Cancer Care

New Head and Neck Trial

Hello, Friends!

I am pleased to announce that we have opened a trial for patients with cancer starting in their mouth or throat (Head and Neck Cancer). The trial is for patients who are unable to have surgery because their cancer is too advanced. Patients recieve both chemotherapy and radiation therapy as their main treatment, this is considered standard of care. However, instead of just watching patients after this treatment and hoping that the cancer does not return, this trial allows two thirds of patients to receive a medication by mouth that we hope will significantly increase their chance of staying in remission.

The drug is called afatinib. Afatinib blocks the action of several receptors common on cancer cells from head and neck cancer patients. It blocks the EGFR receptor as well as other receptors in the Her2neu family. By blocking these receptors the drug keeps them from binding together and causing cell growth signals to be sent internally that would keep these cancer cells dividing and growing. The hope is that if any cancer cells still are present despite being attacked with both chemotherapy and radiation therapy, this drug will not let them grow or divide and the final remnant of the cancer will go away forever.

I am excited to announce that we are the FIRST SITE to have this trial available to head and neck cancer patients in the United States.

As I have described before, we are committed to bringing the most scientifically promising and novel therapies to cancer patients in North Central Washington. Certainly if any patients from Seattle, Spokane, Oregon or Idaho are looking for a clinical trial that may increase their odds for surviving their cancer, we would be happy to see them as well.

As always I wish you and your loved ones the very best,

Mitch

Bone Marrow Transplant Physician Visits Wenatchee

Hello, Friends!

I wanted to report to you a privilege our oncology group had last week. Dr. Paul O'Donnell, MD, PhD made his way to Wenatchee on Thursday, January 26 to visit with the local oncologists and to participate in our monthly Journal Club.

Dr. O'Donnell is the medical director of the Adult Transplant Service and is a researcher in the Clinical Research Division at Fred Hutchinson Cancer Research Center in Seattle, WA. Dr. O'Donnell also holds the title of Associate Professor, Medical Oncology Division at the University of Washington School of Medicine.

Dr. O'Donnell is a pioneer in finding donors for patients that need a bone marrow transplant but do not have a traditional donor. His work includes investigation into using umbilical cord for stem cell donors and using haploidentical related donors (parents and children of patients). This allows for almost all patients that need a bone marrow transplant to be able to find a donor.

Here is the YouTube link to a brief Bio on Dr. O'Donnell:  http://www.youtube.com/watch?v=Xa6lpJGoydg

Wenatchee Valley Medical Center is a Network Site and partner with the Seattle Cancer Care Alliance. Through our partnership we have developed close working relationships with global cancer experts that work and live in Seattle. This allows us to provide the most current and novel cancer therapies to all of our wonderful patients in North Central Washington.

Best Regards Always,

Mitch

Head and Neck Cancer Drug Expanded Approval

Hello, Friends.

Today the FDA approved a new use for a common treatment for head and neck cancers. The FDA approved the use of cetuximab to be given with platinum-based chemotherapy and 5-FU for the first line treatment of advanced or metastatic head and neck cancer.

Cetuximab had previously been approved for use with radiation to battle localized head and neck cancer. It had also been approved for use by itself in metastatic head and neck cancer. 

But now a new study found that if it is given with two chemotherapy drugs right from the start of the treatment for advanced or metastatic head and neck cancer patients, then patients do better. The addition of cetuximab almost doubled the chance of the cancer substantially shrinking to the therapy. More importantly the average survival time improved by 36%!

It is so gratifying to see better treatments for patients with Head and Neck Cancer. Let's continue to build on smart drug development and design and getting these better drugs to the right patients at the right time!!

Best Regards Always,

Mitch

New Hodgkin's Lymphoma Drug (Smart Bomb Technology) Available

Hello, Friends.

What a great week in oncology. Another breakthrough drug was approved by the FDA yesterday. This time for Hodgkin's Lymphoma!

The drug brentuximab vedotin received accelerated approval because it was so effective in patients whose Hodgkin's lymphoma relapsed after multiple different standard chemotherapy treatments, even if the lymphoma relapsed after one of the most powerful treatments for Hodgkin's lymphoma...an autologous stem cell transplant. 73% of these patients had their lymphoma regress with treatment with this monoclonal antibody...phenomenal! One third of these patients had their lymphoma completely disappear. Such welcomed news!

Brentuximab vedotin (Trade name ADCETRIS) is a unique CD30-directed antibody-drug conjugate. That means a chemotherapy type agent is attached to an antibody that targets the CD30 marker on lymphoma cells...basically a smart bomb. It finds it target then kills it more effectively than if the antibody was administered by itself. You have got to love technology.

What an exciting time in oncology. Let's keep the science and progress moving forward.

Best Regards Always,

Mitch

 

New Melanoma Drug Available

Hello, Friends!

Today is an exciting day. Today a new drug was approved for the treatment of metastatic melanoma...a notoriously difficult cancer to treat. Vemurafenib was approved for patients with unresectable or metastatic melanoma with the BRAF(v600E) mutation.

