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Availability of Oral Chemotherapy Drugs on the Rise

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When we think about chemotherapy (chemo) treatment for cancer, more often than not we harbor visions of intravenous (IV) injections of chemicals with complicated names, usually being administered in sterile medical environments with the patient surrounded by attending oncology professionals. But advances in chemotherapy drugs over the past decade are quickly changing the perceptions most of us have developed about chemotherapy and how it is administered. The fact that chemotherapy is available in oral (pill) form for numerous types of cancer is a surprise to many. In fact, an estimated 30% of cancer drugs in development are oral, and the trend is increasing.

With cancer survival rates consistently increasing over the past decade, cancer is becoming a chronic illness for cancer patients. The ability to receive extended cancer therapy protocols at home and by mouth is beneficial in time, convenience and cost that accompanies typical IV administered treatments. Oral anticancer medications (OAMs) have become available to treat many different cancers, including lung, leukemia, colorectal, kidney, and prostate and have been shown to be as effective as other forms of treatment. “The efficacy of chemotherapy pills … are similar to the traditional intravenous therapy, with research showing that the overall survival with oral chemotherapy is the same as patients would have with traditional intravenous chemotherapy,” says Dr. Hannah Luu, California-based oncologist and CEO and founder of OncoGambit.

However, OAMs shift much of the responsibility for proper administration from attending medical professionals to the patient and family members. Dr. Luu cautions, “Chemotherapy pills have the potential to cause the same serious toxicities as intravenous chemotherapy. If used incorrectly, they can potentially have fatal outcomes. It’s important for patients to be aware of their treatment plan and take their chemotherapy drugs accordingly. It’s even more important that the patient doesn’t take the missed pills with the next dose.”

Doctor appointments are still necessary with the use of OAMs, to perform regular scans or blood tests to ensure the medication is working safely and effectively. Handling of these oral medications requires careful attention as well as consistent adherence to the treatment regimen. Not skipping doses is critical to effective treatment.

A recent study showed that both providers and patients face barriers from insurance carriers on the use of OAMs. Some insurers cover OAMs as a prescription drug benefit, rather than a medical procedure. Delays in getting approval may be labor intensive and take several weeks. Out-of-pocket costs can vary and may require additional administrative support to overcome.

Gettysburg Cancer Center, a leader in oncology care across south central Pennsylvania since 1989, is dedicated to providing all-encompassing oncology and hematology programs and a complete range of diagnosis, treatment, and follow-up care for patients. For more information call (717) 334-4033.

Immunotherapy Drug Is Providing Exciting Results in the Treatment of Lung Cancers

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Alex was in his early 40s when he was diagnosed with Stage 4 Lung Cancer. A non-smoking, healthy man, who exercises regularly and eats relatively well is not who most people think of when they think of lung cancer.  However, people exactly like Alex are the new faces of lung cancer diagnoses. Alex is also one of a select few who qualified for a new targeted therapy drug recently approved by the FDA.

Lung cancer is the leading cause of cancer death globally, causing 1.7 million deaths a year. In the United States, it is expected to kill more than 154,000 people in 2018, but recent studies are producing credible progress in finding new drugs that, when combined with more traditional chemotherapy, are greatly improving the survival rates among lung cancer patients. The findings are dramatically changing the way physicians are treating lung cancers. “What it suggests is that chemotherapy alone is no longer a standard of care,” said Dr. Leena Gandhi, a leader of the study and director of the Thoracic Medical Oncology Program at the Perlmutter Cancer Center at New York University Langone Health.

So far, four drugs called checkpoint inhibitors, which unleash the patient’s own immune system to kill malignant cells, have been approved by the FDA. “I’ve been treating lung cancer for 25 years now, and I’ve never seen such a big paradigm shift as we’re seeing with immunotherapy,” said Dr. Roy Herbst, Chief of Medical Oncology at the Yale Cancer Center.

