Cincinnati region. NK cells collected from a healthy donor are modified in a lab, much like T-cells for CAR-T, before being infused into a patient. This immunotherapy should have less side effects than CAR-T and through clinical trials is being evaluated for the treatment of several blood and solid tumor cancer types. OHC expects to bring more NK cell therapies to the Tri-State this year.
Cancer vaccines are another form of immunotherapy that trains the immune system to recognize cancer cells and protect against the formation of cancer cells or eradicate cancer cells already present in the body. Preventive cancer vaccines already exist for cancers caused by human papillomavirus (HPV) and hepatitis B virus (HBV). More research needs to be done to develop cancer vaccines against “intelligent” cancer cells that resemble our normal, healthy cells. Soon, OHC expects to be among a select few cancer practices in the US to open a clinical trial for a personalized colorectal cancer vaccine.
We anticipate that advances in radiation oncology will continue to offer shorter courses of radiation and more targeted delivery of radiation.
Hypofractionated radiation therapy safely and effectively administers higher doses of radiation over less treatments than standard radiation therapy, offering patients greater convenience. “A recent National Cancer Institute (NCI)-funded clinical trial revealed that radiation oncologists can administer hypofractionated whole breast irradiation to breast cancer patients following a lumpectomy,” said OHC radiation oncologist Joseph N. Shaughnessy, MD. Traditionally this treatment was given over a period of four-to-six weeks, but the study proved that a three-week course was just as safe and effective. Additionally, several other studies have shown that some patients are eligible for whole or partial breast radiation over as few as five treatments given over one-to-two weeks.
Last year’s FDA approval of Pluvicto (177Lu-PSMA-617), a radiopharmaceutical therapy (RPT) for men with prostate cancer that has spread beyond the prostate gland and no longer responds to hormone therapy, should spur more use of RPTs for several cancer types. RPTs are targeted radioactive drugs administered through injection that seek out cancer and destroy it.
Cancer care is a rapidly evolving field. Research brings innovative therapies to patients. We anticipate a time when cancer will be perceived as a manageable chronic illness rather than a life-threatening disease. OHC has a robust slate of active clinical trials. To learn more about our cancer clinical trials program or to request a second opinion, call 1-888-649-4800 or visit ohcare.com.Comments (0)