This is the second melanoma drug to be approved this year; following the lead of ipilumimab.

The trial that demonstrated the efficacy of vemurafenib enrolled 675 patients. Overall survival was increased (Yes!) meaning that patients that were in the group that recieved vemurafenib lived longer than the comparison group that received a standad chemotherapy drug called decarbazine. We do not know the average time that the group that recieved the vemurafenib lived, but we know it is greater than nine and a half months, much better than the sobering 7.9 months that the other group lived.

In another trial over 50% (52% to be exact) had significant shrinkage of their cancer...this is unbelievably good in melanoma cancers.

And remember, this is a tablet, not chemotherapy. 

However, one must be aware of the side effects of any drug. Interestingly (and ironically), there is a significant increase in another skin cancer called squamous cell cancer of the skin. This can be easily treated with removal.

So, who would have thought that TWO new drugs for melanoma patients would be approved in the same year; but they have! A great breakthrough for so many wonderful patients suffering from this illness in North Central Washington and around the world.

That is all for now. 

Best Regards Always!

Mitch

Annual Meeting Highlights from ASCO 2011

Hello, Friends!

This week oncology thought leaders and researchers from around the Globe are meeting in Chicago for the annual meeting of the American Society of Clinical Oncology. Although I could not be there in person, we at WVMC are following closely the developments being discussed so that every patient in North Central Washington will always have access to the most modern, novel, and scientifically promising cancer treatments.

Let me share with you a few of the studies presented and being discussed.

 

Breast Cancer Prevention

For women who have not had breast cancer, but have a high risk for breast cancer (for example a sister and a mother with breast cancer), a new drug called exemestene has been shown to decrease the chance of even getting breast cancer. Dr. Paul Goss presented the results of the study comparing exemestene to placebo. Exemestine decrease the chance of getting breast cancer by 65% compared to placebo.

 

 

Breast Cancer Radiation Improves Outcomes

For patients with 1-3 lymph nodes with breast cancer spread it was not clear if radiation to the arm pit area in addition to the breast would improve women's chances of surviving their breast cancer. Dr. Whelan from Hamilton Health Sciences, Canada presented results from the NCI Canada's trial MA20. This showed that radiation would improve the chance of not recurring with one's breast cancer at 5 years by 5.7%. Even more exiting, it likely improves the cure rate and survival rate at 5 years from 90.7% to 92.3%.

 

Gastrointestinal Stromal Tumors

Dr. Joensuu from the Helsinki University Hospital demonstrates that in patients that have had this rare tumor removed, giving 3 years of the drug imatinib versus 1 year of the same drug improves the chance of living without a recurrence of the tumor significantly and can now be considered standard treatment.

 

Melanoma

Melanoma has been notorious for being a resistant cancer to chemotherapy treatment. Groundbreaking science has demonstrated that a portion of melanoma has a mutation in a gene called BRAF that may allow the tumor to be treated with newly designed medication. Dr. Chapman from Memorial Sloan Kettering Cancer Center in New York showed that in patients whose melanoma tumor has this mutation the drug Vemurafenib improves survival rates with a 63% reduction in the chance of dying from melanoma in the early years of this disease.

 

Wow! Amazing science leading to amazing breakthroughs. As the meeting in Chicago finishes up, we'll keep our eyes out for you to make sure you have the best chance of surviving a cancer if it was to inflict you.

Best Regards from Wenatchee Valley Medical Center,

Mitch

Cancer Information

Hello again from WVMC!

Do you like looking for information on the intranet? Is it hard to sort through all the "stuff" that is out there; trying to know if it is reliable or not?

I would like to refer you to several reliable cancer web sites. http://www.cancer.net/portal/site/patient is the patient friendly cancer information site of the American Society of Clinical Oncology...the national professional society of medical oncologists. Information is easy to find, but more importantly easy to understand.

Below is a link to part of their site that can get you quickly to information on things such as cancer basics, treatment, survivorship, tests, prevention and a whole lot more. I encourage you to explore it's many articles.

http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Feature+Articles

Academic websites can be trusted as well. For example, WVMC is affiliated with the Seattle Cancer Care Alliance which includes the University of Washington and the Fred Hutchinson Cancer Research Center. Their web site is https://www.seattlecca.org/. They have patient testimonials that are very inspiring as well as scientific information in readable language.

If your interested in visiting a government website try the National Cancer Institute's (NCI) site at http://www.cancer.gov/.

Enjoy surfing these cancer focused websites. Hope you find what you are looking for. Remember, we are always here to take care of your cancer needs at WVMC.

Best Regards Always,

Mitch 

WVMC Oncology Research Mission Statement

Hello, Friends.

Please see our new WVMC Oncology Research Mission Statement:

 

WVMC Oncology Research Mission Statement

WVMC strives through our Oncology Research program and through clinical trials to provide patients in our rural community access to the most novel and scientifically promising treatments being developed against cancer.

 

 WVMC Oncology Research Core Values 

Community       We strive to consistently deliver high-quality, comprehensive cancer care in a community setting. 