In the trial, patients with metastatic nonsquamous non-small cell lung cancer (NSCLC) who received the drug pembrolizumab (Keytruda) plus chemotherapy had improved overall survival and progression-free survival compared with just chemotherapy alone.  The results from the KEYNOTE-189 clinical trial were presented at the annual meeting of the American Association for Cancer Research (AACR) in Chicago on April 16 and published concurrently in the New England Journal of Medicine.

One of the main factors in the high rate of death due to lung cancer is that the disease is most often undetected until it has spread to other organs of the body. Lung cancer is the second most prevalent form of cancer in men and women and the top cancer killer among both sexes. In addition to the encouraging results from immunotherapy drugs, a newly discovered protein is showing promising results in detecting lung cancer earlier, providing new advanced treatment options to patients at the earliest stages of the disease. “The use of CKAP4 as a biomarker could change current practices regarding the treatment of lung cancer patients, and the diagnostic accuracies may be markedly improved by the combination of CKAP4 and conventional markers,” says Yuichi Sato, Division of Molecular Diagnostics, Kitasato University.

While the news of earlier discovery and new treatment options is very good, reducing risk factors for the disease remains the best approach to avoiding cancer. Exposure to tobacco smoke is one of the leading causes of lung cancer. Smoking marijuana and using electronic cigarettes may also increase the risk of lung cancer, but the actual risk is unknown. People who work with asbestos in a job such as shipbuilding, asbestos mining, insulation, or automotive brake repair and who smoke have a higher risk of developing cancer of the lungs. Exposure to radon has been associated with an increased risk of some types of cancer, including lung cancer. Having your home tested for the presence of Radon is a good and economical method for reducing the risk. Some people also have a genetic predisposition for lung cancer. People with parents, brothers, or sisters with lung cancer could have a higher risk of developing the cancer themselves.

Understanding cancer and how to treat it is constantly evolving toward the day when a cure is discovered. The cure is not here yet, but treatment options have greatly improved in recent decades. The treatments and methods used in clinical trials are promising in every environment in which they are tested. For more information on advancements in cancer detection and treatment, visit https://gettysburgcancercenter.com/.

Gene Therapy. A New Frontier in Medical Innovation

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Cancer is a disease that is experienced by young and old and by every economic and social segment of the world populace. At some point in everyone’s life, cancer will affect us individually, a member of our family or one or many of our friends and acquaintances. The American Cancer Society projects there will be 1,688,780 new cancer patients and 600,920 deaths due to cancer in 2017, for a disease that does not discriminate by race or national origin.

Cancer is where abnormal cell growths form in the body and interfere with normal, healthy body functions. Not new to the world stage, cancer dates back to ancient times. Today, after millennials of research and discovery, new treatments for a vast array of cancer types are being studied, many with promising results.  One such new treatment called chimeric antigen receptor T-cell therapy (CAR-T) involves taking samples of T-immune cells called T-cells from a patient, genetically engineering them, and putting them back in to fight the cancer. Co-developed with the drug giant Novartis, the therapy, CAR-T, genetically alters a patient’s own immune cells to target and destroy cancer cells.

“We’re entering a new frontier in medical innovation with the ability to reprogram a patient’s own cells to attack a deadly cancer,” said FDA Commissioner Dr. Scott Gottlieb. The process takes about 22 days and begins with the extraction of a patients T cells, exposing them to the vector which genetically transforms them. They’re then expanded and frozen for shipment back to the patient. During the out-of-body processing of the cells, the patient receives chemotherapy to wipe out any remaining T cells to avoid interference with the, soon to be, newly implanted cells.

“This is a major advance, and is ushering in a new era,” said Malcolm Smith, a pediatric oncologist at the National Institutes of Health. The treatment appears to strengthen a patient’s immune system allowing their own body to fight the cancer. The treatment is recommended for cancer patients who have run out of options for traditional therapy. The new therapy is only currently available for patients 25 years or younger. Thus far, 83 percent of patients are experiencing positive survival results.