Caring              We are committed to a steadfast focus on patient safety with compassionate care for the whole patient.

Value                We employ scientifically sound drug development and clinical trial design that leads to the highest opportunity for patient clinical benefit.

Innovation        We are dedicated to developing and improving clinical trial implementation, seeking new ways to advance and bring innovative ideas to reality in a rural community.

Collaboration    We engage in partnerships with like-minded organizations to help us reach our common goals.

 

We are excited about pushing for advancement in cancer care in a safe and caring environment.

A special thanks to all our patients who have enrolled on clinical trials....what a great gift you have given to us and our children...advancing cancer treatments for us all. Thank you!

Best Regards Always,

Mitch 

Quality in Cancer Care

Hello, Friends.

What is Quality in cancer care? Tough question. Quality in medicine is not a new concept. Here is a quote from 1918 published by the American College of Surgeons:

    "...all hospitals are accountable to the public for their degree of success...  If the initiative is not taken by the medical profession, it will be taken by the lay public."

Here is the most current definition by the Institute of Medicine:

    " The degree to which health services for individuals and popluations increase the liklihood of desired health outcomes and are consistent with current professional knowledge."

Wow, is that a mouthful!

Essentially we know that we can do better in medicine at keeping patients safe and achieving the best health for every patient. But it has to be a TEAM effort. For so long the doctor has tried to steer the ship himself/herself. Although the doctor is an essential and critical component of the team, the whole system of healthcare needs to continually improve to achieve the goals that we value so much.

I write to you from the American College of Physician Executives Fall Institute in Tucson, AZ. I am attending the course titled the Three Faces of Quality. The course is taught by three national experts in the field of quality medical care David Nash, MD, Harry Leider, MD and Ken Walker, MD. The course is teaching an overview on major quality themes.

For example, the Institute of Medicine outlines the essential components of what a healthcare system will have if it has a high level of quality. These componets are: Safe, Effective, Patient-Centered, Timely, Equitable and Efficient.

We have always been committed to the highest quality care to our cancer patients in North Central Washington. We will continue to implement tools and mechanisms to improve on the safe treatment of patients with life threatening illnesses from cancer in a compassionate and efficient environment. That is our ongoing committment to you.

Out of the sun and the heat tomorrow and back to Wenatchee and the beginning of winter....I can't wait to be home!

Best Regards Always,

Mitch

New Lung Cancer Trial

Hello and Greetings from the Windy City, Chicago, IL!

I am in Chicago attending the Investigator Site Study Training for a new lung cancer trial we will be opening up at WVMC this month. I am joined by fellow investigators and trial coordinators representing cancer centers from around the country. This new trial will be with a new and novel drug called ramucirumab. It will be for patients whose metastatic non-small cell lung cancer has worsened after they have already been treated with initial chemotherapy. What a wonderful group of patients that so desperately need our help.

"RIght Drug, Right Patient, Right Time" was emphasized by presenter Samantha Melemed, Ph.D. Dr. Melemed is echoing one of the new mantras in oncology. It describes the effort to find the best treatment for every individual patient based on individual characteristics of that patient and specific characteristics of the tumor that is in each patient. "Personalized Medicine" is our goal. We have such sophisticated tools to peer into the deepest molecular aspects of tumors that we are starting (and have been successful) in developing compounds that can target the most vulnerable and necessary parts of the tumor needed for growth, while avoiding normal tissues. This will minimize toxicity that has been a hallmark and an obstacle for much oncology care up until this point.

Dr.Sergey Yurasov, a pediatric oncologist from Memorial Sloan Kettering Cancer Center in New York presented the scientific data and study design of ramucirumab. Ramucirumab is an antibody that will bind to an essential receptor on cancer cells that is used to increase blood vessel growth into the tumor. Thus, by blocking blood vessel growth into the tumor, the tumor will be starved of essential nutrients and oxygen needed to grow. Since tumors have more of these receptors compared to normal tissue in the body, the antibody has a preferential effect on tumor growth without effecting normal tissues too dramatically.

The clinical trial is sponsored by Eli Lilly and Company. It is an international trial involving approximately 180 cancer treatment sites in the USA, Europe, South America, and Japan. Wenatchee Valley Medical Center is slated to be the first cancer treatment site worldwide to open the trial!  1242 patients will be enrolled onto this trial which is expected to take about two years to complete. Patients will either be given a standard chemotherapy drug for their lung cancer or the standard chemotherapy plus ramucirumab.

I am so excited to bring such new and exciting cancer therapies to the great people, patients and patient families in North Central Washington!

In addition to attending meetings all day and into the night, I was able to get to see the Stanley Cup Champion Chicago Blackhawks play in the United Center. It was an   exciting game. The people in Chicago were the most patriotic fans I have ever seen. They were also a heavily devoted group of fans with many of the 21,000 in attendance wearing red Blackhawk Jerseys. Unfortunately Chicago lost to the lowly, cellar-dwelling New Jersey Devils 5-3.

Best Regards Always,

Mitch