While overtly touting the success of gene therapy, researchers are tempering their enthusiasm after experiencing some significant life threatening side effects in 47 percent of the studies participants. These side effects have resulted in brain swelling and deaths, casting a shadow over the field. Seizures and hallucinations were also relatively common, but temporary. Though concerning, the side effects have been successfully managed with drugs. Quality control and how to standardize the potency and purity of living cells extracted from each patient are also a concern. Because of the risks, the treatment is only currently available at 20 US hospitals. The individualized nature and relatively small patient population both drive up the cost of the treatment for now.

“This is a big paradigm shift, using this living drug,” says Dr. Kevin Curran, a pediatric oncologist at Memorial Sloan Kettering Cancer Center that will soon be offering the treatment. “It will provide a lot of hope. This is the beginning.”

“The approval of CAR T-cell therapy for pediatric leukemia marks an important shift in the blood cancer treatment paradigm,” says the American Society of Hematology. “We now have proof that it is possible to eradicate cancer by harnessing the power of a patient’s own immune system. This is a potentially curative therapy in patients whose leukemia is unresponsive to other treatments and represents the latest milestone in the shift away from chemotherapy toward precision medicine. Today’s approval is the result of over a decade of hematology research, including research funded by the National Institutions of Health (NIH).”

Targeted Radiation Therapy Effective For Breast Cancer Patients

A new cancer research project funded by the United Kingdom is revealing some very positive results for breast cancer patients. The study (IMPORT LOW trial), led by The Institute of Cancer Research, London and the Cancer Research UK Cambridge Centre indicates that breast “cancer patients who received radiotherapy targeted at the original tumor site experience fewer side effects five years after treatment than those who have whole breast radiotherapy, and their cancer is just as unlikely to return.” The results which were recently published in The Lancet, an independent, international weekly general medical journal. “This approach could spare many women significant physical discomfort and emotional distress,” says Professor Arnie Purushotham, Cancer Research UK. “One of the challenges when treating early stage breast cancer is trying to minimize the side effects that can have a real impact on a woman’s life, without affecting the chances of curing her.”

The study included more than 2,000 women aged 50 or over who had early stage breast cancer that was at a low risk of coming back. Radiation therapy or radiotherapy uses ionizing radiation as part of cancer treatment to control or kill malignant cells. A common and effective treatment for breast cancer for many decades, large field radiotherapy is relatively painless in its application, but often the treatments produce side effects that range from low, short term to more severe, long term in nature. Depending on the intensity of the radiation, higher doses can cause varying, acute side effects for months or years following treatment. The nature, severity, and longevity of side effects depend on a number of treatment factors and the individual patient.

Precisely targeted radiation therapy can eradicate all evidence of disease in patients with cancer that has spread to only a few sites. Because radiation destroys cells, targeting the treatment to specific cancer cells limits the collateral damage to areas not affected by the cancer, reducing the side effects suffered by the patient.

The IMPROT LOW trial found that women who received partial radiotherapy reported fewer long term changes to the appearance and feel of their breast, than those who had radiotherapy to the whole breast. Dr. Charlotte Coles, Reader in Breast Radiation Oncology at Cambridge University, chief investigator for the trial and first author of the publication, said, “We started this trial because there was evidence that if someone’s cancer returns, it tends to do so close to the site of the original tumor, suggesting that some women receive unnecessary radiation to the whole breast. Now we have evidence to support the use of less, but equally effective, radiotherapy for selected patients.”

The technique, delivered by standard radiotherapy equipment, may lead to increased use of this treatment at cancer centers across the country and around the world. Professor Judith Bliss, scientific lead for the study within the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, said: “We’re delighted that the results of this trial have the potential to lead to a real change in the way selected breast cancer patients are treated.”

Gettysburg Cancer Center is actively working with researchers on clinical trials, providing alternative treatments for its patients. For more information on clinical trials at Gettysburg Cancer Center, click here.

Support Groups Can Help Cancer Patients Regain Sense Of Normalcy

Receiving a cancer diagnosis can be one of the most traumatic and stressful moments of a lifetime. Often the unknown aspects of treatment and the potential outcomes can trigger strong emotional feelings of shock and anger. The sense of “why me” is often a common initial experience for many cancer victims when they are informed of their disease. The disruption of daily social patterns due to the regiment of treatments that follow diagnosis can add additional strain and stress to the patient and their immediate family members.

Daily routines, family roles and future plans will be determined by a regiment of treatments and medications that often pose additional physical symptoms and challenges to everyday living. The support of family and friends during this process is critical to help the patient regain a sense of normalcy and maintain emotional stability and can provide assistance to reduce distress that can play a critical role in determining the patient’s clinical outcome.

Formal support groups can help people with cancer feel less depressed and anxious about their disease, help them feel more hopeful and enable them to manage their emotions better. Support groups can be peer-led (facilitated by individual group members), professional-led (by trained counselors) or informational, led by doctors and professional facilitators who focus on providing disease related information. Some groups will be organized around the type of cancer, age of the patient or the stag of the disease. Some groups are also available for family members and care givers because a cancer diagnosis doesn’t only affect the patient but also their family and friends.

“Support groups can be effective in many ways,” says Claire J. Casselman, Social Work Coordinator and Complementary Therapies Clinician, University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan. “Meeting and talking with other people whose lives are affected by cancer can create a sense of community or commonness that helps relieve the stress of isolation that many people experience.”

For those who find the formal group setting uncomfortable or cumbersome, online support groups can offer group forums to those who live in rural areas, who are too ill to attend a meeting in person, those who are without access to transportation or patients who seek a certain amount of anonymity. Most online support groups are available 24-hours a day. When looking to the internet for a support group, a certain amount of due diligence should be exercised to verify their credibility.

Often the most effective emotional support comes from those who provide the care. As a teenager in 2015, Chandler Banko’s was diagnosed with advanced, stage 2 Hodgkin’s Lymphoma. A positive and outgoing personality, Chandler found treatment and personal emotional support he needed at the Gettysburg Cancer Center in Gettysburg, Pennsylvania. At Gettysburg Cancer Center, he found experienced professionals who were dedicated to treating not only the science of his disease but the personal emotional conditions that often accompany a cancer diagnosis and regiment of treatment. Chandler says of his battle with cancer, “No One Fights Alone.”

WHAT YOU NEED TO KNOW: CANCER AWARENESS MONTH

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Cancer awareness month has its origin in the 1980’s when a small grassroots organization, Susan G. Komen, was formed to raise money and public awareness for breast cancer. The group created the now famous pink ribbon in order to create “brand awareness” for breast cancer and to generate much needed funding for cancer research, early detection and ultimately the diseases eventual cure.

The breast cancer program’s success spawned an important and growing expansion of the awareness campaign to cancers across the diseases spectrum. Many non-profit cancer organizations have gravitated towards the goals of the program and have originated specific colors and month of the year to represent their individual identities. The month of May represents three brands of cancers; Brain Cancer, Melanoma/ Skin Cancer and Bladder Cancer.

Brain tumors are growths of abnormal cells in tissues which originate in the brain or spinal cord. Tumors may be benign or malignant and affect nearby areas of the head and neck but rarely spread to other parts of the body. Symptoms vary and are dependent upon where the tumor forms, its size, how fast it is growing, and the age of the patient. More than 150,000 people are living with brain cancer with less than one percent of men and women likely to experience brain and nervous system cancer in their lifetime. Nearly 34 percent of brain cancer victims can expect to survive five years or more with early detection and aggressive treatment. Brain cancer is an extremely complex disease requiring a team of multi specialists including oncologist, primary care physicians and radiation oncologist. Each patient treatment protocol depends on the location of the tumor, its size and type, the patient’s age, and the overall medical condition of the patient. Brain Cancer is represented by the color grey in the month of May.

Melanoma, represented by the color black, is the most dangerous form of skin cancer and is most often caused by over exposure to ultraviolet radiation from sunshine or tanning beds. Cancerous growths develop when unrepaired DNA damage to skin cells initiate mutations that multiply rapidly and form malignant tumors. Discovered in its early stages and treated, skin cancer is almost always curable. But left untreated it can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. Depending on the stage of the disease treatments may include; surgery, immunotherapy, targeted therapy, chemotherapy and radiation.

Bladder Cancer originates when healthy cells in the bladder lining change and grow rapidly forming a tumor. Malignant tumors may spread to other parts of the body if left untreated. The three most common types of bladder cancer are; Urothelial carcinoma, Squamous cell carcinoma and Adenocarcinoma. Represented by the awareness color Marigold/Blue/Purple, bladder cancers are most often detected in patients by the presence of blood in the urine, frequent or burning sensation when urinating or lower back pain. Treatment options include; surgery, chemotherapy, immunotherapy and radiation. Treatment protocols are dependent upon the stage of the cancer, patient’s health, treatment preferences and potential side effects.  Bladder cancer mostly affects older people with an estimated 79,000 adults expected to be diagnosed with bladder cancer in the United States each year. With early detection the 10 year survival rate for bladder cancer is 70 percent.

Increased awareness has had a proven and positive effect on early diagnosis and treatment of various cancers and has resulted in a better educated and prepared patient. Utilizing this marketing approach the stigma once associated with cancer has been greatly diminished.

Grateful for Getting the Care Needed for a Long Life

Receiving news that you have contracted a life-threatening disease is an experience most of us hope will never occur. Most often normal, busy everyday activities put the possibility of suffering such an experience way back in our minds, relegating the concern to the “I’ll deal with that when I’m older and more likely to be a victim of such news.”

A projected 1.6 million Americans will be diagnosed with cancer this year, each one experiencing that moment of shock and disbelief long put away in the back of the mind. But while most of us are well aware of the risk of cancer diagnosis as we progress in age, the news that it can actual happen to us usually comes with a significant dose of disbelief and surprise, and when it comes at an early, usually healthier period in life, the news can be even more emotionally difficult to negotiate.

Matt Sheads, a healthy thirty something insurance executive in a famous small town in Pennsylvania lived an active, healthy lifestyle, performing numerous marathons, playing ice hockey and coaching local youth sports programs. His active, health conscious approach to life statistically identified him as one among many like him who would most likely NOT experience the news that he had a rare (for men) breast cancer. Breast cancer in men is rare with less than one percent of cancer cases of the disease developing in a thousand men. Matt soon learned that breast cancer in men is usually detected as a hard lump located underneath the nipple and areola. Unlike women, men don’t immediately associate the discovery with breast cancer and often delay further investigation and treatment.

“When you are diagnosed with cancer, it all sets in”, says Matt.” I have an 8-year-old son and I was very scared of the possibility of not seeing him graduate from school. It was a huge shock to me, I didn’t even know men got breast cancer. Oh, my gosh, how can it happen to me? I was born and raised in Gettysburg and love the small-town feel.” It was through the local Gettysburg Cancer Center that Matt was referred to nearby Washington D.C. for treatment of his rare disease. A large University hospital, Medstar Georgetown Hospital has the small town, individualized philosophy when it comes to cancer treatment. “I felt very welcome, that I was a part of a family, I felt like I was in my home town” recounts Matt.

After surgery and treatment, the prognosis for Matt is good. His disease is in remission and requires only annual visits and evaluations. He is back to doing the things he loves; coaching his son in sports, playing hockey, running and looking forward to being at his son’s graduation. His advice to other men, “If you find a problem, you find an issue, don’t self-diagnose… go find a specialist… and have a conversation with them.” Don’t delay getting the care you need to live a long life.

To view Matt Sheads video visit  https://www.youtube.com/watch?v=PUJatsj94hQ&feature=youtu.be.